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DISEASES OF THE URINARY SYSTEM
1. The young man with a history of bronchiectasis disease since the early childhood died of renal insufficiency. A post-mortem revealed in lungs plural dilated bronchi and bronchial tubes, filled with a purulent exudate. Besides, the enlarged kidneys had a dense texture, their cortical layer was thickened, white color and dense. Kidney pyramids were anemic and accurate. Name process which has developed in kidneys?
A. *Secondary amyloidosis
B. Glomerulonephritis
C. Chronic pyelonephritis
D. Congenital kidney cysts
E. Secondary nephrosclerosis
2. A postmortem of a 65-year-old patient with a history of the adenoma of a prostate revealed big kidneys with markedly dilated pelvis and calyces filled with a transparent liquid. Name the kidneys pathology.
A. *Hydrohephrosis
B. Glomerulonephritis
C. Amyloidosis
D. Tuberculosis
E. Pyelonephritis
3. A 54-year-old patient with a history of a diabetes mellitus died of chronic renal insufficiency. A post-mortem revealed all uremia symptoms and kidneys alterations. What are most probable microscopical renal changes in that case?
A. * Hyalinosis and sclerosis of capillaries of glomerulus.
B. Spasm of afferent glomerular arteriole.
C. Hyaline cast in the lumen of renal tubules.
D. Necrosis of renal tubular epithelium.
E. Necrosis of renal cortex.
4. Nephrobiopsy is performed to 30-year-old women. Histological investigation revealed a proliferation of mesangial cells, a swelling and proliferation of capillary endothelial cells, enlargement mesangial matrix, is diffusive a thickening of the glomerular basal membrane, mild tubular-interstitial component. Electron-microscopic research showed interposition of mesangium, a diffusive and irregular thickening of a glomerular basal membrane. What form of a glomerulonephritis has developed in that case?
A. *Mesangiocapillary glomerulonephritis.
B. Mesangial proliferative glomerulonephritis
C. Membranous glomerulonephritis.
D. Rapidly progressive glomerulonephritis.
E. Postinfectious glomerulonephritis.
5. Histological investigation of the kidneys biopsy revealed epithelial crescents more than in 50% glomerular tufts, necrotic capillary loops with fibrinous thrombi within their lumens. In addition, expressed tubular interstitial component was also registered. What is the most likely kidneys disease?
A. * Rapidly progressive glomerulonephritis.
B. Lipoid nephrosis.
C. Chronic glomerulonephritis
D. Amyloidosis
E. Necrotic nephrosis
6. A 49-year-old patient died of a massive bleeding from an operating wound. A post-mortem revealed enlarged kidneys with strained fibrous capsule. A gross investigation of a cut surface determined wide, pale grey color cortical layer accurately delimited from cyanotic, dark red pyramids. Histological study showed a necrosis and a marked dystrophy of an epithelium convoluted tubules, tubulorrhexis.What condition has developed in kidneys?
A. * Acute necrotic nephrosis.
B. Postinfectious glomerulonephritis
C. Lipoid nephrosis.
D. Rapidly progressive glomerulonephritis.
E. Secondary amyloidosis of kidneys.
7. An autopsy of a 59- year-old man revealed the coral-like stone filled all renal pelvis of a right kidney. The kidney was enlarged, hyperemic with the capsule, taken out hardly. The pelvis and calyxes cavities were dilated, filled by a turbid, greenish- yellowish viscous liquid. The mucosal layer was dim with some hemorrhages. A cut surface investigation showed motley pattern of the kidney’s tissue, with yellow spots in up to 1cm in diameter. What complication to nephrolithiasis has developed?
A. *Chronic pyelonephritis with exacerbation
B. Tumour of kidney
C. Postinfectious glomerulonephritis
D. Primary amyloidosis
E. Rapidly progressive glomerulonephritis.
8. Histological study of a renal biopsy revealed a necrosis and a marked dystrophy of the convoluted tubules epithelium, tubulorrhexis, stromal edema and hyperemic medulla. Name the pathological process?
A. *Necrotic nephrosis
B. Glomerulonephritis
C. Pyelonephritis
D. Cystic disease
E. Kidney stone disease
9. A 59-year-old man with a long history of bronchiectasis disease, a pneumorrhagia, presented with facial and back edema, and proteinuria of 33mg/l. A pulmonary bleeding soon resulted in his death. A post-mortem revealed the enlarged firm kidneys with a sebaceous (waxy) cut surface. Histological investigation showed the accumulation at glomeruli and under tubular epithelium homogeneous eosinophilic, Congo-Red positive masses, which gave a metachromasia reaction with the methyl violet. Name process which has developed in kidneys?
A. *Amyloidosis
B. Hyalinosis
C. Fatty dystrophy
D. Mucoid swelling
E. Fibrinoid swelling
10. An autopsy revealed substantial enlargement of a right kidney. A gross investigation of a renal cut section showed a stone in it with marked dilation of the pelvis and calyces by urine and thinning of the renal parenchyma. What of diagnoses is the most likely?
A. * Hydronephrosis.
B. Pyelectasia
C. Pyelonephritis.
D. Cyst of kidney
E.
11. An autopsy of a 44-year-old female revealed a substantial enlargement of a right kidney reminding grape clusters. The cut surface showed cavities varying in size from 0, 5 to 3 cm in diameter, which were filled by serous liquid and colloid masses. Kidney parenchyma between cavities was thinned to 0, 1 cm. What is the most likely diagnosis?
A. *Renal cystic disease
B. Chronic pyelonephritis
C. Acute pyelonephritis
D. Nephrolithiasis
E. Dysphasia of kidneys
12. A post-mortem of a patient with a long history of cystitis and a dyskinesia of ureters revealed morphological signs of uremia. Kidneys were contracted, with irregularly scarred surface. In the renal pelvis fine urate stones and sand were registered. Histological investigation showed ‘the thyroid kidney’ and areas of an interstitial inflammation. What is the most likely diagnosis?
A. *Chronic pyelonephritis
B. Acute pyelonephritis
C. Atherosclerotic-contracted kidney
D. Primary- contracted kidney
E. Amyloidal- contracted kidney
13. An autopsy of the 58-year-old patient revealed an enlarged kidneys, which had a well defined yellow-grey with red specs cortical layer. Kidney’s medulla colored in a dark red. Histological investigation revealed proliferation of capsular epithelial cells and podocytes with crescents formation, sclerosis and hyalinosis of the glomerular tufts, stromal fibrosis. What is the most likely kidneys disease?
A. *Extracapillary productive glomerulonephritis
B. Intracapillary productive glomerulonephritis
C. Extracapillary exudative glomerulonephritis
D. Intracapillary exudative glomerulonephritis
E. Interstitial nephrite
14. A 58-year-old patient with a history of purulent osteomyelitis died of chronic renal insufficiency. A post-mortem revealed the enlarged firm kidneys of white-yellow color with a sebaceous (waxy) cut surface. What is the most likely diagnosis?
A. * Amyloidosis of kidneys
B. Chronic glomerulonephritis
C. Subacute glomerulonephritis
D. Septic nephrite
E. Acute necrotic nephrosis
15. A post-mortem revealed the enlarged kidneys with a lobulated surface due to plural cavities with the smooth wall, filled with a transparent liquid. What is the most likely disease?
A. *Renal cystic disease
B. Necrotic nephrosis
C. Pyelonephritis
D. Glomerulonephritis
E. Infarct
16. A physical examination of a young woman revealed marked edemas and high proteinuria. A histological investigation of kidneys biopsy determined a disappearance of podocytes, a declining of heparansulfate in a basal membrane of glomerular capillaries. What is the most likely disease?
A. * Idiopathic nephrotic syndrome
B. Postinfectious glomerulonephritis
C. Rapidly progressive glomerulonephritis
D. Chronic glomerulonephritis
E. Acute necrotic nephrosis
17. A post-mortem of a 52- year-old man, with a long history of chronic glomerulonephritis, resulted in his death, revealed markedly reduced, firm, fine-grained kidneys. Microscopical investigation showed fibrinous inflammation of serous and mucosas, dystrophic changes of parenchymatous organs and a brain edema. What complication has led to the serous and mucosas lesions?
A. *Uremia
B. Anaemia
C. Sepsis
D. DIC-syndrome
E. Thrombocytopenia
18. A young man died of a burn disease. A post-mortem revealed the brain edema, liver and kidneys enlargement. Gross investigation showed the thickened pale-grey cortical layer and hyperemic medulla. Histological study demonstrated focal tubular necrosis at different points along the nephron with a disruption of tubular basement membrane interstitial edema with leukocytic infiltration and a hemorrhage. What of the listed diagnoses the most authentic?
A. * Necrotic nephrosis.
B. Tubulointerstitial nephritis.
C. Pyelonephritis.
D. Gouty kidney.
E. Myeloma kidney.
19. Histological investigation of a kidney biopsy showed sclerosis, lymphocyte - plasmocyte infiltration of the renal pelvis walls and calyces; tubules dystrophy and atrophy. The intact tubules were dilated, stretched by colloid-like masses. The epithelium was flattened. In whole, the microscopic picture of tissue sample had ‘a thyroid kidney’ pattern. What diagnosis is most probable?
A. * Chronic pyelonephritis
B. Sharp pyelonephritis
C. Glomerulonephritis
D. Nephrosclerosis
E. Tubulointerstitial nephritis
20. The patient treated for a cold by the big doses of paracetamol, presented symptoms of an oliguria and azotemia. In 5 days he died of an acute renal insufficiency. Histological investigation of kidneys revealed the diffusive edema of an interstitial tissue of a kidneys cortex, its infiltration by lymphocytes, the eosinophils, some neutrophils. Almost intact glomerules were found along with a destruction of a tubular epithelium. Name the most probable type of a kidneys lesion?
A. * Tubulointerstitial nephritis
B. Acute glomerulonephritis
C. Nephrotic syndrome
D. Pyelonephritis
E. Necronephrosis
21. A macroscopic investigation of the removed kidney reveled renal swallowing, congestion and a capsule easily taken out. Renal pelvis and calyxes were dilated, filled by turbid urine. Their mucosa was dim, with the areas of hemorrhages. The cut surface of a kidney had a motley pattern; yellow-grey zones were surrounded by plethora and hemorrhages areas. To what disease there corresponds such macroscopic picture of kidneys?
A. *Acute pyelonephritis
B. Acute glomerulonephritis
C. Amyloidosis of kidneys
D. Nephrolitiasis
E. Renal cystic disease
22. Histological investigation revealed proliferation of Bowman's capsule epithelial cells, podocytes and macrophages, resulted in crescents formation, which compressed glomeruli. Necrotic capillary loops had fibrinous thrombi within their lumens. A sclerosis and hyalinosis of some glomeruli were detected. In addition, the expressed nephrocytes dystrophy, an edema and stromal infiltration of kidneys was observed. What is the most likely kidneys pathology?
A. * Rapidly progressive glomerulonephritis
B. Postinfectious glomerulonephritis
C. Chronic glomerulonephritis
D. Chronic pyelonephritis
E. Amyloidosis of kidneys
23. A 53-year-old patient with a history of a chronic glomerulonephritis died of chronic renal insufficiency. A post-mortem revealed smaller than normal, firm kidneys. Their capsule was taken out hardly, baring a granular renal surface. On a cut section a cortical and cerebral layers were thin with dry, anemic, grey color kidneys tissue. How is called such kidneys?
A. * Secondary-scarring kidneys
B. Primary- scarring kidneys
C. Atherosclerotic - scarring kidneys
D. Amyloidal- scarring kidneys
E. Pyelonephrotis - scarring kidneys
24. A 5-year-old girl with a history of an acute respiratory virus infection presented with widespread swelling, a massive proteinuria, a hypoalbuminemia, a lipidemia. A microscopic investigation of the renal biopsy revealed an absence of small podocytes processes within vascular glomerulus. What is the most probable diagnosis?
A. *Lipoid nephrosis
B. Postinfectious glomerulonephritis
C. Rapidly progressive glomerulonephritis
D. Focal segmental glomerulosclerosis
E. Membranous glomerulonephritis
25. An autopsy of a patient, who died from poisoning of ethylene glycol, revealed enlarged edematous kidneys. Their capsule was taken out very easily. Gross investigation showed the wide pale-grey cortical layer and dark red medulla. What disease has developed at the patient?
A. * Necrotic nephrosis
B. Acute pyelonephritis
C. Acute glomerulonephritis
D. Acute tubulointerstitial nephritis
E. Lipoid nephrosis
26. A 12-year-old boy with a history of acute tonsillitis two weeks ago presented with edematous face in the mornings, increasing of arterial pressure, urine in a kind of "meat slops”(‘coca-cola’ colour). Immunohistochemistry of kidneys biopsy revealed immune complexes on basal membranes of capillaries and within glomerular mesangium. What disease has developed at the patient?
A. *Acute glomerulonephritis
B. Acute interstitial nephrite
C. Lipoid nephrosis
D. Acute pyelonephritis
E. Necrotic nephrosis
27. The young man presented in hospital with a headache and giddiness. Within last year he often had high arterial pressure. Medical drugs almost did not help. Kidneys biopsy investigation revealed the extra capillary epithelial proliferation with a crescent formation. For what disease described pathology is characteristic?
A. * Rapidly progressive glomerulonephritis
B. Acute glomerulonephritis
C. Lupus glomerulonephritis
D. Wegener’s granulomatosis
E. Chronic glomerulonephritis
28. A 48-year-old woman died of renal insufficiency. A post- mortem revealed enlarged flaccid kidneys with wide, swallowed, dim cortical layer. A yellow-grey with red specks cortex was delimited from dark red cerebral substance. Microscopic investigation showed a proliferation of Bowman's capsule epithelial cells, podocytes and macrophages, resulted in crescents formation. For what disease described changes are characteristic?
A. * Subacute glomerulonephritis.
B. Acute glomerulonephritis.
C. Chronic glomerulonephritis.
D. Acute pyelonephritis.
E. Amyloidosis of kidneys.
29. A macroscopical investigation of a removed kidney revealed in proximal area of an ureter the concrement which obturated its lumen. The kidney was markedly enlarged; a parenchyma was atrophic with considerably dilated pelvis and calyces. Microscopical study of kidney’s sample showed the diffusive sclerosis, an atrophy of glomeruli and tubules. Survived tubules were cystically dilated. What complication of a nephrolithiasis developed at the patient?
A. * Hydronephrosis.
B. Pyonephrosis.
C. Pyelonephritis.
D. Glomerulonephritis.
E. Chronic paranephritis.
30. An autopsy of the 68-year-old man revealed a sallow-grey colour of his skin with petechial hemorrhages. His face and tongue had a powdery ‘uremic frost’. Fibrinous hemorrhagic laryngitis, a tracheitis, a shaggy pericardium and a catarrhal gastroenterocolitis were also diagnosed. For what syndrome the given complex of morphological changes is characteristic?
A. *Chronic renal insufficiency
B. Acute hepatic insufficiency
C. Acute renal insufficiency
D. Chronic heart insufficiency
E.
31. A man died of renal insufficiency. A post- mortem revealed enlarged flaccid kidneys with wide, yellow-grey with red specks cortex. Microscopic investigation showed a proliferation of Bowman's capsule epithelial cells, resulted in crescents formation. Capillary loops exhibited necrotic alterations and fibrin thrombi within their lumens. What is the most likely diagnosis?
A. *Subacute glomerulonephritis
B. Acute glomerulonephritis
C. Lipoid nephrosis
D. Chronic glomerulonephritis
E. Amyloidosis of kidneys
32. A post-mortem of a patient with a history of chronic renal insufficiency revealed the enlarged, firm, sebaceous (waxy) kidneys with multiple retractions on their surface. Histological investigation showed many glomeruli were replaced by the Congo-Red positive masses. The same substance was found on the basal membranes of capillaries, in mesangium and also within arterial walls and kidneys stroma. What of the listed diagnoses the most likely?
A. *Amyloidosis of kidneys
B. Acute glomerulonephritis
C. Chronic glomerulonephritis
D. Subacute glomerulonephritis
E. Lipoid nephrosis
33. A 60-year-old woman died of a chronic renal failure. An autopsy revealed the irregularly contracted and markedly lobulated kidneys with a fibrous tissue alternated with an intact parenchyma. Renal pelvises were dilated, their walls - thickened. Histological investigation showed sclerosis, lymphocyte - plasmocyte infiltration of the renal pelvis walls, and interstitium. What diagnosis is most probable?
A. *Chronic pyelonephritis
B. Acute pyelonephritis
C. Acute glomerulonephritis
D. Tubulointerstitial nephritis
E. Chronic glomerulonephritis
34. The kidney biopsy is taken from the man who is in clinic with symptoms of a mercury poisoning. Histological investigation revealed focal tubular necrosis, an edema, hyperemia, hemorrhages and leukocytic infiltration in a stroma. What condition has developed at the patient?
A. *Acute necrotic nephrosis
B. Acute glomerulonephritis
C. Chronic renal insufficiency
D. Acute pyelonephritis
E. Chronic pyelonephritis
36. A 42-year-old man died of renal insufficiency. Microscopic investigation revealed a proliferation of Bowman's capsule epithelial cells, podocytes and macrophages, resulted in crescents formation, necrosis of capillary loops and fibrin thrombi within their lumens. In addition, the histological study showed sclerosis and hyalinosis of glomeruli, tubular atrophy and stromal fibrosis of kidneys. What of the listed diagnoses the most likely?
A. *Subacute glomerulonephritis
B. Acute glomerulonephritis
C. Chronic glomerulonephritis
D. Focal segmental sclerosis
E. Membranous nephropathy
37. A patient died from uremia. A post- mortem revealed enlarged flaccid kidneys with wide, swallowed with red specks cortex. Medulla had a dark red coloring. Microscopic investigation showed epithelial crescents which compressed capillaries. Nephrocytes exhibited a dystrophy; a stromal edema and infiltration were also recognized. What is the most likely diagnosis?
A. * Glomerulonephritis
B. Pyelonephritis
C. Nephrolithiasis
D. Nephrotic syndrome
E. Amyloidosis of kidneys
38. The elderly man, with 15 years history of a membranous -proliferative glomerulonephritis, constantly received hemodialysis therapy. The last half a year he did not receive a treatment. He presented to the hospital with extremely severe condition, without consciousness, with a smell of urea from his body and edemas. A marked pleuritis, pericarditis and peritonitis were also diagnosed. In a whole, all symptoms were regarded as a uremia. What kind of an inflammation is the most probable?
A. *Fibrinous inflammation
B. Purulent inflammation
C. Catarrhal inflammation
D. Hemorrhagic inflammation
E. Serous inflammation
39. A postmortem of a 58-year-old male revealed in kidneys asymmetrical, coarse, corticomedullary scars. Histological investigation of a kidney showed atrophy of cyst-like dilated tubules, filled with colloid eosinophilic masses. Interstitium was characterized by pronounced periglomerular sclerosis. What diagnosis is most probable?
A. *Chronic pyelonephritis with scarring
B. Chronic glomerulonephritis with scarring of kidneys
C. Amyloidosis of kidneys
D. Tuberculosis of kidneys
E. Kidneys at hypertension
40. At the patient operated concerning a widespread tumour of an abdominal cavity, the considerable bleeding and declining of arterial pressure took place. After operation the acute renal insufficiency, resulted in the patient’s death, developed. An autopsy revealed the wide light pink cortical layer, which was clearly delimited from dark red pyramids. Histological investigation showed the absence of nuclei in epithelium of convoluted tubules, tubulorrhexis, venous hyperemia. Nuclei of the cells of vascular glomeruli and straight tubules were unchanged. What pathology of kidneys has developed at the patient?
A. * Necronephrosis
B. Infarct
C. Glomerulonephritis
D. Pyelonephritis
E. Nephrosis
41. A 49-years-old- patient with a 10 days history of dysentery presented with raised body temperature, a pain in lumbar area, a fever and a considerable quantity of leucocytes in urine. Histological investigation of a puncture renal biopsy revealed hyperemia, interstitial leukocytic infiltration and numerous inflammatory cells (mainly neutrophiles) with a desquamated epithelium, filling renal tubules. What complication has developed at the patient?
A. *Acute pyelonephritis
B. Chronic pyelonephritis
C. Pyelitis
D. Glomerulonephritis
E. Necrotic nephrosis
42. A 28 year old patient had high arterial pressure, hematuria and facial edemata. In spite of treatment renal insufficiency was progressing. 6 months later the patient died from uremia. Microscopic examination of his kidneys and their glomerules revealed proliferation of capsule nephrothelium and of podocytes with "demilune" formation, sclerosis and hyalinosis of glomerules. What disease corresponds with the described picture?
A. *Subacute glomerulonephritis
B. Acute glomerulonephritis
C. Nephrotic syndrome
D. Chronic glomerulonephritis
E. Acute pyelonephritis