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ISCHEMIC HEART DISEASE
MINISTRY OF PUBLIC HEALTH OF UKRAINE
Government Institution
‘Lugansk State Medical University’
Department of Pathomorphology,
Forensic Pathology and Medical Legislation
Case studies in Pathomorphology.
Self assessment textbook.
KROK – 1 (STEP – 1)
Part - 2
Lugansk, 2012
Compilers:
O.S. Reshetnikova
O.V.Teleshova
O.V.Kononenko
I.N.Goryanikova
A.P Sysoenko
O.V.Zinchenko
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 навчально-методичний посібник для студентів вищих медичних навчальних закладів IV рівня акредитації (протокол № 2 від 19.03 2010р.)
All rights reserved. No part of this publication may be reproduced, stored in retrieved system, copied or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without written permission from the author.
CONTENTS
ATHEROSCLEROSIS 4
HYPERTENSION 6
ISCHEMIC HEART DISEASE 8
RHEUMATIC DISEASES 12
THE RESPIRATORY SYSTEM DISEASES 18
DISEASES OF ALIMENTARY SYSTEM 28
DISEASES OF THE LIVER 32
DISEASES OF THE URINARY SYSTEM 36
ENDOCRINE SYSTEM DISORDERS 45
PATHOLOGY OF PREGNANCY 51
DISEASES OF THE REPRODUCTIVE SYSTEM 52
PERINATAL PATHOLOGY 56
GAMETOPATHY 56
AVITAMINOSIS 56
INFECTION DISEASES 57
CHILDHOOD INFECTION 61
BACTERIAL INFECTIONS 68
TUBERCULOSIS 78
SYPHILIS 89
SEPSIS 91
DISEASE OF THE NERVOUS SYSTEM 94
DISEASE OF AN OSTEOMUSCULAR SYSTEM 95
MYCOSISES 98
ATHEROSCLEROSIS
1. A 46-year-old male suddenly died after developing a heart failure. An autopsy revealed in abdominal aorta the yellow color areas, which did not rise over its surface. Histological investigation of aorta showed the aggregations of cells with a foamy cytoplasm among smooth mussels and macrophages. These cells had a motley-orange coloring, when stained by a Sudan Ш. For what stage of an atherosclerosis such picture is characteristic?
А. *Lipoidosis
B. Liposclerosis
C. Atheromatosis
D. Ulceration
E. Atherocalcification
2. A post-mortem of an elderly male revealed microscopic alteration of his coronary artery. There was narrowing of vessel’s lumen due to a fibrous plaque with some admixture of lipids. Name the stage of atherosclerosis:
A. *Liposclerosis
B. Lipoidosis
C. Pre-lipoidosis
D. Atheromatosis
E. Atherocalcification
3. At autopsy of 63-year-old male revealed an atherosclerosis of the brain’s arteries and a thrombosis of the internal carotid artery’s branch. Gross investigation showed a focus of moist softening in his brain’s tissue. Define the pathological process in the brain.
A. * Ischemic infarction
B. Hemorrhagic infiltration
C. Hematoma
D. Encephalitis
E. Tumour of the brain.
4. At autopsy of an elderly female an aorta tissue sample collected for histology. Microscopic investigation revealed in aorta’s intima the accumulation of xanthoma’s cells. At what disease such morphological picture is possible?
A. *Atherosclerosis
B. Hypertension
C. Syphilitic mesaortitis
D. Nonspecific aortoarteritis
E. Nodular periarteritis
5. A 54-year-old male died after developing a heart failure. An autopsy revealed a chronic venous hyperemia of the internal organs, hypertrophy of the left ventricle of a heart and focal cardiosclerosis. Gross investigation of aorta showed yellow-white plaques in the intima with fine-grained masses in their centers, which infiltrated the aortal wall. Give the name of this pathological process.
A. *Atheromatosis
B. Lipoidosis
C. Liposclerosis
D. Arteriolosclerosis
E. Calcinosis.
6. A 66-year-old male suddenly died on his way to operation room. An autopsy revealed a hemorrhage into retroperitoneal fat, a saccular dilatation of the abdominal aorta wall with rupture in arterial wall. The aorta’s defect had uneven edges and stony hardening of surrounding tissues. Name the most likely disease, resulted in described complication?
A. * Atherosclerosis
B. Hypertension
C. Systemic vasculitis
D. Visceral Syphilis
E.
7. At autopsy of 52-year-old male revealed yellowish areas at his aorta’s intima, this did not bulge above its surface. Histological investigation showed the accumulation of cells with foamy cytoplasm, stained by Sudan III in yellow color. Name the most likely stage of atherosclerosis in aorta?
A. *Lipidosis
B. Liposclerosis
C. Atheromatosis
D. Pre-lipoidosis
E. Atherocalcification
8. A post-mortem of a 65-year-old male revealed yellowish streaks and spots in the abdominal aorta’s intima, which did not rise above endothelial surface. These areas were stained by Sudan III in orange color. What stage of atherosclerosis such changes are characteristic for?
A. *Lipidosis
B. Liposclerosis
C. Atheromatosis
D. Ulceration
E. Atherocalcification
9. A 53-year-old female died from acute myocardial infarction. An autopsy revealed multiple whitish dense plaques in her coronal arteries’ intimae, which bulged in and narrowed the vessel’s lumen. Name the most likely stage of a coronary atherosclerosis?
А. * Liposclerosis
B. Lipoidosis
C. Atheromatosis
D. Atherocalcification
E. Ulceration
10. A 45-year-old male died in a traffic accident. A histological investigation of his aorta revealed a lipid infiltration of its intima with fats accumulation in myocytes and macrophages of aortal medial layer. Name the stage of atherosclerosis?
A. *Lipoidosis
B. Liposclerosis
C. Atheromatosis
D. Pre-lipoidosis
E. Atherocalcification
HYPERTENSION
1. An elderly male, with 15 years history of essential hypertension, died from renal failure. What would be the most likely gross picture of his kidneys at autopsy?
A. *Small, dense, a surface is fine-grained.
B. Large pied and soft.
C. Large red
D. Large white and smooth
E. Large with the plural thin-walled cysts.
2. A 52-year-old male had a long history of hypertension. He presented to emergency care physician with complains of an acute, persisted for few hours rise of a blood pressure. What is the most likely alteration of the arterioles’ walls due to hypertonic crisis?
A. *Fibrinous necrosis
B. Hyalinosis
C. Sclerosis
D. Amyloidosis
E. Calcinosis
3. An elderly woman, with a long history of bronchial asthma, ischemic heart disease and hypertension, presented with hypertrophy of her heart’s left ventricle. Name the cause of the heart alteration?
A. *Arterial hypertension
B. Pulmonary insufficiency
C. Chronic ischemia of cardiac muscle
D. Bronchial asthma
E. Emphysema of lights
4. An elderly male, with 20 years history of hypertension, died from uremia. An autopsy revealed a heart hypertrophy and diffuse cardiosclerosis. There were also small, dense kidneys with granularity of their surface. Histological investigation of kidneys tissue showed the collapse of glomerular’s arterioles and sclerosis. Some glomeruli were replaced with pinkish homogenous masses, negative to the Kongo-red staining. Tubules were atrophic. Name the kidney pathology?
A. *Primary-scarring kidneys
B. Secondary - scarring kidneys
C. Amyloidosis
D. Chronic glomerulonephritis
E. Chronic pyelonephritis
5. A 63-years-old patient, with a history of hypertensive disease, died from cardiac insufficiency. At autopsy, the heart enlargement and dilated ventricular cavities were revealed. Microscopical investigation showed marked hypertrophy of cardiomyocytes, with their fatty dystrophy and hyperchromic barrel-like nucleuses. What pathological process is the most likely in a heart?
A *Eccentric hypertrophy
B. Myocarditis
C. Concentric hypertrophy
D. Angiogenic cardiosclerosis
E. Cardiomyopathy
6. A 64-years-old patient died from the brain’s hemorrhage. An autopsy revealed markedly decreased kidneys (6x3x2cm in sizes and 60, 0 grams weight). They were dense, anemic with an even, fine-grained surface. On a cut, there was a constant thinning of the kidneys’ cortex. Changes in kidneys are the implication of:
A. * Arteriolosclerotic nephrosclerosis
B. Atherosclerotic nephrosclerosis
C. Secondary- scarring kidney
D. Amyloidal- scarring kidney.
E. Gouty kidneys
7. A 64-years-old male died from uremia. At autopsy revealed reduced in sizes kidneys, with 50.0g weight. Their surfaces were regularly granulated; the cortexes were thin. A microscopic study showed considerably thickened walls of glomerular arterioles due to deposition of homogeneous unstructured pink masses. The lumens of these vessels were markedly narrowed; nephrons were diminished with sclerotic changes, tubules were atrophic. For what disease the described changes are characteristic?
A. * Hypertension
B. Chronic glomerulonephritis
C. Amyloidosis of kidneys
D. Pyelonephritis with scarring of kidneys
E. Acute necrotic nephrosis
8. A 65-year-old male long time was ill by hypertensive disease and died from chronic kidney insufficiency. The autopsy showed, that both kidneys are considerably decrease in sizes, their surfaces are granulated; histologically - most glomeruluses are containing hyaline, part of them in sclerotic condition, other in hyperplasia; in stroma - the fields of sclerosis, arteriolo- and arteriosclerosis, elastofibrosis of large kidney arteries branches. What is the name of the exposed changes?
A. * Arteriolosclerotic nephrosclerosis
B. Atherosclerotic nephrosclerosis
C. Secondary-restricted kidney
D. Chronic pyelonephritis
E. Amyloidal- scarring kidney.
9. An autopsy of 48-year-old patient, who died from the complications of hypertensive disease, revealed small, dense kidneys with fine-grained surface. Parenchyma and cortex matter were atrophied. Give the name for such kidneys.
A. *Primary-scarring kidneys
B. Amyloidal-scarring kidneys
C. Secondary-scarring kidneys
D. Pyelonephritic-scarring of kidneys
E.
10. An autopsy of an elderly woman, with a long history of hypertensive disease, revealed small size and weight (80 grams), firm kidneys. They had grey color and granular surface. On a cut, there was uniform thinning of a cortex. How it is possible to name the changes in kidneys?
A. *Primary- scarring kidneys
B. Pyelonephritic scarring of kidneys
C. Secondary - scarring kidneys
D. Amyloidal- scarring kidneys
E. Diabetic glomerulosclerosis
11. A 63-year-old man, with a long history of hypertensive disease, died from a hemorrhage in the brain. An autopsy revealed reduced in sizes, firm kidneys with fine-grained surface and thinned cortex matter. These changes in kidneys are characteristic for:
A. *Primary-scarring kidneys
B. Secondary-scarring kidneys
C. Amyloidal-scarring kidneys
D. Pyelonephritic-scarring of kidneys
E. Infarct of the kidney
12. An autopsy of a 61-year –old female revealed the thickening of her heart’s left ventricle up to 2.5 cm. Her kidneys were small, contracted and firm. The surface of the kidneys had a granular appearance. On a cut, there was a thinning of a cortical substance. Microscopical investigation showed arteriolosclerosis, glomerulosclerosis and interstitial sclerosis. What is the most likely disease?
A. *Hypertension
B. Atherosclerosis
C. Ischemic heart disease
D. Rheumatism
E. Amyloidosis of kidneys
ISCHEMIC HEART DISEASE
1. An autopsy of a 49-year-old patient, who died from lungs edema, revealed in myocardium a yellow-grey, large focus and a fresh blood clot in a coronal artery. What is the most likely diagnosis?
A. *Myocardium infarction
B. Cardiosclerosis
C. Myocarditis
D. Amyloidosis
E. Cardiomyopathy
2. An autopsy of a 58-year-old female revealed in myocardium a large, dense, grey focus, which histologically consisted of the rough connective tissue fibers. It was surrounded by the hypertrophied muscular fibers. What changes arose up in a heart?
A. *Postinfarction cardiosclerosis
B. Ischemic stage of myocardial infarction
C. Necrotic stage of myocardial infarction
D. Diffuse cardiosclerosis
E. Myocarditis
3. An autopsy of a 62-year-old male, with a history of ischemic heart disease, revealed an atherosclerosis of coronal arteries and signs of hypertensive disease. On a cut of the heart, in the area of the apex and left ventricle’s frontal and lateral walls, there was a well defined yellowish focus, surrounded by hemorrhages. What is the most likely pathological process in the cardiac muscle?
A. * Myocardium Infarction
B. Postinfarction cardiosclerosis
C. Diffuse cardiosclerosis
D. Myocarditis
E. Fatty dystrophy of myocardium
4. A 32-year-old man suddenly died during the emotionally strained work. An autopsy revealed uneven myocardium blood supply. Histochemical investigation detected a decrease of the amount of glycogen. Electron-microscopical study showed a destruction of mitochondria, the contractures of myofibrils. What is the most likely disorder of a blood circulation?
A. *Acute ischemia
B. Chronic ischemia
C. Vacating arterial hyperemia
D. Acute vein hyperemia
E. Angioneurotic arterial hyperemia
5. An autopsy of a 56-year-old male, with a history of ischemic heart disease, revealed the edema of lungs. What pathological changes could cause a pulmonary disorder?
A. *Acute insufficiency of left ventricle
B. Acute general anemia
C. Acute insufficiency of right ventricle
D. Ischemia of small circle
E. Blood stasis
6. A 48-year-old man, with a history of transmural heart infarction of the left ventricle’s myocardium, died from the veritable rupture of heart (the heart tamponade). What process in an infarct zone could promote a heart’s wall rupture?
A. *Autolysis with melting of myocardium tissue (myomalacia)
B. Substitution of connective tissue in area of infarction (organization)
C. Rising of blood pressure in the small circulatory circle
D. Scar formation with thinning of wall of the left ventricle
7. A patient, with a history of myocardial infarction, develops symptoms of blood circulation insufficiency after physical exercises. There is marked cyanosis and edema of subcutaneous tissue of his lower extremities. What changes have developed on a place of a myocardial infarction at the recovered person?
A. *Cardiosclerosis
B. Intracellular regeneration
C. Myocarditis
D. Atrophy of myocardium
E.
8. A 36-year-old man, with acute transmural infarction of the left ventricle’s myocardium, died from the rupture of the heart and tamponade. What process could be a reason of the heart rupture in the zone of infarction?
A. *Autolysis with melting of myocardium fabric (myomalacia)
B. Substitution of connective fabric in area of infarction (organization)
C. Rising of blood pressure in the small circulatory circle
D. Scar formation with thinning of wall of the left ventricle
9. A 58-year-old male, with a history of hypertensive disease, developed a long attack of substernal pain. The infarction of myocardium was diagnosed. A patient died soon. An autopsy revealed flabby myocardium with uneven blood filling. Histological and histochemical examinations showed disappearance of glycogen granules and decreased activity of oxidizing enzymes. What stage of myocardial infarction presented in that case?
A. *Ischemic stage
B. Necrotic stage.
C. Organization
D. Recurrent myocardial infarction
E. Acute relapsing myocardial infarction
10. A 64-year-old patient, with long history of atherosclerosis and myocardial infarction, developed the attack of substernal pain. A patient was hospitalized in 3 days and died soon from progressive cardiovascular insufficiency. An autopsy revealed in the back wall of the left ventricle and interventricular septum of heart a white color focus, about 3 cm in a diameter. It was fibred, falling back, with a clear boundary. Give the name for these changes:
A. *Focal cardiosclerosis
B. Myocardial ischemia
C. Myocardial infarction
D. Myocarditis
E. Dystrophy of myocardium
11. A 52-year-old male, after repeated intramural heart infarction of myocardium, gradually returned to health and further supervision of a district internist. In 2 years he died in a motor-car accident. Define a pathological process in myocardium, which wound be revealed at the autopsy?
A. *Focal cardiosclerosis
B. Diffuse cardiosclerosis.
C. Atrophy.
D. Necrosis.
E. Hyperplasia
12. A patient developed substernal pains in the 7 o'clock in the morning. He presented at the Emergency Department in 8 o'clock in the morning, where electrocardiograph investigation revealed a myocardial infarction. Ten minutes later he died. What most reliable morphological sign of myocardium infarction would be found at histological investigation after the autopsy?
A * Disappearance of glycogen in myocardial cells
B. Vacuolar dystrophy of myocardial cells
C. Fatty infiltration of myocardial cells
D. Necrosis of myocardial cells
E. Weakening of myofibril of myocardial cells
13. A patient died from progressive cardiac insufficiency. An autopsy revealed a flaccid, dilated in diameter heart. A cut surface investigation showed the irregular blood filling of a myocardium, resulted in the patchy pattern of its tissue. A histological study determined a hyperemia of myocardium and stromal accumulations of small mononuclear cells. The described morphological changes present:
A. *Nonpurulent interstitial myocarditis
B. Vein plethora
C. Fatty dystrophy of myocardium
D. Cardiosclerosis
E. Myocardial infarction
14. A 56-year-old patient presented to the hospital with symptoms of acute myocardial infarction. A diagnosis was confirmed by the EKG and laboratory tests. For 5th days the condition acutely worsened. A progressive cardiac insufficiency resulted in patient’s death. A dissection confirmed the diagnosis of myocardial infarction, complicated by the heart’s wall rupture and tamponade of pericardium. What process developed in the area of myocardial infarction?
A. *Aseptic autolysis
B. Organization
C. Encapsulation
D. Septic disintegration
E. Petrification
15. A 57-year-old man, with a long history of an alcohol abuse, died at the increasing phenomena of chronic heart failure. An autopsy revealed the weight of a heart 580 grams; a languid, clay color myocardium, with intensive diffuse interstitial fibrosis. Coronal arteries were intact. A microscopical study of myocardium showed a combination of hydropic and fatty dystrophy of cells; atrophy and hypertrophy of cardiomyocites. There were also some foci of a cells lysis, accompanied with sclerosis. What kind of cardiomyopathy described in that case?
A. *Alcoholic
B. Hypertrophic
C. Dilatative
D. Restrictive
E. Metabolic
16. A 66-year-old patient presented in the hospital with the acute recurrent myocardial infarction of front-lateral wall of the left ventricle. On the 4th day of disease, an acute, marked difficulty in breathing, a cough with considerable quantity of a foamy sputum discharge and facial cyanosis developed. A patient died from progressive cardiac insufficiency. An autopsy revealed enlarged grey-pink color lungs. A foamy liquid flowed down from the cut surface. What pathological process in lungs caused a death?
A. *Edema of the lungs
B. Lungs infarction
C. Hydrothorax
D. Pneumonia
E. Pneumosclerosis
17. Examination of coronary arteries revealed atherosclerotic calcified plaques closing vessel lumen by 1/3. The muscle has multiple whitish layers of connective tissue. What process was revealed in the myocardium?
A. *Diffusive cardiosclerosis
B. Myocardium infarction
C. Postinfarction cardiosclerosis
D. Myocarditis
E. Tiger heart
RHEUMATIC DISEASES
1. An autopsy of 48-year-old female revealed a mitral stenosis with valve’s incompetence. Histological investigation showed the post- inflammatory cardiosclerosis and Aschoff-Talalayev nodes (granulomas). What is the most likely diagnosis?
А. *Rheumatism
B. Systemic scleroderma
C. Dermatomyositis
D. Nodular periarteritis
E. Lupus erythematosus
2. An autopsy of a 34year-old patient with a long history of rheumatism, revealed the epicardial surface of the heart with shaggy exudate formed by grey strands which easily separate from underlying tissues and described as ‘bread-and–butter’ pericarditis (‘hairy heart’). What is the most likely diagnosis?
А. *Fibrinous pericarditis
B. Purulent pericarditis
C. Hemorrhagic pericarditis
D. Proliferated pericarditis
E. Catarrhal pericarditis
3. A histology investigation of a mitral valve sample of a patient who died from complications of rheumatism revealed a mucoid swelling, a damage of the endothelial cells and also thrombi at the valve closure line. Name the type of the rheumatic endocarditis?
А. *Acute warty endocarditis
B. Diffuse endocarditis
C. Fibroplastic endocarditis
D. Relapsing warty endocarditis
E. Polyps-ulcerated endocarditis
4. A 9-year-old boy presented with painless, firm 1-2 mm nodules at the skin around ulnar and knee joints (at extensor’s area). Biopsy investigation revealed a central area of fibrinoid necrosis of the connective tissue surrounded by lymphocytes and macrophages. What disease these nodules are characteristic for?
А. *Rheumatism.
B. Rheumatoid arthritis.
C. Systemic scleroderma.
D. Nodular periarteritis.
E. Lupus erythematosus.
5. A 28-year old female died from uremia. A post-mortem revealed an enlarged kidneys, which had a patchy pattern with hemorrhages on there surface. Histological investigation showed eosinophilic deposits (hematoxilin bodies), "wire loop" lesions in the basement membrane of the glomerular tuft, hyaline thrombi and foci of fibrinoid necrosis and also ‘onion skin’ sclerosis at the spleen’s vessels. What is the most likely diagnosis?
А. *Lupus erythematosus.
B. Rheumatism.
C. Systemic scleroderma.
D. Rheumatoid arthritis.
E. Nodular periarteritis.
6. A 56-year old male with a long history of a rheumatic heart insufficiency died with symptoms of hemiplegia shortly before death. Histological examination of his mitral; valve revealed severe sclerosis, nodular collection of inflammatory cells and vegetations composed mainly of platelets and fibrin. Name the most likely type of endocarditis?
А. *Relapsing warty endocarditis
B. Acute warty endocarditis
C. Diffuse endocarditis
D. Fibroplastic endocarditis
E. Polyps-ulcerated endocarditis
7. Microscopic investigation of the heart auricle from a patient with a history of mitral stenosis revealed the Achoff- Talalayev’s bodies (granulomas). What was the most likely cause of the heart insufficiency supported by the histology results?
А. *Rheumatic
B. Atherosclerotic
C. Syphilitic
D. Innate
E. Septic
8. A 32-year-old female with a long history of rheumatic valve’s defect presented at the hospital with tachypnea and dyspnea, leg’s edema, ascites and hepatomegaly. She died from the chronic heart insufficiency. An autopsy revealed a mitral stenosis. What was the most likely factor of the mitral stenosis morphogenesis?
A. *Leaves union between itself
B. Sclerosis and bulge of leaves
С. Sclerosis and shortening of leaves
D. Shortening of tendon filaments
E. Presence of small blood thromboses on the surface of valve
9. An autopsy of 61-year-old male with a history of rheumatoid arthritis revealed enlarged dense kidneys, which had yellowish-whitish color and waxy appearance. Grossly, foci of scars were recognized at kidneys surface. Microscopically, at the slides stained by Congo red, homogeneous pink masses at capillaries of glomeruli tufts, arterioles walls and arteries, basal membranes of tubuli and in stroma were found. Name the described complication of rheumatoid arthritis?
A. *Secondary amyloidosis of kidneys.
B. Postinfective glomerulonephritis.
C. Quickly progressive glomerulonephritis.
D. Acute necrotic nephrosis.
E. Fibroplastic glomerulonephritis.
10. A 48-year-old female after exposure to cold presents to her physician with painful deformed fingers joints, which bones were restricted in their movements. Physical examination revealed small firm nodules near the joints. Histological investigation of the nodules biopsy showed the centrally located core of fibrinoid necrosis with surrounding rim of macrophages and hystiocytes. What is the most likely diagnosis?
А. *Rheumatoid arthritis.
B. Dermatomyositis.
C. Rheumatism.
D. Gout.
E. Deformed arthrosis.
11. A post-mortem of 40-year old female who died from uremia revealed enlarged kidneys, which had a patchy pattern of their surface. Histological investigation of kidneys showed eosinophilic deposits (hematoxylin bodies), "wire loop" lesions in the basement membrane of the glomerular tuft, hyaline thrombi and foci of fibrinoid necrosis. Besides these, Libman-Sacks endorcarditis was also determined. What is the most likely pathology in kidneys?
А. *Lupus erythematosus nephritis.
B. Rheumatoid glomerulonephritis.
C. Choleric glomerulonephritis.
D. Sclerotic kidney.
E. Terminal glomerulonephritis
12. A 33-year old female died from chronic kidney failure. A post-mortem revealed multiple scars and infarcts in kidneys and spleen. Histological investigation showed alteration of small and medium sized arteries presented with sclerosis and mild endothelial proliferation. A severe lymphocytes and histiocytes infiltrates were also recognized at the perivascular tissues. What is the most likely disease caused these alterations?
А. *Nodular periarteritis
B. Atherosclerosis
C. Hypertonic disease
D. Morphine’s Disease
E. Visceral syphilis
13. A post-mortem of a 25-year old woman who died from chronic kidney failure revealed a reddish malar rash (‘butterfly rash’) and small (up to 0,2 cm) pale tan spreading vegetations over the mitral valve surface. Histological investigation of kidneys showed foci of fibrinoid necrosis, eosinophilic deposits (hematoxylin bodies), "wire loop" lesions in the basement membrane of the glomerular tuft and karyorrhexis. What is the most likely diagnosis?
А. *Lupus erythematosus.
B. Nodular periarteritis.
C. Rheumatism.
D. Rheumatic arthritis.
14. Histological investigation of the mitral valves of the heart revealed the focal desquamation of endothelial cells replaced by thrombi. The connective tissue had mucoid swelling areas and also zones of sclerosis and revascularization. Name the type of valve’s endocarditis?
А. *Relapsing warty endocarditis
B. Diffuse endocarditis
C. Acute warty endocarditis
D. Fibroplastic endocarditis
E. Polyps-ulcerated endocarditis
15. A 62-year-old woman presents to her physician with considerable deformation of metacarpal phalangeal and feet joints. Histological examination of the soft tissues adjacent to the joints revealed a mucoid swelling of the connective tissue, areas of a fibrinoid necrosis surrounded by palisading epithelioid macrophages and sclerosis. Few ‘rice bodies’ were found within a synovial cavity. What is the most likely diagnosis?
A. *Rheumatic arthritis
B. Rheumatism
C. Behterev’s Disease
D. Hematogenic tuberculosis
E. Gout
16. A 44-year-old woman presents to her physician ulnar deviation of the hands and flexion-hypertension (‘swan neck” or “walrus flipper”) deformities of the fingers. Her metacarpal phalangeal joints are easily exposed to a dislocation and a subluxation. Microscopical examination revealed nodular proliferations of synovium, cartilage destruction and “pannus” formation. What is the most likely diagnosis?
A. *Rheumatoid arthritis
B. Rheumatic arthritis
C. Osteoarthritis.
D. Lupus erythematosus.
E -
17. An autopsy of a child, who died of a heart failure, revealed the dilated heart chambers. Microscopic investigations showed the hyperemia of the myocardial stroma, edema, and diffuse interstitial infiltrates consists of hystiocytes, lymphocytes, some scattered neutrophils and eosinophils. What is the most likely diagnosis?
A. *Diffuse interstitial exudative myocarditis
B. Focal interstitial exudative myocarditis
C. Nodular productive myocarditis
D. Interstitial productive myocarditis
E. Alternative myocarditis
18. A 35- year- old female presented her physician intermittent episodes of ischemia of her fingers, marked by pallor, paresthesias and pain, accompanied by tightening and thickening of the skin and poliarthralgia. Histological investigation of the skin biopsy from affected areas revealed mild epidermal atrophy, hyalinosis of collagen fibers within derma, scattered perivascular lymphocytes’ infiltrates. Underlying skeletal muscles expressed interstitial edema, loss of cross-section striation, nidal necroses followed with petrification. What is the most likely diagnosis?
А. *Dermatomyositis
B. Systemic scleroderma
C. Lupus erythematosus
D. Nodular periarteritis
E. Rheumatism
19. A post-mortem of a 19-year old female revealed multiple furuncles on her skin, a warty endocarditis of the heart valves (Libman-Sacks endocarditis), a focal hemorrhage under the endocardium, ulcerative stomatitis, esophagus ulcers, pneumonia, nephritis, and a spleen hyperplasia with a perivascular sclerosis. Morphological investigation of her brain showed areas of necrosis and signs of vasculitis within thalamus. What is the most likely diagnosis?
А. *Lupus erythematosus
B. Rheumatism.
C. Septic endocarditis.
D. Ischemic heart disease.
E. Hypertensive disease.
20. The woman of 45 years within several years has difficulties at swallowing. She also notes the limitation of fingers movements at printing on the computer keyboard, though joints are not painful. Physical investigation revealed her “stony face” (no wrinkles) owing to tightening of the facial skin and restricted motion of the mouth. The skin biopsy showed a widespread fibrosis of a derma without inflammatory infiltration. Diagnose disease on the listed clinical and morphological data.
А. *Scleroderma
B. Lupus erythematosus
C. Dermatomyositis
D. Amyloidosis
E. Rheumatic arthritis
21. A 43-year-old woman presents to her physician with pain and immobility of the bones in metacarpal phalangeal and feet joints. Similar complains in symmetric pattern were about ulnar and knee joints, though not so severe. Physical examination revealed pastous skin over the joints, a partial ankylosis of metacarpal phalangeal and feet joints, and also ulnar deviation of the hands and flexion-hypertension (‘swan neck”or“walrus flipper”) deformities of the fingers. In addition, movable firm, rubbery and tender 1cm hypodermic nodules were found in the phalangeal joints area. An aspirate of joint fluid showed increased turbidity and presence of white “grains” (“rice bodies”). Immunofluorescence also revealed the rhematoid factor. What is the most likely diagnosis?
A. *Rheumatic poliartritis
B. Systemic disease of connective tissue
C. Gout
D. Osteoartrosis
E-
22. A post-mortem of the patient who died from uremia revealed deformation of a spine column with severe restriction of its mobility. Articular cartilages of spine joints were destructed with persistent chronic inflammation in tissues of joints. The joints cavities filled with connective tissue, in some places leading to ossification and ankylosis formation. In an aorta, heart, lungs a chronic inflammation and a focal sclerosis were discovered. In kidneys an amyloidosis was recognized. What diagnosis in this case is most probable?
A. *Ankiloid spondiloartritis (the Behterev’s disease)
B. The Pedget’s disease (deforming ostosis)
C. Rheumatoid arthritis.
D. Parathyroid osteodystrophy.
E. Osteopetrosis (marble disease).
23. At the patient with suspicion on a systemic disease a biopsy from a site of the skin tightening and restricted motility was taken. A histology investigation revealed all kinds of disorganization of connective tissue fibers with mild cellular reaction and also transition in excessive sclerosis and a hyalinosis. What is the most likely diagnosis?
A. *Scleroderma
B. Nodular periarteritis
C. Lupus erythematosus
D. Psoriasis
E. Dermatomyositis