Examination tasks of the specialty "General Medicine"

Task №1.

The middle-aged man suffered from chronic alcoholism, death occurred from alcohol intoxication (the content of ethyl alcohol in the blood is 5.2%). At the forensic autopsy, the liver was enlarged, ochre-yellow in color, and flabby in consistency.

1. The type of dystrophy that has developed in the liver.

2. Microscopic changes in hepatocytes with this dystrophy.

3. The figurative name of the liver in this dystrophy.

4. The etiological factor of liver dystrophy in this case.

5. Reversibility of this dystrophy in patients with alcoholism.

Task № 2.

A patient with peptic ulcer developed profuse gastric bleeding, which led to

to death. The vomit was the color of "coffee grounds." During the autopsy, a chronic ulcer was found on the small curvature of the stomach, the bottom of which is colored black.

1. What pigment is associated with the characteristic color of the gastric contents and the bottom of the ulcer?

2. Which group of pigments does it belong to?

3. What is the result of this pigment?

4.Does this pigment contain iron?

5. By what histochemical reaction are iron-containing pigments detected? The result of the reaction.

Task № 3.

An autopsy of an elderly woman revealed atherosclerosis of the cerebral vessels. In the right hemisphere, in the area of the subcortical nuclei, there is an irregular 4x5x3cm focus with no clear boundaries, in which the brain tissue has a mushy consistency and a light gray color.

1. The name of the pathological process in the brain.

2. Definition of this pathological process.

3. The immediate causes of its development.

4. The clinical and morphological form of the process in this case.

5. The possible outcome of this process in the brain.

Task № 4.

The death of a patient who had been suffering from a chronic form of coronary heart disease for a long time was caused by chronic heart failure. The autopsy revealed pronounced signs of chronic venous congestion with typical changes in the liver, kidneys, and spleen. About 1000 ml of clear light yellow liquid was found in the abdominal and pleural cavities. There is swelling of the subcutaneous tissue of the body.

1. The name of the liver in chronic venous fullness.

2. Terms applied to changes in the kidneys and spleen during venous stasis.

3. The appearance of the skin and soft tissues of the lower extremities of the deceased.

4. The name of the accumulation of fluid in the abdominal and pleural cavities.

5. The name of the edema of the subcutaneous tissue of the body.

Task № 5.

The patient underwent phlebectomy due to varicose veins of the lower extremity. The removed sections of veins were sent for histological examination. The vascular lumens are unevenly dilated and contain dull, red, and soft thrombotic masses surrounding them. In one of the veins there are blood clots of gray-brown color, with a mottled surface, tightly fixed to the vascular wall, in which narrow slits with blood are visible on the incision.

1. Definition of thrombosis.

2. The main reason for this process in this case.

3. Name the blood clots found in the surgical material by their color.

4. Explain the appearance of narrow gaps in the thickness of the blood clot.

5. List the adverse outcomes of thrombosis.

Task № 6.

A 14-year-old child was hospitalized with newly diagnosed rheumatism (rheumatic fever). Clinical examination revealed various manifestations of rheumatism, including fibrinous pericarditis.

1. Macroscopic description of the heart in fibrinous pericarditis.

2. Figurative name of fibrinous pericarditis.

3. The type of fibrinous inflammation in this case.

4. Possible outcomes of fibrinous pericarditis.

5. Other pathological conditions and diseases leading to fibrinous pericarditis.

Task № 7.

The patient experienced hyperemia, pronounced swelling, and soreness in the gluteal region after injection, accompanied by an increase in body temperature. For therapeutic purposes, the surgeon used dissected fatty tissue. On a large area devoid of clear boundaries, it has a dull appearance, diffusely impregnated with purulent exudate. A week later, bleeding appeared from the surgical wound, which was stopped.

1. Name the type of purulent inflammation in the patient.

2. The cause of bleeding from the wound.

3. The name of this bleeding.

4. A favorable outcome of inflammation in this case.

5. Unfavorable outcomes of inflammation in this case.

Task № 8.

A puncture biopsy of the liver was performed in a patient suffering from chronic viral hepatitis. Inflammatory infiltrates from mononuclear cells located in the stroma of the organ were found in the biopsy. There are dystrophic changes in hepatocytes, incipient fibrosis.

1. Inflammation found in the liver, depending on the type of prevailing tissue reaction.

2. There are three types of this type of inflammation.

3. The type of this type of inflammation in this case.

4. Possible cellular composition of the inflammatory infiltrate.

5. An unfavorable outcome of inflammation in this case.

Task № 9.

A few minutes after intravenous administration of the antibiotic, the patient developed itching, erythema, dyspnea, bronchospasm, vomiting, tachycardia, and a sharp drop in blood pressure, resulting in death. An autopsy revealed edema, hemorrhages, and acute emphysema with dilation of the right ventricle of the heart.

1. A complication that has developed in the patient.

2. The group of immunopathological processes to which this reaction belongs.

3. Two forms of these reactions.

4. The type of reaction to which this complication should be attributed.

5. The main link of pathogenesis.

Task № 10.

An endoscopic examination of the stomach revealed a 1 cm diameter polypoid formation in the antrum, from which a biopsy was taken. Microscopic examination of the mucous membrane revealed the following changes: active proliferation of the glandular epithelium with impaired histoarchitectonics, pseudomonicity, polymorphism and cell atypia. The basement membrane of the glands is preserved.

1. A pathological process that has developed in the gastric mucosa.

2. Its definition.

3. Its clinical significance.

4. What general pathological process does it belong to?

5. The modern name of this process.

Task № 11.

A resected colon with a tumor sprouting all the membranes of the organ was delivered to the pathology department. There is an enlarged lymph node in the mesentery, replaced by gray tissue. Histologically, the tumor is represented by various sizes and shapes of glandular structures consisting of atypical cells.

1. Morphological diagnosis.

2. The type of tumor growth relative to the intestinal wall.

3. The nature of changes in the mesentery lymph node.

4. Definition of this tumor.

5. Possible localization of such tumors other than the intestine.

Task № 12.

The patient died from a myocardial infarction. An autopsy examination of the liver revealed a tumor-like node under the capsule, 5 cm in diameter, with clear boundaries, and a full-blooded red incision. Microscopically, the neoplasm consists of large, thin-walled vascular cavities filled with blood, resembling cavernous bodies.

1. Name the tumor.

2. Different localization of this tumor.

3. The group of neoplasms to which this tumor belongs.

4. The malignant analogue of neoplasms of this group

5. Possible complications of this neoplasm.

Task № 13.

A 66-year-old patient was diagnosed with prostate cancer with generalized bone metastases. Death occurred from a cerebral hemorrhage. The autopsy revealed multiple hemorrhages in the skin and internal organs. Widespread tumor metastases have been identified in the bone marrow.

1. The name of the syndrome that the patient has developed.

2. The suspected pathological condition underlying this syndrome.

3. Its definition.

4. There are two main groups of causes of this pathological condition.

5. Other possible complications in this process.

Task № 14.

A 64-year-old woman has been suffering from hypertension for 25 years. Recently, the patient began to have swelling on her face, the patient began to notice frequent urination at night. Ultrasound of the kidneys revealed a decrease in their size, a biochemical blood test revealed hypoproteinemia and a mild increase in creatinine levels. Angiography of the renal arteries revealed signs of uneven narrowing of the lumens up to 70%.

1. Clinical and morphological form of hypertension in the patient.

2. Macroscopic changes in the kidneys.

3. The name of the changes in the kidneys.

4. Microscopic changes in the kidneys.

5. Possible outcome of the process.

Task № 15.

The patient's death occurred with increasing symptoms of cardiovascular insufficiency. An autopsy revealed stenosing atherosclerosis of the coronary arteries of the heart. The lumen of the descending branch of the left coronary artery is obstructed by a thrombus. In the lateral wall of the left ventricle, an irregular gray-yellow focus was found, bordered by a red border, extending to the entire thickness of the myocardium.

1. Pathological process in the myocardium.

2. The group of diseases to which it belongs.

3. The immediate causes of this process.

4. The type of this process depends on the layer of myocardial lesion.

5. Possible outcomes of this pathology.

Task № 16.

A 30-year-old woman has been diagnosed with rheumatic mitral heart disease since childhood. She was hospitalized with clinical signs of an exacerbation of rheumatism. Against the background of increasing heart failure, left-sided hemiplegia developed and death occurred.

1. Clinical and morphological form of rheumatism.

2. Changes in the mitral valve during the last exacerbation of the disease.

3. The pathomorphological form of valvular endocarditis in this case.

4. The pathological process in the brain that caused hemiplegia.

5. The mechanism of development of pathological changes in the brain.

Task №17.

A 40-year-old man was hospitalized with complaints of an increase in body temperature to 39 ° C, severe weakness, shortness of breath, and pain when breathing in the right half of the chest, which occurred after hypothermia. The examination revealed a dulling of the percussion sound, breathing in the lower lobe of the right lung is not carried out, and auscultation noise of pleural friction is heard. The treatment proved ineffective, and death occurred on the sixth day after the onset of the disease with symptoms of pulmonary heart failure. On autopsy, the lower lobe of the right lung has a dense consistency with a fibrin coating on the pleura. On the incision, the lung tissue is airless, gray in color.

1. Diagnosis.

2. The stage of the disease at the time of death.

3. The cause of pleural friction noise.

4. Possible pulmonary complications.

5. Possible extrapulmonary complications.

Task № 18.

At the autopsy of a patient who died in the surgical department, an oval-shaped 2x3cm defect with thickened dense edges was found in the posterior wall of the stomach with a slight curvature, the bottom of which is covered with loose masses of coffee grounds. Such masses are contained in the stomach in an amount of 1000 ml. The defect penetrates the underlying pancreas.

1. The pathological process in the stomach.

2. Microscopic characteristics of this pathology.

3. Complications that have developed.

4. Possible other complications.

5. The main etiological factors of this pathology.

Task № 19.

The patient went to the clinic complaining of frequent mushy stools with an admixture of blood and mucus, abdominal pain, fever up to 38 ° C. During fibroileocolonoscopy, a continuous lesion of the colon was diagnosed in the form of erosions and ulcers, pseudopolypes. Examination of biopsies revealed inflammatory infiltration by lymphocytes, polymorphonuclear leukocytes, eosinophils and plasma cells of the intestinal mucosa, limited by the limits of its own plate, with the development of crypt abscesses.

1. Diagnosis.

2. The parts of the intestine that are affected by this disease.

3. The main etiological theories of the development of this pathology.

4. Intestinal complications of this disease.

5. Distinguishing features of the chronic form of this disease.

Task № 20.

The patient has been suffering from chronic alcoholism for 20 years. On examination: dilated veins are visible on the anterior abdominal wall, the liver is reduced in size, dense, the surface is bumpy, the spleen is palpated. A liver biopsy was performed.

1. The intended diagnosis.

2. Macroscopic changes in the liver.

3. Basic microscopic changes.

4. The pathological process that preceded this disease.

5. The most common complications of this pathology.

Task № 21.

After suffering hypothermia, a 30-year-old man experienced an increase in blood pressure, hematuria and facial swelling. After 7 months, the patient died with symptoms of chronic renal failure.

1. The intended diagnosis.

2. Macroscopic changes in the kidneys.

3. Basic microscopic changes.

4. The prognosis of this disease.

5. Does this disease belong to inflammatory or non-inflammatory glomerulopathies?

Task № 22.

The young man was taken to the hospital with multiple injuries sustained as a result of a traffic accident. Upon admission of BP 90/50 mmHg, liver rupture with massive intra-abdominal bleeding was diagnosed. The patient underwent surgery and received a blood transfusion. During the first day after the operation, 300 ml of urine was released. A biochemical blood test revealed an increase in the level of residual nitrogen and creatinine.

1. A clinical complication that has developed in the patient.

2. Its morphological equivalent.

3. The main reason for this complication.

4. The stages of this process.

5. Structural changes underlying this condition.

Task № 23.

A 7-year-old child complains of weakness, sweating, and fever, and an X-ray examination revealed rounded and irregularly shaped shadows in the third segment under the pleura and at the root of the right lung. Mantoux's reaction is sharply positive.

1. Presumptive diagnosis, its clinical and morphological form.

2. The main morphological manifestation of this form.

3. The components of this morphological manifestation.

4. The main ways of development of this form of the disease.

5. Other clinical and morphological forms of the disease.

Task № 24.

The death of a 48-year-old man who had been in prison for a long time occurred at the height of pulmonary hemorrhage. An autopsy revealed a multicameral cavity with dense, fibrous walls containing blood clotts in the upper lobe of the right lung. There are phenomena of pneumosclerosis and multiple miliary tubercles around the cavity.

1. The most likely diagnosis, clinical and morphological form of the disease.

2. Its form is a phase.

3. The structure of the cavity wall.

4. Other possible complications of this form are the phases of the disease.

5. Other forms are phases of this disease.

Task № 25.

A 70-year-old patient came to the clinic complaining of intense pain in his lower limb, swelling, and blackening of the first and second toes. He has a history of type 2 diabetes mellitus.

1. A complication that has developed in the patient.

2. The immediate causes of this complication.

3. Generalized name of lower limb lesions in diabetic patients.

4. The main vascular changes in diabetes mellitus.

5. Complications of diabetes mellitus.

Answers to Tasks:

Task № 1.

1.Parenchymal fatty degeneration.

2.The cytoplasm of hepatocytes contains fatty vacuoles (small and large droplets).

3."Goose liver."

4.Toxic effects of alcohol.

5.In the early stages, when the toxic effects stop, the process is reversible.

Task № 2.

1. With the presence of hydrochloric acid hematin.

2. Hematins (a group of hemoglobinogenic pigments).

3. Hydrochloric acid hematin is formed in erosions and ulcers of the stomach by the interaction of enzymes and hydrochloric acid of gastric juice with hemoglobin.

4.Contains.

5. Using the Perls histochemical reaction. The result of the reaction: iron-containing pigments turn greenish-blue (Prussian blue).

Task № 3.

A heart attack.Infarction is vascular necrosis.Thrombosis, thromboembolism, prolonged vasospasm, functional organ overstrain in hypoxia.Colliquation necrosis.Cyst formation.

Task № 4.

1.Nutmeg liver.

2.Cyanotic induration.

3.The skin is cyanotic, acrocyanosis occurs, and the soft tissues of the lower extremities are swollen.

4.Ascites, hydrothorax.

5.Anasarka.

Task № 5.

1.Thrombosis is an intravital coagulation of blood in the lumen of a vessel, in the cavities of the heart, and in places of hemorrhage.

2.Violation of blood flow.

3.Red, mixed.

4.The appearance of cracks in a blood clot – canalization followed by their transformation into vessels – vascularization are favorable outcomes of thrombosis.

5.An increase in the size of a blood clot, thromboembolism, purulent meltdown.

Task № 6.

1. Fibrinous exudate loosely associated with the pericardium is detected in the form of a film or villous overlays.

2. "The Hairy Heart."

3. Croup inflammation.

4. Organization with obliteration of the pericardial cavity, resorption, calcification.

5. Uremia, myocardial infarction, pneumonia.

Task № 7.

1. Phlegmon.

2. Histolysis, corrosion of the vessel wall.

3. Arrosive.

4. Scarring.

5. Formation of fistulas, local progression of the purulent process, chronic course, heart attacks and gangrene in vascular thrombosis, sepsis.

Task № 8.

1. Productive.

2. Interstitial (interstitial), granulomatous, hyperplastic overgrowth.

3. Interstitial (interstitial).

4. Lymphocytes, macrophages, histiocytes, plasma cells.

5. Cirrhosis of the liver.

Task № 9.

1. Anaphylactic shock.

2. Hypersensitivity reactions.

3. Hypersensitivity of the immediate type and delayed type.

4. Type I reaction (anaphylaxis).

5. In response to the allergen, IgE antibodies are formed with the participation of T2 helper cells. They are sorbed on mast cells and basophils. Upon repeated contact of mast cells and basophils sensitized by IgE antibodies with a specific antigen, an immediate release of mediators causing clinical manifestations occurs.

Task № 10.

1. Dysplasia.

2. Dysplasia is a pathological regeneration with the development of cellular atypism and a violation of histoarchitectonics.

3. It is regarded as a precancerous process.

4.Towards regeneration.

5. Intraepithelial neoplasia.

Task № 11.

1. Adenocarcinoma.

2. Infiltrating, invasive.

3. Lymphogenic metastasis.

4. Malignant tumor of the glandular epithelium.

5. Stomach, mammary glands, lungs, uterus, prostate and other organs with glandular epithelium.

Task № 12.

1. Cavernous hemangioma.

2. Skin.

3. Hemangiomas.

4. Angiosarcoma.

5. Rupture, intra-abdominal bleeding.

Task № 13.

1. Hemorrhagic syndrome.

2. Thrombocytopenia.

3. Thrombocytopenia is a pathology in which there is a decrease in the number of platelets in the blood.

4. Thrombocytopenia may be caused by decreased production of platelets in the bone marrow or increased destruction of them.

5. Gastric, intestinal, and pulmonary hemorrhages.

Task № 14.

1. Renal (renal).

2. The kidneys are reduced, compacted, and have a finely rounded surface.

3. Primary shrunken kidneys, nephrosclerosis.

4. Arteriosclerosis, glomerulosclerosis, atrophy and replacement of nephrons by connective tissue.

5. Chronic renal failure.

Task № 15.

1. Myocardial infarction.

2. Coronary heart disease.

3. Thrombosis, spasm, thromboembolism of the coronary artery, functional overstrain of the myocardium with insufficient blood supply.

4. Transmural infarction.

5. Myocardial rupture, acute cardiac aneurysm, large-focal cardiosclerosis, chronic cardiac aneurysm, thromboembolic syndrome, postinfarction syndrome.

Task № 16.

1. Cardiovascular.

2. Sclerosis, hyalinosis, valve deformity, fresh thrombotic overlays.

3. Recurrent warty endocarditis.

4. Cerebral infarction.

5. Thromboembolism from the heart to the cerebral vessels.

Task № 17.

1. Croup pneumonia.

2. Gray liver.

3. Fibrinous pleurisy.

4. Carnification, abscess, lung gangrene, pleural empyema.

5. Purulent mediastinitis and pericarditis, metastatic brain abscesses, purulent meningitis, acute ulcerative and polypous-ulcerative endocarditis, purulent arthritis, peritonitis.

Task № 18.

1. Chronic ulcer.

2. Microscopically, the bottom of a chronic ulcer is covered with fibrinous-purulent exudate, under it is a zone of fibrinoid necrosis, granulation tissue is located deeper than this zone, and coarse–fibrous scar tissue is located deep in the bottom of the ulcer.

3. Penetration, bleeding.

4. Perforation, gastritis, perigastritis, cicatricial stenosis of the entrance and exit openings of the stomach.

5.H. pylori, nonsteroidal anti-inflammatory drugs, stress.

Task № 19.

1. Ulcerative colitis.

2. The large intestine, sometimes the distal part of the ileum is involved in the process.

3. Infectious theory, theory of the influence of environmental factors, genetic theory, immunological theory.

4. Toxic dilatation of the intestine, perforation of the wall with the development of peritonitis or paraproctitis, colorectal cancer.

5. The predominance of reparative-sclerotic processes, with the presence of scarring ulcers, scarring and atrophy of the mucous membrane.

Task № 20.

1. Alcoholic cirrhosis of the liver.

2. The liver is reduced, dense, with a finely rounded surface. The incision consists of small nodules less than 5 mm in diameter (small nodular cirrhosis).

3. Fibrosis around central veins (centrolobular) and individual hepatocytes (pericellular); fibrosis in the form of layers of connective tissue around groups of hepatocytes; steatosis, necrosis, apoptosis, hepatocytes; Mallory corpuscles.

4. Alcoholic hepatitis.

5. Bleeding from varicose veins of the esophagus, liver failure.

Task № 21.

1. Extracapillary proliferative glomerulonephritis, (malignant, rapidly progressing, glomerulonephritis with half moons).

2. The kidneys are reduced, dense, and have a finely rounded surface.

3. Clusters of macrophages and epithelial cells of the renal corpuscle capsule in the form of half-moons compress the capillary glomerulus. In the final, the glomeruli are completely obliterated and fibrosed.

4. Secondary shrunken kidneys, early development of renal failure.

5. Inflammatory.

Task № 22.

1. Acute renal failure.

2. Acute tubular necrosis.

3. Blood loss, shock.

4. Initial (shock), oligoanuric, stage of restoration of diuresis.

5. Necrosis of the epithelium of the renal tubules.

Task № 23.

1. Tuberculosis. Primary tuberculosis.

2. Primary tuberculosis complex.

3. Primary pulmonary affect, lymphangitis, lymphadenitis.

4. Healing of the primary complex; progression with generalization of the process; chronic course.

5. Hematogenous and secondary tuberculosis.

Task № 24.

1. Secondary tuberculosis.

2. Fibrous-cavernous tuberculosis.

3. The cavity wall has three layers: the inner one is pyogenic (necrotic), the middle one is a layer of tuberculous granulation tissue; the outer one is connective tissue.

4. Bleeding, rupture of the contents of the cavity into the pleural cavity, pneumothorax, empyema of the pleura, amyloidosis.

5. Acute focal tuberculosis, fibrous-focal, infiltrative, tuberculosis, caseous pneumonia, acute cavernous tuberculosis, cirrhotic.

Task № 25.

1. Gangrene of the lower extremity.

2. Diabetic neuropathy and angiopathy.

3. "Diabetic foot".

4. Diabetic macroangiopathy (atherosclerosis, mediacalcinosis); diabetic microangiopathy (thickening of the basement membranes of the endothelium, atrophy of endotheliocytes, hyalinosis).

5. Pyoderma, bronchopneumonia, pyelonephritis, sepsis, tuberculosis, hyper- and hypoglycemic coma, myocardial infarction, intracerebral hemorrhage or cerebral infarction, gangrene of the lower extremity, renal failure.