Professional Documents
Culture Documents
METHODICAL RECOMMENDATION
FOR MEDICAL FACULTY STUDENTS
FROM PATHOPHYSIOLOGY
VINNITSIA - 2011
The manual from Pathophysiology is approved and confirmed
for the introduction into the educational process at Pathophysiology
department meeting.
3
THEMATIC PLAN OF PRACTICAL LESSONS:
Lesson 7 «Allergy.»
4
Theme 1: "SUBJECT AND TASKS OF PAHOPHYSIOLOGY. METHODS
OF PATHOPHYSIOLOGICAL INVESTIGATIONS. MAIN
STAGES OF PATHOPHYSIOLOGY AS A SCIENCE
DEVELOPMENT".
5
The checking of primary level of knowledges.
Give the answers to the following questions:
1. How is realized the mechanisms of neuro-reflector regulation of external
breathing?
2. How is realized the mechanisms of humoral regulation of external breathing.
3. How is realized the mechanisms of neuro-humoral regulation of external
breathing.
4. Significance of the reflexes from receptors of the mucous shell of the upper
respiratory ways at regulation of the external breathing.
5. The modern beliefs about respiratory centre.
6. The role of hydrogen at regulation of the external breathing.
7. The role CO2 at regulation of the external breathing.
8. The direct indexes of efficiency of the external breathing.
6
Literature is necessary for studying of the theoretical questions.
1. Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005. – P.5-7.
2. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. – Р.3-10.
Object of work: to show how respiratory regulation occurs in the case of the
stricture of the airways and effect of the chemical irritans.
Description of experiment:The work is of demonstration type with the assistance
of the students.
Each subgroup carries out an acute experiment with a rabit. The rabit is tied to the
bench. The graphic recording of the initial respiration is performed on the tape
measure of the kimograph with the help of the cuff applied to the thoracic cavity
and connected by means of a rubber tube with a capcule of Mareae.
Conclusion:________________________________________________________
__________________________________________________________________
__________________________________________________________________
___
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Conclusion:________________________________________________________
__________________________________________________________________
__________________________________________________________________
___
Experiment 3. Inject 0,5 ml of 0,1n solution of lactic acid into the lateral vein of
the rabbit's ear. To record respiration in this condition. To make the analysis. To
make the conclusions.
Conclusion:________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____
Conclusion:________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
8
__
Situational task:
The foreign bodey is diagnosed in the larynx of a child. Objectively: the skin is
cyanotic, the puls is rapid. What is the type of breathing that develops at this
pathology?
___________________________________________________________________
9
Theme 2: " GENERAL STUDY ABOUT NOSOLOGY, ETIOLOGY AND
PATHOGENESIS (the SEMINAR)".
10
of disease development.
3. Analyze various options for the cause-effective relationships in pathogenesis.
4. Analyze of pathological phenomena in the pathogenesis: adaptive-compensatory,
general and local, specific and nonspecific, leading to main link of
pathogenesis.
5. Evaluate the importance of modern methods of research (experimental and
clinical) for the pathophysiology.
11
Information required for renewing the base knowledges it is possible
to find at the following textbook:
1. Lectures from the philosophy course.
Check primary level of knowledge.
Give the answers to the following questions:
1. Name the main history directions of development of the teaching about disease.
2. Name the factors, from which the different looks at disease on different stage of
mankind development are depending on.
3. Hippocrates contribution at development of the general teaching about a
disease.
4. Characterize the humoral and the solidary direction.
5. Galen contribution at development of the general teaching about disease.
6. Avicenna contribution at development of the general teaching about disease.
7. Paracelsus contribution at development of the general teaching about disease.
8. Characterize the jatrochemical and the jatrophysical direction.
9. R. Virhov contribution at development of the general teaching about disease.
10. Formulate the main positions of cellular pathology of Virhov.
11. Name positive and negative importance of cellular pathology of Virhov.
12. Give definition of the conception "health".
13. Give definition of the conception "disease".
14. Give the definition of the conception "pathological process" (cite an example).
15. Give the definition of the conception "pathological reaction" (cite an example).
16. Give the definition of the conception "pathological state".
17. Give the definition of the conception "typical pathological process" (cite an
example).
18. Principles of classifications of the diseases (cite an example).
19. Name the periods of disease and give the feature of each period.
20. Name the outcomes of the diseases.
21. Give the definition of the conception "clinical death".
22. Give the definition of the conception "biological death".
23. Give the definition of the conception "social death".
24. Give pathophysiologycal characteristic of the terminal states.
25. Name the factors, from which duration of clinical death depends.
26. Name the pathophysiologycal principles of reanimations
27. Give the definition of conception "etiology".
28. Name the main stages of the development of the teaching about etiology at
pathology.
29. What is the monocausalism? Explain the reasons of origin this direction in
medicine?
30. Significance of monocausalism in the development of the general studying
about etiology.
31. What is the conditionalism?
32. Significance of conditionalism in the development of the general studying about
etiology.
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33. What is the constitutionalism?
34. Significance of constitutionalism in the development of the general studying
about etiology.
35. Give the definition of psychosomatic direction.
36. 1Significance of psychosomatic direction in the development of the general
studying about etiology.
37. What is the philosophical base of general etiology?
38. 1What is a methodological base of general etiology?
39. Name the main positions of dialectics-materialistic determinism.
40. Modern understanding of causality at pathology.
41. Role of the conditions at arising of the diseases. Classification of conditions.
42. Notion about mono- and polyetiologic diseases.
43. Classification of etiological factor.
44. What is the "risk factors"? Cite an example.
45. Significance of "risk factors" at development of the diseases.
46. Significance of the general studying about etiology for theoretical and practical
medicine.
47. Give definition of concept «pathogenesis».
48. Explain the role of etiologic factor in pathogenesis (to make examples).
49. Name the variants of interaction factor with an organism in time.
50. Give description of role of structural and functional changes in pathogenesis.
51. Give description correlation between “general” and “local” in a pathological
process.
52. What is “main link” of pathogenesis?
53. Name the types of cause-effect relations.
54. Give definition of conception «Vicious circle» in pathogenesis.
55. Make an example of direct type of cause-effect relations.
56. Make an example of cause-effect relations on the type of «convergence».
57. Make an example of cause-effect relations on the type of «divergence».
58. Make an example of cause-effect relations on the type of «vicious circle».
59. Significance of common studies about pathogenesis.
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9. Pathophysiological basis of reanimation.
10. Main directions of study about the disease: humoral (Hippocrates), solidary
(Democritus), cellular pathology (R. Virkhov).
11. The development of these areas today.
Theme of reports:
1. Hyperbaric oxygenation, it’s using in medicine.
2. Social death as physician-social problem of mankind.
3. Adaptation, compensation. Mechanisms of immediate and long duration
adaptation.
4. Role of Virchov in development of study about pathogenesis. Positive and
negative value of cellular theory.
5. Adaptation, compensation. Mechanisms of immediate and long duration
adaptation.
6. Role of Virchov in development of study about pathogenesis. Positive and
negative value of cellular theory.
1. Insufficiency of the mitral valve was founded at man who 12 years ago
suffered from rheumatic myocardites. Investigations have shown that the
inflammatory process is absent, minute volume of circulation is sufficient.
Name the nition of general nosology.
A. Pathological state
B. Pathological reaction
C. Disease process
D. Typical pathological process
E. Compensating reaction
2. Atrophy of bone marked in the patient after the removal of teeth. This is an
example of:
A. Pathological condition
B. Pathological reaction
C. Pathological process
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D. Structural adaptation
E. Disease
2006-2009
1. A 50-year –old man has a stomach ulcer. After the treatment digestion
become to normal, pain dissapiared, and his mood improved. However, in a
couple of weeks the patient developed pain in epigastric region, heartburn and
acd belching. How this situation might be interpreted?
A. Disease relaps
B. Remission period
C. Terminal status
D. Premonitory period
E. Latent period
2. A 12-year-old boy after coming home from the school began to complaint of
headache, nausea, chill, periodic muscle pain, loss of appetite, and fatigue.
What disease period can show such signs?
A. Prodromal
B. Latent
C. Incybation
D. Height of the disease
E. End of the disease
3. A student fell ill with acute respiratory disease at the end of winter following
long period of mental overloading. What is the cause of the disease?
A. Pathogenic microorganism
B. Irrational diet
C. Mental overloading
D. Supercooling
E. Hypovitaminosis
4. Pain in aleft half of the chest and dyspnea appear in a patient during
walking. This pain increases during respiration. The attack of the pain was
stopped by using narcotics. At examination of the patient following data were
revealed: severe condition, respiratory rate is 28 per min., respiration is
shallow and is dull in the left axillary region. Blood pressure is 140/80 mm Hg.
Patient has sputum with blood. This patient has varicose dilation of veins. In
purpose to correct main pathogenic link it is necessary to use:
A. Anticoagulants
B. Antibiotics
C. Antihistamin preparation
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D. Spasmolytics
E. Coronarilytics
5. A 39-years-old patient has been suffering from gastric ulcer for last 4 years.
Pain in epigastric region, heartburn, nausea, and constipation appear mainly
in autumn and spring. Name this condition.
A. Remission
B. Acute period
C. Complication
D. Pathologic condition
E. Relapse
10. Increase in pulse rate, respiratory rate, and increase of BP were noticed on
the height of 1000 m above the sea in a 25-year-old woman, coming for holydaj
in the mountainous resort. In some time all those symptoms disappeared.
Which process was noticed in a woman?
A. Adaptation
B. Compensation
C. Decompensation
D. Stress
E. Parabiosis
11. A man with the complex of deviation of his health is considered sick. What
is the more typically for disease?
A. Disorder of physiological regulation of functions
B. Decrease of ability to work
C. Disorder of immunity
D. Psychological deviations
E. Decrease of adaptation
Situation tasks:
1. Patient A., 45, arrived in Khmelnik for spa treatment with complaints of
weakness and pain in the muscles of the right leg in time of walking. Five years
ago, on the basis of vascular disease dry gangrene of his left foot developed,
about what it was amputated. The warm hydrogen sulfide bath resort was
recommended to the patient. Soon, however, recommendations was canceled
because painful compression associated with the development of inflammation
in the veins (phlebitis) developed along the subcutaneous veins of the right leg.
In addition, the patient endured the treatment bad: while taking bath his
blood pressure rose and headaches appeared.
1. What pathological reaction, pathological process and pathological condition
developed in a patient?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
2. Justify your conclusion.
___________________________________________________________________
___________________________________________________________________
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___________________________________________________________________
2. Patient S., 18, delivered at the reception department of the hospital in grave
condition. During ski trips he lost in the woods and fell asleep under a tree. He
was founded in a day. Objective: consciousness is lost, rectal temperature
250C, skin and visible mucous membranes are pale, with a cyanotic tint, the
pupils are dilated, blood pressure - systolic 40mm.Hg. (Diastole is not defined).
Pulse 30 beats / min, breathing is unrapid and superficial, reflexes are
decreased, pain sensitivity is absent.
1. Name the terminal condition of the patient?
___________________________________________________________________
2. Justify your conclusion.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
3. Worker P., 42 years old, during an accident at work snatch by hand wire
through which current pass 220 V. As a result of the muscles contractions he
wasn’t able to disconnect by himselve. He quickly lost consciousness. In a few
minutes he was disconnected from the wire by other workers. The doctor
diagnosed the stoping of breathing on the base of intact cardiac activity. There
are small deep wounds of burned with slightly charred edges on the hands and
both feet. Artificial respiration was carried out to the patient during 2.5 hours
(before the appearance of self-breathing).
1. Was the victim in a state of clinical death?
___________________________________________________________________
2. Justify your conclusion.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
4. Patient Z., 27, delivered in a hospital in a grave condition. Skin and mucous
membranes are cyanotic, pulse 146 beats / min, weak content. Blood pressure
90/60 mm Hg, respiration is frequent and shallow, the body temperature 40.5 0
C. According to the victims, who eliminated the accident within 40 minutes the
patient was working at 700C air and high humidity.
1. Is the state of the patient a terminal staye?
___________________________________________________________________
2. Justify your conclusion.
___________________________________________________________________
___________________________________________________________________
5. Patient A., age 22, entered the clinic with a diagnosis “adhesive bowel
obstruction”. During the operation, carried out under the endotracheal
anesthesia, there was a blockage of mucus endotracheal tube. The patient
stopped to breath, soon the pulse disappeared. After 2 min after the onset of
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clinical death the mucus from the trachea was suction and artificial
respiration was started . Simultaneously 300 ml of blood with 1 ml of
adrenaline (1:1000) under the pressure of 220 mm Hg was injected into the
right brachial artery. In the absence of effect the chest was disclosed and
direct cardiac massage started. After 1 min. after the massage were the
contraction of heart and breathing resumed. Postoperative condition is
satisfactory.
1. Can you juistify the ventricular fibrillation of the heart as the cause of ineffective
resuscitation in the first stage?
___________________________________________________________________
2. How, without revealing the chest, to diagnose fibrillation of ventricular of the
heart?
___________________________________________________________________
3. What are the basic principles of resuscitation?
___________________________________________________________________
___________________________________________________________________
4. Is it justified the transition from indirect to direct cardiac massage during
ventricular fibrillation without prior defibrillation?
___________________________________________________________________
6. Patient A. came to the clinic with complaints of cough, fever to 38-39 0C,
general weakness, sweating, headache. Diseases linked to the fact that before
he drove several hours on a motorcycle and was cold. Clinical and radiological
examination allowed diagnosis: pneumonia.
1. What is the direct cause of disease?
___________________________________________________________________
2. What is the role of cooling in this case?
___________________________________________________________________
3. What changes in blood might occur in a patient?
___________________________________________________________________
___________________________________________________________________
7. Patient S., 28 years old, delivered to the resuscitation department
emergency hospital in a grave condition. He was founded on the street with
gunshot wounds of the chest and massive bleeding. Objective: consciousness is
lost, rectal temperature is 250C, skin and visible mucous membranes are pale,
with a cyanotic tint, the pupils are dilated, blood pressure - 0. Pulse is not
defined, breathing and reflexes reduced pain sensitivity is absent.
1. What terminal condition developed at the patient?
___________________________________________________________________
2. What resuscitative measures should be applied?
___________________________________________________________________
___________________________________________________________________
8. Patient S., 37, who suffered as a result of the accident, was taken to the
admission department of the hospital in grave condition. The patient fractured
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bones of the pelvis and lower limbs, he has massive bleeding. Objective:
consciousness is lost, rectal temperature 250C, skin and visible mucous
membranes arepale, with a cyanotic tint, the pupils are dilated, blood pressure
- systolic 40mm.rt.st. (Diastolic is not defined). Pulse 30 beats / min, Gasping-
breathing, reflexes are decreased, pain sensitivity is absent.
1. What terminal condition developed at the patient?
___________________________________________________________________
2. What resuscitative measures should be applied?
___________________________________________________________________
___________________________________________________________________
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Theme 3: PATHOGENIC EFFECT OF THE ENVIRONMENTAL
FACTORS (mechanical factor, ionizing radiation, barometric
pressure, high and low temperatures)
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2. Physical nature of different types of ionizing radiation (the department of
physics).
3. Biological nature of different types of ionizing radiation (the department of
physics).
4. Blood cells and methods of their counting (the department of normal
physiology).
5. Gas composition of the blood and partial pressure of oxygen in the atmospheric
air (normal physiology department).
6 Dependence of degree of hemoglobin saturation with oxygen on its partial
pressure (normal physiology department).
7. Dependence of physic and chemical properties of gases in liquids on barometric
pressure (department of physics).
8. Dependence of physic and chemical properties of proteins on the temperature of
environment (department of physics).
9. Regulation of heat exchange is an organism (normal physiology department).
10. Basic physical parameters of electric current (department of physics).
11. Electric properties of living tissue (physical department).
22
15. What is radiolysis of water? What is its significance in the mechanisms of
pathogenic action of ionizing radiation?
16. What types of radiation do you know?
17. What are radiotoxins? What radiotoxins do you know? What is their
significance in the mechanisms of pathogenic action of ionizing radiation?
18. What system is most sensible to radiation? Motivate you answer.
19. What does the sensitivity of tissues to the action of ionizing radiation depend
on?
20. What are the stages of traumatic shock?
21. Call the main the mechanisms of the pathogenic action of the mechanical
factor?
22. What mechanisms of the pathogenic action of ionizing radiation consist of?
23. When does a man undergo the action of high barometric pressure?
24. When does a man undergo the action of diminished barometric pressure ?
25. What is euphoria?
26. What is saturation?
27. What is desaturation?
28. What changes of gas composition of blood characterize mountain sickness?
29. How does solubility of gases change at the elevation of barometric pressure?
30. How does solubility of gases change at the diminishing of barometric pressure?
31. At what altitude does boiling of biologic liquids at the body temperature take
place?
32. What is explosive decompression?
33. What is gas embolism? How does the change of barometric pressure influence
on its development?
34. What is bleeding from the nose and ears at the diminishing of barometric
pressure associated with?
35. What is hyperoxia? What is the manifestation of toxic action of oxygen?
36. Why in removing of СО2 disturbed at hyperoxia?
37. What is burn disease?
38. Stages of burn disease.
39. When does heat stroke develop?
40. When does sunstroke develop?
41. What conditions are favorable for the pathogenic effect of high temperature of
the environment?
42. What properties does the pathogenic action of electric current depend from (to
enumerate)?
43. What is the significance of pathway of electric current in the organism?
Ground.
44. What is the significance of physiological state of organism at the action of the
electric current?
45. What forms the base of the electrochemical effect of the electric current?
46. What forms the base of the electro thermal effect of the electric current?
47. What does the electromechanical effect of the electric current consist of?
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48. What local disorders develop in the tissues at passing of the electric current?
24
2. Pathogenic effect of infra-red rays.
3. Pathogenic effect of ultraviolet rays.
4. Medical aspects of consequences of the accident in Chernobyl atomic station..
5. Hypothermia. Its application in medicine.
6. Application of hypothermia in modern medicine.
Testing for checking of final level of knowledge
“KROK-1” open database 2010
1. In result of the damage of one of the Atomic Power Plant reactor the run-
out of radioelements happened. People in the increased radiation zone were
radiated with approximately 250-300 r. They were immediately hospitalized.
What changes in the blood count would be typical?
A Lymphopenia
B Leukopenia
C Anemia
D Thrombopenia
E Neutropenia
2006-2009
4. As a the result of the damage of the reactors at AES running out of radio-
active products took place. People that were in the area of high radiation got
about 250-300R. They were immediately hospitalized. What main symptom
will the victims have?
A. Lymphopenia
B. Leucopenia
C. Anemia
D. Thrombocytopenia
E. Neutropenia
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Er-3,2 x 1012/L, reticulocytes - 0,01% Hb-60g/L, L - 2,3x 10 9/L, thrombocytes-
50 G/L What period of radiation sickness is characterizes by such changes?
10. Pathogenic action of ionizing radiation was studied during the experiment.
Name the symptomocomplex that dosn’t develop at radiation of the organism
by the median doses of ionizing radiation.
A Rough structural changes and death of nervous cells
B. Hemorrhagic syndrome
C. Intestinal autointoxication
D. Nervous-reflex disorders
E. Depression of hemopoesis
11. Victim during an accident on a submarine atomic boat got the dose of
irradiation 6 Gr. It expected essential disorders of functions and structure of
cells:
A. Bone marrow
B. Intestinal epithelium
C. Epithelium of skin
D. Pulp of spleen
E. Thyroid gland
12. A driver was admitted to the resuscitation department. He does not reacts
to the questions, is indifferent to everything, pale, his breathing is superficial,
infrequent. Arterial pressure -75/50 mm. Name the main link of pathogenesis
of abovementioned pathology.
A. Central nervous system inhibition
B. Excitation of CNS
C. Loss of blood
D. Toxemia
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E. Redistribution of blood
13. How can one liquidate the main link that appears at traumatic shock?
A. By anesthesia
B. By excitation of vasomotor centre
C. By hypertensive drugs
D. By activating of blood sedimentation
E. By antioxidants
14. The worker of AES was admitted to the a clinic after a single radiation
with the complaints of a headache, loss of consciousness, high of temperature,
weakness, vomiting, diarrhea. Blood analyses showed leukocytosis with
lymphopenia. What period of radiation sickness is the most possible in a
patient?
A. Primary reactions
B. Prodromal
C. Lethal
D. Developed clinical picture
E. Period of imagined sufety
15. A patient that is in the clinic for acute radiation sickness complaints of a
headache, insomnia, marked weakness, difficulties of eating. The gums
inflammation, necrotic angina, skin hemorrhagis, blood in urine and fecus
were founded in the physical examination. Damage of what tissue is the main
in pathogenesis of disorders in this case?
A. Hemopoietic
B. Bone tissue
C. Glandular epithelium
D. Nervous
E. Lymphoid
16. On the peak of acute radiation sickness a patient had acute weakness, his
skin was pail, tachycardia, pain in the different parts of the intestine,
vomiting, fecus with the tinge of blood. Arterial pressure – 70/40 mm Hg. Two
weeks before the patient got a radiation dose 30 Gr. What form of radiation
sickness is characterized by such symptoms?
A. Intestinal
B. Toxemic
C. Osseo-cranial
D. Hemorrhagic
28
E. Cerebral
17. White rat got the X-ray radiation in a dose 10 Gr. Give the most possible
change of the peripheral blood picture that is observed in 0 hours after the
radiation.
A. Neutrophyic leukocytosis
B. Leukopenia, anemia
C. Anemia
D. Anemia, leukopenia, thrombocytopenia
E. Afranulocytosis
18. A rabbit was radiated with a dose 0,5 Gr. In what system are the most
marked disorders observed in 10 hours after radiation?
A. Hemopoietic
B. Nervous
C. Cardio-vascular
D. Sexual
E. Lymphoid
19. During the work for liquidation of the consequences of AES liquidation of
the consequences a worker got radiation in a dose of 10 Gr. He complains of a
headache, nausea, loss of consciousness. What changes of leukocytes can one
expect in a patient 10 hours after later after radiation?
A. Lymphocytosis
B. Leucopenia
C. Agranulocytosis
D. Neutrophilic leucocytosis
E. Leukemia
29
21. A 35-year-old man following 30 min after a car incident presented massive
trauma of the low extremities without significant external bleeding. The
patient it agitated. What component of the traumatic shock is prominent in
this case and needs to be corrected immediately.
A. Pain
B. Internal haemorrhage
C. Internal loss of plasma
D. Intoxication
E. Disorder of the internal organs
22. At the height of the acute radiation sickness a patient had leukopenia,
thrombocytopenia, autoinfection, autointoxication, hemorrhagic diathesis, and
fever. What kind of the radiation sickness might be accompanied by these
symptoms?
A. Bone marrow
B. Intestinal
C. Toxemic
D. Cerebral
E. Haemorrhagic
23. A primary pathogenic mechanisms of the radiation cell lesion is bound
with:
A. Water radiolosos
B. Activation of the cell membrane phospholipase
C. Accumulation of the Ca++ in the cells
D. Increasing of the Na+ diffusioan in the cell
E. Intracellular acidosis
24. A man was brought to the hospital in 3 days after the influence of ionizing
radiation in a dose # Gr. What physiological system might be primary
involved into the pathological process?
A. Blood
B. Digestive
C. Cardiovascular
D. Immune
E. Endocrine
30
B. Primary acute reactions
C. Imaginary clinical well-being
D. Restoration
E. Disease outcome
26. A diver that for a long time was on the depth 40 m at decompression
developed in cassion disease. The main of pathogenic link was embolism:
A. Gas
B. Air
C. Fatty
D. Paradoxal
E. Tissue
27. At the decompression of the cabin of airplane at the altitude of 19km the
immediate death of the pilots came. What is its cause?
A. Boiling of blood
B. Cerebral hemorrhages
C. Gas embolism of cardiac vessels
D. Bleeding
E. Paralises of respiratory center
28. The state Of passengers of the airplane with partial decompression became
sharply worse. Pain in the ears, frontal sinus, meteorism, bleeding from the
nose. What peripheral blood disorder caused this bad state?
A. Gas embolism
B. Ischemia
C. Venous hyperemia
D. Thromboembolism
E. Stasis
29. The patient with burns of 40% surface of body burn shock developed.
What is the primary mechanism of its development?
A. Pain
B. Dehydration
C. Disorder of mineral metabolism
D. Autoimmunization
E. Disorder of protein metabolism
30. After the forced quick getting a diver up to the surface from the depth he
developed the signs of caisson disease: pain in joints, itching of the skin,
winkiig in the eyes, loss of consciousness. What type of embolism caused them?
31
A Gas
B. Air
C. Fatty
D. Tissue
E. Thromboembolism
33. At the emergency getting up from the depth the diver developed cramps
with the loss of consciousness. What pathogenic mechanism is the main one in
the development of this disorder?
A. Gas embolism
B. Hypoxia
C. Toxic effect of oxygen
D. Toxic effect of nitrogen
E. Toxic effect of C02.
34. At the development of mountain sickness subsequently develop below
mentioned changes of indices of the state of vital functions of the organism.
What of them are of pathologic character?
A. Increase of respiratory rate
B. Increase of breathing depth
C. Increase of pulse rate
D. Hypoxemia
E. Hypodynamia and apathy
35. For the first time the character of breathing of the alpinist who was at the
altitude of 5000 m above a see level changed during sleep: after some
respiratory movements there begins respiratory standstill than deep
32
respiratory movements were restored again and so on. What is the most
possible cause of changes of respiration?
A. Decrease of air temperature
B. Decrease of partial pressure of C02 in air
C. Decrease of partial pressure of 02 in air
D. Increase of blood flow rate
E. Increase of oxygen blood volume
36. An alpinist during climbing the mountain at the altitude of 6 000 m above
a sea level developed euphoria, inadequate estimation of situation,
hallucinations. What IS the main cause of the development of these symptoms
of mountain sickness?
A. Physical overstrain
B. Decrease of atmospheric pressure
C. Snow ophthalmia
D. Decrease of partial pressure of air oxygen
E. Expansion of air in frontal sinus
37. A man lived in high -mountain conditions for a long time. What change in
the system of blood is observed?
A. Increase of the diameter of the blood vessels
B. Decrease of the number of leucocytes
C. Decrease of the number of erythrocytes
D. Increase of the number of erythrocytes
E. Decrease of the number of thrombocytes
38. An alpinist was climbing the mountains for several days. At the altitude of
5 000 m tachypnoe, tachycardia, pain in the ears, headache of expansive
character developed. Indicate possible cause of these symptoms.
A. Increase of partial pressure of air oxygen
B. Insufficient ventilation of lungs
C. Gas embolism
D. Decrease of air temperature
E. Decrease of barometric pressure
44. After a long-term staing on the sun a patient had the temperature up the
41°C. on the background of the intensive therapy with salicylates the body
temperature became to 36,6°C. in this case fall in body temperature to the
normal indices is:
A. Active process, regulated by jatrogenic antipyretics
B. Active signal of hypothalamus to the end of the program of the fever
34
C. Passive process due to the exhaustion exo- and endogenous pyrogens
D. Active process, regulated by the natural pyrogenes
E. Pathological reaction to salycilates
45. On admitting to the hospital the man with the closed craniocerebral
trauma had a headache, nausea, vomiting, high t°C. Pathology from the side of
inner organs was not revealed. What form of thermoregulation disorder is
observed in a patient?
A. Exogenic hyperthermia
B. Fever
C. Endogenic hyperthermia
D. Centrogenic hyperthermia
E. All answers are correct
46. A man that had suffered from the explosion in the mine was admitted to
the reception department of the hospital. His general state was satisfactory. He
was conscious. There were areas of hyperemia of skin with blisters on the face,
hands and trunk. What factor mainly had the effect on the miner?
A. Chemical
B. Thermal
C. Airwave
D. Psychological
E. Toxic
48. At what directions of passing of the electric current through the organism
there is the greatest threat to the life of the patient?
A. Back of the head -lower jaw.
B. Left leg -right leg.
C. Right leg - right hand.
D. Left leg-left hand.
E. back-abdomen
35
49. During a rain storm a ragged electric wire fell down on the head of the
victim whereupon he perished. Death occurred as a result of:
A. Paralysis of respiratory center
B. Disorders of cerebral blood circulation
C. Oppression of the cortex
D. Paralysis of the motor -vascular center
E. Irritation of nuclei of vagus nerve
51. Electric current with the voltage of 1000 V was passed through the brain
of an experimental animal. The animal perished. The skin was cyanotic.
Determine the course of death:
A. Respiration standstill
B. Cardiac arrest
C. Collapse
D. Psychogenic shock
E. Cardiogenic shock
52. As a the result of a contact with the bare electric wire a small damage of
grayish color by sizes appeared 2 x 1,5 s-m appeared on the skin. It was
separated Irom healthy tissues by the demarcation line. There was no exudate
and erythema. Define the described damage:
A. Electric burn of II degree
B. Electric burn of a I degree
C. Inflammation
D. Necrosis
E. All answers are correct
53. In 2 weeks after electric trauma necrosis of the skin and surrounding
tissues developed in the peace of a contact with the electric wire. Define the
leading factor of the necrosis development in this case:
A. Discharge of a greatest amount of heat
B. Coagulation of proteins
C. Polarization of cell membranes
D. Damage of blood vessels
E. Injury of the skin and muscles with the products of POL
36
54. A direct electric current passed through the organism of a man that was in
the state of easy alcoholic intoxication (I = 20 ma, U = 220 V, t = 0,03 sec) at
the position of electrodes «head - leg» whereupon the paralysis of respiratory
center was observed. What factor contribute to the above mentioned
complication?
A CNS disorder
B. The pass way of electric current
C. State of alcohol intoxication
D. Types of electric current
E. The time of current action
55. A man who ignored the rules of accident prevention got an electric trauma
with electric current passing through the cardiac muscle. What dangerous
disorder in the work of the heart requires immediate interference may develop
in this situation?
A Tachycardia
B. Extrasystolia
C. Fibrillation
D. Arrhythmia
E. Bradycardia
56. The doctor of the first-aid station determined respiratory standstill with
the signs of the work of the heart in the victim from the influence of electric
current. What was the most possible pass way of the electric current passing in
this case?
A. A right hand - head
B. A left leg - right hand
C. A right leg - right hand
D. A left leg - right hand
E. Abdomen - right leg
57. A man had an electric trauma with the electric current passing through
ihmuscle of the heat. What dangerous disorders in the work of the heart that
require immediate interference may develop in this situation?
A. Bradycardia
B. Extrasystolia
C. Fibrillation of die auricle
D. Fibrillation of ventricles
E. Tachycardia
37
A. Atrial and ventricular fibrillation
B. Complete atrioventricular heart block
C. Depression of the sinoatrial automatism
D. Decreasing of contractive capacity of the heart muscle
E. Disorder of the vagal heart regulation
59. As a result of a trauma a patient has developed traumatic shock that led to
the following disorders: AP is 140/90 mm Hg, Ps is 120 bpm. The patient is
fussy, talkative, psie. Such state relates to the following shock phase:
A. Terminal
B. Latent period
C. Erectile
D. Torpid
E.-Desorder of the vagal heart regulation
Situational tasks:
2. A man was engaged in the repairing of the TV-set that was switched on the
electric system. The loss of consciousness was sudden.
1. What is lead to the loss of the consciousness?
________________________________________________________________
2. What physical parameters of the electric current have the affecting influence?
___________________________________________________________________
________________________________________________________________
3. What directions of the electric current is the most dangerous one?
___________________________________________________________________
________________________________________________________________
4. What does the first aid consist of?
___________________________________________________________________
________________________________________________________________
5. What does the pathogenic action of electric current consist of?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
6. What local and general disorders take place at the actionof electric current?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
7. What rules of accident prevention were violated?
___________________________________________________________________
________________________________________________________________
39
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____
40
Theme 4: PATHOGENIC EFFECT OF THE ENVIRONMENTAL
FACTORS (chemical, biological, social and psyhical).
41
4. Mention the biological effects that appear due to the action of chemical
environmental factors.
5. What is a psychical effect?
6. What pathology may develop under the influence of the psychical factors?
7. What are social factors?
8. What are jatrogenic diseases?
Abstinence (Lat. abstinentia - retention) is the state that develops when some
substances that cause narcotic dependence stop getting into the organism.
Abstinence is characterized by the vegetosomatic, psychical, neurological
disorders.
1. A woman who was infected with toxoplasmosis during the pregnancy has a
child with multiple congenital defects.This is a result of:
A Teratogenesis
B Cancerogenesis
C Biological mutogenesis
D Chemical mutogenesis
E Recombination
42
2006-2009
3. A patient very often has diseases of nasopharynx, which appear under the
influence of different factors and in the most cases manifest by inflammation.
Which of listed factors is the most probable reason for these diseases?
A. Microorganisms
B. General cooling of organism
C. Overstrain
D. Immunodeficiency
E. Insufficiency of nutrition
Practical work:
“Pathogenic action of chemical factors”
Conclusions:________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____
Literature.
1. Pathogenic action of the environmental factors. Manuals for the students.
-Vinnitsia, 2007.
Themes of reports:
1. Teratogenic action of the drugs.
2. Medicosocial aspects of the alcoholism problem.
3. Medicosocial aspects of the narcomania.
44
Theme 5: ROLE OF REACTIVITY, RESÍSTANSE AND SMPh IN
DEVELOPMENT OF PATHOLOGY. IMMUNOLOGICAL
REACTIVITY.
Themes of reports:
1. Inborn and acquired violations of phagocytosis.
2. Biological barriers. Value in resistance of an organism.
3. AIDS - pathophysiologycal characteristic.
3. A 10-year-old girl suffers from viral and mycotic diseases very often. She
has congenital heart disease and insufficiency of thyroid gland. T-lymphocytes
is absent from her immunological test What disorder of immune system takes
place in this case?
A. Bruton's hypogammaglobulinemia
B. Mixed immunodeficiency
C. Terner's syndrome
D. Hypoplasia of thymus
48
E. Inherited defect of complement system
4 Decrease in levels of IgG and particularly IgA, IgM was found during
examination of immune status in 5-year-old boy. B-lymphocyfes_and plasma
cejteare absent from his blood and lymph nodes. Reactions of T-lymphocytes
are normal. This is inherited sex-linked disease. What diagnosis is more
possible?
A. Bruton's disease
B. Luis-Barr syndrome\
C. Wiskott-Aldrich syndrome
D. Swiss type of immunodeficiency
E. Early hypogammaglobulinemia
2006-2009
2. A boy, aged 1,5, is ill with chronic pyodermia and three times was ill with
pneumonia. The number of immunoglobulins G and A is decreased in blood.
What type of immunodeficiency has a child?
A.Bruton's hypogammaglobulinemia
B. Swiss type
C.Hypoplasia of gland
D.Wiskott-Oldrich syndrome
E. Luis-Barr syndrome
3. The diagnosis of thymus hyperplasia was made in a child of two years old.
What indices of the state of the immune system is the most characteristic for
this immunodeficiency?
A. Decrease of T-lymphocytes
B. Decrease of B- lymphocytes
C. Deficiency of T and B - lymphocytes
D. Absence of plasmatic cells
E. Decrease of immunoglobulins M
49
4. A girl was born in term. Up to 1 year old was breast fed. At the end of the
first year of life she suffered from lingering pneumonia. A girl lately began to
walk; the gait was unstable, with the disorder of movement coordination.
There was teleangiectasia on the skin and conjunctiva. Decreases of T-cell
level (32%), absence of Ig; were revealed at examination. What syndrome
developed in a child?
A. Luis-Barr syndrome
B. Di George syndrome
C. Bmlon's disease
D. Chcdiak-Higashi syndrome
E. I mmunodeficiency of Swiss type
5. Decrease of IgG and especially IgA and IgM was revealed in a boy 5 months
aged the examination of immune status B-lymphocytes and plasmatic cells
were absent in Mood and lymphatic nodes. Reactions of T-cell are preserved.
The disease is Inhered as inoculated with sex. What diagnosis is the most
possible?
A. Bruton's disease
B. Luis-Barr syndrome
C. Wiskott-Aldrich syndrome
D. Swiss type of immune deficiency
E. Early hypogammaglobulinemia
50
8. The decrease of immune system activity is observed in AIDS-infected
patient. Injury of what cells is the most responsible for the state of
immunodeficiency in this patient?
A. T-helpers
B. T-suppressors
C. macrophages
D. B-lymphocytes
E. Neutrophils
10. Pneumonias and purulent injuries of the skin are often in a boy aged
5, as well as in his grand-dad. The absence of B -lymphocytes is revealed at
immunological examination. What immune system disorder is observed in
this case?
A. Hypogammaglobulinemia of Bruton
B. Hypoplasia of thymus
C. Combined immunodeficiency
D. Syndrome of Shereshevskii-Turner
E. Inherited deficiency of the complement system
13. Mice without hairs and eel! reactions of slow type were brought to the
laboratory. I 01 this pathology the most possible is?
A. Absence thymus gland
B. Absence of gamma globulins in blood
C. Disorder of hemopoiesis
D. Disorder of phagocytosis
E. Insufficiency of complement factors
14. At immunodeficiency according the system of B-lymphocytes diseases
develop. The main role in pathogenesis of witch belongs to:
A. Disorder of synthesis of antibodies
B. The disorder of immunological reactions of cellular type
C. To the loss of ability to rejection of transplant
D. To the decrease of slow hypersensitivity
E. To the decrease of antitumor immunity
15. Viral and bacterial infections, eczematous injuries of the skin often
develop in a boy, aged 12. Decrease of T~lymphocytes and IgM at normal
content of IgE and IgG were revealed at the examination. What type of
pathology of the immune system is observed in a boy?
A. Combined immunodeficiency
B. Hypoplasia of thymus
C. Hypogammaglobulinemia of Bruton
D. Syndrome of Shereshevskii-Turner
E. Inherited deficiency of the complement system
16. There are often fungi and viral diseases in a girl aged 20 who suffer
intestinal poliposis. The lack of what link of the immune system is the most
possible in this case?
A. T-Iymphocytes
B. B-lymphocytes
C. Natural killers
D. Complements
E. Phagocytes
17. Viral and fungi diseases are often in a girl aged 10 with hereditary defects
of the heart and thyroid. Absence of T-cell is revealed at the immunological
analysis. What disorder of the immune system is observed in this case?
A. Hypoplasia of thymus
B. Hypogammaglobulinemia of Bruton
C. Combined immunodeficiency
52
D. Syndrome of Shereshevskii-Turner
E. Inherited deficiency of the complement system
21. The patient was made transplantation of donors heart. What conditions
must one follow to prevent regection of organ transplantate?
A. Transplantation of bone marrow
B. Transfusion of donors blood
C. Choosing the donor after the antigens of HLA
D. removal of spleen
E. Administration of immunomodulators
22. A boy aged 3 years is ill with chronic pneumonia. He has the low indices of
B - lymphocytes system. The diagnosis is hypogammaglobulinemia of Bruton.
Indicate the complication of B -lymphocytes system insufficiency.
A. Decreased resistance of organism to the viruses
B. Decreased resistance of organism to the mycotic and tubercular infection
C. Decreased resistance of organism to the pyrogenic cocci flora
D. Absence of reaction of transplant regection
53
E. Increased of risk of development of tumors in an organism
23. A child with inherited heat defect face defect absence of thyroid and
thymus inland and blood T-lymphocytes was admitted to the children hospital.
What inherited pathology is it associated with?
A Luis-Barr syndrome
B. Syndrom of Terner
C. Bruton's disease
D. Down's disease
E. Di George syndrome
26. The patient with radiculitis was made a novocaine blockade after which he
grew dark in eyes, his arterial pressure decreased to 90/50 mmHg, breathing
became more frequent up to 24 per minute. The state of patient is the result of
reactivity:
A. Physiology
B. Hypoergic
C. Normoergic
D. Nonspecific
E. Hyperergic
27. After the trauma of one eye patient the sight of the second eye began
gradually to rail. What mechanism can one explains this phenomenon?
A. By the decrease of organism resistance
B. By an infection
54
C. By the damage of histohematic barrier
D. By immunodeficiency
E. By immune depression
55
D. Allergic reactions of slow type;
E. Immunodeficiency state;
Situational tasks:
56
___________________________________________________________________
________________________________________________________________
4. Patient P. Was admitted to the clinical hospital with a trauma of right eye.
A patient complained of gradual loss of sight of left eye.
1. What mechanism explains this phenomenon?
___________________________________________________________________
2. What is biobarriers?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
3. What histobarriers do you know?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
Practical work: „REACTIVITY OF THE ORGANISM. FUNCTIONS OF
SYSTEM OF MONONUCLEAR PHAGOCYTES (SMPh) IN
CONDITIONS OF PATHOLOGY."
57
III stage - absorption
II stage - adhesion
IV stage - digestion
Conclusion:_______________________________________________________
__________________________________________________________________
__________________________________________________________________
58
1 – erythrocytes of a frog
2 – leukocytes with the elements of
Indian ink
59
Theme 6: ROLE OF HEREDITY, CONSTITUTION AND AGE FACTORS
IN DEVELOPMENT OF PATHOLOGY.
Actuality of theme.
Recently, the disease occurrence in which genetic factors play an
important role, causing an increased interest in communication because of the fact
that the structure of morbidity, they acquire a large share. Scientific basis in the
ratio becomes hereditary and acquired human pathology.
Constantly expanding amount of information about the mutagenicity of
environmental factors.
Great importance of the disease, in which the matter of genetic
predisposition (peptic ulcer, hypertension, atherosclerosis, diabetes, allergies and
many others). Treatment and prevention of them will be based on the role of
heredity.
Noteworthy diseases that arise during fetal development under the
influence of pathogenic factors on pregnant women.
All this testifies to the importance of studying the mechanisms of heredity,
diagnosis and correction of genetic disease.
60
1. Name mutagenic factors of external environment.
2.Name types of mutations.
3. What is chromosomal aberration?
4. What is a mutation? Classification of mutations after the reasons for origin.
5. Classification of mutations after their value for an organism.
6. Reasons for origin of mutations.
7. Name the types of inheriting.
8. Name the examples of the inherited diseases, which are passed after a autosomic-
recessive type.
9. Name die examples of the inherited diseases, which are passed after an
autosomic-dominant type.
10. Name the examples of the inherited diseases, which are passed with a sex
chromosom.
11 What are the chromosomal diseases?
12. Name examples of syndromes which related with change of amount of somatic
chromosomes.
13. Name examples of syndromes which related with change of amount of sex
chromosomes.
14. Name the kinds of chromosomal aberration?
15. Name classifications of constitutional types of a human. Give their
characteristic.
61
Th emes of rep orts:
1. Gene engineering and inherited diseases.
2. Value of heredity in pathology.
3. Inherited enzymopaty, characteristic. Principles of classification and medical
treatment.
4. Inherited propensity to diseases.
1. A child is pale, pastose, muscular tissue is bad developed, lymph nodes are
enlarged. He often suffers from angina and pharyngitis, blood has signs of
lymphocytosis. The child is also predisposed to autoallergic diseases. What
type of diathesis can be presumed in this case?
A Lymphohypoplastic
B Exudative
C Gouty
D Asthenic
E Hemorrhagic
62
and lower limbs as a result of growth disorder of epiphyseal cartilages of long
tubal bones. This disease is:
A Inherited, dominant
B Inherited, recessive
C Inherited, sex-linked
D Congenital
E Acquired
3. A couple had a child with Down's disease. Mother is 42 years old. This
disease is most probably caused by the following impairment of prenatal
development:
A Gametopathy
B Blastopathy
C Embryopathy
D Non-specific fetopathy
E Specific fetopathy
4. A married couple came to the genetic counseling. The husband suffers from
the insulin-dependant diabetes, the wife is healthy. What is the probability
that this couple will have an insulin-dependant child?
A Higher than throughout the population
B The same as throughout the population
C Lower than throughout the population
D 100%
E 50%
63
7. During a prophylactic medical examination a 7-year-old boy was diagnosed
with daltonism. His parents are healthy and have normal colour vision, but his
grandfather on his mother’s side has the same abnormality. What is the type
of the abnormality inheritance?
A Recessive, sex-linked
B Dominant, sex-linked
C Semidominance
D Autosomal recessive
E Autosomal dominant
8. A woman who was sick with rubella during the pregnancy gave birth to a
deaf child with hare lip and cleft palate. This congenital defect is an example
of:
A Phenocopy
B Edward’s syndrome
C Genocopy
D Patau’s syndrome
E Down’s syndrome
9. A couple came for medical genetic counseling. The man has hemophilia, the
woman is healthy and there were no cases of hemophilia in her family. What is
the risk of having a sick child in this family?
A 0%
B 100%
C 75%
D 50%
E 25%
10. A healthy woman has three sons affected by color blindness who were born
after her two marriages. Children both of her husbands are healthy. What is
the most possible pattern of inheritance of this disease?
A X-linked recessive
B Y-linked
C Autosomal recessive
D Autosomal dominant
E X-linked dominant
2006-2009
64
A. 50%
B 0%
C. 25%
D. 75%
E. 100%
65
6. At amniocentesis three lumps of sexual chromatine were found in nuclei of
cells of It-mail sex. What kariotype does this disorder correspond to?
A. 49,XXXXY
B. 47, XXX
C. 48,XXXY
D. 47,XXY
E. 48,XXXX
9. A girl, aged 16, has some deviations from norm: her hight is lower than in
children of the same age, signs of the sexual maturety are absent, she has a
short neck) wide shoulders. Intellect is in a norm. What of abovementioned
syndromes may be supposed?
A. Patau's syndrome
B. Down's syndrome
C. Edward's syndrome
D, Klinefelter's syndrome
E. Syndrome of Shereshevskii-Turner
10. A women has deviation from norm in physical and sexual development. At
the microscopical examination of mucos cell of oral cavity sexual chromatin
was not found. What diagnosis is the most possible?
A. Syndrome of Shereshevskii-Turner
B. Klinefelter's syndrome
66
C. Down's syndrome
D. Rcclingauzen's disease
E. Trisomy for X chromosome
12. A man has a high stature, astenic structure of body, gynecomastia, mental
insufficiency. At the microscopic examination of mucus cells of the oral cavity
there was found in 30% cells sexual chromatine (one Barras body). What the
most possible diagnosis in this case?
A. Icenko-Cushing syndrome
B. Reclingauzen's disease
C. Syndrome Di George
D. Down's syndrome
E. Klinefelter's syndrome
13. A patient aged 60 consulted a doctor. She complained of pain in the small
joints of legs and hands. Joints are inlarged, look like as bulged nods. There is
increased content of urates in the blood serum. The disorder of what
metabolism caused the development of this state?
A. Metadiazines
B. Amino acid
C. Purine
D. Lipids
E. Carbohydrates
67
15. A child aged 6 months is observed has deceleration of motor and psychical
development, pallor of skin iris of eye, positive test of Felling (with a 5%
solution of trichloracetate iron). What of abovementioned inherited diseases is
diagnosed in a child?
A. Urine acid
B. Alkaptonuria
C. Down’s disease
D. Albinism
E. Phenylketonuria
17. A child was born in a mother who suffers from alcoholism. The signs of
mental and physical deficiency in the process of growth and development were
observed. Of what character is this pathology?
A. Inherited
B. Chromosomal
C. Acquired
D. Inborn
E. Prenatal
18. The physical examination of a patient revealed thin stature, large skull,
strongly developed frontal part of face, short extremities. What stature type is
it characteristic of?
A. Respirator
B. Muscle
C. Digestive
D. Cerebral
E. Mixed
19. What diseases is a man with astenic type of stature according Crechmer's
classification more often ill with?
A. Acute respiratory infections
B. Tuberculosis of lungs
68
C. Hypoacidic gastritis
D. Hysteria
E. Schizophrenia
21. Physical examination of the a patient revealed: thin stature, large skull,
strongly developed frontal part of face, short extremities. What constitutional
type is it characteristic of?
A. Mixed
B. Digestive
C. Muscles
D. Cerebral
E. Respiratory
22. Karyotype 47 XXY was revealed in a young 20-year-old tall asthenic man
with signs of hypogonadism, gynecomastia and decreased sperm production
(azoospermia). What hereditary syndrome might be diagnosed in this case?
A. Klinefelter'
B. Wiskott-Aldrich
C. Turner's syndrome
D. Louis-Bar
E. Down's
23. Three lumps of sexual chromatin were revealed in the cell nuclei of the woman
fetus. What karyotype would be appropriate in this case?
A. XXXXY
B. XXX
C. XXXY
D. XXY
E. XY
69
B. Turner's syndrome
C. Patau's syndrome
D. Triple X syndrome
E. Edwards' syndrome
Ситуаційні задачі:
70
time. Objective: the skin is pale, pastosic, high temperature and hyperemia of
skin in the area of knee-joints are observed . At X-ray examination the
deformation of knee-joints is seen.
1. What type of diathesis can one expect in this case?
___________________________________________________________________
2. What type of diathesis do you know?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
71
Theme 7: ALLERGIC REACTIVITY
72
10. Classification of allergic reactions by the pathogenesis (due to Gell and Cumbs
classification):
11. What biologically active substances are the mediators of early phase of allergy?
12. What biologically active substances are the mediators of late phase of allergy?
13. What biological effects of histamine at the action on Hrhistaminoreceptors do
you know?
14. What biological effects of histamine at the action on H2-histaminoreceptors do
you know?
15. What groups of mediators are the lipid mediators?
16.Name the leukotriens at the «slow reactive substance»?
17.What reactions are the hypersensitiveness of immediate type?
18.What reactions are the hypersensitiveness of slow type?
19. What allergic reactions of anaphylaxic type do you know?
20. What allergic reactions of cytotoxic type do you know?
21. What allergic reactions of immunocomplex type do you know?
22. What allergic reactions of cellular-mediated type do you know?
23. Name the process of decline of sensitiveness of organism to the action of
allergens.
24. Name the types of hyposensibilization:
Standards of answers:
1. It is the increased sensitiveness of organism to the repeated introduction of
allergen, at the base of which are immune mechanisms.
2. A) Immune reactions
B) Pathochemical
C) Pathophysiological
3. A) Exogenous
B) Endogenous
4. A) Complete
B) Incomplete
5. A) Infectious
B) Uninfectious: domestic, epidermal, pollens, medicinal, food, industrial
6. A) Primary
B) Secondary: infectious, uninfectious
7. It is the state of the promoted sensitiveness of organism to the certain antigen, at
the base of which are the processes of antibodies or sensibilizated lymphocytes
formation.
8. A) Active
B) Passive
9. A) Hypersensitiveness of immediate type
B) Hypersensitiveness of slow type
10. A) I type, anaphylaxic
B) II type, cytotoxic
C) III type, immunocomplex
73
D) IV type, cellular-mediated
11. A) Biogenic amines: histamine, serotonin
B) Lipid: prostaglandins, leukotriens
C) Factor of thrombocytes activation
D) Polypeptide: khemaza, treptaza
12. A) Histaminase
B) Prostaglandins E1, E2
C) Arhylsulfatase
D) Phospholipase B and D
E) Polysaccharides: heparin, heparan sulfate
13. At the action on Hr histaminoreceptors: results an itch, pain, expansion of
arterioles, multiplying formation of mucus in overhead respiratory tracts,
increase of permeability of vascular wall, reduction of muscular fibers of
bronchial tubes, uterus, intestine.
14. At the action on H2- histaminoreceptors: results reduce of anaphylaxic reactions
by braking of basophiles degranulation in tissues, oppressing of lymphocytes
activity, T-supressors activation.
15. Prostaglandins, leukotriens.
16. Leukotriens C4, D4, E4.
17. Anaphylaxic shock, bronchial asthma, pollenosis, hives.
18. Reaction of tearing away of transplant, contact dermatitis, bacterial
allergy, autoallergy.
19. Anaphylaxic shock, bronchial asthma, pollenosis, hives.
20. Medians allergy, hemolytic disease of new-born, hemotransfusion
reactions, autoallergic reactions.
21. Glomerulonefritis, Vaskulitis, dermatitis.
22. Reaction of tearing away of transplant, contact dermatitis, bacterial allergy,
autoallergy.
23. Hyposensibilization.
24. Specific, nonspecific.
74
10. Allergoid reactions, determination. Reasons, mechanisms of development.
Differentiation with allergic reactions.
1. A 27 y.o. patient put eye drops that contain penicillin. After a few minutes
she felt itching and burning of her body, there appeared lip and eye-lid
edemata; arterial pressure began to drop. What immunoglobulins took part in
the development of this allergic reaction?
A lgE and lgG
B IgM and IgG
C IgA and IgM
D IgM and IgD
E IgG and IgD
2. A 27- year-old woman has dropped penicillin containing eye drops. In few
minutes there appeared feeling of itching, burning of the skin, lips and eyelids
edema, whistling cough, decreasing of BP. What antibodies take part in the
development of this allergic reaction?
A IgE and IgG
B IgM and IgG
C IgA and IgM
D IgM and IgD
E IgG and IgD
3. A woman has been applying a new cosmetic preparation for a week that
resulted in eye-lid inflammation accompanied by hyperemia, infiltration and
painfulness. What type of allergic reaction was developed?
A ІV
B I
C II
D III
75
E V
2006 - 2009
1. Pain in the heart and joints and pneumonia appeared in a patient three
weeks later acute myocardial infarction. What is the main mechanism of
development of post infarction Dressler's syndrome?
A. Ischemia of myocardium
B. Resorption of enzymes from necrotized area of myocardium
C. Secondary infection
D. Thrombosis of vessels
E. Autoimmune inflammation
76
5. A 24-years-old patient has edema of face and increase in BP, which
appeared 1.5 weeks later severe streptococcus tonsillitis. The patient has
hematuria and proteinuria of 1.2 g/L. Anti-streptococcus antibodies and
decrease in content of compliment system components were revealed in
patient's blood. Which microvessels do deposits of immune complexes localize
in and cause nephropathy?
A Proximal tubules
B. Glomerule
C. Dcscendent tubules
D. Loop of Henle
E. Pyramids
6. Nausea, fatigue, stomachache, palpitation, difficult respiration, and skin
blisters developed in a patient 25 minutes later injection of antibiotics. What
stage of allergic reaction is observed in this patient?
A. Pathochemical
B. Biochemical
C. Pathophysiological
D. Immunological
E. Sensibilization
7. Skin tuberculin test was carried out in a patient with chronic lung
tuberculosis. Local hyperemia and edema appeared in the site of
inracutaneous introduction of tuberculin preparation within 24-48 hours.
What cells are primary effectors in mechanism of this reaction?
A. Neutrophils
B. T-lymphocytes
C. B-lymphocytes
D. Endotheliocytes
E. Smooth muscle cells of microvessels
8. Hyperemia, swelling and then necrosis of tissue, their rejection and ulcer
(Arthus phenomenon) develop at the rabbit in the place of secondary
intracutaneus injection of a substance with strongly pronounced antigenic
properties (for example horse serum). What factors play the main role in
pathogenesis of this phenomenon?
A. Antibodies presented by IgE
B. Antibodies presented by IgD
C. Antibodies presented by IgA
D. Antibodies presented by IgG and/or IgM
E. Specific T-lymphocytes-effectors
9. Skin rash, itching, swelling and pain in joints, increase in body temperature,
and proteinuria appeared in a patient in 5-8 days after use lots of medical
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serum. Serum sickness was diagnosed. What is the main factor in pathogenesis
of this syndrome?
A. Primary systemic accumulation of circulating immune complexes in
the blood
B. Primary systemic degranulation of mast cells in the organism
C. Primary systemic activation of T-killers
D. Primary systemic activation of endoteliocytes
E. Primary systemic cytolysis of blood cells
10. Allergic diagnostic tests are used for the diagnosis of many infectious
diseases (tuberculosis, brucelosis, tularemia etc). Diagnosis is confirmed if
papula and redness appear in the place of the allergen injection. Antigens
interaction reaction is conditioned by:
A. IgE and lymphokines
B. IgM and macrophages
C. T-lymphocytes and lymphokines
D. IgE and T-lymphocytes
E. IgM and tissue basophiles
13. Hives, itching of the skin, swelling of the skin and mucous membranes,
swelling of lymphatic nodes develop in the patient in 9 days after injection of
medicinal serum. What disease develops?
A. Pollinosis
B. Serum sickness
C. Shwartzman's phenomenon
D. Overy phenomenon
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E. Quincke's edema
14. Dressler's syndrome was diagnosed at the patient 1.5 month later
myocardium infarction. It is characterized by pericarditis, pleurisy, and
pneumonia. What is the reason for this syndrome?
A. Sensitization of the organism by myocardium antigens
B. Decrease in resistance to microorganisms
C. Activation of saprophytic microflora
D. Intoxication of organism by products of necrosis
E. Release of myocardial enzymes to the blood
15. A 20-year-old man has injury of the right testicle. What danger does it
brings for the left (healthy) testicle?
A. Mimicry of antigens and development of antibody-mediated damage
B. Development of infectious process
C' Development of atrophy
D. Development of hypertrophy
E. No danger
16. Guinea-pig's nephrocytotoxic serum was injected to the rabbit under the
experiment. What human disease is modeled in this case?
A. Nephrotic syndrome
B. Acute pyelonephritis
C. Chronic renal insufficiency
D. Acute diffuse glomerulonephritis
E. Chronic pyelonephritis
18. Severe edema of soft tissues of upper and lower jaws, rash on the skin of
face, redness, and itching appear in the patient in response to using anesthetic
drag at tooth extraction. Which pathological process underlies the reaction to
anesthetic?
A. Inflammation
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B. Drag toxic action
C. Allergy
D. Insufficiency of blood circulation
E. Disorder of lymph outflow
22. A dentist injected ultracain to a patient before tooth extraction for the
purpose of anesthesia. Sensitivity test was not made. Anaphylactic shook
developed in the patient in few minutes after drag injection. What cells
produce reagins, which take part in development of anaphylactic reaction?
A. Plasma cells
B. B-lymphocytes
C. T-lymphocytes
D. Mast cells
E. Eozinophiles
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23. Tooth was extracted in a teenager under Novocain anesthesia. Paleness of
skin, dyspnea and hypotension occurred in the patient 10 minutes later. What
type of allergic reaction is it?
A. Anaphylactic
B. Cytotoxic
C. Arthus phenomenon type
D. Delayed type hypersensitivity
E. Stimulating
26. 0.1 ml of horse serum was injected to the guinea-pig for sensitization.
What are external signs of sensitization?
A. No external signs
B. Skin rashes
C. Joints swelling
D. Increase in body temperature
E. Pain
30. Contact dermatitis of upper extremities developed in the nurse, who has
been working in manipulation room for 20 years. Which type of allergic
reactions docs this pathology belong to?
A. Delayed-type hypersensitivity
B. Primary immunodeficiency
C. Immediate type hypersensitivity
D. B-cells immunodeficiency
E. T-cells immunodeficiency
31. Pain in the joints and loins, hemorrhagic eruptions on the skin, and
increase in body temperature occur in the patient with toxemic stage of burn
disease in 2 hours after allogenic plasma transfusion. What allergic reaction
takes place in this case?
A. Serum sickness
B. Urticaria
C. Quincke's edema
D. Anaphylactic
E. Autoimmune vasculitis
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32. Hyperergic inflammation form of upper respiratory tract (larynx, trachea,
bronchi) develops at 6-year-old child. Threat of respiratory impairment
develops and then necessity of using anti-inflammatory hormones occurs.
Which hormone has anti-inflammatory property?
A. Cortisol
B. Adrenaline
C. Growth hormone
D. Testosterone
E. Insulin
35. Which one among mentioned below pathologic processes can be described
as a reaction of immediate type?
A. Polynosis
B. Autoallergy
C. Contact allergy
D. Graft-versus-host reaction
E. Bacterial allergy
37. It was decided to inject antitetanus serum to a patient, but allergic test
appeared to be positive. What is the appropriate way to conduct
desensitization?
A. Injecting of small doses of antitetanus serum
B. Injecting of glucocorticoids
C. Injecting of a full dose of antitetanus serum
D. Prescribing of antihistamine medications
E. Prescribing of immunosuppressants
38. A 10-year old child had the mantoux tuberculin test administered. 48
hours later a papule up to 8 mm in diameter appeared on the site of the
injection. What type of hypersensitivity reaction developed after the
tuberculin injection?
A. Atopic reaction
B. Seroreaction
C. Arthus phenomenon
D. Type IV hypersensitivity reaction
E. Type II hypersensitivity reaction
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development of an acute hyperergic inflammation with necrosis is formed after 5
injections on the site of injections.
1 – necrosis
2 – place of injections
Conclusion:
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EXPERIMENT 2. For 3 days a guinea-pig is injected 0,2ml of horse serum into
the abdominal cavity. In 12-14 days the final dose 2ml (better intravenously or
intracardiac) is inlected and the development of anaphylactic shock is observed.
After the animal’s death the cardio-pulmonary preparation is extracted. Pay
attention to the characteristic changes in the lungs.
Conclusion:
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