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UNIT (14) : Disease Of Genital Tract & Breast 1. Name types of ectopic pregnancy?

(p=3) y tubal y ovarian y abdominal 2. Name types of tubal pregnancy according to sites of fetus implantation. (p=3) y ampular y interstitial y fimbrial 3. What is placenta polyps? (p=3) y tissue masses of variable size with polypous structure y surrounded by hyperplastic trophoblast ,may have necrosis y projects into myometrium 4. What is hydatidiform mole? How does it affect pregnancy? (p=3) y gestational trophoblastic disease y appear as mass of hydrophic swelling [swollen] ,cystically dilated chorionic vili covered by proliferating cytotrophoblast and syncytial trophoblast. y fetus is absent is called complete hydatidiform mole: or dying not later than 4th month of gestation called partial hydatidiform mole. 5. Describe microscopic composition of the choriocarcinoma. (p=5) y choriocarcinoma is malignanization tumour develop from complete hydatidiform mole. from artificial abortion or after normal pregnancy. y only epithelial cells with anaplastic cuboidal syncytiotrophoblast and cytotrophoblast with tissue atypism. y stroma vessel and vili are absent y invading surrounding structure with hemorrhage and necrosis. 6. Specify most typical complications of uterus carcinoma. (p=6) y cachexia y hemorrhage y thrombosis of pelvic vein y peritonitis y appearance of uterus fistula 7. Peritoneal pregnancy was found. Identify possible variants of its origin. (p=2) y Complete tubular abortion 8. During vagina examination there is found a broad bright red crown near external orifice of cervix .The crown does not give hemorrhages by instrumental spatula touch. During microscopic examination there are columnar epithelial cells covering vaginal surface with numerous glands in its thickness. Give your diagnosis. (p=2) y Diagnose:endocervicosis of neck of uterus ADDITIONAL QUESTIONS: 1. In post-mortem examination of elderly man there are found the enlargement of the prostate to marked degree and its compression of urethra lumen. Mucous

membrane of the bladder is dull.hyperemic with hemorrhages. The ureter is enlarged.pelvis are filled with pus.on cut surface of the kidney small abseccess are observed.what is the disease of urinary tract described here.what is the pathogenesis ? (p=3) y disease: ascending pyelonephrits y pathogenesis: stagnation of urine and nodular hyperplasia of prostate. 2. Specify preinvasive form of exocervical carcinoma in the uterus. (p=1) y Carcinoma in situ 3. The ovary has been supplied as a biopsy samples. It is presented by gross cyst about 20 cm in diameter with fluid & heavy pappilary projection with white cauliflower tissue remainder. Microscopically papillaries of the tumor are covered by columnar epithelium with nuclear hyperchromia & mitosis. On separate sections adenous complex grows through cystic wall. Specify the tumor. (p=3) y papillary cystoadenocarcinoma Unit (15) : Diseases of Endocrine 1. Which are typical microscopic changes in thyroid gland in Basedov s disease [Grave s disease]? (p = 4) y star shaped follicles (hypertrophy & hyperplasia of follicular epithelium) y papilla of epithelium projecting into follicular lumen y pale colloid y lymphoid infiltration of stroma 2. Name histology types of colloid goiter. (p = 3) y microfollicular y macroflollicular y mixed 3. Name causes of death with patients of Basedov s disease. (p = 4) y heart insufficiency y liver failure during toxic hepatitis y acute adrenal insufficiency during thyroectomy y cachexia 4. Name common symptoms of diabetes mellitus. (p = 6) y hyperglycemia y polyuria y glucosuria y polydypsia y ketonuria, ketoacidosis y hyperlipidemia y polyphagia 5. Name changes of Langerhan s islets found in diabetes mellitus. (p = 2) y decrease number of beta-cells y atrophy 6. Name causes of death in patients with diabetes mellitus. (p = 4) y diabetic coma y sepsis y heart failure y uremia

7. Name clinical morphologic changes of Icenko-Cushing s disease. (p = 6) y coentaneous striae y arterial hypertension y glucosuria y hyperglycemia y hirsutism y polydipsia y weight gain (buffalo hump) y arrested sexual development 8. Give the definition of parathyroid osteodystrophy concept. (p = 4) y A disease associated with increase parathyroid hormone production. y disturbance in calcium and phosphate exchange lead to hypercalcemia & hypophosphataemia. y marked destruction of bony tissue and defect of bone structure( osteodystrophy). 9. Specify basic changes in bone tissue in hyperparathyreosis. (p = 6) 10. 55 yrs old male of 112cm height is proportionally built and his mental progress is adequate to his age. Give your diagnosis. Specify the character and the localization of pathologic process. (p = 6) y Diagnosis: pituitary dwarfism y characteristic: decrease production of growth hormone by somatotrophic producing cells y localization: anterior pituitary gland y causes: -pituitary tumour in childhood -necrosis in pituitary in childhood -hemorrhage into pituitary in childhood y retarded sexual development, but normal intelligence UNIT (16) : Rheumatic fever & Congenital heart disease 1. Give definition of rheumatism.(p=3) y rheumatism is an immunologically mediated inflammation with systemic disorganization of connective tissue. y as acute and chronic disease with damage of many organs but prefers cardiovascular system. 2. Specify clinical anatomic forms of rheumatism.(p=4) y cardiovascular form y cerebral form y arthritic form y nodosal form 3. What is the main organ involved in rheumatic pathology.(p=1) y heart 4. Designate forms of rheumatic endocarditis according to the process localization and to the character of morphologic changes.(p=7) According to localization:  Valve  Chordal  Visceral According to morphologic changes:  Valvulitis  Fibroplastic endocarditis  Acute verruceous endocarditis  ecurrent verruceous endocarditis

5. Name thromboendocarditis types.(p=2) y polypous-ulcerate y verruceous 6. What is valvulitis?Give its morphologic signs.(p=6) y valvulitis is diffuse endocarditis characterized by dystrophic changes in valvular CT without affecting endothelium , no thrombus formation. y morphologic sign:  inflammation  sclerosis  mucoid & fibrinoid swelling (in vessel)  fibrinoid necrosis 7. Show most typical localization of rheumatic granulomas in the myocardium.(p=1) y At perivascular connective tissue(in the auricle of left atrium) OR left ventricular auricle,posterior wall of left ventricle and ventricle septa. 8. Give forms of rheumatic myocarditis.(p=2) y Nodular proliferative inflammation (granulomatous) y Local and diffuse exudative interstitial 9. Name formation stages of rheumatic valve disease.(p=4) 10. Specify clinical anatomic forms of rheumatic mitral valve disease.(p=2) y Stenosis mitral valve y Mitral insufficiency 11. Specify forms of rheumatic aortic valve disease leading to the hypertrophy of left ventricular of the heart.(p=2) y Stenosis of aortic valve y Insufficiency of the aortic valve 12. Specify forms of valve insufficiency according to the pathogenesis.(p=2) 13. Specify results of connective tissue disorganization within the skin due to scleroderma.(p=2) y Sclerosis y Hyalinosis y Petrification of heart 14. What are LE-cells?(p=2) y Lupus cells are leukocytes with autoimmune antinuclear antibodies. y Take up cells with destroyed DNA.Usually found within vesicle of phagocytic macrophages. 15. Specify diseases leading to the formation of valvular heart disease.(p=6) y Rheumatism y Athesclerosis y Brucellosis y Trauma y Mitral valve prolapse y Systemic lupus erythromatosus with Libman s Sacks lupus endocarditis y Arterial endocarditis

16. Name most frequent forms of congenital heart disease.(p=4) y Stenosis of pulmonary artery y Tetralogy of fallots y Pathologic patent ductus arteriosus (channel between pulmonary artery and aorta) y Atrial and ventricle septal defect 17. Name anatomic changes of the heart with tetralogy of fallot.(p=4) y Dextra position of aorta y Stenosis of pulmonary artery y Ventricular-septal defect y Hypertrophy of right ventricle myocardium 18. During postmortem examination,sclerosis and growth into one of cusps are found in mitral valve.The obliteration of pericardial cavity with calcified deposits in the lesion are found.Name changes found and disease to developed them.(p=3) Changes: y Obliteration of pericardial cavity with connective tissue. y Petrification of Calcium in pericardium(shell heart) y Endocarditis lead to stenosis Disease: rheumatism 19. During postmortem examination of the child there are found stenosis of pulmonary artery,hypertrophy of the right ventricular myocardium,ventricular septal defect and dextraposition of aorta.What is your diagnosis? y Tetralogy of fallot Unit (17) : Arterial Hypertension.Hypertension disease.Cerebrovascular disease 1. Give the definition of the hypertonic crisis. (P=4) y Exacerbation of hypertension y Characterized by rapid elevation of in arterial hypertension due to generalized spasm of arterioles which leads to morphological changes in wall of arterioles. y Characterized by rapid elevation in arterial blood pressure with lesion of the organ, especially within brain. 2. Name stages of hypertensive disease (primary arterial hypertension). (P=3) y Functional changes of arteries and small arterioles y Changes in walls of small arteries and arteriole y Changes within organs 3. What morphological changes in small vessels of the brain due to hypertensive disease (primary arterial hypertension). (P=4) y Increase vascular permeability with plasmorrhagia y Fibrinoid necrosis of wall y Microaneurysm y Hemorrhage y Vasospasm

4. Name outcome of arterial changes of hypertensive disease (primary arterial hypertension). (P=2) y Hyalinosis y Sclerosis (atherosclerosis) y Lipidosis and narrowing of lumen 5. Name signs that are typical for malignant hypertension having in mind; the frequency of crisis; the nature of morphological changes in small vessels; cause of death. (P=3) y Frequency: Often crisis y Nature of morphological changes in small vessels:- Fibrinoid necrosis - Microaneurysm - Increase permeability with plasmarrhagia y Cause of death : Uremia, Ischemic infarct of brain. 6. Give the definition of hypertensive disease (primary arterial hypertension). (P=4) y Chronic disease with elevation of arterial pressure y When relationship btw blood volume and total peripheral resistance is altered y Without connection with lesion of organs y Due to disturbances of nerve regulation, constriction of artery and alteration of vessels, insufficiency mechanism of vascular dilatation. 7. What are the most frequent causes of death due to hypertensive disease (Primary arterial hypertension)? (P=3) y Cardiac insufficiency/ cardiac failure(acute,chronic) y Uremia y Stroke (Cerebral vascular accident) 8. In anamnesis, the patient had firm elevation of blood pressure during of long duration with repeated crisis of the brain has right sided hemiplegic. Death is of heart decompensation. What is the disease described here? What possible macroscopic (gross) changes are found in the heart, the brain? What is the localization of changes in brain? (P=6) y Disease: Hypertension (primary arterial hypertension) y Macroscopic changes:-Heart: hypertrophy of left ventricle and myogenic dilatation, fatty dystrophy -Brain: hemorrhagic infiltration and hematoma with cyst formation y Localization of changes in brain: Left Hemisphere due to right sided hemiplegia.

UNIT (17) : Atherosclerosis & Ischemic heart disease 1. Give the definition of atherosclerosis. (p=6) y Atherosclerosis is a chronic disease with abnormal lipid and protein metabolism y and destruction of large artery & aorta(elastic & myoelastic type) y with formation of atherosclerotic plaque called fibro-fatty plaque in the intima of muscular elastic artery (large artery : aorta). 2. Give successive names of progress stages of atherosclerosis according to the view of scientists supporting infiltrate (combinative) theory of atherosclerosis. (p=6) y Prelipidosis y Lipidosis y Liposclerosis y Artheromatosis y Ulceration y Artherocalcinosis 3. Give pathological anatomic characteristics of the atherosclerotic plaque and specify its localization. (p=5) y Cells components (smooth muscle cells, macrophages, leukocytes) y Extracellular matrix (collagen, elastic fibres, proteoglycans) y Intracellular & extracellular lipids y Localization: aorta & large arteries (elastic & myoelastic type) 4. Specify histological findings in atherosclerotic (primary wrinkled) kidney. (p=4) y Atherosclerotic plaque in large arteries y Sclerosis of stroma y Narrowing of lumen y Hyalinosis & sclerosis of small arteries 5. What are complications connected with the ulceration of atherosclerotic plaques on the aorta? (p=4) y Aneurysm of aorta y Rupture of aorta with hemorrhage y Thrombosis & thromboembolism y Cholesterol embolism 6. What is the ischemic heart disease? (p=3) y roup of closely related disease with abnormality of cardiac blood circulation y Caused by imbalance between myocardium oxygen demand & blood supply (absolute relative insufficiency). 7. What coronary arteries changes lead most frequently to the progress of myocardial infarction? (p=4) y Stenotic atherosclerosis y Thrombosis y Spasm of vessel for long time y Embolism 8. Specify results of myocardial infarction. (p=4) y Acute aneurysm (necrotic tissue undergoes rupture at any case) y Rupture of heart with hemorrhage into pericardial cavity y Chronic aneurysm (connective tissue)

Post infarction cardiosclerosis

y y

Sclerosis of kidney Recovery

9. What are typical changes of the brain due to atherosclerosis of the cerebral arteries? (p=2) y Ischemic white infarction of brain y Atrophy of brain (with encephalopathy & memory) 10. During postmortem examination fluid blood and clots of the blood are found in pericardial cavity. Heart weights 650g. The thickness of the wall of left ventricle is 2.5cm. vast section of the wall is near the top of the heart and is gray-yellow color, soft consistency, blood-layered. What is the disease described here according to modern international classification of diseases? What is its manifestation of this case? What is the direct cause of death? Name background disease. (p=6) y Disease: ischemic heart disease y Manifestation: transmural myocardial infarction with rupture of heart y Direct cause of death: from hemotamponade of heart y Background disease: hypertension 11. Name forms of valvular heart deficiency according to the pathogenesis. (p=2) y Functional y Organic Unit (18) : Renal Disease 1. Name two basic groups of diffuse nephropathies. (p=2) y Tubulopathy lomerulopathy y 2. Name general mechanisms of glomerulonephritis development. (p=3) y Deposit of immunocomplex (circulation/ cell-mediated) or antibodies lomerulosclerosis y y Leukocytes infiltration 3. Specify typical renal symptoms of the glomerulonephritis. (p=4) y Nephrotic syndrome y Proteinuria y Haematuria y Casturia 4. Specify typical extra renal symptoms of the glomerulonephritis. (p=6) y Hypoalbuminemia y Hypertension y Azotemia & Uremia eneralized edema y y Hyperlipidemia y Hyperglobulinemia 5. Specify forms of the glomerulonephritis according to the process localization. (p=2) y Intracapillary y Extracapillary 6. Name morphologic phases of development of acute glomerulonephritis. (p=3) y Changes to chronic glomerulonephritis

7. Name basic morphologic types of chronic glomerulonephritis. (p=6) y Membranous proliferative y Mesengial proliferative y Rapidly progressive y Mesengial capillary y Focal segmental lomerulonephritis associated with y nephrotic syndrome 8. Name glomerulopathies of noninflammation character frequently found in clinic and accompanied by nephrotic syndrome. (p=3) y Nephropathy during pregnancy y Diabetic nephropathy y Amyloidosis 9. Define morphologic substrate of primary nephrotic syndrome (lipoid nephrosis) .(p=3) y Characterized by minimal changes of glomerular filtration y Expressed by loss of podocytes and small branches 10. Give the characreristics of basic electronic microscopic sign of membranous glomerulopathy. (p=4) y Membranous transformation associated with deposition of immunocomplex in the epithelial cells of the basal membrane 11. What is the renal amyloidosis? What are renal structures with amyloid deposition? What are groups of symptoms to give clinical manifestations of this process? (p=7) y Renal amyloidosis is a disease with deposition of amyloid into the renal structure. y Structure: - glomerular - vessels - stroma (interstitial peritubular tissue) y Symptoms: - chronic renal failure - nephrotic syndrome - hypoalbunemia - hyperlipidemia - edema - uremia 12. Name most frequent renal diseases that leading to secondary contracted kidneys. ( p=3) y Chronic glomerulonephritis y Chronic pyelonephritis y Amyloid nephrosis y Chronic renal failure 13. Specify most frequent causes of development of acute renal failure. (p=5) y Acute drug-induced interstitial nephritis y Trauma (Crush Syndrome) y Incompatible blood transfusion y Sepsis y Endogenic & exogenic intoxication

14. Name stages of development of acute renal failure. (p=4) y Initial y Oliguria (maintainence) y Polyuria y Recovery 15. Specify causes of death patients with necrotic nephrosis. (p=2) y Uremia y Acute heart insufficiency 16. Microscopical renal changes typical for acute renal failure of toxic nature: a) bleeding filling in the cortex b) the condition of interstitial tissue c) the condition of epithelial cells in the convoluted tubules d) the condition of the tubular lumen. ( p=4) a) ischemia of cortex b) edematous of interstitial tissues c) epithelial cells of proximal tubular are necrosis d) granular casts are seen in the enlarged tubular lumen 17. Name most frequent types of chronic hereditary tubulopathies. (p=3) y cystiuria y phosphatic diabetes y oxcalaturia y syndrome of Debra de Toni Fancon 18. Give the definition of the pyelonephritis. (p=4) y Pyelonephritis is renal disorder with purulent inflammation affecting stroma, calyx,tubules, interstitial and renal pelvis. y Cause by bacteria infection 19. Name diseases frequently leading to ascending pyelonephritis. (p=4) y Stones of ureter y Constriction of ureter y Sclerosis of ureter & urethra y Hypertrophy of prostate y Tumor in urethra, ureter or prostate 20. Name most severe manifestations of acute purulent pyelonephritis. (p=3) y Pyonephrosis y Urogenic sepsis y Papillonecrosis y Suppurative paranephritis y Aponematous nephritis 21. Give the definition of urolithias disease. (p=5)

23. Name variants of macroscopic (gross) types of kidney with the urolitiasis. (p=5) y Hydronephrosis y Atrophy y Purulent nephritis y Pyonephrosis y Replacement of kidney with fatty tissue 24. Name most frequent renal diseases that leading to nephrosclerosis. (p=7) y Chronic glomerular nephritis y Interstitial nephritis y Pyelonephritis y Atherosclerosis y Amyloid nephrosis y Hypertension y Diabetes mellitus 25. Give the definition of the uremia. (p=4) y Uremia is a pathologic condition associated with azotemia and a constellation of clinical signs and symptoms of organs and biochemical alteration (including uremic gastroenterocolitis, neuropathy, uremic fibrinous pericarditis). 26. Due to terminal stage of the glomerular nephritis, patient had oliguria and azotemia. He died. During postmortem examination, there were found very small contracted kidneys, fibrinous tracheal bronchitis, pericarditis and enteroclolitis with effects of hemorrhage diathesis. What is the designation of renal complication? What is the origin of mechanisms? What is the term for renal changes? (p=3) y Designation: Chronic renal failure y Origin of mechanism: Kidneys can t regulate volume and soluble composition of urine y lomerular filtration rate is less than 20% y Renal changes: secondary wrinkled kidney 27. After taking the solution of sublimate by mistake patient has anuria , very high urea and creatinine. What disease is it? What are microscopic changes of renal structures? Where are they involved? (p=4) y Disease: necrotic nephrosis y Microscopic changes : - dystrophy of tubular - necrosis of the epithelial cells - cylinder /cast in glomerular and tubular - edema of stroma 28. For histology essay, extracted kidney was delivered. There is super enlarged kidney. On cut it is expressed by multichamber formation. Chambers are filled with slightly turbid fluid. Parenchyme of kidney is thinned replaced by fibrous tissue. In the enlarged pelvis and cups, partially the stone goes into ureter mouth. Pelvis membrane has hyperemia, it is rough and dull.

y y y y

29. During postmortem examination of elderly man, there are found the enlargement of prostate to marked degree and its compression of urethra lumen. Mucous membrane of the bladder is dull, hyperemic with hemorrhages. The ureter is enlarged. Pelvis is filled with pus. On cut surface of the kidney small abscesses are observed. What is the disease of urinary tract described here? What is the pathogenesis? (p=3) 30. Give the definition of Addison s disease. (p=3) y Also call Chronic Primary Adrenal Insufficiency y Uncommon disorder resulting from progressive destruction of adrenal cortex. Additional Questions: 1. What are typical morphologic manifestations of acute exudative and proliferative intracapillary glomerulonephritis? (p=3) y Development of pathological process in the vessels of glomerular y Proliferation of cells in glomerular y Leukocytic infiltration 2. What exudative glomerular nephritis types do u know? (p=3) y Serous y Fibrinous y Hemorrhagic 3. Give the definition of nephrolithias disease. (p=5) y Nephrolithias disease is chronic disease y Formation of stones in kidney calyces, pelvis, ureter y Stones is of different sizes, structure and chemical composition 4. Name of 2 general theories of stone formation in urinary tract. (p=2) y Matrix y Colloid crystal

22. Specify stones structures most frequently found in the kidney according to their composition.( p=3) y Calcium oxalate and phosphate stone y Magnesium ammonium phosphate stones y Uric acid stone y Cystine stone

Give your diagnosis. What is process most frequently associated by that disease? What is microorganism most frequently induces it? Name renal changes according to the process. What is common diseases with the source as this associated process? (p=6) Diagnose: Hydronephrosis Microbes: E.coli Kidney changes: pyelonephritis, pyonephrosis Common disease: - calculi - tumor - congenital atresia of urethra - spinal cord damage with paralysis of bladder eneral disease: Urosepsis

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