Pathological anatomy
Pathological anatomy
Питань: 73
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Питання 1 з 73
Питання 1
A 60-year old man with a history of hypertension, diabetes and hyperlipidemia had a sudden onset of right-sided weakness. By the time the ambulance arrived, he had difficulty speaking. Unfortunately, the patient died within the next 2 hours and an autopsy was performed immediately. The gross examination of the cerebral left hemisphere showed brain swelling, widened gyri and poorly demarcated gray-white junction. Which of the following is the most likely cause of this patient's death?
Питання 2
A 38-year-old woman, who was diagnosed with systemic lupus erythematosus (SLE) 3 years ago, comes to her physician with a complaint of facial swelling and decreased urination that she first noticed 2 weeks ago. She currently takes azathioprine and corticosteroid. Her vital signs show blood pressure 150/90 mm Hg, pulse – 91/min., temperature – 36.8 C and respiratory rate – 15/min. On physical examination, the doctor notices erythematous rash on her face exhibiting a butterfly pattern. The laboratory studies reveal hypertriglyceridemia and proteinuria. Which of the following is the most likely mechanism of SLE`s complication in this patient?
Питання 3
A 27-year-old woman suffering from rheumatic heart disease since her childhood has developed cardiac decompensation and died. Autopsy shows mitral stenosis; mitral valve cusps are sharply thickened, sclerotic, and fused together along the closure line. Specify the type of endocarditis in this case:
Питання 4
Autopsy of the body shows that the soft meninges of the deceased individual are plethoric, thickened, opaque, and yellow-green colored. What type of exudative inflammation can be characterized by such changes in the soft meninges?
Питання 5
A 38-year-old woman presents for evaluation to a clinic with painful ulceration in her right breast for the last 2 months. She is worried because the ulcer is increasing in size. On further questioning, she says that she has a discharge from her right nipple as well. Her mother and aunt died of breast cancer at 60 and 54 years of age, respectively. On examination, the right breast is enlarged and firm, with thickened skin, diffuse erythema, edema, and an ulcer measuring 3x3 cm. Mammography is ordered that shows a mass with a large area of calcifications, parenchymal distortion, and extensive soft tissue
and trabecular thickening in the aflected breast. The patient subsequently undergoes core needle and full-thickness skin punch biopsies. The pathology report states a clear dermal lymphatic invasion by tumor cells. Which of the following is the most common site for metastatic disease in this pathology?
Питання 6
A 60-year old man with a history of hypertension, diabetes and hyperlipidemia had a sudden onset a right-sided weakness. By the time the ambulance arrived, he had difficulty speaking. Unfortunately, the patient died within the next two hours and an autopsy was performed immediately. The gross examination of the cerebral left hemisphere showed brain swelling, widened, gyri and poorly demarcated gray-white junction. Which of the following is the most likely cause of this patient`s death?
Питання 7
A 65-year-old woman was brought into the emergency department because of shortness of breath and chest pain that started a few hours ago. She denied having fever, expectoration, or any accompanying symptoms. She had a 5-year-long history of deep vein thrombosis in her thin. After a time, she died of respiratory distress. Autopsy reveals red loose masses lodged in the bifurcation of the pulmonary trunk with extensions into both the left and the right pulmonary arteries. What is the most likely diagnosis?
Питання 8
A woman was bitten by a venomous snake (Macrovipera lebetinis). Autopsy of her body shows marked intravascular hemolysis. Her pancreas, bone marrow, and lymph nodes are brown. Microscopy detects abundant brown pigment in the macrophage cytoplasm. What pigment accumulates in the tissues in such cases?
Питання 9
After severe emotional strain a 45-year-old man suddenly developed constricting pain in the area of his heart. The pain was irradiating into his left arm, neck, and left shoulder blade. His face was pale and covered in cold sweat. Nitroglycerine was able to relieve the pain. What condition developed in the patient in this case?
Питання 10
A soft tissue node obturated the patient’s middle lobe bronchus, leading to the development of right middle lobe atelectasis. In the area of obturation, bronchial biopsy detected proliferations of atypical glandular epithelium with pathological mitoses. Epithelium penetrates into the underlaying tissues and cartilage. What disease is the most likely in this case?
Питання 11
A patient underwent surgical removal of a cavitary liver lesion 2 cm in diameter. It was revealed that the cavity wall was formed by dense fibrous connective tissue; the cavity contained muddy, thick, yellowish greenish fluid with an unpleasant odor. Microscopically, the fluid consisted mainly of polymorphonuclear leukocytes. What pathological process are these morphological changes typical for?
Питання 12
During pathomorphological kidney investigation of a patient, who for a long time had been suffering from osteomyelitis and died from progressing renal failure, the following was revealed: deposits of homogeneous eosinophilic masses in glomerular mesangium, arterial and arteriolar walls, and stroma, which became red when stained with Congo red. What pathological process is this?
Питання 13
Autopsy of a young man revealed some lung cavities with inner walls made up of granulation tissue with varying degrees of maturity; pronounced pneumosclerosis and bronchiectasis. Some cavities had caseation areas. What is your presumptive diagnosis?
Питання 14
A 65-year-old patient had been treated for 3 days in the resuscitation unit for a cardiac pathology. Suddenly he developed ventricular fibrillation which turned out to be the immediate cause of death. Microscopy of the left ventricular myocard revealed a large focus of cardiomyocyte karyolysis demarcated by the zone of hyperaemia. What cardiac pathology was the cause of death?
Питання 15
A patient with a long history of chronic periodontitis underwent removal of a maxillary cyst located at the root of the affected tooth. Microscopy shows that the bone wall is made up of fibrous tissue infiltrated by lymphocytes and plasma cells. The inner surface of the cyst is covered with stratified squamous epithelium with no signs of keratinization. What is the most likely diagnosis?
Питання 16
A patient has a long history of dental caries. The pulp of the affected tooth started to resemble a gray-black mass with a putrid odor. Microscopically, it is unstructured and contains microbes. What pathological process has developed in the dental pulp in this case.
Питання 17
After an injury, the patient developed a focus, of purulent inflammation in the alveolar process of the jaw in its outward area, with the development of subperiosteal abscess and edema of the adjacent soft tissues. What is the most likely diagnosis in this case?
Питання 18
A section of a multi-rooted tooth shows a tissue located at the apices of the dental roots and in the place of their branching. This tissue contains cells with processes located in the lacunae, and numerous collagen fibers arranged radially or longitudinally. Name this tissue:
Питання 19
What infectious-allergic disease is associated with the development of bilateral diffuse or focal non-purulent inflammation of the glomerular apparatus of the kidneys with characteristic renal and extrarenal symptoms?
Питання 20
A patient was diagnosed with a malignant neoplasm of the tongue. What characteristics of this tumor make it possible to classify it as a malignant one?
Питання 21
A patient was diagnosed with acute glomerulonephritis. What substance in the urine indicates a damage to the basement membrane of the renal glomerular capillaries in case of this pathology?
Питання 22
A 43-year-old woman against the background of septic shock presents with thrombocytopenia, low fibrinogen levels, fibrin degradation products in the blood, and development of petechial hemorrhages. What is the cause of these pathological signs?
Питання 23
A patient has made an appointment with a dentist. A cavity was detected in the softened dentin of his premolar. A narrow layer of dentin remains between the carious cavity and the pulp. What is the most likely diagnosis in this case?
Питання 24
During the extraction of a carious tooth, the dental surgeon found a gray-pink soft-elastic nodule 1.3 cm in diameter in the area of the dental root. Microscopically, the nodule is represented by granulation tissue with lymphocytes, plasma and mast cells, macrophages, xanthoma cells, and fibroblasts. What pathological neoplasm can be suspected in this case?
Питання 25
A 58-year-old woman comes to her dentist complaining of a «strange mass» in her mouth. On intraoral examination of the oral mucosa the dentist reveals a vegetative lesion with a pedunculated base observed at the soft palate level lateral to the base of the uvula. An excisional biopsy performed and histopathological examination shows proliferations of stratified keratinized squamous epithelium with fibrovascular connective tissue stroma and many papillary infoldings of the epithelium. Which of the following is the most likely pathology revealed by the dentist?
Питання 26
Examination of an oral cavity shows puffy gums, pus between teeth and gums, contact bleeding. The dentist suspects gum infection that damages the soft tissue and destroys the bone that supports the teeth. This pathology can cause teeth to loosen or lead to tooth loss. Which of the following is the most likely diagnosis?
Питання 27
A 10-year-old Indian boy is brought by his parents to a dentist for a routine dental care. They want to remove the noticeable yellow discoloration of his teeth. His mother reports that they immigrated to Ukraine approximately 6 months ago and a lot of children in their state had the similar staining of their teeth. On intraoral examination there are isolated areas of brown staining, which is particularly severe on the incisors and canines. In addition, some areas have pits which expose the underlying dentin. Which of the following is the most likely diagnosis?
Питання 28
A 34-year-old male comes to the dentist because of a 1-year history of swelling in the right upper jaw. On intraoral examination, a single diffuse 2x1.5 cm swelling is seen on the right side of anterior maxilla. A biopsy specimen of the lesion shows numerous thin-walled sinusoids in the connective tissue, hemosiderin deposition, and numerous giant cells in a hemorrhagic background. Which of the following is the most likely diagnosis?
Питання 29
At autopsy, section of the right ovary shows a round lesion 2.5 cm in diameter with a clear serous fluid, surrounded by a smooth glistening membrane. Which of the following macroscopic lesions best represents the autopsy findings?
Питання 30
A 10-year-old child has painful swallowing, neck edema, temperature rise up to 39.0°C, the whole body is covered with bright-red petechial rash. Back of the throat and tonsils are hyperemic, the tongue is crimsoncolored. Tonsillar surface is covered with isolated grayish-colored necrosis nidi. What disease is it?
Питання 31
A 25-year-old patient complains of increasing pain in his leg muscles occurring during walking and forcing him to make frequent stops. Objectively: skin of legs is pale, no hair-covering, toenails are with trophic changes, no pulsation of pedal arteries. The most probable cause of these changes is:
Питання 32
Granulomas containing lymphocytes and macrophages were detected during analysis of skin biopsy material. Among macrophages there are large cells with fat inclusions, which contain microorganisms in spheric packages (Virchow’s cells). The following disease is based on the described type of hypersensitivity:
Питання 33
A patient with femoral neck fracture, who for a long time had to remain in bed in a forced (supine) position, has developed dark-brown lesions along the backbone; soft tissues are swollen, in the areas of maceration there is a foul-smelling liquid. Name the clinicopathologic type of necrosis:
Питання 34
A 59-year-old man has signs of jaundice and portal hypertension. Histology of the puncture biopsy material obtained from the liver reveals the following: lobar and trabecular structure is disturbed, a number of hepatocytes have signs of fatty degeneration, porto-portal connective tissue septa and pseudolobules with periportal lymphoid-macrophageal infiltration are being formed. What liver disease is described?
Питання 35
A newborn delivered at 33 weeks of gestation has a respiratory rate of 70/min, and heart rate of 148/min, 2 hours after birth. He is grunting and has intercostal and subcostal retractions. He has peripheral cyanosis as well. An immediate chest radiograph is taken which shows a fine reticular granulation with ground glass opacity on both lungs. A neonatologist suggests respiratory distress syndrome due to surfactant deficiency: Which of the following is the most likely mechanism of these clinical and imaging findings?
Питання 36
At the post-mortem examination the stomach of a patient with renal failure was found to have a yellow-brown coating on the thickened mucosa. The coating was firmly adhering to its surface and had significant thickness. Microscopy revealed congestion and necrosis of mucosal and submucosal layers, fibrin presence. What is the most likely diagnosis?
Питання 37
In the body of a 37-year-old woman, who died with signs of pulmonary edema, there was detected an acute deformation of the aortic valve: it is shortened, thickened, ulcerated, has areas of stone-like density. On its external surface there are large, up to 2 cm in diameter, thrombotic plaques. The left ventricle wall is 2.2 cm thick. The cardiac muscle is dull, matt, and flaccid. What type of endocarditis corresponds with the described changes in the aortic valve?
Питання 38
A 37-year-old woman presents to the emergency department complaining of palpitations, dry cough, and shortness of breath. She is a nonsmoker. Her
blood pressure 100/65 mm Hg, pulse - 76/min., respiratory rate - 23/min. Her physical exam is significant for bibasilar lung crackles and a low-pitched, middiastolic rumbling murmur best heard at the apical region without radiation. She has jugular vein distention and bilateral pitting edema in her lower
extremities. Despite considerable efforts in the emergency department, she dies from sudden cardiac death at night. The family requests an autopsy to
determine her cause of death. The patient's heart shows a mitral stenosis. Histologic examination reveals increased connective tissue in the myocardium
and Ashoff-Talalaev's granulomas. Which of the following is the most likely diagnosis?
Питання 39
A 65-year-old woman presents to the emergency department because of shortness of breath and chest pain that started a few hours ago. She did not have a fever, expectoration, or any accompanying symptoms. She has a history of right leg deep vein thrombosis that occurred 5 years ago. Some time later, she dies of severe respiratory distress. A pulmonary autopsy specimen reveals red loose mass that is lodged in the bifurcation of the pulmonary trunk with extensions into both the left and right main pulmonary arteries. Which of the following is the most likely diagnosis?
Питання 40
A 78-year-old woman presents to the emergency department for fever and generalized malaise. Her symptoms began several days ago, when she noticed
pain with urination and mild blood in her urine. Earlier this morning she experienced chills, flank pain and mild nausea. Her temperature is 38.7°C, blood pressure is 140/80 mm Hg, heart rate is 98/min. Later she dies of unknown cause. At autopsy, her kidney is swollen with punctate abscesses that outlined by a thin red margin (signs of marginal vascular dilation). Microscopic observation reveals a large number of neutrophils. Which of the following is the most likely diagnosis?
Питання 41
In the removed uterus of a 55-year-old woman, a pathologist has found a dense node in the thick of the myometrium. The node is 5 cm in diameter and has clear boundaries. On section, its tissues are gray-pink and fibrous. Microscopically, the tumor consists of smooth muscle cells that form bundles of varying thickness, which run in different directions, and of layers of connective tissue, hyalinized in some places. What tumor has developed in the patient?
Питання 42
A poisoning caused by sulema (mercury dichloride) has occurred at a factory. Two days later, the person, who had suffered from the sulema exposure, developed the 24-hour diuresis of 620 mL, headache, vomiting, convulsions, and dyspnea. What diagnosis can be made in this case?
Питання 43
Autopsy of the body of a 72-year-old woman with rheumatoid arthritis, who died of uremia, revealed enlarged, dense, pale gray kidneys with a shiny sebaceous surface on a section. What pathology can be suspected based on the revealed changes?
Питання 44
Six hours have passed since the development of an acute myocardial infarction in the patient. During autopsy of the body, staining was used to identify the area of infarction. What was used to detect the area of necrosis?
Питання 45
A 56-year-old woman complains of pain in the small joints of her hands and feet. She has been experiencing these symptoms for the last 12 years. Examination of her hands detects a subluxation of the metacarpophalangeal joints with her fingers bent outwards ("walrus flippers"). There are high molecular weight immune complexes in the patient's blood. What diagnosis can be made in this case?
Питання 46
The disease onset was acute in a 7-year-old child, manifesting as hyperthermia, catarrhal phenomena, and diarrhea. During the second week, the child developed respiratory disorders and flaccid paralysis of the legs. X-ray detected bilateral focal pneumonia. Autopsy of the body revealed foci of glial reaction around the dead neurons in the anterior horns of the spinal cord. What disease has caused the child's death?
Питання 47
A 45-year-old woman has developed a pigmented formation in the form of a nodule on the skin of her face. Microscopically, fields of spindle-shaped and polymorphic cells containing brown pigment and undergoing a large number of mitoses were detected in the biopsy material. What pathological condition has developed in the patient?
Питання 48
A newborn delivered at 33 weeks of gestation has the respiratory rate of 70/min. and the pulse of 148/min. at the second hour of life. The neonatologist suspects respiratory distress syndrome caused by surfactant deficiency. What is the most likely mechanism of developing such a clinical presentation?
Питання 49
Autopsy detected stenosis of the left atrioventricular opening in the heart of a 50-year-old woman. Histology revealed focal cardiosclerosis in the myocardium and “flowering" Aschoff-Talalaev granulomas. What is the most likely cause of the patient's death?
Питання 50
In a 39-year-old woman diagnosed with a malignant lung tumor, CT has revealed new foci in different locations. What process causes these phenomena?
Питання 51
Two soldiers, who were bitten by ticks during training in a forest area, came to a medical station with complaints of fever, chills, general weakness, and headache. Objectively, the site of the bite exhibits redness with a clearly visible center surrounded by a flat peripheral zone that expands. What disease can be diagnosed in these soldiers?
Питання 52
Autopsy of the body of a 67-year-old man, who died of chronic cardiovascular failure, revealed macrophages with a brown pigment in the alveoli of the lungs. This finding indicates accumulation of a certain pigment. Name this pigment.
Питання 53
Autopsy of the body of a 47- year-old man detects an ulcer 3 cm in diameter on the posterior gastric wall. The ulcer penetrates into the pancreatic tissue adjacent to the intestine. There are multiple steatonecroses in the area of the ulcer in the pancreas and in the surrounding fatty tissue. What complication of peptic ulcer disease has occurred in this man?
Питання 54
Autopsy of the body of a 49-year-old woman, who had community-acquired pneumonia and died of pneumococcal sepsis, revealed up to 700 mL of turbid greenish-yellow fluid with an unpleasant odor in the left pleural cavity. The pleural layers are dull and plethoric. What pathological process occurred in the pleural cavity of the deceased woman?
Питання 55
Autopsy of the body of a 56-year-old man, who had fibro-cavernous pulmonary tuberculosis, revealed an enlarged dense spleen. On section, the spleen tissue is brownish-pink, smooth, with a waxy surface. What pathological process is most likely being observed in the spleen in this case?
Питання 56
During the autopsy of the body of a 58-year-old woman with diabetes mellitus, histology of the kidneys reveals segmented, homogeneous, oxyphilic deposits in the glomeruli. The walls of the arterioles were diffusely thickened, homogeneous, and oxyphilic. What pathological condition has developed in the renal glomeruli and blood vessels?
Питання 57
A 5-year-old child developed chills, a fever of 39°C, agitation, and vomiting. Nuchal rigidity was detected. On the third day after the onset, the child died. Autopsy of the body reveals thickened dull, yellow-green pia mater. Microscopically, the pia mater was infiltrated by neutrophilic leukocytes with some lymphocytes and monocytes. What disease occurred in the child?
Питання 58
A man with complaints of a hoarse voice has undergone laryngoscopy that revealed a gray- white tumor on his right vocal cord. The tumor is seated on a wide peduncle and resembles a cauliflower Microscopically, the biopsy material shows well-defined fibrovascular stroma, increased number of layers in the stratified squamous epithelium, no cellular atypia. What is the most likely diagnosis in this case?
Питання 59
A woman with menstrual irregularities came to a gynecologist who, during a vaginal examination, detected a bright red area on the vaginal part of the cervix around its external os. A biopsy sample was taken. Histologically, the biopsy material from this area exhibits proliferation of prismatic (columnar) epithelium with formation of glands. What disease ha patient?
Питання 60
Examination of the oral cavity shows marked edema and hyperemia of the gums, supragingival and subgingival calculus, and formation of pocket-like cavities filled with structureless masses and food debris in the area of the dentogingival junction. These pockets produce purulent discharge, when pressed. X-ray shows resorption of the bone tissue in the tooth sockets. What is the diagnosis in this case?
Питання 61
During the examination of a pregnant woman, a dentist detected 3 round formations on her oral mucosa. The formations appeared 3 days ago. They have a white-gray surface with a red rim and are up to 1 cm in diameter. What is the diagnosis in this case?
Питання 62
Hyposalivation, observed in sialolithiasis, and both acute and chronic inflammations of the salivary glands, causes the development of:
Питання 63
During the examination of a 10-year-old child, a dentist detected numerous brown spots with a smooth surface and without enamel defects, located all over the surface of the dental crowns. What is the most likely dental pathology in this child?
Питання 64
A 37-year-old man has been diagnosed with dilation of the subcutaneous veins of the anterior thoracic and abdominal wall, intestinal bleeding, and splenomegaly. What pathological condition is observed in the patient?
Питання 65
Histology of a jaw bone tumor shows that it consists of epithelial islands with signs of cellular atypism and a small amount of keratinized substance in their center - "cancer pearls". What oncological condition has developed in the patient?
Питання 66
Examination of the kidneys of a man, who died of uremia, revealed their atrophy, induration, and pale color. Congo Ked staining of the microslides revealed red deposits in the glomeruli, vessel wall, stroma, and under the tubular epithelium. What pathological process was detected by the doctor in this case?
Питання 67
Autopsy of the body of a man revealed cavities in his lungs. The inner walls of the cavities consist of granulation tissue of varying degree of maturity, Marked pneumosclerosis and bronchiectasis are observed. Some of the cavities have areas of caseous necrosis. What pathological condition has developed in the patient?
Питання 68
A 30-year-old woman diagnosed with systemic lupus erythematosus developed dry mouth. Histology of the biopsy material obtained from the salivary glands revealed signs of chronic sialadenitis with significant lymphocytic infiltration of the stroma and parenchymal atrophy with proliferation of the connective tissue. What pathological condition has developed in the patient?
Питання 69
The patient presents with rapid growth of a tumor node and its progressing malignization. What stage of tumor growth can be characterized by these presentations?
Питання 70
On X-ray examination of the 59-year-old patient, in the lower lobe of the right lung there was detected a distinct shadow,
differential for tumor. It was pre-determined that the tumor is benign. Which of the following features characterizes the tumor аs benign?
Питання 71
When tongue of an experimental rabbit is smeared with turpentine, the affected area reddens and its blood supply increases. What type of arterial hyperemia occurs in this case?
Питання 72
A tumor has been removed from the lower lip of a 60-year- old man. The tumor was invading the surrounding tissues. It looks like a soft nodule with an uneven, ulcerated surface. Histologically, the tumor is composed of strands, consisting of atypical cells of stratified epithelium. The strands were invading the underlying tissue and destroying it, forming nest-like clusters. What type of tumor is it?
Питання 73
A 5-year-old boy has a three- dimensional mass in his right upper jaw, and enlarged cervical and supraclavicular lymph nodes. Biopsy results: the structure of the lymph nodes is blurry, and there are diffuse proliferations of small lymphocyte-like cells, among which there are large macrophages with light-colored cytoplasm, which together resemble "starry sky". What disease is most likely in this case?