Perinatal pathology

1. A 33-year-old woman gave birth to a dead fetus with gestational age more than 43 weeks. The fetal skin was dry and chap. An autopsy revealed a general hypotrophy and nuclei of ossification (Beclard’s nuclei) in a proximal epiphysis of tibial and humeral bones. Amniotic fluid, an umbilical cord and placental membranes were dyed by meconium. Name the period of the described perinatal pathology?

А *The antenatal period

B. The prenatal period

C. The intranatal period

D. The postnatal period

E. The progenesis period

Gametopathy

1. A 3-month-old child died of pneumonia. A macroscopical investigation revealed upward slant of palpebral fissures of the eyes, a sinking down dorsum of nose, dolichouranic, a low locating of small auricles. An autopsy revealed a defect of a heart and the main vessels’ development. A genetic study showed a chromosome 21 trisomy. What of the listed diagnoses is the most likely?

А * Down's syndrome

B. Patau's syndrome

C. Shereshevsky-Turner's syndrome (gonadal dysgenesis)

D. Edwards' syndrome

E.

Avitaminosis.

1. A 3-year-old child, with history of alimentary dyspepsia, presented with progressing gingival hemorrhage, petechial hemorrhages on a skin and a mouth mucosa. There was also a peridental infection. The described changes characteristic for:

А * Avitaminosis C

B. Avitaminosis D

C. Avitaminosis В1

D. Avitaminosis В6

E. Avitaminosis A

2. A 9-month-old child presented with retarded dentition, the teething order disturbance, a reconfiguration of the upper jaw in a horizontal direction (dolichouranic). Microscopical investigation of his teeth revealed the irregular mineralization of the enamel and crumpled enamel prisms. Some of them were rich with vacuoles. There were also expansion of a predentin zone and a presence of solitary denticles. What is the most likely disease in that case?

А *Rachitis, early stage

B. Rachitis, late stage

C. Osteomalacia

D. A gout

E. Hypervitaminosis D

3. A 1, 5-year-old child presented with focal thickenings of ribs, wrists, and a curvature of legs. A stomatologist pointed to retarded dentition, the teething order disturbance, the irregular mineralization of the enamel and dentine, a reconfiguration of the upper jaw in a horizontal direction (dolichouranic). What is the most likely disease presented in that case?

А * Rachitis

B. A dystrophic calcification

C. A metabolic calcification

D. A metastatic calcification

E. Osteomalacia

Infection diseases

1. A post-mortem of a patient, with a history of a drug abuse, revealed red-purple papular nodules and blotches on the skin of his lower extremities (Kaposi's sarcoma). In addition, acute pneumocystosis carinii pneumonia was also determined. For what disease the given symptoms are characteristic?

А. *AIDS

B. Influenza

C. Measles

D. Diphtheria

E. Anthrax

2. A 48-year-old woman died of pulmonary insufficiency. A post-mortem revealed the enlarged lung with the dark red and pinkish-yellow colour areas ("the big motley lung") and necrotic tracheobronchitis. What is the preliminary diagnosis in that case?

А. * Influenzal pneumonia

B. Croupous pneumonia

C. Caseous pneumonia

D. Fibrosing alveolitis

E. Measles virus pneumonia

3. A 44-year-old man died of pulmonary insufficiency and severe intoxication. A post-mortem investigation of a lungs cut surface revealed a motley pattern with plural focal hemorrhages and the zones of emphysema. Histological study showed a hemorrhagic bronchopneumonia with abscesses formation. A cytoplasm of bronchial epithelium cells had eosinophilic and basophilic inclusions. What is the most likely diagnosis?

А. * Influenza

B. Parainfluenza

C. Adenoviral infection

D. Respiratory syncytial infection

E. Staphylococcal bronchopneumonia

4. A young man presented with rash in the form of roseolas and small hemorrhages (petechias) on a skin of a stomach, thorax and petechial rash on eyes conjunctiva. Lesion of his brain soon resulted in his death. A microscopical investigation revealed in destructive-proliferative endo-trombovasculitis in medullar oblongata and pons of a brain, also in a skin, kidneys and myocardium. What is the most likely disease?

А. *Epidemic typhus

B. Sepsis

C. Periarteritis nodosa

D. Systemic Lupus Erythematosus

E. Brucellosis

5. A 67-year-old man died of pulmonary insufficiency. A post-mortem investigation of a lungs cut surface revealed multiple, bright, red, deaerated 2,5 cm foci with irregular form and inaccurate borders. A microscopic study showed erythrocytes and some lymphocytes within alveoli. The described changes are characteristic for:

А. * Influenzal pneumonia

B. Croupous pneumonia

C. Hemorrhagic infarction of the lung

D. Measles virus pneumonia

E. Aspiration pneumonia

6. A 42-year-old man, with a history of an acute respiratory disease, died of pulmonary insufficiency. A post-mortem investigation revealed fibrinous –hemorrhagic inflammation in a larynx and trachea mucosa, destructive panbronchitis and enlarged lungs. Multiple abscesses, hemorrhages and necroses created a motley appearance of a pulmonal tissue. What of the listed diagnoses the most likely?

А. * Influenza

B. Parainfluenza

C. Respiratory syncytial infection

D. Measles

E. Adenoviral infection

7. A post-mortem of a 40-year-old patient revealed a pneumocystosis carinii pneumonia, Kaposi's sarcoma and B-cell lymphoma. Medical records suggested that he actively practiced unsafe sexual intercourse with multiple partners at his life. What is the most likely diagnosis?

А *A human immunodeficiency virus infection, AIDS stage

B. A human immunodeficiency virus infection, pre- AIDS stage

C. A secondary immunodeficiency as a result of primary B-cell lymphoma

D. A secondary immunodeficiency as a result of Kaposi’s sarcoma

E.

8. A 38-year-old man presented with an acute fever, elevated temperature to 40°С, a headache, a cough and dyspnea. He died on the 5^th day of a disease. An autopsy revealed enlarged lungs with a motley pattern of a pulmonary tissue – “the big motley lung”. For what disease the described signs are characteristic?

А.* Influenza

B. Adenoviral infection

C. Croupous pneumonia

D. Respiratory syncytial infection

E. Bronchiectasis

9. A 35-year-old narcomaniac (drug abuser) with a history of HIV-infection died at the hospital. A post-mortem revealed that both lungs were dense, dark-red-grey color, with little air. Histological study showed that interalveolar septs were infiltrated by lymphocytes. Some alveolocytes were transformed to the big cells, with a centrally located round nucleus with a light rim of cytoplasm (“an owl's eye”). What opportunistic infection caused pneumonia in that case?

А *Cytomegalovirus

B. Pneumocystis carinii

C. Atypical mycobacterium

D. Herpes-virus

E. Toxoplasma

10. A 48-year-old male presented with a sustained high fever, severe headache, a dyspnea, palpitation. A physical investigation revealed a pediculosis, a rash in the form of roseolas and small hemorrhages (petechias) on his thorax skin. In addition, decubituses of legs and foot gangrene were also determined. He died of a heart failure. A histological study showed in the medullar oblongata a hyperemia, stasis, perivascular plasmocytes infiltrates and a proliferation of a microglia (Popov’s granuloma). What is the most likely diagnosis?

А *Epidemic typhus

B. Antrax meningocephalitis

C. Meningococcal meningitis

D. Typhoid fever

E. Rubella

11A patient died as a result of a heart failure. Macroscopically traces of a pre-existed rash in the form of maculae and spots were recognized. A gross investigation revealed decubituses at the areas of breeches and spinous processes of vertebra. Microscopical study showed a destructive-proliferative endo-trombovasculitis and Popov’s granulomas in the central nervous system, in a skin, and adrenals. An interstitial myocarditis was diagnosed in his heart. What is the most likely disease?

А * Epidemic typhus

B. Q fever

C. Typhoid fever

D. Periarteritis nodosa

E. HIV-infection

12. A post-mortem of a woman revealed a septicopyemia with metastatic abscesses of lungs and kidneys; pyosalpinx, a purulent peritonitis, a cachexia and lymphadenopathy. Medical records indicated HIV- positive blood test results within last 5 years. What clinical period of AIDS corresponds with the given pathomorphologic signs?

A. *Acquired immunodeficiency syndrome (AIDS)

B. Incubation period

C. Persisten generalised lymphadenopathy

D. Pre-AIDS (AIDS -related complex)

E. Reactive lymphadenopathy

13. A gross investigation of a brain at a post-mortem revealed the edema, a plethora, and fine hemorrhage in medulla oblongata. A microscopical investigation showed a chromatolysis, hydropy and a necrosis of nervous cells. In addition, the eosinophilic intracytoplasmic formations (little bodies the Babesh- Negri bodies) were defined in pyramidal neurons of the hippocampus. What diagnosis answers the described morphological implications?

A. * Rabies

B. Meningococcal meningitis

C. Encephalitis

D. Encephalomyelitis

E. Brucellosis

14. A post-mortem investigation of a 42-year-old man revealed serous –hemorrhagic inflammation in a larynx and trachea mucosa, a focal pneumonia, areas of atelectases and acute lungs emphysema. Histological research showed a vacuolar dystrophy and loss of cilia within the epithelium layer, an exfoliating of cells with oxyphile inclusions. Such changes in lungs are caused:

A. *Influenza viruses

B. Parainfluenza viruses

C. Measles virus

D. Adenoviruses

E. RS-viruses

15. A 66-year-old man presented with acute tracheitis and bronchitis, soon resulted in bronchopneumonia. He died on the 12^th day at the hospital from the pulmonal-heart failure. An autopsy revealed fibrinous –hemorrhagic inflammation in a larynx and trachea mucosa, enlarged lungs. On a cut section lungs had a motley pattern due to areas of pneumonia, hemorrhages in lung parenchyma, acute abscesses and atelectases. In addition, circulative disturbances and dystrophies were determined in internal organs. What is the most likely diagnosis?

A. *Influenza, severe form

B. Influenza, moderately severe form

C. Parainfluenza

D. Respiratory syncytial infection

E. Adenoviral infection

16. A post-mortem of a patient, who died of a HIV- infection, revealed alterations of his brain. A histological investigation determined in subcortical white matter, midbrain and a brain stem fine, perivascular necroses, microglial nodules with multinuclear giant cells, focal gliosis and fibrosis. Name the most likely lesion of the central nervous system?

A. *Subacute meningocephalitis

B. Metabolic encephalopathy

C. Cytomegaloviral encephalitis

D. Primary lymphoma of CNS

E. Vacuolar myelipathy

17. A patient presented to his physician with expressed immunodeficiency, lymphopenia with change of parity T-helpers to T- suppressors, the lesion of a skin of the lower extremities. The cutaneous pathology was characterized by plural tumorous nodules, dome-shaped purple plaques, involved in skin breakdown with resulting fungating lesions. A histological investigation of the skin’s biopsy showed the neoplasm of blood vessels, a dilatation of capillaries, slit-like blood-filled vascular spaces. What is the most likely diagnosis?

A. *Kaposi’s sarcoma

B. Basalioma

C. Dermatomycosis

D. Phoma of skin

E. Inflammatory dermatitis

18A man, with a history of frequent drinking non- boiled water from the river, has developed vomiting and explosive ‘rice-water’ diarrhea. The abdominal pains were absent; the body temperature did not rise. The intestine biopsy revealed a plethora, a marked swallowing, an edema of enterocytes, and some infiltration of villi by lymphocytes, plasmocytes, and few leucocytes. What is the most likely disease?

A. *Cholera

B. Salmonellosis

C. Typhoid fever

D. Dysentery

E. Lambliasis