Tuberculosis

1. A histological investigation of the cervical lymph node revealed the aggregation of epithelioid cells, lymphocytes and giant Pirogov - Langhans cells. In the centre of a lesion a caseous necrosis was present. Specify the most likely pathology.

A. * Tuberculosis

B. Rhinoscleroma.

C. Sarcoidosis (Boeck's disease)

D. Glanders

E. Syphilis

2. An autopsy of a 42-year-old man revealed in the second segment of the right lung the focus of consolidation, 5 cm in diameter, surrounded with a thin capsule. The centre was presented by a dense dry crumbling tissue with a dim surface. Morphological changes in a lung are characteristic for:

A. Tuberculoma

B. Carcinoma of lung

C. Chondromas

D. The tumorous formof a silicosis

E. Postinflammation pneumosclerosis

3. An autopsy of a 63-year-old man revealed in the second segment of the right lung a tubercular panbronchitis, with the focus of a caseous bronchopneumonia. The focus was surrounded by a wall of epithelioid cells with some lymphocytes and few giant Pirogov -Langhans cells. What form of a pulmonary tuberculosis presented in this case?

A. *Acute pulmonary tuberculosis

B. Primary tuberculous complex

C. Growth of primary affect

D. Acute miliary tuberculosis

E. Infiltration tuberculosis

4. A 26-year-old patient arrived in a hospital with complaints to a fever and weakness. One of the enlarged cervical lymph nodes was taken for histological study. Microscopical investigation showed in lymphoid tissue the centers of necrosis, surrounded with epithelioid cells, giant multinuclear Pirogov-Langhans cells and lymphocytes. What is the most likely disease?

A. * Tuberculosis

B. Lymphogranulomatosis (Hodgkin's disease)

C. Lymphatic leukemia

D. Sarcoidosis (Boeck's disease)

E. Syphilis

5. An autopsy of a 44-year-old man revealed tuberculosis. A macroscopical investigation showed in the apex of the right lung the foci of caseous pneumonia. There were caseous lymphadenitis of enlarged lymph nodes of mediastinum and plural milium nodules in many organs. Name the described form of tuberculosis?

A. * Primary with mixed form of progressing

B. Primary with gematogenic spreading

C. Primary with lymphogenic spreading

D. Primary with growth of a primary affect

E. Gematogenic

6. A 7-year-old boy with a history of tonsillitis presented with markedly enlarged paratracheal, bifurcate and cervical lymph nodes. A microscopical investigation of the removed cervical lymph node revealed the centers of a necrosis surrounded with lymphocytes, epithelioid cells and Pirogov-Langhans cells. Specify the most likely pathology.

A. *Tuberculosis

B. Sarcoidosis (Boeck's disease)

C. Rhinoscleroma.

D. Glanders

E. Syphilis

7. A 40- year-old man died of a pulmonary bleeding. An autopsy revealed in the upper lobe of the right lung a cavity, 4cm in diameter, with dense walls and a rough internal surface, filled with blood clots. A microscopical study of the wall showed the inner layer, presented with fell to pieces leucocytes; the middle layer formed by epithelioid, lymphoid and giant multinuclear cells with nuclei located like a horseshoe. The changes found out in a lung are characteristic for:

A. Tuberculous cavern (cavity)

B. Bronchiectatic cavern (cavity)

C. Abscess of lungs

D. Congenital cyst

E. Infarct of lung with septic disintegration

8. A post-mortem of a 43-year-old man revealed in the 3 segment of the right lung under the pleura an area of consolidation, 1,5 cm in diameter, with the accurate borders, surrounded with a whitish fibrous tissue. A gross investigation of a cut section showed the white-yellow crumbling foci. Presence of the described focus is characteristic for:

A. Encapsulation of primary affect

B. Peripheral carcinoma

C. Chondroma

D. Fibroma

E. Infarct of lung with organization

9. A 48- year-old man died of a pulmonary –heart failure. An autopsy revealed pneumosclerosis, emphysema of lungs, and hypertrophy of a right ventricle of heart. In both lungs, mainly under pleura, there were plural foci, 1 cm in diameter. Histological investigation of the foci showed a necrosis zone in the centre and a wall of epithelioid cells, lymphocytes with some macrophages and plasmocytes on periphery. Giant Pirogov -Langhans cells were also defined. The small numbers of vascular capillaries were present on a periphery of the foci. What is the most likely disease?

A. Gematogenic tuberculosis.

B. Actinomycosis of lungs.

C. Sarcoidosis (Boeck's disease)

D. Syphilis.

E. Silicosis.

10. A 56-year-old man with a long history of fibrous – cavernous pulmonary tuberculosis died of a chronic pulmonary and heart failure. Within last months the expressed proteinuria was observed. A post-mortem revealed enlarged, firm kidneys, with a waxy surface. What changes developed in kidneys at this form of tuberculosis?

A. Amyloidosis of kidney

B. Tuberculosis of kidney

C. Glomerulonephritis

D. Nephrolithiasis

E. Necrotic nephrosis

11. A child died of a diffuse peritonitis. An autopsy revealed the primary intestinal tubercular complex with primary affect, a lymphangitis and regional caseous lymphadenitis. In addition, an ulcer of an empty intestine with perforation was found within the primary affect focus. What is the most likely way of tuberculosis infection in presented case?

A. Alimentary (nutritional)

B. Transplacental

C. Aerogenic

D. Mixed

E. Contact

12. A 24-year-old man presented with enlarged cervical lymphatic node. A histological investigation revealed the growth of epithelioid, lymphoid cells and macrophages with nuclei in the form of a horseshoe. In some centers the aggregates of unstructured light pink color masses with nuclei fragments were determined. For what disease the described changes are characteristic?

A. Tuberculosis

B. Lymphogranulomatosis (Hodgkin's disease)

C. Actinomycosis

D. Metastasis of tumor

E. Syphilis

13. A patient with a history of fibrous – cavernous tuberculosis died of a renal failure. A post-mortem revealed a urine smell, left ventricle hypertrophy, fibrinous pericarditis, and fibrinous – hemorrhagic enterocolitis. Kidneys were small, reduced in sizes, dense, with plural foci of shrinkage. Histological investigation of the slides with Congo-Red staining showed pink masses within glomuleruli and vessels walls. In addition, destruction and an atrophy of the majority of nephrons, accompanied with a nephrosclerosis were determined. What is the most likely pathology of kidneys?

A. Amyloid- contracted kidneys

B. Contracted kidney

C. Arteriolosclerotic kidney

D. Atherosclerotic contracted kidneys

E. Pielonephritic contracted kidneys

14. An autopsy of a 7-year-old child revealed in the apex of the right lung, under the pleura, a focus of caseous necrosis, 15 mm in diameter. There were also enlarged bifurcational lymph nodes with small necrotic foci. A microscopical investigation of the pulmonal focus and the lymph node’s lesion showed necrotic masses surrounded by epithelioid cells, lymphocytes and solitary giant multinuclear Pirogov- Langhans’ cells. What is the most likely disease?

A. *Primary tuberculosis

B. Gematogenic tuberculosis with the lesions of lungs

C. Gematogenic generalized tuberculosis

D. Secondary inflammatory tuberculosis

E. Secondary fibro-inflammatory tuberculosis

15. A post-mortem of a 58-year-old patient revealed plural pathological cavities in both lungs. Microscopical study showed the inner layer of one cavity presented with necrotic masses and diffuse neutrophil infiltration; the middle one contained an infiltrate of epithelioid cells, lymphocytes and multinuclear giant cells. The external layer consisted of a mature connective tissue. Diagnose the form of secondary tuberculosis.

A. *Fibrocavernous tuberculosis

B. Acute inflammatory

C. Fibro-inflammatory

D. Acute cavernous

E. Cirrhotic tuberculosis

16. An autopsy of a 74- year-old man revealed the enlargement and deformation of the right knee joint. A histological investigation determined the massive foci of a caseous necrosis, surrounded by peripheral mantle of epithelioid, lymphoid cells and some multinucleated giant cells.

What is the most likely disease?

A. *Tuberculous arthritis

B. Syphilitic arthritis

C. Rheumatic arthritis

D. Gonorrheal arthritis

E. Deforming osteoarthrosis

17. A 52- year-old man with a long history of tuberculosis died of a bleeding from lungs. An autopsy revealed in lungs some oval and round cavities. The walls of cavities were presented with necrotic masses and a pulmonal tissue. What is the most likely form of tuberculosis presented in that case?

A. *Acute cavernous

B. Fibrocavernous

C. Tuberculoma

D. Caseous pneumonia

E. Acute inflammatory

18. A post-mortem of a 58-year-old patient, with a history of tuberculosis, revealed in the upper lobe of the right lung a cavity, 3×2cm in sizes, which connected with a bronchus. A cavity had dense walls and three layers. The internal layer was pyogenic; the middle one was presented with tubercular granulation tissue and the external coating of connective tissue. What of the listed diagnoses the most likely?

A. *Fibrocavernous tuberculosis.

B. Fibrous focal tuberculosis

C. Tuberculoma.

D. Acute focal tuberculosis.

E. Acute cavernous tuberculosis

19. A 42-year-old patient complained of a voice timbre change. The larynx biopsy was taken. A histological investigation revealed the aggregates of large, oblong form cells with light nuclei, rich with a cytoplasm. The nuclei were located on periphery in the form of a horseshoe. The described histological changes are characteristic for:

A. *Tuberculosis

B. Leprosy

C. Syphilis

D. Rhinoscleroma

E. Lymphogranulomatosis (Hodgkin's disease)

20. A histological investigation of the enlarged cervical lymph nodes revealed the nodules consisted mainly of flat, slightly extended cells with pale nucleus. There were also giant cells with spherical-oval form, light pink cytoplasm and with nuclei located on a cell periphery. The centre of some nodules was presented with the unstructured, light pink colored masses. The described changes are characteristic for:

A. *Tuberculosis

B. Lymphogranulomatosis (Hodgkin's disease)

C. Sarcoidosis (Boeck's disease)

D. Brucellosis

E. Nonspecific hyperplasic lymphadenitis

21. A histological investigation of the enlarged supraclavicular lymph nodes, removed from a 40-year-old woman, revealed an alteration of their structure with aggregates of slightly extended cells with a light nucleus. The multinuclear, large, oval-round form cells were also determined. These cells were rich with a cytoplasm and their nuclei were located on periphery in the form of a paling. The lymphoid cells created the next layer. The unstructured pinkish masses were seen within the centers of lesions. What the described changes are characteristic for?

A. *Tuberculous lymphadenitis

B. Metastasis of tumor

C. Lymphogranulomatosis (Hodgkin's disease)

D. Hyperplasic lymphadenitis

E. Sarcoidosis (Boeck's disease)

22. A lung lobe was removed at Surgery Department due to preliminary diagnosed purulent inflammation of a cyst. A gross investigation of the operative material revealed within the 8 segment a dense focus with irregular roundish form, 1,8 cm in diameter. On a cut, it had white-yellow coloring with a dim surface and fine sites of osteal density. The described macroscopical picture characteristic for:

A. * Tuberculous affect with healing

B. Peripheral carcinoma of lung

C. Chondromas

D. Carnification

E. Chronic pneumonia

23. A 52-year-old man with a long history of a tubercular prostatitis died of a meningocephalitis. An autopsy revealed in arachnoids of the basis and lateral surfaces of a brain, in a spleen, kidneys and liver a considerable quantity of dense grey color nodules 0, 5-1mm in diameter. Histological investigation of nodules showed epithelioid, lymphoid and some giant cells with nuclei located on a cell periphery in the form of a horseshoe. What is the most likely diagnosis?

A. *Acute milliary tuberculosis

B. Acute tuberculous sepsis

C. Chronic milliary tuberculosis

D. Disseminated tuberculosis

E. Septicopyemia

24. A post-mortem of a 40-year-old patient, with a 10 years history of tuberculosis, revealed a cavity in the 1 and П segments of his right lung. It had dense walls. The inner layer was rough, with beams formed by the obliterated bronchi and the thrombosed vessels. The middle and lower lobes were firm, with the yellow foci on a cut surface. What form of tuberculosis is the most likely in that case?

A. * Fibrocavernous

B. Acute cavernous

C. Fibrous inflammatory

D. Tuberculoma

E. Cirrhotic

25. A 40-year-old prisoner died in penitentiary of tuberculosis. An autopsy revealed a deformation and reduction of the both lungs apexes, plural cavities with dense, 2-3 mm thick walls in the upper lobes of both lungs. In addition, disseminated foci of a caseous necrosis, 5mm-2 cm in diameter, were found in the lower lobes of lungs. Diagnose the tuberculosis form.

A. * Secondary fibrocavernous

B. Secondary fibro-inflammatory

C. Gematogenic inflammatory with lesion of lungs

D. Primary, growth of primary affect

E. Secondary cirrhotic

26. A10-year-old girl arrived in traumatological unit with symptoms of pathological fracture of the right femur. A histological investigation of an operational material revealed in a bone marrow of a femur fragment, a plural foci of a caseous necrosis with peripheral mantle of epithelioid cells, lymphocytes and solitary Pirogov-Langhans’ giant cells. Zones of a caseous necrosis extended on adjoining sites of a bone tissue, resulting in osseous destruction. What is the most likely disease?

A. *Tuberculous osteomyelitis

B. Tuberculous spondylitis

C. Tuberculous koxitis

D. General(common) macrofocal tuberculosis

E. Secondary acute focal tuberculosis

27. An autopsy of a 48-year-old man revealed in the first segment of the right lung the round formation, 5 cm in diameter, surrounded with a thin connective tissue layer. The centre was presented by write, brittle masses. Diagnose the form of secondary tuberculosis.

A. *Tuberculoma.

B. Caseous pneumonia

C. Acute cavernous tuberculosis

D. Acute inflammatory tuberculosis

E. Fibrocavernous tuberculosis

28. A post-mortem of the 17-year-old girl, who died of a pulmonary insufficiency, revealed confluent zones of a caseous necrosis in the lower lobe of the right lung. The caseous necrosis was also determined in broncho- pulmonal, bronchial and bifurcational lymph nodes. What of the listed diagnoses the most likely?

A. *Growth primary affect at primary tuberculosis

B. Gematogenic form of progress of primary tuberculosis

C. Gematogenic tuberculosis with lesion of lungs

D. Tuberculoma

E. Caseous pneumonia at the secondary tuberculosis

29. A 50-year-old man with a history of tuberculosis died of a chronic pulmonary and heart failure. A post-mortem revealed a lobar lesion of the right lung. The upper lobe of the right lung was enlarged, dense, with fibrinous membranes on pleura. A gross investigation of a cut surface showed the yellow brittle tissue. What is the most likely form of secondary tuberculosis described in that case?

A. *Caseous pneumonia

B. Fibrous-focal tuberculosis

C. Infiltrative tuberculosis.

D. Tuberculoma

E. Acute focal tuberculosis

30. An autopsy of a man with a history of tuberculosis revealed in the second segment of the right lung the white-grey focus, 3 cm in diameter, surrounded with a capsule. Microscopic study showed a focus of necrosis with a capsule and lack of a perifocal inflammation. Name the tuberculosis form.

A. * Tuberculoma

B. Acute cavernous tuberculosis

C. Fibrocavernous tuberculosis.

D. Cirrhotic tuberculosis

E. Caseous pneumonia

31. A died woman had a chronic pulmonal abscess in her medical records. An autopsy revealed in 2nd segment of the right lung a roundish cavity, 5cm in the size. The internal surface of a cavity was created by caseous masses; the external one - by a dense pulmonal tissue. A pyogenic membrane was absent. What is the most likely pathology?

A. * Acute cavernous tuberculosis

B. Fibrocavernous tuberculosis.

C. Acute abscess.

D. Chronic abscess.

E. Primary pulmonary cavity (cavern).

32. A lungs roentgenogram investigation revealed a dark patch. During a diagnostic express biopsy of a lymph node of a bronchus was removed. A histological study showed a caseous tissue necrosis, round which lied epithelioid and lymphoid layers with few multinuclear large cells (Langhans' cells). Specify the cause of the lymphadenitis.

A. * Tuberculosis

B. Pneumonia

C. Syphilis

D. Metastases of cancer

E. Adenoviral infection

33. A 68-year-old woman, with a 20 years history of fibrous – cavernous pulmonary tuberculosis, presented to the Department of Nephrology with symptoms of uremia. Intravital test on amyloid in kidneys appeared positive. What is the most likely form of an amyloidosis presented in this case?

A. *Secondary systemic

B. Primary systemic

C. Limited (local)

D. Familial congenital

E. Senile (gerontal)

34. An 8-year-old child, with no disease in his medical history, presented to the hospital with a dyspnea. An x-ray inspection showed the air and a liquid in a pleural cavity. During operation in the right lung the subpleural cavity, 2,4 cm in diameter was found. It had an irregular form with the residual caseous masses inside. The lesion was connected with the pleural cavity. The similar caseous masses were found at a cut of the enlarged radical lymph nodes. A histological research of a cavity’s wall determined lymphocytes, epithelioid cells and multinuclear giant cells. How correctly to name a cavity?

A. * Primary pulmonary cavity (cavern) at tuberculosis

B. Abscess of lungs

C. Empyema of pleura

D. Cavity (cavern) at acute cavernous tuberculosis

E. Cavity at fibrocavernous tuberculosis.

35. The girl within last 3 months ate the crude cow milk. She arrived in the hospital with the "acute abdomen" symptoms. An operation revealed in a caecum a circular ulcer with perforation. A histological study of the ulcer edges determined necrotic masses, lymphocytes, epithelioid cells, and few multinucleated giant cells. What is your diagnosis?

A. * Primary intestinal affect at tuberculosis

B. Nonspecific ulcerous colitis

C. Amebiasis

D. Carcinoma of blind gut (cecum)

E. Dysentery

36. A histological study of the enlarged cervical lymph nodes revealed nodules with giant, spherical-oval form cells. These cells had a light pink cytoplasm and nuclei located on a periphery. The found out changes are characteristic for:

A. *Tuberculosis

B. Lymphogranulomatosis (Hodgkin's disease)

C. Sarcoidosis (Boeck's disease)

D. Brucellosis

E. Nonspecific hyperplastic lymphadenitis

37. A 63-year-old man with a long history of a tubercular prostatitis died of a meningocephalitis. An autopsy revealed in arachnoids of the basis and lateral surfaces of a brain, in a spleen, kidneys and liver a considerable quantity of dense grey color nodules 0, 5-1mm in diameter. Histological investigation of nodules showed epithelioid, lymphoid and some giant cells with nuclei located on a cell periphery in the form of a horseshoe. What is the most likely diagnosis?

A. *Acute milliary tuberculosis

B. Chronic milliary tuberculosis

C. Acuter tubercular sepsis

D. Macrofocal disseminated tuberculosis

E. Septicopyemia

38. A man died of liver cirrhosis. An autopsy revealed in the 1-2 segment of the right lung three grey-yellow, dense foci, 1-1,5см in diameter with a dim surface. A histological research showed the tubercular endobronchitis, foci of a caseous bronchopneumonia, surrounded with a wall of epithelioid, lymphoid and giant Pirogov-Langhans cells. For what form of a tuberculosis the described changes are characteristic?

A. * Acute focal tuberculosis

B. Infiltrative tuberculosis

C. Fibrous-focal tuberculosis

D. Caseous pneumonia

E. Primary pulmonary tuberculous complex

39. An autopsy of a 40-year-old man with a history of AIDS revealed both lung lobes enlarged, dense, air free, with fibrinous membranes on pleura. A gross investigation of a cut surface showed the yellow dim pulmonal tissue. A histological investigation determined in alveoli the serofibrinous and fibrinous exudate with large foci of a pulmonal tissue necrosis. For what disease the described changes in lungs are characteristic?

A. * Caseous pneumonia

B. Infiltrative tuberculosis

C. Croupous pneumonia

D. Lymphogranulomatosis of lungs (Hodgkin's disease)

E. Carcinoma of lung

40. A 47- year-old man died of an acute anemia, resulted from the pulmonary bleeding. An autopsy revealed in the 2 segment of the right lung the cavity, 5-6 cm in the size, which had connection with the bronchus lumen. The cavity had irregular roundish form and filled with blood. The internal surface of a cavity was rough and covered by a flabby unstructured yellowish tissue. A wall was thin, presented by the condensed, inflammatorily changed pulmonary tissue A histological investigation showed that the cavity inside layer consisted of the fused caseous masses with a considerable quantity of segmented leucocytes. What is the most likely pathology presented in that case?

A. * Acute cavernous tuberculosis

B. Abscess of lung

C. Disintegrating carcinoma of lung

D. Infarction of lung with septic disintegration

E. Bronchiectatic cavity (cavern)

41. A 56-year-old man died of a progressing heart failure. A post-mortem revealed small, dense lungs; the upper lobes were deformed, penetrated by a cicatrical tissue, with the encapsulated foci of a caseous necrosis, 0, 2-0,5сm in diameter. In the upper and middle lobes there were cavities, 3-4 and 4-5cm in the size, with dense walls and fiber internal surface, filled with the opaque yellow-green liquid. The surrounding pulmonary tissue was sclerotic. The heart was enlarged at the expense of the hypertrophied right ventricle. Define the form of secondary pulmonary tuberculosis

A. * Cirrhotic tuberculosis

B. Fibrous-focal tuberculosis.

C. Infiltrative tuberculosis

D. Acute cavernous tuberculosis

E. Fibrocavernous tuberculosis

42. A post-mortem of a 72-year-old vagabond, with marked kypho-scoliosis, revealed the partially destructed thoracal vertebral bodies due to formation of cavities (sequesters), filled with white-yellow brittle masses. A histological investigation determined within altered vertebras big foci of a caseous necrosis, surrounded with solitary giant multinucleated Pirogov-Langhans’ cells, epithelioid cells and lymphocytes. Similar changes were diagnosed at mediastinum lymph nodes and disseminated in lungs and kidneys. What is the most likely diagnosis?

A. *Tuberculous osteomyelitis

B. Purulent osteomyelitis

C. Syphilitic osteomyelitis

D. Osteoporosis

E. Osteoarthrosis

43. An ultrasound investigation of the young 17-year-old man’s right kidney revealed pyeloectasis, accompanied with disturbance of outflow of urine by urethra. Microscopical investigation of the renal biopsy showed a diffusive infiltration of the interstitium by lymphocytes and hystiocytes. In the cortical and medullar zones there were the foci of a destruction with formation of the cavities, surrounded by peripheral mantle of epithelioid , lymphoid cells and some multinucleated Pirogov-Langhans’ giant cells. What disease is the most probable?

A. * Tuberculosis of kidney

B. Suppurative (apostematous) nephritis

C. Nonspecific tubular-interstitial nephritis

D. Polycystic kidney

E. Chronic pyelonephritis

44. An autopsy of a child, who died of meningocephalitis revealed under pleura and in pulmonal tissue plural, punctual, yellow-white lesions which reminded millet grains. Histological investigation showed granulomas with a necrosis zone in the centre and a wall of epithelioid cells, lymphocytes, macrophages and some giant Pirogov -Langhans cells. What is the most likely disease?

A. *Primary milliary tuberculosis

B. Secondary tuberculosis

C. Focal pneumonia

D. Croupous pneumonia

45. A medical record of a dead child reveled meningeal symptoms in his medical history. His X-ray showed a dark patch in the ІІІ segment of the right lung and enlarged radical lymph nodes. At autopsy, in cerebral arachnoids, the millet grains-like nodules were found. Microscopical study of a nodule determined a focus of a caseous necrosis with wall of epithelioid, lymphoid cells with giant cells between them. These giant cells had big nuclei, situated on periphery in the form of a half moon. What is the most likely kind of meningitis?

A. *Tuberculous

B. Syphilitic

C. Brucellous

D. Influenzal

E. Meningococcal

46. A patient ill with tuberculosis died from progressing cardiopulmonary decompensation. Autopsy in the area of the right lung apex revealed a cavity 5 cm in diameter communicating with lumen of a segmental bronchus. On the inside cavity walls are covered with caseous masses with epithelioid and Langhans cells beneath them. What morphological form of tuberculosis is it?

A. *Acute cavernous tuberculosis

B. Infiltrative tuberculosis

C. Caseous pneumonia

D. Acute focal tuberculosis

E. Tuberculoma