Rheumatic diseases

1. An autopsy of 48-year-old female revealed a mitral stenosis with valve’s incompetence. Histological investigation showed the post- inflammatory cardiosclerosis and Aschoff-Talalayev nodes (granulomas). What is the most likely diagnosis?

А. *Rheumatism

B. Systemic scleroderma

C. Dermatomyositis

D. Nodular periarteritis

E. Lupus erythematosus

2. An autopsy of a 34year-old patient with a long history of rheumatism, revealed the epicardial surface of the heart with shaggy exudate formed by grey strands which easily separate from underlying tissues and described as ‘bread-and–butter’ pericarditis (‘hairy heart’). What is the most likely diagnosis?

А. *Fibrinous pericarditis

B. Purulent pericarditis

C. Hemorrhagic pericarditis

D. Proliferated pericarditis

E. Catarrhal pericarditis

3. A histology investigation of a mitral valve sample of a patient who died from complications of rheumatism revealed a mucoid swelling, a damage of the endothelial cells and also thrombi at the valve closure line. Name the type of the rheumatic endocarditis?

А. *Acute warty endocarditis

B. Diffuse endocarditis

C. Fibroplastic endocarditis

D. Relapsing warty endocarditis

E. Polyps-ulcerated endocarditis

4. A 9-year-old boy presented with painless, firm 1-2 mm nodules at the skin around ulnar and knee joints (at extensor’s area). Biopsy investigation revealed a central area of fibrinoid necrosis of the connective tissue surrounded by lymphocytes and macrophages. What disease these nodules are characteristic for?

А. *Rheumatism.

B. Rheumatoid arthritis.

C. Systemic scleroderma.

D. Nodular periarteritis.

E. Lupus erythematosus.

5. A 28-year old female died from uremia. A post-mortem revealed an enlarged kidneys, which had a patchy pattern with hemorrhages on there surface. Histological investigation showed eosinophilic deposits (hematoxilin bodies), "wire loop" lesions in the basement membrane of the glomerular tuft, hyaline thrombi and foci of fibrinoid necrosis and also ‘onion skin’ sclerosis at the spleen’s vessels. What is the most likely diagnosis?

А. *Lupus erythematosus.

B. Rheumatism.

C. Systemic scleroderma.

D. Rheumatoid arthritis.

E. Nodular periarteritis.

6. A 56-year old male with a long history of a rheumatic heart insufficiency died with symptoms of hemiplegia shortly before death. Histological examination of his mitral; valve revealed severe sclerosis, nodular collection of inflammatory cells and vegetations composed mainly of platelets and fibrin. Name the most likely type of endocarditis?

А. *Relapsing warty endocarditis

B. Acute warty endocarditis

C. Diffuse endocarditis

D. Fibroplastic endocarditis

E. Polyps-ulcerated endocarditis

7. Microscopic investigation of the heart auricle from a patient with a history of mitral stenosis revealed the Achoff- Talalayev’s bodies (granulomas). What was the most likely cause of the heart insufficiency supported by the histology results?

А. *Rheumatic

B. Atherosclerotic

C. Syphilitic

D. Innate

E. Septic

8. A 32-year-old female with a long history of rheumatic valve’s defect presented at the hospital with tachypnea and dyspnea, leg’s edema, ascites and hepatomegaly. She died from the chronic heart insufficiency. An autopsy revealed a mitral stenosis. What was the most likely factor of the mitral stenosis morphogenesis?

A. *Leaves union between itself

B. Sclerosis and bulge of leaves

С. Sclerosis and shortening of leaves

D. Shortening of tendon filaments

E. Presence of small blood thromboses on the surface of valve

9. An autopsy of 61-year-old male with a history of rheumatoid arthritis revealed enlarged dense kidneys, which had yellowish-whitish color and waxy appearance. Grossly, foci of scars were recognized at kidneys surface. Microscopically, at the slides stained by Congo red, homogeneous pink masses at capillaries of glomeruli tufts, arterioles walls and arteries, basal membranes of tubuli and in stroma were found. Name the described complication of rheumatoid arthritis?

A. *Secondary amyloidosis of kidneys.

B. Postinfective glomerulonephritis.

C. Quickly progressive glomerulonephritis.

D. Acute necrotic nephrosis.

E. Fibroplastic glomerulonephritis.

10. A 48-year-old female after exposure to cold presents to her physician with painful deformed fingers joints, which bones were restricted in their movements. Physical examination revealed small firm nodules near the joints. Histological investigation of the nodules biopsy showed the centrally located core of fibrinoid necrosis with surrounding rim of macrophages and hystiocytes. What is the most likely diagnosis?

А. *Rheumatoid arthritis.

B. Dermatomyositis.

C. Rheumatism.

D. Gout.

E. Deformed arthrosis.

11. A post-mortem of 40-year old female who died from uremia revealed enlarged kidneys, which had a patchy pattern of their surface. Histological investigation of kidneys showed eosinophilic deposits (hematoxylin bodies), "wire loop" lesions in the basement membrane of the glomerular tuft, hyaline thrombi and foci of fibrinoid necrosis. Besides these, Libman-Sacks endorcarditis was also determined. What is the most likely pathology in kidneys?

А. *Lupus erythematosus nephritis.

B. Rheumatoid glomerulonephritis.

C. Choleric glomerulonephritis.

D. Sclerotic kidney.

E. Terminal glomerulonephritis

12. A 33-year old female died from chronic kidney failure. A post-mortem revealed multiple scars and infarcts in kidneys and spleen. Histological investigation showed alteration of small and medium sized arteries presented with sclerosis and mild endothelial proliferation. A severe lymphocytes and histiocytes infiltrates were also recognized at the perivascular tissues. What is the most likely disease caused these alterations?

А. *Nodular periarteritis

B. Atherosclerosis

C. Hypertonic disease

D. Morphine’s Disease

E. Visceral syphilis

13. A post-mortem of a 25-year old woman who died from chronic kidney failure revealed a reddish malar rash (‘butterfly rash’) and small (up to 0,2 cm) pale tan spreading vegetations over the mitral valve surface. Histological investigation of kidneys showed foci of fibrinoid necrosis, eosinophilic deposits (hematoxylin bodies), "wire loop" lesions in the basement membrane of the glomerular tuft and karyorrhexis. What is the most likely diagnosis?

А. *Lupus erythematosus.

B. Nodular periarteritis.

C. Rheumatism.

D. Rheumatic arthritis.

14. Histological investigation of the mitral valves of the heart revealed the focal desquamation of endothelial cells replaced by thrombi. The connective tissue had mucoid swelling areas and also zones of sclerosis and revascularization. Name the type of valve’s endocarditis?

А. *Relapsing warty endocarditis

B. Diffuse endocarditis

C. Acute warty endocarditis

D. Fibroplastic endocarditis

E. Polyps-ulcerated endocarditis

15. A 62-year-old woman presents to her physician with considerable deformation of metacarpal phalangeal and feet joints. Histological examination of the soft tissues adjacent to the joints revealed a mucoid swelling of the connective tissue, areas of a fibrinoid necrosis surrounded by palisading epithelioid macrophages and sclerosis. Few ‘rice bodies’ were found within a synovial cavity. What is the most likely diagnosis?

A. *Rheumatic arthritis

B. Rheumatism

C. Behterev’s Disease

D. Hematogenic tuberculosis

E. Gout

16. A 44-year-old woman presents to her physician ulnar deviation of the hands and flexion-hypertension (‘swan neck” or “walrus flipper”) deformities of the fingers. Her metacarpal phalangeal joints are easily exposed to a dislocation and a subluxation. Microscopical examination revealed nodular proliferations of synovium, cartilage destruction and “pannus” formation. What is the most likely diagnosis?

A. *Rheumatoid arthritis

B. Rheumatic arthritis

C. Osteoarthritis.

D. Lupus erythematosus.

E -

17. An autopsy of a child, who died of a heart failure, revealed the dilated heart chambers. Microscopic investigations showed the hyperemia of the myocardial stroma, edema, and diffuse interstitial infiltrates consists of hystiocytes, lymphocytes, some scattered neutrophils and eosinophils. What is the most likely diagnosis?

A. *Diffuse interstitial exudative myocarditis

B. Focal interstitial exudative myocarditis

C. Nodular productive myocarditis

D. Interstitial productive myocarditis

E. Alternative myocarditis

18. A 35- year- old female presented her physician intermittent episodes of ischemia of her fingers, marked by pallor, paresthesias and pain, accompanied by tightening and thickening of the skin and poliarthralgia. Histological investigation of the skin biopsy from affected areas revealed mild epidermal atrophy, hyalinosis of collagen fibers within derma, scattered perivascular lymphocytes’ infiltrates. Underlying skeletal muscles expressed interstitial edema, loss of cross-section striation, nidal necroses followed with petrification. What is the most likely diagnosis?

А. *Dermatomyositis

B. Systemic scleroderma

C. Lupus erythematosus

D. Nodular periarteritis

E. Rheumatism

19. A post-mortem of a 19-year old female revealed multiple furuncles on her skin, a warty endocarditis of the heart valves (Libman-Sacks endocarditis), a focal hemorrhage under the endocardium, ulcerative stomatitis, esophagus ulcers, pneumonia, nephritis, and a spleen hyperplasia with a perivascular sclerosis. Morphological investigation of her brain showed areas of necrosis and signs of vasculitis within thalamus. What is the most likely diagnosis?

А. *Lupus erythematosus

B. Rheumatism.

C. Septic endocarditis.

D. Ischemic heart disease.

E. Hypertensive disease.

20. The woman of 45 years within several years has difficulties at swallowing. She also notes the limitation of fingers movements at printing on the computer keyboard, though joints are not painful. Physical investigation revealed her “stony face” (no wrinkles) owing to tightening of the facial skin and restricted motion of the mouth. The skin biopsy showed a widespread fibrosis of a derma without inflammatory infiltration. Diagnose disease on the listed clinical and morphological data.

А. *Scleroderma

B. Lupus erythematosus

C. Dermatomyositis

D. Amyloidosis

E. Rheumatic arthritis

21. A 43-year-old woman presents to her physician with pain and immobility of the bones in metacarpal phalangeal and feet joints. Similar complains in symmetric pattern were about ulnar and knee joints, though not so severe. Physical examination revealed pastous skin over the joints, a partial ankylosis of metacarpal phalangeal and feet joints, and also ulnar deviation of the hands and flexion-hypertension (‘swan neck”or“walrus flipper”) deformities of the fingers. In addition, movable firm, rubbery and tender 1cm hypodermic nodules were found in the phalangeal joints area. An aspirate of joint fluid showed increased turbidity and presence of white “grains” (“rice bodies”). Immunofluorescence also revealed the rhematoid factor. What is the most likely diagnosis?

A. *Rheumatic poliartritis

B. Systemic disease of connective tissue

C. Gout

D. Osteoartrosis

E-

22. A post-mortem of the patient who died from uremia revealed deformation of a spine column with severe restriction of its mobility. Articular cartilages of spine joints were destructed with persistent chronic inflammation in tissues of joints. The joints cavities filled with connective tissue, in some places leading to ossification and ankylosis formation. In an aorta, heart, lungs a chronic inflammation and a focal sclerosis were discovered. In kidneys an amyloidosis was recognized. What diagnosis in this case is most probable?

A. *Ankiloid spondiloartritis (the Behterev’s disease)

B. The Pedget’s disease (deforming ostosis)

C. Rheumatoid arthritis.

D. Parathyroid osteodystrophy.

E. Osteopetrosis (marble disease).

23. At the patient with suspicion on a systemic disease a biopsy from a site of the skin tightening and restricted motility was taken. A histology investigation revealed all kinds of disorganization of connective tissue fibers with mild cellular reaction and also transition in excessive sclerosis and a hyalinosis. What is the most likely diagnosis?

A. *Scleroderma

B. Nodular periarteritis

C. Lupus erythematosus

D. Psoriasis

E. Dermatomyositis