Theme: LOCAL DISORDERS OF CIRCULATION OF BLOOD (To ...



THE MINISTRY OF PUBLIC HEALTH OF UKRAINE

VINNITSIA NATIONAL MEDICAL UNIVERSITY

named after M.I.PIROGOV

EDUCATIONAL-METHODICAL RECOMMENDATION

FROM PATHOPHYSIOLOGY

FOR THE 3RD YEAR

PHARMACEUTICAL FACULTY STUDENTS

Module N 1 GENERAL PATHOLOGY

Practical training N 2 TYPICAL PATHOLOGICAL PROCESSES

The manual from Pathophysiology is approved and confirmed for the introduction into the educational process at Pathophysiology department meeting.

Protocol N 1 from 30.08.2011

Сompilers: Head of Department N.A. Rikalo

as. A.S. Grytsenko

as. O.Y. Guminska

The manual is recommended for the foreign students of pharmaceutical faculty (3rd course).

Thematic plan

Specialization: “Pharmacy”

|Lesson 9. Injury of the cell. |

|Lesson 10. Local disorders of blood circulation (hyperemia, ischemia, stasis, thrombosis, embolism). |

|Lesson 11. Inflammation. |

|Lesson 12. Disorder of heat exchange. |

|Lesson 13. Neoplasia. |

|Lesson 14. Practical training: “Typical pathological processes.” |

Specialization: “Clinical pharmacy”

|Lesson 12. Injury of the cell. |

|Lesson 13. Local disorders of blood circulation (hyperemia, ischemia, stasis, thrombosis, embolism). |

|Lesson 14. Inflammation (vascular reactions). |

|Lesson 15. Inflammation (pus enzymes). |

|Lesson 16. Disorder of heat exchange. |

|Lesson 17. Neoplasia. |

|Lesson 18. Practical training: “Typical pathological processes.” |

Theme: «CELL INJURY»

Actuality of theme.

Violations of intracellular homeostasis, which constitute the essence of cell injury, may develop as a result of direct action of pathogenic agent on the cell, or indirectly as a result of internal environment constancy violations.

Cell injury – is a typical pathological process, that is based on changes of intracellular homeostasis, which lead to disorder of the structural integrity of cells and its functional features.

General purpose of the lesson. To become familiar with the reasons of the main forms of the cells injury and their pathogenic significance.

For this it is necessary to know (the concrete purposes):

1. To treat concepts: cell injury.

2. To analyze the mechanisms of pathomorphological manifestations and consequences of cell damage.

For realization of purposes of lesson it is necessary to have the base knowledges-skills:

1. Cells structure (Biology Department).

2. Functional significance of subcellular structures (cytoplasmic membrane, lysosome, mitochondrion, nuclei, endoplasmic reticulum) (Biology Department).

The checking of primary level of knowledges.

1. Reasons that lead to cell damage.

2. Specific manifestations of the cell damage.

3. Nonspecific manifestations of the cell damage.

4. Pathogenic significance of different subcellular structures damage.

Theoretical questions at the base of which the execution of purpose types of activity is possible.

1. Concept about the cell damage.

2. Exogenous and endogenous causes of the cell damage.

3. Types of the cell damage.

4. Direct and indirect effects of cell damaging agent.

5. Basic mechanisms of cell damage: lipid, calcium, electrolyte, osmotic, acidotic, protein, nucleic.

6. Role of free radicals in the development of cell damage.

7. Concept about the antioxidant defense system.

8. Manifestations of the cell damage - structural and functional.

9. Concept about dystrophy (parenchymal, mesenchymal, mixed).

10. Concept about "necrosis" and "apoptosis." Role of apoptosis in the development of disease.

11. Morphological characteristics of necrosis and apoptosis.

12. Principles of cytoprotective therapy.

Literature.

1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU, 2005. p.87-96

2. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005. p.30-41

3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin – Vinnytsia: Nova Knuha Publishers – 2011. p.135-165

Topic for the abstract (for the independent student work):

1. Apoptosis.

Theme: “LOCAL DISORDERS OF BLOOD CIRCULATION”.

Actuality of theme.

Prevalence of local violations of circulation of blood, such as arterial and venous hyperemia, ischemia and stasis is very important. Their development is predefined violation of the neurohumoral regulation of local blood circulation. Disorders of local blood circulation need the detailed study, as they are the main link of pathogenesis of many pathological processes. Knowledges about general mechanisms of their development are needed for successful treatment and prophylaxis of the proper violations.

It is known that the system of blood circulation takes leading place in support of vital functions of an organism as the whole system.

Providing of necessary blood stream is a difficult process which depends on the adequate functioning of heart, integrity of vascular wall and balance between coagulative and anticoagulative systems of blood.

All known diseases are accompanied with disorders of blood stream.

Local disorders of blood circulation, such as thrombosis and embolism is one of the most frequent reasons of death (thromboembolism of cerebrum vessels, pulmonary artery). That is why knowledge of reasons, mechanisms of development and consequences of thromboembolism has a large significance for a practical doctor.

General purpose of the lesson.

To learn the reasons of arterial and venous hyperemia, ischemia, stasis origin, mechanisms of their development, manifestations, significance for an organism. To learn reasons, mechanisms of development, manifestations, significance of thrombosis and embolism for the organism.

For this it is necessary to know (the concrete purposes):

1. To know the concept about local disorders of blood circulation.

2. To analyze specific signs of different disorders of local blood circulation.

For realization of purposes of lesson it is necessary to have the base knowledges-skills:

1. Division of vessels on the functional departments (Normal Physiology Department).

2. Structural and functional organization of the circulatory system (Normal Physiology Department).

3. Concept about central and peripheral circulation (Normal Physiology Department)

4. Concept about microcirculation (Normal Physiology Department).

5. Mechanisms of blood flow regulation in arteries, capillaries and venules (Normal Physiology Department).

6. Structure and function of endothelial cells, basal membrane, pericyte (Histology Department).

7. Concept about the hemostasis system (Normal Physiology Department)

8. The concept of the fibrinolytic system (Normal Physiology Department)

9. Platelet function (Normal Physiology Department)

The checking of primary level of knowledges.

Give the answers to the following questions:

1. Basic forms of local blood circulation disorders.

2. Arterial hyperemia, definition.

3. What are the reasons of arterial hyperemia development?

4. Types of arterial hyperemia.

5. Venous hyperemia, definition.

6. Reasons of venous hyperemia development.

7. Ischemia, definition.

8. Stasis, definition.

9. Types of ischemia?

10. Types of stasis?

11. Thrombosis, definition.

12. Basic factors which are promote thrombus formation (Virchow’s triad).

13. What are the phases of thrombus formation process?

14. Consequences of thrombosis? From what does it depend?

15. Embolism, definition.

16. Types of embolisms according to origin.

17. Types of embolisms according to localization.

18. Types of exogenous embolisms.

19. Types of endogenous embolisms.

Standards of answers at the theoretical questions of initial level of knowledges:

1. Arterial and venous hyperemia, ischemia, stasis, thrombosis, embolism.

2. Arterial hyperemia – it is increased blood supply through the organ or part of tissue against of increased blood inflow from the arteries.

3. Influence of physical, chemical and biological factors of external environment, multiplying loading on an organ or area of tissue, psychogenic influencing.

4. Types of arterial hyperemia:

1) Physiological (after intensive work of organ, reactive)

2) Pathological (neurogenic, metabolic)

5. Venous hyperemia – it is increased blood supply through the organ or part of tissue against of decreased blood outflow from the veins.

6. Reasons of venous hyperemia:

1) intravascular (obturation of veins by a thrombus or embolus);

2) extravascular (compression of veins by a tumour, scar, tourniquet, by the enlarged organ (for example, by a pregnant uterus) by an edema);

3) constitutional weakness of elastic apparatus of veins, reduced tone of muscle elements of their walls;

4) disorders of general hemodynamics (cardiac failure, diminishing of suction ability of thorax).

7. Ischemia - it is decreased blood supply through the organ or part of tissue against of decreasing or complete stoppage of blood inflow from the arteries.

8. Stasis – it is slowing-down and stoppage of blood flow in the capillaries, small arteries and veins.

9. Basic types of ischemia:

1) Compressive

2) Obturative

3) Angiospastic.

10. Basic variants of stasis:

1) Ischemic

2) Venous

3) True (capillary).

11. Thrombosis - is the vital formation on the internal surface of vessel wall blood clots which consist of its elements. These clots got the name thrombus.

12. 1) Damage of vascular wall; 2) Violation of coagulative and anticoagulative blood system (increase of coagulative system activity or decline of anticoagulative system activity; 3) Deceleration of blood flow.

13. Cellular and plasma.

14. Necrosis (infarcnion), aseptic and septic meltdown, tromboembolism, disseminated intravascular clotting (DIC).

15. Embolism – is transfer of foreign bodies which do not meet there in a norm by the blood or lymph current with the next complete or partial vessel obturation.

16. Exogenous and endogenous.

17. By localization: embolism of greater circulation, embolism of lesser circulation and embolism of portal vein system.

18. Exogenous types of embolisms: air, gas, bacterial, parasite, embolism by foreign bodies.

19. Endogenous types of embolisms: thromboembolism, fatty, tissue, embolism by amniotic fluid.

Test control is for verification of primary level of knowledges:

1. What substance from recital can result arterial hyperemia development?

А. Noradrenaline

B. Thyroxin

C. Aldosterone

D. Somatotropin

E. Acetylcholine

2. What manifestations are not characteristic for arterial hyperemia?

A. Acceleration of blood stream

B. Deceleration of blood stream

C. Increase of local temperature

D. Multiplying the amount of functional capillaries

E. Redness

3. What manifestations are characteristic for venous hyperemia?

А. Increasing of organ blood supply

В. Cyanosis

С. Deceleration of blood stream

D. Hypoxia

Е. All answers are correct

4. Name possible reasons of physiological arterial hyperemia development?

А. Action of angiotensin-ІІ on the vessels of microcirculation

В. Endothelium injuries

С. Increased loading on an organ

D. Compression of the vessels by the enlarged organ or tumour

Е. Obturation of arteries by the atherosclerotic plaque

5. Name possible reasons of venous hyperemia development?

А. Obturation of vein by a thrombus or embolus

В. Obturation of arteries by the atherosclerotic plaque, blood clot, embolus

С. Spasm of arterioles

D. Action of angiotensin-ІІ on the vessels of microcirculation

Е. Increased loading on an organ

6. Hyperproduction of what matters by endothelium can be the reason of arterial hyperemia development?

А. Prostaglandins

В. Nitrogen oxide

С. Endothelins

D. Villebrand factor

Е. All answers are correct

7. What are credible consequences of venous hyperemia?

А. Edema of tissues

В. Hypoxia

С. Enlargement of connecting tissue

D. Liver cirrhosis

Е. All answers are correct

8. What are possible consequences of arterial hyperemia?

А. Hypoxia

В. Hemorrhage in tissues

С. Enlargement of connecting tissue

D. Atrophy of the organ

Е. All answers are correct

9. What biologically active substances which operate on intact vascular wall can be the reason of angiospastic ischemia development?

А. Angiotensin-ІІ

В. Acetylcholine

С. Atrial natriuretic hormone

D. Prostaglandins

Е. Nitrogen oxide

10. The obturative ischemia is the result of -

А. Arteriole spasm

В. Particulate or complete obturation of veins

С. Compression of arteries

D. Partial or complete obturation of arteries

Е. All answers are correct

11. The compressive ischemia is the result of -

А. Particulate or complete obturation of arteries

В. Particulate or complete obturation of veins

С. Compression of arteries

D. Increased loading on an organ

Е. All answers are correct

12. Rubbing by ointment on the basis of snake venom was done to a patient with lumbar radiculitis. Apparent redness arised at the place of rubbing after completion of procedure. What type of local blood circulation disorders took place in this case?

А. Thrombosis

В. Venous hyperemia

С. Stasis

D. Ischemia

Е. Arterial hyperemia

13. Cyanosis of back surface of leg in the middle and overhead third is observed at the patient with thrombophlebitis of lower limb veins. What type of local blood circulation disorders take place in this case?

A. Stasis

В. Arterial hyperemia

C. Ischemia

D. Venous hyperemia

E. Thrombosis

14. Paleness of skin of foot and leg is observed at the patient with endarteritis. The skin is cold by touch. What disorder of local blood circulation took place in this case?

А. Arterial hyperemia

В. Stasis

С. Ischemia

D. Venous hyperemia

E. Embolism.

15. The vessel wall is formed by endothelium, basal membrane and pericytes. This vessel is:

А. Arteriole

В. Venule

С. Hemocapillary

D. Lymphocapillary

Е. Artery with middle caliber

16. Specify factors which promote thrombosis development:

А. Increase of thrombocytes amounts in the unit of blood volume

В. Decrease of red corpuscles amounts in the unit of blood volume

С. Disorders of the acidic - basic state

D. Damage of vascular wall endothelium

Е. Гіпокальціємія

17. What form of embolism from the indicated can develop at transition from the area of the increased barometric pressure to normal?

А. Fatty

В. Thromboembolism

С. Gas

D. Retrograde

Е. Tissue

18. Name the vessels at the damage of which most probable is an origin of air embolism:

А. Femoral vein

В. Jugular vein

С. Ulnar vein

D. Hepatic vein

Е. Portal vein

19. What is the amount of thrombocytes in a norm?

A 60 – 80x109/l

B. 200 – 400x109/l

C. 450 – 500x109/l

D. 30 – 40x109/l

E. 1 – 5x109/l

20. Name the basic factors of thrombosis (Virchow’s triad) (3):

А. Thrombocytes damage

В. Disorders of coagulative and anticoagulative blood systems

С. Deceleration of the blood stream

D. Multiplying speed of blood stream

Е. Damage of vascular wall endothelium

21. What is the main point of physical and chemical content of thrombosis cellular phase?

А. Change of vascular wall electric charge

В. Change of thrombocytes electric charge

С. Stability of vascular wall electric potential

D. Stability of thrombocytes electric potential

Е. All answers are right.

22. Name the basic consequences of thrombosis:

А. Necrosis (infarction)

В. Gangrene (extremities)

С. Aseptic or septic meltdown

D. Ischemia

E. All answers are right

23. The neck is injured at man as a result of accident. What is the most probable type of embolism will develop?

А. Fatty

В. Gas

С. Air

D. Tissue

Е. Thromboembolism

24. A woman got the opened fracture of right femur bone as a result of accident. What is the most probable type of embolism will develop?

А. Bacterial

В. Gas

С. Air

D. Fatty

Е. All answers are right

25. Damage of venous sinus of durae matris was diagnosed at a patient as a result of trauma. What is the most probable type of embolism will develop?

А. Gas

В. Fatty

С. Air

D. Bacterial

Е. Tissue

26. What type of embolism can arise up at a patient as a result of lungs trauma?

А. Gas

В. Air

С. Bacterial

D. Fatty

Е. Parasitogenic

27. What type of embolism can arise up at a diver who was quickly come up from the depth?

А. Gas

В. Air

С. Tissue

D. Fatty

Е. Bacterial

28. What type of embolism can arise up at a pilot as a result of dehermetization of airplane?

А. Parasitogenic

В. Air

С. Fatty

D. Tissue

Е. Gas

|Correct answers |

|1 |

|1 |

|1 |

|1 |

|1 |

|1 |

|1 |A |2 |A |

|1 | | | |

|2 | | | |

|3 | | | |

Conclusion:__________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________

EXPERIMENT 2. Take the temperature in the floor of the auricle of a rabbit. Put the rabbit in to the thermostat and rise up the temperature to 42°C. Study the changes of the temperature of the rabbit's body and its common reaction at the overheating.

Initial level of temperature - ______°C.

Initial respiratory rate - ______in min.

Temperature of the rabbit after the overheating - ______°C.

Respiratory rate after the overheating - _______in min.

Conclusion:__________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

EXPERIMENT 3 Brake the frog's spinal cord. Fix the frog on the board, cut the thoracic cavity. Grasp the apex of the heart with a cerfine connected with the myograph. Record with the kymograph the curve of the heart contractions at the effect (under the influence) of Ringer's solution of different t° 25, 30, 40, 50, 60,

70, 80 and so on up to the heart failure.

|Ringer's solution temperature, °C |Heart biting rate, in min. |

| | |

| | |

| | |

| | |

| | |

Conclusion:__________________________________________________________

____________________________________________________________________

EXPERIMENT 4. The students study available records of respiration of different animals: guinea - pigs, rabbits, cats

[pic]

Conclusion:__________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

°

Theme: «Pathology of tissue growth. Tumours».

Actuality of theme.

By the prognoses of Worldwide health protection organization morbidity and death rate from oncologic diseases in the whole world will grow in 2 times for period from 1999 year for 2020: from 10 to the 20 million new cases and from 6 to the 12 million registered deaths.

Taking into account that in the developed countries there is a tendency to deceleration of growth of morbidity and death rate from malignant tumours (due to the prophylaxis and due to the improvement of early diagnostics and treatment), clearly, that a basic increase will be at developing countries (countries of former USSR). That is why doctors have to expect serious increase of morbidity and death rate from oncopathology.

From data of Committee of cancer prophylaxis 90% tumours are related to influencing of external factors, and 10% - depend on genetic factors.

That is why it is necessary for future specialist to know etiological factors and « risk factors» of tumours origin. Taking into account that tumours appear at the different age, race, sex people understanding of carcinogenesis and metastasis mechanisms and differences of innocent tumours from malignant are necessary for the doctor of any profession.

General purpose of the lesson.

To learn reasons, mechanisms of development, biological features of tumour growth.

For this it is necessary to know (the concrete purposes):

1. Neoplasia, definition.

2. Pathological and adaptative-compensatory processes at the development of typical pathological processes.

3. Analyze of pathomorphological features of tissue growth disorders.

For realization of purposes of lesson it is necessary to have the base knowledges-skills:

1. To know the morphology of the cells (Histology Department).

2. To know the mechanisms of cells deviation (Biology Department, Hystology department).

3. To know the principles of metabolism (protein, carbohydrate, lipid) (Biochemistry Department).

4. Concept about DNA- and RNA-viruses (Microbiology Department).

5. Concept about structure, function and regulation of a gen (Biology Department).

The checking of primary level of knowledges.

Give answers to the followings questions:

1. Tumour, definition.

2. What carcinogenic substances do you know?

3. What carcinogens refer to the physical (make examples)?

4. What carcinogens refer to the chemical (make examples)?

5. What carcinogens refer to the biological (make examples)?

6. What characteristic of tumours properties do you know (transfer).

7. Stages of tumours development.

8. What is Heyflik’s limit (barrier)?

9. What is immortalisation?

10. What is apoptosis?

11. What the transformation mechanisms do you do know (transfer)?

12. What is proto-oncogene?

13. What is dedifferentiation?

14. What is antigen simplification?

15. What is the Pasteur’s negative effect?

Standards of answers at the theoretical questions of initial level of knowledges:

1. Tumour - is the typical pathological process, which is characterized by unregulated limitless cells and tissues growth which is unconnected with a general structure and function of the damaged organ.

2. Physical, chemical, biological carcinogens, endogenous

3. Physical carcinogens (ionizing radiation, ultraviolet, infra-red radiation, mechanical influence).

4. Chemical carcinogens:

exogenous - organic (multiring hydrocarbon - benzyl, 3,4- benzpyrene, methylholantren), aromatic amine and amide (b-naphtylamine, benzidine, dimethylaminoazobenzene), nitrosamines, which appear in a stomach from nitrites and amines in the presence of HCl (diethylnitrosamine, dimethylnitrosurea, threemethylnitrosurea), aflatoxinы from Aspergillus flavum and sterigmatoсistin from Aspergsllus nidulans, other - uretan, CCl4, epoxideы, plastics, peroxides) and inorganic (chrome, arsenic, cobalt, nickel, beryllium, lead, cadmium);

endogenous (follicle-stimulating hormone, sexl hormones; phenylalanine tryptophan, tyrosine, indole derivatives; free radicals and peroxides, bile acids, cholesterol, vit.В12, nicotine acid).

5. Biological carcinogens: RNA- (viruses of mouse and chickens leukemia, Rous sarcoma, Bittner's virus, and others; for a human - the retrovirus was selected from the leukemia cells - HTLV (Human T- Lymphoma Virus), that causes Т-cellular), DNA - contained viruses (papova - viruses, adenoviruses, viruses (the of Epstein - Barr virus which result of Burkett’s lymphoma development) of herpes, hepadnavirus - is a virus of hepatitis causes the cancer of liver), human papilloma virus (neck of uterus cancer).

6. Anaplasia, metaplasia, displasia, invasive growth, metastasis.

7. Initiation, promotion, progression.

8. Heyflik’s limit - it the maximal amount of cell divisions, which is genetically programmed. It is different for every cells type. For fibroblasts, for example, it is divisions.

9. Immortalisation - is the phenomenon, when cells can be divided long time without signs of senescence.

10. Apoptosis - is programed self-destruction of cells which is characterized by activating of anlyzosomal endogenous endonucleas, which divides nuclear DNA on little fragments.

11. Mechanisms of transformation - mutational, epigenomic.

12. Protoonkogenes - are normal cellular genes which are able at violation of their structure to induce tumour growth.

13. Dediferentiation or anaplasia - is getting by the tumours cells of properties characteristic for the embryo stage of organism development.

14. Antigen simplification is a loss of own antigens (declines of organo-specifity, individualities) and appearance of new tumour-embryos antigens (returning to the embryo state).

15. Pasteur’s negative effect - is disintegration of carbohydrates to pyruvate and transformation of it on lactic acid in aerobic conditions.

Theoretical questions at the base of which the execution of purpose types of activity is possible.

1. General description of the main types of violations of tissues growth.

2. Concept of hypo- and hyperbiotic processes: atrophy, hyperthrophy, hyperplasia, regeneration, metaplasia, dysplasia, neoplasia.

3. Definition of the concepts of "tumor" and "neoplastic process". Modern views about etiology of tumors.

4. Role of ionizing radiation, ultraviolet rays and mechanical factors in cancerogenesis.

5. Chemical carcinogens exo- and endogenous origin, direct and indirect actions.

6. Role of viruses in the development of tumors.

7. Carcinogenesis: the basic stages (transformation, promotion, progression), the mechanisms (mutative and epìgenomic).

8. Physical, chemical, biological features of the cancerogenesis.

9. Functional, morphological, biochemical, physico-chemical, antigenous features of the tumors.

10. Principles of tumors classification. The concept of benign and malignant tumors.

11. Methods to experimental reproduction of tumors.

12. Patophysiological basics of prevention and treatment of tumors.

Literature.

1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU, 2005. – p. 130-138

2. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005 – p.105-114

3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin – Vinnytsia: Nova Knuha Publishers – 2011. p. 166-183

Testing according system “Krok-I”

Tests of an open database (2010)

1. A 57-year-old worker at an asphalt plant complains of weakness, cough with blood-streaked sputum, chest pain. He has been diagnosed with lung cancer. What is the first stage of carcinogenesis?

A Transformation

B Promotion

C Activization

D Progression

E Induction

2. A 56-year-old female patient complains about a fast growing hard neoplasm in the mammary gland that appeared a month ago. Objectively: the formation is fused with the surrounding tissues, it is uneven, slightly painful. What are the peculiarities favouring the infiltrative growth of a malignant tumour?

A Lack of contact inhibition

B Intensified chalone formation

C Intensified contact inhibition

D Intensified formation of tight contacts

E Rise of embryonal antigens

3. What pathology of tissue growth is characterized by cellular and tissue atypia from the point of histomorphology?

A Malignant tumour

B Dystrophy

C Degeneration

D Benign tumour

E Regeneration

4. A patient suffering from gastric ulcer for a long time has dramatic emaciation, skin pallor, appetite loss, aversion to meat products. Biopsy of mucous membrane of stomach revealed cellular atypia. What pathology are these symptoms typical for?

A Malignant tumour of stomach

B Benign tumour of stomach

C Polyposis

D Hypertrophic gastritis

E Helminthic invasion

(2006-2009)

5. Indicate which of below mentioned factors in not cancerogenous

A. Rh- ionizing

B. Helmints

C. Aminoazocompounds

D. Virus

E. Aromatic carbohydrates compouds

6. In 1915 the Japan scientists Ishikava and Jamagiva for the first time caused the tumor in the experiment painting rabbit's ear skin with coal-tar resin. What experimental method of causing tumors was used?

A. Explantation

B. Induction of chemical substances

C. Transplantation

D. Induction oof outcells filtrates

E. Induction of radioactive isotops

6. A woman, aged 56, complains of some induration in the mammary gland, wich appeared a month ago and increases quickly in size. Objectively: the formation is connected with nearby tissues formation, it is undulating and sluggish. Call the paculiarities contributing to infiltrative growth of the malignant tumor:

А. Lack of contact inhibition

В. Appearance of embrional antigens

С. Increasing of contact inhibition

D. Increase formation of keilons

E. Increase formation of contacts

7 A 56-years-old patient, who had contact with diethylnitrozamine at his work place, complains of pain in right subcostal area, weakness, loss of appetite, and decreased workability. At examination of this patient: surface of his liver is rough, splenomegaly and ascites are present in him; his body temperature is 37.2oC; in his blood analysis ESR is 25 mm/hour, besides neutrophilic leukocytosis, and hypochromic anemia were found. What disease developed in the patient’s organism?

A. Cancer of liver

B. Hepatitis

C. Cirrhosis of liver

D. Gallstone disease

E. Dyskinesia of bile ducts

8. A male, aged 40, has stenotic (without metastases) esophagus cancer. The following changes were revealed in that patient: muscular and fat tissue atrophy, brownish color of the skin, thin epidermis, and cardiac atrophy. What’s the reason of such symptoms?

A. Alimentary cachexy

B. Myasthenia

C. Addison’s disease

D.Cancer cachexy

E. Brown induration

9. What biological process augmentation is typical for tumor cells?

A. Anaerobic glycolysis

B. Decarboxilation

C. Tissue respiration

D. Lipolysis

E. Gluconeogenesis

10. What cell structure is a «target» for chemical cancerogens?

A. Nuclear DNA

B. Lysosomes

C. Mitochondria

D. Cytoplasmic membrane

E. Ribosomes

11. A patient with lung cancer has been smoking 30 cigarettes per day for 20 years. What the group of cancerogens is in tobacco smog?

A. Polycyclic carbohydrates

B. Aminoasosubstances

C. Nitrosamines

D. Amines

E. Heterocyclic carbohydrates

12. A patient with urinary bladder cancer was working in coke factory. What substance was the most probable reason of this pathological condition?

A. Naphtylamine

B. Dichlorethane

C. Vinegar acid

D. Alcohol

E. Pethroleynic aether

13. After Chernobyl disaster morbidity of tumors has been increasing. What action of the radiation has been appearing?

A. Oncogenic

B. Thermal

C. Mutagenic

D. Cytostatics

E. Immunostimulative

|Correct answers |

|1 |

|1 |A |2 |B |3 |A |4 |D |

Situate task:

1. Esophagus stenosis, which obstruct food intake developed at a patient after a chemical burn. Acute weight loss developed, mass of body diminished on 16%. At laboratory research of blood the following changes were found out: erythrocytes-3,1x1012/l, haemoglobin-113g/l, glucose-4,7 of mmol/l, protein-57g/l.

1) What is the type of starvation at a patient?

____________________________________________________________________

2) What are the possible consequences of hypoproteinemia?

____________________________________________________________________

3) What are the reasons of this type of starvation?

________________________________________________________________________________________________________________________________________

2. A man, 45 years, passes in a clinic the course of medical starvation concerning obesity. On 4th day from the beginning of starvation, feeling of hunger is saved, a general weakness, oppressing a psyche, some weight loss are marked. The level of glucose in blood makes 2,8 mmol/l, a selection nitrogen with urine makes 10 g per day. Respiratory coefficient 0,9.

1) What is the type of starvation at a patient?

____________________________________________________________________

2) What is the period of starvation?

____________________________________________________________________

3) Characteristic of this period of starvation.

____________________________________________________________________________________________________________________________________________________________________________________________________________

3. The weight loss of a 45% of rats body is marked at the 7th days from the beginning of complete starvation with water. A respiratory coefficient is 0,8. At some animals there are areas of skin necrosis. What is the period of starvation?

1) What is the type of starvation at a patient?

____________________________________________________________________

2) What is the period of starvation?

____________________________________________________________________

3) Characteristic of this period of starvation.

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4. For a patient with stenosis of pyloric part of stomach, the labored reception of meal takes place, there are weight loss, muscular weakness, edema of lower extremities.

1) What is the type of starvation at a patient?

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2) What are the reasons of this type of starvation?

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5. Esophagus stenosis, which obstruct food intake developed at a patient after a chemical burn. Acute weight loss developed, mass of body diminished on 16%. At laboratory research of blood the following changes were found out: erythrocytes-3,1x1012/l, haemoglobin-113g/l, glucose-4,7 of mmol/l, protein-57g/l.

1) What is the type of starvation at a patient?

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2) How to explain the decrease of blood cells and haemoglobin in the blood?

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3) Will resistance of organism to the infectious agents change in this case? Explain the answer.

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6. A child, 2 years old, was delivered to the clinic in grave condition. The family lives in one of the poorest countries in Asia, conditions of life and nutrition are not satisfactory. Breastfeeding is terminated early. Objectively: child is weakened, flaccid, there is a lack of weight and stunting, muscles hypotonia and dystrophy, thinning of hair, generalized edema, hyper-pigmentation and desquamation of a skin in the places of clothes friction.

1) What pathology developed at a child?

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2) What are the causes and mechanisms of this pathology development?

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7. During the earthquake, the scientists, who investigated the mountain caves, were caught under the blockage without supplies of food and water.

1) What kind of a starvation will develop at people?

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2) That is the duration of this type of starvation?

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3) That is the difference of this type of starvation from incomplete?

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