What is pathology?
the science that studies the changes at cellular, tissue and organ level caused by diseases
the science that studies the body structure and morphology
medical discipline which aims to find the cause of death when a crime is suspected
medical discipline which provides the morphological diagnosis for the clinical practice
Define the main branches of pathology
general pathology
clinical pathology
systemic pathology
experimental pathology
Mark the correct statements.
"clinical pathology" builds up a theoretical idea of the pathological process
"general pathology" studies the specific morphological changes in organs and systems caused by a particular disease
'experimental pathology" researches the diseases using experimental animals and follows up the morphological changes caused by their treatment.
a and b statements are correct in reverse manner
What are the possible outcomes of a disease.
recovery
to become chronic
death
all of the above
Which of the following isn't a sign of death?
livores
rigor mortis
decay
calor
Mark the correct statement(s)
Algor mortis is stiffness of muscles after death
Rigor mortis is drying of the body after death
Livores are a violet-colored skin areas which develop after death
Decay is an early sign of death
Which are the specific methods of pathology?
autopsy
biopsy
clinical examination
clinical laboratory tests
Which of the followings are methods for taking biopsy?
excision
incision
surgical
all of the listed
Which are the purposes of pathological autopsy?
to accuse the clinicians of medical malpractice
to establish the cause of death and the definitive diagnosis
to help and educate clinicians and to improve their work
to help the relatives of the deceased to convict the doctors
Which are the conditions for an autopsy to be done?
death occurred in a hospital due to a disease
available medical history of the patient
presence of the treating doctor
all of the listed above
What are the characteristics of a frozen section?
urgent diagnosis given during an operation
the preparation of the tissue samples is done by a paraffin method
the preparation of the tissue samples is done on a freezing microtome
sometimes the diagnosis is not exactly clear because of the preparation method but information like "malignant tumor" "benign tumor" or "inflammation" is given to the surgeons to know how to proceed with the operation
Which fixative is most commonly used?
bouin solution
absolute alcohol
formalin 10%
salts of heavy metals
What fixative should be used for a liver biopsy from a baby with a suspected inherited metabolic disease?
Formalin 10%
1.5-4% glutaraldehyde
Frozen section
Zenker's fixative
What is the role of immunohistochemical stains?
to give urgent answers about the diagnosis or at least orientation about the pathological process during surgery
to determine the histogenesis of the tumor especially in highly undifferentiated malignant tumors
to determine the proliferative activity and the hormonal receptors of the tumor that is highly important for the treatment
to help determine the cause of death
Cytokeratin, S-100 protein, Vimentin, Desmin, CD-20 are examples of:
special stains to prove different substances
immunohistochemical markers
In which cases a pathological autopsy is performed?
when there is suspicion for diagnostic or therapeutic malpractice
death of a person outside the hospital
when there is suspicion of violent death
death of a patient in the hospital and when the relatives don't ask the principal to cancel the autopsy
Which of the followings is not a part of performing an autopsy?
dissection of organs
opening the body
taking biopsy from organ changes
extraction of abdominal and thoracic organs
Size, shape, elasticity, consistency, color and cut surface are characteristics of:
microscopic examination of organs
gross examination of organs
ultramicroscopic examination of organs
none of the listed
Indicate correctly the name of the described test. The pericardial sac is cut in Y-like section and filled with water, after that, in the presence of a witness, the right ventricle is punctured with a knife.
test for thromboembolism
test for pneumothorax
test for air and gas embolism
test for fat embolism
Indicate correctly the name of the described test. The pulmonary artery is cut at the place of truncus pulmonalis. Tweezers are inserted and the content of the artery is taken out for examinationion.
Indicate correctly the name of the described test. A pocket between the skin and the ribs is formed and is filled with water. In the presence of a witness, the thorax is punctured with a thin knife in an intercostal space.
Where is the main accumulation of glycogen in patients with diabetes?
in epithelial cells of convoluted tubules and Henle's loop
in epithelial cells of gastrointestinal mucosa
in the nuclei and in the cytoplasm of the hepatocytes
endothelial cells of the vessels
Mark the correct statement(s) for Mallory bodies?
they are accumulations of glycogen in the cytoplasm of the hepatocytes
they are hyaline inclusions in the cytoplasm of the hepatocytes
they are caused by consumption of toxic mushrooms
they are seen in Wilson's disease, liver cancer, primary biliary cirrhosis but mainly in alcoholic disease
Mark the correct statement(s) for Von Gierke's disease?
it is a genetic autosome-recessive disease
another name is glycogenosis type Il
it affects mainly the heart leading to severe heart failure in infants
there is excessive storage of normal glycogen in the liver and kidneys
Mark the correct statement(s) for cellular edema
it is abnormal accumulation of water in the cytoplasm
it is reversible cellular injury
cells are small and shrunken
there are a few etiological factors that caused cellular edema
Abnormal intracellular accumulation of proteins can be seen in:
the epithelial cells of the proximal tubules in proteinuria
in the cardiomyocytes in heart infarction
in the plasma cells in chronic inflammatory diseases as Russel's bodies
in the cells of pancreatic islets in diabetes mellitus
The abnormal inclusions in the hepatocytes in alpha-I antitrypsin deficiency are composed of:
glycogen
lipids
bile
proteins
"Hyaline droplets" in the epithelial cells of renal tubules is another name for:
glycogen inclusions
protein inclusions
vacuolar degeneration
lipid inclusions
Vacuolar degeneration and hydropic degeneration are more severe stages of:
fatty degeneration
protein degeneration
cellular edema
glycogen accumulation
PAS reaction with PAS control is used to distinguish:
Cholesterol from other lipids
Glycogen from mucus
DNA from RNA
Denaturated intracellular proteins from accumulated extracellular proteins
PAS —control is done using:
sulfuric acid
hydrochloric acid
amylase
picric acid
What is fatty degeneration?
abnormal accumulation of lipids in parenchymal cells
abnormal accumulation of lipids in the specialized fatty cells
abnormal accumulation of lipids in the ECM of an organ
abnormal accumulation of cholesterol in the large and medium-sized vessels
What is lipomatosis?
abnormal accumulation of lipids in the cells of the interstitium of an organ
What is obesity?
What is the relation between fatty degeneration of the liver and diabetes?
there is no relation between them
patients with diabetes have increased intake of lipids to provide more energy
the fatty liver in diabetes is caused by increased lipolysis and increased delivery of fatty acids in the liver
the fatty liver leads to diabetes mellitus
What is android type of obesity?
also called "male"or "apple" type, it is the accumulation of lipids in the fatty cells around the shoulders, thorax and waist
also called "female"or "pear"type, it is the accumulation of lipids in the fatty cells around the hips, tights and legs
generalized obesity predominantly on the face, shoulders and thorax
generalized obesity predominantly in the tights, hips and legs
What is gynoid type of obesity?
What is upper type of obesity?
also called "male"or "apple" type, accumulation of lipids in the fatty cells around the shoulders, thorax and waist
What is lower type of obesity?
also called "female"or "pear"type — accumulation of lipids in the fatty cells around the hips, tights and legs
Which type of obesity has worse prognosis?
gynoid type
male type
the obesity doesn't affect the patient's health
all of the obesity types have the same prognosis
In "tiger heart" the abnormal accumulation of lipids is:
in the cell of the heart's interstitium
in the cells around the pericardium
in the cardiomyocytes of the papillary muscles along the venules and the venous part of the capillaries
in the cardiomyocytes of the anterior wall of the left heart chamber
Which exogenous pigment could be accumulated in the eyes?
copper
lead
coal dust
none of the above
Which exogenous pigment could be deposited in the oral cavity?
Which exogenous pigment(s) could be deposited in the skin?
carotene
silver
tattoo ink
Which exogenous pigments could be deposited in the liver?
Which exogenous pigment could be deposited in the kidney?
Which exogenous pigment could be deposited in the lungs and lymph nodes?
Which exogenous pigment could be deposited in the brain?
Examples for non-organic pigments are:
Indicate the types of jaundice.
haemolytic/pre-hepatic
obstructive/ post-hepatic
hepatocellular/parenchymal
Haemolytic jaundice is characterized by the following laboratory findings:
increased indirect bilirubin in the serum, hypercholic stools and increased urobilinogen in the urine
both types of bilirubin are increased in the serum, normal colour of the stools, both bilirubin and urobilinogen are increased in the urine
increased direct bilirubin in the serum, hypoholic or acholic stool, increased bilirubin in the urine
Mechanical jaundice is characterized by the following laboratory findings:
increased direct bilirubin in the serum, hypocholic or acholic stools, increased bilirubin in the urine
Parenchymal jaundice is characterized by the following laboratory findings:
inceased indirect bilirubin in the serum, hypercholic stools and increased urobilinogen in the urine
Which of the following stains are used to prove hemosiderin?
Sudan Ill in orange colour
Congo-Rod in brick-red colour
Perls in blue-green colour
Van Gieson in red colour
What is the etiology of brown induration of the lungs?
chronic left sided heart failure'
chronic right sided heart failure
mitral valve stenosis
acute left sided heart failure
What is the common between fibrosis, sclerosis and cirrhosis?
the common is the increased development of connective tissue in the organ
the common is the lipid accumulation in the intetitium of the organ
the common is the fibrinoid degeneration of the organ
they are different processes and don't have anything common between them
Which of the following extracellular changes shows basophilia on H-E stain?
fibrinoid degeneration
hyalinosis
mucoid degeneration
amyloidosis
Which of the following changes are characterized by eosinophilia on H-E stain?
fibrinoid necrosis
Metachromasia can be seen in which of the following changes on ToluidinBlue stain?
Special stains for fibrin are also used in:
amyoidosis
Infiltration of lymphocytes and plasma cells is typical for:
mucoid edema
What is the clinical significance of hyalinosis of the heart arterioles?
it causes myocarditis
it causes rheumatic heart disease
it causes ishaemic heart disease
it cause subacute endocarditis
What is the clinical significance of hyalinosis of the pancreatic arteroles?
it can cause diabetes mellitus
it can cause pancreatic cancer
it can cause acute pancreatitis
hyalinosis in the pancreas is a physiological process related with ageing
What is the common between "glazed spleen" and corpus albicans ovarii?
the process in both is hyalinosis
the process in both is fibrosis
the process in both is fibrinoid degeneration
the process in both is amyloidosis
Which stain is used to prove rheumatism in acute stage in a heart valve?
Prussian Blue
Toluidin-Blue
Congo-Red
Perls
Mucoid swelling can be seen in:
Heart valves in rheumatism
Basedow's dermopathy
Myxedema
Which are the types of fibrinoid?
fibrinoid related to immune complexes in autoimmune diseases
physiological fibrinoid degeneration with aging
fibrinoid caused by the influence of biological, chemical and physical factors
fibrinoid caused by fast plasmorrhagia in the vessel walls in malignant hypertention
The necrosis which develops at the base of an acute or chronic active ulcer in the stomach or duodenum is:
coagulative
caseous
fibrinoid
liquefactive
Which degeneration in the extracellular matrix is seen during the acute stages of autoimmune diseases?
hyaline
amyloid
Indicate the correct statement(s) for nephrosclerosis arteriolosclerotica:
it affects microscopically the afferent and efferent arterioles
it is a result of prolonged benign hypertention
it is a reversible process
the process is hyalinosis
What are the microscopic changes seen in the brain in benign long-term hypertention?
hyalinosis of the vessels' walls
edema around vessels
accumulation of lymphocytes and plasma cells in the soft brain membranes
developments of specific granulomas in the brain tissue
The gross description: thick, hard, glassy whitish depositions, non-digestable by enzymes, is indicative for
steatonecrosis
liquefactive necrosis
fibrinoid deposition
Mark the correct statements for Corpus albicans ovarii (white bodies of the ovaries).
they are example of physiological hyalinosis
they are example for pathological hyalinosis after inflammatory processes in the ovaries
they are example for physiological accumulation of fibrinoid
they develop after the regression of corpus luteum
The following diseases are examples of amyloid depositions. Find the mistake!
rheumatoid arthritis — AA amyloid
multiple myeloma — AL amyloid
medullary carcinoma of the thyroid gland — AA amyloid
Alzheimer's disease — A4 amyloid
'Sago spleen and lardaceous spleen' are:
gross appearance of the localized (sago-spleen)and generalized (lardaceous spleen) amyloidosis of the spleen
sago spleen is amyloidosis of the spleen, while lardaceous spleen is hyalinosis of the spleen
gross appearance of the spleen in Hodgkin's lymphoma depending on the severity of the process
in lardaceous spleen the amyloid is deposited in the white pulp only, while in sago spleen both white and red pulp have amyloid deposition
Systemic amyloidosis is proven by a biopsy from?
gingiva
heart
fat tissue from abdominal wall
ileum
What type of calcification develops in the complicated atherosclerotic plaques?
metastatic
dystrophic
metabolic
physiological
Which are the causes for hypocalcaemia?
hypoparathyroidism
hyperparathyroidism
intoxication with vit. D
senile osteoporosis
What kind of gout can develop in a patient with leucemia?
gout caused by excessive consumption of meat and meat products
genetic gout caused by error in the metabolism of uric acid
renal injury because kidneys cannot excrete the excessive amount of uric acid
patients with leucosis never develop gout
Which of the following microscopic descriptions most likely suggest kidney amyloidosis? The stain is H-E in all the described specimens.
highly enlarged glomeruli, the capillary tufts filled almost all of the capsular space, capillary lumens are obliterated; pink homogeous substance is deposited also in the mesangium, in the basement membranes of the tubules and in the walls of the blood vessels
afferent and efferent arterioles have homogenously thick walls stained in pink, some of the glomeruli look smaller, with totally effaced structure and homogenously pink in color, while others may look normal in size, or even with compensatory hypertrophy.
the interstitium shows chronic inflammatory reaction, the main change is seen in the kidney tubules which look dilated and filled with pinkish substance (these tubules look like thyroid follicles)
many glomeruli show crescent proliferations, encompassing 2/3 f the Bowman's space; the process ends with global sclerosis of the gomerulus
Which of the following stain(s) is used to prove amyloidosis?
Van Gieson
Methyl violet
Mark the correct statement(s) for kidney alymoidosis
small, shrunken kidneys with granular surface and difficult decapsulation
enlarged pale kidneys with waxy texture
amyloidosis affects only one of the kidneys and doesn't lead to chronic renal failure
kidney amyloidosis is reversible after the treatment of the primary disease and has very good prognosis
Mark the terms which indicate amyloidosis of the spleen.
lardaceous spleen
glazed spleen
sago spleen
porphiric spleen
Granulomatous structures, consisting of uric acid crystals, lymphocytes, macrophages, fibroblasts and giant multinucleated cells type "foreign body" are characteristic for which disease?
tuberculosis
sarcoidosis
gout
brucellosis
Calcification of the aorta characterizes with:
hard, rigid wall of the aorta
soft, elastic wall of the aorta
can be complicated with mural thrombosis and aneurysm
is a result of metabolic calcification
Amyloidosis of the liver:
develops because of liver dysfunction and liver failure due to chronic liver disease
is characterized grossly with small, brown liver with decreased elasticity
can develop in chronic inflammatory diseases or in autoimmune diseases
is characterized grossly with enlarged, pale liver with waxy texture
Renal complications of gout include:
uric crystals nephrolithiasis
uric-acid infarction
urate nephropathy
Indicate the correct statement(s) for necrosis.
It is a programmed cell death
It is provoked cell death
It affects single cells and the extracellular matrix is not involved in the process
there is a demarcation inflammation at the periphery of the affected area
Indicate the correct statement(s) for apoptosis.
it affects single cells and the extracellular matrix is not involved
there is demarcation inflammation at the periphery of the affected area
it ends with phagocytosis of the cellular fragments
it is always accompanied by inflammation at the periphery of the area
What is the difference between fibrinoid degeneration and fibrinoid necrosis?
fibrinoid degeneration is accumulation of fibrinoid in the extracellular space while fibrinoid necrosis includes not only fibrinoid degeneration but also death of cells and extracellular components in the area of fibrinoid degeneration
these isn't any difference, the two terms are synonyms
fibrinoid degeneration is a physiological process while fibrinoid necrosis is a pathological process
fibrinoid degeneration is accumulation of fibrin in the extracellular matrix while fibrinoid necrosis is necrosis of the fibrin in the extracellular matrix
