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THE MINISTRY OF PUBLIC HEALTH OF UKRAINEVINNITSIA NATIONAL MEDICAL UNIVERSITY

named after M.I.PIROGOV

EDUCATIONAL-METHODICAL RECOMMENDATIONFROM PATHOPHYSIOLOGY

FOR THE 3RD YEARMEDICAL FACULTY STUDENTS

Module N 1 GENERAL PATHOLOGY

Practical training N 2TYPICAL PATHOLOGICALPROCESSES

TYPICAL DISORDERS OF METABOLISM

VINNITSIA - 2015

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

Protocol N 1 from 30.08.2015

Сompilers: Head of Department N.A. Rikaloas. O.Y. Guminskaas. S.G.Polinkevich

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

Thematic plan Medical faculty

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

Inflammation.Disorder of heat exchange. Starvation.Neoplasia.Disorders of carbohydrate metabolism.Disorders of water-electrolytes metabolism.Disorders of acidic-basic state.Practical training 2: “Typical pathological processes. Typical disorders of metabolism.” Test control for

the semester.

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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 arterial and venous hyperemia, ischemia, stasis definitions.2. To know the reasons of origin and mechanisms of peripheral blood circulation disorders development.3. To describe the basic manifestations of different of, explain the mechanisms of their development.4. To explain the value of local blood circulation disorders for an organism.5. To be able to make the arterial and venous hyperemia, ischemia at experiment.6. To give determination of conceptions: "thrombosis", "embolism".7. To be able to explain principal reasons of origin, mechanisms of thrombosis development.8. To explain the consequences of thrombosis.9. To be able to classify embolism by origin and localization.10. To explain the mechanisms of different kind of embolisms development.11. To explain the significance of thrombosis and embolism for the organism.

For realization of purposes of lesson it is necessary to have the base knowledges-skills: 1. Dividing of bloodstream into the functional parts (Normal Physiology Department).2. The conception about the vessels of microcirculation (Normal Physiology Department).3. Mechanisms of bloodstream regulation (Normal Physiology Department).4. Structure and functions of endotelial cells, basal membrane (Histology department).5. Structural and functional organization of the blood circulation system (Normal Physiology and Histology

Departments).6. View about central and peripheral blood circulation (Normal Physiology Department)7. Conception about the hemostasis system (Normal Physiology Department)8. Concept about the fibrinolytic system (Normal Physiology Department)9. Thrombocytes functions (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.

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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) Compressive2) Obturative3) Angiospastic.

10. Basic variants of stasis:1) Ischemic2) Venous3) 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.

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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.

Theoretical questions at the base of which the execution of purpose types of activity is possible.1. Classification of peripheral blood circulation disorders.2. Arterial hyperemia, determination of conception. Kinds. Reasons, basic mechanisms of development.

Manifestations. Significance for an organism.3. Venous hyperemia, determination of conception. Reasons, basic mechanisms of development.

Manifestations. Significance for an organism.4. Ischemia, determination of conception. Kinds. Reasons. Mechanisms of development. Manifestations.

Significance for an organism. 5. Stasis, determination of concept. Kinds. Reasons, mechanisms of development. Significance for an

organism.6. Thrombosis, determination of conception. Value of Virchow’s triad in the mechanism of thrombosis

development.7. Modern views about thrombosis pathogenesis. 8. Consequences of thrombosis.9. Embolism, determination of conception. Types of embolisms. Reasons of their origin and mechanisms

of development. Value for an organism.

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

54-66, 68-712. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005 – p.60-683. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin – Vinnytsia: Nova Knuha

Publishers – 2011. – p. 105-121.

Testing according system “Krok-I”

Tests of an open database (2014)

A 54-year-old female was brought to the casualty department after a car accident. A traumatologist diagnosed her with multiple fractures of the lower extremities. What kind of embolism is most likely to develop in this case? A. FatB. Tissue C. Thromboembolism D. Gaseous E. Air

Tests of an open database (2013)1. While playing volleyball a sportsman made a jump and landed on the outside edge of his foot. He felt acute pain in the talocrural joint, active movements are limited, passive movements are unlimited but painful. A bit later there appeared a swelling in the area of external ankle, the skin became red and warm. What type of peripheral circulation disturbance is the case? A Arterial hyperemia B Stasis C Embolism D Venous hyperemia E Thrombosis

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2. A patient with obliterating endarteritis underwent ganglionic sympathectomy. What type of arterial hyperaemia should have developed as a result of the surgery? A Neuroparalytic B Neurotonic C Metabolic D Functional E Reactive

3. A 42 year old woman with neuralgia of trifacial nerve complains about periodical reddening of the right part of her face and neck, sense of warmth gush, increased skin sensitivity. These effects can be explained by the following type of arterial hyperemia: A Neurotonic B Neuroparalytic C Metabolic D Functional E Reactive

4. A rabbit's nerve that innervates the right ear was cut and its right superior cervical ganglion was removed. Immediately after operation the temperature of ear skin was measured. It was revealed that the temperature of the rabbit's ear skin on the side of denervation was by 1,50C higher than on the opposite intact side. What of the following is the most probable explanation of the above-mentioned effects?

A Arterial neuroparalytic hyperemia B Arterial neurotopical hyperemia C Atrerial hyperemia induced by metabolic factors D Reactive arterial hyperemia E Physiological arterial hyperemia

5. A patient with obliterating atherosclerosis underwent sympathectomy of femoral artery in the region of femoral trigone. What type of arterial hyperemia was induced by the operation? A Neuroparalytic B Reactive C Metabolic D Neurotonic E Functional

6. Upper neck node of sympathetic trunk was removed from the rabbit on experiment. Reddening and increased temperature of the skin of head is observed. What form of peripheral circulation of the blood developed in the rabbit?A Neuroparalytic arterial hyperemiaB Neurotonic arterial hyperemiaC Metabolic arterial hyperemiaD Venous hyperemia E Stasis


1. Increase of blood viscosity, - impression of microvessels walls at capillaroscopy were founded in a patient with chronic heart failure. What of these violations is possible in this case?

A. Sludge-phenomenonB. ThrombosisC. EmbolismD. Arterial hyperemia

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E. Venous hyperemia

2. While playing volleyball a sportsman jumped and then landed across the external edge of his foot. This caused acute pain in the talocrural articulation, active movements became limited, passive movements remained unlimited but painful. In the region of the external ankle a swelling appeared, the skin turned red and became warmer to the touch. What type of peripheral circulation disorder has developed in this case?

A. EmbolismB. Venous hyperaemiaC. Arterial hyperaemiaD. ThrombosisE. Stasis

3. Postganglionic sympathectomy was made at a patient with obliterating endarteritis. What type of arterial hyperemia will arise up as a result of the conducted operation?

A. Neuroparalitic В. Neurotonic С. Metabolic D. Working Е. Reactive

4. Woman, 42 age old, with trigeminal nerve neuralgia complain of periodic redness of face and neck right half, sensation of hot flushes and increase of the skin sensitiveness. Development of what kind of arterial hyperemia is able to explain these phenomena?

A. NeuroparaliticB. Neurotonic С. Metabolic D. Working Е. Reactive

5. Nerve which innervate the rabbit right ear was cut. Measuring of ears skin temperature conducted after operation. Temperature of rabbit ear skin at the side of denervation higher than at the opposite intact side on 1,50С. What form of peripheral blood circulation disorders was developed at rabbit?

A. Neuroparalitic arterial hyperemiaB. Neurotonic arterial hyperemia C. Physiological arterial hyperemiaD. Reactive arterial hyperemiaE. Metabolic arterial hyperemia

6. Student wasn’t able to give the right answer on exam. Redness of skin, feeling of heat and uncertainty of behavior developed at the student. What type of arterial hyperemia will arise up in this case?

A. NeurotonicB. NeuroparaliticC. MetabolicD. Pathological E. Reactive

7. Desympathisation of the femoral artery in the area of the femoral triangle was made in a patient with atherosclerosis. What type of arterial hyperemia will arise up as a result of the conducted operation?


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8. Puncture of abdominal cavity for the extraction of fluid was performed to a 45-year-old patient with diagnosis “cirrhosis of liver, ascites”. State of unconsciousness suddenly developed in the patient as a result of decrease in blood pressure after extraction of 5L of fluid. That was considered as a manifestation of brain blood circulation insufficiency. Which disorder of microcirculation occurs in this case?

A. IschemiaB. Arterial hyperemiaC. Venous hyperemiaD. ThrombosisE. Embolism

9. Course of atherosclerosis at a patient, 70 years old, was complicated by thrombosis of lower extremities, a gangrenous fingers of the left foot. Beginning of thrombosis development is associated with:

A. Transformation of fibrinogen into fibrinB. Activation prothromboplastinC. Transformation of prothrombin into thrombinD. Adhesion, aggregation and agglutination of plateletsE. Reduced synthesis of heparin

10. Thrombocytopenia, reduction of fibrinogen in the blood, appearance of fibrin degradation products, appearance of petechial hemorrhages are marked at a patients, 43 years, on the base ofseptic. Specify the cause of these changes:

A. DIC-syndromeB. Autoimmune thrombocytopeniaC. Hemorrhagic diathesisD. Violation of platelet formationE. Exogenous intoxication

(2006-2009)

11. Injury of sympathetic fibers of the sciatic nerve developed in a patient due to trauma. What kind of peripheral blood flow disorder takes place in the patient?

A. Neurotonic arterial hyperemiaB. Venous hyperemiaC. Angiospastic ischemiaD. Neuroparalitic arterial hyperemiaE. Obturative ischemia

12. At which from processes does arterial hyperemia take place? А. Arterial hypertensionВ. Tumor growth С. Inflammation D. Necrosis E. Arterial hypotension

13. What disorders of peripheral blood circulation will be observed after cutting of sympathetic (adrenergic) fibres?

А. IschemiaВ. Venous hyperemia С. Arterioly spasm D. Arterial hyperemiaЕ. Stasis

14. At the design of inflammation on mesentery of frog looked after arterial vessels dilation, acceleration of blood stream under a microscope. What type of hyperemia arised up here?

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A. WorkingВ. Postischemic С. Venous D. Reactive Е. Metabolic arterial

15. At the design of inflammation on mesentery of frog looked after arterial hyperemia. What is the main factor of this disorder of blood circulation pathogenesis?

А. Biologically active substances eliminationВ. Accumulation of potassium at the area of inflammation С. Decreasing of potassium amount at the area of inflammation D. Increasing of β- adrenergic nerves tone Е. Vasodilators paralysis

16. A patient, 54 age old, entered to the surgical department with complaints of pain in lower extremities, which increases at the walking. Objectively: the skin of lower extremities is pale, cold, the pulsation is weak, the sensitiveness is reduced. Obliterating endarteritis was diagnosed and postganglionic sympathectomy was planned. What type of arterial hyperemia will arise up as a result of the conducted operation?


17. A 42-year-old woman, shop assistant by profession, complains of edema of the lower extremities at the end of a workday. Her legs are cyanotic, their temperature is decreased. Venous hyperemia of lower extremities was established, which is due to constitutional weakness of the elastic apparatus of veins and the occupation. What is the major pathogenic factor causing local changes in venous hyperemia?

A. Disorders of metabolismB. HypoxiaC. AtrophyD. DystrophyE. Sclerosis

18. A 57-year-old man complains of heart pain that has developed after prolonged negative emotions. An emergency doctor diagnosed ischemic heart disease manifesting by stenocardia. What kind of ischemia is the most probable?

A. CompressiveB. ObliterativeC. Angiospastic resulting from deficiency of vasodilatorsD. --E. Obturative

19. A patient was admitted to the hospital with diagnosis of acute left-ventricle heart failure. Patient’s condition suddenly became worse and edema of lungs developed in him. What kind of disorders of peripheral blood circulation causes the lungs edema?

A. Arterial hyperemia neurotonic typeB. Arterial hyperemia neuroparalytic typeC. Arterial hyperemia metabolic typeD. IschemiaE. Venous hyperemia

20. Edema and cyanosis of low extremities appear in a food shop assistant at the end of workday. What is the main factor of edema development in this patient?

A. Dilatation of resistant vessels

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B. Increase of venous pressureC. Increase of number of functional capillariesD. Increase of collateral blood flowE. Increase of tissue drainage

21. A 23-year-old woman had intense psycho-emotional excitement. Hyperemia of face skin, tachycardia and increase in BP were observed in her. What is the mechanism of redness of her face skin?

A. Congestive venous hyperemiaB. Neuroparalytic arterial hyperemiaC. Post-ischemic arterial hyperemiaD. Neurotonic arterial hyperemiaE. Stasis

22. Destruction of endothelial layer of vessel leads to vasoconstriction. Decreased secretion of endothelial-derived factor plays the leading role in this phenomena development. What is this factor?

A. Nitric oxideB. AdenosineC. HistamineD. BradykininE. Adenosine monophosphate

23. Patient’s arm was put in plaster cast on account of simple fracture of humeral bone. Swelling, cyanosis, and decrease in temperature of the traumatized arm appear next day. What disorder of peripheral blood flow do these symptoms testify to?

A. ThrombosisB. Venous hyperemiaC. IschemiaD. EmbolismE. Arterial hyperemia

24. The patient which injured the left hand a few days before appealed to the doctor. He complaint of the pain in the site of damage, limitation of movement of fingers. Objectively: increase of hand volume, hyperemia of the skin, increase of local skin temperature. What pathological process these signs testify?

A. ThrombosisB. TumourC. InflammationD. EmbolismE. Lymphostasis

25. At patient with the ancle joint fracture after the removal of plaster bandage an edema of foot, cyanosis, decrease of local temperature, increase of organ volume were developed. What type of blood circulation disorders is observed here?

A. Working hyperemiaB. Arterial hyperemiaC. Venous hyperemiaD. Reactive hyperemiaE. Ischemia

26. Convulsions and loss of consciousness develop in a diver during the emergency raising from the depth. What is the major pathogenic mechanism in these disorders development?

A. Gas embolismB. HypoxiaC. Toxic action of oxygenD. Toxic action of nitrogen

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E. Hypercapnia

27. Acute heart arrest develops in a patient with thrombophlebitis of calf profound veins. What is its reason?

A. Pulmonary thromboembolismB. Left ventricle hypertrophyC. Myocardial dystrophyD. Endocarditis of mitral valveE. Atherosclerosis

28. Gas embolism developed in a diver who was lifted to the surface very fast. It results from fast change:A. From increased atmospheric pressure to normalB. From normal atmospheric pressure to increasedC. From normal atmospheric pressure to decreasedD. From decreased atmospheric pressure to normalE. --

29. Pulmonary embolism developed in a patient with coxal bone fracture. What kind of embolism does this patient have?

A. FatB. ThromboembolismC. TissueD. GasE. Air

30. A patient has acute pain in his chest, dyspnea, tachycardia, cyanosis, and decreased BP. Pulmonary infarction was diagnosed in this patient. Which factor is the most common cause of pulmonary infarction?

A. Embolism by thrombus from veins of lower extremitiesB. Congestion in the pulmonary circulationC. Increase in number of plateletsD. Activation of fibrinolytic systemE. Pneumothorax

31. Instantaneous death of pilots occurs under depressurization of airplane cabin at the altitude of 19 km. What is the reason for it?

A. Multiple gas embolismsB. Hemorrhage to the brainC. Gas embolism of cerebral vesselsD. BleedingE. Paralysis of respiratory center

32. Dyspnea, acute pain in the chest, cyanosis, and jugular venous distention suddenly develop in a patient with thrombophlebitis of lower extremities. What is the most possible disorder of blood circulation developed in the patient?

A. Thromboembolism of coronary vesselsB. Thromboembolism of mesenteric vesselsC. Thromboembolism of cerebral vesselsD. Thromboembolism of portal veinE. Thromboembolism of pulmonary artery

33. A pilot experienced aircraft decompression on the altitude 14000 m. What type of embolism could develop?

A. Gas

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B. TissueC. ThromboemboliaD. AirE. Fat

34. The state of a patient, 27 years old, with polytrauma (thorax closed injury, closed fracture of the femoral bone) in two hours after conducting of skeletal extraction was sharply deteriorated. Death came on the base of acute pulmonary-cardiac insufficiency. The drops of orange color, which obturate the vessels lumen, were founded at histological research of lungs and cerebrum blood vessels, coloring by sudan ІІІ. What polytrauma complication developed?

A. ThromboembolismB. Air embolismC. Bacterial embolismD. Fatty embolismE. Gas embolism

Correct answers1 A 2 C 3 A 4 B 5 A 6 A 7 A 8 B 9 D10 A 11 D 12 C 13 D 14 E 15 A 16 A 17 B 18 C19 E 20 B 21 D 22 A 23 B 24 C 25 C 26 A 27 A28 A 29 A 30 A 31 A 32 E 33 A 34 D

Situational tasks:

1. Patient complains of the pain at extremities, numbness of hands fingers, which frequently arises up on a cold. Sharp paleness of hand and fingers skin, decrease of skin temperature and disorders of sensitiveness present in it.1) What disorder of local blood circulation is the reason of founded clinical symptoms? _________________________________________________________________________________________2) Explain its pathogenesis.___________________________________________________________________________________________________________________________________________________________________________________________________________________________________2. Cyanosis, edema of lower extremities, decrease of extremities skin temperature were founded at a patient with stenosis of the left atrioventricular foramen. 1) What disorder of peripheral blood circulation was developed? _________________________________________________________________________________________2) Explain its etiology and pathogenesis__________________________________________________________________________________________________________________________________________________________________________________

3. Superior cervical ganglion of rabbit sympathetic trunk was cut in an experiment. The redness and increase of skin temperature were developed on the side of cutting. 1) Explain, what disorder of peripheral blood circulation developed a t a rabbit?_________________________________________________________________________________________2) Reasons, mechanism of development of this violation.___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________3) Who reproduced this type of local violation of blood circulation first?____________________________________________________________4) Explain the mechanisms of basic signs development.___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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4. Girl, 5 years old, delivered in a clinic with the burn of right upper extremity. Objectively: skin of hand in the place of burn of red color, the local increase of temperature, painfullness are marked.1) What violation of circulation of blood arised up?____________________________________________________________2) Explain the mechanism of increase of local temperature ?__________________________________________________________________________________________________________________________________________________________________________________3) What is the mechanism of skin redness development?__________________________________________________________________________________________________________________________________________________________________________________

5. Plaster bandage was imposed to the patient with the right humeral bone fracture. Next day the soft-tissue swelling appeared, extremity became cyanotic, the temperature of the injured hand skin decraesed.1) What violation of circulation of blood arised up?____________________________________________________________2) Explain the mechanisms of development of the soft-tissues swelling.__________________________________________________________________________________________________________________________________________________________________________________

3) What is the mechanism of skin cyanosis?__________________________________________________________________________________________________________________________________________________________________________________

6. Decrease of skin temperature and its paleness, decrease of the artery pulsation on the dorsal foot surface, painfulness during a walk were marked at a patient K., 60 years old with the atherosclerotic defeat of lower extremities vesselsl.1) What violation of circulation of blood arised up?____________________________________________________________2) What is the mechanism of skin paleness development?__________________________________________________________________________________________________________________________________________________________________________________7. The collective farmer sensed the pain in a right eye during the work. Lacrimation appeared. At the review by the medical assistant the foreign body was discovered in the corner of eye. Palpebral conjunctiva of red color, vessels dilated. The conjunctiva of the second eye is also injured but less than opposite.1) What violation of circulation of blood arised up?2) _________________________________________________________________________________________How to explain the red color of conjunctiva?__________________________________________________________________________________________________________________________________________________________________________________3) Explain the mechanism of vascular changes in the conjunctiva of left and right eyes?___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. Group of 2nd course students was inspected by a doctor after autumn cross-country race. Hyperemia of face skin paid attention at all inspected. A skin had bright red color, was moisture and hot by touch. Frequency of pulse for all students - 110-150 beats per minute. Breathing frequency -40-60 per minute.1) What violation of circulation of blood arised up?_________________________________________________________________________________________2) Explain the mechanisms of development of this violation.__________________________________________________________________________________________________________________________________________________________________________________

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9. The diver was dipped on a depth 20 m for implementation of caissons works, where he was during one hour, and then he was quickly lifted up. In a half of hour muscles pain was marked, which increased, head pain, syncope, numbness of hands and feet fingers, disorders of hearing.1) What is happened with a diver?_______________________________________________________________________________________2) What mechanisms of described violations development?________________________________________________________________________________________________________________________3) What should surrounding to do in this case?_________________________________________________________________________________________

10. Alpinists slowly rose on the slope of mountain during 6 hours. With every step, getting up was given all more heavy. A general weakness, palpitation, shortness of breath, syncope, head pain, decrease of appetite, meteorism ware marked.1) What was the direct reason of these disorders at alpinists?_________________________________________________________________________________________2) How is this simptom-complex named?________________________________________________________________________________________3) Explain the mechanism of violations development.__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4) At what height were alpinists on approximately?________________________________________________________________________________________5) What value has tachicardia and tachipnoe at this situation, what are the mechanisms of their development?_________________________________________________________________________________________________________________________________________________________________________________

11. Patient V. was in a surgical clinic with thrombophlebitis of right lower extremity. After a careless movement the expressed shortness of breath, pain in a thorax, cyanosis arose up.

1) Are these violations resulted by thrombophlebitis of lower extremity?_______________________________________________________________________________________

2) In what cases are such consequences of thrombophlebitis possible?________________________________________________________________________________________________________________________________________________________________________________

3) What did arise up at the patient?_________________________________________________________________________________________

4) Is localization of complications at this patient casual? Explain._________________________________________________________________________________________________________________________________________________________________________________

5) Is development of complications of thrombophlebitis possible from the side of other organs - brain, kidney, spleen?

__________________________________________________________________________________________________________________________________________________________________________________

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Practical work: “LOCAL DISORDERS OF BLOOD CIRCULATION”

Object of work: to show development of venous and arterial hyperemia and ischemia at animals (experiment on frogs and rabbit).

Description of experiment: arterial post-anaemic hyperemia is demonstrated at a rabbit after gripe of central artery of ear and venous hyperemia is demonstrated after gripe of regional vein of ear.

EXPERIMENT 1. Every brigade of students (2-3 students) narcotize a frog. Stretch a tongue above opening of small plank and examine under a microscope. Then ligate both regional veins of tongue and mark under a microscope deceleration of blood stream, pendular movements of blood and stasis. Sketch macro- and microscopic picture of preparation.

EXPERIMENT 2. Choose a place in the tongue of frog with few capillaries, veins, arteries and sketch it. Inflict the drop of warmed-up physiological solution at this place. Look after the acceleration of blood stream in all vessels, expansion of vessels and increase of number of capillaries. Sketch the changes of vascular net.

EXPERIMENT 3. Immobilize a frog by destruction of spinal cord. Fix a tongue of frog above opening of small plank. Examine a normal vascular net under a microscope. Then inflict the drop of adrenalin solution (1:1000) by a Pasteur’s pipette on a tongue. Look after the picture of local ischemia, expressed in the vasoconstriction, deceleration of blood stream and growing pale of tongue. Sketch this picture.

Blood supply at norm Arterial hyperemia

Venous hyperemia Ischemia

EXPERIMENT 4. The spinal cord of the frog is broken with the probe-needle. The thoracic cavity is cut. The heart is separated from the pericardium. 0,2ml of lypocodium suspension is carefully injected in the ventricle. The mesentery of the frog and then the lungs are stretched over the opening in the board.

Look after the blood stream in the vessels. Observe the changes of the blood movement and movement of the emboli in the vessels, occlusion of the vessels with the emboli of lypocodium.

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EXPERIMENT 5. Another frog is injected 0,2ml of fatty emulsion and air into the cardiac cavity. The mesentery of the frog and then the lungs are stretched over the opening in the board.

Look after the blood stream in the vessels. Observe the changes of the blood movement and movement of the emboli in the vessels, occlusion of the vessels with the emboli of fatty emulsion and air.

Embolism

1 – shots of lycopodium 2 – blebs of air3 – drops of fat

Conclusion:______________________________________________________________________________________________________________________________________________________________________________________________________________

Theme: “INFLAMMATION (vascular reactions)”.

Actuality of theme.Inflammation (infammatio – from Latin) - it is organo-tissue reaction is formatted in the process of

evolution and is developed under the injured action which is characterized by three components: alteration, exudation and proliferation.

The inflammatory reaction, as a typical pathological process, lies in base of many diseases of infectious and uninfectious nature.

Knowledges of principal reasons of origin, mechanisms of development, consequences and external manifestations of inflammatory reaction are needed for timely and correct diagnostics of diseases of inflammatory character, conducting of rational pathogenic therapy at different stages of inflammatory process development.

General purpose of the lesson.To have a clear picture of etiology and pathogenesis of inflammation. To define the role of mediators in

inflammatory reaction development.For this it is necessary to know (the concrete purposes):

1. To give determination of conception «inflammation».2. To define reasons which cause an inflammatory reactions.3. To give description of alteration as inflammatory component.4. Describe vascular reactions at inflammation, to explain their significance in inflammatory reaction

development.5. To be able to explain the features of vascular reactions and their value at inflammation in the neonatal

period and early postnatal period for children.6. To give description of mediators of inflammation, explain their value in inflammation development.7. To give description of proliferation, explain its significance in inflammation development.

For realization of purposes of lesson it is necessary to have the base knowledges-skills:1. Functional parts of bloodstream (Normal Physiology Department).2. Conception about the microcirculation (Normal Physiology Department).3. Mechanisms of regulation of blood circulation in capillaries and venules (Normal Physiology

Department)

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4. Conception about the role of connecting tissue cells, their structure, main functions (Histology Department).

5. Concept is about the products of arachidonic acid cascade, kalikrein-kinin system of blood, complement system (Biochemistry Department).

The checking of primary level of knowledges.Give the answer to the followings questions:

1. Inflammation, definition.2. What components is process of inflammation consist of?3. What is alteration?4. What are the kinds of alteration?5. What is mediator of inflammation?6. What mediators of inflammation do you know?

1) name cellular mediators;2) name plasma mediators;3) what mediators refer to cytokines?4) what mediators refer to arachidonic acid cascade?

7. Vascular reactions which take place in the area of inflammation. Who described them first?Theoretical questions at the base of which the execution of purpose types of activity is possible.

1. Determination of conception «inflammation».2. Reasons of inflammation.3. Basic components of inflammation, their determination.4. Alteration, kinds, description. Significance for an organism.5. Role of mediators in inflammatory reaction development.6. Vascular reactions at inflammation, mechanisms of their development. Significance for an organism.

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

97-1062. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005 – p.68-703. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin – Vinnytsia: Nova Knuha

Publishers – 2011/ - p. 184-197

Testing according system “Krok-I”Tests of an open database (2010)

1. Necrotic focus has appeared on burn, swallowing and red skin. What is the main mechanism of necrobyosis improvement in inflammatory area?

A. Secondary alterationB. Primary alterationC. Emigration of leucocytesD. Dyapedesis of erythrocytesE. Fibroblasts proliferation

(2006-2009)

2. Painfulness of tooth and edema of lower part of face at the side of ill tooth are present in a patient with acute pulpitis. What is leading mechanism of edema development in this case?

A. Increase in production of aldosteroneB. Disturbances of trophic function of nervous systemC. Disorder of neural regulation of water-salt metabolismD. Disorders of microcirculation at the focus of injuryE. Hypoproteinemia

3. A cook burnt his arm with steam. What substance increased and led to development of redness, edema and painfulness of affected area of skin?

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A. LysineB. HistamineC. ThiamineD. GalactosamineE. Glutamine

4. Enlargement and deformation of joints were revealed in a patient with rheumatism. What type of inflammation underlies these changes?

A. AlterativeB. ProliferativeC. ExudativeD. FibrinousE. Hemorrhagic

5. Prevalence of proliferative processes was revealed in a patient with chronic inflammation of skin and subcutaneous adipose tissue. Which hormone deficiency can lead to this situation?

A. CortisolB. AldosteroneC. InsulinD. Growth hormoneE. Thyroxin

6. Indicate inflammatory mediators which have to be inhibited for decrease in exudation:A. CatecholaminesB. HistamineC. HeparineD. ThromboxanE. Interleukine-1

7. Condition of biological active substances (BAS) prevalence over there inhibitors usually occurs in inflammation. Indicate correct correspondence of BAS to their inhibitor

A. Histamine - carboxypeptidaseB. Catecholamines - cholinesteraseC. Kinins - monoaminooxidaseD. Leukotriens - arylsulfataseE. Serotonin-protease inhibitor

8. A patient has high body temperature, redness, edema, painfulness on her right forearm. What biological active substances intensify inflammatory reaction?

A. VasopressinB. ProstacyclinsC. Phospholipase DD. Proteolysis inhibitorsE. Kinins

9. There are edema, redness and soreness in a place of injury. What is the reason for inflammation’s symptoms appearance?

A. Sympathetic nervous system activationB. Monoamine oxidase activationC. BAS discharged by cellsD. Carboxypeptidase activationE. Limited proteolysis inhibition

10. What inflammatory mediator is formed due to limited proteolysis of plasma globulins?A. Histamine

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B. LeukotriensC. BradykininD. ProstaglandinsE. Lymphokines

11. Fever and increase of antibodies and leukocytes have appeared in animal under experimental modeling of inflammation. What substances conditioned to all these common reactions in inflammation?

A. LeukotriensB. InterleukinsC. MineralocorticoidsD. GlucocorticoidsE. Somatomedins

12. Which of following inflammatory mediators are formatted under the influence of lypooxygenases?A. LeukotriensB. Prostaglandins E1, E2C. ProstacyclinsD. ThromboxansE. Thrombocytes activation factor

13. A male patient, 16, was admitted to the hospital with acute appendicitis. What typical pathological process is the basis of this disease?

A. InflammationB. HypoxiaC. FeverD. TumorE. Allergy

14. The secondary alteration is caused by:A. Lysosomal enzymesB. KininsC. LympokynesD. ProstaglandinsE. Complement components C3a and C5a

15. Glucocorticoid treatment is usefull in rheumatic arthritis. What is the basal action of glucocoricoids?A. Histamine decreasingB. Emigration inhibitionC. Phagocytosis inhibitionD. Prostaglandins synthesis inhibitionE. Cell membranes stabilization

16. It is known that inflammatory mediators are cellular or humoral. What from the following is a humoral mediator?

A. KallidineB. HistamineC. SerotoninD. Interleukine-2E. Hydrogenium peroxide

Correct answers1 A 2 D 3 B 4 B 5 A 6 B 7 D 8 E9 C 10 C 11 B 12 A 13 A 14 A 15 E 16 A

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Situational tasks:1. Plaster bandage was imposed to the patient with the right humeral bone fracture. Next day the soft-tissue swelling appeared, extremity became cyanotic, the temperature of the injured hand skin decraesed.1) What violation of circulation of blood arised up?____________________________________________________________2) Explain the mechanisms of development of the soft-tissues swelling.__________________________________________________________________________________________________________________________________________________________________________________3) Explain the decreasing of temperature of the injured hand skin?________________________________________________________________________________________________________________________4) What is the mechanism of cyanosis development?________________________________________________________________________________________________________________________2. Redness of damaged area, local disorder of temperature, feelings of pain appeared as a result of burn of lower extremity at a woman.1) What disorder of blood circulation arised up at a patient?________________________________________________________________________________________2) Explain the mechanism of redness of extremity._________________________________________________________________________________________________________________________________________________________________________________3) Explain the mechanism of temperature increasing._________________________________________________________________________________________________________________________________________________________________________________3. Necrosis focus arised at the area of hyperemia and edema of skin at a patient in a few hours after a burn.1) What is the leading mechanism provides strengthening of the destructive phenomena in the area of inflammation?________________________________________________________________________________________2) Explain the mechanisms of necrosis origin.________________________________________________________________________________________________________________________________________________________________________________3) Explain the mechanisms of edema origin._________________________________________________________________________________________________________________________________________________________________________________

20

Practical work: “THE INFLAMMATION (vascular reactions)”Object of work: to demonstrate die development of some phases of vascular reactions in inflammation.

EXPERIMENT 1. Kongeim’s test.Break the frog's spinal cord and fix the frog on the cork board. Make a small skin lateral incision of the

frogs abdomen, cut the abdominal cavity, pull the loop of the small intestine, straiten the mesentery over the opening in the board and fix the loop with the pins. The stretching and drying of the mesentery are the factors causing the inflammation. Increase the inflammation put a crystal of NaCl on the mesentery.

Study under the microscope the development of the main vascular reactions in the inflammation (change in the blood stream rate, change of the vascular lumen, lateral arrangement of the leucocytes and their emigration). Draw the vascular reaction.

1 - margination;2 - passing of leucocytes through a vascular wall;3 - accumulation of leucocytes in the hearth of inflammation

Conclusion:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________EXPERIMENT 2. Break the frog's spinal cord, fix the frog on the board with its belly down. Stretch its tongue, touch it with a crystal of azitro-aeid argentum and study it under the microscope

The damaged site is in the state of coagulation necrosis. Around it one can see the field of vessels with complete stasis and in some places with the diapedesis of the erythrocytes. Far from the necrotic focus one can see the field of the dilated vessels with slow-blood stream, lateral stasis and emigration of leucocytes. Farther from the necrotic site one can observe the belt of vessels in the stage of active hyperemia and normal blood stream. The vascular belts may be arranged in other succession.

Draw the microscopic picture. Write down the results of the experiment.

1 - coagulation necrosis;2- reflex spasm of arterioles;3- arterial hyperemia;4- venous hyperemia;5- stasis;6- normal blood circulation.

Vessel lumen

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Conclusion:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Theme: INFLAMMATION (PUS ENZYMES).

Actuality of theme.Processes of exudation and emigration of leucocytes, phagocytic function of leucocytes are key moments

in inflammatory reaction development, that determine its biological maintenance and value as the evolutional produced standard reaction of organism on a damage.

Ability to estimate character of exudate, its cellular composition, physical and chemical and biological properties helps to a doctor not only to decide a question about etiology of this process, but also correctly to appoint the treatment, assume possible consequences. The study of fermental activity of exudate gives the ability to conclude the state of nonspecific mechanisms of organism reactivity, in particular, cellular immunity.

General purpose of the lesson.To have a knowledge about the mechanisms of exudation and proliferation us components of

inflammation.

For this it is necessary to know (the concrete purposes):1. To give determination of conception "exudation".2. To expose the basic mechanisms of exudation, explain the value of this component of inflammation.3. To define the types of exudates.4. To explain the change of metabolism, physical and chemical violations at the area of inflammation.5. To describe proliferation, to define the value of this component of inflammation for an organism.

For realization of purposes of lesson it is necessary to have the base knowledges-skills:1. Structure of capillary wall (Histology Department).2. Phagocytes. Kinds (Histology Department).3. Mechanisms of phagocytosis (Biology Department).4. Cells of connecting tissue, their basic functions (Histology Department).

The checking of primary level of knowledges.Give an answer to the followings questions:

1. Exudation, definition.2. What form of cells first emigrate into the area of inflammation?3. What is exudate? 4. What is transsudate?5. What is emigration of leucocytes?6. What types of exudate do you know?7. Proliferation, definition.8. Local manifestations of inflammation.9. General manifestations of inflammation:

Standards of answers at the theoretical questions of initial level of knowledges:1. Exudation- it is an exit of liquid and components of blood plasma dissolved in it from the vessels of

bloods into the area of inflammation.2. Neutrophils3. Exudate - is the inflammatory irritant fluid. 4. Transsudate – is the uninflammatory irritant fluid5. Emigration - it is an exit of leucocytes from the vessels into the area of inflammation.6. Serous, catarrhal, fibrinous (croupous and diphtheritic), purulent, hemorrhagic, saprogenic.7. Proliferation – is the proliferation of cells.

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8. Redness (rubor), increase of temperature (calor), swelling (tumor), pain (dolor), disorders of function (functio laesa).

9. Fever, leukocytosis, changes of leukocytic formula, increase of «albumens of acute phase of inflammation» in the blood, acceleration of ESR, intoxication.

Theoretical questions at the base of which the execution of purpose types of activity is possible.1. Exudation, determination of conception.2. Mechanisms of exudation.3. Types of exudate. Difference of exudate from transsudate.4. Changes of metabolism, physical and chemical violations at the area of inflammation.5. Significance of exudation for an organism.6. Proliferation, determination of conception. Mechanisms of proliferation. Significance for an organism 7. Significance of inflammatory reactions for an organism.



Publishers – 2011. p. 197-208

Testing according system “Krok-I”Tests of an open database (2014)1. As a result of careless handling of an iron, a 34-year-old female patient has got acute pain, redness, swelling of her right index finger. A few minutes later, there appeared a blister fi- lled with a transparent liquid of strawyellow color. The described changes are a manifestation of the following pathological process: A. Exudative inflammation B. Traumatic edema C. Alternative inflammation D. Proliferative inflammation E. Vacuolar degeneration

Tests of an open database (2010-13)

1. A patient sustained trauma of knee joint and posttraumatic hemorrhagic bursitis appeared. After 3 months passive movements limitation in extend was observed. Limitation was a result of scar formation. What inflammatory component was a basis of this complication?

A. Secondary alterationB. ExudationC. Tissue hyperplasiaD. ProliferationE. Primary alteration

2. Gout is often associated with increasing and deformation of the joints. What type of inflammation is at the base of these changes?

A. ProliferativeB. AlternativeC. ExudativeD. FibrinousE. Mixed

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3. Youth, 17 years old, became ill sharply. The body temperature rose to 38,50С, the cough, nasal catarrh, lacrimation, nasal effluent appeared. What kind of inflammation developed at the youth?

A. PurulentB. CatarrhalC. HemorragicD. FibrinousE. Serous

4. The growing of "acute phase" proteins is characteristic for the inflammatory processes. What substances are the stimulants of their synthesis?

A. Angiotensin IIB. ImmunoglobulinsC. InterferonsD. Biogenic aminesE. Interleukin 1

(2006-2009)

5. A patient with inflammation of a forefinger has acute pain, edema, enlargement of local lymph nodes, temperature rising to 38,5oC. What factors lead to exudation in the inflammatory focus?

A. Lymph flow augmentationB. ProliferationC. Resistive vessels tone increaseD. Increase of volumetric flow rate of bloodE. Increasing in endothelial permeability

6. In a patient with eczema there are 5 typical symptoms of inflammation (Celsius - Halen pentad). Find the one of them:

A. CyanosisB. JaundiceC. PigmentationD. RednessE. Albinism

7. An 8-year-old child was admitted to the infectious department with fever (upto 38°C) and punctuate bright-red skin rash. The child was diagnosed as havingscarlet fever. Objectively: mucous membrane of pharynx is apparently hyperaemic and edematic, the tonsils are enlarged and have dull yellowish-grey foci with some black areas. What inflammation is the reason for the pharynx alterations?

A. HaemorrhagicB. SerousC. Purulent necroticD. Catarrhal E. Fibrinous

8. In female patient, 28, abscess opening was performed and fast wound reparation was observed. Reparation was preceded without score formation. What cells play the main role in proliferation?

A. EosinophilsB. NeutrophilsC. FibroblastsD. LymphocytesE. Monocytes

9. In examination of abscess punctate under a microscope different blood cells were revealed. Which of them appears the first in inflammatory focus?

A. Monocytes

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B. Mast cellsC. EosinophilsD. NeutrophilsE. Lymphocytes

10. It is known, that inflammatory mediators play the main role in inflammation pathogenesis. What is the histamine action on inflammation?

A. ChemotaxisB. Blood vessel permeability increasingC. Thrombocytes aggregationD. Blood vessels constrictionE. Blood coagulation

11. A patient 6 years old was admitted to the hospital with asphyxia. The membranous coats on mucosa of fauces were revealed. The coats can be removed easy. What type of inflammation is in patient?

A. FibrinousB. NecroticC. PusD. CattharalE. Hemorrhagic

12. There are lots of neutrophils in abdominal pus exudates in a patient with peritonitis. What is the main function of neutrophils in inflammatory area?

A. PhagocytosisB. Prostaglandins secretionC. DegranulationD. Histamine liberationE. Local blood flow regulation

13. Keloid cicatrix has formatted in a place of abscess. Name the stage of inflammation, which caused scar appearing.

A. ProliferationB. ExudationC. Primary alterationD. Secondary alterationE. Emigration

14. Eyeball inflammation resulted pus in the anterior chamber of the eye (hypopyon). What stage of inflammation was it?

A. ExudationB. ProliferationC. Primary alterationD. Secondary alterationE. Emigration

15. In a patient with skin pathological process which has 5 typical symptoms: tumor, rubor, calor, dolor, functio laesa. The development of such process includes 3 stages: Alteration, .......... , proliferation. What is the second one?

A. ExudationB. RegenerationC. ReparationD. FibrosisE. Petrification

25

16. The woman, 30 years old, is ill about year, when pain soft-tissues swelling, redness of skin appeared in the area of joints first time. Previous diagnosis is rheumatoid arthritis. Changing of what component of connecting tissue protein structure is one of reasons of this disease?

A. CollagenB. OvoalbuminC. MucinD. MyosinE. Troponin

18. At patient, 38 years old, rheumatism is in an active phase. Determination of what blood serum laboratory index has a diagnostic value at this pathology?

A. UreaB. TransferrinC. C-reactive proteinD. Uric acidE. Creatinine

Correct answers1 D 2 A 3 B 4 E 5 E 6 D 7 C 8 C 9 D10 B 11 A 12 A 13 A 14 A 15 A 16 A 17 C

Situational tasks:1. Puncture of pleural cavity was done to a patient. Exudate of the following composition: protein - 4,8%, leucocytes - 6200/mcl, mainly neutrophiles, a lot of damaged and un damaged cells, pH - 5,4 – was got. 1) Name the type of exudate.____________________________________________________________2) Explain the mechanisms of its development in a pleural cavity.__________________________________________________________________________________________________________________________________________________________________________________3) Expose the positive and negative value of exudate.__________________________________________________________________________________________________________________________________________________________________________________4) What is the difference of exudate from transsudate?_________________________________________________________________________________________________________________________________________________________________________________5) What value has research of its composition?_________________________________________________________________________________________2. Patient A, 36 years old, suffers of maxillary sinus mucus inflammation more than a year. The common state was worsened during the last two weeks. The body temperature range of 37,5 - 38,5 0С, headache increased, breathing through a nose became todiscomfort. Nasal mucus was red and swollen. From the side of blood: neutrophile leukotsitosis and acceleration of ESR.1) What type of inflammation developed at the patient? _________________________________________________________________________________________2) What are the mechanisms of common manifestation of inflammation development?_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Boy Y.,13 years old, applied to the doctor concerning a furuncle of right cheek. He suffered of pain at mastication, headache, increase of temperature. Infiltration was palpated by the size of a hazelnut at the center of cheek. The skin at the periphery of infiltration is red and cyanotic at the center.1) What type of inflammation developed at a patient? ________________________________________________________________________________________2) How to explain the different colouring of skin at the staggered area?__________________________________________________________________________________________________________________________________________________________________________________

26

Practical work: “THE INFLAMMATION (pus enzyme)”.

Object of work: to acquaint the students with the methodic of determination of the subtitles of amylolytic enzymes of pus.

Summary; to determine the enzymic special features of pus the serum of pus is prepared. For this purpose the pus exudate is centrifuged, the upper layer is aspirated, and diluted with the physiological solution in 10 times.

The amylolytic adaptability of the pus is determined by the following way: prepare several test - tubes (8) with the main solution of pus serum. Pour 1 ml of the physiologic solution into each test - tube except the first one

Pour 1 ml of pus serum into the first test - tube. Pour 1 ml of pus serum into the second one and mix it with 1ml of the physiologic solution; pour 1 ml of mixture from the second test - tube into the third-one, from the third one into the fourth one and so on to the end. Pour 1 ml of mixture out of the 8 th test - tube. In such a way we get a number of dilutions of the serum of the pus 1:10,1:20, 1:40 and so on. Add to each dilution 5 ml of starch 1:1000 and put the test - tube rack into the thermostat for 30 min. The stark is decomposed under the influence of the amylolytic enzymes passing the stages of the formation of erythro - and achrodextrins. Lughole’s iodine solution is an indicator of stark decomposition. The latter acts with not decomposed stark -a blue staining, with erythrodextrin - a red one and with achrodextrin - a yellow staining.

For example, if a red staining is obtained in the 6th test-tube it means that the enzyme titer is 1.320 as 1 ml of serum in the dilution 1 : 320 decomposes 5 ml of stark in the dilution 1:1000 for 30 min before erythrodextrins.

1:10 1:20 1:40 1:80 1:160 1:320 1:640 1:1280Conclusion:______________________________________________________________________________________________________________

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Theme: «DISORDERS OF THERMAL HOMEOSTASIS. FEVER».

Actuality of theme.Disorders of thermal homeostasis often enough meet in everyday life of man. For example, a fever

accompanies the different diseases of infectious and uninfectious nature. A study of etiology and pathogenesis of this typical pathological process is necessary and important for the doctor of any profession.

Knowledge of reasons and mechanisms of fever development will allow to develop rational approaches to pathogenetic treatment of fever. Extraordinarily important in doctor practice is using of pyrotherapy.

A study in an experiment with the poikilotherm and homoitherm animals of thermal homeostasis violations allows to understand the difference for them thermal exchange, and mechanism of fever development for at homoitherm animals and human.

Except for a fever, take place and other violations of thermal homeostasis, such as an overheat (physical hyperthermia), hyperthermal syndrome. Knowledge of reasons and mechanisms of their development will allow correctly to conduct differential diagnostics between the different types of thermal homeostasis violations, which will allow to choose faithful medical tactic.

General purpose of the lesson.Students must know etiology, mechanisms of development of such violations of heat exchange as fever,

overheat, hyperthermal syndrome.For this it is necessary to know (the concrete purposes):

1. To define the conception of basic heat exchange violations.2. To define a difference between an overheat, fever and hyperthermal syndrome.3. To expose the changes of metabolism and functions of organism at a fever.4. Base the value of heat exchange violations.

For realization of purposes of lesson it is necessary to have the base knowledges-skills:1. To know the structure of heat-regulating center and its functioning (Normal Physiology Department);2. To expose the mechanisms of heat exchange in a norm (Normal Physiology Department);3. To explain the mechanisms of heat production and ways of heat loss (Normal Physiology Department).

The checking of primary level of knowledges.Give the answers at following questions:

1. Localization of heat-regulating center.2. What groups of neurons does heat-regulating center consist of?3. Basic types of thermal homeostasis violations.4. Factors which cause a fever.5. Types of pyrogens according to origin.6. Types of pyrogens according to the mechanism of development.7. Primary pyrogens.8. Secondary pyrogens.9. Stages of fever.10. What correlation of heat production and heat loss processes is at the 1st stage of fever:

A) heat production high than heat lossB) heat production less than heat lossC) heat production equal to heat loss

11. What correlation of heat production and heat loss processes is at the 2nd stage of fever: А) heat production high than heat lossB) heat production less than heat lossC) heat production equal to heat loss

12. What correlation of heat production and heat loss processes is at the 3rd stage of fever: А) heat production high than heat lossB) heat production less than heat lossC) heat production equal to heat loss

13. How is the rapid decrease of temperature in 3rd stages of fever named?14. How is the slow decrease of temperature in 3rd stages of fever named?

28

15. How is the graphic image of day temperature fluctuations in 2nd stages of fever named?16. What is the base of temperature curve?17. Types of temperature curves.18. Organ at human which makes the highest heat production is:

A. BrainВ. Heart С. Kidney D. Liver Е. Splien

Standards of answers at the theoretical questions of initial level of knowledges:1. medulla oblongata;2. central, peripheral, standard neurons; 3. a) fever;

b) overheat (physical hyperthermia); c) hyperthermal syndrome; d) supercooling;

4. pyrogens;5. a) exogenous b) endogenous6. a) primary b) secondary7. exo- and endogenous pyrogens by origin8. a) interleukini-1, 6;

b) TNF;c) -interferon;

9. a) increase of temperature; b) standing of temperature at one level; c) decrease of temperature;

10. А11. C12. B13. critical;14. lytic (lysis);15. temperature curve;16. graphic image of day temperature fluctuations;17. febris continua, febris remittens, febris intermittens, febris recurrens, febris hectica, febris undulans,

febris atypica, febris inversa, febris ephemera;18. D.

Theoretical questions at the base of which the execution of purpose types of activity is possible.1. Classification of thermal exchange violations.2. Fever, determination of conception.3. Etiology of fever. Description of pyrogens.4. Mechanisms of fever development.5. Metabolic and functions disturbance of different organs at the fever.6. Significance of fever is for an organism. Using of pyrogens in the medical practice.7. Overheat of organism. Reasons and mechanisms of development. Difference from fever. Heat stroke.8. Hyperthermal syndrome, determination of conception. Reasons, mechanisms of development.

Description.



Publishers – 2011. p. 257-280

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1. The processes of heat transfer in a naked person at room temperature have been studied. It was revealed that under these conditions the greatest amount of heat is transferred by: A. Heat radiation B. Heat conduction C. Convection D. Evaporation E. –Tests of an open database (2013)1. A 25 year old man has spent a long time in the sun under high air humidity. As a result of it his body temperature rose up to 39oC. What pathological process is it? A Hyperthermia B Infectious fever C Hypothermia D Noninfectious fever E Burn disease 2. After transfusion of 200 ml of blood a patient presented with body temperature rise up to 37,9 oC. Which of the following substances is the most likely cause of temperature rise? A Interleukin-1 B Interleukin-2 C Tumour necrosis factor D Interleukin-3 E Interleukin-4

3. On simulation of inflammation of the lower extremity the animal exrerienced raise of the temperature, increase of amount of antibodies and leucocytes in the blood. What substances caused this general reaction of the organism on inflammation? A InterleukinB GlucocorticoidC MineralcorticoidD LeucotriensE Somatomedins


1. At the patients with relapsing fever occurs fever that is characterized by periods of several days of high temperatures, alternating with periods of normal temperature. This temperature curve is called:

A. Febris recurrensB. Febris hecticaC. Febris intermittensD. Febris continuaE. Febris atypica

2. Body temperature at the patient with an infection disease was increased to a day 39,5-40,5 0C and has been kept at this altitude about an hour and then returned to baseline. What type of temperature curve described in this case?

A. RemittentB. ConstantC. IntermittensD. HecticaE. Atypical

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3. Body temperature at the patient with an infection disease was increased to a day 39,5-40,5 0C and has been kept at this altitude about an hour and then returned to baseline. At which disease does this type of temperature curve occur?

A. MalariaB. TuberculosisC. InfluenzaD PeritonitisE. Brutselosis

4. Woman came to hospital with a diagnosis of acute pneumonia. She is ill during last 2 days when the body temperature rised up to 390C and she fell the weakness, dry cough. Which of the mediators of inflammation has the properties of endogenous pyrogens?

A. Interleukin 1B. Thromboxane A2C. HistamineD. SerotoninE. Bradykinin

5. A patient with the pneumonia lungs has an increase of body temperature. What biologically active substance plays the main role in the origin of this manifestation?

A. Interleukin -ІB. SerotoninC. BradykininD. HistamineE. leukotriene

6. During the examination of the patient following symptoms were revealed: redness of skin, skin is hot and dry to touch, heart bit rate is 92 per minute, respiratory rate is 22 per minute, body temperature is 39,2oC (102.5 degree Fahrenheit). What is the correlation between heat production and heat loss in described period of fever?

A. Heat production surpasses heat lossB. Heat production equals to heat lossC. Heat production is less than heat lossD. Decreasing of heat production without changes of heat lossE. Increasing of heat production without changes of heat loss

7. After transfusion of 200 ml of blood a patient presented with body temperature rise up to 37,9°C. Which of the following substances is the most likely cause of temperature rise?

A. Intcrleukin-4B. Interleukin-2C. Tumour necrosis factorD. Interleukin-3E. Interleukin-l

8. The body temperature of the patient suddenly rose up to 39 ⁰C in the afternoon and after 6 hours returned to normal. On the second day attack doubled: temperature climbed to 41⁰C and period apyrexia stepped after 8 hours. Name the type of temperature curve.

A. IntermittingB. RecurentC. HecticD. SepticE. Constant

9. The body temperature of a patient rose up to 390C after long finding the sun with high humidity of air. What pathological process does observe in this case?

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A. Hyperthermia.B. Infectious fever.C. Hypothermia.D. Noninfectious fever.E. Burn disease.

(2006-2009)

10. A patient has felt cold, chills, “goose flesh”, increase of body temperature. Which else changes characterize the first period of rapid elevation of body temperature?

A. TachycardiaB. Equilibration between heat production and heat lossC. Dilation of skin vesselsD. Decrease of arterial pressureE. Increase of metabolism on 100-200%

11. Body temperature of patient becomes pyretic. Which substances have to act to neurons of thermoregulation for fever development?

A. InterferonB. KallidinumC. ProstaglandinsD. Free radicalsE. Leucotriens

12. Fever in a patient develops in following succession of stages:A. Incrementi; fastigii; decrementiB. Incrementy; decrementy; fastigiiC. Fastigii; decrementi; incrementiD. Fastigii; incrementi; decrementiE. Decrementi; fastigii; incrementi

13. A patient had fever after injection of pyrogenal. His skin has become pale, cold; chill appeared in him, oxygen consumption increased. How do the processes of thermoregulation change in described period of fever?

A. Increase of heat production and decrease of heat lossB. Decrease of heat lossC. Heat loss is equal heat productionD. Decrease of heat production and increase of heat lossE. Decrease of heat production

14. A patient suffers from osteomyelitis of maxilla. His body temperature increases to 40 0C and then sharply decreases to 35.6 0C every day. Which type of fever curve is characterized by these changes?

A. ContinuaB. IntermittentC. ReccurensD. AtypicaE. Hectica

15. Pallor of the skin, “goose flesh” and increase of oxygen consumption appeared in the patient’s skin after injection of pyrogenal. Which stage of fever is characterized by these changes?

A. Stadium incrementiB. Stadium fastigiiC. The stage of falling temperature by crisis

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D. The stage of falling temperature by lysis

16. Acute increase of body temperature, dyspnea, tachycardia, nausea, convulsions, and loss of conciousness developed in a worker, working in the thick uniform in summer. What was the most possible reason of development of those symptoms?

A. Equilibration between heat loss and heat productionB. Decrease of heat productionC. Decrease of heat lossD. Increase of heat productionE. Increase of heat loss

17. Inclination of the set point of thermoregulation to higher level due to action of IL-1 is in a patient. What is the name of this typical pathological process?

A. FeverB. HyperthermiaC. HypothermiaD. InflammationE. Hypoxia

18. The body temperature of a patient with crupous pneumonia is 39 0C. The difference between the morning and evening temperature of his body didn’t exceed 1 0C during 9 days. Which type of the fever curves was that?

A. ContinuaB. HecticaC. IntermittentD. HyperpyreticE. Reccurens

19. A patient has fever with following stages: incrementi, fastigii, decrementi. Which disease these features can characterize?

A. Acute pneumoniaB. AcromegalyC. Diabetes mellitusD. HyperaldosteronismE. Myocardial hypertrophy

20. The body temperature of a patient with pneumonia was keeping on the level 38.3-38.5 0C all the first week of disease. Such fever is called:

A. FebrileB. HyperpyreticC. PyreticD. Subfebrile

21. Increase of “acute phase” proteins level in blood such as ceruloplasmin, fibrinogen, C-reactive protein is typical for development of fever. Indicate the possible mechanism of this phenomenon.

A. Stimulative influence of IL-1 on hepatocytesB. Destructive action of elevated temperature to the cells of the organismC. Proliferate action of IL-2 to T-lymphocytesD. Adaptive reaction of the organism to pyrogenE. Degranulation of mast cells

22. Body temperature of a patient is 39 0C for several hours (stadium fastigii). Indicate which changes of physiological functions are the most typical for this stage of fever.

33

A. BradycardiaB. Ingibition of phagocytosisC. Increase of heat lossD. Increase of heat productionE. Heat production is equal heat loss

23. In a patient with prolonged fever after the course of treatment body temperature begins decreasing. What is the possible mechanism of temperature decrease?

A. Protective activation of immune systemB. Decrease of heat production due to reducing metabolic rateC. Decrease of production of pyrogensD. Increase of resistance of organism to action of the pyrogensE. Increase of heat loss due to peripheral vasodilatation

24. Animal was injected with pyrogen to reproduce fever. What mechanism starts process of temperature increasing?

A. Activation of non-shivering thermogenesisB. Activation of shivering thermogenesisC. Rise of set point of thermoregulation in hypothalamusD. Reduction of heat lossE. Dissociation of oxidation and oxidative phosphrilation in tissues

25. After blood trasfusion patient complaints feeling of heat, rigor, increase of body temperature to +400C. It’s known the cause of elevation temperature is secretion of endogenous pyrogens. Which cells produce endopyrogens?

A. ErythrocytesB. PlateletsC. EndotheliocytesD. B-lymphocytesE. Macrophages

26. Most infectious diseases are characterized by development of fever. It can be explained:A. Formation of IL-1 during phagocytosis of microorganismsB. Intoxication of the organismC. Degranulation of mast cellsD. Activation of T- and B-lymphocytesE. Processes of exudation

27. A man in light clothes is staying in a room with air temperature +14 0C. Windows and doors are closed. Which way of heat loss is the most considerable in this case?

A. EvaporationB. PerspirationC. ConductionD. RadiationE. Convection

28. Sharp increase of the temperature to 38.7 0C was marked in a patient with acute purulent periodontitis. His body temperature has decreased to normal level after opening the pulp cavity. Which type of fever was in the patient?

A. EfemeralB. SepticC. RecurrentD. RemittentE. Continua

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29. After being in the room with air temperature 40 0C and humidity 80% a patient has been brought to hospital in grave condition. He was unconscious; he had tachypnea, tachycardia, and body temperature 41 0C. Reanimation was failed. The patient has died. What is the most possible direct reason of death in this case?

A. Paralysis of the breath centerB. CollapseC. Coagulation of blood and decrease of volume of circulating bloodD. DehydrationE. Heart failure

30. The temperature of the ambient environment is 38°C and relative air humidity is 50%. What ways of heat emission provide maintaining a constant temperature of the human body?

A. ConvectionB. RadiationC. EvaporationD. Convection and conduction E. Heat conduction

Correct answers1 A 2 A 3 A 4 A 5 A 6 B 7 E 8 A 9 A 10 E11 C 12 A 13 B 14 E 15 A 16 C 17 A 18 A 19 A 20 A21 A 22 D 23 E 24 C 25 E 26 A 27 B 28 B 29 E 30 C

Situational tasks:

1. The pale, dry skin, chill, gooseflesh arised at patient after introduction of pyrogenal.1) Name the period of fever.____________________________________________________________2) How to explain the mechanisms of thermoregulatory center alteration in this stage.__________________________________________________________________________________________________________________________________________________________________________________2. Increase of temperature of body to 39,50С arised at patient with pneumonia. Red moist skin arised after conducting of febrifuge therapy.1) Name the period of fever.____________________________________________________________2) How to explain the mechanisms of thermoregulatory center alteration in this stage.__________________________________________________________________________________________________________________________________________________________________________________

3. Patient S., 48 years old, was hospitalized in a surgical department concerning planned cholecystectomy. Anaesthetist marked expressed tachycardia to - 200 bit per minute during conducting of inhalation anesthesia with myorelaxants,. Temperature of body - 43,10 C.1) What violation of thermoregulation developed at this patient?____________________________________________________________2) Name the reasons, mechanisms of development and consequences.__________________________________________________________________________________________________________________________________________________________________________________

4. Patient K., 25 years old, hospitalized in a surgical department concerning acute appendicitis. Anaesthetist marked expressed tachycardia to - 200 bit per minute during conducting of inhalation anesthesia with myorelaxants. Temperature of body - 43,20 C.1) What violation of thermoregulation developed at this patient?____________________________________________________________2) Name the differences of this thermoregulatory violation from other existent violations.__________________________________________________________________________________________________________________________________________________________________________________

35

5. Anaesthetist marked expressed tachycardia to - 200 bit per minute during conducting of inhalation anesthesia with myorelaxants at operation concerning strangulated hernia. Temperature of body - 43,30

C.1) What violation of thermoregulation developed at this patient?____________________________________________________________2) Name the reasons, mechanisms of development and consequences of this violation of thermoregulation.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Algorithm of practical skills: "Differentiation of temperature curves"

Types of fever according to the temperature curves:

1. Constant type2. Aperient type3. Intermittent type4. Hectic type5. Reverse type6. Relapsing type7. Undulating type

8. Irregular type

I. Features of the temperature curve.1. Febris continua: the difference between morning and evening body temperature ranges between 0,5-1,0 º

C.2. Febris remitens: the difference between morning and evening body temperature ranges between 1,0-2,0 º

C, morning body temperature falls below 38 º C, but not reduced to normal levels.3. Febris intermittens: there is a periodic, approximately at regular intervals (1 to 3 days) acute increasing of

body temperature (usually in the afternoon, sometimes at night) for several hours with next its decline to normal levels.

4. Febris hectica: continued fever with daily fluctuations of temperature 4,0-5,0 º C, with fever to 40,0-41,0 º C at night and its drop to subfebrile and normal values at morning.

5. Febris inversa: the maximal temperature is observed in the morning, at night it drops to normal or subfebrile values.

6. Febris recurrent: several days of alternating periods with next several days of apyretic (apyrexia).7. Febris undulans: there is a gradual increase of body temperature with next litical decline of it and more or

less long apyretic period.8. Febris atypica: there is an uncertain duration of the wrong variety and daily fluctuations of body

temperature as a constant, hectic, intermittent, recurrent, and other curves and combinations of it.

II. Type of temperature curve in English and Latin.1. Constant (continuous) type: febris continua2. Aperient (remittent) type: febris remittens3. Intermittent type: febris intermittens4. Hectic type: febris hectica5. Reverse (inverted) type: febris inversa6. Relapsing (recurrent) type: febris recurrens7. Undulating type: febris undulans8. Irregular (atypical) type: febris atipica

III. What disease this type of temperature curve is characteristic for?1. Febris continua: membranous pneumonia, rheumatism.2. Febris remitens: purulent inflammation, focal pneumonia.

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3. Febris intermittens: malaria.4. Febris hectica: sepsis, active pulmonary tuberculosis with disintegration of lung tissue.5. Febris inversa: sepsis, severe pulmonary tuberculosis.6. Febris reccurent: relapsing fever.7. Febris undulans: lymphogranulomatosis, brucellosis.8. Febris atypica: chronic bronchitis, cholecystitis.

Practical work: “HEAT EXCHANGE DISODERS”.

Object of work: to study the thermoregulation and common reaction of the cold-blooded and warm-blooded animals at overheating; To take the temperature in the oral cavity of a frog and to compare it to the temperature of the air and water.

EXPERIMENT 1. Put a frog into the glass and place it on a water-bath. Take the t°C of the water in the glass pot gradually rising it up to 40°C. Note the stage of the excitement and the pose at hyperthermia.

Take the frog out of the glass pot and again to take the temperature in the oral cavity. Study the common behavior of the frog. Count the respiratory rate before the overheating and at the movement of the overheating up to 40°C. Then gradually cool the frog. Write down the results of the experiment. Make the conclusions.

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:__________________________________________________

№ Temperature of water, °C

Temperature of frog, °C

Behavior of the frog

1

2

3

37

__________________________________________________________________________________________________________________________________________________________________________________

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

Conclusion:__________________________________________________________________________________________________________________________________________________________________________________

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Theme: ALIMENTARY STARVATION

Actuality of theme.Alimentary starvation is a pathological process which can arise up not only at the action of external

factors but can conduct a lot of diseases (oral cavity, esophagus, stomach, intestine, liver and other). Alimentary starvation can be at certain terms and the treatment factor. That is why a study of reasons, mechanisms of development of different forms of starvation, study of metabolic disturbance at stervation is important in the system of doctor preparation.

General purpose of the lesson.To know principal reasons, mechanisms of starvation development and metabolic disturbance in it.

For this it is necessary to know (the concrete purposes):1. To explain external and internal reasons of starvation.2. To adopt the conceptions of energetic, basic exchange.3. To describe factors which influence on the level of energetic exchange.4. To expose the changes of metabolism in different periods of starvation.5. To be able to explain changes at starvation at children.6. To describe etiology and pathogenesis of rachitis at children. To know principles of prophylaxis and

therapy of rachitis.

For realization of purposes of lesson it is necessary to have the base knowledges-skills:1. Indexes of metabolism and energy exchange in an organism (Biochemistry Department).2. Value of meal components (albumens, lipids, carbohydrates, vitamins and other) for the normal vital

functions of organism (Biochemistry Department).3. Mechanisms of the neurohumoral regulation of metabolism and energy exchange (Normal Physiology

Department).

The checking of primary level of knowledges.Give an answer to the followings questions:

1. What is the basic metabolism?2. External reasons of starvation.3. Internal reasons of starvation.4. Classification of starvation.5. What periods of complete starvation with water do you know?6. What is respiratory coefficient (RC)? What is it equal at norm?7. How RC changes at the I period of complete starvation with water?8. How RC changes at the II period of complete starvation with water?9. How RC changes at the III period of complete starvation with water?10. What is physiological starvation? Make examples.11. What life-span at complete absolute starvation?12. What life-span at complete starvation with water?13. What does incomplete starvation mean? Make examples. 14. What does partial starvation mean? What kinds of it do you know?15. What type of starvation is the base pathology which got the name „kwashiorkor”?

Theoretical questions at the base of which the execution of purpose types of activity is possible.1. Alimentary starvation, determination.2. Reasons of starvation.3. Pathophysiological description of complete starvation periods. Contribution of V.Pashutin to

development of studies about starvation.4. Pprotein-calorie deficiency. Reasons. Mechanisms of basic manifestations development.5. Starvation at children. Reasons of origin. Features of development.6. Kwashiorkor. Reasons of development. Description.7. Factors which influence on resistance of an organism to starvation.8. Conception about starvation diet.

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9. Etiology and pathogenesis of rachitis. ypervitaminosis D at children. Principles of prophylaxis and therapy of rachitis.



Publishers – 2011. p. 288-294



1. There is only one source of water for the body at absolute starvation - a process of organic compounds oxidation. Which of the following substances in these conditions is the main source of endogenous water?

A. FatsB. ProteinsC. CarbohydratesD.GlycoproteinsE. Lipoproteins

2. Negative nitrogen balance, hypoproteinemia, violation of water-solt metabolism combined with normal function of digestive system were founded at the vegetarians. Name the reason of this state.

A. Monotonous protein dietB. Monotonous carbohydrate dietC. Lack of unsaturated fatty acidsD. Deficiency of phospholipids in the foodE. Lack of vitamin E in the food

3. At 10th day of medical starvation the patient suffers from excitation, deep, noisy breathing, blood pressure dropped to 90/60 mmHg, oligouria, urine with a smell of acetone. Name the reason of this state.

A. KetosisB. Non-gas alkalosisC. HyperglicemiaD. HypoglycemiaE. Gas acidosis

4. Esophagus stenosis developed at a patient after a chemical burn. Sharp weight loss arised. In the blood: erythrocyte.-3,0х1012/l, Hb-106 g/l, whole [crude] protein - 57 g/l. What type of starvation developed at a patient?

A. AbsoluteB. AlbumenC. WaterD. IncompleteE. Complete

(2006-2009)

5. When is duration of starvation multiplied?А. At multiplying the body surface В. At increasing of basic methabolismС. At action of low temperatureD. At hyperfunktion of thyroid glandЕ. At decreasing of basic metabolism

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6. Basic metabolism is increase at starvation. The energy demand of the organism are provided due to the carbohydrates of reserves. RC=1. Synthesis of albumen is limited. The biosynthesis of amino acids from ketonic acid and ammonia is reduced. What is the period of starvation?

А. IndifferenceВ. OppressionС. ParalysisD. TerminalЕ. Excitation

7. Patient, 28 years, middle fatness starves 48 hours. What substances are used by muscular tissues as an energy source in this case?

A.GlucoseB. Amino acidC. Keton bodies and fat acidsD.LaktateE. Piruvate

8. At the long starvation hungry edema appear at people. What changes in an organism results it?A.Decline of onkotic pressure of bloodB. Decline of osmotic pressure of bloodC.Increase of secretion of ADGD.Decline of secretion of ADGE. Increase of onkotic pressure of blood

9. At the inspection of woman 50 years, who long time was on a vegetable diet, hypothermia, low blood pressure, muscular weakness, negative nitrous balance were founded. What factor caused such state of patient?

A.Increased amount of carbohydrates in a rationB. An insufficient amount of carbohydrates in a rationC.Increased using of liquidD.An insufficient amount of fats in a rationE. An insufficient amount of albumens in a ration

10. In an experiment in the conditions of absolute starvation water insufficiency is partly compensated by formation of endogenous water. What from the resulted matters at oxidization give the most account of water?

A.GlucoseB. FatsC.GlycerinD.GlikogenE. Protein

11. A patient presents with twilight vision impairment. Which of the following vitamins should be administered?

A. Retinol acetateB. CyanocobalaminC. Pyridoxine hydrochlorideD. Nicotinic acidE. Ascorbic acid

12. After a disease a 16-year-old boy is presenting with decreased function of protein synthesis in the liver as a result of vitamin K deficiency. This may cause disorder of:

A. Blood coagulationB. Osmotic blood pressure C. Erythrocyte sedimentation rate

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D. Anticoagulant productionE. Erythropoіetin production

13. In patients with the biliary tract obstruction the blood coagulation is inhibited; the patients have frequent haemorrhages caused by the subnormal assimilation of the following vitamin:

A. AB. KC. E D. DE. C

14. While determining power inputs of a patient's organism it was established that the respiratory coefficient equaled 1.0. This means that in the cells of the patient the following substances are mainly oxidized:

A. Proteins and carbohydratesB. Carbohydrates and fatsC. ProteinsD. CarbohydratesE. Fats

Correct answers1 A 2 B 3 A 4 D 5 E 6 E 7 A8 A 9 E 10 A 11 A 12 A 13 B 14 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.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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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.__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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?____________________________________________________________2) What are the reasons of this type of starvation?__________________________________________________________________________________________________________________________________________________________________________________

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?____________________________________________________________2) How to explain the decrease of blood cells and haemoglobin in the blood?__________________________________________________________________________________________________________________________________________________________________________________3) Will resistance of organism to the infectious agents change in this case? Explain the answer. __________________________________________________________________________________________________________________________________________________________________________________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?____________________________________________________________2) What are the causes and mechanisms of this pathology development?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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?____________________________________________________________2) That is the duration of this type of starvation?____________________________________________________________3) That is the difference of this type of starvation from incomplete?_________________________________________________________________________________________________________________________________________________________________________________

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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. To know determination of conceptions " hypertrophy", " hyperplasia ", "regeneration", "atrophy",

"dystrophy", "tumour".2. To know the features of innocent and malignant tumours growth.3. To describe principal reasons of tumour growth.4. To be able to explain the mechanisms of transformation of normal cell in a tumour one.5. To know general principles of patients treatment with malignant tumours.

For realization of purposes of lesson it is necessary to have the base knowledges-skills:1. To know the structure of cell (Histology Department).2. To know the mechanisms of cell division (Biology and Hystology Departments).3. To know principles of metabolism (albumen, carbohydrate, fatty) (Biochemestry Department).4. To have imagination about DNA- and RNA-contained viruses (Microbiology department).5. Conception about structure, functions and gene regulation (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?

44

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, endogenous3. 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. Tumour, determination. Morphological, biochemical and physiological features of of tumours cells.2. Reasons of tumours origin.3. Basic mechanisms of carcinogenesis.4. Description of tumour progression.5. Ways and terms of tumour cells metastasis.6. Co-operation of tumour and organism. Mechanisms of cancer cachexy.7. Experimental study of tumours etiology and pathogenesis.8. Pathophysiological bases of tumours prophylaxis and treatment.9. Tumours at children.



Publishers – 2011. p. 166-183

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1. Lung cancer developed at the patient who smoked tobacco for a long time. What of the carcinogens contained in tobacco smoke and concern to PAH?

A. BenzpirenB. DymethylaminoazobenzolC. β - naphthylaminD. DiethylnitrozaminE. Ortoaminoazotoluol

2. There is high stage of interaction between lung cancer and tobacco smoking. What chemical carcinogen is contained in tobacco smog?

A. 3,4-benspyrenB. OrhtoaninotoluolC. AphlatoxinD. MethylcholatrenE. Dyethylnitrosamine

3. Patient, 62 years old, a fireman, complains of general weakness, sudden weight loss, husky voice, shortness of breathing, dry cough. Laryngeal tumor that germinates vocal cords and epiglottis was discovered at laryngoscopy. Name the most likely cause of the tumor in this patient:

A. Polycyclic aromatic hydrocarbonsB. NitrosaminesC. Aromatic amine and amidesD. RetrovirusE. Ionizing radiation

(2006-2009)

4. In a patient with metastases of lung carcinoma introduction of cytostatics led to suspension of metastases growth at first but later metastases resumed spread. What is the most possible mechanism of secondary growth of metastases?

A. Absence of contact brakingB. Absence of Heiflik’s limitC. Rise of genetic heterogeneity of tumor cells D. Increased glucose consumption by tumourE. Increased amino acids consumption by tumour

5. 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 liverB. HepatitisC. Cirrhosis of liverD. Gallstone diseaseE. Dyskinesia of bile ducts

6. Malignant tumor of lung was diagnosed in a patient. What feature of tumour growth testifies its malignancy?

46

A. Infiltrative growth B. Unregulated growthC. Unlimited growthD. Expansive growthE. Appearance from one cell

7. The woman complained to the doctor for changing of voice, appearance of hair on the face, and reduction of breast. Where would a tumor develop that could lead to these symptoms?

A. Tumor of zona reticulata of adrenal glandsB. Tumor of ovariesC. Tumor of anterior lobe of pituitary glandD. Tumor of zona glomerulata of adrenal glandsE. Tumor of zona fasciculata of adrenal glands

8. Following changes can occur in development of tumor:A. Pheochromocitoma – hypotensionB. Insulinoma – hypoglycemiaC. Aldosteroma – hypohydratationD. Tumor of zona reticulata of adrenal glands – inhibition of sexual growthE. Tumor of thyroid gland – hypothyroidism

9. A male patient, 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 cachexyB. MyastheniaC. Addison’s diseaseD. Cancer cachexyE. Brown induration

10. In 1910 Rhauss managed to cause sarcoma in chickens by cell-free infiltrate inserting. What was the method of experimental modeling?

A. InductionB. ExplantationC. IsotransplantationD. HomotransplantationE. Heterotransplantation

11. What biological process augmentation is typical for tumor cells?A. Anaerobic glycolysisB. DecarboxilationC. Tissue respirationD. LipolysisE. Gluconeogenesis

12. Erlich’s tumor was transplanted to animal. What is the evidence of tumor progression?A. Unlimited growthB. Resistance to cytostaticsC. AnaplasiaD. InfiltrationE. Tumor weight increasing

13. Unpainted formation under the jaw was appeared in liquidator of Chernobyl’s disaster after 12 years of accident. The size of it has increased till last month. The blood analysis is in norm. What pathological process is most suspicious in this case?

A. Lymphadenitis

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B. SyaloadenitisC. AbscessD. Malignant tumorE. Cyst

14. There is a tumor of tongue in patient. What characteristics of tumor may be considered as malignant?

A. DysplasiaB. ExpansionC. InfiltrationD. Pasteur’s positive effectE. Mitosis increasing

15. What cell structure is a «target» for chemical cancerogens?A. Nuclear DNAB. LysosomesC. MitochondriaD. Cytoplasmic membraneE. Ribosomes

16. 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 carbohydratesB. AminoasosubstancesC. NitrosaminesD. AminesE. Heterocyclic carbohydrates

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

A. NaphtylamineB. DichlorethaneC. Vinegar acidD. AlcoholE. Pethroleynic aether

18. It is established that tumor tissue receives in 20-25 times less of glucose that intact tissue in equal glucose amount. What metabolic changings lead to such event?

A. Aerobic glycolysis enhancementB. Oxydation improvementC. Normal interaction of these processesD. Tissue respiration improvementE. Decreasing of anaerobic glycolysis

19. They got nitrogenous nitrite to experimental animals. A tumor was developed in 80% of animals. What was the group of cancerogens?

A. NitrosaminesB. AminoasosubstancesC. Polycyclic carbohydratesD. Simple chemical substancesE. Hormones

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

A. Oncogenic

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B. ThermalC. MutagenicD. CytostaticsE. Immunostimulative

Correct answers1 A 2 A 3 A 4 C 5 A 6 A 7 A 8 B 9 D 10 A11 A 12 B 13 D 14 C 15 A 16 A 17 A 18 A 19 A 20 A

Situate task:1. Man, 65 years old, who were smoking during 35, signs the decrease of appetite, weight loss, dry cough, shortness of breath, decrease of capacity during last few months. At an inspection: anaemia, leucocytes - 10,5x10 9 /l, methamielocytes-3%, stab neutrophiles -9%, segmentonuclear neutrophiles-61%, lymphocytes-17%, monocytes -10%, ESR - 21 mm/hour. The orbed darkening in the area of right bronchial tube with the diameter of 2sm was discovered at X-ray examination. 1) What kind of pathology was diagnosed at patient?___________________________________________________________2) Possible etiologic factors of this pathology._________________________________________________________________________________________________________________________________________________________________________________2. Man, 49 years old, was on a clinical account concerning ulcerous illness of stomach during 25 years. Tumular formation of small curvature of stomach was founded at the duty fibrogastroscopy review. Cancer of stomach was diagnosed after cytological examination.1) Tumor, definition.________________________________________________________________________________________________________________________________________________________________________________2) What is the mechanism of this tumour development?__________________________________________________________________________________________________________________________________________________________________________________3. Woman, 53 years old, complain of the periodic uterine bleeding and general weakness at the gynecologist reception. Fibromyoma of uterus was diagnosed after careful inspection.1) Tumor, definition.________________________________________________________________________________________________________________________2) Basic differences of benigh tumour from malignant.__________________________________________________________________________________________________________________________________________________________________________________4. Man, 57 years old, complain of acute weight loss on 15 kg during last 8 months, general weakness, decrease of appetite. Cancer of stomach was diagnosed after careful inspection.1) Tumor, definition._________________________________________________________________________________________________________________________________________________________________________________2) Basic mechanisms of cancer cachexy development.__________________________________________________________________________________________________________________________________________________________________________________

5. Patient K., 50 years old, was operated concerning the cancer of thyroid gland. Adjacent lymph nodes were removed also by a doctor during operation.1) Why the lymph nods were remote? ____________________________________________________________2) Mechanisms of malignant tumours metastasis?__________________________________________________________________________________________________________________________________________________________________________________3) Possible ways of metastasis.________________________________________________________________________________________________________________________________________________________________________________

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Theme: PATHOLOGY OF CARBOHYDRATE METABOLISM

Actuality of the theme.Violation of carbohydrate metabolism is the leading link in pathogenesis of many diseases (nervous, cardio-

vascular systems, liver). Most frequent and the most heavy form of pathology of carbohydrate metabolism is diabetes mellitus.

Diabetes mellitus - one of the most widespread diseases with steady tendency to growth. From data of WHO, frequency of him on the average hesitates from 1,5 to 3-4%, considerably growing in the developed countries of the world (to 5-6%).

Growth of morbidity, heavy invalidization consequences and high lethality, especially among capable of working population develops due to diabetes mellitus and it complications.

Fight against diabetes mellitus is delivered to the medico-social problems. Understanding of reasons which influence on growth of morbidity on diabetes finding out of thin mechanisms of its development, understanding of prophylactic, sanitary educational measures on morbidity of population of Ukraine on diabetes mellitus, has an irrefutable value.

General purpose of the lesson Learn reasons and mechanisms of development of basic types hypo- and hyperglycemia. To study

etiology, pathogenesis, mechanism of development of basic displays of diabetes mellitus, its pathogenic treatment.

For this it is necessary to know:1. To expose the typical forms of violations of carbohydrate metabolism.2. To define reasons and mechanisms of hypo- and hyperglycemia development.3. To expose reasons and mechanisms of hypo- and hyperglycemia development at the children of

different age, value of these changes for child's organism.4. To explain the modern views of reasons and pathogenesis of diabetes mellitus.5. To explain intercommunication between disorders of metabolism and basic functional violations at

diabetes mellitus.6. To expose features, which is typical for diabetes mellitus at children.7. Transfer the base moments of the first aid during hypo- and hyperglycemic states.

For realization of purpose of lesson it is necessary to have the base knowledges-skills. 1. Role of carbohydrates in an organism (department of biochemistry).2. Intercommunication between carbohydrate, lipid and protein metabolism (BiochemistryDepartment).3. Neurohumoral regulation of carbohydrate metabolism (Normal Physiology Department)

The checking of primary level of knowledges. Give the answer to the followings questions:1. Hormones which take part in regulation of carbohydrate metabolism.2. Participation of the nervous system in the carbohydrate metabolism regulation.3. Contrinsular hormones.4. Where is the place of insulin production?5. What is hyperglycemia? Kinds.6. What is hypoglycemia? Kinds.7. What is glycosuria?8. What is a kidney threshold for glucose? Why is it evened?9. What is diabetes mellitus? Definition.10. Types of diabetes mellitus.11. Commas which arise up at diabetes mellitus, mechanisms of their development12. Ketoacidotic coma, reasons.13. Hyperosmolar coma, reasons.14. Reasons of hypoglycemic coma development at diabetes mellitus?15. What are consequences of hypoglycemia?16. What are complications of diabetes mellitus?17. What are the experimental models of diabetes mellitus?

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Theoretical questions for FMC №1.1. Typical forms of violations of carbohydrate metabolism.2. Hyperglycemia, kinds, reasons of origin, mechanisms of

development. Value for organism.3. Children’s hyperglycemia. Reasons and mechanisms of

development. Value for child's organism.4. Hypoglycemia, reasons of origin, mechanisms of development.

Value for an organism.5. Child kidneys hypoglycemia. Reasons and mechanisms of

development. Value for the children of different age.6. Diabetes mellitus. Modern view of etiology and pathogenesis.

Classification.7. Childkidneys diabetes mellitus. Reasons, mechanisms of

development. Communication with the antigens of HLA.8. Mechanisms of development of diabetes mellitus main

manifestations.9. Metabolic disorders at diabetes mellitus.10. Coma, determination of concept. Pathogenesis of basic types of

comas which can arise at diabetes mellitus, pathogenic treatment.11. Basic experimental models of diabetes mellitus.

Literature is necessary for theoretical questions .1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU,

2005.p.146-1512. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005.134-1443. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin – Vinnytsia: Nova Knuha

Publishers – 2011. p.294-321Nota bene!

Glycated hemoglobin - (НвА1с) - contains glucose, attached to terminal valin in every ß chain.It is permanent index of the compensative state of diabetes mellitus.The concentration of it is increased in patients with decompensate diabetes mellitus.Normal index of НвА1с in blood: 5-7% from the general level of hemoglobin.

THEMES of reports for individual work of students:1. Modern view in mechanisms of development of microangiopathy at diabetes mellitus.2. Modern view in mechanisms of development of macroangiopathy at diabetes mellitus.3. Modern view in mechanisms of development of diabetic coma. Pathogenetic treatment.4. Modern view in mechanisms of development of hyperosmolar coma. Pathogenetic treatment.


Tests of an open database (2014)Prolonged fasting causes hypoglycemia which is amplified by alcohol consumption, as the following process is inhibited: A. Gluconeogenesis B. Glycolysis C. Glycogenolysis D. Lipolysis E. Proteolysis

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1. A patient with the symptoms of acute alcoholic poisoning was brought to the hospital. What carbohydrates metabolism changes are typical for this condition? A The gluconeogenesis velocity in liver is decreased B The gluconeogenesis is increased in liver C The breakage of glycogen is increased in liver D The anaerobic glucose metabolism predominates in muscles E The anaerobic breakage of glucose is increased in muscles


1. A patient, 24, suffers from dryness in a mouth, decline of waight on the base of the increased appetite, increase of urine amount. What test for the diagnosis is it necessary to make first of all?

A Determination of glucose level in the day's amount of urine B Analysis of urine according to Zimnitskyy C General analysis of urine D Research of albuminous factions of the blood serumE Coagulograme

2. Apatient with a diabetes mellitus delivered in a hospital in the state of unconsciousness. Kussmaul’s breathing, blood pressure 80/50 mmHg, the smell of acetone from a mouth. By accumulation of what substances in the organism it is possible to explain the origin of these disorders?

A Keton bodies B Modified lipoproteidsC Lactic acid D Coal acid E Complete carbohydrates

3. Glucose was founded in the purine of patient who suffers from polyuria and polydipsia. Content of dlucose in the blood plasma is normal. What is the mechanism of glucosuria development for a patient?

A Violation of glucose reabsorption in the tubulis. B Violation of glucose filtration in the glomerulis. C Insufficient production of insulin by a pancreas. D Resistance of cell receptors to insulin. E Hyperproduction of glucocorticoids by the adrenal gland.

4. A woman 26 years suffers from dryness in to the mouth, thirst. At an inspection: a level of glucose in the blood is 6,5 mmol/l, glucosuria. For what from the marked below states these symptoms are most characteristic for?

A Kidney diabetesB Steroid diabetes C Diabetes insipidusD Alimentary glucosuria E Diabetes mellitus

5. Insulin was entered to a patient with insulindepended diabetes mellitus. After some time general weakness, irritability, increase of sweating arose up. What basic mechanism of of hypoglycemic comma development?

A Carbohydrate starvation of brain. B Intensification of glycogenolysis. C Intensification of ketogenesis. D Intensification of lipogenesis. E Diminishing of glyconeogenesis.

6. A 12-year-old teenager has significantly put off weight within 3 months; glucose concentration rose up

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to 50 millimole\l. He fell into a coma. What is the main mechanism of its development? A Hyperosmolar B Hypoglycemic C Ketonemic D Lactacidemic E Hypoxic

7. A child 12 years after the carried rubella had loss of weight, permanent feeling of thirst, increase of appetite, polyuria. Objectively: diuresis 6 l, glucose of blood - 17,8 mmol/L, in urine found out glucose and acetone. What pathology can be assumed for a patient?

A. Diabetes mellitus Ι typeB. Diabetic nephropathyC. Diabetes mellitus ІІ typeD. Violation of tolerance to glucoseE. Diabetes insipidus

8. Patient with diabetes didn't get insulin injection in time that caused hyperglycemic coma (glucose in the blood 50mmol/L). What mechanism is prevalent in the development of the coma?

A Hyperosmia B HypokaliemiaC HypoxiaD HyponatremiaE Acidosis

9. A woman, aged 58, was admitted to the hospital in severe condition. She has confused consciousness; dry skin, hollow eyes, cyanosis, and scent of acetone from her mouth. At laboratory examination of her: glucose in blood – 15.2 mmol/L, ceton bodies – 100 mcmol/l. What is the most possible reason for this condition?

A. Hypoglycemic comaB. Ketoacidotic coma C. Hypovolemic comaD. Uremic comaE. Anaphylactic shock

10. A patient was admitted to the hospital. Objectively: the state is heavy, consciousness is absent, adynamia. Skin is dry, hollow eyes, cyanosis, taxicardia, smell of acetone from a mouth. Results of analyses: glucose of blood -20,1 mmol/L (normal -3,3-5,5 mmol/L), in urine -3,5% (normal - 0). What the most reliable diagnosis?

A. Sharp alcoholic poisoningB. Hypoglycemic comaC. Аnaphylactic shockD.Hyperglycemic comaE. Cardiac insufficiency

11. A patient suffering from pheochromocytoma complains of thirst, dry mouth, hunger. Blood test for sugar revealed hyperglycemia. What type of hyperglycemia is it?

A Adrenal B Hypercorticoid C Alimentary D Somatotropic E Hypoinsulinemic

(2006-2009)

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12. Patient has diabetes mellitus. Hyperglycemia over 7,2 mmol/L. The level of what protein of plasma does allow retrospectively (previous 4-8 weeks to an inspection) to estimate the level of glycemia?

А. Ceruloplasmin В. Glycated hemoglobinС. FibrinogenD. С-reactive proteinE. Albumen

13. In a patient with diabetes mellitus loss of consciousness and cramps were observed after insulin injection. What is a possible result of blood test for glucose in this case?

A. 5.5 mmol/LB. 3.3 mmol/LC. 8.0 mmol/LD. 10 mmol/LE. 1.5 mmol/L

14. At diabetes mellitus can develop ketosis as a result of activation of lipid acids oxygenation. What violations of ABB can bring accumulation of keton bodies in blood?

А. Respiratory acidosisВ. Respiratory alkalosisС. Exogenous acidosis D. Metabolic acidosis Е. Excretory acidosis

15. Content of glucose in patient’s blood is: on an empty stomach - 5,6 mmol/l, in 1 hour after taking sugar - 13,8 mmol/l, and in 3 hours -9,2 mmol/l. What pathology such indexes characterise?

А. Healthy personВ. Аcromegaly С. Ichenko- Kushinga diseaseD. Diabetes mellitusЕ. Thyreotoxycosis

16. Content of glucose in patient’s blood is: on an empty stomach – 5.65 mmol/l, in one hour after taking sugar – 8.55 mmol/l, and in two hours after taking sugar – 4.95 mmol/l. These signs are characteristic for:

A. Healthy personB. Person suffered from hidden diabetes mellitusC. Person suffered from non-insulin-dependent diabetes mellitusD. Person suffered from insulin-dependent diabetes mellitusE. Person suffered from thyrotoxicosis

17. Newborn has been refusing food, having vomiting and diarrhea, and some time later its crystalline lens become opaque. At examination of newborn: glucose in blood – 8.5 mmol/L and in urine – 1%. What is the most possible diagnosis?

A. GalactosemiaB. PhenylketonuriaC. TyrosinosisD. CystinuriaE. Alkaptonuria

18. Introduction of adrenalin in the experiment to the animal causes the increase of glucose in blood. A result of what hormone action is this hyperglycemia?

A. Increase of absorption of glucose in intestineB. Decrease of glicogenesisC. Activation of gluconeogenesisD. Activation of glycogenolysis in the liver

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E. Decrease of hexokinase activation

19. At the inspection of patient glycemia -16 mmol/L, acetone bodies - 0,52 mmol/L, at urine - 2% glucose, acetone bodies + + +, diures 10 l in day. About what disease it is possible to think?

A. Illness of Itsenko-KuchingB. Steroid diabetesC. Kidney diabetesD. Diabetes mellitus E. Diabetes insipidus

20. During examination the increase of glucose level is marked in students blood. What mechanism linked in this case?

A. Increase of products of glucagonsB. Increase of products of STHC. Increase of insulin production by pancreasD. Activating of the sympato-adrenal systemE. Increase of tonus of the parasympathic nervous system

21. To the patient with diabetes mellitus with the purpose of hyperglycemic effect appointed insulin. What mechanism of insulin action?

A. Warning of suction of glucose in a thin intestineB. Activation of gluconeogenesisC. Increasing of selection of endogenous insulin by pancreasD. By the assistance of penetration of glucose to the cell and its utilizationE. Activation of anaerobic glicolis

22. A patient was admitted to the hospital in comatose state with the smell of acetone from mouth. Level of glucose in plasma of blood - 18 mmol/L. What type of coma is the most possible in this patient?

A. Ketoacidotic B. ToxicC. Hyperosmolar comaD. Lactic acidosis E. Hypoglycemic coma

23. Patient has hyperglycemia, polyuria, hyperstenuria, ketonuria, glucosuria. What nosology can connect all these indexes?

A. Diabetes mellitus B. Diencephalic obesityC. Diabetes insipidusD. GlikogenosisE. Kidney diabetes

24. A patient suffers from frequent head aiche, somnolence, crabbiness. At laboratory tests the level of glucose of blood is on an empty stomach - 2,8 mmol/L, after taking sugar the maximal concentration of glucose 4,7 mmol/L. The contents of insulin in blood in 10 times exceeds normal indexes, that characteristically for insulinoma. Activity of which processes is most promoted at this pathology?

A. LipolisB. Suction of glucose in an intestineC. Absorption of glucose by cellD. Synthesis of glicogenesE. Litogenesis

25. A man, aged 38, is under the course of treatment for schizophrenia at in-patient department. Contents of glucose, ketone bodies, and urea in his blood are normal. Shock therapy with regular

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injections of insulin has led to development of insular coma, and after that state of patient becomes better. What is the most possible reason for insulin coma?

A. GlucosuriaB. Dehydration of tissuesC. HypoglycemiaD. Metabolic acidosisE. Ketonemia

26. Man, 28 years, suffers diabetes mellitus from 6 years age, he hospitalized in the comatose state which arose up after the physical loading. Skin moisture, tone of muscles and reflexes of tendons promoted, breathing is superficial, taxicardia, low blood pressure, level of glucose in blood - 1,88 mmol/L. This symptoms most characteristic for?

A. Diabetic ketoacidosisB. Lactic acidosis C. Hypoglycemic coma D. CollapseE. Hyperosmolar coma

27. Man, 43years, delivered to the hospital in the comatose state. Objectively: a skin is dry, breathing is superficial frequent, the smell of acetone is absent, taxicardia, hypotension. Level of glucose in blood - 48 mmol/L, the reaction of urine on the acetone is negative. These symptoms most characteristic for?

A. Hypertensive crisB. Ketoacidotic comaC. Lactic comaD. CollapseE. Hyperosmolar coma

28. Person, 42, was admitted to the hospital in the comatose state. Objectively: a skin is dry, pale, smell of acetone from the mouth, Kussmaul respiration, taxicardia, low blood pressure, level of glucose in blood - 27,7 mmol/L. What kind of coma has developed in this patient?

A. StarvationB. Ketoacidotic coma C. Hyperosmolar comaD. Lactic comaE. Alcoholic intoxication

29. Woman, 45 years, the symptoms of diabetes are absent, but the level of glucose on an empty stomach determined in blood (7,5 mmol/L). What index must be conducted for clarification of presence of diabetes?

A. Remaining nitrogen of bloodB. Glucose of blood on an empty stomachC. Acetone bodies in urine, bloodD. Tolerance to glucoseE. Glycated hemoglobin

30. Patient with the Itsenko-Cushing syndrome has hyperglycemia because of hyperprodaction of glycocorticoids. What leading mechanism of hyperglycemia in this case?

A. Decrease of activity of hexokinasB. Activating of glycogenolisis in liverC. Activating of glyconeogenesis in liverD. Strengthening of absirbtion of glucose in an intestineE. Activating of insulinase in liver

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31. A patient with diabetes mellitus did not take the dose of insulin in time. Thus hyperglycemic coma developed (content of glucose in patient’s blood is 50 mmol/L). What is the leading factor for such coma development?

A. Hyperosmolarity of blood plasmaB. HypokalemiaC. HypoxiaD. HyponatremiaE. Acidosis

32. On the second week after gastrectomia for a patient in a hour after taking sweat food on the empty stomach develop sharp hypoglycemic state. What phenomenon does lie in basis of this state?

A. Alimentar hypoglycemiaB. GlikogenosC. PhermentopatiaD. Adrenal insufficiencyE. Dumping-syndrome

33. During the experiment rat was injected with 5% alloxan solution in dose 200 mg per kg of rat weight. What kind of pathology arises in this case?

A. Arterial hypertensionB. Acute renal failureC. Diabetes insipidusD. Diabetes mellitusE. Hepatic failure

34. After the break of diet (taking the easy for assimilation carbohydrates) in a woman, who has been suffering from diabetes mellitus for a long time, general malaise and increase of blood pressure gradually develop and hallucinations and cramps appear. Woman has dry skin and distinct signs of dehydration. What is the reason for worsening of patient’s condition?

A. Hypoglycemic comaB. Hyperosmolar hyperglycemic comaC. Diabetic ketoacidosisD. Heart failureE. Respiratory failure

35. What is the reason for glucosuria appearance under diabetes mellitus?A. HyperglycemiaB. Increase of renal thresholdC. Rise of hexokinase activityD. Increase of glomerular membrane permeabilityE. Polyuria

36. A patient, aged 50, complains of increased appetite, thirst, and loss of body weight, weakness. At laboratory examination rise of amount of glucose in his blood revealed. What type of cells is injured in case of this disease development?A. LipotropocytesB. ThyrocytesC. B-cells of Langerhans isletsD. A-cells of Langerhans isletsE. Pancreatocytes

37. A patient address to a doctor with complaints of constant thirst. Hyperglycemia, polyuria and increased content of 17-ketosteroids in urine were revealed. What is the most probable disease in this case?

A. Addison’s disease

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B. MychedemaC. Glycogenosis of I typeD. Insulin dependent diabetes mellitusE. Steroid diabetes

38. A patient was admitted to the hospital in comatose state. Accompanying people said that hi lost consciousness at training while he was finishing the Marathon distance. What sort of coma is the most possible in this patient?

A. HyperglycemicB. HypoglycemicC. HypothyroidD. HepaticE. Diabetic ketoacidosis

39. In 18-years-old patient, while laboratory examining presence of glucose in urine and normal concentration of glucose in blood plasma were revealed. What disorder is the most possible cause of these changes?

A. Disorders of glomerular filtrationB. Disorders of tubular secretionC. Disorders of glucocorticoids secretionD. Disorders of insulin secretionE. Disorders of tubular reabsorption

40. A 19-years-old patient has suffered from diabetes mellitus since he was 8. He took cure irregularly. He was admitted to the hospital in connection to diabetes ketoacidosis development. What kind of respiration is the most possible in this condition?

A. Kussmaul respirationB. Biot’s respirationC. Chane-Stocks respirationD. Inspiratory breathlessnessE. Expiratory breathlessness

41. In a patient, who has poisoning with flodzine, glucosuria was revealed; concentration of glucose in patient’s blood is 5.6 mmol/L. What is the mechanism of glucosuria in this case?

A. Disturbances of tubular reabsorptionB. Reduction of glomerular filtrationC. Increase of glomerular filtrationD. Disorders of tubular secretionE. Rise of oncotic pressure of blood

42. Woman, 45 years disease of Kuchinga - steroid diabetes. At a biochemical inspection: hyperglycemia, hypochloremia. What processes is activated first of all?

A. Glicogenolis B. Тransportation of glucose in a mewC. GlicolisD. GluconeogenesisE. Reabsorption of glucose

43. A patient suffers from neurodermitis for a long time, use prednisolon. During examination increase of glucose in blood was found. In what link of carbohydrate metabolism prednisolon influence ?

A. Increase of suction of glucose in an intestineB. Activation of gluconeogenesisC. Decrease of synthesis of glicogenD. Activating of breaking up of insulinE. Activating of glycogenogenesis

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44. Patient with diabetes mellitus. In blood increase of level of free lipid acids. Reason of what it can be:A. Increase of thriglyceridlipase of adipocytes activity B. Accumulation in cytosolum palmitin-KoAC. Activating of apolipoprotein А-1, А-2, А-4synthesisD. Decrease of activity of phosphatidilcholin –cholesterin - acetyltransferase of plasmaE. Activating of utilization of keton bodies

Correct answers1-A 2-A 3-A 4-A 5-A 6-A 7-A 8-A 9-B10-D 11-A 12-B 13-E 14-D 15-D 16-A 17-A 18-D19-D 20-D 21-D 22-A 23-A 24-C 25-C 26-C 27-E28-B 29-B 30-C 31-A 32-E 33-D 34-C 35-B 36-C37-E 38-B 39-E 40-A 41-A 42-D 43-B 44-A

Situational tasks:

1. A patient is delivered to the clinic in the comatose state. Breathing is deep, noisy. Smell of acetone. Level of glucose in blood - 16,1 mmol/L. Found out glucosuria. Reaction of urine on acetone ++++.1. What disease is described?____________________________________________________________2. Mechanisms of hyperglycemia?_________________________________________________________________________________________3. Mechanism of glucosuria?_________________________________________________________________________________________4. Mechanism of the appearance of acetone in urine?_________________________________________________________________________________________5. Mechanism of the smell of acetone._________________________________________________________________________________________6. Mechanism of the violation of breathing?_________________________________________________________________________________________7. What is the type of pathological breathing in this case._________________________________________________________________________________________

2. Patient, 45 years, which uses an alcohol, feels a weakness, dizziness, thirst last time. He marks appearance of shortness of breathing, acute weakness, sweating after psychical overload. He lost consciousness in a transport.Objectively: skin is pale, AP is 70/45 mm Hg, tachicardia (120/min), violation of breathing (breathing of Chein-Stoks).1. What additional researches are necessary for diagnosis._________________________________________________________________________________________2. What form of carbohydrate metabolism pathology in a patient?_________________________________________________________________________________________3. What role of alcohol intoxication in development of this pathology?_________________________________________________________________________________________________________________________________________________________________________________4. During conducting of test with glucose loading was inspected: level of glucose on an empty stomach - 6,66 mmol/L, in two hours after loading - 8 mmol/L.1. What the results of test testify about?____________________________________________________________2. How have to maintenance of glucose change in blood for a healthy man through the same time after loading? ________________________________________________________________________________________________________________________________________________________________________________

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3. What is practical value of test with glucose loading?________________________________________________________________________________________________________________________

Algorithm for skills passing"Analyses of the glucose-tolerance test indexes at the patients with

diabetes mellitus" 1. Name the reasons for the GTT

Standard answer:- Capillary blood glucose on an empty stomach - more than 5.5 mmol / l- Presence of a diabetes mellitus at the family- Presens of the paradіabetes symptoms (itching of the skin and mucous membranes, often purulent disease, candidiasis)

2. Name the main stages of the GTT

Standard answer:- Weigh the patient- Determination of the concentration of glucose in the capillary blood- Peroral intake of glucose at a rate of 1g/kg of body weight- Determination of the glucose concentration in capillary blood of patient after 2 hours

3. Appraise the results of GTT in this patient in accordance with the diagnostic criterias of diabetes mellitus and other categories of hyperglycaemia.

Standard answer:

Conclusion Concentration of glucose in the capillary blood on an empty stomach

concentration of glucose in capillary blood after 2 hours after the glucose loading

Diabetes mellitus More than 6.1 mmol/l More than or equal to 11.1mmol/L

Disordered glucose tolerance Less than 6.1 mmol/l 7,8 - 11.1 mmol/lDisordered blood glucose 5.6 - 6.1 mmol/l Less than 7.8 mmol/l

Practical work: “PATHOLOGY OF CARBOHYDRATE METABOLISM”

Object of work: to model experimental hypoglicemia for a rabbit. Content of work: determination of glucose concentration in condition of insulin intoxication.

EXPERIMENT 1. Students work as brigades. The first brigade carries out the test on determination of glucose in the control samples; the other one carries out the test in experimental samples: before and after insulin introduction.Insulin is entered to the rabbit which was not fed by 24 hours in an amount 10 ME on the 1 kg of weight under the skin of the back.

First test is carried out in 15 minutes after insulin introduction, than in 30 min., in 1 hour, in 1,5 hour.Blood for the test in an amount 0,1 ml is taken from an ear regional vein.After taking the blood the 10-15 ml of 30% glucose solution is entered to the rabbit throw the ear

regional vein or through the mouth with the purpose to remove of insulin hypoglicemia.COURSE OF ANALYSIS:

1. Fill in two test tubes by 1 ml of decinormal solution of caustic soda and 5 ml of 0,45% solution of sulfuric zinc.

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2. Add to one of test tubes 0,1 ml of blood, wash a pipette by solution from a test tube 2-3 times. The second test tube remains the control.

3. Put both test tubes on an water bath on 3 min.4. Filter the maintenance of test tube through the sterile cotton wool in glass.5. Wash test tubes twice by 3 ml of the distilled water which is poured on a filter. At the end of filtration

the filter is levitated on an edge of bailer. Wait while all liquid will flow from it. Take away the filter from the bailer and shake off the drops of liquid which remained in the bailer in glass.

6. Add to the filtrate 2 ml K3[Fe(CN) 6] 1: 200.7. Boil on an water bath during 15 min.8. Cool glasses and add to each 2 ml of mixture of salts.9. Add to each glasses 2 ml of 3 % to solution of СН3СООН.10. Add 2-3 drops of 1 % to solution of starch.11. Titrate the maintenance of glasses by hyposulphite 1:200 till discolouring.12. Find the maintenance of glucose at the table by the amounts of hyposulphite which we used for

titration.13. Find the maintenance of glucose in the control tube at the table by the amounts of hyposulphite

which we used for titration.14. Find a difference in the maintenance of glucose in an experimental test tube, take away an error,

determine the maintenance of glucose in blood in mg % . For the translation of the got result in mmol/l (international unit) use the coefficient - 0,05.An initial maintenance of glucose in the blood before the introduction of insulin

is___________mmol/l, after the introduction of insulin : in 15 min. - _________mmol/l, in 30 min. - _________ mmol/l in 90 min. - _________ mmol/l in 120 min.- _________ mmol/l

Conclusion:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Theme: VIOLATION of WATER-ELECTROLYTE METABOLISM.Actuality of the theme.The changes of water and electrolytes maintenance in the organism and their redistribution between the

separate sectors of water violate such major parameters of homeostasis, constancy of volume, osmotic and ionic composition of blood, extracellular and intracellular liquid. It can cause violation of blood circulation, retraction of heart function, edema, changes of acid basic balance and other.

Violations of water-electrolyte metabolism can be the result not only external influencing but also internal disorders.

A lot of diseases and the pathological states accompanied with the changes of water-electrolyte homeostasis parameters which complicates their course.

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The effective correction of water-electrolyte homeostasis changes is possible only on condition of etiology and mechanisms of their development knowledge.

General purpose of the lesson To learn violation of water-electrolyte metabolism, reason for origin and mechanisms of their development.

Learn reasons and mechanisms of edema development.For this it is necessary to know:1. To select principal reasons for violations of water-electrolyte metabolism. 2. To explain the mechanisms of their development.3. To modulate different pathogenetic forms of edema, to be able to explain the mechanisms of their

development.

For realization of purpose of lesson it is necessary to have the base knowledges-skills. 1. Metabolism of water between blood and tissues after Starling (Normal Physiology Department).2. Contents of electrolytes in blood plasma in a norm (Normal Physiology Department).3. Regulation of water-electrolyte metabolism (Normal Physiology Department)

Information that is necessary for addition to knowledges-abilities of bases on these questions, can be found in the followings textbooks:

Materials from normal physiology course.The checking of primary level of knowledges

Give the answer to the followings questions:1. What is «positive water balance»?2. What is «negative water balance»?3. Hormones which take part in regulation of water-electrolyte metabolism.4. What is «dehydration»?5. Types of dehydration.6. What is «isoosmolar dehydration»?7. What reasons for isoosmolar dehydration origin?8. What is «hypoosmolar dehydration»?9. Reasons for hypoosmolar dehydration origin.10. What is «hyperosmolar dehydration»?11. Reasons for hyperosmolar dehydration origin.12. What is «hyperhydration»?13. Types for hyperhydration.14. What is «isoosmolar hyperhydration»?15. Reasons for isoosmolar hyperhydration origin.16. What is «hypoosmolar hyperhydration»?17. Reasons for hypoosmolar hyperhydration origin.18. What is «hyperosmolar hyperhydration»?19. Reasons for hyperoosmolar hyperhydration origin.20. What is edema?21. What is «dropsy»? Kind of dropsy.22. Types of edema according to pathogenesis.23. Mechanism of oncotic edema development.24. Mechanism of osmotic edema development.25. Mechanism of hydrostatical edema development.26. Mechanism of membranogenic edema development.27. Mechanism of lymphatic edema development.28. Quantity of sodium in blood plasma in a norm.29. Quantity of potassium in blood plasma in a norm.30. Quantity of calcium in blood plasma in a norm.31. Quantity of phosphorus in blood plasma in a norm.

Standards of answers:1. It is the state at which entering of fluid in organism exceeds its excreting.2. It is the state at which excreting of fluid from an organism exceeds its receipt.

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3. Aldosteron, vasopresin (antidiuretic hormone), atrial Na-uretic factor.4. Diminishing of volume of extracellular fluid.5. А) Isoosmolar

B) Hypoosmolar C) Hyperosmolar

6. It is a type of dehydration in case of which osmotic pressure of extracellular liquid does not change.7. А) Polyuria

B) Diarrhea C) First hours after hemorragia.

8. It is a type of dehydration, with exceed loss of salts, which is accompanied the decrease of osmotic pressure of extracellular liquid.

9. А) Vomiting B) DiarrheaC) Sweating

10. It is a type of dehydration, with exceed loss of water which is accompanied the increase of osmotic pressure of extracellular liquid.

11. А) Hyperventilation B) Increased sweating C) Hypersalivation D) DiarrheaE) Vomiting

12. Increasing of volume of extracellular liquid.13. А) Isoosmolar

B) Hypoosmolar В) Hyperosmolar

14. It is a type of hypergidration, in case of which osmotic pressure of extracellular fluid does not change.15. Surplus introduction of isotonic solutions.16. It is a type of hypergidration, in case of which osmotic pressure of extracellular fluid is decreased.17. А) Reflectory anuria

B) Acute kidney insufficiency18. It is a type of hypergidration, in case of which osmotic pressure of extracellular fluid is increased.19. The use for drink of sea water.20. It is a surplus accumulation of liquid in intercellular space as a result of water metabolism violation

between blood and tissues.21. It is an accumulation of liquid in cavities.22. А) Oncotic

B) Osmotic C) Hydrostatic D) Membranogenic E) Lymphogenic

23. А) In the condition of reduced blood plasma oncotic pressure (the deficiency of proteins in organism at starvation, violation of liver protein syntesis function, loss of albumens with urine at pathology of kidney) B) In the condition of promoted oncotic pressure in tissues (output of albumens in the tissues in case of increased permeability of vascular wall, at the damage of cell)

24. In the condition of increased osmotic pressure in the tissues.25. In the condition of increased venous hydrostatical pressure.26. In the condition of increased permeability of vascular wall (action of biologically active substances,

endo- and exotoxins on a vascular wall).27. In the condition of lymphostasis.28. 135 - 155 mmol/L 29. 3,5 - 5,5 mmol/L 30. 2,1 - 3,1 mmol/L 31. 0,9 - 1,2 mmol/L

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Theoretical questions for FMC №1.1. Basic types of water-electrolyte metabolism violations.2. Dehydration. Kinds. Reasons. Mechanisms of development. Value for

an organism.3. Reasons for dehydration development at children. Consequences of

dehydratation. Principles of pathogenetic treatment of dehydratation different forms.

4. Hyperhydration. Kinds. Reasons. Mechanisms of development. Value for an organism.

5. Edema, determination of concept. Pathogenetic factors of edema development.

6. Pathogenesis of edema is at the diseases of heart, kidney, liver, inflammation, allergy, starvation.

7. Violation of sodium metabolism. Reasons for origin, mechanisms of development, consequences.

8. Violation of potassium metabolism. Reasons for origin, mechanism of development, consequences.

9. Violation of calcium metabolism. Reasons for origin, mechanisms of development, consequences.

10. A value of violations of water-electrolyte metabolism for organism. Principles of pathogenetic therapy.

Literature:4. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU,

2005.p.152-159, 167-1715. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005.p.154-1626. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin – Vinnytsia: Nova Knuha

Publishers – 2011. p.333-343

Testing according system “Krok-I”Tests of an open database (2013)

1. Inflamation is characterised by increasing penetration of vessels of microcirculation stream, increasing of their fluid dynamic blood pressure. Increasing of the osmotic concentration and dispersity of protein structures present in the intercellular fluid. What kind of edema will appear in this case?A MixedB HydrodynamicC Colloid-osmoticD LymphogenicE Membranogenic

2.A patient who suffers from heart failure has enlarged liver, edemata of lower extremities, ascites. What is the leading mechanism in the development of this edema? A Hydrodynamic B Colloid osmotic C Lymphogenous D Membranogenic E -

3. A 56 year old patient suffering from cardiac insufficiency has edema of feet and shins, edematous skin is pale and cold. What is the leding mechanism of edema pathogenesis?

A Rise of hydrostatic pressure in venules B Drop of oncotic pessure in capillaries

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C Increase of capillary permeability D Disorder of lymph outflow E Positive water balance

4. A 50-year-old patient complains of thirst, drinking of a lot of water, marked polyuria. Blood glucose is 4,8 mmol/L, urine glucose and acetone bodies are absent, urine is colorless, specific gravity is 1,002-1,004. What is the cause of polyuria?A Vasopressin insufficiencyB HypothyroidismC Insulin insufficiency D AldosteronismE Thyrotoxicosis

5. A patient with nephrotic syndrome has massive edemata of his face and limbs. What is the leading pathogenetic mechanism of edemata development? A Drop of oncotic blood pressure B Increase of vascular permeability C Rise of hydrodynamic blood pressure D Lymphostasis E Increase of lymph outflow

6. Hepatitis has led to the development of hepatic failure. Mechanism of edemata formation is activated by the impairment of the following liver function: A Protein-synthetic B Barrier C Chologenetic D Antitoxic E Glycogen-synthetic

7. A patient was stung by a bee. Examination revealed that his left hand was hot, pink, edematic, there was a big red blister on the site of sting. What is the leading mechanism of edema development? A Increased vessel permeability B Reduced vessel filling C Injury of vessels caused by the sting D Drop of oncotic pressure in tissue E Drop of osmotic pressure in tissue

8. A patient ill with enteritis accompanied by massive diarrhea has low water rate in the extracellular space, high water rate inside the cells and low blood osmolarity. What is such disturbance of

water-electrolytic metabolism called? A Hypo-osmolar hypohydration B Hyperosmolar hypohydration C Osmolar hypohydration D Hypo-osmolar hyperhydration E Hyperosmolar hyperhydration

9.A patient was admitted to the infectious department. His symptoms: dry skin, decreased skin turgor, rice-water stool. The patient was diagnosed with cholera. What disorder of water-electrolytic balance is most often observed in this disease? A Isoosmotic hypohydration B Hyperosmotic hyperhydration C Hypoosmotic hypohydration

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D Hyperosmotic hypohydration E Hypoosmotic hyperhydration

10. Chronic glomerulonephritis was diagnosed in a 34-year-old patient 3 years ago. Edema has developed in the last 6 monthes. What caused it?A ProteinuriaB Hyperproduction of vasopressinC Disorder of albuminous kidneys functionD Hyperosmolarity of plasmaE Hyperaldosteronism


1. A 56 year old patient suffering from cardiac insufficiency has edema of feet and shins, edematous skin is pale and cold. What is the leding mechanism of edema pathogenesis?

A Rise of hydrostatic pressure in venules B Drop of oncotic pessure in capillaries C Increase of capillary permeability D Disorder of lymph outflow E Positive water balance

2. A patient with nephrotic syndrome has massive edemata of his face and limbs. What is the leading pathogenetic mechanism of edemata development?

A Drop of oncotic blood pressure B Increase of vascular permeability C Rise of hydrodynamic blood pressure D Lymphostasis E Increase of lymph outflow

3. A patient was stung by a bee. Examination revealed that his left hand was hot, pink, edematic, there was a big red blister on the site of sting. What is the leading mechanism of edema development?

A Increased vessel permeability B Reduced vessel filling C Injury of vessels caused by the sting D Drop of oncotic pressure in tissue E Drop of osmotic pressure in tissue

4. A patient ill with enteritis accompanied by massive diarrhea has low water rate in the extracellular space, high water rate inside the cells and low blood osmolarity. What is such disturbance of water-electrolytic metabolism called?

A Hypo-osmolar hypohydration B Hyperosmolar hypohydration C Osmolar hypohydration D Hypo-osmolar hyperhydration E Hyperosmolar hyperhydration

5. A patient was admitted to the infectious department. His symptoms: dry skin, decreased skin turgor, rice-water stool. The patient was diagnosed with cholera. What disorder of water-electrolytic balance is most often observed in this disease?

A Isoosmotic hypohydration B Hyperosmotic hyperhydration C Hypoosmotic hypohydration D Hyperosmotic hypohydration E Hypoosmotic hyperhydration

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6. Edema was modeling to the white rat by the injection of adrenalin. What pathogenetic mechanism of edema development?

A. Oncotic B. HydrodynamicC. Membranogenic D. Lymphogenic E. Colloid-osmotic

7. Patient of D., 35 years, complains about permanent thirst, decrease of appetite, headache and convulsion. He drinks 9 l during a day. Day's diuresis is increased, urine without pathological changes, specific gravity - 1005. The reason of development such pathology is the damage of:

A. The epithelium of kidney tubuleB. AdenohypophisC. Epyphis D. Hypothalamic nucleusE. Basal membrane of glomerulus capillaries

8. Inflamation is characterised by increasing penetration of vessels of microcirculation stream, increasing of their fluid dynamic blood pressure. Increasing of the osmotic concentration and dispersity of protein structures present in the intercellular fluid. What kind of edema will appear in this case?

A MixedB HydrodynamicC Colloid-osmoticD LymphogenicE Membranogenic

9. Inflammation of a patient's eye was accompanied by accumulation of turbid liquid with high protein at the bottom of anterior chamber that was called hypopyon. What process underlies the changes under observation?

A Disturbance of microcirculation B Primary alteration C Secondary alteration D Proliferation E -

10. A patient who suffers from severe disorder of water-salt metabolism experienced cardiac arrest in diastole. What is the most probable mechanism of cardiac arrest in diastole?

A Hyperkaliemia B Hypernatremia C Organism dehydratation D Hypokaliemia E Hyponatremia

11. An animal with aortic valve insufficiency got hypertrophy of its left heart ventricle. Some of its parts have local contractures. What substance accumulated in the myocardiocytes caused these contractures?

A Calcium B Potassium C Lactic acid D Carbon dioxide E Sodium

12. A patient who suffers from heart failure has enlarged liver, edemata of lower extremities, ascites. What is the leading mechanism in the development of this edema?

A Hydrodynamic B Colloid osmotic

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C Lymphogenous D Membranogenic E -

13. Periodic renal colics attackes are observed in the woman with primery hyperparathyroidizm. Ultrasonic examination revealed small stones in the kidneys. What is the cause of the formation of the stones?

A HypercalcemiaB HyperphosphatemiaC HypercholesterinemiaD HyperuricemiaE Hyperkalemia

14. Transmural myocardial infarction in the patient was complicated with progressive acute left ventricle insufficiency. What is the most typical for this state?

A Edema of the lungsB Edema of the extremitiesC CyanosisD AscitesE Arterial hypertension

15. Patient suffered from cirrhosis of liver was intravenous injected 500 ml of 5% glucose solution. What disturbances of water-salt balance may appear in this patient?

A. Hypoosmolar hyperhydrationB. Hyperosmolar hyperhydrationC. Isoosmolar hyperhydrationD. Hypoosmolar hypohydrationE. There is no dyshydration

16. A person, who has been on vegetable diet for along time, has edemas. What is the main mechanism of edema development in this case?

A. HypoaminoacidemiaB. HypoproteinemiaC. Decrease of quantity of microelements in bloodD. HypoglycemiaE. Anemia

17. Persons, 32, during 4 years suffers on chronic glomerulonephritis. Edemas are marked on face, lately edemas appeared in trunk, that glomerulonephritis with a nephrotic syndrome. What pathogenetic factor of edemas development for this patient?

A. Increase of tissue liquid oncotic pressure B. Difficulty of lymph outflowC. Decrease of oncotic blood pressureD. Increase of hydrodynamic blood pressure in capillariesE. Increase of capillaries permeability

(2009)

18. As a result of continuous starvation the glomerular filtration rate has increased by 20%. The most probable cause of the glomerular filtration alteration under the mentioned conditions is:

A. Increase in the systemic arterial pressureB. Increase in the permeability of the renal filterC. Increase of the renal blood flow D. Decrease in the oncotic pressure of blood plasmaE. Increase of the filtartion quotient

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(2006-2008)

19. After a surgery a 36-year-old woman was given an intravenous injection ofconcentrated albumin solution. This has induced intensified water movement in the following direction:

A. From the intercellular fluid to the cells B. From the intercellular fluid to the capillariesC. No changes of water movement will be observedD. From the cells to the intercellular fluidE. From the capillaries to the intercellular fluid

20. A patient has osmotic pressure of blood plasma at the rate of 350 mOsmol/l (norm is 300 mOsmol/l). This will cause hypersecretion of the following hormone:

A. CortisolB. AdrenocorticotyropinC. VasopressinD. NatriureticE. Aldosterone

21. Patient, 62 years, during 15 years suffers on insufficiency of mitral valve. Last month the edema of lower extremities began to arise up. What is the mechanism of edema development?

A. Increase of permeability of capillariesB. Decrease of oncotic blood pressure C. Increase of oncotic pressure of tissue liquidD. Violation of lymphatic vesselsE. Increase of hydrostatical blood pressure

22. A patient with chronic cardiac insufficiency have edema of lower extremities. What is the leading link of their pathogenesis?

A. Hypothalamo-hypophysar systemB. Renin-angiotensin-aldosteron systemC. Sympato-adrenal systemD. Parasympathetic systemE. Kalikrein-kinin system

23. A person, after the long period of starvation has edema. What is the main mechanism of edema development in this case?

A. Decrease of oncotic pressure in the bloodB. Increase of oncotic pressure in tissuesC. Increase of hydrostatic pressure of venous bloodD. Decrease of hydrostatic pressure of tissuesE. Decrease of blood circulating volume

24. Pulmonary hypertension and right-ventricle heart insufficiency with ascites and edemas develop in a patient suffered from pneumosclerosis. What is the main mechanism of edema development in this case?

A. Increase of hydrostatic pressure in veinsB. Increase of oncotic pressure of tissuesC. Decrease of oncotic pressure of bloodD. Reduction of heart stroke volumeE. Increase of vascular permeability

25. Which of followings may cause the isoosmolar hypohydration?A. Acute blood lossB. DiarrheaC. Vomiting

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D. PerspirationE. Hyperventilation

26. A patient has uneasiness in the chest and difficult breathing after physical exertion. Some time later cough with foamy liquid phlegm appears. Significant cyanosis develops in the patient. What is the leading mechanism for edema development in this case?

A. HydrodynamicB. ColloidC. MembranogenousD. LymphogenicE. Osmotic

27. Development of toxic edemat is predefined: A. Hypoproteinemia B. By the promoted permeability of vesselsC. Hypernatriemia D. AcidosisE. By the promoted hydrostatic pressure

28. Patient had trauma, hyperemia of skin is appeared in place of damage, she became hot. Pain, limitation extremity motions, edema appeared. Name the initiating pathogenetic factor of inflammatory edema?

A. Increase of microvessels permeabilityB. Decrease of oncotic blood pressureC. An increase of blood pressure in capillariesD. Violation of lymph outflow E. An increase of osmotic pressure in the region of inflammation

29. A patient with severe nephropathy accompanied by severe oedema syndrome that develops as complication of bronchiectasis. Laboratory examination of this patient displays abundant proteinuria, cylinderuria, distinct decrease of protein content in blood serum, hyperlipidemia, hypokalemia, and other pathological changes. What is the most important link in development of edemas in this patient?

A. Decrease of oncotic pressure of bloodB. Increase of osmotic pressure of interstitial fluidC. Increase of hydrostatic pressure of bloodD. Blockade of lymphatic drainageE. Increase of microvessel permeability

30. At complete starvation (with taking water) generalized edemas develop. What is the leading pathogenic factor in this case?

A. Increase of oncotic pressure of interstitial fluidB. Decrease of osmotic pressure of blood plasmaC. Decrease of oncotic pressure of blood plasmaD. Increase of osmotic pressure of interstitial fluidE. Decrease of hydrostatic pressure of interstitial fluid

31. What is the leading factor of edema development in case of nephrotic syndrome?A. Increase of hydrostatic pressure in capillariesB. Increase of vascular permeabilityC. HypoalbuminemiaD. Dynamic lymphatic insufficiencyE. Increase of blood volume

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32. A patient complain about a muscular weakness, feeling of weight in the epigastral area. At an inspection found out taxicardia, arterial hypotension, on ECG - lengthening the interval of PQ, decrease of T voltage. What violation of mineral metabolism causes development of these disorders?

A. Hypernatriemia. B. HypokaliemiaC. Hyperkaliemia. D. Hyponatriemia. E. Deficit of iron.

33. A patient was admitted to the infectious hospital with complaints about unrestrained vomit. What violations of water-salt metabolism are there?

A. Isoosmolar dehydration B. Hyperosmolar dehydration C. Hypoosmolar hyperhydration D. Hyperosmolar hyperhydration E. Hypoosmolar dehydration

34. People found themselves on the island after a catastrophe in the ocean, without fresh water. What form of water-salt metabolism violations will develop?

A. Hyperosmolar hyperhydration B. Isoosmolar hypergidration C. Hypoosmolar hyperhydration D. Hyperosmolar dehydration E. Hypoosmolar dehydration

35. Osmotic diuresis develops at diabetes mellitus. What violations of water-electrolyte balance are observed?

A. Isotonic dehydration B. Hypoosmolar dehydrationC. Hyperosmolar hyperhydrationD. Hyperosmolar dehydration E. Isoosmolar hyperhydration

36. Patient carried heavy infectious disease, after that appeared the signs of diabetes insipidus. Day's diuresis was increased to 10l. Afterwards dehydration of organism purchased threatening character. What mechanism of development?

A. Increase of ultrafiltrate osmolarity B. Braking of water suction in the intestine C. Decrease of reabsorbtion of water in kidneyD. Decrease of reabsorbtion of sodium in kidney E. Decrease of plasma oncotic pressure

37. Patient 43 years, appeared the signs of cardiac activity decompensation with the origin of edema and ascyt after the sharpening of rheumatic heart disease. The increase of production of what matter may cause those violation

A. Aldosteron B. Insulin C. Cortisol D. Vasopresin E. Corticothropin

38. At a examination the edema is discovered in the area of left forearm, which arose up after the bite of bee. Name the leading pathogenetic mechanism of this edema:

A. HydrodynamicB. Oncotic

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C. OsmoticD. LymphogenicE. Membranogenous

39. When treating for dehydration by means of salt-poor fluids at the background of sharply reduced excretory renal function resulted from tubular necrosis the worsening of general condition, confused consciousness, convulsive readiness, and brain edema with vomiting develop. What kind of water-salt metabolism disturbances takes place in this case?

A. Hypoosmolar hyperhydrationB. Isoosmolar hyperhydrationC. Hyperoosmolar hyperohydrationD. Hypoosmolar hypohydrationE. Hyperosmolar hypohydration

40. Edemas are developed in a patient with renal disease. High quantity of albumen in the analyses of urine. What mechanism is it possible to explain the origin of edemas for such patient?

A. By the decrease of lymph oncotic pressure B. By the decrease of filtration pressure in budsC. By the decrease of blood plasma oncotic pressure D. By the decrease of interstitial oncotic pressureE. By the increase of blood plasma osmotic pressure

41. Person, 64years, complain about the dysphnoe, frequent heart beating, rapid fatigueability. In the evening edemas appear on legs. What main pathogenetic factor in the development of edemas?

A. Increase of tissue liquid oncotic pressure B. Violation of lymph outflowC. Decrease of oncotic blood pressureD. Increase of hydrodynamic pressure E. Increase of capillaries permeability

42. Edema of Kvinke (common edema of tissues) developed in the patient with allergy. What pathogenetic factor is starting in this case?

A. Decrease of hydrostatical pressure in tissuesB. Decrease blood plasma oncotic pressure C. Increase of permeability of capillaries wallsD. An increase of hydrodynamic blood pressureE. An increase of osmotic pressure in tissues

43. Considerable part of alimentar starvation cases are accompanied with edema. What is the main pathogenetic factor of edema in this case?

A. Decrease of tissues hydrostatical pressureB. Decrease of blood plasma oncotic pressureC. Increase of blood osmotic pressure D. Increase of intercellular liquid oncotic pressure E. Increase of blood hydrodynamic pressure

44. Patient with burn shock next to anaestetic drugs it is vitally necessary to enter antishock solutions in connection with water-electrolyte metabolism violations. What water-electrolyte metabolism violation most probably arise up at burn illness?

A. Hypoosmolar of hypohydriaB. Hypoosmolar hyperghydrationC. Isoosmolar dehydrationD. Hyperosmolar dehydrationE. Hyperosmolar hyperhydria

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45. Patient, 35 years, carried hepatitis and continued to adopt an alcohol, the signs of liver cirrhosis developed with ascyt and edemata of lower extremities. What blood composition changes did become deciding in development of edema?

A. HypokaliemiaB. HypoglobulinemiaC. HypoalbuminemiaD. HypocholesterinemiaE. Hypoglycemia

46. Patient carried operative interference concerning intestinal impassability, after the signs of considerable dehydration appeared. What blood ions must be appointed in the first turn for water-salt balance correction?

A. ChlorB. CuprumC. SodiumD. CalciumE. Magnesium

47. A woman ate orange, after she has edema of palpebra, lips, neck, and tongue. Before on oranges there were pouring out on a skin, itch. What pathogenetic mechanism lies in development of edema?

A. An increase of hydrodynamic blood pressure in capillariesB. Violation of lymph outflowC. Increase of capillaries permeability D. Decrease of oncotic blood pressure E. Increase of tissue fluid oncotic pressure

48. Patient, 35 years, who drinks alcohol often, has strong muscular and cardiac weakness, vomit, diarrhea, AP-100/60 mm Hg. All those symptoms developed during diuretics treatment. Reason of such state is the increased selection with urine:

A. PhosphatesB. NaC. КD. ClE. Ca

49. Hypertensive solution of glucose was intravenously entered a patient. It will increased motion of water:

A. From intercellular liquid to the capillariesB. There were no changesC. From capillaries to the intercellular liquidD. From cell to the intercellular liquidE. From intercellular liquid to the cell

50. Patient has reduced synthesis of vasopresin, that why he has polyuria and dehydration of organism. In what does consist mechanism of polyuria development of polyuria?

A. Increase of glomerular filtration speedB. Decrease of water reabsorbtion in tubulsC. Decrease of Na+ reabsorbtion in tubuls D. Decrease glucose of reabsorbtionE. Decrease of protein reabsorbtion in tubuls

Correct answers1-A 2-A 3-A 4-A 5-A 6-B 7-D 8-A 9-A 10-A11-A 12-A 13-A 14-A 15-A 16-A 17-C 18-D 19-B 20-C21-E 22-B 23-A 24-A 25-A 26-A 27-B 28-E 29-A 30-C31-C 32-B 33-E 34-A 35-D 36-C 37-A 38-E 39-A 40-C41-D 42-C 43-B 44-C 45-C 46-C 47-C 48-C 49-D 50-B

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Situational tasks:

1. The worker of hot workshop had the unendurable feeling of thirst, increase of body temperature and brief loss of consciousness.1) Type of water-electrolyte metabolism violation.____________________________________________________________

2) What measures of prophylaxis need to be taken, to prevent this violation? _________________________________________________________________________________________________________________________________________________________________________________3) What water-electrolyte metabolism violation will develop if patient will drink water without the salt?____________________________________________________________

2. Patient suffers from insufficiency of the mitral valve, patient marks the presence of edemas on lower extremities in the evening after work.1) What is the mechanism of this edema development?___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2) Explain their localisation?__________________________________________________________________________________________________________________________________________________________________________________

3. A child had dehydration of organism in the result of diarrhea. Isotonic solution of sodium chloride and desoxycortikosteron (mineralocortikoid) were appointed intravenous. Muscular weakness developed after some time. The level of Na in plasma is - 180 mmol/L (in a norm - 135-155 mmol/L), to potassium - 3,4 mmol/L (in a norm - 3,5-5,5 mmol/L).1) What is the mechanism of complication?_________________________________________________________________________________________________________________________________________________________________________________

2) Is the medical tactic correct? Explain.__________________________________________________________________________________________________________________________________________________________________________________4. A 0,1% solution of adrenalin was injected to the white rat intraabdominal in dose - 1 мg/100g of body mass. In 30 minutes, breathing became frequent and superficial, then sharp and convulsive, than foamy liquid appeared from the nose cavity, there was acrocyanosis. At appearance of sharp edema of lungs an animal die. What pathogenetic mechanism of edema development? 1) What mechanism of edema development takes place in this case? Explain.__________________________________________________________________________________________________________________________________________________________________________________

5. Patient D. 35 years, complain about permanent thirst, decrease of appetite, headache, convulsions. He drinks 9 l during a day. Diuresis is increased, urine without pathological changes, specific gravity - 1005.1) What is the disease at the patient?_________________________________________________________________________________________2) Reasons for its origin._________________________________________________________________________________________________________________________________________________________________________________3) Explain the mechanisms of its development.________________________________________________________________________________________________________________________________________________________________________________4) What forms of this disease do you know?_________________________________________________________________________________________________________________________________________________________________________________

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5) What is the treatment of the disease?__________________________________________________________________________________________________________________________________________________________________________________

6. Patient D., 82, delivered in a hospital with chronic cardiac insufficiency in the decompensate state. Taxycardia, arterial pressure is decreased/ There is edema of lower extremities. 1) What are the main pathogenetic factors in development of edemas at cardiac insufficiency.__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Practical work: „EXPERIMENTAL EDEMA”Object of work: to show formation of frog back arms edema at the passing through the vascular net of solution

of lactic acid; to show development of lungs edema at a white rat after intraperitoneal introduction of adrenalin.

EXPERIMENT № 1. Prepare preparation of back arms of frog. Dissect an abdominal region by the longitudinal slit, extract internals.

Place ligature under an aorta, incise an aorta, insert into a glass cannula and fix it by ligature. The upperparts of trunk is chopped off. Fill a cannula by Ringer’s solution for cool-blooded animals and unite it with the apparatus which consists of two Marriott’s tubes connected with a T-joint by rubber tubing with pressed-on clamps.

Fill one burette by solution of Ringer and another one by lactic acid solution painted by methylene-blue.At first pass Ringer’s solution through the preparation of arms vessels and count up the amount of

drops.Close the clamp of burette with Ringer’s solution and open the clamp of burette with lactic acid

solution. Count up the amount of drops.Pass a few times by turns Ringer’s solution and lactic acid solution.Look after development of frog back arms edema.

№ Amount Ringer’s solution drops

Amount lactic acid solution drops

1234

Conclusion:______________________________________________________________________________________________________________________________________________________

EXPERIMENT № 2. Count up the initial respiration rate at a rat. Make the intraperitoneal injection of adrenalin on the basis of 0,5 ml a 0,1% solution on 100g of rat

weight. Look after the changes of breathing during 10-15 min.After animals death extract the lungs, weigh it.Counted up a pulmonary coefficient (ratio of lungs weight in g to the rat’s body weight in kg).In a norm a pulmonary coefficient is equal 3-4.

Conclusion:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Theme: VIOLATION of the ACID-BASIC BALANCE.

Actuality of the theme. Constancy of pH of internal environment is the necessary condition of existence of higher organisms. It is

provide certain correlation of acids and bases (acid-basic balance - ABB) in biological environments, at violation of which an organism perishes. Violations of ABB are observed at many diseases and complicate their course. Knowledge of indemnification mechanisms of ABB violations and their support is one of major steps in the prophylaxis of many diseases complications.

General purpose of the lesson. To learn reasons and mechanisms of basic acid-basic state (ABS) violations development, and also indexes which characterize these violations.

For this it is necessary to know:1. To interpret the main reasons which result in the origin of ABB.2. To expose the mechanisms of ABB violations development. 3. To explain compensate possibilities of organism which are included at the different forms of

ABB violations.4.To design violation of the ABB.

For realization of purpose of lesson it is necessary to have the base knowledges-skills:1. Concept about the buffer systems. (Normal Physiology Department);2. Concept about blood pH (Normal Physiology Department).

Information that is necessary for addition to knowledges-abilities of bases on these questions can be found in the followings textbooks:

Materials from normal physiology course

The checking of primary level of knowledges Give the answer to the followings questions:

1. Acid-basic balance, definition.2. What index of blood active reaction and what is it evened?3. Chemical buffer systems of organism.4. What physiological systems take part in supportion of ABB?5. How does the system of the external breathing take part in regulation of ABB?6. How does the kidney take part in regulation of ABB?7. What is acidogenesis?8. What is amoniogenesis?9. Mian forms of ABB violation.10. Acidosis, definition.11. Alkalosis, definition.12. How does divide acidosis and alkalosis depending on the pH changes?13. How does divide acidosis and alkalosis after the mechanisms of development?14. Main reasons for gas acidosis origin.15. Main reasons for gas alkalosis origin.16. Types for nongas acidosis.17. Types fon nongas alkalosis.18. What are the reasons of metabolic acidosis origin?19. What are the reasons for exogenous acidosis origin?20. What are the reasons for excretory acidosis origin?21. What are the reasons for hypochloremic alkalosis origin?22. What are the reasons for hypokaliemic alkalosis origin?23. What are the reasons for exogenous alkalosis origin?

Standards of answers.

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1. It is permanent correlation between hydrogen and OH ions in the internal environment of organism.2. pH = 7,36 - 7,443. А) Hydrocarbonatic

B) Phosphatic C) Hemoglobin D) Protein

4. А) System of the external breathing B) Kidney C) Digestive system

5. Supports pressure of CO2 in arterial blood.6. А) Acidogenesis

B) Amoniogenesis C) Reabsorbtion of hydrocarbonat

7. Synthesis and secretion in the kidney tubules H+ ions.8. Synthesis and secretion in the kidney tubules the ammonium ion.9. А) Acidosis

B) Alkalosis10. It is an absolute or relative accumulation of acids in the internal environment of organism.11. It is an absolute or relative accumulation of bases in the internal environment of organism.12. А) Compensated (if pH keeps in physiological norm)

B) Uncompensated (if pH goes outside physiological norm)13. А) Gas (caused the primary changes of CO2 pressure in blood)

B) Non gas (caused an accumulation in the organism of non-flying products of acid or alkaline character)

14. А) Hypoventilation of lungs, that is accompanied violation of CO2 destroying from the organism B) Breathing in air with high maintenance of СО2

15. А) Hyperventilation of lungs B) Incorrectly guided artificial respiration

16. А) Metabolic B) Excretory C) Exogenous

17. А) Excretory (hypochloremic, hypokaliemic) B) Exogenous (hypernatriemic)

18. An accumulation in the organism of non-flying acids as a result of metabolic disturbances: lactatatsidosis, ketoacidosis.

19. Hit in the organism of exogenous non-flying acids.20. Loss of hydrocarbonat by an organism at kidney function violation and digestive disorders.21. Repeating vomit which is accompanied the loss of Cl-.22. Hyperaldosteronism, that is accompanied the loss of potassium ions with urine.23. Hit in the organism of exogenous bases (for example, introduction of hydrocarbonat during wrong

correction of nongas acidosis).

Theoretical questions for FMC №1.1. Classification of ABB violations. 2. Acidosis, definition of concept. Kinds. Reasons and mechanisms of

development.3. Compensation and violation of functions at acidosis.4. Alkalosis, determination of concept. Kinds. Reasons and

mechanisms of development.5. Violation of functions and compensation of the different types of

alkalosis.6. Main indexes of the acid-basic state. Changes of indexes at different

ABB violations.

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Literature:1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU,

2005.p.160-1662. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005.p.162-1663. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin – Vinnytsia: Nova Knuha

Publishers – 2011. p.343-348



1. After taking poor-quality food a patient developed repeated episodes of diarrhea. On the next day he presented with decreased arterial pressure, tachycardia, extrasystole. Blood pH is 7,18. These abnormalities were caused by the development of: A Nongaseous acidosis B Gaseous acidosis C Nongaseous alkalosis D Gaseous alkalosis E Metabolic alkalosis

2. A patient with diabetes developed a diabetic coma due to the acid-base imbalance. Specify the kind of this imbalance: A Metabolic acidosis B Metabolic alkalosis C Respiratory acidosis D Gaseous alkalosis E Non-gaseous alkalosis

3. A newborn child with pylorostenosis has often repeating vomiting accompanied by apathy, weakness, hypertonicity, sometimes convulsions. What disorder form of acid-base balance is it? A Nongaseous alkalosis B Gaseous alkalosis C Gaseous acidosis D Metabolic acidosis E Excretory acidosis

4. Disorder of the airways passage in small and middle bronchi was revealed in the patient. What disorder of the acid-base equilibrium can be detected in the blood?A Respiratory acidosisB Metabolic acidosis C Respiratory alkalosisD Metabolic alkalosis E --


1. Trauma of the head brain a patient is accompanied by repeated vomiting and shortness of breathing. At an inspection it is marked: рН = 7,62; pСО2 = 40 mm of Hg. What is violation of the acid-basic state at a patient?

A Ungas alkalosisB Gas alkalosis C Ungas acidosis D Gas acidosis E -

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2. Hypoxemia and hypercapnia are educed at the research of blood gas composition at the patient with the chronic disease of respiratory system on a background of the shortness of breathing, tachicardia and cyanosys.Because of what violations of the external breathing these changes were arise up?

A Hypoventilation B HyperventilationC HyperperfusionD HypoperfusionE Hyperdiffusion

3. A newborn child with pylorostenosis has often repeating vomiting accompanied by apathy, weakness, hypertonicity, sometimes convulsions. What disorder form of acid-base balance is it?

A Nongaseous alkalosis B Gaseous alkalosis C Gaseous acidosis D Metabolic acidosis E Excretory acidosis

4. After taking poor-quality food a patient developed repeated episodes of diarrhea. On the next day he presented with decreased arterial pressure, tachycardia, extrasystole. Blood pH is 7,18. These abnormalities were caused by the development of:

A Nongaseous acidosis B Gaseous acidosis C Nongaseous alkalosis D Gaseous alkalosis E Metabolic alkalosis

5. Disorder of the airways passage in small and middle bronchi was revealed in the patient. What disorder of the acid-base equilibrium can be detected in the blood?

A Respiratory acidosisB Metabolic acidosis C Respiratory alkalosisD Metabolic alkalosis E --

6. 48 y.o. patient with diabetes mellitus was admitted to the hospital in severe pre-coma state. When examining of acid-base balance metabolic acidosis was revealed. What is the main possible mechanism of found changes development?

A. Disorders of O2 using in cellsB. Disorders of buffer systems of bloodC. Decrease of CO2 removingD. Excretion of alkali elements with urineE. Formation of products of incomplete oxydation

7. A group of mountain climbers went through the blood analysis at the height of 3000 m. It revealed decrease of HCO3

_ to 15 micromole/l (standard is 22-26 micromole/l). What is the mechanism of HCO3_

decrease? A Hyperventilation B Intensification of acidogenesis C Hypoventilation D Decrease of ammoniogenesis E Decrease of bicarbonate reabsorption in kidneys

8. For a patient with respiratory insufficiency рН of blood is 7,35. Determination of рСО2 showed the presence of hypercapnia. At research of рН of urine the increase of her acidity is marked. What form of violation of the acid-basic state in this case?

A Compensated gas acidosis

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B Compensated metabolic acidosis C Decompensated metabolic acidosis D Compensated gas alkalosis E Decompensated gas alkalosis

9. Toxicosis with the heavy repeated vomiting for a day long developed at a pregnant woman. After twenty-four hours tetaniform convulsions and dehydration of organism began to show up. What change of pH caused the described changes?

A Excretory alkalosisB Gas alkalosisC Gas acidosisD Metabolic acidosisE Secretory acidosis

(2006-2009)

10. In a patient with diabetes mellitus metabolic acidosis developed as a result of accumulation of keton bodies. Arterial blood pH is:

A. 7,40 B. 7,32 C. 7,48 D. 7,56 E. 7,66

11. Patient of D., 48 y.o., which suffers from obesity, conducted the course of medical starvation in home terms. The deep, noisy breathing appeared on 10 day, arterial pressure went down to 90/60 mm Hg, a selection of urine diminished, urine with the smell of acetone. What is conditioned described?

A. Non gas alkalosis B. Hyperglycemia C. Ketosis D. HypoglycemiaE. Gas acidosis

12. A 65-years-old patient with multiple fractures of ribs was admitted to the hospital. What type of acid-base balance disorder may develop in him?

A. Gas acidosisB. Gas alkalosisC. Non-gas acidosisD. Non-gas alkalosisE. There are no disorders of acid-base balance

13. A pregnant woman has toxicosis, which accompanied by prolonged vomiting. Data of her biochemical analyses show: pH of blood – 7.38, pCO2 of arterial blood – 46 mmHg, SB – 17 mmol/L, BE – (+ 6 mmol/L). What type of acid-base balance disorder takes place in this case?

A. Compensated non-gas alkalosisB. Decompensated non-gas alkalosisC. Compensated non-gas acidosisD. Decompensated non-gas acidosisE. Compensated gas alkalosis

14. A 58-years-old female patient was admitted to the hospital in severe state. Data of her biochemical analyses show: pH of blood – 7.33, pCO2 of arterial blood – 36 mmHg, SB – 17 mmol/L, BE – ( - 6 mmol/L). What type of acid-base balance disorder takes place in this case?

A. Compensated non-gas alkalosisB. Decompensated non-gas alkalosisC. Compensated non-gas acidosis

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D. Decompensated non-gas acidosisE. Compensated gas alkalosis

15. What is the reason for gas alkalosis?A. Pulmonary hyperventilationB. Loss of gastric juiceC. Loss of intestine juiceD. Pulmonary hypoventilationE. Hyperaldosteronism

16. What kind of acid-base balance disturbances may be observed in case of diabetes mellitus?A. Non-gas acidosisB. Gas acidosisC. Gas alkalosisD. Non-gas alkalosisE. Excretory acidosis

17. At examination of patient following were found: hyperglycemia, ketonuria, polyuria, hyperstenuria, and glucosuria. What kind of acid-base balance disturbances occurs in this case?

A. Gas alkalosisB. Non-gas alkalosisC. Metabolic alkalosisD. Metabolic acidosisE. Gas alkalosis

18. At getting up in mountains euphoria, head pain, dizziness, heart beating, dyspnoe, which was alternated from apnoe, developed for an alpinist. What did violation of the acid-basic state develop for an alpinist?

A. Metabolic alkalosis B. Gas alkalosis C. Non gas alkalosis D. Gas acidosis E. Non gas acidosis

19. Respiratory alkalosis developed in group of alpinists during ascending to on Everest. Thus pressure of СО2 in arterial blood:

A. 40 mm Hg B. 50 mm Hg C. 60 mm HgD. 70 mm HgE. 30 mm Hg

20. A patient suffered from diabetes mellitus was admitted to the hospital because of worsening of his condition. He has general malaise, polyuria, lethargy, and sleepiness. Kussmaul respiration, heart arrhythmia, and acetone scent in expired air are noticed in this patient. What kind of shift of acid-base balance contributes these symptoms?

A. Gas alkalosisB. Gas acidosisC. Non-gas metabolic alkalosisD. Non-gas metabolic acidosisE. Non-gas excretory alkalosis

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21. What violation of the acid-basic state does take place at blood pH 7,48?A. Alkalosis decompensateB. Alkalosis compensated C. Metabolic decompensated acidosis D. Acidosis compensated E. Acidosis excretory decompensated

22. What acid –basic balance disorder can develop in 2 hours after repeated vomiting?A. Excretory acidosisB. Excretory alkalosisC. Eczogenic alkalosisD. Metabolic acidosisE. Eczogenic acidosis

23. Patient, who suffers from severe diarrhea, was admitted to the hospital with consequences disorder, Kussmaul respiration. Blood pH 7,30, deficiency of base. Acidic reaction of urine, contain many phosphates and ammonium salts. What is acid-basic balance disorder develop in this case?

A. Non-gas alkalosisB. Non-gas acidosisC. Excretory alkalosisD. Gas alkalosisE. Gas acidosis

24. Repeated vomiting occurs in patient suffered from pylorostenosis which is bring to severe state. Appeared appation, weakness, increased muscular tonus, cramps. What is acid-basic balance disorder develop in this case?

A. Non-gas alkalosisB. Non-gas acidosisC. Excretory alkalosisD. Gas alkalosisE. Gas

25. In the case of development of mountain disease compensatory lung hyperventilation is developed. What is acid-basic balance disorder develop in this case?

A. Non-gas alkalosisB. Non-gas acidosisC. Excretory alkalosisD. Gas alkalosisE.Gas acidosis

26. During bronchial asthma attack patient developed gas acidosis (hypercapnia). What type of acid-base balance disorder takes place in this case?

A. Gas alkalosisB. Gas acidosisC. Non-gas metabolic alkalosisD. Non-gas metabolic acidosisE. Non-gas excretory alkalosis

27. Patient was appointed solution of glucose intravenously with potassium bicarbonat. Such indexes are determined: pH- 7,43; рСО2 - 61 mm Hg; SB - 31,5 mecv/l; BB - 59 mecv/l; BE +8,5 mecv/l . What ABB violation does take place in this case?

A. Non gas alkalosisB. Non gas acidosisC. Excretory alkalosis

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D. Gas acidosisE. Gas alkalosis

28. Patient had such laboratory parameters – pH-7,32, pCO2 35 mm Hg, SB- 16,5mecv/l, BB – 35,0 mecv/l, BE – 9,0 mecv/l, TK day urine - 8,0 mecv/day. What is acid-basic balance disorder develop in this case?


29. Patient get head trauma, which accompanied with repeated vomiting and dyspnoe. Laboratory tests: pH -7,48, pCO2 – 30 mm Hg, SB – 27 mecv/l, BB- 50,0 mecv/l., BE -+ 3,0 mecv/l. What is acid-basic balance disorder develop in this case?

A. Non-gas alkalosis B. Non-gas acidosisC. Excretory alkalosisD. Gas alkalosisE. Gas acidosis

30. For a patient with nefrotic syndrome polyuria observed, hyponatriemia (patient gets diacarb). Patient had such laboratory parameters: pH - 7,30; рСО2 - 36 mm Hg;SB- 17,0 mecv/l; BB - 42 mecv/l; BE - 8,0 mecv/l. What ABB violation does take place in this case?

A. Non gas alkalosisB. Non gas acidosisC. Excretory alkalosisD. Gas acidosisE Gas alkalosis

31. Patient in comatose state. Laboratory tests: keton bodies – 58 mg%, TK day urine- 40 mecv/day, pH – 7,30, p CO2 – 50 mmHg, SB – 15,5 mecv/l, BB – 38,0 mecv/l, BE – 13,0 mecv/l. What is acid-basic balance disorder developing in this case?


32. Patient suffers from severe toxic damage of kidney with anuria. Laboratory tests: lactic acid – 20 mg%, pH -7,25, p CO2 - 47 mecv/l, SB -18,5 mecv/l, BB – 40,5 mecv/l, BE -70 mecv/l. What is acid-basic balance disorder develop in this case?


33. An operation is conducted with artificial ventilation of lungs. Patient had such laboratory parameters: pH -7,47; рСО2-75 mm Hg; SB-27,0 mecv/l; BB-49,0 mecv/l; ВЕ+3,5 mecv/l. What ABB violation does take place in this case?


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34. An operation is conducted with artificial ventilation of lungs. Patient had such laboratory parameters: pH -7,32; рСО2-25 mm Hg; SB-20 mecv/l; BB-40 mecv/l; ВЕ+3,0 mecv/l. What ABB violation does take place in this case?


35. Patient suffers from sharp insuffiency of left ventricle of heart. Edema of lung developed. Patient had such laboratory parameters: pH - 7,32; рСО2 - 51 mm Hg; SB - 18,0 mecv/l; BB - 45 mecv/l; BE +8.0 mecv/l. What ABB violation does take place in this case?


36. For a patient with diabetes mellitus hyperglicemia, ketonuria, glycosuria is marked, hyperstenuria and polyuria. What form of ABB violation does take place in this situation?

A. Gas acidocicB. Metabolic acidosisC. Gas alkalosisD. Non gas alkalosisE. Excretory alkalosis

Correct answers1-A 2-A 3-A 4-A 5-A 6-E 7-A 8-A 9-A10-B 11-C 12-A 13-A 14-D 15-A 16-A 17-D 18-B19-E 20-D 21-A 22-B 23-B 24-C 25-D 26-B 27-A28-B 29-C 30-B 31-B 32-B 33-E 34-D 35-B 36-B

Situational tasks:

1. An alpinist frequency and breathing depth was sharply increased. After some time breathing depressed and loss of consciousness came suddenly.1) What type of ABB violation take place in this patient?____________________________________________________________2) What are possible reasons for it origin?________________________________________________________________________________________________________________________3) Explain the mechanism of frequent and deeply breathing at getting up on a height.________________________________________________________________________________________________________________________4) Why did breathing stimulation change its depression?________________________________________________________________________________________________________________________5) What does a patient need to appoint - the breathing by clear oxygen or carbogen?________________________________________________________________________________________________________________________

2. Patient get head trauma, which accompanied with repeated vomiting and frequent breathing. During inspection found out the followings indexes of ABB: pH - 7,56; рСО2 = 30mm Hg; SB = 28 mmol/L; BB = 50 mmol/L; BE = +5 mmol/L.

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1) What type of ABB violation takes place in this patient?____________________________________________________________2) What are possible reasons of origin?_________________________________________________________________________________________3) What are the mechanisms of functions compensation in this case?__________________________________________________________________________________________________________________________________________________________________________________4) What possible violations can arise up?__________________________________________________________________________________________________________________________________________________________________________________5) How to correct ABB violation in a patient?_________________________________________________________________________________________3. A pregnant woman has toxicosis, which accompanied by prolonged vomiting. Data of her biochemical analyses show: pH of blood – 7.38, pCO2 of arterial blood – 46 mmHg, SB – 38 mmol/L, BE – (+ 6 mmol/L). 1) What type of ABB violation takes place in this patient?____________________________________________________________2) What are the mechanisms of functions compensation in this case?_________________________________________________________________________________________3) What possible violations can arise up?_________________________________________________________________________________________4) How to correct ABB violation in a patient?____________________________________________________________

4. Patient with diabetes mellitus has violation of acid-basic state, which developed as a result of keton bodies accumulation. Blood pH 7,32. 1) What type of ABB violation takes place in this patient?____________________________________________________________

2) What possible violations can arise up from the side of different organs and systems?__________________________________________________________________________________________________________________________________________________________________________________3) How to correct ABB violation in a patient?_________________________________________________________________________________________

5. A 58-years-old patient was admitted to the hospital in severe state. Data of her biochemical analyses show: pH of blood – 7.33, pCO2 of arterial blood – 36 mmHg, SB – 17 mmol/L, BE – (- 6 mmol/L).1) What type of ABB violation takes place in this patient?____________________________________________________________2) What are the mechanisms of functions compensation in this case?_________________________________________________________________________________________3) What possible violations can arise up from the side of different organs and systems?_________________________________________________________________________________________4) How does to correct ABB violation in a patient?________________________________________________________________________________________________________________________6. Patient with bronchial asthma has disturbances of airways passage at the level of small and medium bronchi.1) What type of ABB violation takes place in this patient?____________________________________________________________2) What possible violations can arise up from the side of different organs and systems?_________________________________________________________________________________________3) How to correct ABB violation in a patient?_________________________________________________________________________________________

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7. Patient suffers from bronchial asthma.рН 7,35рСО2, mm Hg 52SВ, mmol/l 22ВВ, mmol/l 45ВЕ, mmol/l +21. Name the type of ABB violation at the patient.________________________________________________________________________________________2. Explain the reasons of described violation origin._________________________________________________________________________________________3. How to correct the described violation?_________________________________________________________________________________________

8. An operation with using of artificial blood circulation is performed to the patient.рН 7,34рСО2, mm Hg 37SВ, mmol/l 14ВВ, mmol/l 29ВЕ, mmol/l -121. Name the type of ABB violation at the patient._________________________________________________________________________________________2. Explain the reasons of described violation origin._________________________________________________________________________________________3. How to correct the described violation?_________________________________________________________________________________________9. Primary diagnosis of the patient is “diabetes mellitus”.pН 7,36рСО2 mm Hg 36SB, mmol/l 19,5ВВ, mmol/l 39BE, mmol/l -5TA, mmol/l 37NH+

4, mmol/l -171. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.____________________________________________________________3. How to correct the described violation?____________________________________________________________

10. Primary diagnosis of the patient is “chronic glomerulonephritis, acute phase”.pН 7,28рСО2 mm Hg35SB, mmol/l 16,5ВВ, mmol/l 35BE, mmol/l 9TA, mmol/l 8NH+

4, mmol/l -1. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.____________________________________________________________3. How to correct the described violation?____________________________________________________________

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11. Small intestine fistula with loss of intestine juice was diagnosed at the patient.рН 7,35рСO2, mm Hg 36SB, mmol/l 14ВВ, mmol/l 24BE, mmol/l -8LA, mg% -28NH+4, mmol/l -15TA, mmol/l -81. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.____________________________________________________________

3. How to correct the described violation?____________________________________________________________

12. Patient suffers from severe form of toxic injury of the liver and kidneys with oliguria.рН 7,25рСO2, mm Hg 47SB, mmol/l 18,5ВВ, mmol/l 40,5BE, mmol/l -7LA, mg% -NH+4, mmol/l -TA, mmol/l -1. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.________________________________________________________________________________________________________________________3. How to correct the described violation?____________________________________________________________13. Patient suffers from acute left ventricle insufficiency complicated by the lung edema.рН 7,47рСO2, mm Hg 25SB, mmol/l 20ВВ, mmol/l 40BE, mmol/l 21. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.____________________________________________________________3. How to correct the described violation?_________________________________________________________________________________________14. An operation with using of artificial blood circulation is performed to the patient.рН 7,47рСO2, mm Hg 25SB, mmol/l 20ВВ, mmol/l 40BE, mmol/l 21. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.____________________________________________________________

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3. How to correct the described violation?____________________________________________________________

15. Patient suffers from uncontrolled vomiting, tetany.рН 7,50рСО2, mm Hg 36SB, mmol/l 28ВВ, mmol/l 57BE, mmol/l +5,51. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.____________________________________________________________3. How to correct the described violation?____________________________________________________________

16. Patient suffers from brain concussion with uncontrolled vomiting and dyspnea.рН 7,56рСО2, mm Hg 30SB, mmol/l 28ВВ, mmol/l 50BE, mmol/l +51. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.____________________________________________________________3. How to correct the described violation?____________________________________________________________

17. Patient suffers from acute blood loss.рН 7,19рСО2, mm Hg 25SB, mmol/l 11ВВ, mmol/l 27BE, mmol/l -17Ht 0,36LA, mg% 231. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.____________________________________________________________3. How to correct the described violation?____________________________________________________________

18. Patient is in the state after the operative removing of the clot from the abdominal part of aorta.рН 7,35рСО2, mm Hg 49SB, mmol/l 19,5ВВ, mmol/l 44BE, mmol/l -3,0Ht -LA, mg% -1. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.

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____________________________________________________________3. How to correct the described violation?____________________________________________________________

19. Patient suffers from hemolytic anemia of unknown reason.рН 7.31рС02, mm Hg 35SB, mmol/l 18ВВ, mmol/l 42ВЕ, mmol/l -5.5TA, mmol/l 12LA, mg% -12Ht 0,301. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.____________________________________________________________3. How to correct the described violation?____________________________________________________________

20. Patient suffers from brain concussion with uncontrolled vomiting.рН 7,43рС02, mm Hg 28SB, mmol/l 25ВВ, mmol/l 48ВЕ, mmol/l +4,0TA, mmol/l -LA, mg% -Ht -1. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.____________________________________________________________3. How to correct the described violation?____________________________________________________________

21. The blood was taken from the patient after the episode of the hysteria.рН 7,42рСО2, mm Hg 30SB, mmol/l 20,0ВВ, mmol/l 50,5ВЕ, mmol/l -0,5Ht 0,40TA, mmol/l -18LA, mg% -25,1. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.____________________________________________________________3. How to correct the described violation?____________________________________________________________

22. Patient was hospitalized 9 days before with diagnosis “acute myocardial infarction”.рН 7,22рСО2, mm Hg 51

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SB, mmol/l 15ВВ, mmol/l 38ВЕ, mmol/l -12,5Ht -TA, mmol/l -LA, mg% -1. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.____________________________________________________________3. How to correct the described violation?____________________________________________________________

23. Patient suffers from purulent peritonitis. рН 7,48рСО2 49 mm HgSB 26,5 mmol/lВВ 52,5 mmol/lВЕ +6 mmol/lTA 18 mmol/l1. Name the type of ABB violation at the patient.____________________________________________________________2. Explain the reasons of described violation origin.________________________________________________________________________________________________________________________3. How to correct the described violation?____________________________________________________________

Practical work: “VIOLATION of the ACID-BASIC STATE”

Object of work: to define titratable acidity of urine at acidosis and alkalosis.

EXPERIMENT № 1. Take 5 ml of urine, add 2 drops of phenolphthalein. Titrate by the drops of decinormal solution of NaOH till the colour of solution become to rose.

Titratable acidity – it’s the amount of alkali (ml), which we use for neutralization of 1 liter of urine acidic products.

In a norm this index is equal 200-400 ml.

For titration of 5 ml of urine we used ______ ml of alkali.5 ml of urine - _______ ml of alkali1000 ml of urine – X ml of alkali

X = ____________________________ ml

Conclusion:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Theme: VIOLATION OF PROTEIN AND LIPID METABOLISM.

Actuality of the theme.Metabolic disturbances can appear at all levels of biological organization – from molecular and cellular to

the organism level. These changes can be investigation of violation of nervous hormonal mechanisms, changes of genetic information, action of pathogenic factors. A primary metabolic disturbance lies in the basis of many diseases, f. ex. diabetes mellitus, obesity, gout and other.

The secondary violations accompany the most pathological processes.The studies of reasons, mechanisms of development, displays of metabolic disturbance at different levels,

their diagnostics, treatment and prophylactic have great significance in preparation of future doctor.

General purpose of the lesson: To learn the basic stages of violations of protein and lipid metabolism.

For this it is necessary to know:1. To expose the typical forms of violations of protein and lipid metabolism. 2. To expose violation of blood protein composition.3. To explain the mechanisms of development of gout, general pathophysiologycal principles of its

treatment.4. To describe the inherited disorders of amino acid metabolism.5. To expose main forms of lipid metabolism violations.6. To explain the main mechanisms of obesity.7. To define the main classes of lipoproteids and their role in pathology.8. To explain the role of cholesterol and blood plasma lipoproteids in the origin of atherosclerosis.

For realization of purpose of lesson it is necessary to have the base knowledges-skills. 1. Value of protein, lipid for an organism (Biochemistry Department).2. Regulation of protein and lipid metabolism (Normal Physiology Department).3. Negative and positive nitrous balance (Biochemistry Department).4. Protein composition of blood (Normal Physiology Department).5. A concept about lipoproteids (Biochemistry Department).

Information, necessary for addition to knowledges-abilities of bases on these questions, can be found in the followings textbooks:

Materials from normal physiology course.

The checking of primary level of knowledges Give the answer to the followings questions:

1. What is positive nitrous balance?2. What is negative nitrous balance?3. Reasons which lead to the origin of negative nitrous balance?4. Reasons which lead to the origin of positive nitrous balance?5. What is hypoproteinemia? Make examples.6. What is hyperproteinemia? Make examples.7. What is dysproteinemia? Make examples.8. What is hypernitrogenemia? Make examples.9. What is products hypernitrogenemia? Make examples.10. What is retentional hypernitrogenemia? Make examples.11. What is phenylketonuria? What type of its inheritance?12. What is alcaptonuria? What type of its inheritance?13. Gout, mechanisms of development.14. What acid does accumulate in blood at a gout? 15. What is obesity? Name the types of obesity.16. What is the secondary obesity? Make examples.17. Basic classes of blood plasma lipoproteids.18. What are the „modificated” lipoproteids? Make examples.

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19. Make examples of hormonal obesity.

Theoretical questions for FMC №1.1. Main stages of violations of protein metabolism.2. Violation of protein composition of blood plasma: hypo-, hyper,

dysproteinemia, paraproteinemia.3. Hereditary disorders of aminoacid metabolism.4. Gout. Reasons and mechanisms of development. Basic

pathophysiologycal principles of treatment.5. Characteristic features of violations of purins bases for children.

Hyperurikemia and uraturia of new-born.6. Main stages of lipid metabolism violations.7. Obesity, determination. Reasons and mechanisms of obesity

different forms development.8. Basic classes of lipoproteids and their role in pathology.9. Disorder of cholesterin metabolism for children and adults.

Literature.1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU,

2005.p.142-1442. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005.p.125-133, 145-1533. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin – Vinnytsia: Nova Knuha

Publishers – 2011. p.286-287, 322-333

THEMES of reports for individual work of students:1. Inherited disorders of metabolism of amino acid.2. Pathogenesis of obesity.3. Gout. Role of eczo- and endogenous factors in its origin. Mechanisms of development. Pathogenic

treatment.4. Modern pictures of pathogenesis of atherosclerosis.5. Obesity and diabetes mellitus.



1. A 58-year-old patient suffers from the cerebral atherosclerosis. Examination revealed hyperlipoidemia. What class of lipoproteins will most probably show increase in concentration in this patient’s blood serum?

A Low-density lipoproteins B High-density lipoproteins C Fatty acid complexes with albumins D Chylomicrons E Cholesterol

2. A patient who had been working hard under conditions of elevated temperature of the environment, has now a changed quantity of blood plasma proteins. What penomenon is the case?

A Relative hyperproteinemia B Absolute hyperproteinemia C Absolute hypoproteinemia D Disproteinemia E Paraproteinemia

3. A patient being treated for viral hepatitis type B got symptoms of hepatic insufficiency. What blood changes indicative of protein metabolism disorder will be observed in this case?

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A Absolute hypoalbuminemia B Absolute hyperalbuminemia C Absolute hyperfibrinogenemia D Proteinic blood composition is unchanged E Absolute hyperglobulinemia

(2009 year)

4. A 1,5-year-old child presents with both mental and physical lag, decolorizing of skin and hair, decrease in catecholamine, concentration in blood. When a few drops of 5% solution of trichloroacetic iron had been added to the child's urine it turned olive green. Such alteration are typical for the following pathology of the amino acid metabolism:

A. Tyrosinosis B. AlkaptonuriaC. PhenylketonuriaD. AlbinismE. Xanthinuria

5. Nappies of a newborn have dark spots being the evidence of homogentisic acid formation. This is caused by the metabolic disorder of the following substance:

A. CholesterolB. MethionineC.GalactoseD. Tyrosine E. Tryptophan

(2006-2008)

6. Patient suffers from pellagra. Disorder of metabolism of what amino acid lie in basis of this disease? А. Thrypthofan В. ТhyrosinС. Phenylalanine D. Cystein E. Valin

7. A child with phenylcetonuria suffers from mental insufficiency. What mechanism will be main in development of damage of the central nervous system?

А. Increase ecscreation with urine of phenylceton bodiesВ. Increase of thyrosin synthesisС. Decrease of the synthesis of thyreiod hormonesD. Decline of synthesis of melaninЕ. Accumulation of phenylalanine in the blood

8. Child, 8 months, found disorders in mental and physical development. What amino acid must be excluded from the meal of child?

А. HystidinВ. LeicinС. ТhyrosinD. ThrypthofanЕ. Phenilalanin

9. Colouring of sclera, mucous membranes were founded during examination of infant. Darkening of urine in air was determined. Homogenthisin acid was founded in the blood and urine. For what state it is characteristically?

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А. CystinuriaВ. HystidinemiaС. АlcaptonuriaD. AlbinismЕ. Galakozemia

10. Albinos do not carry sun influencing- sunburn does not develop, and burns appear. Violation of what aminoacid lies in a basis of this phenomenon?

А. ThrypthofanВ. HystidinС. МеthioninD. Glyutamin acidЕ. Phenylalanine

11. To the woman with pathological obesity for the decline of body mass conducted an operation, as a result she lost 30 kg That it was remote during an operation.

А. Part of stomachВ. Gall bladerС. Part of pancreasD. Part of colonЕ. Part of thin bowel

12. Man has cerebral obesity developed after the carried encephalitis. What is the leading mechanism of this obesity?

А. Decrease of basic metabolismВ. Increase converting of glucose into lipidsС. Decrease of lipolisD. HyperinsulinemiaE. Bulemia, polyphagia

13. Why develops obesity at hyperinsulinism?А. Decrease of pentozophosphatic wayВ. Proteins convert into lipidsС. Activaiting of glycogenesisD. Glyconeogenes increasesЕ. Carbohydrates converts into lipids

14. A sportsman after stopping of trainings had obesity. What is pathogenetic mechanism?А. Increase of the tonus of the parasympathetic nervous systemВ. Decrease of the tonus of the sympathetic nervous systemС. Insufficiency of mobilizations lipids from a depoD. Oppressing the center of saturationЕ. Uncorrespondence of using energy to the amount of food which is used

15. Child, 10 months (parents has dark hair), has very light skin and blue eyes. During the last 3th months there were violations of cerebral blood circulation. Reason for such state can be:

А. Sharp porphyriaВ. HystidinemiaС. GlicogenomD. Phenilcetonuria Е. Galakozemia

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16. A patient, 60 years, suffered from pain in the small joints of feet and hands. Joints are increased, have the appearance of the thickened nodes. Maintenance of urats is increased in blood. What metabolism disorders can be the reason of this state?

A. PyrimidinB. Amino acidC. PurinsD. LipidE. Carbohydrates

17. Multiplying maintenance of phenylalanine is discovered in the pregnant women blood. What disorder can arise up in a child?

A. Development of oligofreniaB. Development of galaktozemiaC. Birth of child is with the Turner syndromeD. Development of Vilson diseaseE. Birth of child is with the Dawn’s syndrome

18. Man, 65 years, complaints about acute pain in large fingers of legs. He drinks beer often. There was suspicion on a gout. Level of what acid is it necessary to define in blood for confirmation of diagnosis?

A. Urinary acidB. BilirubinC. Keton bodiesD. UreaE. Lactate

19. It is known that phenylcetonuria - is result of gene mutation, responsible for transformation of phenylalanine and disintegration of it to the finished products of metabolism - СО2 and Н2О. What way of phenylalanine metabolism will result development of phenylcetonuria?

A. Phenylalanine - thyrosin - thyroxin B. Phenylalanine - thyroxin - noradrenalinC. Phenylalanine - thyroxin D. Phenylalanine - phenylpiruvat - keton acidE. Phenylalanine - thyrosin - melanin

20. Sick K., 48 years, suffers from obesity, conducted the course of medical starvation at home. The deep noisy breathing appeared on 10th day, arterial pressure 90/60 mm Hg, a selection of urine diminished, urine with the smell of acetone. What does this phenomenon testify about?

A. Nongas alcalosB. Hyperglycemia C. KetosisD. Hypoglycemia E. Gas acidosis

21. Slow physical and psychical development, pale skin, hairs, iris of eye, positive Feling’s test were marked at child 6 months. What inherited disease found out at a child?

A. GalaktozemiaB. AlcaptonuriaC. Illness of DaunaD. AlbinismE. Phenylcetonuria

22. Patient suffers from alcaptonuria. Deficiency of what enzyme was present in this case?A. ThyroxinhydroxylaseB. Oxydase of homogenthisin acidC. PhenylalaninhydroxylaseD. Thyrosinase

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E. Monoaminooxydase

23. A month ago patient was delete of considerable part of thin bowel. In his blood explored maintenance of albumen in plasma, which made 3,5 g/l. How to classify the changes of albuminous composition of blood?

A. DesproteinemiaB. HyperproteinemiaC. ParaproteinemiaD. HypoproteinemiaE. Hypernitrogenemia

24. The promoted maintenance of low density lipoproteids was founded in the blood at an inspection of patient. What disease can be expected in this patient?

A. PneumoniaB. Acute pancreatitisC. GastritisD. AtherosclerosisE. Damage of kidneys

25. A patient with a fever lost weight during three weeks. Rest nitrogen of blood is 70 mmol/L. What is nitrous balance in a patient?

A. PositiveB. NegativeC. NormalD. Relative

26. The concentration of albumen in patient with infectious disease blood is 120 g/l. What quantitative change of blood albuminous composition is present?

A. HyperproteinemiaB. HypoproteinemiaC. ParaproteinemiaD. DysproteinemiaE. Hypernitrogenemia

27. Maintenance of common protein in the patient with hepatic coma blood is 40 g/l, maintenance of albumen and fibrinogen is reduced, γ-globulin is promoted. Name the changes of blood albuminous composition?

A. HypoproteinemiaB. HyperproteinemiaC. DysproteinemiaD. HypernitrogenemiaE. Paraproteinemia

28. The maintenance of lipids in the blood of patient at starvation (in the second period) can increase. What is the form of hyperlipidemia in this case?

A. CerebralB. RetentionalC. TransportD. AlimentaryE. Diencephalic

29. Ventromedial nucleos of hypothalamus were ruined at animal in an experiment. As a result it has an obesity. What is the type of obesity in this case?

A. Alimentary

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B. CerebralC. HormonalD. HyperplasticE. Hypertrophic

30. Maintenance of urinary acid in a patient blood is promoted, that causes the pain syndrome development as a result of urats deposit in the joints. What is the reason of this acid appearance?

A. Catabolism of HEMB. Pirimidin nucleotids disintegrationC. Purin bases reutilisationD. Purin nukleotids disintegrationE. Protein disintegration

31. Hyperlipidemia was founded at patient 67 years, suffers from atherosclerosis of cerebrum vessels. What class of blood lipoproteids of probably will be promoted at biochemical research?

A. Low density lipoproteidsB. High density lipoproteidsC. α-lipoproteidsD. ChilomicronsE. Lipid acids and albumin complexes

32. Negative nitrous balance was founded at the inspection of man 45 years, which was long time on a vegetable diet. What is the reason of this phenomenon?

A. Insufficient quantity of proteinsB. Surplus quantity of waterC. Surplus quantity of carbohydratesD. Insufficient quantity of lipidsE. Insufficient quantity of lipids and proteins

33. Child, 2 years, was delivered to the hospital with slow mental and physical development, frequent vomiting after taking a meal. Phenylpirovinograde acid was founded in urine. Violation of what metabolism is in this pathology?

A. CarbohydrateB. Amino acidC. Water-saltD. Phosphoric-calciumE. Lipid metabolism

34. A prisoner declared starvation. Hypoglycemia, hypoproteinemia, hyperlipemia and ketonemia were founded in his blood after the week of starvation. What form of hyperlipemia developed?

A. Alimentary B. FoodC. TransportD. EsentialE. Retentional

35. Hypotension, muscular weakness, negative nitrous balance were founded at the inspection of woman 50 years, who long time was on a vegetable diet. What factor resulted such state?

A. Surplus carbohydrates amount in a foodB. Insufficient carbohydrates amount in a foodC. Surplus consumption of waterD. Insufficient lipids amount in a foodE. Insufficient protein amount in a food

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36. A patient with normal maintenance of general protein in blood has changes of separate albuminous fractions correlation. Name this phenomenon.

A. HyperproteinemiaB. DysproteinemiaC. ParaproteinemiaD. HypoproteinemiaE. Monoproteinemia

37. Polyunsaturated ω- 3-lipid acids which are contained in marine fish, and preparations, created on their basis, are recommended for the atherosclerosis prophylaxis. What is the mechanism of the lipid acids action?

A. In the human organism these acids transform on eycosanoidsB. There are vasoconstrictors and activators of trombocytes agregationC. There are vasodilyatators and inhibitors of trombotocytes agregationD. Activate lecitin -cholestirin-acetyltransferase, that is contained in LDLPЕ. Inhibitor of Co-A- reductase

38. Apoprotein - is:А. Protein cellular receptors to lipoprotein of blood plasma В. Variant of „modificated” lipoproteidsС. Lipoproteins of blood plasma without albuminous partD. Albuminous component of blood plasma lipoproteins Е. Anomal proteins with characteristics of lipoproteins

39. Woman, 62years, suffers from frequent pain in the area of thorax and vertebra, breaks of ribs. A doctor assumed mielom disease (plasmocytoma). What laboratory indexes will have a main diagnostic value?

A. HypoproteinemiaB. Paraproteinemia C. ProteinuriaD. HyperalbumenemiaE. Hypoglobulinemia

40. The quantity of plasma albumens changed in a man which executed a physical work in the conditions of high temperature. How did quantity of plasma albumins change?

A. Relative hyperproteinemiaB. ParaproteinemiaC. Dysproteinemia D. Absolute hyperproteinemiaE. Absolute hypoproteinemia

41. Increase of free lipid acids in patients with diabetes mellitus blood was observed. What is the reason of this state?

A. Increase of adipocytes trigliceridlipase activityB. Accumulation of palmytin –Co-A in cytosolum C. Activating of apolipoproteins of А-1, А-2, А-4 synthesis D. Decline of phosphatidilcholin – cholesterin acetyltransferase activity in the bloodE. Activating of keton bodies utilization

42. Man, 70 years, suffers from atherosclerosis of lower extremities vessels and ischemic heart disease. Violation of lipid composition of blood was founded during examination. What lipoprotein is the main link in atherosclerosis pathogenesis?

A. Low densityB. Cholesterol

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C. High densityD. Intermediate densityE. Chilomicrons

Correct answers1-A 2-A 3-A 4-C 5-D 6-A 7-E 8-E 9-C10-C 11-E 12-E 13-E 14-E 15-D 16-C 17-A 18-A19-E 20-C 21-E 22-B 23-D 24-D 25-A 26-A 27-C28-C 29-B 30-D 31-A 32-A 33-B 34-C 35-E 36-B37-D 38-D 39-B 40-A 41-A 42-A

Situational tasks:

1. Patient, 60 years, suffers from atherosclerosis of the vessels of the lower extremities, ischemic heart disease. At the investigation hyperlipidemia was founded.

1. What class of lipoproteins od blood plasma will be increased?____________________________________________________________

2. What classes of lipoproteins do you know? Characteristic._________________________________________________________________________________________

3. Рrinciples of pharmacocorrection.____________________________________________________________

2. Patient, 60 years, suffers from atherosclerosis of the vessels of the lower extremities, ischemic heart disease. At the investigation hyperlipidemia was founded.1. What is hyperlipoproteinemia?_________________________________________________________________________________________2. Classification of hyperlipoproteinemia._________________________________________________________________________________________3. Рrinciples of pharmacocorrection._________________________________________________________________________________________

3. Patient has encephalitis. After the disease she suffers from increasing of appetite (polyphagia), increasing of body weight. Obesity developed. 1. What is the type of obesity?____________________________________________________________2. What are the reasons of its development?_________________________________________________________________________________________3. Classification of the obesity according to pathogenesis?_________________________________________________________________________________________

4. Patient has encephalitis. After the disease she suffers from increasing of appetite (polyphagia), increasing of body weight. Obesity developed. 1. Obesity, definition._________________________________________________________________________________________2. What is the kind of obesity. Explain the answer. _________________________________________________________________________________________3. Рrinciples of pharmacocorrection .____________________________________________________________

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5. Patient admitted to the clinic at the comatous state. At anamnesis diabetes mellitus II type during 5 years. Objectively: deep and noisy breathing, smell of acetone in the expiratory air. 1. What are the changes of lipid metabolism at the patient? Explain your answer.____________________________________________________________2. For what complication of present disease described symptoms are characteristic?_________________________________________________________________________________________

6. Patient admitted to the clinic with diagnosis “adenoma of β-cells of pancreas". Obesity is characteristic.1. What is the reason of obesity in this case?______________________________________________________________________2. What kinds of obesity do you know? __________________________________________________________________________________________________________________________________________________________________________________3. What is type of obesity at this patient?____________________________________________________________4. Рrinciples of pharmacocorrection._________________________________________________________________________________________

6. A child complains on general weakness, diarrhea. Depigmentation of the skin was founded. The diagnoses was made: kwashiorkor. 1. Explain the reasons and mechanisms of development of described pathology._________________________________________________________________________________________2. Which else manifestations of kwashiorkor do you know?_________________________________________________________________________________________3. Prophylaxis and treatment of this pathology._________________________________________________________________________________________

7. Dark spots at the area of the nose, scleras and ears appeared at the child, 2 years old. Urine is become black on the air.1. Accumulation of what substance in the blood and urine can lead to such changes?____________________________________________________________2. What is the pathology?____________________________________________________________3. What is the type of inheritance of this pathology?____________________________________________________________

8. Amount of homogenthisinic acid is increased at the child, 5 years old. 1. What pathology is observed at the patient?____________________________________________________________2. What enzyme insufficiency takes place at this pathology? ____________________________________________________________3. What is the type of inheritance of this pathology?____________________________________________________________

9. A child, 9 monthes. He has light-colored hair (parents are dark-haired) very light-colored skin and blue eyes. He has physical and mental developmental retardation. Feling’s test is positive.1. Lever of what amino acid have to be checked? ____________________________________________________________2. Defect of what hormone takes place at this pathology?____________________________________________________________3. What is the type of inheritance of this pathology?

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____________________________________________________________

10. A child, 9 monthes. He has light-colored hair (parents are dark-haired) very light-colored skin and blue eyes. He has physical and mental developmental retardation. Feling’s test is positive.

1. Lever of what amino acid have to be checked? ____________________________________________________________2. What is the mechanism of this pathology development?________________________________________________________________________________________________________________________3. Prophylaxis and treatment of this pathology. ____________________________________________________________

11. Patient enter to the doctor with complains on the pain at the small joints of the hands and foots. Objectively: increasing of these joints, their deformation. Increased level of the urates in the blood was founded.1. What is the disease at the patient?____________________________________________________________2. What is the mechanism of described changes?____________________________________________________________3. Prophylaxis and treatment of this pathology._________________________________________________________________________________________

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theme: local disorders of circulation of · web viewexcept for a fever, take place and other...

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