PATHOLOGICAL ANATOMY

Digestive tract pathology

218. Physical examination of the feces of a patient with angina has shown hyperemia of the mucous
membrane of the palate, enlarged red tonsils with small yellow-pale focuses on their surface. What
clinicopathologic type of angina is the most possible?
A. Fibrinous.
B. Catarrhal.
C. Suppurative.
D. Lacunar tonsillitis.
E. Necrotic.
219. A vermiform appendix is 9 cm long and 0,9 cm thick. Serous membrana is dark and plethoric.
Microscopically: the wall is edematous, stases and small haemorrhages in capillaries and venules. Necrosis
focuses surrounded by leukocytic infiltration are located in mucous and submucous membranae. What is the
most possible diagnosis?
A. Acute ulcerophlegmonous appendicitis.
B. Acute simple appendicitis.
C. Acute phlegmonous appendicitis.
D. Acute superficial appendicitis.
E. Acute gangrenous appendicitis.
220. A vermiform appendix, sent to a pathomorphologic department after the operation, is thickened and
enlarged. Serous membrane is dark and plethoric. Yellow-green fluid excretes from the cut. The wall is
diffusely infiltrated with leukocytes. In case of what type of appendicitis do the changes develop?
A. Superficial catarrhal.
B. Simple catarrhal.
C. Phlegmonous.
D. Gangrenous.
E. Apostematous.
221. A microscopical examination of the vermiform appendix that had been operatively removed has shown
edema, diffuse neutrophilic infiltration of the wall with necrosis, and the presence of mucous membrane
defect with the affection of its muscle plate. What form of appendicitis has developed?
A. Ulcerophlegmonous.
B. Phlegmonous.
C. Gangrenous.
D. Superficial.
E. Apostematous.
222. Morphological examination of a stomach has shown a deep defect of the wall with the affection of
muscular tunic; the proximal margin is sapped, the distal one is flat. Microscopically an area of necrosis is
detected at the bottom of the defect. Granulation tissue and a massive area of a healing tissue are in the
muscle layer. Diagnose the disease.
A. Chronic ulcer at the remission stage.
B. Chronic ulcer with malignization.
C. Acute ulcer.
D. Chronic ulcer at the exacerbation stage.
E. Cancer-ulcer.
223. Autopsy of a dead 29-year-old man, who had had duodenal ulcer for a long time, has shown the signs of
peritonitis, numerous steatonecroses of retroperitoneal fat and pancreas. In the area of pancreas body an ulcerlike defect is located (5 mm in diameter and 10 mm deep), the margins of which contain necrotic masses.
Diagnose the complications of the duodenal ulcer.
A. Malignancy.
B. Hemorrhage.
C. Stenosis.

2
D. Perforation.
E. Penetration.
224. During the palliative operation of a 46-year-old woman with stomach cancer Krukenberg's tumor has
been detected. What way of metastasis led to the ovaries affection?
A. Lymphogenous retrograde.
B. Lymphogenous orthograde.
C. Hematogenic.
D. Implantation.
E. Canalicular.
225. Autopsy of a dead 42-year-old woman, who had an operation on stomach tumor, has shown sharply
enlarged white ovary of solid consistence. Histologically there were detected atypical epithelial cells located
between the layers and tension bars of the connective tissue. What is the most possible disease?
A. Serous cystadenocarcinoma.
B. Krukenberg's carcinoma.
C. Pseudomucinous cystcarcinoma.
D. Malignant thecoma.
E. Malignant granulosa cell tumor.
226. Left subclavicular lymph nodes of a 45-year-old patient are enlarged. A metastasis of signet ring cell
carcinoma was detected in the node biopsy material. Choose the most possible localization of the primary
tumor.
A. Cancer of lung.
B. Esophageal cancer.
C. Thyroid carcinoma.
D. Gastric carcinoma.
E. Cervical carcinoma.
227.Microscopical examination of a removed appendix revealed an edema, diffuse neutrophilic infiltration of
appendix wall along with necrosis and defect of mucous membrane with affection of its muscle plate. What
appendicitis form was developed?
A Ulcerophlegmonous
B Phlegmonous
C Gangrenous
D Superficial
E Apostematous
228.A pathology-histology laboratory received a vermiform appendix up to 2,0 cm thick. Its serous membrane
was pale, thick and covered with yellowish-green films. The wall was flaccid, of grayish-red colour. The
appendix lumen was dilated and filled with yellowish-green substance. Histological examination revealed that
the appendix wall was infiltrated with neutrophils. Specify the appendix disease:
A Acute simple appendicitis
B Acute gangrenous appendicitis
C Acute superficial appendicitis
D Acute phlegmonous appendicitis
E Chronic appendicitis
229.A patient died from acute cardiac insufficiency, among clinical presentations there was gastrointestinal
haemorrhage. Examination of mucous membrane of stomach revealed some defects reaching myenteron; their
edges and bottom were mostly even and loose, some of them contained dark-red blood. What pathological
process was revealed?
A Acute ulcers
B Chronic ulcers
C Erosions
D Thrombosis
E Inflammation
230. A 39
year old
man who had
been operated for the stomach ulcer died 7
days after the
surgery.
Autopsy
revealed that peritoneal leaves were dull, plethoric,

3
covered
with
300 ml
of
toneal cavity?

massive
yellow-greenish
films, the peritoneal cavity contained for about
thick yellow-greenish
liquid. What pathologic process was revealed in the peri-

A. Serous peritonitis
B. Fibrinous haemorrhagic peritonitis
C. Fibrinous suppurative peritonitis
D. Fibrinous serous peritonitis
E. Peritoneal commissures

Liver pathology
231. A histological examination of a dead man, who had received numerous drug injections, has shown a
hydropic hepatocytes dystrophy, lusterless glassy hepatocytes, acidophilic Kaunsilmann corpuscles, and
lymphocytic-macrophagocytic conglomerations in portal tracts. What is the most possible etiology of the
disease?
A. Bacterial.
B. Viral.
C. Toxic.
D. Parasitic.
E. Fungous.
232. A patient with chronic viral hepatitis died of acute posthemorrhagic anemia caused by the hemorrhage
from varicose esophagus veins. Autopsy has shown a sharply diminished liver of solid consistence; its surface
is microtuberous. Microscopically: thin-looped net of connective tissue and small false lobules. Name the
morphogenetic type of cirrhosis.
A. Postnecrotic.
B. Portal.
C. Mixed.
D. Viral.
E. Biliary.
233. Autopsy of a dead man, who had had alcohol abuse for a long time, has shown a small, solid,
microtuberous liver. Microscopically: false lobules arc small and separated by a thin layer of connective tissue
with lymphomacrophagal infiltrates. Hepatocytes are at the stage of the giant-drop adi posal degeneration.
What is the most possible diagnosis?
A. Alcoholic cirrhosis.
B. Chronic active alcoholic hepatitis.
C. Chronic long-lasting alcoholic hepatitis.
D. Massive hepatic necrosis.
E. Fatty hepatosis.
234.A 59-year-old man has signs of the parenchymatous jaundice and portal hypertension. On histological
examination of the puncture of the liver bioptate, it was revealed: beam-lobule structure is affected, part of
hepatocytes has signs of fat dystrophy, port-portal connective tissue septa with formation of pseudolobules,with periportal lympho-macrophage infiltrations. What is the most probable diagnosis?
A Liver cirrhosis
B Alcohol hepatitis
C Chronic hepatosis
D Viral hepatitis
E Toxic dystrophy
235. On autopsy of the man with alcohol abuse for a long time it was revealed: dense, small-knobby, small
size liver. Microscopically: small pseudo-lobules, divided with thin layers of connective tissue with
lymphomacrophagial infiltrates; hepatocytes in the state of globular fatty dystrophy. What is the most likely
diagnosis?
A Fatty hepatosis

4
B Chronic active alcohol hepatitis
C Chronic persistent alcohol hepatitis
D Toxic liver dystrophy
E Alcohol cirrhosis
236.Analysis of a punction biopsy material of liver revealed hepatocyte dystrophy with necroses as well as
sclerosis with disorder of beam and lobulous structure, with formation of pseudolobules and regenerative
nodes. What is the most probable diagnosis:
A Liver cirrhosis
B Chronic hepatosis
C Chronic hepatitis
D Progressive massive liver necrosis
E Acute hepatitis
237. A 38 year old patient with full-blown jaundice, small cutaneous hemorrhages, general weakness and
loss of appetite underwent puncture biopsy of liver. Histological examination revealed disseminated
dystrophy, hepatocyte necrosis, Councilman's bodies. Lobule periphery has signs of significant infiltration by
lymphocytes, there are also individual multinuclear hepatocytes. What is the most probable diagnosis?
A Acute viral hepatitis
B Acute alcoholic hepatitis
C Miliary hepatic cirrhosis
D Toxic degeneration of liver
E Chronic hepatitis
Kidneys pathology
238. Autopsy has shown that kidneys are enlarged; the cortex is wide, yellow-gray with red impregnation,
well separated from the murrey marrow. Histological examination detected the excrescence of nephrothelium
and podocytes in the glomerules capsule with crescents formation, phenomena of sclerosis and hyalinosis of
glomeruli, stroma fibrosis. What disease is meant?
A. Interstitial nephritis.
B. Intracapillary productive glomerulonephritis.
C. Extracapillary exudative glomerulonephritis.
D. Intracapillary exudative glomerulonephritis.
E. Extracapillary productive glomerulonephritis.
239. Microscopical examination of kidneys has shown the proliferation of nephrothelium in Bowman's
capsule, of podocytes, and macrophages with the formation of crescent structures that compress the
glomerule. Capillaries of glomerules are necrotizing; in their lumens fibrinous thrombi can be seen. Some
glomerules are affected with sclerosis or hyalinosis. The dystrophy of neurocytes, edema and infiltration of
the nephral stroma are observed. Name the renal pathology.
A. Malignant glomerulonephritis.
B. Postinfectious glomerulonephritis.
C. Chronic glomerulonephritis.
D. Chronic pyelonephritis.
E. Renal amyloidosis.
240. A 36-year-old woman died of renal insufficiency. Microscopical examination detected the proliferation
of the capsule nephrothelium, podocytes and macrophages with crescents formation, capillary loops necrosis
with fibrinous thrombi in their lumens, sclerosis and hyalinosis of glomeruli, atrophy of the tubules, and renal
stroma fibrosis. What is the most possible diagnosis?
A. Membranous nephropathy.
B. Acute glomerulonephritis.
C. Chronic glomerulonephritis.
D. Focal segmental sclerosis.
E. Subacute glomerulonephritis.

5
241. Autopsy has shown enlarged kidneys with coarse-tuberous surface caused by the presence of numerous
cavities with smooth walls filled with transparent fluid. What disease is meant?
A. Cystic disease.
B. Necrotic nephrosis.
C. Pyelonephritis.
D. Glomerulonephritis.
E. Infarction.
242. Autopsy of a man, who died of burn disease, has shown cerebral edema, enlargement of liver and
kidneys, the cortex of which is wide and gray-pale, but medullary substance is plethoric. Microscopically:
necrosis of the tubules of main departments with the destruction of basal membranes, edema of the
interstitium with leukocytic infiltration and hemorrhages. What is the most possible diagnosis?
A. Tubulointerstitial nephritis.
B. Necrotic nephrosis.
C. Pyelonephritis.
D. Gouty kidney.
E. Myeloma kidney.
243. A 42-year-old man with a complicated form of typhoid had acute renal insufficiency developed which
caused his death. Autopsy has shown enlarged edematous kidneys, fibrous capsule can be easily removed; on
the cut surface the cortex is gray-pale, pyramids are murrey. Histological examination has detected narrow
lumen of most tubules; enlarged epithelial cells without nuclei; collapsed glomeruli; edematous stroma with
small leukocytic infiltration and small hemorrhages. What pathology is meant?
A. Pyonephrosis.
B. Acute pyelonephritis.
C. Acute glomerulonephritis.
D. Necronephrosis.
E. Hydronephrosis.
244. A patient with signs of mercuric poisoning has the following processes in kidneys: focal necrotic changes
in tubules of the main departments, edema, leukocytic infiltration, and hemorrhages of the intersticium and
venous congestion. What condition has developed?
A. Acute glomerulonephritis.
B. Acute necrotic nephrosis.
C. Chronic renal insufficiency.
D. Acute pyelonephritis.
E. Chronic pyelonephritis.
245. In the renal biopsy material sclerosis, lymphoplasmocytic infiltration of renal pelves and chalices,
dystrophy and atrophy of the tubules were detected. Preserved tubules were widened, stretched by colloid-like
masses; the epithelium was flat (thyroid kidney). What is the most possible diagnosis?
A. Nephrosclerosis.
B. Acute pyelonephritis.
C. Glomerulonephritis.
D. Chronic pyelonephritis.
E. Tubulointerstitial nephritis.
246. Autopsy of a woman, who died of renal insufficiency, has shown unevenly reduced in size kidneys with
coarse-tuberous surface; on the cut surface the areas of healing tissue alternate with unchanged parenchyma,
renal pelves are widened with thick walls. Microscopically in the walls of renal pelves, chalices, and in the
intersticium there are signs of sclerosis and lymphoplasmocytic infiltration. What is the most possible
diagnosis?
A. Acute glomerulonephritis.
B. Acute pyelonephritis.
C. Chronic pyelonephritis.
D. Tubulointerstitial nephritis.
E. Chronic glomerulonephritis.

6
247. Morphological examination of a removed kidney has detected in the proximal part of the ureter the
presence of a concrement that obturated its lumen. The kidney is sharply enlarged with parenchyma atrophy;
renal pelves and chalices are considerably widened. Microscopically: diffuse sclerosis, atrophy of glomeruli
and tubules; preserved tubules are cystically widened. What complication of nephrolithiasis appeared?
A. Hydronephrosis.
B. Pyonephrosis.
C. Pyelonephritis.
D. Glomerulonephritis.
E. Chronic paranephritis.
248. Kidneys of a patient, who died of chronic renal insufficiency caused by chronic glomerulonephritis, are
reduced in size, of solid consistence; the capsule can be hardly removed exposing granular surface. On the cut
surface cortex and medulla are thin; renal tissue is dry, anemic, gray. How can we term such kidney?
A. Atherosclerotically contracted.
B. Secondary contracted.
C. Arteriolosclerotic.
D. Amyloid contracted.
E. Pyelonephritic contracted.
249.On autopsy it is revealed that kidneys are enlarged, surface is large-granular because of multiple cavities
with smooth wall, which are filled with clear fluid. What kidney disease did the patient have?
A Polycystic kidney
B Necrotic nephrosis
C Pyelonephritis
D Glomerulonephritis
E Infarction
250.For a long time a 49-year-old woman was suffering from glomerulonephritis which caused death.On
autopsy it was revealed that kidneys size was 732.5 sm, weight is 65,0 g, they are dence and small-grained.
Microscopically: fibrinogenous inflammation of serous and mucous capsules, dystrophic changes of
parenchymatous organs, brain edema. What complication can cause such changes of serous capsules and inner
organs?
A Uraemia
B Anemia
C Sepsis
D DIC-syndrome
E Thrombopenia
251.Autopsy of a man who died from burn disease revealed brain edema, liver enlargement as well as
enlargement of kidneys with wide light-grey cortical layer and plethoric medullary area. Microscopic
examination revealed necrosis of tubules of main segments along with destruction of basal membranes,
intersticium edema with leukocytic infiltration and haemorrhages. What is the most probable postmortem
diagnosis?
A Gouty kidney
B Tubulointerstitial nephritis
C Pyelonephritis
D Necrotic nephrosis
E Myeloma kidney
252.Microscopical renal examination of a 36 y.o. woman who died from renal insufficiency
revealed
in
the glomerules proliferation of capsule nephrothelium as well as of podocytes and phagocytes accompanied
by formation of "crescents", capillary loop necrosis, fibrinous thrombs in their lumens; sclerosis and
hyalinosis of glomerules, atrophy of tubules and fibrosis of renal stroma. What is the most probable
diagnosis?
A Subacute glomerulonephritis
B Acute glomerulonephritis
C Chronic glomerulonephritis
D Focal segmentary sclerosis

7
E Membranous nephropathy
253. A 33 year old man died from uraemia. Autopsy revealed enlarged kidneys weighing 500,0 each and
consisting of multiple cavities 0,5-2 cm in diameter. The cavities were full of light-yellow transparent liquid.
Renal pelvis and ureters had no pecularities. What renal disease caused uraemia?
A Bilateral polycystic renal disease
B Chronic pyelonephritis
C Renal tumour
D Renal tuberculosis
E Rapidly progressing glomerulonephritis
254. A 28 year old patient had high arterial pressure, hematuria and facial edemata. In spite of treatment renal
insufficiency was progressing. 6 months later the patient died from uremia. Microscopic examination of his
kidneys and their glomerules revealed proliferation of capsule nephrothelium and of podocytes with
"demilune" formation, sclerosis and hyalinosis of glomerules. What disease corresponds with the described
picture?
A Subacute glomerulonephritis
B Acute pyelonephritis
C Nephrotic syndrome
D Chronic glomerulonephritis
E Acute glomerulonephritis
255.Acute renal impairment caused death of a bleeding patient. Autopsy revealed enlarged kidneys with a
broad pale pink cortical layer expressively demarcated from dark red renal pyramids. Macroscopic
examination revealed lack of epithelial nuclei of convoluted tubules, tubulorrhexis, phlebostasis. The cell
nuclei of choroid glomus and straight tubules were present. What pathology is it?
A.Glomerulonephritis
B. Necronephrosis
C. Pyelonephritis
D. Infarction
E. Nephrosis
256. Autopsy of a man who died from ethylene glycol poisoning revealed that his kidneys are a little bit
enlarged, edematic; their capsule can be easily removed. Cortical substance is broad and light-grey. Medullary
substance is dark-red. What pathology had this man?
A. Acute pyelonephritis
B. Necrotic nephrosis
C. Acute glomerulonephritis
D. Lipoid nephrosis
E. Acute tubular-interstitial nephritis

Endocrine system pathology

257. A patient with diabetes mellitus died of chronic renal insufficiency with uremia development. Autopsy
has shown all signs of uremia with changes in kidneys. What microscopical changes do the kidneys have?
A. Necrosis of nephron tubules epithelium.
B. Spasm of afferent arterioles.
C. Hyaline cylinders in the nephron tubules lumen.
D. Hyalinosis and sclerosis of glomerular capillaries.
E. Focal necrosis of renal cortex.
258. Autopsy of a 67-year-old man, who died of hypoglycemic coma, has shown the areas of connective
tissue excrescence, necrotic focuses, and the atrophy of islets of Langerhans in the pancreas. What disease led
to such changes?
A. Diabetes mellitus.
B. Mucoviscidosis.
C. Acute pancreatitis.

8
D. Head of pancreas cancer.
E. Pancreatic hypoplasia.
259. Thyroid gland of a patient is twice enlarged. Palpation shows a solid gland with irregularly tuberous
surface. Histological examination detects diffuse infiltration of the tissue by lymphocytes, plasma cells with
the formation of follicles and intensive excrescence of the connective tissue. What disease do these facts
indicate?
A. Hashimoto's thyroiditis.
B. Endemic goiter.
C. Sporadic goiter.
D. Diffuse toxic goiter.
E. Hyperplastic goiter.
260. In the postoperative thyroid gland biopsy, among the follicles filled with colloid, lymphoid structures
with growth centers were histologically detected. Diagnose the disease.
A. Diffuse toxic goiter.
B. Endemic goiter.
C. Sporadic goiter.
D. Hashimoto's thyroiditis.
E. Hyperplastic goiter.
261. Examination of a patient, who lives in the mountain region of Middle Asia, shows the enlargement of the
thyroid gland that makes swallowing difficult, increased weight, lethargy, drowsiness, and puffy face.
Microscopic examination of the gland detects follicles of different size with hypochromic colloid. What is the
most possible diagnosis?
A. Endemic goiter.
B. Diffuse toxic goiter.
C. Hashimoto's thyroiditis.
D. Sporadic goiter.
E. Hyperplastic goiter.
262. Histological examination of a thyroid gland detects moderate atrophy of the parenchyma, sclerosis and
diffuse infiltration of the stroma by lymphocytes and plasma cells with lymphoid follicles formation. What is
your diagnosis?
A. Autoimmune thyroiditis.
B. Parenchymatous goiter.
C. Thyrotoxicosis.
D. Thyroiditis.
E. Hyperplastic goiter.
263. A 40-year-old woman had a thyreoidectomy done. Histological examination of the gland detects big
follicles of different size with a foamy colloid. Follicular epithelium is high and forms papillae in some
places. Stroma has a focal lymphocytic infiltration. Diagnose the disease of the thyroid gland.
A. Diffuse toxic goiter.
B. Hashimoto's thyroiditis.
C. Riedel's disease.
D. De Quervain's disease.
E. Nodular goiter.
264. A patient, who used to be ill with hematogenous tuberculosis, has hypermelanosis of skin and mucous
membranes, cachexy, and cardiovascular insufficiency. What disease caused such changes?
A. Addison's disease.
B. Pheochromocytoma.
C. Simmond's disease.
D. Cushing's syndrome.
E. Graves' disease.
265. Gradually, the patient's feet, right hand, nose, and lips began to increase proportionally. A hypophysial
adenoma was detected. Diagnose the disease.
A. Addison's disease.

9
B. Nanism.
C. Diffuse toxic goiter.
D. Acromegaly.
E. Diabetes mellitus.
266. Autopsy of a man, who died of cachexy, has shown parathyroid glands adenoma, deformity of bones,
especially of extremities, spinal column, and ribs. The bones are soft, porous, easily cut. What is the most
possible diagnosis?
A. Parathyroid osteodystrophy.
B. Osteopetrosis.
C. Chondrodysplasia.
D. Osteomyelitis.
E. Fibrous dysplasia.
267. Autopsy of a man has shown a bronzed color of skin and tunica mucosa of mouth. There are caseous
masses in the adrenal glands. What disease did the patient have?
A. Addison's disease.
B. Cushing's syndrome.
C. Diffuse toxic goiter.
D. Acromegaly.
E. Pheochromocytoma.
268. A patient ill with diabetes mellitus felt acute pain in his right foot. Objectively: foot thumb is black, foot
tissues are edematous, there are foci of epidermis desquamation, stinking discharges. What
clinicopathological form of necrosis is it?
A Dry gangrene
B Bedsore
C Sequestrum
D Moist gangrene
E Infarction
269.Arterial hypertension, hyperglycemia, glucosuria were observed clinically for a long time in the patient
with upper type of obesity. Death was due to the cerebral haemorrhage. Basophilic hypophysis adenoma,
hyperplasia of adrenal gland cortex were revealed on pathomorphological examination. What is the likely
diagnosis?
A Cushing disease
B Diabetes mellitus
C Acromegaly
D Hypophysis nanism
E Adiposogenitalis dystrophy
270.A patient with android-type obesity had been suffering from arterial hypertension, hyperglycemia,
glycosuria for a long time and died from the cerebral haemorrhage. Pathologic examination revealed pituitary
basophil adenoma, adrenal cortex hyperplasia. What is the most likely diagnosis?
A Itsenko-Cushing's syndrome
B Diabetes mellitus
C Acromegalia
D Pituitary nanism
E Adiposogenital dystrophy
271.Examination of a 42 year old patient revealed a tumour of adenohypophysis. Objectively: the patient's
weight is 117 kg, he has moon-like hyperemic face, red-blue striae of skin distension on his belly.
Osteoporosis and muscle dystrophy are present. AP 210/140 mm Hg. What is the most probable diagnosis?
A. Cushing's syndrome
B. Cushing's disease
C. Diabetes mellitus
D. Essential hypertension
E. Conn's disease

10