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1.

A patient working at a pig farm complains    about    paroxysmal    abdominal pain,  liquid  feces with admixtures of mucus and blood, headache, weakness, fever. Examination of large intestine revealed  ulcers  from 1 mm up to several cm large, feces contained oval unicellular organisms  with cilia. What disease should be suspected?

Explanation

1.    IMG_9915

     Balantidium coli causes balantidiasis. It is the only ciliated protozoan that causes human disease i.e. diarrhea. Domestic animals, especially pigs are the main reservoir for the organism and humans are infected after ingesting the cysts in food or water contaminated with animal or human faeces. Diagnosis is made by finding large ciliated trophozoites or large cysts with a characteristic V-shaped nucleus in the stool. The trophozoites excyst in the small intestine, travel to the colon (large intestine) and by burrowing into the wall cause an ulcer similar to that of Entamoeba histolytica.

2. 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:

Explanation

Heat Radiation is a way the surface of the human body emits heat to the environment in the form of infrared rays. The amount of heat the body radiates to the environment is proportional to the surface of radiation area and to the difference between the mean values of skin and environment temperature. The surface radiation area is the total surface area of body parts that contact the air. Elimination of heat by radiation increases with a decrease in ambient temperature and decreases with its increase. It is possible to reduce elimination of heat by radiation via reduction of the surface of radiation area (“winding oneself into a ball”). Heat radiation does not require a medium for transfer of heat. (Key words: naked or lightly clothed).

Convection is a way the body eliminates heat by means of transferring heat via moving particles of air or water. To dissipate heat by means of convection, body surface shall be airflowed at a temperature that is lower than the temperature of the skin. At that, air layer contacting with the skin warms up, decreases its density, rises and is replaced by cooler, denser air. By increasing the speed of the air flow (wind, ventilation) heat emission increases significantly as well (forced convection). Convection requires convection current; current of gases or liquids (Key words: air over exposed area of skin).

Evaporation is a way the body dissipates heat to the environment by its evaporation via sweat or evaporation of moisture from the skin and respiratory tract mucous membranes of (“wet” heat loss). Evaporation closely related to relative humidity.

 

Conduction is a way the body eliminates heat by means of direct contact with another object. Heat is transferred down the temperature gradient (i.e. from the object of higher temperature to the object of lower temperature). Conduction requires contact with another object (Key words:  in water). 

3.

Examination of the duodenal contents revealed some pear-shaped protozoa with two nuclei and four pairs of flagella. The organisms had also two axostyles between the nuclei and a ventral adhesive disc. What protozoan representative was found in the patient?

Explanation

image

image

Giardia lamblia is pear shape or “clownface” with two nuclei, 4 pairs of flagella. The two nuclei are outlined by adhesive discs. Transmitted by cysts in water. The cysts are oval, have 4 nuclei and have clearly visible axostyles. It causes Giardiasis – bloating, flatulence, foul-smelling, fatty diarrhea. Diagnosis: trophozoites or cysts in stool.

4.

In cancer patients who have been continuously receiving methotrexate, the target cells of tumor with time become insensitive to this drug. In this case, gene amplification of the following enzyme is observed:

Explanation

IMG_9914

Methotrexate is structurally related to folic acid and acts as an antagonist of that vitamin by inhibiting dihydrofolate reductase (in humans), which is the enzyme that converts folic acid to its active coenzyme form, tetrahydrofolic acid. Trimethoprim and pyrimethamine inhibit the same enzyme but in bacteria and protozoa respectively. This decreases dTMP, needed for DNA synthesis.

5.

Pancreas is known as a mixed gland. Endocrine functions include production of insulin by beta cells. This hormone affects the metabolism of carbohydrates. What is its effect upon the activity of glycogen phosphorylase (GP) and glycogen synthase (GS)?

Explanation

krushkrok No196 (2014)

Insulin stimulates glycogen synthase by dephosphorylation. Insulin is an anabolic hormone (build up). So, it stimulates glycogen synthase to favor the synthesis of glycogen (glycogenesis) and inhibits glycogen phosphorylase used in glycogenolysis (glycogen breakdown). Glucagon and Epinephrine stimulates glycogen phosphorylase to break down glycogen to glucose and make energy available for “fight and flight” reactions.

6.

A 35-year-old female patient has undergone biopsy of the breast nodules. Histological examination has revealed enhanced proliferation of the small duct and acini epithelial cells, accompanied by the formation of glandular structures of various shapes and sizes, which were located in the fibrous stroma. What is the most likely diagnosis?

Explanation

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Adenoma: benign epithelial tumor from the epithelium of the glands and glandular organs. More often they can be found in the breast, thyroid gland, liver, ovaries, prostate gland, GIT. In the question, it is located in the fibrous stroma – FIBROADENOMA.

7.

A patient with suspected tumor of lung had been admitted to the oncological department. Examination revealed localised pathology in the inferior lobe of the left lung. How many bronchopulmonary segments does this lobe have?

Explanation

krushkrok No100 (2014) The inferior lobe of left lung has 5 segments: superior, medial basal, anterior basal, lateral basal, posterior basal segments.
8. A 60 year old patient has impaired perception   o high-frequenc sounds. These changes were caused by damage  of the following auditory analyzer structures:

Explanation

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Two membranes divide the spiral canal of cochlea into 3 compartments – vestibular and basilar membrane. Along the basilar membrane are 20,000-30,000 tiny fibers called basilar fibers. Each fiber has different size and shape. Fibers near the oval window (base) are short and stiff (narrowest), while approaching towards helicotrema (apex), the basilar fibers gradually become longer and soft (widest). The motion of the basilar membrane is generally described as a travelling wave. The parameters of the membrane (stiffness, narrow, wide) at a given point along its length determine its characteristic frequency at which it is most sensitive to sound vibrations. High frequency sounds localize near the base of the cochlea (near the round and oval windows), while low frequency sounds localize near the apex (helicotrema); and the middle frequency sounds – middle part of helix.

There is an impaired perception of high frequency sounds; that means there is damage near the base of cochlea (i.e. near the round and oval windows). 

9.

Sanitary  bacteriological research on water by the membrane filter method revealed  two red colonies on a membrane filter (Endo agar)  through which 500 ml of analyzed  water  were passed.  Calculate the coli index and coli titer of the analyzed water:

Explanation

Coli titer is the smallest amount of water where 1 E.coli is present.

Coli index is the amount of E. coli in 1 liter of water.

            2 E.coli   -  500ml

            1 E.coli   -  ?

                        ? = 250

Therefore, Coli titer = 250

 

1 liter of water  =  1000ml

            2 E. coli   -  500ml

                   ?       -   1000ml (1L)

                        ? = 4

Therefore, Coli index = 4

 

Coliform index (Coli index) and Coli titer are used to rate the purity of water, soil and air based on the count of fecal bacteria by testing for coliforms especially the well known Escherichia coli (E. coli).

10.

A young man complains  about urination disorder. Examination of the external  genitals revealed  that the urethra was split and urincould flow out of this orifice. What anomaly of the external genitals development is it?

Explanation

image

Defects in male genitalia:

Hypospadia: fusion of the urethral folds is incomplete and abnormal openings of the urethra occur along the inferior (undersite) surface of the penis, usually near the glans, along the shaft or near the base of the penis.

 

Epispadia is a rare abnormality (1/30000 births) in which the urethral meatus is found on the dorsum (superior) surface of the penis.