PREFACE
OSTEOLOGY
The science of bones
The bone as an organ
Composition of the bones
Development and growth of bones
AXIAL SKELETON (Skeleton axiale)
Vertebral column (Columna vertebralis)
Sacral bone (os sacrum)
Tailbone (os coccygis)
Thoracic cavity (thorax)
Sternum
SKULL (Cranium)
Bones of the cerebral skull (Neurocranium)
Occipital bone (os occipitale)
Sphenoidal bone (os sphenoidale)
Temporal bone (os temporale)
Parietal bone (os parietale)
Frontal bone (os frontale)
Ethmoid bone (os ethmoidale)
Bones of the facial skull (Viscerocranium)
Upper jaw (maxilla)
Palatine bone (os palatinum)
Inferior nasal concha
Vomer
Nasal bones
Lacrimal bone
Zygomatic bone
Mandiblе
Hyoid bone
Skull as a whole
Vault of the skull (calvaria)
External base of the skull
Internal base of the skull
Orbit
Bony nasal cavity
Fossae on the lateral skull surface
Age-related features of the skull
Skull of the newborn
Changes of the skull after birth
BONES OF THE LIMBS
Bones of the upper limb
Scapula
Clavicle
Humerus
Ulna
Radius
Bones of the hand
Carpal bones
Metacarpal bones
Bones of the fingers (phalanges)
Bones of the lower limb
Hip bone
Femur
Patella
Tibia
Fibula
Bones of the foot
Tarsal bones
Metatarsal bones
Bones of the toes (phalanges)

Материалът Human osteology е публикуван за пръв път на Лакс Бук издателство за медицинска литература.

PREFACE
The collection contains sample test questions with indicated
correct answers from the dermatology and venereology curriculum
for the specialties of medicine and dentistry. The questions are
divided into 17 sections, covering general, specialized dermatology,
and venereology.
The collection is designed to help students prepare, self-test,
and verify the knowledge they have acquired in the specialty. The
questions are used to conduct an online exam test in dermatology
and venereology.
Prof. Dr. Hristo Dobrev, MD, PhD, DMSc

CONTENT
1. Structure and functions of the skin……………………………………….6
Answers…………………………………………………………………………18
2. Rash elements and diagnosis of skin diseases………………………19
Answers…………………………………………………………………………32
3. Treatment of skin diseases…………………………………………………33
Answers…………………………………………………………………………42
4. Bacterial infections of the skin……………………………………………43
Answers…………………………………………………………………………52
5. Parasitic infections of the skin……………………………………………53
Answers…………………………………………………………………………62
6. Viral infections of the skin…………………………………………………63
Answers…………………………………………………………………………74
7. Fungal infections of the skin……………………………………………..75
Answers…………………………………………………………………………83
8. Allergic diseases of the skin………………………………………………84
Answers…………………………………………………………………………99
9. Papulosquamous diseases of the skin…………………………………100
Answers……………………………………………………………………….108
10. Autoimmune bullous diseases of the skin…………………………109
Answers……………………………………………………………………….116
11. Autoimmune connective tissue diseases…………………………..117
Answers……………………………………………………………………….128
12. Benign and malignant skin tumors………………………………….129
Answers……………………………………………………………………….173
13. Other non-infectious skin diseases…………………………………..138
Answers……………………………………………………………………….151
14. Syphilis and gonorrhea…………………………………………………..152
Answers……………………………………………………………………….164
15. Non-gonococcal urethritis……………………………………………..165
Answers………………………………………………………………………169
16. Skin manifestations of AIDS………………………………………….170
Answers………………………………………………………………………174
17. Clinical cases…………………………………………………………………175
Answers……………………………………………………………………….216

Материалът Compilation of sample test questions in dermatology and venereology е публикуван за пръв път на Лакс Бук издателство за медицинска литература.

Материалът Medical Biochemistry – part II е публикуван за пръв път на Лакс Бук издателство за медицинска литература.

1. Захарен диабет.

2. Базедова болест.

3. Хипотиреоидизъм

4. Хиперпаратиреоидизъм

5. Хипопаратиреоидизъм

6. Болест на иценко-cushing

7. Болест на addison

8. Акромегалия

9. Безвкусен диабет.

II. Болести на кръвта – м. панчовска – мочева

10. Желязодефицитна анемия

11. Витамин в12 дефицитна анемия

12. Хемолитични анемии

13. Апластични анемии

14. Остри левкози

15. Хронична миелолевкоза

16. Хронична лимфолевкоза

17. Миеломна болест.

18. Лимфогрануломатоза

19. Истинска полицитемия

20. Болест на scholein-henoch

21. Есенциална тромбоцитопения

22. Хемофилия

III. Болести на храносмилателната система – м. панчовска-мочева

23. Остър езофагит.

24. Гастроезофагеална рефлуксна болест.

25. Ахалазия на хранопровода

26. Рак на хранопровода

27. Остър гастрит. 82

28. Хроничен гастрит.

29. Язвена болест.

30. Рак на стомаха

31. Хроничен хепатит.

32. Алкохолна болест на черния дроб

33. Автоимунен хепатит.

34. Цироза на черния дроб

35. Хроничен холецистит.

36. Жлъчнокаменна болест.

37. Хроничен улцерозен колит.

38. Рак на колона и ректума

39. Хроничен панкреатит.

40. Остър панкреатит – н. белев

41. Библиография

IV. Алергология. алергични заболявания – хр. лалабонова, и. стоева

42. Библиография

V. Клинично-лаболаторни резултати. референтни граници за възрастни лица – д. терзиева

Материалът Ръководство по вътрешни болести – част 2 е публикуван за пръв път на Лакс Бук издателство за медицинска литература.

CHAPTER I

PULMONOLOGY

THE MOST IMPORTANT SYMPTOMS OF PULMONARY DISEASES

OBJECTIVE EXAMINATION

DIAGNOSTIC METHODS

PNEUMONIA

SUPPURATIVE LUNG DISEASE

OBSTRUCTIVE LUNG DISEASES

RESPIRATORY FAILURE

PULMONARY CARCINOMA

PLEURAL EFFUSIONS

SARCOIDOSIS

PULMONARY TUBERCULOSIS

CHAPTER II

CARDIOLOGY

EXAMINATION OF THE CARDIOVASCULAR SYSTEM

HEART FAILURE

RHYTHM AND CONDUCTION DISORDERS

CHRONIC PULMONARY HEART

PULMONARY THROMBOEMBOLISM

RHEUMATISM

INFECTIVE ENDOCARDITIS

ACQUIRED HEART DESEASES

AORTIC VALVE DESEASES

ISCHEMIC HEART DISEASE

STABLE ANGINA

UNSTABLE ANGINA

MYOCARDIAL INFARCTION

ARTERIAL HYPERTENSION

CARDIOMYOPATHIS

MYOCARDITIS

PERICARDIAL DISEASES

DISEASES OF THE AORTA

ATHEROSCLEROSIS

CONGENITAL HEART DISESES IN ADULTS

CHAPTER III

GASTROENTEROLOGY AND HEPATOLOGY

DISEASES OF THE STOMACH

DISEASES OF THE SMALL INTESTIN

DISEASES OF THE COLON AND RECTUM

LIVER DISEASES

DISEASES OF THE BILIARY SYSTEM

DISEASES OF THE PANCREAS

CHAPTER IV

NEPHROLOGY

ANATOMICAL NOTES, PHYSICAL AND LABORATORY EXAMINATIONS

KIDNEY BIOPSY

SYMPTOMS AND SYNDROMES RELATED TO KIDNEY DISEASES

PRIMARY GLOMERULAR DISEASES. CLASSIFICATION, ETIOLOGY,PATHOGENESIS

ACUTE POSTREPTOCOCCAL GLOMERULONEPHRITIS

RAPIDLY PROGRESSING GLOMERULONEPHRITIS

CHRONIC GLOMERULONEPHRITIS. PODOCYTOPATHY. IDIOPATHIC

NEPHROTIC SYNDROME

GLOMERULONEPHRITIS WITH MINIMAL CHANGES

IgM NEPHROPATHY

FOCAL-SEGMENTAL GLOMERULOSCLEROSIS

MEMBRANOUS GLOMERULONEPHRITIS

MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS AND C3

NEPHROPATHIES

IMMUNOGLOBULIN A NEPHROPATHY (BERGER’S DISEASE)

SECONDARY SATELLITE GLOMERULOPATHIES. KIDNEY DAMAGE IN SYSTEMIC VASCULITIS

KIDNEY DAMAGE IN SYSTEMIC LUPUS (SEL)

KIDNEY DAMAGES IN DIABETES MELLITUS

KIDNEY DAMAGE IN AMYLOIDOSIS

GOUTY NEPHROPATHY

URINARY INFECTIONS

ACUTE INTERSTITIAL HYPERSENSITIVE NEFRITIS

CHRONIC INTERSTITIAL NEPHRITIS

CONGENITAL AND HERITABLE DISEASES OF THE KIDNEYS. AUTOSOMALDOMINANT KIDNEY. POLYCYSTOSIS

CONGENITAL AND HEREDITARY DISEASES OF THE KIDNEYS. ALPORT SYNDROME. FABRI SYNDROME. THIN MEMBRANE DISEASE

KIDNEY STONE DISEASE. NEPHROCALCINOSIS

ACUTE KIDNEY INGURY (AKI)

CHRONIC KIDNEY DISEASE (CKD). KIDNEY FAILURE

EXTRA-KIDNEY METHODS OF CLEANSING THE BLOOD

KIDNEY TRANSPLANTATION

CHAPTER V

ENDOCRINOLOGY

DISEASES OF THE GLANDS WITH INTERNAL SECRETION

INTRODUCTION

HYPOTALAMUS AND PITUITARY GLAND

THYROID GLAND

PARATHYROID GLANDS

ENDOCRINE PANCREAS

ADRENAL GLANDS

MALE REPRODUCTIVE SYSTEM

FEMALE REPRODUCTIVE SYSTEM

DISEASES OF THE HYPOTHALAMUS AND PITUITARY GLAND

DISEASES OF THE THYROID GLAND

DISEASES OF THE PARATHYTIC GLANDS

DISEASES OF THE ENDOCRINE PANCREAS

DISEASES OF THE ADRENAL GLANDS

ENDOCRINE DISORDERS IN THE MALE REPRODUCTIVE SYSTEM

ENDOCRINE DISORDERS IN THE FEMALE REPRODUCTIVE SYSTEM

AUTOIMMUNE POLYGLANDULAR SYNDROMES

MULTIPLE ENDOCRINE NEOPLASIA

CHAPTER VI

HEMATOLOGY

BASIC DATA ON HEMATOPOIESIS

EXAMINATION OF A PATIENT WITH HEMATOLOGICAL DISEASE DISEASES OF ERYTHROPOIESIS

IRON DEFICIENCY ANEMIA

ANEMIA IN CHRONIC DISEASES (ACD)

MEGALOBLASTIC ANEMIA

FOLATE DEFICIENCY ANEMIA

BONE MARROW FAILURE HYPO- AND APLASTIC ANEMIA

HEMOLYTIC ANEMIAS. CLASSIFICATION

CONGENITAL HEMOLYTIC ANEMIAS – MEMBRANOPATHIES

CONGENITAL HEMOLYTIC ANEMIA – ENZYMOPATHIES

CONGENITAL HEMOLYTIC ANEMIAS – HEMOGLOBINOSIS

CONGENITAL HEMOLYTIC ANEMIAS – THALASEMIA

ACQUIRED HEMOLYTIC ANEMIAS. ISOMIMMUNE HEMOLYTIC ANEMIAS

MICROANGIOPATHIC HEMOLYTIC ANEMIA

MALIGNANT DISEASES OF THE BLOOD AND THE BLOOD-FORMING ORGANS

ACUTE MYELOPROLIFERATIVE DISEASES

MYELODYSPLASTIC SYNDROMES

CHRONIC MYELOID LEUKEMIA – PH (+)

POLYCYTHAEMIA VERA

ESSENTIAL THROMBOCYTEMIA

OSTEOMYELOFIBROSIS. PRIMARY MYELOPHIBROSIS

LYMPHOPROLIFERATIVE NEOPLASMS – BASIC DATA

HODGKIN’S LYMPHOMA (MORBUS HODGKIN)

NON-HODGKIN’S LYMPHOMAS – BASIC DATA

ACUTE HIGHLY AGGRESSIVE LYMPHOPROLIFERATIVE NEOPLASMS

DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL)

MANTLE CELL LYMPHOMA

INDOLENT NON-HODGKIN’S LYMPHOMAS CHRONIC LYMPHOCYTIC LEUKEMIA

FOLLICULAR NON-HODGKIN’S LYMPHOMA

MARGINAL ZONE LYMPHOMA. EXTRANODAL LYMPHOMAS OF MUCOSAASSOCIATED

LYMPHOID TISSUE

DIFFERENTIAL DIAGNOSIS OF LYMPHADENO – AND SPLENOMEGALIA

DISEASES OF THE PLASMOCYTIC SERIES. MONOCLONAL

PARAPROTEINEMIA (GAMAPATHIES)

MULTIPLE MYELOMA (MYELOMA MULTIPLEX)

LIGHT CHAIN DEPOSITION DISEASE (LCDD)

AL-AMYLOIDOSIS

HEMOPOETIC STEM CELL TRANSPLANTATION

COAGULATION AND BLEEDING DISORDERS

DISEASES OF THE PLATELET SERIES

DISEASES WITH IMPAIRED PLATELET FUNCTIONS. CONGENITAL AND

ACQUIRED THROMBOCYTOPATHIES

CONGENITAL COAGULOPATHIES

INHIBITORY HEMOPHILIA

WILLEBRAND’S DISEASE (Morbus von Willebrand)

VASOPATHY

DISSEMINATED INTRAVASAL COAGULATION (DIC)

PRIMARY ACTIVATED FIBRINOLYSIS

CHAPTER VII

RHEUMATOLOGY

EXAMINATION OF PATIENTS WITH RHEUMATIC DISEASES

RHEUMATOID ARTHRITIS (POLYARTHRITIS RHEUMATOIDES)

ANKYLOSING SPONDYLITIS (SPONDYLITIS ANKYLOSANS)

PSORIATIC ARTHRITIS (ARTHRITIS PSORIATICA)

GOUT. GOUTY ARTHRITIS (PODAGRA, ARTHRITIS URICA)

OSTEOARTHRITIS (OA)

SYSTEMIC LUPUS ERYTHEMATOSUS (LUPUS ERYTHEMATOSUS SYSTEMICUS)

PROGRESSIVE SYSTEMIC SCLEROSIS

AUTOIMMUNE MYOSITES

SJOGREN SYNDROME

BEHCET’S DISEASE

RHEUMATIC POLYMYALGIA

GIANT CELL ARTERIITIS

SYSTEMIC VASCULITIDES

FIBROMYALGIA

OSTEOPOROSIS

Материалът Internal Diseases е публикуван за пръв път на Лакс Бук издателство за медицинска литература.

Preface

1. History of psychiatry. Fundamental theoretical explanations

2. Patient evaluation

3. Disturbances of perceptio

4. Disturbances in thought – flow and form

5. Disturbances in the thought content

6. Disturbances of emotions

7. Disturbances of memory

8. Disturbances of volition, psychomotorics and attention

9. Disturbances of consciousness

10. Neuroanatomy and neurodevelopment

11. Pathogenesis of psychiatric disorders

12. Antipsychotics. Tranquilizers

13. Antidepressants. Mood stabilizers

14. Psychotherapy

15. Psychiatric nosology: classification and nomenclature

16. Mental disorder due to a somatic disease

17. Psychotic disorder. Schizophrenia

18. Other psychotic disorders

19. Bipolar disorders

20. Depressive disorders

21. Anxiety disorders

22. Obsessive-compulsive disorders

23. Trauma and stress related disorders

24. Somatic symptom and related disorders

25. Eating disorders

26. Sexuality and sexual disorders

27. Substance-related disorders. Basic syndromes

28. Specific substance related disorders

29. Neurodevelopmental disorders

30. Old age psychiatry

31. Personality disorders

32. Emergency psychiatry

33. Psychiatric expertise

Appendix

References

Материалът Psychiatry е публикуван за пръв път на Лакс Бук издателство за медицинска литература.

1. Mental Systems

2. Developmental Psychology

3. Personality Theories

4. Methods for Assessment in Psychology

5. Communication and Theories of Communication

6. Clinical Interview

7. Doctor-Patient Relationship. Health Attitude. Behavior of Illness

8. Iatrogenesis. Placebo. Euthanasia. Informed Consent

9. Stress and Theory of Stress

10. Theory of Psychosomatics

11. Work. Psychological Climate. Burnout

12. Psychology of Vulnerable Groups in Medical Practice

13. Late Adulthood. Grief. Bereavement. Death

14. Psychotherapy

15. Crises and Crisis Interventions

16. Breaking the Bad News

17. Person Centered Medicine. Values-Based Health Practice

Материалът Medical Psychology е публикуван за пръв път на Лакс Бук издателство за медицинска литература.

1. Subject, tasks and methods of pathology – Marina Tomova, V. Belovejdov
2. Health and disease. Main categories in pathology (etiology, pathogenesis, Morphogenesis, sanogenesis, tanatogenesis) – M. Tomova, E. Poryazova
3. Death. Clinical and biological. Signs of biological death – M.Tomova
4. Cell injury. Definition. Categories of cellular injury. Causal factors. Pathogenetic and morphogenetic mechanisms – M. Tomova, E. Poryazova
5. Cellular injury. Types of degeneration. Acute reversible cellular damage (cellular swelling). Hydropic degeneration – M. Tomova, E. Poryazova
6. Abnormal accumulation of substances in the cell. Mechanisms. Accumulation of protein (hyaline-drop degeneration, Lewy and Mallory bodies; Russel bodies) and carbohydrates. Methods of proof – M. Tomova, E. Poryazova
7. Disorders of the metabolism of lipids. Types of adipose degeneration. Accumulation of cholesterol and cholesterol esters. Methods of proof. Total obesity. Lipomatosis. Cachexia – M. Tomova, E. Poryazova
8. Lysosomal diseases (tesaurismoses) – features. Lipidoses (Gaucher disease, Niemann-Pick disease, Tay-Sacks, disease, Hand-Schuller-Christian disease) and glycogenoses – M. Tomova, E. Poryazova
9. Disturbances in the metabolism of the pigments. Classification. Accumulation of exogenous pigments – D. Bojkova, E. Poryazova
10. Accumulations of iron-containing pigments (hemoglobinogenics) – D. Bojkova
11. Accumulation of iron-free hemoglobinogenic pigments. Jaundice – D. Bojkova
12. Disturbances in the metabolism and accumulation of proteinogenic (tyrosine, tryptophan) and lipidogenic native pigments – D. Bojkova, V. Belovejdov
13. Abnormal accumulation of substances in the extracellular matrix Mucoid edema. Fibrinoid. Hialinosis – types. Accumulation of fibrillary substances in the interstitium: scarring, fibrosis (sclerosis) and cirrhosis – D. Bojkova, E. Poryazova
14. Amyloidosis. Common physical and chemical characteristics. Classification. Types according to their composition. Methods of proof – D. Bojkova, E. Poryazova
15. Types of amyloidosis depending on the cause and spread of the process. Organ deposits. Diagnosis – D. Bojkova, E. Poryazova
16. Disturbances in the metabolism of calcium and copper. Abnormal accumulation of salts of the uric acid – D. Bojkova, E. Poryazova
17. Cell death. Necrobiosis. Necrosis: definition and types (coagulation and kaseous; liquefactive). Nuclear and cytoplasmic morphological changes – M. Koleva, V. Belovejdov
18. Clinical and anatomical forms of necrosis (infarction, gangrene, decubitus, sequesters, mutilation, steatonecrosis, fibrinoid necrosis, ‘noma’). Evolution and complications – M. Koleva, E. Poryazova
19. Apoptosis. Definition, differences between apoptosis and necrosis. Role of apoptosis – M. Koleva, E. Poryazova
20. Hemodynamic disorders: an overview, local and general hemodynamic disorders. Changes in the amount of blood. Arterial hyperemia – M. Gulinac, V. Belovejdov
21. Venous plethora (congestion). Acute and chronic left heart failure – morphological changes – M. Gulinac, E. Poryazova
22. Venous plethora. Acute and chronic right heart failure – morphological changes. Local venous plethora – M. Gulinac, E. Poryazova
23. Ischemia: definition, types, complications – M. Gulinac, E. Poryazova
24. Bleeding and bleeding disorders. Plasmoraghia. Terminology, mechanisms, outcome – M. Gulinac, E. Poryazova
25. Rheological disorders: prestasis, stasis, ‘sludge’-phenomenon – M. Gulinac
26. Thrombosis. Order and Morphogenesis. Structure of thrombi. Difference between the thrombus and post-mortem blood clot – M. Gulinac, E. Poryazova
27. Thrombosis. Types of blood clots, complications and evolution. Disseminated intravascular coagulopathy (DIC syndrome) – M. Gulinac, E. Poryazova
28. Embolism. Definition. Types of embolism by the way of their distribution: venous and arterial, orthograde, retrograde and paradoxical embolism – M. Gulinac
29. Pulmonary thromboembolism: cause, proof, complications and outcomes – M. Gulinac
30. Types of embolism, according to the substrate: air, gas, fat, amnial, bacterial, parasitic, tumor cell. Comparison between embolism and metastasis – M. Gulinac, E. Poryazova
31. Infarction. Definition. Types. Morphological characteristics of anemic infarction – M. Gulinac, V. Belovejdov
32. Infarction. Definition. Types. Morphogenesis of hemorrhagic infarctions. Types of hemorrhagic infarctions – M. Gulinac, E. Poryazova
33. Shock. Definition, pathogenetic types and organ morphological changes – M. Gulinac
34. Disorders of lymph circulation: terminology and complications. Quantitative changes of tissue fluid. Oedema: definition, types. Pulmonary and cerebral edema. Dehydration – M. Gulinac, E. Poryazova
35. Inflammation. Definition. Terminology. Main features. Etiologyc factors – I. Bivolarski
36. Inflammation. Phases of inflammatory reaction. Pathogenesis and morphogenesis of inflammation. Plasma and cellular mediators – I. Bivolarski, E. Poryazova
37. Morphogenesis of acute (exudative) inflammation.Hemodynamic changes in microcirculation. Leukocyte migration and phagocytosis – I. Bivolarski
38. Cell types in the outbreak of acute and chronic inflammation – I. Bivolarski
39. Exudative inflammation. Morphology, complications and outcomes – I. Bivolarski
40. Productive inflammation: forms and morphological characteristics of diffuse productive inflammation – I. Bivolarski, E. Poryazova
41. Nonspecific and specific productive – ‘granulomatous’ inflammation. Morphology of foreign body granuloma, tubercle, luetic ‘gumma’, granulomas in leprosy and sarcoidosis, catscratch disease, toxoplasmosis, rhinoscleroma – I. Bivolarski, E. Poryazova
42. Pathology of immunity. Hypersensitivity reactions. Anaphylactic cytotoxic type immune reactions (first and second type reactions) – Sv. Bachurska, E. Poryazova
43. Pathology of immunity. Hypersensitivity reactions. Immune complexes reactions. Delayed type hypersensitivity (third and fourth type reactions) – Sv. Bachurska, E. Poryazova
44. Pathology of immunity – types. Autoimmune diseases. Congenital syndromes and acquired immune deficiency – Sv. Bachurska, E. Poryazova
45. Adaptivey processes: hypertrophy and hyperplasia, atrophy – definition, types, morphological characteristics – Sv. Bachurska, E. Poryazova
46. Metaplasia – definition, types, morphological characteristics, complications – Sv. Bachurska, E. Poryazova
47. Regeneration. Restitution and substitution. Factors affecting recovery processes. Wound healing. Regeneration of bone tissue – Sv. Bachurska, E. Poryazova
48. Tumors: definition, incidence and prevalence. Biology of tumor growth (irreversibility, relative autonomy, tumor impact on the whole body) – D. Serteva, E. Poryazova
49. Tumors: Terminology. Classification. Tumor structure – D. Serteva, E. Poryazova
50. Etiology of tumors. Chemical, physical, genetic and viral carcinogenesis. Role of growth factors – D. Serteva, V. Belovejdov
51. Morphogenesis of tumors. Monocentric and multicentric theories for their emergence Proliferating and non-proliferating tumor fractions. Biological basis of invasion of malignant tumors. Metastasis – D. Serteva, E. Poryazova
52. Morphological characteristics of tumors. Differences between benign and malignant tumors. Tissue and cellular atypia – D. Serteva, E. Poryazova
53. Precancerous. Dysplasia. Carcinoma in situ – D. Serteva, E. Poryazova
54. Metastasis of tumors – D. Serteva, E. Poryazova
55. Degree of differentiation and staging in the development of tumors. TNM-system – D. Serteva, V. Belovejdov
56. Structure and shape of tumors – macroscopic and microscopic characteristics. Role of immunohistochemistry for the diagnosis of tumors – D. Serteva, E. Poryazova
57. Benign tumors of epithelial origin – D. Serteva, E. Poryazova
58. Malignant tumors of epithelial origin – D. Serteva, E. Poryazova
59. Benign soft tissue tumors – Kr. Dangalov, E. Poryazova
60. Malignant soft tissue tumors – Kr. Dangalov, E. Poryazova
61.Tumors of the central nervous system – general features, classification, basic representatives – Kr. Dangalov, V. Belovejdov
62. Tumors of the nerve sheath. Tumors of the meninges – Kr. Dangalov
63. Tumors and tumor-like entities of melanocytes. Teratomas – Kr. Dangalov

Материалът Lecture Course in General Pathology е публикуван за пръв път на Лакс Бук издателство за медицинска литература.

Preface

Dear 3rd and 4th year medical students, we have prepare for you “Lecture course in
Clinical Pathology”. You have motivated us to give you a more comprehensive, useful and
practical approach to the topics in the syllabus, which you have to learn for your exam in
Pathology. Your interest in our subject has raised the requirements and standards we have
to meet. This is why we have prepared this manual in order to give you an accessible and
organized information on our subject.
Clinical pathology is a key step into clinical medicine. It lays the foundations of the basic
pathological process that can occur in the human body. We hope that we will effectively
help you in your studies with the information given in these notes.
Every topic in your syllabus for the exam in Clinical Pathology is discussed here in a
report form. Please, do use the references given for each topic in order to complete the information
you need to know for the exam.
We will appreciate any feedback from you, since we would like to improve our work
and be as useful as possible to you, the students who will use this book.
We wish you pleasant reading!

Assoc. Prof. Elena Poryazova-Markova, MD, PhD
Department of General and Clinical Pathology
and Forensic Medicine
MU – Plovdiv

Материалът Lecture Course In Clinical Pathology е публикуван за пръв път на Лакс Бук издателство за медицинска литература.

Table of contents
Preface – E. Poryazova…………………………………………………………………………..10
Histological Sample preparation – N. Penkova, E. Poryazova………………..11
Special /histochemical/ staining – D. Serteva………………………………………..13
Immunohistochemical testing – E. Poryazova………………………………………..14
Chapter I. General pathology…………………………………………………………………15
Reversible cell damage (acute and chronic) – E. Poryazova……………………16
Intracellular accumulation of pathologic substances – E. Poryazova……..17
Fig. 1 Hepatitis epidemiсa (viralis)………………………………………………………17
Fig. 2 Hydropic degeneration: renal tubular cells…………………………………..17
Fig. 3 Degeneratio adiposa hepatis (steatosis hepatis)…………………………… 18
Fig. 4 Degeneratio adiposa hepatis, Sudan III………………………………………..18
Accumulation of pigments – E. Poryazova…………………………………………….19
Fig. 5 Anthracosis pulmonis………………………………………………………………..19
Fig. 6 Haemosiderosis pulmonis………………………………………………………….20
Fig. 7 Haemosiderosis pulmonis, Perls…………………………………………………20
Fig. 8 Icterus hepatis………………………………………………………………………….21
Fig. 9 Icterus renis……………………………………………………………………………..21
Accumulation of pathologic substances in the intercellular matrix –
E. Poryazova…………………………………………………………………………………………22
Fig. 10 Degeneratio mucoidea – Toluidin Blue………………………………………23
Fig. 11 Corpus albicans ovarii……………………………………………………………..23
Fig. 12 Hyalinosis arteriolarum renis……………………………………………………24
Fig. 13 Hypertonia arterialis benigna (cerebrum)……………………………………24
Fig. 14 Amyloidosis renis……………………………………………………………………25
Fig. 15 Amyloidosis renis, Congo rot……………………………………………………25
Fig. 16 Amyloidosis localis (glandulae mammae)…………………………………..26
Fig. 17 Amyloidosis lienis…………………………………………………………………..26
Fig. 18 Amyloidosis hepatis………………………………………………………………..27
Fig. 19 Tophi urici……………………………………………………………………………..27
Fig. 20 Calcificatio aortae……………………………………………………………………28
Compensatory-adaptive processes – N. Penkova, E. Poryazova………………..29
Fig. 21 Hypertrophia myocardii……………………………………………………………29
4 Handbook of Histopathology and Immunohistochemistry
Fig. 22 Normal myocardium………………………………………………………………..30
Fig. 23 Hyperplasia mucosae uteri glandularis cystica…………………………….30
Fig. 24 Hyperplasia glandulae prostatae………………………………………………..31
Fig. 25 Atrophia fusca hepatis……………………………………………………………..31
Fig. 26 Atrophia fusca myocardii…………………………………………………………32
Fig. 27 Atrophia gl. Thyreoideae………………………………………………………….32
Irreversible cell damage. Necrosis – I. Bivolarski…………………………………..33
Fig. 28 Necrosis coagulativa lienis……………………………………………………….34
Fig. 29 Necrosis colliquativa cerebri…………………………………………………….34
Fig. 30 Steatonecrosis pancreatis…………………………………………………………35
Fig. 31 Necrosis caseosa lymphonodi…………………………………………………..35
Circulatory disorders – D. Serteva…………………………………………………………36
Fig. 32 Cyanosis hepatic……………………………………………………………………..36
Fig. 33 Hepar mouschatum…………………………………………………………………37
Fig. 34 Haemorrhagiae punctatae cerebri……………………………………………..37
Fig. 35 Oedema pulmonis…………………………………………………………………..38
Fig. 36 Thrombus mixtus……………………………………………………………………38
Fig. 37 Embolia adiposa pulmonis, Sudan III……………………………………….39
Fig. 38 Infarctus anaemicus renis………………………………………………………..39
Fig. 39 Infarctus haemorrhagicus pulmonis……………………………………………40
Inflammation – V. Belovejdov…………………………………………………………………41
Fig. 40 Pericarditis fibrinosa………………………………………………………………..41
Fig. 41 Leptomeningitis purulenta………………………………………………………..42
Fig. 42 Appendicitis phlegmonosa………………………………………………………..42
Fig. 43 Myocarditis acuta abscedens…………………………………………………….43
Fig. 44 Granulatio………………………………………………………………………………43
Fig. 45 Polypus nasalis……………………………………………………………………….44
Fig. 46 Granuloma typus corporis alieni……………………………………………….44
Fig. 47 Echinococcus hepatis………………………………………………………………45
Fig. 48 Chitin and germinative membranes (Echinococcus cyst)………………45
Fig. 49 Lymphadenitis granulomatosa………………………………………………….46
Fig. 50 Langhans giant cell…………………………………………………………………46
Fig. 51 Mesaortitis luetica…………………………………………………………………..47
Fig. 52 Actinomycosis………………………………………………………………………..47
Table of content 5
Regeneration and fibrosis – D. Serteva………………………………………………..48
Fig. 53 Cicatrix myocardii…………………………………………………………………..48
Fig. 54 Cicatrix myocardii-Van Gieson…………………………………………………49
Fig. 55 Regeneratio medullae ossea……………………………………………………..49
Tumours – E. Poryazova………………………………………………………………………..50
Fig. 56 Lipoma………………………………………………………………………………….53
Fig. 57 Haemangioma cavernosum hepatis……………………………………………53
Fig. 58 Haemangioma capillarae cutis………………………………………………….54
Fig. 59 Leiomyoma uteri…………………………………………………………………….54
Fig. 60 Leiomyosarcoma…………………………………………………………………….55
Fig. 61 Teratoma adultum……………………………………………………………………55
Fig. 62 Carcinoma basocellulare………………………………………………………….56
Fig. 63 Squamous cell papilloma …………………………………………………………56
Fig. 64 Carcinoma planocellulare keratodes………………………………………….57
Fig. 65 Carcinoma planocellulare nonkeratodes…………………………………….57
Fig. 66 Undifferentiated carcinoma………………………………………………………58
Fig. 67 Normal skin……………………………………………………………………………58
Fig. 68 Merkel cell carcinoma……………………………………………………………..59
Fig. 69 Naevus pigmentosus………………………………………………………………..59
Fig. 70 Melanoma malignum……………………………………………………………….60
Fig. 71 Lymphogenous tumour embolism……………………………………………..60
Fig. 72 Perineural invasion (adenocarcinoma)……………………………………….61
Fig. 73 Angiosarcoma…………………………………………………………………………61
Fig. 74 Rabdomyosarcoma………………………………………………………………….62
Fig. 75 В-cell malignant lymphoma …………………………………………………….62
Chapter II. Clinical pathology………………………………………………………………..63
Respiratory system – V. Belovejdov………………………………………………………..63
Fig. 76 Normal lung…………………………………………………………………………..65
Fig. 77 Lung of newborn (with intraalveolar hemorrhages)…………………….65
Fig. 78 Bronchitis chronica………………………………………………………………….66
Fig. 79 Emphysema pulmonis………………………………………………………………66
Fig. 80 Pneumonia crouposa………………………………………………………………..67
Fig. 81 Silicosis pulmonis…………………………………………………………………..67
Fig. 82 Carcinoma pulmonis planocellulare keratodes…………………………….68
6 Handbook of Histopathology and Immunohistochemistry
Fig. 83 Carcinoma adeno-squamosus pulmonis………………………………………68
Fig. 84 Carcinoma pulmonis parvocellulare…………………………………………..69
Cardiovascular system – E. Poryazova……………………………………………………70
Fig. 85 Atherosclerosis aortae………………………………………………………………71
Fig. 86 Endocarditis verrucosa……………………………………………………………..72
Fig. 87 Normal myocardium……………………………………………………………….72
Fig. 88 Infarctus myocardii recens……………………………………………………….73
Fig. 89 Myocarditis reumatica……………………………………………………………..73
Autoimmune diseases and connective tissue disorders – D. Serteva………..74
Fig. 90 Struma lymphomatosa (Hashimoto thyroiditis)…………………………..75
Fig. 91 Polyartheriitis nodosa………………………………………………………………75
Fig. 92 Polyarthritis rheumatoides……………………………………………………….76
Hemato / lymphopoietic system – N. Penkova, E. Poryazova………………….76
Fig. 93 Normal spleen………………………………………………………………………..78
Fig. 94 Normal thymus……………………………………………………………………….79
Fig. 95 Normal liver…………………………………………………………………………..79
Fig. 96 Lymphadenosis leucaemica hepatis……………………………………………80
Fig. 97 Myelosis leucaemica hepatis…………………………………………………….80
Fig. 98 Follicular hyperplasia (lymph node)………………………………………….81
Fig. 99 Lymphoma malignum typus non Hodgkin………………………………….81
Fig. 100 Morbus Hodgkin (Lymphogranulomatosis maligna)………………….82
Fig. 101 Plasmocytoma………………………………………………………………………82
Digestive system – E. Poryazova……………………………………………………………83
Fig. 102 Gingivitis chronica hypertroficans…………………………………………..84
Fig. 103 Stomatitis candidosa……………………………………………………………..85
Fig. 104 Leucoplakia………………………………………………………………………….85
Fig. 105 Epulis gigantocellularis………………………………………………………….86
Fig. 106 Carcinoma planocellulare linguae……………………………………………86
Fig. 107 Cysta radicularis……………………………………………………………………87
Fig. 108 Sialoadenitis chronica…………………………………………………………….87
Fig. 109 Amelloblastoma (Adamantinoma)…………………………………………..88
Fig. 110 Adenoma pleomorphae glandulae parotis…………………………………88
Fig. 111 Adenolymphoma, Warthin’s tumor…………………………………………..89
Fig. 112 Tonsilitis chronica (hypertroficans)………………………………………….89
Table of content 7
Pathological changes of the stomach – E. Poryazova…………………………….90
Fig. 113 Gastritis chronica atrophicans…………………………………………………91
Fig. 114 Ulcus acutum duodeni……………………………………………………………92
Fig. 115 Ulcus chronicum ventriculi exacerbate…………………………………….92
Fig. 116 Adenocarcinoma ventriculi……………………………………………………..93
Fig. 117 Signet ring cell carcinoma………………………………………………………93
Pathological changes of the small and large intestines – E. Poryazova………94
Fig. 118 Colitis chronica……………………………………………………………………..97
Fig. 119 Tubular adenoma (large colon)………………………………………………..98
Fig. 120 Adenomatous polyp (with high-grade dysplasia)………………………98
Fig. 121 Adenocarcinoma of colon (moderately differentiated)……………..99
Fig. 122 Adenocarcinoma gellatinosum (colon), PAS…………………………..99
Fig. 123 Carcinoid tumour, (small intestine)………………………………………..100
Pathological changes of the liver, gall bladder and exocrine pancreas –
E. Poryazova……………………………………………………………………………………….100
Fig. 124 Hemangiosarcoma hepatis…………………………………………………….102
Fig. 125 Cirrhosis hepatis micronodularis……………………………………………102
Fig. 126 Cholecystitis chronica………………………………………………………….103
Endocrine system – V. Belovejdov……………………………………………………….103
Fig. 127 Struma colloides………………………………………………………………….105
Fig. 128 Struma Basedowiana…………………………………………………………….106
Fig. 129 Carcinoma papillare gl. thyreoideae……………………………………….106
Fig. 130 Glomerulosclerosis diabetica………………………………………………..107
Kidney and urinary tract – I. Bivolarski……………………………………………..107
Fig. 131 Normal kidney…………………………………………………………………….110
Fig. 132 Glomerulonephritis semilunaris (subacuta)……………………………..110
Fig. 133 Glomerulonephritis mesangiocapillaris…………………………………..111
Fig. 134 Nephrosclerosis glomerulonephritica……………………………………..111
Fig. 135 Pyelonephritis acuta abscedens……………………………………………..112
Fig. 136 Pyelonephritis chronica………………………………………………………..112
Fig. 137 Carcinoma renis…………………………………………………………………..113
Fig. 138 Carcinoma vesicae urinariae…………………………………………………..113
Female reproductive system – E. Poryazova………………………………………….114
8 Handbook of Histopathology and Immunohistochemistry
Diseases related to pregnancy – E. Poryazova……………………………………….114
Fig. 139 Abortus……………………………………………………………………………….115
Fig. 140 Decidua……………………………………………………………………………….115
Fig. 141 Arias-Stella reaction……………………………………………………………..116
Fig. 142 Mola hydatidosa…………………………………………………………………..116
Fig. 143 Choriocarcinoma (chorionepithelioma)…………………………………..117
Diseases of the cervix – V. Belovejdov……………………………………………………117
Uterine body and endometrium disorders – E. Poryazova……………………..118
Fig. 144 Hyperplasia mucosae uteri glandularis cystica…………………………120
Fig. 145 Atypical endometrial hyperplasia…………………………………………..120
Fig. 146 Endometriosis……………………………………………………………………..121
Fig. 147 Adenocarcinoma corporis uteri……………………………………………..121
Inflammatory and tumour disorders of the ovaries – E. Poryazova…………..122
Fig. 148 Cystadenoma papilliferum serosum ovarii………………………………123
Fig. 149 Cystadenocarcinoma papilliferum serosum ovarii……………………123
Mammary gland disorders – E. Poryazova…………………………………………….124
Fig. 150 Fibrosis cystica glandulae mammae……………………………………….125
Fig. 151 Fibroadenoma glandulae mammae…………………………………………125
Fig. 152 Carcinoma ductale glandulae mammae…………………………………..126
Fig. 153 Carcinoma scirrhosum………………………………………………………….126
Male reproductive system – D. Serteva…………………………………………………..127
Fig. 154 Carcinoma glandulae prostate……………………………………………….129
Fig. 155 Atrophic testis……………………………………………………………………..129
Fig. 156 Seminoma testis…………………………………………………………………..130
Fig. 157 Yolk sac tumor (tumor of Teilum)………………………………………….130
Nervous system – E. Poryazova……………………………………………………………131
Fig. 158 Polioencephalitis acuta…………………………………………………………133
Fig. 159 Poliomyelitis anterior acuta…………………………………………………..133
Tumours of the nervous system – E. Poryazova……………………………………..135
Fig. 160 Astrocytoma………………………………………………………………………..136
Fig. 161 Glioblastoma multiforme………………………………………………………136
Fig. 162 Neurinoma (schwanoma)………………………………………………………137
Fig. 163 Meningioma………………………………………………………………………..137
Table of content 9
CHAPTER III. Immunohistochemical testing…………………………………….138
Reading the results of the IHC test – E. Poryazova………………………………..138
IHC-markers for proving the histogenesis of tumours – E. Poryazova…..140
Fig. 164 IHC-testing, Cytokeratin……………………………………………………….140
Fig. 165 IHC-testing ,Cytokeratin 20………………………………………………….140
Fig. 166 IHC-testing, Cytokeratin 7……………………………………………………141
Fig. 167 IHC-testing, Vimentin…………………………………………………………..141
Fig. 168 IHC-testing, S-100 protein , Х100…………………………………………142
Fig. 169 IHC-testing, СЕА………………………………………………………………..142
Fig. 170 IHC-testing, S-100 protein……………………………………………………143
Fig. 171 IHC-testing, Desmin…………………………………………………………….143
Fig. 172 IHC-testing, CD 117 ……………………………………………………………144
Fig. 173 IHC-testing, CDX2………………………………………………………………144
Fig. 174 IHC-testing, Chromogranin A……………………………………………….145
Fig. 175 IHC-testing, CD20……………………………………………………………….145
Fig. 176 IHC-testing, CD3…………………………………………………………………146
Fig. 177 IHC-testing, Factor VIII……………………………………………………….146
IHC-markers for detecting the proliferative activity of tumours –
E. Poryazova……………………………………………………………………………………….147
Fig. 178 IHC-testing, Ki-67……………………………………………………………….147
Fig. 179 IHC-testing, Ki-67……………………………………………………………….147
Fig. 180 IHC-testing, p-53…………………………………………………………………148
Fig. 180 IHC-testing, p-53…………………………………………………………………148
Fig. 182 IHC-testing, p-53…………………………………………………………………149
Fig. 183 IHC-testing, E –Cadherin……………………………………………………..149
Fig. 184 IHC-testing, Beta-catenin……………………………………………………..150
Fig. 185 IHC-testing, AMACR…………………………………………………………..150
Fig. 186 IHC-testing, AMACR…………………………………………………………..151
IHC-testing of the hormone receptors and the antigens of growth factorsm –
E. Poryazova……………………………………………………………………………………….151
Fig. 187 IHC-testing, ЕR…………………………………………………………………..151
Fig. 188 IHC-testing, РR…………………………………………………………………..152
Fig. 189 IHC-testing, Her 2……………………………………………………………….152
Fig. 190 IHC-testing, Her 2……………………………………………………………….153
Index………………………………………………………………………………………………154

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