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Two healthy individuals have a healthy son. His

physical, motor, psychological, and social development fully corresponded to

his age. Now at the age of two, the patient is admitted for a suspected

fracture of the right tibia. The injury is negative and the mechanism of

fracture is unknown. In addition, he was already hospitalized once 5 months ago

for a left radius fracture. The mechanism of fracture was not identified here

either. Physical examination reveals limited mobility of the right lower

extremity, soreness in the lower tibia and gluteal region and a relatively

greater amount of bruising on the body overall. Slightly bluish sclerae are

noticeable. X-ray confirms the diagnosis of a fracture of the right tibia.

Basic laboratory findings (blood count and biochemistry) are normal. Genetic

testing shows that the disease is caused by a mutation and defect in collagen

formation associated with, among other things, increased bone fragility. This

is the disease

osteogenesis imperfecta.

In this disease, glycine is

replaced by other, larger amino acids in the structure of collagen. Which type

of collagen is affected in this disorder?

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55-year-old wo

man

with a history of chronic kidney disease comes

to the physician for a 2-month history of easy

fatigability. Physical examination shows subconjunctival pallor. Her hemoglobin

concentration is 80 g/l. Treatment with erythropoietin has been administered. A

peripheral blood smear is obtained one week after treatment. A photomicrograph

of the smear after specialized staining is shown. The prominent color of the intracellular structure in

some of the cells is most likely the result of staining which of the following?

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A 75-year-old woman has been suffering from

right hip pain for a long time. An X-ray showed signs of severe osteoarthritis.

Therefore, the patient underwent total hip replacement. Histological

examination of the surgical specimen revealed a significantly damaged articular

surface with marked cartilage degeneration. Which of the following factors is

primarily responsible for the poor regeneration of articular cartilage?

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A 33-year-old man visits a general

practitioner's office complaining of loss of smell, frequent nosebleeds,

difficulty swallowing, and hoarseness. During the interview he admits to

cocaine use since his college days. Subsequent examination in the ENT clinic,

to which the patient is referred, reveals the presence of severe inflammation

of the nasal mucosa and a disrupted cartilage structure in the nasal septum.

What type of collagen predominates in this type of cartilage?

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A 16-year-old boy

fell and injured his knee during the school’s recent game. A physical

examination showed strong instability of the knee and an MRI examination

confirmed a rupture of the anterior cruciate ligament. What type of tissue is

the anterior cruciate ligament?

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A 54-year-old woman presents with numbness and

weakness in her lower extremity as well as pain that radiates from her lower

back down the back of the thigh. Imaging reveals that the patient has a

herniated intervertebral disk. This occurs when the softer center of the disk,

the nucleus pulposus, herniates out of the stronger outer portion, the annulus

fibrosus. What is typical for the tissue forming the annulus fibrosus?

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A 62-year-old man has a red, warm, painful lesion on his skin that

extends across his calf from the popliteal fossa to the ankle. This condition

is diagnosed as cellulitis, a bacterial infection of the deeper layers of the

skin. The red colour, increased temperature, and pain of the affected area are

due to an inflammatory response to the infection. In the patient, this

inflammatory reaction is largely caused by the release of pro-inflammatory

substances from the cells of the immune system, which are abundant in the

connective tissue. Which of the following cell types are involved?

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A 67-year-old woman suffers from back and hip

pain. Physical examination reveals that she has a slightly stooped posture and

is slightly shorter than she was a few years ago. The patient is most likely

suffering from osteoporosis, which particularly affects postmenopausal women.

To confirm this, a bone density measurement, called densitometry, is performed

using X-rays. What should the measured bone density be to confirm osteoporosis?

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A 36-year-old man is required to attend a

Pulmonary clinic as part of a contact investigation for a person who tested positive for tuberculosis. He works in a factory where he encounters a large number of

unvaccinated persons among whom the disease has begun to spread. Since the man

is properly vaccinated and his results are negative, this check is performed only a

once.

Mycobacterium tuberculosis

is a specific bacterium that is

able to survive after phagocytosis inside macrophages. Once it is engulfed by

macrophages, it starts to produce a protein called PtpA (protein tyrosine

phosphatase A). These molecules knock out two different mechanisms that the

macrophage needs to create the acidic environment necessary for bacteria to

break down. As a result, the tuberculosis bacteria hide inside the macrophages

and completely escape the attention of the immune system. When they multiply

sufficiently, they escape the cell and invade other parts of the body. What

should properly occur after phagocytosis and destruction of these bacteria

inside the macrophage?

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A 9-year-old female presents with flushing, urticaria, pruritus, dizziness, and shortness of breath following an insect bite. In the

emergency, she was treated with high-flow oxygen, fluids, and corticosteroids. Activation of which of the following cell types was responsible for her presenting symptoms?

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