Hematology

2 Уровень

1

*!Man, 57 years old, admitted to doctor with complaints against weakness, dizziness, blackout, paresthesias in feet. Above-mentioned complaints appeared few months ago, and increased slowly. In the examination: slight icterity of coverlets, angular stomatitis. BP – 120/70 mmHg. Pulse – 96 bpm. Heart sounds are rhythmic, systolic murmur. In the common blood analysis – Er. 3.2 × 10¹²/l; Hb – 83 g/l, CI – 1.4, platelets 110 × 10⁹/l, leukocytes – 4.5 thousand, ESR – 16 mm/h, macrocytosis, hypersegmentation of neutrophils.

Which diagnosis is MOST probable?

*Asiderotic anemia

*В12-deficient anemia

*Thalassemia

*Aplastic anemia

*Microspherocytosis

2

*!A woman, 35 years old. She suffers from frequent hemorrhages at mensis. Objectively: condition of average severity, skin and mucous membranes of pale color, white covered tongue, heart borders normal, sounds are loud, systolic murmur, tachycardia, pulse 106 bpm, BP 90/40 mmHg. Liver and spleen are not enlarged. CBA: Er 2.1 × 10¹²/l, Hb 64 g/l. CI 0.6, L. 4.4 × 10⁹/l, ESR - 26 mm/h, serum iron 6.5 mmol/l.

Which diagnosis is MOST probable?

*Iron-deficiency anemia

*В12-deficient anemia

*Folic-deficient anemia

*Aplastic anemia

*Microspherocytosis

3

*! Girl 14 years old with complaints against weakness, fatigue, skin icteritious. From her childhood, she notes episodes of icteritiousness. At the examination, physician noted paleness of coverlets with icteric faint, enlarged spleen by 3 cm under the costal arch. US: gallstones. In the common blood analysis, HВ – 80 g/l, erythrocytes – 2 × 10¹²/l, CI – 0.8, reticulocytes – 25%. Blood free bilirubin level – 34 µmol/l.

Which diagnosis is MOST probable?

*Asiderotic anemia

*В12-deficient anemia

*Folic-deficient anemia

*Aplastic anemia

*Microspherocytosis

4

*!A woman, 40 years old, applied to doctor with complaints against weakness, dyspnea at physical activity, palpitation, hemorrhagic lesions on the skin. She considers herself ill for a year. Objectively: coverlets and visible mucous membranes are pale, hemorrhagic rash on the skin. Liver and spleen are not enlarged. CBA: Hb 66 g/l, Er. 2,1× 10¹²/l, CI 1.0, L 1,5 × 10⁹/l, e.0%, p. 11%, s.36%, l 50%, m 10%, reticulocytes 0.2%, thrombocytes 55 × 10⁹/l, ESR – 51 mm/h. Coombs' test is negative, myelogram: not enough material was obtained.

Which diagnosis is MOST probable?

*immune thrombocytopenia

*acute hemolytic anemia

*immune pancytopenia

*aplastic anemia

*posthemorrhage anemia

5

*!A woman, 22 years old, has admitted in urgent department with complaints against general weakness, dizziness and dyspnea. She became ill 2 days ago on background of acute viral infection. Objectively: paleness and icteric coloration of the skin and mucous membranes. Tongue is smooth, red. Spleen comes out from the edge of costal arch by 3 cm. Blood count: HВ – 83 g/l, Er. – 2.3 × 10¹²/l, reticulocytes – 20%, platelets – 210 × 10⁹/l, leuk. – 4.5 × 10⁹/l. Anisopoikilocytosis, macropolycytes. Bilirubin indirect – 110 µmol/l. Coombs' test – positive.

Which diagnosis is MOST probable?

*Autoimmune hemolytic anemia

*Immune pancytopenia

*Aplastic anemia

*Glucoso-6-FDG-deficient anemia

*Minkowsky-Shauffard disease

6

*! Man, 33 years old, with complaints against increased body temperature to 38.7C, pain at swallowing, gingival hemorrhage, weakness, dizziness. According to him, earlier he was treated due to necrotic tonsillitis. He is often troubled by a cold. Coverlets are pale, bad smell from mouth. At the mouth cavity examination, there is multiple ulcerative stomatitis, gum is hyperplastic, tonsils are hyperemic and enlarged. Submaxillary lymph nodes are enlarged, painless.

Which diagnosis is MOST probable?

*Acute lymphoblastic leucosis

*Acute myeloblastic leucosis

*Chronic lymphocytic leukemia

*Chronic myelogenous leukemia

*Hodgkin's disease

7

*! Woman, 19 years old, with complaints against increased body temperature to 38.7C, pain at swallowing, gingival hemorrhage, weakness, dizziness. Coverlets are pale, bad smell from mouth. Examination: necrotic lesions, enlarged and swelling tonsillar glands. Submaxillary lymph nodes are enlarged, painless.

Indicate most informative examination for this disease?

*Blast cells detection

*Anemia detection

*Thrombocytopenias detection

*Leukocytosis detection

*Megaloblasts detection

8

*!A patient, 64 years old, complains of weight loss, fatigue, weakness, dizziness, hyperhydrosis. Pains in area of right and left hypochondrium. He works in research center of nuclear physics. He is often troubled by a cold. At objective examination, coverlets are pale, moist, there are hematomas (he don't remember them), bad smell from mouth. At palpation, hepatomegaly, splenomegaly was detected. Submaxillary lymph nodes are enlarged, painless. In CBA, ER – 3x10¹²/l, НВ – 90 g/l, Leukocytes – 90x10⁹/l., myeloblasts – 4%, promyelocytes – 6%, metamyelocytes – 10%, stabs neutrophils – 10%.

Set the most probable clinical diagnosis:

*Acute lymphoblastic leucosis

*Acute myeloblastic leucosis

*Chronic lymphocytic leukemia

*Chronic myelogenous leukemia

*Hodgkin's disease

9

*!Man, 28 years old, on the body appeared petechial spotty skin rash, he is bothered by nasal, gingival hemorrhages. Edge of spleen is palpated. In blood – Er. 4.0 × 10¹²/l, leukocytes 4.5 × 10⁹/l, leucoformula – normal, platelets 15 × 10⁹/l. Which diagnosis is MOST probable?

*DIC syndrome

*Acute leucosis

*Hemolytic anemia

*Aplastic anemia

*Autoimmune thrombocytopenia