3 Уровень
10
*!A woman, 35 years old, in the last 5 years notes frequent nasal hemorrhages, easy formation of bruises on skin. She felt herself satisfactory, didn't consulted a doctor. Two weeks ago, after abundant hemorrhage, weakness, dizziness became stronger. She is pale, on chest, legs skin, multiple petechial hemorrhagic eruptions and single extensive exchimoses. Liver, spleen are not enlarged. In CBA: Hb 94 g/l, Er. 3.8 × 1012/l, CI 0.64, l. 6.2 × 109/l, st/n-3%, seg/n-67%, eosinophils-2%, lymphocytes-23%, monocytes-5%, platelet 15.0 × 109/l.
What treatment tactic?
*Antiobiotics
*Prednisolonum
*Thrombopoietin *Whole blood transfusion
*Fresh frozen plasma transfusion
11
*!Woman, 45 years old, has admitted to the doctor with complaints against general weakness, dizziness, shortness of breath at the walk, hunger for chalk. From the anamnesis came out that she has abundant menstruations. Objectively: Skin is pale, dry, deformation of nails:
Vesicular respiration, RR 22 per min. Heart sounds are rhythmic, subdued, systolic murmur on the apex of heart. Pulse 100 per minute, rhythmic, of poor volume. BP 90/60 mmHg. CBA: Er. 2.9 × 1012/l, Hb 87 g/l, CP 0.8, L. 4.4 × 109/l, ESR – 22mm/h, serum iron 5.3 mmol/l.
Prescription of which of listed drugs is MOST reasonable?
*iron sulphate orally
*prednisolone orally
*iron sulphate intravenously
*deferoxamin intramuscularly
*concentrated red cells intravenously
12
*!Man, 46 years old, has admitted to polyclinic with complaints against acute weakness, numbness of limbs, dyspnea. From the life history: gastrecomia because of neoplasms. Objectively: Skin is pale, icteric. Vesicular respiration, BR 22 per min. Heart sounds are rhythmic, subdued, systolic murmur on the apex. BP 100/60 mmHg. PS 96 bpm. Abdomen is soft, painless. Liver at the edge of costal arch. Spleen is not palpated. CBA: Er. 2.5 × 1012/l, Hb 94 g/l, CP 1.3, L. 3.4 × 109/l, thrombocytes 182 × 109/l, ESR – 23 mm/h, bone marrow punctuate picture: megaloblasts 78%. Treatment with parental preparation began.
What study must be done in order to control the efficiency of treatment?
*Bone marrow puncture 1 month later
*Bone marrow puncture 3 month later
*Common blood analyses on 10-12 day of treatment
*Common blood analyses on 20-21 day of treatment
*Common blood analyses on 29-30 day of treatment
13
*! A woman, 55 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 45 g/l, Er. 1,9 × 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. PCR – HCV – positive.
Which management tactics is MOST reasonable?
*antiviral therapy
*bone marrow transplantation
*erythropoietin application
*GM-CGF application
*recombinant IL-1 beta application
14
*!A woman, 55 years old, complains of weakness, dizziness, numbness of limbs. In the life history 10 years ago, stomach resection due to stomach ulcer was performed. At the examination: CBA: Er. 2.8 × 1012/l, Hb 76 g/l, CP 1.4, L. 4.4 × 109/l, ESR - 22 mm/h, serum iron 12.3 mmol/l.
Which management tactics is MOST reasonable?
*deferoxamine application
*vitamin В12 application
*iron preparations application
*erythromass transfusion
*whole blood transfusion
15
*!In a woman, 28 years old, suffered from lupus erythematosis, in the blood analysis – Erythrocytes – 2.0 × 10/12/l; Hb – 73 g/l; CP – 1.01, platelets 243 × 109/l, Leukocytes – 3.2 × 109/l, Neutrophils: seg/n – 65%, st/n – 4%, Monocytes – 6%, eosinophils – 3%, Lymphocytes – 12%, ESR – 24 mm/h. In biochemical blood analysis, total bilirubin – 82 µmol/l, indirect – 71 µmol/l. ANA positive, anti-DNA - positive
Which drug MOST probably should be prescribed in the first place?
*Prednisolone orally
*Methotrexate i.v.
*Cyclophosphamide pulse therapy
*Metylprednisolone pulse therapy
*Plasmaferesis
16
*!Into urgent department arrived a woman, 20 years old, with nasal bleeding. Complaints against dizziness, palpitation, blackout. Objectively: pale coverlets, cyanotic mucosal membranes, hematomas on legs. BR – 24 min. P – 102 per min. BP 60/40 mmHg. APTT – 42 sek, prothrombin index – 42%, fibrinogen А – 1.5 g/l, fibrinogen positive +. Platelets – 88 × 109/l.
Which treatment tactics is MOST reasonable?
*Prednisolone i.v.
*Cyclophosphamide pulse therapy
*Plasmaferesis
*Fresh frozen plasma transfusion
*Thrombomass transfusion
17
*!In a woman, 25 years old, after acute viral infection, for the first time multiple spontaneous subcutaneous hemorrhages, nasal bleeding appeared. Bandage, pinch signs are positive. In blood analysis: Hb – 100 g/l, platelets – 8 × 109/l.
Which treatment tactics is MOST reasonable?
*Splenectomy
*bone marrow transplantation
*Platelet mass transfusion
*GM-CGF application
*recombinant IL-1 beta application
18.
At the man of 36 years in a hemogram are revealed: leukocytes – 78x109/l, % promyelocytes-3, % myelocytes-8, % metamyelocytes-12, p/ya-21%, s/ya-41%, % basophiles-3, % eosinocytes-6, % lymphocytes-6, thrombocytes-784h109/l, Nv-114 of a g/l. In a myelogram: hyper cellularity, the maintenance of myelocariocytes and megacaryocytes is increased, all elements of a granulocyte cells line are defined.
What research MOST will possibly allow to verify the diagnosis and it is necessary for assessment of effectiveness of treatment?
*Lymphonodus punctate research
*Cytochemical research of bone marrow
*Immunophenotyping of cells of bone marrow
*Immunohistochemical research of bone marrow
*An immunogenetic research on identification of a Ph-chromosome
19
At the patient with suspicion on acute lymphoblast leukemia immunophenotyping of blast cells had carrying out. On a membrane of blast cells the following antigens were revealed: CD 19, CD20, CD21, CD79. What clinical option of acute leukemia at the patient?
*В-cell
*Т-cell
*Natural killers
*Mixed cells
*Nondifferentiated