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At the man of 65 years for the 2nd days after a Q-wave myocardial infarction symptoms of a pulmonary thromboembolism suddenly developed. Objective: diffuse cyanosis, skin "marble", cold sweat. In lungs a crepitation and fine crackles. Pulse filliformis. Cardiac sounds are muffled, the HR 130 /min., a BP 70/50 mm Hg. CBA: Err-2,2x10¹²/l, Hb-80 g/l, Tr-120x10⁹. Coagulogram: Prothrombin time-20min, fibrinogen-4,8 g/l, ethanol test ++, antithrombin III – 65%.

What of following states most possibly was the reason of this complication?

*cardiogenic shock

* Dressler's syndrome

* acute antiphospholypid syndrome

*lung edema

*+Dessiminated intravascular coagulation syndrome

21

*!A 55-year-old man with complains of weakness, breathlessness, nasal and gingival hemorragia, weight loss. Physical examination: skin pallor. Body temperature – 38.1°C. Submandibular and axillary lymph nodes are increased, painless. Liver and spleen protrude below the costal margin for 3 and 4 cm relevant. In the blood: RBC-2.5x10¹² /l, Hb-76 g/l, color index-0.9, WBC-2, 5x10⁹/l, PLT-40x10⁹ /l, ESR-40 mm/hour. Choose the most possible results of bone marrow investigation:

*Lymphoid methaplasia

*Erythroid lineage stimulation

*Megaloblastic type of hemopoesis

*+Fatty marrow domination

*Present marrow domination

22

*!A 39-year-old man after having ARVI starts complaining on fever onset, vomiting, lumbar region aching pain, urine darkening, weekness developing. Physical examination: skin paleness. HR-118 per min. Kidney percussion test is positive from both sides. In the blood: RBC-2.2x10¹² /l, Hb-62 g/l, color index-0.9, WBC-3,5x10⁹/l, PLT-140x10⁹ /l, ESR-40 mm/hour., reticulocytes-7%, total bilirubin-36.8 mkmol/L, urea-9.7mmol/L. Uranalysis show: leukocyturia, hemosiderinuria. Ham test is positive.

Choose the most reasonable procedure to set on:

*Spleenectomia

*Antioxidants

*Anabolic steroides

*Transfusion of whole blood

*+Transfusion of washed erythrocytes

23

*!A 32-year-old man experiences a sudden onset of fever. Physical examination demonstrate skin and scleras jaundice, spleenomegalia. In the blood: RBC-2.1x10¹² /l, Hb-42 g/l, color index-0.9, WBC-3,5x10⁹/l, PLT-140x10⁹ /l, ESR-48 mm/h, reticulocytes-7%, total bilirubin-34mkmol/L, indirect bilirubin-17 mmol/L.

Which of the following treatment is appropriate:

*Cytostatic

*Plasmapheresis

*Spleenectomia

*Glucocorticosteroids

*+Erythromass transfusion

24

*!A 35-year-old woman with rheumatoid arthritis, on the 3 day after a total knee arthroplasty, develops a fever, chilling, drenching sweat, an issue of blood from operative wound, pethechias. Broad-spectrum antibiotic treatment, fresh frozen plasma and heparin were set on. In blood count: anemia, hyperleucytosis, increased ERS, toxic neutrophils. In refreshed coagulogramm: PLT-80 000cells/mc/L, prothrombin time-17sec., prothrombin index– 115%, fibrinogen-3 g/L, APPT-42sec., positive ethanol gelation test. Choose the appropriate treatment:

*packed white cells admission

*platelet concentrate admission

*tranexamic acid admission

*Aminocaproic acid addition

*+Continue cryoprecipitate transfusion

25

*!17 year-old girl complains on rash, fugitive arthralgias and epigastric pain; the rise of body temperature to 37,70С. Physical examination: erythematous macular rash on lower extremities, which doesn’t disappear after pressing. In blood count: PLT-397 000cells/mc/L, WBC-11,200 cells/mcL, ERS-24 mm/hour, hyper-alpha2 and hyperhammaglobulinaemia. In coagulogramm: fibrinogen-6.1 g/L, paracoagulation tests are positive. Urinalyses: protein-1.2 g/L, red blood cells- 6-8 field of microscope. Choose the most appropriate preparation for treatment:

*Fresh frozen plasma

*+Fraxiparine

*Clopidogrel

*Warfarin

*Heparin