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Variant 11. A 58 y.o. male patient is examined by a physician and suffers from general weakness, fatigue, mild pain in the left subcostal area, sometimes frequent painful urination. Moderate splenomegaly has been revealed. Blood test: neutrophilic leukocytosis with the progress to myelocyte; basophil- 2%; eosinophil-5%. There is a urate crvstales in urine, erythrocyte- 2-3 in the fieldof vision. What is the preliminary diagnosis?
Chronic myeloid leukemia
2. A 60-year-old asymptomatic man is found to have a leukocytosis when a routine CBC is obtained. Physical exam shows no abnormalities. The spleen is of normal size. Lab data includes: Hgb: 9 g/dL (normal 14 to 18) Leukocytes: 40,000/μL (normal 4,300 to 10,800) Peripheral blood smear shows a differential that includes 97% small lymphocytes. The most likely diagnosis is
a. Acute monocytic leukemia
b. Chronic myelogenous leukemia
c. Chronic lymphocytic leukemia
3. Thе patient with сhronic lymphocytic leukemia will require chemotherapy
a. If the white blood cell count rises
b. If lymphadenopathy develops
c. To control anemia or thrombocytopenia
d. Only when acute lymphocytic leukemia develops
4. A 41 y.o. woman complains of weakness, fatigue, fever up to 380C, rash on the face skin, pain in the wrists and the elbows. On physical examination: erythematous rash on the cheeks with "butterfly" look, the wrists and elbow joints are involved symmetrically, swollen, sensitive, friction rub over the lungs, the heart sounds are weak, regular, HR- 88/min, BP- 160/95 mm Hg. CBC shows anemia, leucopenia, lymphopenia; on urine analysis: proteinuria, leukocyturia, casts. What is the main mechanism of disease development?
A. Production of myocytes antibodies
B. Production of myosin antibodies
C. Production of antibodies to endothelial cells
D. Production of antimitochondrial antibodies
E. Production of antibodies to double-stranded DNA
5. A 27 y.o. patient has been having for almost a year fatigue, hyperhidrosis, heaviness in the left hypochondrium, especially after meals. Objectively: spleen and liver enlargement. In blood: erythrocytes - 3, 2 • 1012/l, Hb- 100 g/1, colour index - 0,87, leukocutes - 100 • 109/l, basophi1s - 7%, eosinophils - 5%, myelocytes - 15%, juveniles - 16%, stab neutrophi1s - 10%, segmentonuclear leukocytes -45%, lymphocytes - 2%, monocytes -0%, reticulocytes - 0,3%, thrombocytes - 400 • 109/l, ESR- 25 mm/h. What is the most probable diagnosis?
Acute leukosisChronic myeloleukosis6. A 18 year old patient complains about subfebrile temperature, enlargement of lymph nodes, nasal haemorrhages. Objectively: the patient's skin and mucous membranes are pale, palpation revealed enlarged painless lymph nodes; sternalgia; liver was enlarged by 1 cm, spleen - by 4 cm, painless. In blood: erythrocytes 1, 7 • 1012/1, Hb-74 g/1, leukocytes – 66*l09/l, eosinophils - 1%, stab neutrophils - 2%, segmented neutrophils - 12%, lymphocytes - 83%, lymphoblasts - 2%, smudge cells; ESR- 60 mm/h. What is the most probable diagnosis?
Acute myeteleukemiaChronic lymphatic leukemia
Acute lymphatic leukemia
7. A 54 y.o. woman complains of increasing fatigue and easy bruising of 3 weeks' duration. Physical findings included pale, scattered ecchymoses and petechiae and mild hepatosplenomegaly. In blood: RBC-2, 5 • 1012/l; Hb- 73 g/L; HCT- 20%; PLT-23 *109/L, and WBC- 162 • 109/l with 82% blasts, that contained Auric rods; peroxidase stain was positive. What is the most probable diagnosis?
A. Acute leukemia
B. Chronic leukemia
C. Hemolytic anemia
D. Megaloblastic anemia
8. Patient 65 years old complaints about headache, dizziness, skin icterus. Objectively: skin with red-cyanotic color, splenomegaly. Blood count: RCC 8.5xl012/l, Hb 210 g/1, CI 0.95, WCC 11.3xl09/l, ESR 1mm/hr. your diagnosis?
Erythremia (polycythemia vera).
Acute myeloleukosisChronic myeloleukosis9. A 65 y.o. male patient suffers from fatigue, sometimes frequent painful urination. Moderate splenomegaly has been revealed. Blood test: neutrophilic leukocytosis with the progress to myelocyte; basophil- 2%; eosinophil-5%. There is a urate crvstales in urine, erythrocyte- 2-3 in the fieldof vision. What is the preliminary diagnosis?
Chronic myeloid leukemia
10. A 50-year-old man is found to have a leukocytosis when a routine CBC is obtained. Physical exam shows no abnormalities. The spleen is of normal size. Lab data includes: Hgb: 100 g/L Leukocytes: 44,000/μL (normal 4,300 to 10,800) Peripheral blood smear shows a differential that includes 92% small lymphocytes. The most likely diagnosis is
Acute monocytic leukemia
Chronic myelogenous leukemia
2. Situational problem:
A 32 year old welder complains of weakness and fever. His illness started as tonsillitis a month before. On exam, BT of 38,90C, RR of 24/min, HR of 100/min, BP of 100/70 mm Hg, hemorrhages on the legs, enlargement of the lymph nodes. CBC shows Hb of 70g/1, RBC of 2,2 • 1012/1, WBC of 3,0*109/1 with 32% blasts, 1% of eosinophiles, 3% of bands, 36% of segments, 20% of lymphocytes, and 8% of monocytes, ESR of 47 mm/h. What is the most probable diagnosis?
What investigations should be done?
With what diseases differential diagnosis should be made?What treatment should be administered?