Variant 4

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Variant 41. A 32 -year-old welder complains of weakness and fever. His illness started as tonsillitis a month before. On exam, BT of 38.9°C, 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 70 g/L, RBC of 2.2·1012/L, WBC of 3.0·109/L with 32% of blasts, 1% of eosinophiles, 3% of bonds, 36% of segments, 20% of lymphocytes, and 8% of monocytes, ESR of 47 mm/h. What is the cause of anemia?
Chronic hemolytic anemia
Vitamin B12 deficiency anemia
Aplastic anema
Acute leukemia
Chronic lympholeukemia
2.15. Patient 55 years old complaints about headache, dizziness, skin icterus bleeding of gums. Objectively: skin with red-cyanotic color, splenomegaly. Blood count: RCC 7.5xl012/l, Hb 206 g/1, CI 0.95, WCC 10.3xl09/l, ESR 2mm/hr. your diagnosis?
Erythremia (polycythemia vera).
Myeloma disease
Acute myeloleukosisHodkin's disease
Chronic myeloleukosis3. A 40-year-old male complains of hematuria and an aching pain in his flank. Laboratory data show normal BUN, creatinine, and electrolytes. Hemoglobin is elevated at 18 g/dL and serum calcium is 11 mg/dL. A solid renal mass is found by ultrasound. The most likely diagnosis is:
a. Polycystic kidney disease
b. Renal carcinoma
c. Adrenal adenoma
d. Urolithiasis
4. A 30-year-old female with Graves’ disease has been started on propylthiouracil. She complains of low-grade fever, chills, and sore throat. The most important initial step in evaluating this patient’s fever is
a. Serum TSH
b. Serum T3
c. CBC
d. Chest x-ray
e. Blood cultures
5. A 42 y.o. patient complains of weakness, heartbeat, nasal hemorrhages, cutaneous hemorrhages. His condition has been worsening progressively for a month. Objectively: grave condition, the extremities and body skin has spotted and petechial hemorrhages, lymph nodes are not palpable, Ps- 116/min, liver is +2 cm enlarged, spleen is not palpable. Blood has evident pancytopenia. What disease should you think about first of all?
A. Acute leukemia
B. Hypoplastic anemia
C. Werlhof's disease
D. Acute agranulocytosis
E. Hemorrhagic vasculitis.
6. A 27 year old welder complains of weakness. On exam, BT of 37,90C, RR of 28/min, HR of 103/min, BP of 100/60 mm Hg, hemorrhages on the legs, enlargement of the lymph nodes. CBC shows Hb of 72g/1, RBC of 2,5 • 1012/1, WBC of 3,1*109/1 with 35% blasts, 1% of eosinophiles, 3% of bands, 36% of segments, 20% of lymphocytes, and 8% of monocytes, ESR of 45 mm/h. What is the cause of anemia?
Vitamin B12 deficiency anemia
Acute leukemia
Chronic hemolytic anemia
Chronic lympholeukemia
Aplastic anemia
7. A 25 year old patient complains about weakness, dizziness, haemorrhagic skin rash. She has been suffering from this for a month. Blood count: erythrocytes1,0 • 1012/1, Hb- 37 g/1, colour index - 0,9, 1eukocytes l,2 • 109/1, thrombocytes 42 • 109/1. What diagnostic method will be the most effective?
Abdominal ultrasound
Liver biopsy
Spleen biopsy
CoagulogramЕ. Sternal puncturе
8. A 60 year old man complains of fever, significant weight loss, bone and joint pain, bleeding gums. Examination revealed paleness, lymphadenopathy, hepato- and splenomegaly. CBC: WBC - 270 • 109/1 with 13% lymphocytes, 1% monocytes, 21% basophiles, 29% neutrophils, 9% blasts, 12% promyelocytes, 12% myelocytes, 2% metamyelocytes, 1 % eosinophils. ESR - 22 mm/h. Name the drug for treatment:
A. CytosarB. Prednisolone
C. Vinblastine
D. Blood transfusion
E. Myelosan9. 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?
Lymphogranulomatosis
Chronic myeloid leukemia
Urolithiasis
Hepar cirrhosis
Leukemoid reaction
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
Tuberculosis
Acute monocytic leukemia
Chronic myelogenous leukemia
Chronic lymphocytic leukemia
2. Situational problem:
A 38 year old patient complains about inertness, subfebrile temperature, enlargement of lymph nodes, nasal haemorrhages, bone pain. Objectively: the patient's skin and mucous membranes are pale, palpation revealed enlarged painless lymph nodes; sternalgia; liver was enlarged by 2 cm, spleen - by 5 cm, painless. In blood: erythrocytes 2, 7 • 1012/1, Hb-84 g/1, leukocytes – 58*l09/l, eosinophils - 1%, stab neutrophils - 2%, segmented neutrophils - 12%, lymphocytes - 83%, lymphoblasts - 2%, smudge cells; ESR- 57 mm/h. What is the most probable diagnosis?
What is the most probable diagnosis?
What investigations should be done?
With what diseases differential diagnosis should be made?What treatment should be administered?