Variant 8

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Variant 81. Patient L, 35 year-old, complains of weakness, itchiness, subfebrile, pain in the left and right subcostal, increase of lymph nodes. General Blood Analysis: neutrophils leucocytosis, lyphocytopenia, anemia, increase of ESR. Biopsy of lymph nodes: Polymorphic cell, Berezovsky-Shternberg cells. Your diagnosis?
A. Lymphogranulomatous
B. Chronic lympholeucosis
C. Chronic Myelo-leucosis
D. Acute leucosis
E. Myeloma disease
2. Patient 50 yrs complains of weakness, pain in bones, level of Hb 65 g/l, proteinuria 22g/l, level of albumin in serum 40 g/l. diagnosis?
A. Myeloma disease.
B. Chronic glomerulonephritis in stage of uremia.
C. Secondary amyloidosis of kidney.
D. Chronic pyelonephritis.
E. Polycystosis of kidney
3. A patient complains of fatigue and night sweats associated with itching for 2 months. On physical exam, there is diffuse nontender lymphadenopathy, including small supraclavicular, epitrochlear, and scalene nodes. A chest x-ray shows hilar lymphadenopathy. The next step in evaluation is
a. Excisional lymph node biopsy
b. Monospot test
c. Toxoplasmosis IgG
d. Serum angiotensin converting enzyme level
4. The patient is found on biopsy to have mixed-cellularity Hodgkin’s lymphoma. Liver function tests are normal, and the spleen is nonpalpable. The next step in evaluation is
a. CT scan of abdomen and pelvis
b. Liver biopsy
c. Staging laparotomy
d. Erythrocyte sedimentation rate
5. Stage III B Hodgkin’s disease. Match the chemotherapeutic agent with the anticipated response.
a. Better than 50% chance that the lesion will be cured
b. Prolongation of survival
c. Palliation
d. Little or no response
6. A 7 y.o. girl fell ill abruptly: fever, headache, severe sore throat, vomiting. Minute bright red rash appear in her reddened skin in 3 hours. It is more intensive in axillae and groin. Mucous membrane of oropharynx is hyperemic. Greyish patches is on the tonsills. Submaxillary lymph nodes are enlarged and painful. What is your diagnosis?
Enteroviral infection
Scarlet fever
7. A 2 y.o. girl has been ill for 3 days. Today she has low grade fever, severe catarrhal presentations, slight maculopapular rash on her buttocks and enlarged occipital lymph nodes. What is your diagnosis?
A. Scarlet fever
B. Rubella
C. Measles
D. Aden oviral infection
E. Pseudotuberculosis
8. A 63 year old patient complained about pain in the lumbar area. He underwent a course of physiological treatment on account of radiculitis but this led to no improvement of his condition. R-graphy of spinal column and pelvic bones revealed osteoporosis and serious normochromic anaemia, urine analysis revealed proteinuria. Whole blood protein made up 10,7 g/1. What disease should be suspected?
A. Acute radiculitis
B. Urolithiasis
C. Metastases in bones
D Myelomatosis
Systemic osteoporosis
9. A 44 year old patient complains of profuse sweating, skin itching, weight loss (12 kg within the last 4 months). Examination revealed malnutrition, skin pallor. Palpation of neck and inguinal areas revealed dense elastic lymph nodes for about 1 cm in diameter, nonmobile, non-adhering to skin. What is the most probable diagnosis?
Chronic lymphadenitis
Burkitt's lymphoma
Cancer metastases
10. The definitive diagnosis of multiple myeloma is best made by:
24-h urine protein
Renal biopsy
Rouleaux formation on blood smear
Greater than 10% plasma cells in bone marrow
2. Situational problem:
A 77-year-old male complains of 4 months of fatigue. On physical exam, he has pain over several vertebrae and rales at the left base. Laboratory results are as follows: Hemoglobin: 75 g/L MCV: 88 fL (normal 86 to 98) WBC: 11,000/μL
BUN: 44 mg/dL Creatinine: 3.2 mg/dL Ca: 11.5 mg/dL Chest x-ray: LLL infiltrate Reticulocyte count: 1%
What is the most probable diagnosis?
What investigations should be done?
With what diseases differential diagnosis should be made?What treatment should be administered?