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Variant 31. The patient, 18-years-old was admitted to the hospital with complaints of headache, weakness, high temperature, pain in the throat. Objectively: enlargement of all groups of lymphatic nodules was revealed. The liver is enlarged by 3 cm, spleen - by 1 cm. In the blood - leukocytosis, atypical lymphocytes - 15%. What is the probable diagnosis?
B. Infectious mononucleosis.
C. Acute lymphoid leucosis
E. Adenoviral infection
2. A 70-year-old male complains of 2 months of low back pain and fatigue. He has developed fever with purulent sputum production. On physical exam, he has pain over several vertebrae and rales at the left base. Laboratory results are as follows: Hemoglobin: 7 g/dL MCV: 86 fL (normal 86 to 98) WBC: 12,000/μL BUN: 44 mg/dL Creatinine: 3.2 mg/dL Ca: 11.5 mg/dL Chest x-ray: LLL infiltrate Reticulocyte count: 1% The most likely diagnosis is
a. Multiple myeloma
c. Metastatic bronchogenic carcinoma
d. Primary hyperparathyroidism
3. The definitive diagnosis of multiple myeloma is best made by
a. 24-h urine protein
b. Greater than 10% plasma cells in bone marrow
c. Renal biopsy
d. Rouleaux formation on blood smear
4. Renal insufficiency in myeloma patients may have developed in this patient secondary to
a. Obstruction of collecting tubules by Bence-Jones protein
c. Amyloid deposition
d. Plasma cell infiltration of the kidney
e. All of the above
5. A 20-year-old male is found to have weight loss and generalized lymphadenopathy. He has hypogammaglobulinemia with a normal distribution of immunoglobulin isotypes. Histologic exam of lymphoid tissue shows germinal center hyperplasia. A diagnosis of common variable immunodeficiency is made. Which of the following is correct?
a. The patient likely had symptoms in childhood
b. At least one parent is also afflicted with the disease
c. The patient may develop recurrent bronchitis and chronic idiopathic diarrhea
d. The patient should receive the standard vaccine protocol
6. A 34 year old patient complains of profuse sweating at night, skin itching, weight loss (9 kg within the last 3 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?
7. A patient has got pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is evident, the tongue is coated with white coating. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary area. The skin is erythematous and glistering over the lymphatic nodes. What is the most probable diagnosis?
A. Acute purulent lymphadenitis
B. Bubonic plague
8. 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 leukosis
B. Hypoplastic anemia
C. Werlhof's disease
D. Acute agranulocytosis
E. Hemorrhagic vasculitis.
9. A patient complains of fatigue associated with itching for 3 months. 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:
Serum angiotensin converting enzyme level
Excisional lymph node biopsy
10. 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:
Erythrocyte sedimentation rate
CT scan of abdomen and pelvis
2. Situational problem:
Patient 19 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.
What investigations should be done?
With what diseases differential diagnosis should be made?What treatment should be administered?