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BASE TEST CROC 2

Diseases of the blood and blood-forming organs (HEMATOLOGY)

Methodical instructions for English medium students 3?6th course of medical university (III?IV level of accreditation)

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3?6- III?IV

. 5 21.04.16.

2016

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Base test croc 2 Diseases of the blood and blood-forming organs (Hematology) : methodical instructions for English medium students 3?6th course of me-

dical university (III?IV level of accreditation) / comp. T. V. Ashcheulova,

O. N. Kovalyova, N. A. Safargalina-Kornilov, N. N. Gerasimchuk. ? Kharkiv :

KhNMU, 2016. ? 16 p.

Compilers

T. V. Ashcheulova O. N. Kovalyova N. A. Safargalina-Kornilov N. N. Gerasimchuk

2. () / . . . 3?6- . - . III?IV / . . . , . . , . . -, . . . ? : , 2016. ? 16 .

. . . . . . - . .

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1. A 15 y.o. patient has a developmental lag, occasionally he has skin yellow-

ing. Objectively: spleen is 16 12 10 cm, cholecystolithiasis, skin ulcer of the lower third of left crus. Blood count: RBC ? 3,0 1012/L, Hb ? 90 g/L, C.I. ? 1,0;

microspherocytosis, reticulocytosis. Total serum bilirubin is 56 mcmol/L, un-

conjugated ? 38 mcmol/L. What therapy will be the most appropriate?

A. Splenectomy.

C. Portacaval shunt. E. Omentohepatopexy.

B. Spleen transplantation. D. Omentosplenopexy.

2. A 16 y.o. female presents with abdominal pain and purpuric spots on the skin.

Laboratory investigations reveals a normal platelet count, with haematuria and

proteinuria. The most likely diagnosis:

A. Schonlein-Henoch purpura.

B. Haemolytic uremic syndrome.

C. Thrombotic thrombocytopenic purpura.

D. Heavy metal poisoning.

E. Subacute bacterial endocarditis.

3. A 16-year-old patient who has a history of intense bleedings from minor cuts

and sores needs to have the roots of teeth extracted. Examination reveals an in-

crease in volume of the right knee joint, limitation of its mobility. There are no

other changes. Blood analysis shows an inclination to anaemia (Hb ? 120 g/l).

Before the dental intervention it is required to prevent the bleeding by means of:

A. Cryoprecipitate.

C. Fibrinogen.

E. Calcium chloride.

B. Epsilon-aminocapronic acid. D. Dried blood plasma.

4. A 16-year-old boy was admitted to the hospital for the reason of intractable

nasal haemorrhage and intolerable pain in the right cubital articulation. Objec-

tively: the affected articulation is enlarged and exhibits defiguration and skin

hyperaemia. There are manifestations of arthropathy in the other articulations. Ps ? 90 bpm; colour index ? 1,0, WBC ? 5,6 109/l, thrombocytes ? 220 109/l,

ESR ? 6 mm/h. Lee-White coagulation time: start ? 24', finish ? 27'10". What

drug will be the most effective for this patient treatment?

A. Cryoprecipitate.

C. Erythromass.

E. Vicasol.

B. Calcium chloride. D. Aminocapronic acid.

5. A 16 y.o. teenager complains of weakness, dizziness, sense of heaviness

in the left hypochondrium. Objectively: skin and visible mucous membranesare

icteric. Steeple skull. Liver +2 cm, the lower pole of spleen is at the level of navel. Blood test: RBC ? 2,7 1012/L, Hb ? 88 g/L, WBC ? 5,6 109/L, ESR ? 15 mm/h.

What is the most probable reason of bilirubin level change?

A. Increase of unconjugated bilirubin.

B. Increase of conjugated bilirubin.

C. Increase of unconjugated and conjugated bilirubin.

D. Decrease of conjugated bilirubin.

E. Decrease of unconjugated bilirubin.

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6. An 18 y.o. woman complains of weakness, dizziness, loss of appetite, menorrhagia. There are petechiae on the skin of the upper extremities. Blood test: Hb ? 105 g/L; RBC ? 3,2 1012/L; colored index ? 0,95; thromb. ? 20 109/L. The sedimentation time according to Lee White is 5 min; hemorrhagia duration according to Duke is 8 min, "pinch and tourniquet" test is positive. What is the most probable diagnosis?

A. Idiopathic thrombocytopenic purpura. B. Hemophilia. C. Hemorrhagic diathesis. D. Iron deficiency anemia. E. Marchiafava-Micheli's disease. 7. An 18 y.o. patient was admitted to the hematologic department with complaints of headache, general weakness, poor appetite, body temperature rise up t? 39 ?C, neck swelling. Objectively: skin and mucous membranes are extremely pale, lymph nodes on the both sides of neck are up to 1 cm large, painless. Liver is enlarged +1 cm, painless, spleen +0,5 cm, t?- 38 ?. Blood count: b ? 98 g/L, RBC ? 2,9 1012/L, leukocytes ? 32 109/L, stab neutrophils ? 0 %, segmental leukocytes ? 28 %, monocytes ? 2 %, lymphocytes ? 39 %, blasts ? 31 %, reticulocytes ? 31 %, thrombocytes ? 120 109/L, ESR ? 36 mm/h. What form of leukosis does the patient have? A. Acute lymphoblastic leukosis. B. Acute myeloblastic leukosis. C. Chronic lympholeukosis. D. Chronic myeloleukosis. E. Undifferentiated leukosis. 8. An 18 y.o. girl complains of weakness, dizziness, loss of appetite, menorrhagia. There are many-coloured petechiae on the skin of the upper extremities. Blood test: Hb ? 105 g/l; RBC ? 3,2 1012/L; C.I. ? 0,95; thromb. ? 20 109/L. The sedimentation time according to Lee White is 5min; hemorrhagia duration according to Duke is 8min, "pinch and tourniquet" test is positive. What is the most probable diagnosis? A. Idiopathic thrombocytopenic purpura. B. Hemophilia. C. Hemorrhagic diathesis. D. Iron deficiency anemia. E. Marchiafava-Micheli's disease. 9. An 18-year-oldpatient since childhood suffers from bleeding disorder after minor injuries. His younger brother also has bleeding disorders with occasional haemarthrosis. Which laboratory test will be informative for diagnosis verification? A. Clotting time. C. Blood clot retraction. E. Determination B. Fibrinogen rate. D. Thrombocyte count. of prothrombin time.

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10. An 18 year old patient was admitted to a hospital with complaints of head-

ache, weakness, high temperature, sore throat. Objectively: enlargement of all

groups of lymph nodes was revealed. The liver is enlarged by 3 cm, spleen ?

by 1 cm. In blood: leukocytosis, atypical lymphocytes ? 15 %. What is the most

probable diagnosis?

A. Infectious mononucleosis. C. Diphtheria. E. Adenoviral infection.

B. Acute lymphoid leukosis. D. Angina.

11. A 19 y.o. patient was admitted to the hospital with acute destructive appen-

dicitis. He suffers from hemophilia B-type. What antihemophilic medicine

should be inclended in pre-and post-operative treatment plan?

A. Fresh frosen plasma. C. Fresh frosen blood. E. Dried plasma.

B. Cryoprecipitate.

D. Native plasma.

12. A 19-year-old boy was admitted to a hospital with closed abdominal trau-

ma. In course of operation multiple ruptures of spleen and small intestine were

revealed. AP is falling rapidly, it is necessary to perform hemotransfusion. Who

can specify the patient's blood group and rhesus compatibility?

A. A doctor of any speciality. C. A surgeon.

E. An anaesthesilogist.

B. A laboratory physician. D. A traumatologist.

13. A 19-year-old male patient complains of intense pain in the left knee joint.

Objectively: the left knee joint is enlarged, the overlying skin is hyperemic, the joint is painful on palpation. Blood test results: RBC? 3,8?1012/l, Hb ? 122 g/l,

lymphocytes ? 7,4 109/l, platelets ? 183 109/l. ESR ? 10 mm/h. Duke bleeding

time is 4 minutes, Lee-White clotting time ? 24 minutes. A-PTT is 89 sec.

Rheumatoid factor is negative. What is the most likely diagnosis?

A. Hemophilia, hemarthrosis.

B. Werlhof's disease.

C. Rheumatoid arthritis.

D. Thrombocytopathy.

E. Hemorrhagic vasculitis, articular form.

14. A 20-year-old patient was delivered to a surgical unit complaining of an in-

cised wound on his right forearm that has been bleeding for 1,5 days. Suffers

from general weakness, vertigo, cold sweat, opplotentes. Skin and visible mu-

cous membranes are pale. Heart rate is 110/min, BP is 100/70 mm Hg. Blood

test: Hb is 100 g/l, erythrocytes 2,5 1012/l. What is the cause for the patient's

general condition?

A. Posthemorrhagic anemia.

B. Aplastic anemia.

C. Wound infection.

D. Concomitant disease.

E. Acute thrombophlebitis.

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15. During an exam, a 22-year-old female student fainted. She grew up in a fa-

mily with many children, has a history of frequent acute respiratory infections.

Objectively: the patient has pale skin and mucous membranes, splitend hair, brittle nails. Blood test results: RBC ? 2,7 1012/l, Hb ? 75 g/l, color index ? 0,7, WBC ? 3,2 109/l, platelets ? 210 109/l, ESR ? 30 mm/h. Blood serum iron

is 6 mmol/l. What is the most likely diagnosis?

A. Iron-deficiency anemia. C. B12-deficiency anemia. E. Aplastic anemia.

B. Acute leukemia.

D. Vegetative-vascular dystonia.

16. A 22-year-old vegetarian patient with signs of malnutrition consulted

a doctor about smell and taste distortion, angular stomatitis. Objectively:

marked blue sclerae. The patient was diagnosed with iron deficiency anemia.

What is the dominating clinical syndrome?

A. Sideropenic.

C. Haemologic.

E. Myelodysplastic.

B. Anaemic.

D. Haemolytic.

17. A 24-year-old patient consulted a doctor about enlarged submandibular lymph

nodes. Objectively: submandibular, axillary and inguinal lymph nodes are en-

larged. Chest radiograph shows enlarged mediastinal lymph nodes. In blood: RBCs ? 3,4 1012/l, Hb ? 100 g/l, colour index ? 0,88, thrombocytes ? 190 109/l,

WBCs ? 7,5 109/l, eosinophils ? 8 %, stab neutrophiles ? 2 %, segmented neu-

trophiles ? 67 %, lymphocytes ? 23 %, ESR ? 22 mm/h. What study is required

to verify the cause of lymphadenopathy?

A. Open biopsy of lymph nodes.

B. Ultrasound examination of the abdomen.

C. Mediastinal tomography.

D. Puncture biopsy of lymph nodes.

E. Sternal puncture.

18. A 25 y.o. woman complained of fatigue, hair loss and brittle nails. The exami-

nation revealed pallor of skin, Ps- 94/min, BP- 110/70 mm Hg. On blood count: Hb ? 90 g/L, RBC ? 3,5 1012/L, C.I. ? 0,7; ESR ? 20 mm/h. Serum iron level

was 8,7 mcmol/L. What treatment would you initiate?

A. Ferrous sulfate orally. C. Vitamin B12-intramuscularly. E. Packed RBCs

B. Iron dextrin injections. D. Blood transfusion.

transfusion.

19. A 25-year-old female patient complains of marked weakness, sleepiness,

blackouts, dizziness, taste disorder. The patient has a history of menorrhagia.

Objectively: the patient has marked weakness, pale skin, cracks in the corners

of her mouth, peeling nails, systolic apical murmur. Blood test results: RBC ? 3,4 1012/l, Hb- 70 g/l, colour index ? 0,75, platelets ? 140 109/l, WBC ? 6,2 109/l. What is the most likely diagnosis?

A. Chronic posthemorrhagic anemia.

B. Acute leukemia.

C. Acute posthemorrhagic anemia.

D. B12-deficiency anemia. E. Werlhof's disease.

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20. A 25-year-old patient complains about weakness, dizziness, appearance of hae-

morrhagic skin rash. She has been suffering from this for a month. Blood count:

erythrocytes: 1,0 1012/l, Hb ? 37 g/l, colour index ? 0,9, leukocytes ? 1,2 109/l,

thrombocytes ? 42 109/l. What diagnostic method will be the most effective?

A. Sternal puncture. C. Liver biopsy.

E. Abdominal ultrasound.

B. Spleen biopsy.

D. Coagulogram.

21. A 25-year-old patient has been admitted to the hospital with the following

problems: weakness, sweating, itching, weight loss, enlarged submandibular,

cervical, axillary, inguinal lymph nodes. Objectively: hepatomegaly. Lymph node

biopsy revealed giant Berezovsky-Reed-Sternberg-cells, polymorphocellular

granuloma made by lymphocytes, reticular cells, neutrophils, eosinophils, fibrous

tissue, plasma cells. What is the most likely diagnosis?

A. Lymphogranulomatosis.

B. Lymph node tuberculosis.

C. Lymphoreticulosarcoma.

D. Cancer metastases to lymph nodes.

E. Macofollicular reticulosis.

22. A 27-year-old patient complains of nasal haemorrhages, multiple bruises

on the anterior surface of the trunk and extremities, sudden weakness. In blood: Hb ?

74 g/l, reticulocytes ? 16 %, RBCs ? 2,5 1012/l, platelets ? 30 109/l, ESR ? 25 mm/h.

What is the most effective measure for the treatment of thrombocytopenia?

A. Splenectomy. B. Iron preparations.

C. Hemotransfusion. D. Cytostatics.

E. Vitamin B12.

23. 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/l, colour

index ? 0,87, leukocutes ? 100 109/l, basophils ? 7 %, eosinophils ? 5 %, myelo-

cytes ? 15 %, juveniles ? 16 %, stab neutrophils ? 10 %, segmentonuclear leuko-

cytes ? 45 %, lymphocytes ? 2 %, monocytes ? 0 %, reticulocytes - 0,3 %,

thrombocytes ? 400 109/l, ESR- 25 mm/h. What is the most probable diagnosis?

A. Chronic myeloleukosis. C. Acute leukosis. E. Hepatocirrhosis.

B. Chronic lympholeukosis. D. Erythremia.

24. A 27 year old patient suffers from haemophilia. He was admitted to the

hospital with melena and skin pallor. Objectively: Ps- 110 bpm, AP- 100/60mm Hg. In blood: Hb- 80 g/l, erythrocytes - 2,8 ? 1012/l. What medication should be

administered in the first place?

A. Cryoprecipitate.

B. Stored blood.

C. Packed red blood cells.

D. Dicinone.

E. Epsilon-aminocapronic acid.

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25. A 28-year-old patient underwent endometrectomy as a result of incomplete

abortion. Blood loss was at the rate of 900 ml. It was necessary to start hemo-

transfusion. After transfusion of 60 ml of erythrocytic mass the patient presented

with lumbar pain and fever which resulted in hemotransfusion stoppage. 20 minutes

later the patient's condition got worse: she developed adynamia, apparent skin

pallor, acrocyanosis, profuse perspiration. t ?? 38,5 ?C, Ps ? 110/min, AP ?

70/40 mm Hg. What is the most likely diagnosis?

A. Hemotransfusion shock. C. Septic shock.

E. DIC syndrome.

B. Hemorrhagic shock.

D. Anaphylactic shock.

26. A 30-year-old male patient complains of inertness, low-grade fever, bleeding

gums, frequent quinsies, aching bones. Objectively: the patient has pale skin

and mucous membranes, sternalgia, +2 cm liver, +5 cm painless spleen. Blood

test results: RBC ? 2,7 1012/l, b ? 80 g/l, WBC ? 3 109/l, eosinophils ? 4 %,

basophils ? 5 %, blasts ? 4 segmented neutrophils ? 17 %, lymphocytes ? 29 %,

myelocytes ? 25 %, promyelocytes ? 12 %, monocytes ? 2 %, platelets ? 80 109/l,

ESR ? 57 mm/h. What test should be performed to verify the diagnosis?

A. Sternal puncture. C. Lymph node biopsy. E. Chest X-ray.

B. Trephine biopsy.

D. Lumbar puncture.

27. A 30-year-old patient undergoes treatment because of Werlhof's disease.

Objectively: the patient is pale, there are petechial haemorrhages on the exten-

sion surfaces of forearms. Ps is 92 bpm, AP is 100/60 mm Hg. The lower edge

of spleen is at a level with umbilicus. Blood count: erythrocytes: 2,8 1012/l, Hb ?

90 g/l, Ht ? 0,38, thrombocytes ? 30 109/l. The patient is being prepared for

splenectomy. What transfusion medium should be chosen in the first place for

the preoperational preparation?

A. Thrombocytic mass. C. Native erythrocytic mass. E. Washed erythrocytes.

B. Stored blood.

D. Erythrocytic suspension.

28. 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 bands, 36 % of segments, 20 %

of lymphocytes, and 8 % of monocytes, ESR of 47 mm/h. What is the cause

of anemia?

A. Acute leukemia.

B. Chronic lympholeukemia.

C. Aplastic anema.

D. Vitamin B12 -deficiency anemia. E. Chronic hemolytic anemia.

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