Medicine 3

81問 • 2年前

問題一覧

A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day, stool is not solid, with some mucus in it. Appetite is normal, she has not put off weight. First such symptoms appeared 1,5 year ago, but colonoscopy data reveals no organic changes. Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are normal. What is the preliminary diagnosis?

Irritable bowels syndrome

A 75 year old man who has been suffering from diabetes for the last six months was found to be jaundiced. He was asymptomatic except for weight loss at the rate of 10 pounds in 6 months. Physical examination revealed a hard, globular, right upper quadrant mass that moves during respiration. A CT scan shows enlargement of the head of the pancreas, with no filling defects in the liver. The most likely diagnosis is:

Carcinoma of the head of the pancreas

A patient is 65 y.o. He has been a smoker for 40 years. Hew has lost 10 kg during the last 3 months. Complains of pain in the epigastric area after taking meals, diarrhea, jaundice. Physical examination revealed enlarged, painless gallbladder. Feces are light-coloured and clay-like. Blood analysis revealed increased level of whole and direct bilirubin, alkaline phosphotase and glutaminepyruvate transferase. Clinical urine analysis showed positive bilirubin reaction and negative urobilinogene reaction. Where is the initial process that caused these changes?

In pancreas

A patient with hepatic cirrhosis drank some spirits that resulted in headache, vomiting, aversion to food, insomnia, jaundice, fetor hepaticus, abdominal swelling. What complication of hepatic cirrhosis is meant?

Hepatocellular insufficiency

A 48-year-old patient complains of heaviness in the right hypochondrium, itching of the skin.He had been treated in infectious diseases hospital repeatedly due to icterus and itch. On physical exam: meteorism, ascitis, dilation of abdominal wall veins, protruded umbilicus, spleen enlargement. What can be diagnosed in this case?

Liver cirrhosis

A 42-year-old female patient suffers from micronodular cryptogenic cirrhosis. Over the last week her condition has deteriorated: she developed convulsions, mental confusion, progressing jaundice. What study may give reasons for such aggravation?

Determination of serum ammonia

During the doctor's round, a 56-year-old male patient with decompensated cirrhosis complains of dizziness, palpitations, moving black specks seen before the eyes, general weakness. The patient is pale, Ps- 110/min, AP- 90/50 mm Hg. What complication is most likely to have occurred in the patient?

Bleeding from esophageal varices

4 hours after having meals a patient with signs of malnutrition and steatorrhea experiences stomach pain, especially above navel and to the left of it. Diarrheas take turns with constipation lasting up to 3-5 days. Palpation reveals moderate painfulness in the choledochopancreatic region. The amylase rate in blood is stable. X-ray reveals some calcifications located above navel. What is the most likely diagnosis?

Chronic pancreatitis

A 48-year-old male patient complains of constant pain in the upper abdomen, mostly on the left, that is getting worse after taking meals; diarrhea, weight loss. The patient is an alcohol abuser. 2 years ago he had acute pancreatitis. Blood amylase is 4 g/hcdotl. Coprogram shows steatorrhea, creatorrhea. Blood glucose is 6,0 mmol/l. What treatment is indicated for this patient?

Panzinorm forte

A 64-year-old male patient has a 35-year history of chronic pancreatitis. In the last 5 years, he claims to observe the pain abatement, bloating, frequent bowel movements up to 3-4 times a day, grayish, glossy stool with undigested food rests, the progressive loss of body weight. Change of symptoms in the patient is due to overlay of:

Exocrine pancreatic insufficiency

A 45 y.o. man has complained of having epigastric and right subcostal aching pain, pruritus, indigestion, dark color of the urine and acholic stool, fever and significant weight loss for 1 month. On examination: jaundice, presence of Curvuasier's sign. US scan did not reveal stones in the gallbladder and choledochus. What is the most likely diagnosis?

Cancer of the pancreas head

A patient suffers from chronic recurrent pancreatitis with evident disturbance of exocrinous function. After intake of rich spicy food and spirits his stool becomes fatty. Reduced production of what factor is the most probable cause of steatorrhea?

Lipase

A 68 year old patient has been suffering from chronic pancreatitis for 35 years. During the last 5 years he has been observing abatement of pain syndrome, abdominal swelling, frequent defecations up to 3-4 times a day (feces are greyish, glossy, with admixtures of undigested food), progressing weight loss. Change of symptom set is caused by joining of:

Exocrine pancreatic insufficiency

A 46-year-old male patient complains of periodic epigastric pain that occurs at night. Objectively: HR- 70/min, AP- 125/75 mm Hg, tenderness in the epigastric region is present. EGD confirms duodenal ulcer of 0,6 cm in diameter. Test for H. Pylori is positive. Which of the given antisecretory drugs will be a compulsory element of the treatment regimen?

Omeprazole

A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive girdle pain in the abdomen. Profuse nonformed stool 2-3- times a day has appeared for the last 2 years, loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood amylase - 12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most reasonable treatment at this stage?

Pancreatine

A 60 y.o. woman complains of unbearable pains in the right hypochondrium. In the medical hystory: acute pancreatitis. Body temperature is 38,20С. Objectively: sclera icteritiousness. No symptoms of peritonium irritation are present. There are positive Ortner's and Hubergrits-Skulski's symptoms. Urine diastase is 320 g/h. What diagnosis is the most probable?

Chronic pancreatitis

A 28-year-old patient has been hospitalized for the pain in the epigastric region. He has a 10-year history of duodenal ulcer (DU). Recently, the pain character has changed: it became permanent, persistent, irradiating to the back. There are general weakness, dizziness, fatigue. The patient has put off weight. Objectively: HR- 68/min, AP- 120/80 mm Hg. What is most likely cause of deterioration?

Penetration

A 32 year old patient complains about heartburn and dull pain in the epigastrium that appear 2-3 hours after meal. Exacerbations happen in spring and in autumn. The patient has food intolerance of eggs and fish. Objectively: stomach palpation reveals painfulness in the gastroduodenal area. Electrophasoduodenoscopy revealed a 5 mm ulcer on the anterior wall of duodenum. Urease test is positive. What is the most probable leading mechanism of disease development?

Chelicobacterial infection

In autumn a 25-year-old patient developed stomach ache that arose 1,5-2 hours after having meals and at night. He complains about pyrosis and constipation. The pain is getting worse after consuming spicy, salty and sour food, it can be relieved by means of soda and hot-water bag. The patient has been suffering from this disease for a year. Objectively: furred moist tongue. Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal muscles in the same region. What is the most likely diagnosis?

Duodenal ulcer

A 33 y.o. male patient was admitted to a hospital. A patient is pale, at an attempt to stand up he complains of strong dizziness. There was vomiting like coffee-grounds approximately hour ago. BP- 90/60 mm Hg., pulse- 120 b/min. In anamnesis, a patient has suffered from ulcer of the stomach, painless form during 4 years. An ulcer was exposed at gastrofiberoscopy. Your diagnosis:

Ulcer of stomach, complicated with bleeding

A 60-year-old patient complains of nearly permanent sensation of heaviness and fullness in the epigastrium, that increases after eating, foul-smelling eructation, occasional vomiting with food consumed 1-2 days ago, weight loss. 12 years ago he was found to have an ulcer of pyloric channel. The patient has taken ranitidine for periodic hunger pain. The patient's condition has been deteriorating over the last 3 months. Objectively: splashing sound in the epigastrium is present. What kind of complication is it?

Pyloric stenosis

For 3 days, a 28-year-old emale patient had had the body temperature increase up to $38^oC$, weakness, poor appetite, nausea, a single vomiting. On the 4th day the temperature was normal, the condition improved, but the jaundice developed. Objectively: moderate ictericity of skin, +3 cm enlarged liver of elastic consistency. Ortner's, Kehr's and Voznesensky's symptoms are negative. What test will verify the diagnosis?

IgM Anti-HAV detection

A 41 year old woman has suffered from nonspecific ulcerative colitis for 5 years. On rectoromanoscopy: evident inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous membrane. In blood: WBC- 9,8109 /l, RBC3,01012/l, ESR - 52 mm/hour. What medication provides pathogenetic treatmentof this patient?

Sulfosalasine

A 20-year-old woman has a 3-4 month history of bloody diarrhoea; stool examination proved negative for ova and parasites; stool cultures negative for clostridium, campylobacter and yersinia; normal small bowel series; edema, hyperemia and ulceration of the rectum and sigmoid colon seen on sigmoidoscopic examination. Select the most likely diagnosis:

Ulcerative colitis

A 45 y.o. man complains of having intensive pain in the epigastric region 1,5-2 hours later after food intake. He has been suffering from ulcer for 11 years. Objectively: t0 - 36,50С, RR- 16/min, Ps- 70 bpm, AP- 120/80 mm Hg. On palpation: local painfulness in the right epigastric region. What parameters of intragastric Ph-meter in the region of stomach body are the most typical for this patient's disease?

рН = 1,0-2,0

A 42 y.o. man who has been ill with duodenal ulcer for 20 years complains of getting a sense of heaviness in stomach after meal, foul-smelling eructation, vomiting, weight loss. Objectively: his state is relatively satisfactory, tissue turgor is diminished. On palpation the belly is soft, there are no symptoms of peritenium irritation, "splashing sounds" in epigastrium. Defecation - once in 3 days. What complication corresponds with the patient's state and described clinical presentations?

Ulcerative pyloric stenosis

A 43 y.o. woman complains of severe pain in the right abdominal side irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth. There were multiple vomitings without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis?

Perforative ulcer

A 36-year-old alcoholic patient has cirrhosis and pancreatic insufficiency due to recurrent pancreatitis. He complains of night blindness, decreased ability to taste food, and dry skin with hyperpigmentation. These complaints suggest deficiency of:

Zinc

A 33-year-old patient has acute blood loss: erythrocytes - 2,2*1012/l, Hb- 55 g/l, blood group is A(II)Rh+ . Accidentally the patient got a transfusion of donor erythrocyte mass of AB(IV)Rh+ group. An hour later the patient became anxious, got abdominal and lumbar pain. Ps- 134 bpm, AP- 100/65 mm Hg, body temperature - 38,6oC. After catheterization of urinary bladder 12 ml/h of dark-brown urine were obtained. What complication is it?

Acute renal insufficiency

A 33 y.o. patient was admitted to the hospital with stopped repeated ulcerative bleeding. He was pale and exhausted. Blood count: Нb- 77 g/l, Нt- 0,25. In view of anemia there were made two attempts of blood transfusion of the same group - А(ІІ) Rh+ . In both cases the transfusion had to be stopped because of development of anaphylactic reaction. What transfusion medium would be advisable in this case?

Washed erythrocytes

A 56 y.o. patient ill with cholecystectomy suddenly had an intense hemorrhage. She needs blood transfusion. Her blood group is АВ(ІV) Rh- . Hemotransfusion station doesn't dispose of this group. What group of donors can be involved?

Donors of rare blood groups

A 48 year old man complains of fatique and shortness of breath. His Ht is 32%, and Hb - 103 g/l. Peripheral blood smear reveals macrocytosis. Serum vitamin B12 level is 90 pg/ml (normal is 170 to 940); serum folate level is 6 ng/ml (normal is 2 to 14). Possible causes to consider include all of the following EXCEPT:

Colonic diverticulitis

A 60 y.o. patient cpmplains of weakness, dizziness, heaviness in the upper part of abdomen, paresthesia of toes and fingers. Objectively: skin icteritiousness, tongue is crimson, smooth. Hepatomegaly. In blood: Hb- 90 g/l, erythrocytes - 2,3*1012/l, reticulocytes - 0,2%; color index - 1,2, macrocytosis; Jolly's bodies, Cabot's ring bodies. What medication is the most appropriate for treatment?

Vitamin В12

A 35 y.o. woman is suspected of aplastic anemia. The bone marrow punction has been administered with the diagnostic purpose. What changes in the marrow punctatum are suggested?

Replacement of marrow elements with adipose tissue

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 - 3,8x1012/l, Hb - 122 g/l, lymphocytes - 7,4x109 /l, platelets – 183x109 /l. ESR - 10 mm/h. Duke bleeding time is 4 minutes, Lee-White clotting time - 24 minutes. A-PTT is 89 s. Rheumatoid factor is negative. What is the most likely diagnosis?

Hemophilia, hemarthrosis

A full-term newborn child has a diagnosis newborn's Rh-factor hemolytic disease. Bilirubin rate is critical. The child's blood group is B(III), his mother's blood group - A(II). The child has indication for hemotransfusion. What donor blood must be chosen?

Blood group B(III) Rh-

A patient who works as a nightman was diagnosed with of chronic arsenious intoxication. What form of anemia is characteristic for this disease?

Haemolytic anemia

A 42-year-old patient complains of back pain, darkened urine, general weakness, dizziness that occurred after treating a cold with aspirin and ampicillin. Objectively: the patient is pale, with subicteric sclerae. HR - 98 bpm. Liver - +2 cm, spleen - +3 cm. In blood: RBCs - $2,6¥cdot10^{12}$/l, Hb - 60 g/l, CI - 0,9, WBCs - $9,4¥cdot10^9$/l, basophils - 0,5¥%, eosinophils - 3¥%, stab neutrophils - 6¥% segmented neutrophils - 58¥%, lymphocytes - 25¥%, monocytes - 7¥%, ESR - 38 mm/hour, reticulocytes - 24¥%. Total bilirubin - 38 millimole/l. What complication occurred in the patient?

Acquired hemolytic anemia

A 25 year old patient complains about weakness, dizziness, haemorrhagic skin rash. She has been suffering from this for a month. Blood count: erythrocytes: 1,01012/l, Hb- 37 g/l, colour index - 0,9, leukocytes - 1,2109 /l, thrombocytes - 42*109 /l. What diagnostic method will be the most effective?

Sternal puncture

An 18-year-old patient 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?

Clotting time

A 14-year-old patient with signs of internal haemorrhage has been taken to a hospital after a fight. He has had haemophilia A since childhood. He has been diagnosed with retroperitoneal hematoma. What should be administered in the first place?

Cryoprecipitate

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 increase 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:

Cryoprecipitate

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. Objectively: 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 - 5,6109/l, thrombocytes- 220109/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?

Cryoprecipitate

During an exam, a 22-year-old female student fainted. She grew up in a family with many children, has a history of frequent acute respiratory infections. Objectively: the patient has pale skin and mucous membranes, split-end hair, brittle nails. Blood test results: RBC2,71012/l, Hb- 75 g/l, color index - 0,7, WBC- 3,2109 /l, platelets – 210*109 /l, ESR- 30 mm/h. Blood serum iron is 6 mmol/l. What is the most likely diagnosis?

Iron-deficiency anemia

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?

Hypoplastic anemia

A man, 42 years old, died in a road accident after the hemorrhage on the spot, because of acute hemorrhagic anemia. What minimum percent of the whole blood volume could result in death by acute hemorrhage?

25-30%

A 7 y.o. boy suddenly felt pain in his right knee, it became edematic. The day before he took part in a cross-country race. Family anamnesis has no data about hemophilia and bleeding sickness. Objectively: body temperature is 37,50С. The knee is painful, hot to the touch, edematic with local tissue tension over it. Blood count: Нb- 123 g/L, leukocytes - 5,6109 L, thrombocytes - 354109 L, prothrombin time - 12 seconds (normally 10-15 seconds), partly activated thromboplastin time - 72 seconds (normally 35-45 seconds). Hemorrhage time is normal, VIII:C factor is 5\% of norm. What is the most probable diagnosis?

Hemophilia A

A 27 year old patient suffers from haemophilia. He was admitted to the hospital with melena and skin pallor. Objectively: Ps- 110 bpm, AP- 100/60 mm Hg. In blood: Hb- 80 g/l, erythrocytes - 2,8*1012/l. What medication should be administered in the first place?

Cryoprecipitate

A 37-year-old woman complains of generalized fatigue, irritability, dysphagia, chalk hunger. On physical exam: t- 36,50C, respirations - 20/min, Ps - 96 bpm, BP - 110/70 mm Hg. Satisfactory nourishment. The skin and visible mucous membranes are pale. Blood test: Hb -70g/L, erythrocytes - 3,41012/L, CI - 0,7, reticulocytes - 2%, leucocytes - 4,7109 /L, eosinophilis. - 2%, band neutrophils - 3%, segmented neutrophils - 64%, lymphocytes - 26%, monocytes - 5%, ESR - 15 mm/min. Serum ferrum - 7,3μmol/L, total protein - 70g/L. Deficit of what factor caused the development of the disease?

Ferrum

A 25 y.o. woman complained of fatigue, hair loss and brittle nails. The examination evealed pallor of skin, Ps- 94/min, BP- 110/70 mm Hg. On blood count: Hb- 90 g/L, RBC3,5*1012/L, C.I.- 0,7; ESR- 20 mm/h. Serum iron level was 8,7 mcmol/l. What treatment would you initiate?

Ferrous sulfate orally

The physician must undertake measures for primary prophylaxis of iron deficiency anemia. Which of the following categories of patient are subject to such primary prophylactic measures?

Pregnant women

A 42-year-old female lives in the basement, is unemployed, undernourished. She complains of having general weakness, hair loss, brittle nails for six months, likes to eat chalk. Objectively: the patient is emaciated, pale, has dry skin. Peripheral lymph nodes are not enlarged. Liver is +1,5 cm. In blood: RBCs - $1,8¥cdot10^{12}$/l, Hb- 62 g/l, colour index - 0,78, reticulocytes - 0,5$^o/{oo}$, ESR- 18 mm/h. Leukogram exhibits no pathology. What is a provisional diagnosis?

Nutritional iron deficiency anaemia

Medical examination of a 43 y.o. man revealed objectively pailness of skin and mucous membranes, smoothness of lingual papillas, transverse striation of nails, fissures in the mouth corners, tachycardia. Hemoglobin content amounts 90 g/l; there are anisocytosis, poikilocytosis. The most probable causative agent of this condition is deficiency of the following microelement:

Iron

A 16 y.o. teenager complains of weakness, dizziness, sense of heaviness in the left hypochondrium. Objectively: skin and visible mucous membranes are icteric. Steeple skull. Liver +2 cm, the lower pole of spleen is at the level of navel. Blood test: RBC2,71012/L, Hb- 88 g/L, WBC- 5,6109 /L, ESR- 15 mm/h. What is the most probable reason of bilirubin level change?

Increase of unconjugated bilirubin

A 54 year old woman complains of increasing fatigue and easy bruising of 3 weeks' duration. Physical findings included pale, scattered ecchymoses and petechiae and mild hepatosplenomegaly. Blood count: RBC- 2,51012/l; Hb - 73 g/l; Ht - 20%; PLT23109 /l; and WBC- 162*109 /l with 82% blasts, that contained Auric rods; peroxidase stain was positive. What is the most probable diagnosis?

Acute leukemia

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 /l 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:

Myelosan

Against the background of angina a patient has developed pain in tubular bones. Examination revealed generalized enlargement of lymph nodes, hepatolienal syndrome, sternalgia. In blood: RBCs - 3,6¥cdot10^{12}$/l, Hb- 87 g/l, thrombocytes - $45¥cdot10^9$/l, WBCs - $13¥cdot10^9$/l, blasts - 87¥%, stab neutrophils - 1¥%, segmented neutrophils - 7¥%, lymphocytes - 5¥%, ESR - 55 mm/h. What is the most likely diagnosis?

Acute leukemia

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 - 2,7x1012/l, Нb - 80 g/l, WBC – 3x109 /l, eosinophils - 4%, basophils - 5%, blasts - 4%, stab neutrophils - 2%, segmented neutrophils - 17%, lymphocytes - 29%, myelocytes - 25%, promyelocytes - 12%, monocytes - 2%, platelets – 80x109 /l, ESR - 57 mm/h. What test should be performed to verify the diagnosis?

Sternal puncture

A 43-year-old female complains of significant weakness, sore throat, occurrence of multiple unexplained bruises on her skin. These symptoms have been present for a week, the disease is associated with quinsy which she had some time before. Objectively: body temperature - 38,9oC, respiratory rate - 24/min, Ps - 110/min, AP - 100/65 mm Hg. The patient has pale skin, petechial rash on the extremities, enlarged lymph nodes. Blood test results: Hb - 80 g/l, RBC - 2,2x1012/l; WBC - 3,5x109 /l; blasts - 52%; eosinophils - 2%; stab neutrophils - 3%; segmented neutrophils - 19%; lymphocytes - 13%; monocytes - 1%; platelets – 35x109 /l. ESR - 47 mm/h. What test is required to specify the diagnosis?

Immunophenotyping

A man, aged 68, complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood test: WBC- 35*109 /L, lymphocytes - 60%, Botkin and Gumprecht bodies, level of haemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?

Chronic lympholeucosis

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 - 3,21012/l, Hb- 100 g/l, colour index - 0,87, leukocutes - 100109 /l, basophils - 7%, eosinophils - 5%, myelocytes - 15%, juveniles - 16%, stab neutrophils - 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?

Chronic myeloleukosis

A 32 year old welder complains of weakness and fever. His illness started as tonsillitis a month before. On exam, BT of 38,9oC, 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 2,21012/l, WBC of 3,0109 /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?

Acute leukemia

An 18 y.o. patient was admitted to the hematologic department with complaints of headache, general weakness, poor appetite, body temperature rise up to 390С, 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, t0 - 380С. Blood count: Нb- 98g/L, RBC- 2,91012/L, leukocytes - 32109 /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?

Acute lymphoblastic leukosis

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 crystales in urine, erythrocyte2-3 in the field of vision. What is the preliminary diagnosis?

Chronic myeloleucosis

A 58-year-old female patient complains of spontaneous bruises, weakness, bleeding gums, dizziness. Objectively: the mucous membranes and skin are pale with numerous hemorrhages of various time of origin. Lymph nodes are not enlarged. Ps is 100/min, AP - 110/70 mm Hg. There are no changes of internal organs. Blood test results: RBC - 3,0x1012/l, Нb - 92 g/l, colour index - 0,9, anisocytosis, poikilocytosis, WBC – 10x109 /l, eosinophils - 2%, stab neutrophils - 12%, segmented neutrophils - 68%, lymphocytes - 11%, monocytes - 7%, ESR - 12 mm/h. What laboratory test is to be determined next for making a diagnosis?

Platelets

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 wasdiagnosed with iron deficiency anemia. What is the dominating clinical syndrome?

Sideropenic

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 mouth, peeling nails, systolic apical murmur. Blood test results: RBC - 3,4x1012/l, Hb - 70 g/l, color index - 0,75, platelets – 140x109 /l, WBC - 6,2x109 /l. What is the most likely diagnosis?

Chronic posthemorrhagic anemia

A 52 y.o. woman complains of weakness, painful itching after washing and bathing, sensation of heaviness in the head. On examination: hyperemia of skin of face, neck, extremities. АP- 180/100 mm Hg. Speeln is 4 cm below the rib arch edge. What is the most probable diagnosis?

Erythremia

A 50 year old patient has been admitted to the clinics with atrophic gastritis. Blood count: erythrocytes - 3,8*1012/l, Hb - 68 g/l, c.i. - 1, macroanisocytosis, poikilocytosis. There is megaloblastic type of haemopoesis. A number of leukocytes, reticulocytes and thrombocytes is lreduced. Which pathology is suspected?

Irondeficiency anemia

A 38-year-old patient complains about inertness, subfebrile temperature, enlargement of lymph nodes, nasal haemorrhages, ostealgia. 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 - 2,71012/l, Hb- 84 g/l, leukocytes – 58109 /l, eosinophils - 1%, stab neutrophils - 2%, segmented neutrophils - 12%, lymphocytes - 83%, lymphoblasts - 2%, smudge cells; ESR- 57 mm/h. What is the most likely diagnosis?

Chronic lymphatic leukemia

A 22-year-old girl has been complaining of having itching rash on her face for 2 days. She associates this disease with application of cosmetic face cream. Objectively: apparent reddening and edema of skin in the region of cheeks, chin and forehead; fine papulovesicular rash. What is the most likely diagnosis?

Allergic dermatitis

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- 3,21012/L; C.I.- 0,95; thromb.- 20109/L. The sedimentation time according to Lee White is 5'; hemorrhagia duration according to Duke is 8', "pinch and tourniquet" test is positive. What is the most probable diagnosis?

Idiopathic thrombocytopenic purpura

A 42-year-old woman complains about bruises on her both legs and prolonged menstruation; general weakness, tinnitus cerebri. Objectively: multiple macular haemorrhages on the legs and body. The patient presents with tachypnoe, tachycardia, systolic murmur in all auscultatory points. AP- 75/50 mm Hg. Blood count: RBC - 1,91012/l, Нb- 60 g/l, colour index - 0,9, WBC - 6,5109 /l, thrombocytes - 20*109 /l, ESR- 12 mm/h. Duke bleeding time - 12 minutes. Bone marrow analysis revealed plenty of juvenile immature forms of megacaryocytes without signs of thrombocyte pinch-off. What is the most likely diagnosis?

True thrombocytopenic purpura

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 - $2,5¥cdot10^{12}$/l, platelets - $30¥cdot10^9$/l, ESR- 25 mm/h. What is the most effective measure for the treatment of thrombocytopenia?

Splenectomy

A 40-year-old female patient has been hospitalized for attacks of asphyxia, cough with phlegm. She has a 4-year history of the disease. The first attack of asphyxia occurred during her stay in he countryside. Further attacks occurred while cleaning the room. After 3 days of inpatient treatment the patient's condition has significantly improved. What is the most likely etiological factor?

Household allergens

After a wasp-bite there was an itching of skin, hoarse voice,barking cough, anxiety. On physical exam: there is edema of lips, eyelids, cyanosis. What medicine is to be taken first?

Prednisolone

A 16-year-old adolescent was vaccinated with DTP. In eight days there was stiffness and pain in the joints, subfebrile temperature, urticarial skin eruption, enlargement of inguinal, cervical lymph nodes and spleen. What kind of allergic reaction is observed?

Immunocomplex

A 42 year old man applied to a hospital 10 minutes after he got stung by a bee and complained about face edema and difficult respiration. Objectively: Ps- 98 bpm, AP- 130/80 mm Hg. A doctor on duty injected him 1 ml of 1% dimedrol solution intramuscularly and recommended to apply to his local therapeutist on the next day. What tactics of treatment should be chosen for this patient?

Intravenous introduction of prednisolone and hospitalization

A youth, aged 15, from childhood suffers from atopic dermatitis and allergy to the shellfish. In the last 3 months after acquiring aquarium fish rhinitis, conjunctivitis, itching in the nose developed. Level of what immunologic index should be defined in this case?

IgE

A 19-year-old patient complains about skin rash that appeared 2 days ago after eating smoked fish. The rash disappears after 4-6 hours but then turns up again. It is accompanied by itch. Objectively: trunk and upper limbs are covered with multiple pink blisters as big as a pea or a bean. What is the most likely diagnosis?

Acute urticaria

A 32 y.o. woman has got the Laiel's syndrome after taking the biceptol. What immunotrope medicines are to be prescribed in this situation?

Steroid immunosupressants

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問題一覧

Irritable bowels syndrome

Carcinoma of the head of the pancreas

In pancreas

Hepatocellular insufficiency

Liver cirrhosis

Determination of serum ammonia

Bleeding from esophageal varices

Chronic pancreatitis

Panzinorm forte

Exocrine pancreatic insufficiency

Cancer of the pancreas head

Lipase

Exocrine pancreatic insufficiency

Omeprazole

Pancreatine

Chronic pancreatitis

Penetration

Chelicobacterial infection

Duodenal ulcer

Ulcer of stomach, complicated with bleeding

Pyloric stenosis

IgM Anti-HAV detection

Sulfosalasine

Ulcerative colitis

рН = 1,0-2,0

Ulcerative pyloric stenosis

Perforative ulcer

Zinc

Acute renal insufficiency

Washed erythrocytes

Donors of rare blood groups

Colonic diverticulitis

Vitamin В12

A 35 y.o. woman is suspected of aplastic anemia. The bone marrow punction has been administered with the diagnostic purpose. What changes in the marrow punctatum are suggested?

Replacement of marrow elements with adipose tissue

Hemophilia, hemarthrosis

Blood group B(III) Rh-

A patient who works as a nightman was diagnosed with of chronic arsenious intoxication. What form of anemia is characteristic for this disease?

Haemolytic anemia

Acquired hemolytic anemia

Sternal puncture

Clotting time

Cryoprecipitate

Iron-deficiency anemia

Hypoplastic anemia

25-30%

Hemophilia A

Cryoprecipitate

Ferrum

Ferrous sulfate orally

The physician must undertake measures for primary prophylaxis of iron deficiency anemia. Which of the following categories of patient are subject to such primary prophylactic measures?

Pregnant women

Nutritional iron deficiency anaemia

Iron

Increase of unconjugated bilirubin

Acute leukemia

Myelosan

Acute leukemia

Sternal puncture

Immunophenotyping

Chronic lympholeucosis

Chronic myeloleukosis

Acute leukemia

Acute lymphoblastic leukosis

Chronic myeloleucosis

Platelets

Sideropenic

Chronic posthemorrhagic anemia

Erythremia

Irondeficiency anemia

Chronic lymphatic leukemia

Allergic dermatitis

Idiopathic thrombocytopenic purpura

True thrombocytopenic purpura

Splenectomy

Household allergens

After a wasp-bite there was an itching of skin, hoarse voice,barking cough, anxiety. On physical exam: there is edema of lips, eyelids, cyanosis. What medicine is to be taken first?

Prednisolone

Immunocomplex

Intravenous introduction of prednisolone and hospitalization

IgE

Acute urticaria

A 32 y.o. woman has got the Laiel's syndrome after taking the biceptol. What immunotrope medicines are to be prescribed in this situation?

Steroid immunosupressants