Hematology krok 2 part 1

1.) A  14  y.o.  girl complains  of  profuse  bloody  genital discharges  during 10

days after suppresion of menses for 1,5 months. Similiar bleedings recur since 12

years on the background of disordered menstrual cycle. On rectal examination: no

pathology on the internal genitalia. In blood: Нb– 70 g/L, RBC- 2, 3 ∗ 1012/L, Ht–

20. What is the most probable diagnosis?

A.   Juvenale bleeding, posthemorrhagic anemia

B. Werlholf’s disease

C.Polycyst ovarian syndrome

D. Hormonoproductive ovary tumor

E. Noncomplete spontaneous abortion

Explanation:-

 2) 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 si-ckness. Objectively: body temperature is 37, 50 . The

knee is painful, hot to the touch, edematic with local tissue tensi-on over it. Blood

count:  Нb-  123  g/L,  leukocytes  -  5,  6  ∗  109/L,  thrombocytes  -  354  ∗109/L,

prothrombin   time   -   12   seconds   (normally   10-15   seconds),   partly   acti-vated

thromboplastin time - 72 seconds (normally 35-45 seconds). Hemorrhage ti-me is

normal, VIII:C factor is 5% of norm. What is the most probable diagnosis?

A. Hemophilia A

B. Hemophilia B

C.Schoenlein-Henoch disease

D. Vitamin K deficiency

E. Thrombocytopenia
Explanation:Hemophilia A is a hereditary bleeding disorder caused by a lack of blood clotting factor VIII. Without enough factor VIII, the blood cannot clot properly to control bleeding. In the given patient just clotting factor VIII just 5 % normal, which is not enough thus he develops above mention symptoms (knee is pa.inful, hot to the touch, edematic with local tissue tensi-on over it).

3.)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?

A. Chronic lympholeucosis

B. Chronic myeloleucosis

C.Lymphogranulomatosis

D. Acute leucosis

E. Tuberculous lymphadenitis

4.) A  27  y.o.  patient has  been  havi-ng for  almost a  year fatigue,  hyperhi-drosis,

heaviness in the left hypochondri-um, especially after meals. Objectively: spleen
and liver enlargement. In blood: erythrocytes -   3, 2   · 1012/l,   Hb-   100 index   -

0,87,    leukocutes    g/l,    colour  100  ·  109/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?

A. Chronic myeloleukosis

B. Chronic lympholeukosis

C.Acute leukosis

D. Erythremia

Hepatocirrhosis

 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. Hypoplastic anemia

B. Acute leukosis

C.Werlhof’s disease

D. Hemorrhagic vasculitis

E. Acute agranulocytosis

Explanation: Hypoplastic anemia is a Progressive nonregenerative anemia resulting from greatly depressed,inadequately functioning bone marrow that may lead to aplastic anemia(It's is a rare disease in which the bone marrow and the hematopoietic stem cells that reside there are damaged. This causes a deficiency of all three blood cell types (pancytopenia): RBC (anemia),WBS (leukopenia), and platelets (thrombocytopenia).

     

6.) Medical examination of a 43 y.o. man revealed objectively pailness of skin and

mucous membranes, smoothness of li-ngual 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

condi-tion is deficiency of the following mi-croelement:

A. Iron

B. Copper

C.Zinc

D. Magnesium

E. Selenium
Explanation:- Deficiency of iron leads to iron deficiency anemia /microcytic anemia.

Causes include:

• menstruating state
• pregnant and lactating woman
• chronic blood loss
• colon cancer until proven otherwise in elderly
• dietary deficiency in children
• high cow's milk intake in young children 

• Symptoms
  • fatigue
• Physical exam 
• tachycardia
• smooth tongue
• brittle nails
• esophageal webs
• pallor
• PICA (craving for ice chips)
• Elevated
  • TIBC
• Low
  • serum iron
  • serum ferritin
  • reticulocyte count due to decreased production (no iron to support)
• Blood smear shows
  • hypochromatic RBCs (doughnut cells) with moderate poikilocytosis.

7.) 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?

A.Vitamin B12-deficiency anemia

B. Irondeficiency anemia

C.Hemolytic anemia

D. Post-hemorrhagic anemia

E. Thalassaemia

Explanation:-Vitamin B12 deficiency anemia is a low red blood cell count due to a lack (deficiency) of vitamin B12. Vitamin B12 deficiency leads to Macrocytic, megaloblastic anemia;hypersegmentation PMNs; paresthesias and subacute combined degeneration(degeneration of  dorsal column, lateral corticospinal tract and spinocerebellar tracts) due to abnormal myelin. Prolonged deficiency leads to irreversible nerve damage. 

Pernicious anemia is the most common cause of vitamin B12 deficiency

•  antibody to gastric parietal cell leads to ineffective secretion of intrinsic factor (IF) 
• leads to vitamin B12 deficiency due to decrease uptake in the terminal ilium. decrease uptake in the accompanied by achlorhydia and atrophic gastritis
• atrophic gastritis increases risk of gastric cancer.

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,  5  ·  1012/l;  Hb  -

73g/l;  Ht  -  20%;  PLT-  23  ·  109/l;  and  WBC-162  ·  109/l  with  82%  blasts,  that

contained  Auric  rods;  peroxidase  stain  was  positive.  What  is  the  most  probable

diagnosis?

A. Acute leukemia

B. Chronic leukemia

C.Thrombocytopenia

D. Hemolytic anemia

E. Megaloblastic anemia

Explanation :- Blast cell (abnormal immature white blood cells  fill the bone marrow and spill into the bloodstream).found in acute leukemia.

8.) Examination at an  outpatient’s hospi-tal revealed paleness  of  skin, sleepiness.

Blood count: Hb - 95 g/l, erythrocytes - 3, 5 · 1012/l, reticulocytes - 90/00, colour

index  -  0,7,  osmotic  stability  of  erythrocytes  -  0,44-0,33%,  serum  iron  -  4,9

micromole/l. What is the most probable cause of anemia?

A. Iron deficit

B. Hemogenesis immaturity

C.Infectious process

D. Erythrocyte hemolysis

E. B12 deficit

 Explanation:- Deficiency of iron leads to iron deficiency anemia /microcytic anemia.

Causes include:

• menstruating state
• pregnant and lactating woman
• chronic blood loss
• colon cancer until proven otherwise in elderly
• dietary deficiency in children
• high cow's milk intake in young children 

• Symptoms
  • fatigue
• Physical exam 
• tachycardia
• smooth tongue
• brittle nails
• esophageal webs
• pallor
• PICA (craving for ice chips)
• Elevated
  • TIBC
• Low
  • serum iron
  • serum ferritin
  • reticulocyte count due to decreased production (no iron to support)
• Blood smear shows
  • hypochromatic RBCs (doughnut cells) with moderate poikilocytosis.

Note :given patient has low color index(0.7) .Normal color index 8-1.0. And also patient has low serum iron level. Normal value range 60 to 170 micrograms per deciliter (mcg/dL) or 10.74 to 30.43 micromoles per liter (micromol/L).

9.) 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, 2 · 10  12/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

Explanation:- Blast cell (abnormal immature white blood cells  fill the bone marrow and spill into the bloodstream).found in acute leukemia.

10.) A   38  year   old   patient  complains   about   inertness,   subfebrile  temperature,

enlargement  of  lymph  nodes,  nasal  haemorrhages,  bone  pain.  Objecti-vely:  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/l,  Hb-  84  g/l,leukocytes - 58 · 109/l,

eosinophils   -   1%,   stab   neutrophils   -   2%,   segmented   neutrophils   -   12%,

lymphocytes - 83%, lymphoblasts - 2%, smudge cells; ESR-57 mm/h. What is the

most probable di-agnosis?

A. Chronic lymphatic leukemia

B. Chronic myeloleukemia

C. Acute lymphatic leukemia

D. Acute myeloleukemia

E. Lymphogranulomatosis

Explanation:-Smudge cells are remnants of cells that lack any identifiable cytoplasmic membrane or nuclear structure. They are, also called basket cells, are most often associated with abnormally fragile lymphocytes in disorders such as chronic lymphocytic leukemia (CLL).

                            Part 2