Krok 2 Medicine (Hematology) with Explanation ||
21.) An 18-year-old patient since childhood suffers from bleeding disorder after minor
21.) 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?
A. Clotting time
B. Fibrinogen rate
C. Blood clot retraction
D. Thrombocyte count
E. Determination of prothrombin time
22.) A patient complains of fatigue, lack of appetite, pain and burning sensation in the
tongue, numbness of the distal limbs, diarrhea. Objectively: pale skin with lemon-
yellow tint, face puffiness, brown pigmentation in the form of a "butterfly", bright
red areas on the tongue. The liver is 3 cm below the costal margin, soft. Blood
count: RBCs - 1, 5 · 1012/l, colour index - 1,2, WBCs - 3, 8 · 109/l, thrombocytes -
180 · 109/l, eosinophils -
0%, stab neutrophils - 1%, segmented neutrophils - 58%, lymphocytes - 38%
monocytes - 3%, RBC macrocytosis. ESR - 28 mm/h. What diagnosis are these
presentation typical for?
A. B12-deficiency anemia
B. Iron deficiency anemia
C. Aplastic anemia
D. Acute erythromyelosis
E. Chronic adrenal failure
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.
- color index higher than normal I.e < 1.0
- Symptoms can include:
- Diarrhea or constipation
- Fatigue, lack of energy, or lightheadedness when standing up or with exertion
- Loss of appetite
- Pale skin
- Problems concentrating
- Shortness of breath, mostly during exercise
- Swollen, red tongue or bleeding gums
- Symptoms of nerve damage includ:
- Confusion or change in mental status (dementia) in severe cases
- Depression
- Loss of balance
- Numbness and tingling of hands and feet
23.) 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 · 1012/l, Hb- 87 g/l, thrombocytes - 45 ·
109/l, WBCs - 13 · 109/l, blasts - 87%, stab neutrophils - 1%, segmented
neutrophils - 7%, lymphocytes - 5%, ESR - 55 mm/h. What is the most likely
diagnosis?
A. Acute leukemia
B. Erythremia
C. Chronic lymphocytic leukemia
D. Chronic myeloid leukemia
E. Multiple myeloma
Explanation :- Blast cell (abnormal immature white blood cells fill the bone marrow and spill into the bloodstream).found in acute leukemia.
24.) Examination of a 43-year-old man objectively revealed pallor of skin and mucous
membranes, loss of tongue papillae, transverse striation of fingernails, cracks in the
mouth corners, tachycardia. Blood test results: Hb- 90 g/l, anisocytosis,
poikilocytosis. The most likely causative agent of this state is inadequate intake of:
A. Iron
B. Copper
C. Zinc
D. Magnesium
E. Selene
Explanation:- Deficiency of iron leads to iron deficiency anemia /microcytic anemia.
Causes include:
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 :) .Normal color index 8-1.0. . Normal iron value range 60 to 170 micrograms per deciliter (mcg/dL) or 10.74 to 30.43 micromoles per liter (micromol/L).
25.) A60 year-old female has been suffering weakness, dizziness, fatigue over the last
year. Recently she has also developed dyspnea, paresthesia. Objectively: skin and
mucous membranes are pale and slightly icteric. The tongue is smooth due to the
loss of lingual papillae. Liver and spleen are located at the costal margin.
Blood count: Hb- 70 g/l,RBCs - 1, 7·1012/l, colour index - 1,2, macrocytes.
Administer the patient a pathogenetically justified drug:
A. Vitamin B12
B. Vitamin B6
C. Ascorbic acid
D. Iron preparations
E. Vitamin B1
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
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.
- color index higher than normal I.e < 1.0
- Symptoms can include:
- Diarrhea or constipation
- Fatigue, lack of energy, or lightheadedness when standing up or with exertion
- Loss of appetite
- Pale skin
- Problems concentrating
- Shortness of breath, mostly during exercise
- Swollen, red tongue or bleeding gums
- Symptoms of nerve damage includ:
- Confusion or change in mental status (dementia) in severe cases
- Depression
- Loss of balance
- Numbness and tingling of hands and feet
26.) 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
Explanation:-Lymphogranulomatosis (Hodgkin disease) is tumoral disease is the lymphatic system, characterized by malignant hyperplasia of lymphoid tissue with the formation of lymphogranuloma in the lymph nodes and internal organs. Berezovsky-Reed-Sternberg- cells, is specific for Lymphogranulomatosis.
27.) 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, 4 ·
1012/l, Hb- 70 g/l, color 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
28.) A 58old 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- 100/min, AP- 110/70 mm Hg. There are no changes of internal
organs. Blood test results: RBC - 3,0·1012/l, Нb - 92 g/l, colour index - 0,9,
anisocytosis, poikilocytosis, WBC - 10·109/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 formaking a diagnosis?
A. Platelets
B. Reticulocytes
C. Clotting time
D. Osmotic resistance of erythrocytes
E. Fibrinogen
29.) 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, Нb- 80 g/l, WBC- 3 · 109/l, eosinophils - 4%, basophils
- 5%, blasts - 4segmented 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
B. Trephine biopsy
C. Lymph node biopsy
D. Lumbar puncture
E. Chest X-ray
30.) 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 onpalpation. 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
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, 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 themost likely diagnosis?
A. Iron-deficiency anemia
B. Acute leukemia
C. B12-deficiency anemia
D. Vegetative-vascular dystonia
E. Aplastic anemia
Explanation:- Deficiency of iron leads to iron deficiency anemia /microcytic anemia.
Causes include:
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).