Tests

• 1. A 59-year-old woman with active rheumatoid arthritis presents

with fatigue and joint pain. She received the diagnosis of rheumatoid
arthritis 5 years earlier and has been taking prednisone 10 mg daily
and methotrexate with folate weekly. She has had chronic fatigue and
anemia. Her vital signs are normal. Her conjunctivae are pale, and she
has active synovitis affecting both knees, her wrists, and elbows, with
rheumatoid nodules on the extensor surface of her right forearm. The
remainder of the physical examination findings are normal. Diagnostic
testing results
Which of the following laboratory findings are consistent with
this condition?
a. Elevated hepcidin, elevated ferritin, elevated total iron-
binding capacity (TIBC), elevated serum iron
b.Elevated hepcidin, elevated ferritin, decreased TIBC,
elevated serum iron
c.Decreased hepcidin, elevated ferritin, decreased TIBC,
elevated serum iron
d.Elevated hepcidin, elevated ferritin, decreased TIBC, normal
serum iron
e.Decreased hepcidin, elevated ferritin, elevated TIBC, normal
serum iron
• 2. A 55-year-old man presented to his primary care physician for evaluation of
fatigue. He was previously healthy with the exception of chronic
musculoskeletal low back pain, for which he occasionally takes nonsteroidal
anti-inflammatory drugs. On examination, he is pale. Complete blood cell
count results are as follows: hemoglobin 8.3 g/dL, mean corpuscular volume
73 fL, leukocyte count 6.9×109/L, and platelet count 398×109/L. Results of the
fecal occult blood test are positive. During upper and lower endoscopy, a
1.2×2.5-cm ulcerative lesion is noted in the lesser curvature of the stomach.
The lesion is biopsied and identified as a MALT lymphoma. Which of the
following is characteristic of MALT lymphoma?
• a. Most cases are treated with anthracycline-based chemotherapy.
• b. It is caused by chronic stimulation with Chlamydophila psittaci.
• c. Radiotherapy is necessary in most cases.
• d. It frequently undergoes transformation to a large-cell lymphoma.
• e. The combination of amoxicillin, omeprazole, and clarithromycin is the most
appropriate first-line treatment.
• 3. At the sick M., 42 years old, who was taking mercazolile for a long
time, concerning thyreotoxicosis, agranulotcytosis developed. What
changes are possible to expect in leukoformula:

• А. Leukocytosis with lymphotcytosis

• В. Leukocytosis with neutrophilia
• С. Leukocytosis with lymphopenia
• D. Leukopenia with neutrophilia
• E. Leukopenia with neutropenia
• 4. The patient L., 23 years old, complains on increase of temperature
of body to 38С, appearance of hypodermic hemorrhages. Doctor
diagnosed aplastic anemia. What symptom from the below will be
observed at the sick:

• A. Splenomegaly
• B. Lymphadenia
• C. Leukopenia
• D. Hepatomegaly
• E. Hyperthrombotcytosis
• 5. The sick Z., 68 years old, complains on pain in bones, subfebrile
temperature of body, weight loss. At inspection moderate
normochromic anemia is determined, blood sedimentation-55 mm/h,
proteinuria-0,99 g/l. What of research methods is less informing for
clarification of diagnosis:

• А. Definition of general protein

• В. Definition of albuminous fractions
• С. Roentgenography of bones
• D. Definition of level of iron of blood serum
• Е. Sternal puncture
• 6. At the patient S., 68 years old, during examination yellowness of
white of the eyes, hepatosplenomegaly, symmetrical paresthesia, at
additional research - atrophical gastritis with achlorhydria were
discovered. What sign contradicts the clinic of the described condition:

• A. Macrocytosis
• В. Gunther`s glossitis
• C. Thrombocytopenia
• D. Microcytosis
• Е. Hypersegmentation of nucleus of neutrophiles
• 7. The patient S., 68 years old, immediately hospitalized concerning
hard anemia (Hb- 50 g/l, macrocytosis) with complaints on dyspnea in
rest, disturbance of step. At examination: yellowness of white of the
eyes, tachycardia, hepatosplenomegaly. What help the patient needs:

• A. Preparations of iron intravenous

• B. Vitamin В12, packet red cells
• C. Prednizolon
• D. Anabolic steroids
• E. Packet red cells
• 8. The patient T., 60 years old, complains on dyspnea. During many
years he is suffering on chronic obstructive pulmonary disease.
Hepatosplenomegaly. Blood test: Е-6,8x1012/l, Нb-190 g/l, L-
12x109/l, Т-520x109/l, blood sedimentation-2 mm/h. Define the
reliable diagnosis:

• A. Chronic obstructive pulmonary disease. Symptomatic

erythrotcytosis
• В. Pikvik`s syndrome. Symptomatic erythrotcytosis
• С. Hypertonic illness. Symptomatic erythrotcytosis
• D. Erythremia. Chronic obstructive pulmonary disease
• E. Chronic myeloleukemia. Chronic obstructive pulmonary disease
• 9. The sick K., 58 years old, marks increased lymphatic knots of neck
and subarmpits. At examination: size of lymphatic knots 3х4 sm,
painless, soft, mobile, skin above them is not changed. General
analysis of blood: Е-3,2x1012/l, Hb-102 g/l, CI-1,0; L235x109/l, е-
2%, r/n-4%, s-12%, l-76%, m-6%, Gumprechts` bodies. Define the
reliable diagnosis:

• А. Chronic lympholeukemia
• В. Reactive lymphadenitis
• C. Lymphogranulomatosis
• D. Malignant lymphoma
• Е. Metastasis of cancer in lymphatic knots
• 10. The 63 years old participant of liquidation of failure on CHAES,
complains on causeless weakness, feeling of holding apart in the left
subcostum. The patient feels itself sick for a year. Objectively: skin is
pale, liver + 3 sm, spleen +10 sm. In blood: Е- 3,1x1012/l, Hb-100 g/l,
L-200x109/l, e-6%, b-3%, blast-2%, promiel-10%, miel18%,r/n-27%,
s-10%, l-12%, m-2%, blood sedimentation-40 mm/h. What diagnosis
is the most credible:

• А. Hemolytic anemia
• В. Cirrhosis of liver
• С. Acute leukemia
• D. Chronic myeloleukemia
• Е. Chronic lympholeukemia
• 11. The patient L., 30 years old, complains on general weakness,
fragility of nails, hair fall, considerable and prolonged menstruations.
Objectively: pallor of skin, heart rate– 90, AP-100/70. Blood test: Е-
3,5x1012/l, Нb-90 g/l, CI-0,7; blood sedimentation20 mm/h. Define
the previous diagnosis:

• А. Iron deficiency anemia

• B. В12 deficiency anemia
• С. Aplastic anemia
• D. Acute leukemia
• Е. Follic deficiency anemia
• 12. The sick L., 68 years old, complains on increased lymphatic knots,
perspiration. Objectively: skin and mucouses are pale, increased
inguinal and subaxillary lymphatic knots, palpated by diameter of 2-3
sm, soft, unpainful, mobile. Sizes of liver by Curlov are 18x14x13 sm.
Blood test: Е-3,5x1012/l, Нb-100 g/l, CI-0,8, L-380x109/l, е-3%,
l95%, m-2%, Т-190x109/l. Define the previous diagnosis:

• А. Chronic lympholeukemia
• В. Acute leukemia
• С. Chronic myeloleukemia
• D. Leukemoid reaction of lymphoid type
• Е. Cirrhosis of liver
• 13. The sick A., 56 years old, appealed to doctor with complaints on
perspiration, weight loss, heavy feeling in the left half of stomach.
Skin and mucouses are pale. Large spleen is palpated and liver is
moderately increased. Blood test: Е-3x1012/l, Нb90 g/l, L-240x109/l,
eoz-9%, baz-6%, myeloblast-4%, promyel-3%, myel-23%, metamyel-
16%, r/n-15%, s/n-12%, l-7%, m-5%, blood sedimentation-40 mm/h.
Define the previous diagnosis:

• A. Chronic lympholeukemia
• B. Acute leukemia
• C. Chronic myeloleukemia
• D. Leukemoid reaction of myeloid type
• E. Cirrhosis of liver
• 14. At the formula of blood: Е-1,3x1012/l, Hb-58 g/l, CI-1,3,
megaloblast-2 on 100, reticulotcyt-0,2%, macrocytosis, L-2,8x109/l,
е-3%, r/n-5%, s/n-49%, l-37%, m-6%, Т- 100,0x109/l, blood
sedimentation-30 mm/h, formulate the previous diagnosis:

• A. Iron deficiency anemia

• B. В12 deficiency anemia
• C. Aplаstic anemia
• D. Acute leukemia
• E. Agranulocytosis
• 15. The patient G., 57 years old, complains on diarrhea, increase of
temperature of body to 37,5С, obdormition and tingling in lower
extremities. The resection of stomach concerning ulcer was done 4
years ago. At examination: skin is pale, icteric, liver +3 sm, spleen +2
sm. General analysis of blood: Е-2,3x1012/l, Hb-80 g/l, CI-1,2,
L2,3x109/l, formula is not changed, Т-140x109/l, blood
sedimentation-45 mm/h, macrocytosis. About what disease it is
possible to think:

• А. Iron deficiency anemia

• В. Cancer of stomach
• C. В12 deficiencyanemia
• D. Inborn hemolytic anemia
• E. Follic deficiency anemia
• 16. The 44 years old man is hospitalized to the infectious separation
with the diagnosis of follicular angina. At examination: temperature of
body of 38,6С, skin is pale, pulse 112, AP-100/60. In blood test: Е-
2,5x1012/l, Hb-90 g/l, CI-0,8, L-38x109/l, blast-68%, r/n-2%, s/n-
14%, l-14%, m-2%, blood sedimentation-46 mm/h. What disease it
follows to suspect at the patient:

• А. Chronic lympholeukemia
• В. Chronic myeloleukemia
• С. Acute leukemia
• D. Lymphatic angina
• Е. Leukemoid reaction
• 17. At the patient, 57 years old, after viral infection subfebrile
temperature is saved for a long time, heavy feeling in the left
subcostum is marked. At examination: skin is pale, spleen +6 sm, liver
+3 sm. In blood test: E-2,9x1012/l, Hb-90 g/l, CI-1,0; L540,0x109/l,
eozin-4%, baz-3%, blast-34%, myel-2%, metamyel-3%, r/n-5%, s/n-
27%, l-18%, m- 4%, Т-260x109/l, blood sedimentation-37 mm/h.
What disease it follows to suspect at the patient:

• A. Acute myeloblastic leukemia

• B. Chronic myeloleukemia, blastic crisis
• C. Chronic lympholeukemia.
• D. Lymphogranulomatosis
• E. Leukemoid reaction of myeloid type
• 18. At the patient, who suffers on chronic lympholeukemia, general
weakness increased, yellowness of white of the eyes and skin
appeared. At examination: Hb-65 g/l, reticul- 5%, general bilirubin-
80,3 mkmol/l, indirect-65,3 mkmol/l. Urobilin is increased in analysis
of urine. The direct Coombs` test is positive. What pathogenetic
mechanism is lying in the root of anemia:

• A. Myelofibrosis
• B. Oppressing of erythroid link of hemopoiesis
• С. Autoimmune hemolysis
• D. Deficiency of follic acid
• E. Disturbance of porfirin metabolism
• 19. The pregnant, 18 years old (20 weeks), complains on weakness,
dyspnea at physical load. At women`s dispensary she was not
observed before. Objectively: skin 18 is pale with lemon tint; face is
puffy, language - bright red, liver + 3 sm. In blood test: Е- 3,0x1012/l,
Hb-88 g/l, CI-1,3; L-3,8x109/l, Т-130,0x109/l; е-3%; r/n-4%; s/n-
52%; l- 36%; m-5%; macrocytosis, blood sedimentation-28 mm/h.
What diagnosis is the most reliable:

A. Iron deficiency anemia

B. В12 deficiencyanemia
C. Follic deficiency anemia
D. Acute leukemia
E. Hepatitis
• 20. The patient S., 64 years old, at examination in policlinic increased
lymphatic knots of neck, arm-pits, groin and liver (+3 sm) were found
out. In blood test: Е3,1x1012/l, Hb-98 g/l, L-500,0x109/l, е-2%, r/n-
1%, s/n-13%, l-80%, m-4%, blood sedimentation- 40 mm/h. What
reliable diagnosis the patient has:

• A. Chronic myeloleukemia
• B. Cancer of liver
• С. Chronic lympholeukemia
• D. Tubercular lymphadenitis
• E. Lymphogranulomatsis
• 21. The patient, 20 years old, passed regular course of
polychemotherapy by the scheme of "VAMP" concerning acute
lymphoblastic leukemia. He has complaints on weakness, hair fall. In
blood test: E-3,5x1012/l, Hb-105 g/l, CI-0,9; L-4,2x109/l,
Т120,0x109/l. What picture of bone marrow can testify about
remission:

• А. Content of blastic cells to 5 %

• B. Content of blastic cells to 15 %
• C. Content of blastic cells to 10 %
• D. Content of blastic cells to 1 %
• E. Absence of blastic cells
• 22. The 35 years old woman, is delivered in clinic after loss of
consciousness on the street, complains on acute weakness, dizziness.
Objectively: pallor of skin, there are hemorrhages on the skin of
forearms and thighs, lymphatic knots are not increased, pulse-100, AP-
90/60, liver and spleen are not increased. In blood test: Е-1,5x1012/l,
Hb- 42 g/l, CI-0,8, reticul-0,1%, L-1,0x109/l, е-1%, r/n-1%, s/n-45%,
l-51%, m-2%, Т- 50,0x109/l, blood sedimentation-45 mm/h. What is
the most reliable diagnosis:

• A. Verlgoph`s disease
• B. Aplastic anemia
• C. Iron deficiency anemia
• D. Hemorrhagic vasculitis
• E. Posthemorrhagic anemia
• 23. The 28 years old woman complains on weakness, periodic increase of
temperature of body to 39,0°С, perspiration at night-time, weight loss.
Objectively: skin is pale, increased cervical, supraclavicular and inguinal
lymphatic knots, which are palpated by size to1,5-2 sm, dense, unpainful. In
blood test: E-3,0x1012/l, Hb-90 g/l, CI-0,8, L13,0x109/l, е-3%, r/n-9%, s/n-
78%, l-7%, m-3%, blood sedimentation-48 mm/h. Suspicion about
lymphogranulomatosis appeared, biopsy of lymphatic knot is appointed
to.The presence of what changes is reliable at the research:

• A. Proliferation of prolymphocytes and lymphoblasts

• B. Proliferation of lymphocytes, lymphoblasts
• С. Berezovsky – Shternberg cells
• D. Proliferation of prolymphocytes and lymphocytes
• E. Proliferation of lymphocytes and plasmocytes
• 24. The patient P., 50 years old, complains on weakness, dizziness,
heavy feeling in the upper half of stomach, paresthesias in finger-tips
of hands and feet. Objectively: yellowness of skin, language of
raspberry color, hepatomegaly. At blood: Е2,3x1012/l, Hb-90 g/l,
reticul-0,2%, CI-1,3, macrocytosis, Jolly`s bodies. Specify, what is not
characteristic for this anemia:

• A. Paresthesia
• B. Ataxia
• C. Muscular atrophy
• D. Delirium, hallucinations
• Е. Decrease of intellect
• 25. Patient A., 26 years old, complains on fever, itch of skin,
perspiration at night. Objectively: temperature of body-38,6C, right
supraclavicular lymphatic knot is palpated, it is increased, mobile.
What research is the most informative for confirmation of diagnosis:

• A. Albuminous fractions of blood

• B. General analysis of blood
• C. Survey sciagraphy of pectoral cavity
• D. Immunogram
• E. Puncture of lymphatic knot
• 26. At the 28 years old sick expressed icterus appeared after self-
treatment of flu with unsteroid anti-inflammatory preparations and
antibiotics. At examination increased liver, oliguria, dark colouring of
urine are discovered. Laboratory researches: Е2,0x1012/l, Hb-60 g/l,
CI-0,9, L-12x109/l with change of formula to the left, reticul14%. The
increase of indirect fraction of bilirubin is determined in serum of
blood. The Coombs` test is positive. About what disease it is possible
to think:

• A. Acute glomerulonephritis
• B. Aplastic anemia
• C. Toxic hepatitis
• D. Acute leukemia
• E. Autoimmune hemolytic anemia
• 27. The patient O., 31 years old, appealed to doctor with complaints on
fever, weight loss, itch of skin. At objective inspection increased
unpainful lymphatic knot in the left supraclavicular area is discovered.
Liver and spleen are not increased. In blood test: Hb- 80 g/l, L-
16,6х109/l, е-2%, r/n-8% s/n-60%, l-24%, m-6 %, blood
sedimentation55 mm/h, Т-190x109/l. What is the most expedient
research for confirmation of diagnosis:

• A. FGDS
• B. Trepanobiopsy
• C. Sternal puncture
• D. Bens-Jones protein of urine
• Е. Biopsy of lymphatic knot
• 28. The sick, 30 years old, complains on weakness, hemorrhage of
gums, increase of temperature of body, pain in throat. There was
contact with aniline dyes during 8 years. At examination: skin is pale,
with numerous petechias and ecchymoses, liver and spleen are not
palpated.In blood test: Е-2,5x1012/l, Hb-80 g/l, CI-0,9, L-2,4x109/l,
Thr- 50,0x109/l, blood sedimentation-40 mm/h. In myelogram: bone
marrow is with acutely reduced number of cells. What diagnosis can
be suspected at the patient:

• A. Acute leukemia
• B. Hypoplastic anemia
• C. В12 deficiencyanemia
• D. Verlgoph`s disease
• E. Agranulotcytosis
• 29. The sick I., 41 years old, complains on pain in throat, ribs and
breastbone. At examination: t of body - 38,0°С, skin is pale, with presence
of petechias and bruises, pulse 100, insignificant hepatosplenomegaly, there
are numerous ulcers with necrotic edges on the mucous of mouth. In blood
test: Е-2,5x1012/l, Hb-70 g/l, CI-0,9, L28,0x109/l, blast-78%, s-4%, l-13%,
m-5 %, Т-17,5x109/l. blood sedimentation-60 mm/h. What is the most
reliable diagnosis:

• A. Acute leukemia.
• B. Diphtheria
• C. Hemorrhagic vasculitis
• D. Chronic hepatitis
• E. Stomatitis
• 30. The 60 years old woman complains on general weakness, sense of
overfill in epigastrium, nausea, belch after meal. She is ill over 10
years. Objectively: skin and mucouses are pale, pulse-98, AP-115/75.
In blood test: Е-2,0x1012/l, Hb-100 g/l. 35 Antibodies to oxyntic cells
of stomach are found out. What is the most credible reason of
development of anemic syndrome at the sick:

• A. Production of antibodies to gastromucoprotein

• B. Disturbance of synthesis of hemoglobin
• C. Disturbance of synthesis of erythropoetin
• D. Disturbance of suction of iron
• E. Increase of charge of iron
• 31. The patient P., 60 years old, complains on general weakness,
feeling of weight in epigastrium and belch after meal. Objectively:
skin and of mucouses are pale, pulse110, AP-115/70. In blood test: Е-
2,0x1012/l; Hb-100 g/l; CI-1,5, blood sedimentation28 mm/h.
Antibodies to oxyntic cells of stomach are found out. What is the best
tactic of treatment of anemic syndrome at the sick:

• A. Preparations of hydrochloric acid

• B. Vitamin В12 intramuscular
• C. Preparations of iron per os
• D. Preparations of iron parenteral
• E. Transfusion of packet red cells
• 32. The 45 years old man complains on general weakness, dizziness.
During 15 years there is ulcer of duodenum. Objectively: skin is pale,
pulse-100, AP-90/70. What primary inspection must be conducted at
the patient:

• А. General blood test, maintenance of ferritin of blood

• В. General blood test, FGDS
• C. Content of iron of blood
• D. Content of ferritin of blood
• E. General analysis of blood, maintenance of iron of blood
• 33. The patient T., 19 years old, marked growing weakness, skin
hemorrhages, nosebleedings, subfebrile temperature during last 2
months. Lymphatic knots, liver, spleen, are not increased. In blood
test: Е-1,5x1012/l, Hb-50 g/l, reticul-0,1%, CI-0,9, L1,8x109/l, е-1%,
r/n-3%, s/n-58%, l-33%, m-5%, Т-30,0x109/l, blood sedimentation60
mm/h., iron of blood serum -15 mkmol/l. What is the most credible
diagnosis:

• A. Hemolytic anemia
• B. Acute leukemia
• С. Aplastic anemia
• D. В12 deficiencyanemia
• E. Iron deficiency anemia
• 34. At the patient T., 68 years old, systematic increase of lymphatic
knots, hepatosplenomegaly, icterus are found out. In blood test: Е-
2,4x1012/l, Hb-65 g/l, reticul-10%, Т-190x109/l, L-250x109/l, r/n-
1%, s/n-7%, l-87%, m-5%, blood sedimentation-55 mm/h. What
complication of basic disease can be suspected on clinic- laboratory
indexes:

• A. Toxic neutropenia
• B. Aplastic anemia
• C. Autoimmune hemolysis
• D. Agranulocytosis
• E. Hepatitis
• 35. The patient T., 62 years old, is hospitalized in comma. In blood
test: Нb-38 g/l, E- 0,7x1012/l, CI-1,2, macrocytosis, reticul-0,2 %,
leukopenia, thrombotcyopenia. In bone marrow: megaloblastic type of
blood formation. Name the preparation for effective treatment of the
sick:

• А. Preparations of iron intravenous

• B. Packet red cells intravenous drop
• C. Cyancobalamin intramuscular, packet red cells intravenous drop
• D. Preparations of iron intravenous, packet red cells intravenous drop
• E. Cyancobalamin intramuscular
• 36. The sick K., 50 years old, complains on decline of appetite, nightly
perspiration, discomfort in stomach, weight loss. Objectively: pallor of
skin, hepatosplenomegaly. In blood test there are anemia, leukocytosis
with change of leukocytar formula to the left, bazophil – eozinophil
association. What result of research confirms the previous diagnosis:

• А. Presence of the Philadelphian chromosome

• В. Botkin – Gumpercht shadows
• С. Increase level of alkaline phosphatase
• D. Decrease of cyancobalamin
• Е. Total hyperplasia of bone marrow with megacariocytosis
• 37. 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 • 1012/l, Hb - 60
g/l, CI - 0,9, WBCs -9,4 • 109/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 milli-mole/l. What complication occurred in the patient?

• A. Agranulocytosis
• B. Paroxysmal nocturnal hemoglobinuria
• C. Acquired hemolytic anemia
• D. Toxic hepatitis
• E. Cholelithiasis
• 38. A 38-year-old patient complains of inertness, subfebrile temperature,
enlargement of lymph nodes, nasal haemorrhages, bone pain. 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 -2,7 • 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 likely diagnosis?

• A. Chronic myeloleukemia
• B. Acute lymphatic leukemia
• C. Acute myeloleukemia
• D. Lymphogranulomatosis
• E. Chronic lymphatic leukemia
• 39. 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. Acute leukemia
• B. Acute posthemorrhagic anemia
• C. B12-deficiency anemia
• D. Werlhof’s disease
• E. Chronic posthemorrhagic anemia
• 40. 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 of about 1 cm in diameter,
nonmobile, non-adhering to skin. What is the most probable
diagnosis?

• A. Lymphogranulomatosis
• B. Chronic lymphadenitis
• C. Lymphosarcoma
• D. Burkitt’s lymphoma
• E. Cancer metastases
• 41. A 20-year-old patient was delivered to a surgical unit complaining
of an incised wound on his right forearm that has been bleeding for 1,5
days. Suffers from general weakness, vertigo, cold sweat, opplotentes.
Skin and visible mucous 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
• 42. A 56-year-old patient complains of pain in the epigastrium after eating,
eructation, loss of appetite, slight loss of weight, fatigability. The patient
smokes; no excessive alcohol consumption. Objectively: pale mucosa, BP-
110/70 mm Hg. The tongue is ’lacquered’.’ The abdomen is soft, sensitive
in the epigastric area. Blood test: erythrocytes - 3,0 T/l, Hb- 110 g/l, color
index - 1,1; macrocytosis; leukocytes - 5,5 g/l, ESR- 13 mm/hour. On
fibrogastroduodenoscopy: atrophy of fundic mucosa. What pathogenesis
does this disorder have?

• A. H.pylori persistence
• B. Alimentary factor
• C. Chemical factor
• D. Producing antibodies to parietal cells
• E. Gastropathic effect
• 43. During hemotransfusion the patient developed nausea, tremor,
lumbar and retrosternal pain. On examination the skin is hyperemic,
later developed pallor; the patient presents with hyperhidrosis, labored
respiration, pulse is 110/min., BP is 70/40 mm Hg. Urine is black
colored. What complication developed in the patient?

• A. Anaphylactic shock
• B. Acute renal failure
• C. Pulmonary embolism
• D. Posttransfusion shock
• E. Hypotonic crisis
• 44. A 63-year-old man complains of unmotivated weakness and pressing
and bursting sensation in the left subcostal area. According to him, these
signs have been present for a year already. Previously he was healthy. He
took part in containment measures during the accident at the Chornobyl
Nuclear Power Plant. Objectively: the skin is pale, peripheral lymph nodes
are not enlarged, the liver is +3 cm, the spleen is +10 cm. Complete blood
count: erythrocytes - 3.1 1012/L, Hb- 100 g/L, leukocytes - 109/L, blasts -
2%, promyelocytes - 10%, myelocytes - 18%, band neutrophils - 27%,
segmented neutrophils - 10%, lymphocytes - 12%, eosinophils - 6%,
basocytes - 3%, monocytes - 2%, erythrocyte sedimentation rate - 20
mm/hour. What is the most likely diagnosis?

• A. Hemolytic anemia
• B. Hepatic cirrhosis
• D. Acute leukemia
• C. Chronic myeloleukemia
• E. Chronic lymphatic leukemia
• 45. A 65-year-old man was diagnosed with B12-deficient anemia and
the treatment was prescribed. A week later control blood test was
performed. What would be the early indicator of the therapy
effectiveness?

• A. Increased number of reticulocytes

• B. Increased hemoglobin level
• C. Megaloblastic hematopoiesis
• D. Normoblastic hematopoiesis
• E. Increased erythrocyte number
46. A 56-year-old man comes to his primary care physician following 3 months of fatigue and a full feeling in his abdomen. On physical exam the
spleen is palpable below the costal margin. His blood is drawn and sent to the laboratory for analysis, the results of which are below.

• Hemoglobin 11.2 g/dL

• Hematocrit 34%
• Mean corpuscular volume (MCV) 82 fL
• White blood cell count 75,400/mm3
• Segmented neutrophils 55%
• Bands 6% bands
• Metamyelocytes 2%
• Myelocytes 2%
• Lymphocytes 27%
• Monocytes 4%
• Eosinophils 2%
• Basophils 2%
• Platelet count 450,000/mm3
• Bone marrow biopsy shows hypercellularity with 7% blasts. Which of the following chromosomal abnormalities is most likely present?

• A. t(15;17)
• B. monosomy 5
• C. t(11;14)
• D. t(9;22)
• E. del 13q
• 47. A 71-year-old man comes to the clinic because of fatigue and
malaise for the past three months. He reports that he has lost 4.5 kg
(10 lbs) over the past 3 months without changing his diet or exercise
routine. His past medical/surgical history and family history are non-
contributory. Physical examination shows prominent bilateral cervical
and inguinal lymphadenopathy, and splenomegaly. Which of the
following is the most likely diagnosis?
• A. Acute lymphocytic leukemia
• B. Acute myelogenous leukemia
• C. Chronic lymphocytic leukemia
• D. Chronic myelogenous leukemia
• E. Hairy cell leukemia
• 48. A 45-year-old man comes to the emergency department following fever
and chills for the past 24 hours. The patient is currently taking several
chemotherapy drugs for chronic myelogenous leukemia. His temperature is
38.9°C (102°F), pulse is 124/min, and blood pressure is 120/70 mm Hg.
Physical exam shows an ill-appearing male with a central venous catheter in
the right chest surrounded by a small area of erythema. Laboratory analysis
reveals an absolute neutrophil count of 280/mm3. Blood culture results are
currently pending. Which of the following is the next best step in
management in this patient?

• A. Administer fluconazole
• B. Administer vancomycin and ceftazidime
• C. Administer chemotherapy
• D. Administer levofloxacin
• E. Administer intravenous fluids
• 49. A 6-year-old boy is brought to clinic for a regular check-up. According to the
patient's mother the boy has seemed fatigued and irritable recently. Physical exam
shows palpable lymph nodes in his neck as well as several recent bruises on his
extremities and petechiae on his trunk. Blood is drawn and sent for analysis, the
initial results are below:
• White blood cell count: 60,000/mm3
Hemoglobin: 8.2 g/dL
Hematocrit: 25%
Platelet count: 47,000/mm3
• A bone marrow biopsy is done and the results are sent for cytogenetic analysis.
The presence of which of the following features would most strongly indicate an
acute leukemia?

• A. <20% erythroblastic cells

• B. >20% lymphocytes
• C. >50% hematopoetic cellularity
• D. >20% blast cells
• E. <20% adipose cells
• 50. A 67-year-old woman comes to her primary care physician because of
progressive fatigue and bone pain. She also has easy bruising and bleeding.
Physical examination shows mucosal and conjunctival pallor as well as
delayed capillary filling. She has swollen lymph nodes along her neck. The
sternum is very tender to light touch. A peripheral blood smear Auer rods in
several of the myeloid blast cells. A complete blood count shows increased
leukocytes, decreased platelets, and decreased erythrocytes. The patient is
subsequently started on chemotherapy. Which of the following is most
likely a major part of their initial treatment regimen?
• A. Cytarabine
• B. Dactinomycin
• C. Imatinib
• D. Trastuzumab
• E. Vincristine
• 51. A 67-year-old woman comes to her primary care physician because of
progressive fatigue and bone pain. She also has easy bruising and bleeding.
Physical examination shows mucosal and conjunctival pallor as well as
delayed capillary filling. She has swollen lymph nodes along her neck. The
sternum is very tender to light touch. A peripheral blood smear of her blood
sample shows clumps of granular material forming elongated needles seen
in the cytoplasm of many leukemic blastocytes. A complete blood count
shows increased number of leukocytes, decreased platelets, and decreased
erythrocytes. A bone marrow biopsy will most likely confirm which of the
following diagnoses?
• A. Fanconi anemia
• B. Acute myeloid leukemia
• C. Hodgkin lymphoma
• D. Iron deficiency anemia
• E. Pharyngitis
• 52. A 2-year-old male infant comes to the office because of lethargy and a petechial rash for the past week.
His parents deny the presence of fever or a decrease in feeding. Physical examination shows generalized
lymphadenopathy and a petechial rash. Palpation of the abdomen shows an enlarged liver and spleen. A
complete blood count with differential is collected and shows the following:
Hemoglobin: 8.8 g/dL
Leukocytes: 130,000/mm3
Neutrophils: 29%
Bands: 0%
Eosinophils: 0%
Basophils: 0%
Lymphocytes: 70%
Monocytes: 1%
Platelets: 79,000/mm3
A bone marrow biopsy is obtained and shown below. Cells in the sample stain positively for terminal
deoxynucleotidyl transferase (TdT). Flow cytometry shows expression of CD10, CD19, and CD20. Which of
the following is the most appropriate diagnosis?
• A. Acute myeloid leukemia (AML)
• B. Burkitt lymphoma
• C. Cytomegalovirus (CMV) infection
• D. Precursor B-cell acute lymphoblastic leukemia (B-ALL)
• E. Precursor T-cell acute lymphoblastic leukemia (T-ALL)
• 53. A 4-year-old Hispanic girl has had intermittent fevers over the past
month, and her mother has noticed enlarged lymph nodes in her neck.
She is brought to clinic for refusing to bear weight on her legs,
complaining that her upper legs hurt. Her mother wonders if they may
hurt from when she tripped recently, and she shows you several large
bruises on the girl’s arms and legs. CBC reveals anemia and
thrombocytopenia. Peripheral smear shows the following:
•
What diagnostic step will she need?

• A. Head CT
• B. Flow cytometry on peripheral blood
• C. Bone marrow aspirate
• D. Lymph node biopsy
• E. Bone scan
• 54. A 4-year-old Caucasian boy is brought to clinic because his mother has noticed
some bumps in his neck and he is bruising more easily when he plays outside. He
has seemed fatigued and irritable recently. Physical exam reveals several bruises
on his extremities and petechiae on his trunk. A complete blood count (CBC) is
done, the results of which are below:
• White blood cell count: 58,000/mm3
Hemoglobin: 8.0 g/dL
Hematocrit: 24%
Platelets: 44,000/mm3
• After bone marrow biopsy and cytogenetics, he is diagnosed with acute
lymphoblastic leukemia with “high hyperdiploidy”. Which of his clinical
prognostic indicators is associated with higher risk disease?
• A. High hyperdiploidy
• B. Anemia
• C. Initial WBC >50,000/mL
• D. Age <10
• E. Age >1
• 55. A 14-year-old boy is brought to the clinic for evaluation of his persistent fevers and bruising. His mother
reports his fevers have come and gone for the past month. The boy also notes his thighs and upper arms are
painful, and the pain feels “really deep” within the limbs. On exam, you observe a thin boy with mild limb
tenderness and several non-tender cervical lymph nodes measuring 21 mm each. There is extensive bruising
bilaterally on the lower extremities. When spoken with privately, the boy reports that he feels safe and
supported at home. Laboratory studies show the following:
•
Leukocyte count: 40,000/mm3
Hemoglobin: 10.5 g/dL
Hematocrit: 36%
Platelet count: 90,000/mm3
•

• Peripheral smear shows several immature leukocytes. Which of the following tests is needed to confirm the
diagnosis?

•
A. Bone marrow biopsy
• B. Chest X-ray
• C. Coagulation times
• D. Erythrocyte sedimentation rate
• E. Lumbar puncture
• 56. A 4-year-old boy is brought to the emergency department by his parent
because of a sore throat for the past 2 days. The patient’s parent reports that
the patient feels tired all the time and has not been interested in playing his
favorite video games over the last several weeks. Temperature is 38.3°C
(101°F), pulse is 110/min, respirations are 24/min, and blood pressure is
105/65 mmHg. Physical examination shows pharyngeal erythema without
exudates, mucosal pallor and petechiae on lower extremities. Abdominal
examination reveals hepatosplenomegaly. Peripheral blood smear is shown
below:
The cells stain positive for terminal deoxynucleotidyl transferase (TdT) and
CD10. The cells identified in this patient’s peripheral blood smear are
precursors to which of the following cell types?
• A. T lymphocytes
• B. Erythrocytes
• C. Platelets
• D. Monocytes
• E. B lymphocytes
• 57. A 45-year-old man presents to the office because of a dragging sensation in
the abdomen for the past 2 months. He also reports easy fatigability in this
same time period. Past medical history is significant for an upper respiratory
tract infection treated with antibiotics 6 months ago. The patient has smoked a
pack of cigarettes daily for the past 27 years. Temperature is 37.0°C (98.6°F),
pulse is 95/min, respirations are 20/min, and blood pressure is 135/85 mmHg.
Physical examination shows splenomegaly. Laboratory results are as follows:
Laboratory value Result
Which of the following is the most Complete blood
likely diagnosis in this patient? count
Hemoglobin 10 g/dL
• A. Chronic myeloid leukemia Platelets 600,000/mm3
Leukocytes 60,100/mm3
• B. Acute myeloid leukemia Neutrophils 35%
• C. Acute lymphoblastic leukemia Myelocytes
Metamyelocytes
32%
10%
• D. Hairy cell leukemia Band forms 1%
Blast cells 1%
• E. Chronic lymphocytic leukemia Basophils 6%
Eosinophils 6%
Lymphocytes 9%
• 58. A 59-year-old woman comes to the physician complaining of a “gritty” sensation in the eyes for the last
several months. Her eyes have also been itchy and red. In addition, she has trouble swallowing, and food
tends to “clump together” in her mouth. Past medical history is significant for allergic conjunctivitis and
rhinitis, but these current symptoms are not relieved by oral antihistamines. Temperature is 37.7°C (99.9°F),
pulse is 78/min, and blood pressure is 115/72 mmHg. Physical examination reveals conjunctival injection.
Further ophthalmologic examination reveals a visual acuity of 20/50 in both eyes. Oropharyngeal examination
reveals mucosal atrophy, fissuring of the tongue, and multiple dental caries. No parotid gland swelling is
noted. Laboratory testing reveals the following:
Laboratory value Result
• Which of the following is the most appropriate pharmacotherapy for this patient’s symptoms?
Hemoglobin 12.3 g/dL
Hematocrit 37%

• A. Rituximab Leukocyte count

Platelet count
9,100/mm3
375,000/mm3

• B. Cetirizine Leukocyte count 3,000/mm3

Erythrocyte
• C. Cevimeline sedimentation rate
52 mm/h

• D. Glucocorticoids Antinuclear antibodies Positive

• E. Methotrexate Rheumatoid factor

Anti-dsDNA
Negative
Negative
Anti-Ro/La Positive
• 59. A 35-year-old woman comes to the clinic for a health maintenance
exam. She states she is currently feeling well. Current medications
include a lipid-lowering agent and a corticosteroid. Her temperature is
37.1°C (98.8°F), pulse is 76/min, respirations are 18/min, and blood
pressure is 132/84 mm Hg. Physical examination is unremarkable
except for a malar rash, which she reports is exacerbated by sun
exposure. For which of the following sequelae is this patient at
increased risk?
• A. Osteoarthritis
• B. Osteonecrosis of the femoral head
• C. Paget's disease of the bone
• D. Slipped capital femoral epiphysis
• E. Spondylolisthesis
• 60. A 16-year-old girl comes to the clinic with a 9-month history of
persistent fevers, malaise, and headache. Recently, she has noticed that her
urine is occasionally dark or brown in color. She also notes new onset
shortness of breath when exercising. She denies any illicit or prescription
drug use. Her temperature is 38.3°C (101.0°F), pulse is 70/min, respirations
are 16/min, and blood pressure is 110/76 mm Hg. Physical examination
shows a faint erythematous rash over the upper cheeks and the bridge of the
nose. Microscopy of a urine sample collected today is notable for the
presence of several RBC casts. Which of the following is the most
appropriate next diagnostic test?

• A. Anti-dsDNA and anti-Smith serum antinuclear antibodies

• B. Anti-histone serum antinuclear antibodies and p-ANCA
• C. Lung biopsy
• D. Magnetic resonance imaging of the head
• E. Prothrombin and activated partial thromboplastin times
 • 61. A 60-year-old man with a history of human immunodeficiency virus infection
comes to the clinic because of a newly-formed, non-painful, white lesions on the
inside of his cheek and on the sides of his tongue. He also has a cough and sore
throat. The patient has been non-compliant with his medications but is very
worried about the white lesion and thinks it might be cancer. A scraping of the
lesion is attempted, but it does not come off. A biopsy is performed. Which of the
following is consistent with the most likely histological description?

• A. Subtle vasoformative processes composed of newly formed slit-

like or somewhat jagged vascular spaces
• B. Superficial epithelial hyperkeratosis and parakeratosis
• C. Nests or lobules of hyperchromatic but uniform basaloid cells
with peripheral palisading, surrounded by loose stroma.
• D. Atypical Keratinocytes with, nuclear hyperchromatism, and
cellular pleomorphism with some traces of keratin pearls.
• E. A pseudomembranous, creamy-white, friable, patch composed
of organisms and inflammatory debris
• 62. A 40-year-old man comes to your clinic because of worsening
weakness and recurrent infections for the past 2 months. He has had a
productive cough with white sputum for the past several weeks.
Microbiological analysis indicates infection with Pneumocystis
jirovecii. Serology and Western blot analysis confirm infection with
the human immunodeficiency virus (HIV). Which of the following
laboratory values is most likely to be observed in this patient?
• A. Increased Auer rods
• B. Increased eosinophils
• C. Decreased Reed-Stenberg cells
• D. Reduced lymphocytes
• E. Reduced neutrophils
• 63. A 40-year-old man comes to the emergency department because of
fever and diarrhea for the past 2 days. He has also had severe fatigue
for the past 10 days. Past medical history is significant for human
immunodeficiency virus diagnosed 3 years ago. Physical examination
shows cervical lymphadenopathy and a palpable liver 3cm below the
right costal margin. The CD4 count is <50/mm3. Which of the
following is the most likely diagnosis?
• A. Cytomegalovirus
• B. Kaposi sarcoma
• C. Lymphoma
• D. Mycobacterium avium complex
• E. Pneumocystis jiroveci
 Homework
Lymphadenopathy
 1.
• A 30-year-old man has noticed a painless swelling on the left side of
his neck, which has been present for over 4 weeks. It is slowly
enlarging. There is no relevant past medical history and no history of
fever. Physical examination reveals a single small (21 cm × 0.5 cm)
mobile lymph node in the left anterior triangle of the neck. There are
no other palpable nodes, and the liver and spleen are not palpable.
Investigation shows
• Haemoglobin (Hb) - 119 g/L
• White blood cells (WBC) - 8.6 × 109/L (neutrophils 5.3 × 109/L,
eosinophils 1.1 × 109/L, lymphocytes 2.1 × 109/L)
• Platelets 165 × 109/L
• 1. Comment on the blood film. What are the important causes of this
finding?
• 2. Comment results of the lymph node biopsy.
 • 3. What is the diagnosis?
• 4. What further investigations are required?
• 5. What treatment can you recommend?
 2.
• A 32-year-old female presented with a short history of increasing tiredness and
bruising. Her blood count shows as follows:

• Haemoglobin (Hb) 79 g/L

• White blood cells (WBC) 34.8 × 109/L
• Platelets 21 × 109/L

• A bone marrow aspirate was taken.

• Six weeks later, she developed a febrile illness with facial swelling and orbital
oedema. She also became short of breath and hypotensive, and had a single
episode of haemoptysis.
• A chest x-ray and thoracic computed tomography (CT) scan were performed.
 • 1. What is the diagnosis?
• 2. What is the likeliest cause of her febrile illness?
• 3. How should she be treated?
3.
• A 37-year-old woman has a 6-week history of fever and night sweats. She has lost 2 kg in weight. She has had
a recent cough with productive sputum, but her fever has failed to subside after a course of antibiotics. She
smokes 6 cigarettes a day and drinks 13 units of alcohol a week. On examination, she is pale and looks
unwell. There is no palpable lymphadenopathy or splenomegaly. Investigations show
• Haemoglobin (Hb) 87 g/L
• Mean corpuscular volume (MCV) 81 fL
• Platelets 310 × 109/L
• Erythrocyte sedimentation rate (ESR) 91 mm/h
• Urea and electrolytes Normal
• Immunoglobulins Normal
• White blood cells (WBC) 9.1 × 109/L (differential normal)
• Bilirubin 61 mmol/L (NR 5–17 mmol/L)
• Aspartate aminotransferase (AST) 137 U/L (NR 5–40 U/L)
• Alkaline phosphatase 250 U/L (NR 35–130 U/L)
• Gamma-glutamyl transferase (GGT) 215 U/L (NR 10–48 U/L)
• Albumin 34 g/L (NR 35–50 g/L)
• 1. Comment changes on the chest x-ray and the thoracic computed
tomography (CT) scan.
• A liver biopsy, and lymph node biopsy is performed. A bone marrow
aspirate and trephine are also performed.
2. Comment on the liver biopsy
 • 4. What is the diagnosis?
• 5. What further investigations should be performed?
• 6. How should he be treated?
4.
• A 30-year-old patient, with a past history of intravenous drug abuse,
presents with a 7-day history of progressive shortness of breath. On
examination, he is pyrexial and has clear dyspnoea and tachycardia.
His blood pressure is reduced at 90/60 mmHg. Oxygen saturation
when breathing 40% oxygen is reduced at 86%, and he is sweating.
His full blood count shows
• Haemoglobin (Hb) 85 g/L
• White blood cells (WBC) 17.5 ×109/L (neutrophils 79%)
• Platelets 105 × 109/L
• 1. What is the likeliest diagnosis from the history and chest x-ray?
 • 2. What further tests should be performed?
• 3. How should he be treated?
• 4. What other haematological complications may occur in this
condition?