Chronic leukaemias.

Lymphomas.

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All the following are known to cause splenomegaly EXCEPT

@Sickle cell disease

Hodgkin’s disease

Chronic lymphocytic leukemia (CLL)

Hairy cell leukemia

Polycythemia vera

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Patient, 55 years old, is admitted to a hospital with spontaneous fracture of neck of the femur. During the last year motiveless pains in the muscles and bones were observed. Investigation result shown that concentration of protein in the blood serum of the patient is 115 g/l. What more probably reason for such quantity of blood serum

@Paraproteinemia

Diet rich of protein

Podagra (gout)

Myodistrophy

Kidney insufficiency

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A 62 year woman complains of frequent pain attacks in the area of her chest and backbone, rib fractures. Her doctor suspected myeloma (plasmocytoma). What of the following laboratory characteristics will be of the greatest diagnostic importance?

Hyperalbuminemia

Hypoproteinemia

Hypoglobulinemia

@Paraproteinemia

Proteinuria

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The presence in serum of a mu heavy-chain protein is associated with which of the following disease?

@Chronic lymphocytic leukemia

Lymphoblastic lymphoma

Poorly-differentiated lymphocytic lymphoma

Plasma cell myeloma

Multiple myeloma

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A 64-year-old man is being evaluated for pancytopenia. Clinical examination reveals a marked increase in the size of his spleen. A bone marrow biopsy histologically reveals replacement of the normal marrow cells by a diffuse proliferation of the small mononuclear cells. There is a clear space around each of these abnormal cells (“fried egg” apperance). These cells stained positively for cytoplasmic acid phosphatase and this staining was not inhibited by treatment with tartrate. A bone marrow did not reveal any marrow particles. Although his peripheral leukocyte count was decreased, the majority of the cells were lymphocytes. Which of the following is the expected histologic appearance of these lymphocytes?

“Cerebriform” lymphocytes

“Chicken-footprint” lymphocytes

“Cloverleaf” lymphocytes

@”Hiry” lymphocytes

“Smudge” lymphocytes

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A 54-year-old woman presents with headaches, viral abnormalities, bleeding, and Raynaud’s phenomenon. Work-up reveals normal serum calcium, and no lytic lesions are found within the skeleton by x-ray. Serum electrophoresis reveals a single large M spike in the peripheral blood due to a monoclonal proliferation of IgM. Sections from the patient’s bone marrow reveal numerous plasma cells, lymphocytes, and plasmacytoid lymphocytes. Which of the following is the most likely diagnosis?

IgM multiple myeloma

Monoclonal gammopathy of undetermined significance

Mu heavy-chain disease

Plasmacytoid small-cell lymphoma

@Waldenstrom’s macroglobulinemia

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Clinical investigation of a patient revealed the enlarged lymph nodes, spleen and liver. A microscopical study of the enlarged cervical (neck) lymph node showed the blurring of its structures and absence of lymphatic follicles. All microscopical views were presented by cells with round nuclei and narrow ring of a basophilic cytoplasm. What is the most likely diagnosis?

@ Lymphatic leucosis

Lymphogranulomatosis

Lymphosarcoma

Myeloleukemia

Multiple myeloma

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A 72-year-old man presents with increasing fatigue. Physical examination reveals an elderly man in no apparent distress (NAD). He is found to have multiple enlarged, nontender lymph nodes along with an enlarged liver and spleen. Laboratory examination of his peripheral blood reveals a normocytic normochromic anemia, a slightly decreased platelet count, and a leukocyte count of 72,000 cells/µL. An example of his peripheral blood is seen in the picture below. Which of the following is the most likely diagnosis?

Acute lymphoblastice leukemia

Atypical lymphocytosis

@Chronic lymphocytic leukemia

Immunoblastic lymphoma

Prolymphocytic leukemia

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An autopsy of a 35-year-old woman revealed the enlarged spleen, (weight 800gm), liver (weight 4000 gm) and lymph nodes. A bone marrow of a femur diaphysis was juicy (succulent), crimson-red color. Microscopical study of a liver defined dense infiltrates within portal tracts, consisted of immature blood cells. These cells had a round nuclei and narrow ring of a cytoplasm. What is the most likely diagnosis?

@Chronic lymphatic leukemia

Chronic myeloid leucosis

Generalizated form of lymphogranulomatosis

Acute myeloblasts leucosis

Acute lymphoblastic leucosis

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A liver biopsy was taken from a 66-year-old man, with a history of increased quantity of lymphocytes and pro-lymphocytes in his blood. A histological investigation of a liver sample revealed plural accumulations of the mentioned above cells, mainly between hepatic segments. For what disease above listed changes are characteristic?

@Chronic lymphatic leukemia

Acute lymphatic leukemia

Lymphogranulomatosis

Chronic persistence hepatitis

Hepatocellular carcinoma of liver

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A radiological investigation of a man's head revealed in his maxillary and mandibular bones numerous round defects with smooth walls. A histological study showed osteolysis and osteoporosis accompanied with insufficient bone repair. The laboratory test of the urine detected the Bence Jones protein. What is the most likely diagnosis?

@Multiple myeloma

Chronic myeloleukemia

Chronic erythromyelosis

Acute myeloleukemia

Acute nondifferentiated leucosis

Bone fibrous dysplasia

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Patient, 60 years old, is admitted to a hospital with spontaneous fracture of neck of the femur. During the last year motiveless pains in the muscles and bones were observed. Result of biochemical investigation shown that concentration of protein in the blood serum of the patient is 115 g/l, protein of Bence Jones is present. What diagnosis is it possible to think about?

@Multiple myeloma

Hartnup’s disease

Podagra (gout)

Myodistrophy

Dermatomyositis

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A bone marrow aspirate was obtained from a 70-year-old man whose symptoms included weakness, weight loss, and recurrent infection. Laboratory finding included proteinuria, anemia, and an abnormal component in serum proteins. A photomicrograph of the bone marrow aspirate is shown below. The most probable diagnosis is

Monomyelocytic leukemia

Hitiocytic leukemia

@Multiple myeloma

Gaucher’s disease

Leukemic reticuloendoteliosis

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A 70-year-old man presents with increasing weakness and weight loss. Laboratory finding include anemia, hypercalcemia, and increased serum protein. A photomicrograph of the bone marrow aspirate is shown below. Which of the following histologic finding is present in this photomicrograph?

Accumulation of glycogen in hystiocytes, as seen with Gaucher’s disease

Decreased numbers of myeloid precursors, as seen with aplastic anemia

Increased numbers of myeloblasts, as seen acute myelocitic leukemia

@Increased numbers of plasma cells, as seen multiple myeloma

Numerous inclusions in eritroid precursors, as seen with parvovirus infection

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A 34-year-old male is found to have weakness confusion, other neurologic manifestation and polyuria X-ray examination revealed multifocal destructive bone lesions throughout the skeletal system. Electrophoretic analysis revealed increased level of Ig in the blood and Bence Jones protein in the urine. What is the most likely diagnosis?

@Myeloma

Acute monocytic leukemia

Chronic myeloleukemia

Lymphogranulomatosis

Histiocytosis

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A 65-year-old female is noted to be anemic. He serum protein electrophoresis demonstration a large monoclonal Ig G kappa protein. In her bone marrow are increased numbers of atypical plasma cells. Her skull X-ray show multiple lytic areas. What is the most likely diagnosis?

@Myeloma

Polycytemia vera (erythremia, Osier's disease)

Lymphocytic lymphoma

Chondrosarcoma

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An elderly male is admitted to the hospital for treatment of humeral bone fracture. His fracture's area X-ray showed a new growth and lytic zone within lesion. Histological examination of a biopsy revealed abnormal plasma cells. What is the most likely diagnosis?

@Myeloma

Chronic osteomyelitis

Chondrosarcoma.

Bone fibrous dysplasia

Metastasis of adenocarcinoma

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Chronic myeloid leukemia is LEAST likely to be associated with

Splenomegaly

Basophilia

@Translocation (8; 14)

Thrombocytosis

Low leukocyte alkaline phosphatase (LAP)

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At the roenngenological examination were detected multiple defects that looked like round apertures with plain walls. Histologicaly were revealed the facts of osteolysis and osteoporosis against the background of bad osteogenesis. Bence Jones protein is presented in the urine. Name the disease.

Acute undifferentiated leucaemia

Chronic myeloleucaemia

Chronic erythromyelosis

Acute myeloleucaemia

@Myeloid disease

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Multiple focuses of osteoporosis and osteolysis were visualized in plane bones of the patient during the roenngenological examination. At the biopsy material from bones was revealed an increased amount of tumour plasmatic cells. What is your diagnosis?

Histiocytosis

Acute monocytic leucaemia

Chronic myeloleucaemia

Lymphogranulomatosis

@Myeloid disease

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A 42-year-old female is admitted to the hospital for treatment a blood disorder. A disease complicated with pneumonia led to lethal outcome. An autopsy revealed hyperplasia of a bone marrow with "pus" - like appearance, splenomegaly (5 kg weight), hepatomegaly (6 kg weight), systemic lymph nodes enlargement. What is the most likely diagnosis?

@Chronic myeloleukemia

Chronic lymphatic leukemia

Myeloma

Polycytemia vera (erythremia, Osier's disease)

Lymphogranulomatosis

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Hyperplasia of medulla in plane and tubular bones (pyoid medulla), splenomegaly (6kg), hepatomegaly (5kg), an enlargement of all groups of lymphatic nodules were revealed at the autopsy. What is the most possible disease?

Myeloid disease

Chronic lympholeucaemia

@Chronic myeloleucaemia

Real polycythaemia

Lymphogranulomatosis

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A patient presented with an infiltrative, plaque-like polymorphic skin rash, which had various contours, sizes and a congested -cyanotic color. The lesions tended to peripheral growth and fusion. A microscopical investigation of a skin biopsy revealed massive lymphocytes' proliferation, which occupied the entire derma and a hypodermic fatty layer. What is the most likely diagnosis?

@Limphoma of skin

Systemic lupus erythematosus

Mycosis fungoi'des

Intradermal nevus

-

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A 20-year-old man presents in the emergency room with respiratory distress resulting from a lymphoma involving his mediastinum. These malignant lymphocytes most likely have cell surface markers characteristic of what type of cell?

B lymphocytes

@T lymphocytes

Macrophages

Dendritic reticulum cells

Langenhars cells

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The non-Hodgkin’s lymphoma pictured in the photomicrograph below may be characterized by which of the following?

Increased frequency in adolescents

Lymphoblastic lymphoma

@B lymphocytes

Tingible-body macrophages nodules

Well-differentiated lymphocytic lymphoma

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A 60-year-old man presents with several enlarged lymph nodes involving his right axilla. A biopsy from one in these enlarged lymph nodes reveals effacement of the normal lymph node architecture by a diffuse proliferation of small, normal-appearing lymphocytes. These same cells are present in the peripheral blood, enough to cause a peripheral lynphocytosis. A bone marrow biopsy reveals a diffuse proliferation of these small lymphocytes. Special stains reveal these cells to be positive for CD5 and CD23. Which of the following is the classification for this type of lymphoma?

A high grade non-Hodgkin’s lymphoma (using the Working Formulation)

@A low grade non-Hodgkin’s lymphoma (using the Working Formulation)

A precursor B cell neoplasm (using the REAL classification)

A peripheral T cell neoplasm (using the REAL classification)

A poorly differentiated lymphoma (using the Working Formulation)

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A 65-year-old presents with several enlarged lymph nodes in his left supraclavicular region. Physical examination reveals painless lymphadenopathy in this region. No other abnormalities are found. A biopsy from one of these enlarged lymph nodes, which is shown in the associated picture, reveals effacement of the normal lymph node architecture by numerous nodules of uniform size that are crowded within the cortex and medulla of the lymph node. Tangible-body macrophages are not seen in these nodules. Which of the following in the most likely diagnosis?

@Follicular non-Hodgkin’s lymphoma

Lymphocyte predominate Hodgkin’s disease

Metastatic adenocarcinoma

Reactive follicular hyperplasia

Small lymphocytic lymphoma

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An 8-year-old African girl develops rapidly enlarging mass that involves a large portion of the right side of her maxilla. A smear made from an incisional biopsy of this mass reveals malignant cells of cytoplasmic vacuolis that stain positively with oil red O. Histologic section from this biopsy reveal a diffuse, monotonous proliferation of small, noncleavedlymphocytes. In the background are numerous tangible-body macrophages that impart a “starry-sky” appearance to the slide. Which of the following viruses is most closely associated with this malignancy?

Cytomegalovirus (CMV)

@Epstein-Barr virus (EBV)

Herpes simplex virus (HSV)

Human immunodifeciency virus (HIV)

Human pappilomavirus (HPV)

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A 25-year-old patient presented with peripheral adenopathy, involving a single cervical lymph node. A biopsy sample investigation revealed an unclear node pattern with mixed cellular infiltration. Histologycal study under higher magnification showed numerous variants of Berezovsky-Reed- Stenberg cells, lymphocytes, necrotic area and mild diffuse fibrosis. What is the most likely diagnosis?.

@ Lymphogranulomatosis

Nodular lymphoma

Burkitt's lymphoma

Lymphocytic lymphoma

Chronic lymphatic leukemia

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The young man presented to his physician with enlarged neck lymph nodes. A microscopical investigation of a lymph node biopsy sample revealed the lymphoid tissue proliferation with presence of a giant Reed—Berezovsky - Sternberg cells, eosinocytes, zones of necrosis and sclerosis. What is the most likely diagnosis?

@Lymphogranulomatosis

Chronic lymphatic leukemia

Multiple myeloma

Lymphosarcoma

Histiocytosis

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A microscopic investigation of the enlarged neck lymph node biopsy revealed the blurring of its structures, plenty of proliferating lymphocytes with adding of solitary giant Reed—Berezovsky-Sternberg cells. What is the most likely diagnosis?

@Lymphogranulomatosis, with predominance of lymphatic tissue

Lymphogranulomatosis, with exhaustion of lymphatic tissue

Mixed cell variant of lymphogranulomatosis

Lymphosarcoma

Nodular sclerotic variant of lymphogranulomatosis

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A biopsy of the enlarged lymph node was taken. A histological investigation revealed a diffuse growth of lymphoid cells with adding of eosinocytes, atypical histiocytes, solitary giant Reed—Berezovsky-Sternberg cells with two and more nuclei, cell's necrosis and sclerosis. What is the most likely diagnosis?

@Lymphogranulomatosis

Lymphatic leukemia

Burkett's lymphoma

Sarcoidosis

Myeloleukemia

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At young men the increased cervical lymph node is removed. Microscopic investigation revealed the altered node's structure, an absence of lymphoid follicles, sites of a sclerosis and necrosis. Thecellular infiltrate is polymorphic with a presence of lymphocytes, eosinocytes, and atypical one- nuclear cells and multinuclear giant cells (Reed—Berezovsky - Sternberg cells). What is the most likely diagnosis?

@Lymphogranulomatosis

Acute lymphatic leukemia

Chronic lymphatic leukemia

Burkett's lymphoma

Mycosis fungoides

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A tomography revealed enlarged lymphatic nodes. A histological investigation of lymph node's biopsy showed a circular growths of a connective tissue, which surrounded a granuloma – like formation, made from lymphocytes, plasmocytes and giant double- nuclear cells. What is the most likely diagnosis?

@Lymphogranulomatosis

Lymphosarcoma

Tuberculosis

Sarcoidosis

Lymphatic leukemia

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A physical examination of a 42-year-old man revealed enlarged lymph nodes. A histological investigation of a lymph node showed lymphocytes, histiocytes, reticular cells, small and big Hodgkin's cells, multinuclear Berezovsky -Reed-Sternberg cells (Sternberg-Reed cells) infiltration with solitary necrotic areas. What disease such changes characteristic for?

@Lymphogranulomatosis

Lymphosarcoma

Chronic leucosis

Acute leucosis

Metastasis of carcinoma of lungs

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A patient has a cluster of matted together dense lymph nodes on his neck. Histological examination of a removed lymph node revealed proliferation of reticular cells, presense of Reed-Sternberg cells. What disease is meant?

@Lymphogranulomatosis

Myeloblastic leukosis

Lymphocytic leukosis

Lymphoblastic leukosis

Myelocytic leukosis

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At autopsy an elderly female is found to have enlarged groups of a neck, axillary and mediastinal lymph nodes matted together. They were firm and rubbery. The cut surface was gray-white, producing a "fish-flesh" appearance. Microscopy revealed heterogeneous cellular infiltrate wich contained lymphocytes, classic and mononuclear Reed-Berezovsky-Sternberg cells. What is the most likely diagnosis?

@Lymphogranulomatosis

Chronic lymphatic leukemia

Lymphosarcoma

Retikulosarcoma

Mycosis fungoides

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An autopsy of a 67-year-old man revealed the systemic enlargement of lymph nodes with formation of tumorous conglomerates. The spleen was also enlarged with a motley pattern of a cut surface. There were plural, tiny, yellowish-white spots on a red background of a spleen's pulp. What is the most likely diagnosis?

@Lymphogranulomatosis

Sarcoidosis

Lymphosarcoma

Carcinoma of lung

Lymphatic leukemia

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A 67-year-old female presented with painless enlargement of lymph nodes. Histological examination of a biopsy sample revealed that the whole lymph node pattern was unclear, with heterogeneous cellular infiltrate. It included abnormal, immature cells admixed with lymphocytes, eosinophils, plasma cells and macrophages. Binucleated Berezovsky-Reed-Sternberg cells, where surrounded by multiple cell types. What is the most likely diagnosis?

@Lymphogranulomatosis

Acute myeloleukemia

Chronic myeloleukemia

Mycosis fungoides

Tuberculosis

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A 14-year-old boy presented to a hospital with enlarged submaxillary and cervical lymph nodes. A biopsy procedure was performed. Microscopical investigation revealed the disorder of a lymph node typical structure, a heterogeneous cellular population with a presence of giant multinuclear cells and plural one-nuclear big cells. There were also eosinocytes, neutrophils and lymphocytes in the cell infiltrate. In addition, sites of necrosis and sclerosis were found. What is the most likely diagnosis?

@Lymphogranulomatosis

Hyperplasia of lymphatic nodes

Granulomatous lymphadenitis

Purulent lymphadenitis

Non-Hodgkin's lymphoma

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At the stomatological examination of a 16-year-old teenager, enlarged submandibular and cervical lymphatic nodules were diagnosed. A biopsy was made. Microscopically the typical structure is wiped and the cellular population is heterogeneous. Giant cells with multi nucleus and multiple mononuclear cells of a big size are presented. There are also eosinophilic and neutrophilic leucocytes, lymphocytes, areas of necrosis and focuses of sclerosis. Diagnose the disease.

Hyperplasia of a lymphatic nodule

@Lymphogranulomatosis

Lymphogranulomatous lymphadenitis

Purulent lymphadenitis

Non-Hodgkin’s lymphoma

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Microscopic examination of the enlarged neck gland of a 14-year-old girl revealed destruction of the tissue structure of the node, absence of the lymph follicles, sclerotic areas and necrosis foci, cell constitution of the node is polymorphous, lymphocites, eosinophiles, big atypical cells with multilobular nuclei (Beresovsky-Sternberg cells) and mononuclear cells of the large size are present. What is the most likely diagnosis?

Fungoid mycosis

Acute lympholeucosis

Chronic lympholeucosis

Berkitt's lymphoma

@Lymphogranulomatosis

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A 22-year-old woman has enlarged lymphatic nodules. Histologically there are lymphocytes, histiocytes, reticular cells, small and big Hodgkin’s cells, multinuclear Beresovski-Sternberg’s cells and single focuses of caseous necrosis. What disease is meant?

Chronic leukosis

Lymphosarcoma

@Lymphogranulomatosis

Acute leukosis

Metastasis of pulmonary cancer

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A thoracotomy of a 58-year-old woman revealed in her anterior mediastinum the enlarged and soldered together lymph nodes. Microscopical investigation revealed atypical cells with predominance of Hodgkin cells and giant Reed—Berezovsky - Sternberg cells. A sclerosis was absent. What is the most likely diagnosis?

@Lymphogranulomatosis with low-spirited development of lymphoid tissue

Lymphogranulomatosis with predominance of nodularis sclerosis

Lymphogranulomatosis with predominance of lymphoid tissue

Lymphosarcoma

Mixed-cellular variant of lymphogranulomatosis

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A post-mortem of a 15-year-old girl revealed enlarged neck, mediastinal and mesenteric lymph nodes, which were integrated in conglomerates. On a cut section, the tissue pattern of the nodes was non-uniform, with foci of necrosis. Microscopical investigation showed the uneven structure of lymph nodes, foci of sclerosis and necrosis. The cell population was also heterogeneous and included uninuclear atypical cells, giant multinuclear atypical cells, a significant amount of eosinocytes and neutrophils, and sparse lymphocytes. What is the most likely form of Hodgkin lymphoma (lymphogranulomatosis)?

@Lymphogranulomatosis, mixed cell variant

Lymphogranulomatosis, lymphohistiocytic variant

Lymphogranulomatosis, nodular sclerosis

Lymphogranulomatosis, variant with low-spirited development of lymphoid tissue

Hodgkin's sarcoma

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A patient is 60 years old. During the thoracotomy enlarged and knitted lymphatic nodules were diagnosed in the mediastinum anterius, where a biopsy material was taken. Microscopically atypical cells were revealed, mostly Hodgkin’s and Beresovski-Sternberg’s giant cells; sclerosis was absent. What is the most possible disease?

@Lymphogranulomatosis with a depressed development of lymphoid tissue

Lymphogranulomatosis with a domination of nodular sclerosis

Lymphogranulomatosis with a domination of lymphoid tissue

Lymphosarcoma

Mixed-cellular variant of lymphogranulomatosis

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A 66-year-old man presents for his annual physical examination. Hi is asymptomatic and physical examination is unremarkable. Examination of his peripheral smear, however, reveal the presence of small mononuclear cells with little cytoplasm and a mature nucleus with a prominent nuclear cleft. No “smudge cells” are seen. The presence of these “buttock cells” in the peripheral blood warrants further clinical work-up to search for which one of the following malignancies?

Chronic lymphocytic leukemia

Follicular non-Hodgkin’s lymphoma

Multiple myeloma

@Nodular sclerosis Hodgkin’s disease

Small-cell carcinoma of the lung

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A 22-year-old woman presents with fever, weing loss, night sweats, and painless enlargement of several supraclaviculars lymph nodes. A biopsy from one of the enlarged lymph nodes is shown in the photomicrograph below. The binucleate giant cell with prominent acidofilic “owl-eye” nucleoli shown stain positively with both CD15 and CD30 immunoperoxidase stains. Also present are atypical mononucleare cells that are surrounded by clear spaces (lacunar cells). Which of the following is the most likely diagnosis?

Anaplastic large cell lymphoma

Diffuse non-Hodgkin’s lymphoma

Lymphocyte predominate Hodgkin’s disease

@Nodular sclerosis Hodgkin’s disease

Reactive lymph node hyperplasia

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Date: 2016-03-03; view: 3888