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Anemia. Acute leukaemia.

Private pathology


Intravascular hemolysis results in all the following EXCEPT

Elevated plasma hemoglobin (hemoglobinemia)






A 32-year-old woman who has recently started taking alpha-methyl DOPA develops dark, tea-colored urine. Physical examination reveals mild sclera icterus, a low-grade fever, and mild hepatosplenomegaly. Examination of her peripheral blood reveals many microspherocytes, while laboratory examination finds a positive Coombsí test. Which of the following is the basic pathomechanism that caused this individualís signs and symptoms?

@Autoimmune destruction of red cells in the spleen

Drug-induced destruction of red blood cell precursors in the bone marrow

Hyperimmune destruction of neutrophils in the liver

Immune complex depositive in the capillaries of the kidneys

Isoimmune destruction of red blood cells in the peripheral blood


A 25-year-old woman present with the new onset of severe intermittent pain in her fingers that developed shortly after she recovered from mycoplasma pneumonia. She states the pain occurs when she goes outside in the cold, at which time her fingers turn white and then become numb. Laboratory evaluation finds the presence of an IgM autoantibody that is directed against the I-antigen found on the surface of her blood cells. Based on these clinical findings, the diagnosis of Raynaudís phenomenon is made. Which of the following disorders are most likely presents in this individual?

@Cold autoimmune hemolytic anemia

Isoimmune hemolytic anemia

Paroxysmal cold hemoglobinuria

Paroxysmal nocturnal hemoglobinuria

Warm autoimmune hemolytic anemia


A woman who is 5 weeks post partum (normal delivery, healthy child) develops bleeding episodes with oliguria and hematuria. No fever or neurologic manifestations are present. The blood urea nitrogen level is 65 mg/dL; a peripheral blood smear is presented in the photomicrograph below. This patient most likely has

Thrombotic thrombocytopenic purpura

Isoimmune thrombocytopenic purpura

@Hemolytic uremic syndrome

Disseminated intravascular coagulopathy

Sickle cell crisis


A 5-year-old child develops the sudden onset of bloody diarrhea, vomiting of blood, hematuria, and renal failure following a flulike gastrointestinal illness. The blood urea nitrogen (BUN) level is markedly increased, but fibrin degradation product and blood clotting times are within normal limits. A peripheral blood smear reveals poikilocytes, schistocytes, and a decreased in the number of platelets. No fever or neurologic symptoms are present. Which of the following is the most likely diagnosis?

Autoimmune thrombocytopenic purpura (autoimunne ITP)

Disseminated intravascular coagulopathy (DIC)

@Hemolytic-uremic syndrome (HUS)

Isoimmune thrombocytopenic purpura (isoimunne ITP)

Thrombotic thrombocytopenic purpura (ITP)


Patient 54 year-old, 5th day after surgical operation. Blood count: Erythrocytes 3,6*1012/l, Hemoglobin 95 g/l, Erythrocyteís hemoglobin content (color index) 0,78; Leukocytes 16*109/l, Platelets 450*109/l Blood picture: anizocytosis, poikilocytosis, reticulocytes- 3,8%. What anemia does this patient have?

Chronic posthemorragic anemia

Acquired hemolytic anemia

@Acute posthemorragic anemia

Anemia from iron deficiency

Hypoplastic anemia


An anemic patient is found to have hypochromic, microcytic red cells. Additional tests reveal the serum iron levels the total iron-binding capacity, and the transferring saturation to be reduced. A bone marrow biopsy reveals the iron to be present mainly within macrophages. Which of the following is the most likely diagnosis?

Iron deficiency

Thalassemia trait

@Anemia of chronic disease

Sideroblastic anemia

Pernicious anemia


A 55 y.o. woman consulted a doctor about having continuous cyclic uterine hemorrhages for a year, weakness, dizziness. Examination revealed skin pallor. Hemogram: Hb- 70 g/l, erythrocytes - 3,2*1012/l, color index - 0,6, leukocytes - 6,0*109/l, reticulocytes - 1%; erythrocyte hypochromi A. What anemia is it?

Iron-deficiency anemia

B12-folate-deficiency anemia

Hemolytic anemia

Aplastic anemia

@Chronic posthemorrhagic anemia


A 58-year-old woman complaints of increased tiredness, decreased capasity for work, somnolence and dyspnea during fast walking. Blood test revealed: erythrocytes - 4,6*1012/l, hemoglobin - 92 g/l, colour index - 0,6. Blood smear demonstrated high contents of microcytes and anulocytes. What anemia is it typical for?

Acute posthemorrhagic


@Iron deficiency


Sickle cell


A patient with hypochromic anemia has splitting and loss of hair, increased nail brittling and taste alteration. What is the mechanism of the symptoms development?

Decreased production of parathyrin

Decreased production of thyroid hormones

Deficiency of vitamin ņ

@Deficiency of iron-containing enzymes

Deficiency of vitamin ¬12


A 38-year-old man, with a history of an ulcer, resulted in a stomach's resection, in his blood test had a normal quantity of erythrocytes, but reduced hemoglobin's concentration and decreased color index. An autopsy revealed pale skin and visible mucous membranes; bone marrow of long tubular bones was brightly red. Erythrocytes in a smear had a normal form and the sizes. They look very pale because of bad staining by dyes. What pathological process took place in this case?

@Hypochromic iron deficiency anemia

B12-folic acid deficiency anemia

Acute lymphoblast leukemia

Sicklemia sickle cell anemia

Aplastic anemia


2 years ago a patient underwent resection of pyloric part of stomach. He complains of weakness, periodical dark shadows beneath his eyes, dyspne A. In blood: Hb - 70 g/l, erythrocytes - 3,0*1012/l, colour index - 0,7. What changes of erythrocytes in blood smears are the most typical for this condition?







Hereditary microspherocytic hemolytic anemia (Mincovsky-Shoffar disease) was diagnosed in a woman, aged 34. What mechanism caused hemolysis of erythrocytes in the patient?




Autoimmune impairment

Hypoplasia of bone marrow


Substitution of the glutamic acid on valine was revealed while examining initial molecular structure. For what inherited pathology is this symptom typical?



Minkowsky-Shauffard disease

@Sickle-cell anemia



A 20 year old patient complains of general weakness, dizziness, quick fatigability. Blood analysis results: Hb- 80 g/l. Microscopical examination results: erythrocytes are of modified form. This condition might be caused by:

Obturative jaundice

Addison's disease

Hepatocellular jaundice

Acute intermittent porphyria

@Sickle-cell anemia


A 25-year-old man presents because of a recurrent rash on the sunexposed areas of his face and arms. He has recently moved to the United States from South Africa, where he has lives all of his life. He states that he has always been sensitive to the light and he says that his face will break out in a rash if hi stays in the sun too long. He notes that sometimes alcohol ingestion will make these episodes worse. Pertinent medical history includes episodes of neuropsychiatric changes, including hallucinations and manic-depressive episodes. Physical examination reveals multiple fluid-filled vesicle and bullae on his face and forearms. Laboratory examination reveals elevated levels of delta-aminolevulinic acid and porphobilinogen in the urine. This individualís disorder results from the abnormal synthesis of which one of the following substances?







A 63-year-old man, with 20 years history of working as the engineer for the service of electronic microscopes, died of a sepsis. An autopsy revealed plural hemorrhages in serous and mucous membranes, a general hemosiderosis, a fatty dystrophy of a myocardium, liver and kidneys, ulcerative -necrotic and purulent processes in a gastro -intestinal system. The red bone marrow was replaced by a fatty. What is the most likely diagnosis?

@Hypoplastic anemia

Megaloblastic anemia

Posthemorrhagic anemia

Iron deficiency anemia


A man, with a history of getting a high doze of ionizing radiation, presented to his physician with marked stomatorrhagia (gingival hemorrhage), spontaneous skin and mucosas' haemorrhages. A blood test showed a normochromal anemia and pancytopenia. The concentration of iron in blood's serum was normal. A histological investigation of a bone marrow puncture sample revealed a replacement of a hemopoietic tissue by the fatty tissue. What is the most likely diagnosis?

@Aplastic anemia

B12-folic acid deficiency anemia

Hemolytic anemia

Myelodysplastic syndrome

Immune cytopenia


A 67-year-old man present with increasing fatigue and is found to be anemic. Physical examination reveals a hard 1-cm nodule in the left lobe of the prostate. The prostatic-specific antigen (PSA) level is found to be elevated. Examination of the peripheral blood reveals an occasional myelocyte. The erythrocytes are mainly normochromic and normocytic, and teardrop RBCs are not found. There are however, about two nucleated red blood cells per 100 white cells. Which of the following is most likely diagnosis?

Fanconiís anemia

Microangiophatic hemolytic anemia

@Mmyelophthisic anemia

Autoummun hemolytic anemia

Aplastic anemia


Surgical removal of a part of stomach resulted in disturbed absorption of vitamin B12, it is excreted with feces. The patient was diagnosed with anemi A. What factor is necessary for absorption of this vitamin?


Folic acid

Hydrochloric acid




A 43-year-old man suffers from chronic atrophic gastritis and megaloblastic hyperchromic anemia. He also has methylmalonic aciduria. Insufficiency of what vitamin led to the development of such complex of symptoms?

Vitamin ¬3

@Vitamin ¬12

Vitamin ¬2

Vitamin ¬1

Vitamin ¬5


In patient with hyperchrome anemia during the blood investigation predominance of erythroblasts, normoblasts and megaloblasts is observed. Same cells are found in the red bone marrow. Deficiency of what vitamin can course this disease?







A 44-year-old man presented to a gastroenterologist with pains in his epigastrium. A physical examination revealed an icteritiousness of his skin and scleras, an alteration of a tongue's mucous membrane. A tongue grossly looked shining, smooth, with red spots. In peripheral blood's smear there were found enlarged erythrocytes (megaloblasts). A histological study of a gastrobiopsy from a body of a stomach showed a thinning of mucosa, a reduction of glands quantity, superfluous growth of a connective tissue. Specify, what of diagnoses is the most probable in this case:

@B12-folic acid deficiency anemia

Chronic posthemorrhagic anemia

Hemolytic anemia.

Chronic myeloid leukemia.

Aplastic anemia


A 56 year old patient came to a hospital with complaints about general weakness, tongue pain and burning, sensation of limb numbness. In the past he underwent resection of forestomach. In blood: Hb- 80 g/l; erythrocytes - 2,0*1012/l; colour index - 1,2, leukocytes - 3,5*109/l. What anemia type is it?




@B12-folate deficient



During the revision of the mouth cavity of a patient there was detected the atrophy of the mucous membrane of the tongue with red macules (Gunterís glossitis). Sclerae are yellowish. Color index of the blood passes 1. What anaemia do these changes characterize?

@B12-folic acid deficiency anaemia

Iron deficiency anaemia

Acute posthemorrhagic anaemia

Chronic posthemorrhagic anaemia

Hemolytic anaemia


A physical examination of a young men's oral cavity revealed the atrophy of mucous membrane and red spots on his tongue (atrophic; Hunter's; Moeller's glossitis). Sclera had a yellow coloring. A blood test showed the color index above one. For what anemia these changes are characteristic?

@Nutritional anemia due to vitamine B12 deficiency

Asiderotic anemia

Acute posthemorrhagic

Chronic posthemorrhagic

Hemolytic anemia


A female patient complains of malaise, weakness, breathlessness, rapid fatigability, and dizziness. Her blood test data: erythrocytes-1.8x1012/L, Hb-80 g/L, leukocytes-3.2x109/L, color index-1.5. Anisocytosis, poikilocytosis, megaloblasts, megalocytes were found in smear. What is the possible diagnosis?

@B12-deficiency anemia

Posthemorragic anemia

Acute leukemia

Iron deficiency anemia

Immunohemolytic anemia



The patient, 55 years old, had undergone gastrectomy last year. After examination doctor supposed the development of one of vitamin deficiency. What investigation can confirm the diagnosis in this case?

@Investigation of blood Ė megaloblastic anemia

Investigation of daily urinary excretion of vitamin

Determination of bile excretion of vitamin

Determination of patientís daily requirenment of vitamin

Investigation of activity of vitamin-depended enzymes


In patient with anemia during the blood investigation predominance of erythroblasts, normoblasts and megaloblasts is observed. Same cells are found in the red bone marrow. For what type of anemia this state is characteristic?

@Megaloblastic, pernicious

Hypochrome, iron-deficient

Hyperchrome, iron-deficient

Vitamin C-deficient

For all types of anemia


A 45-year-old woman presents with increasing fatigue, weakness, and tingling of her arms and legs. Physical examination finds numbness and loss of balance, position, and vibratory sense in both of her lower extremities. Histologic examination of a smear made from a bone marrow aspiration reveals asynchrony in red blood cell precursors between the maturation of their nuclei and their cytoplasm. Additional work-up discovers achlorhydria, and a biopsy of the anturm of her stomach reveals chronic atrophic gastritis. Which of the following is the most likely diagnosis?

Fanconiís anemia

Leukoerythroblastic anemia

@Megaloblastic anemia

Myelophthisic anemia

Sideroblastic anemia


A gross examination of a dead body revealed the skin's pallor and a yellowness of a sclera. Livores mortis were not defined. The volume of blood in a heart and large vessels was reduced. A blood looked aqueous. In a skin, mucosa and serous membranes there were petechial hemorrhages. The internal organs, especially a spleen, a liver and kidneys had a rusty color on a cut. A bone marrow of flat bones was a crimson-red and succulent. In cortical [tubular, cylindrical] bones it looked like a crimson jelly. Name the disease, connected with a deficiency of vitamin B12.

@Pernicious anemia

Drepancytic (sickle-cell) anemia


Toxic anemia

Acute posthemorrhagic anemia


A post-mortem of a 56-year-old woman revealed the Hunter's (atrophic; Moeller's) glossitis, atrophy of mucous membrane of a stomach and liver's hemosiderosis. A bone marrow in all investigated bones was red. A microscopical study showed hyper cellular infiltration in a lamina propria of a stomach with a presence of lymphatic follicles. In a spinal cord there was a funicular myelosis and also haemopoiesis foci detected in a spleen. What is the most likely diagnosis?

@Addison-Biermer anemia

Fanconi's (congenital aplastic) anemia

Hypoplastic anemia

Chronic gastritis (type A)

Chronic gastritis (type B)


A 59-year-old woman presents with increasing fatigue and left-side upper abdominal pain. Physical examination reveals a markedly enlarged spleen. No enlarged lymph nodes are found. A CBC reveals a normocytic normochromic anemia. Myelocytes, nucleated red blood cells, and teardrop-shaped red blood cells are seen in the peripheral smear. A bone marrow aspiration could not be performed due to a ďdry tapĒ. The bone marrow biopsy specimen revealed a hypocellular marrow as shown in the picture below. Marrow reticulin was markedly increased in amount. The peripheral leukocyte alkaline phosphatase score was within normal limits. Which of the following clinical finding is most likely to be present in this individual?

@Extramedullary hematopoiesis in the spleen

Increased total protein in the serum

Multiple black stones in the gallbladder

Multiple lytic lesions in the skull

Sequestration of neotrophils in the liver


Acute idiopathic thrombocytopenic purpura (ITP) is characterized by

An insidious onset

Being more common in females of childbearing age

@A history of recent viral infection

Megakaryocytic hypoplasia in the bone marrow

A high mortality


A 37-year-old woman who has a clinical picture of fever, splenomegaly, varying neurologic manifestations and purplish ecchymoses of the skin is found to have a hemoglobin level of 10.0 g/dL, a mean corpuscular hemoglobin concentration (MCHC) of 48, peripheral blood polychromasia with stippled macrocytes, and apherocytes, with a blood urea nitrogen level of 68 mg/dL. The findings of coagulation studies and the patientís fibrin-degradation products are not overtly abnormal. Which of the following is the most likely diagnosis?

Idiopathic thrombocytopenic purpura

@Thrombotic thrombocytopenic purpura

Disseminated intravascular coagulopathy

Submassive hepatic necrosis

Waterhouse-Friderichsen syndrome


The bone marrow biopsy shown below was performed because of splenomegaly and anemia in an adult. On the basic of the appearance of the bone marrow core, choose the most likely diagnosis.

Chronic myeloid leukemia (CML)

Aplastic anemia

Acute leukemia

@Myeloid metaplasia with myelofibrosis

Microagiopathic hemolytic anemia


A patient's blood was analyzed and the decreased erythrocyteís sedimentation rate (ESR) was discovered. What disease from the listed below is accompanied with decreased ESR?

Myocardial infarction




Vitamin B deficiency


As a result of the damage of one of the Atomic Power Plant reactors the run-out of radioelements took place. People in the high-radiation area were radiated with approximately 250-300 r. They were immediately hospitalized. What changes in the blood count would be typical for the victims?







After overdoses of x-rays destruction of B lymphocytes (B cells) in human hematopoietic organs happened. Reduction of what blood plasma substancies will be observe in this case?

@Immunoglobulins (antibodies)






After the radiactive exposure a patient has stem cells disorder. The regeneration of what cells of friable connective tissue will be damaged?




Pigment cells



A 23 y.o. patient complains of weakness, temperature rise up to $38-40^0C$. Objectively: liver and spleen are enlarge d. Hemogram: Hb- 100 g/l, erythrocytes - 2,9*1012/l, leukocytes - 4,4*109/l, thrombocytes Ė 48*109/l, segmentonuclear neutrophils - 17%, lymphocytes - 15%, blast cells - 68%. All cytochemical reactions are negativ e. Make a hematological conclusion:

Acute erythromyelosis

Acute myeloblastic leukosis

Chronic myeloleukosis

@Undifferentiated leukosis

Acute lymphoblastic leukosis


A patient with acute myeloblast leucosis has developed liver and spleen enlargement, anemia, myeloblasts in peripheral blood. What principal sign allows to differ myeloblast leukosis from chronic one?

@Leukemic collapse



Blast cells in peripheral blood



A 28-year-old man presents with widespread ecchymoses and bleeding gums. Physical examination reveals enlargement of this spleen and liver. Laboratory examination of his peripheral blood reveals a normochromic, normocytic anemia, along with a decreased number of platelet and an increased number of white blood cells. Coagulation studies reveal prolonged prothrombin and partial thromboblastin time and increased fibrinogen degradation product. Examination of the patientís bone marrow reveals the presence of numerous granular-appearing blast cells with numerous Auer rods. These immature cells make up about 38%of the nucleated cells in the marrow. Which of the following is the most likely diagnosis?

Acute erythroid leukemia

Acute lymphoblastic leukemia

Acute monocytic leukemia

Acute myelomonocytic leukemia

@Acute promyelocytic leukemia


Acute lymphoblastic leukemia was diagnosed in a 10-year-old child. When this child later developed a patchy pulmonary infiltrative and respiratory insufficiency, a lung biopsy was performed. The material obtained by biopsy was they stained with Gomoriís methenamine-silver stain and is shown in the photomicrograph below. In consideration of the patientís signs and microscopic evaluations, the prognosis is now complicated by

Pseudomonas pneumonia

Aspergillus pneumonia

@Pneumocystis carinii pneumonia

Pneumococcal pneumonia

Influenza pneumonia


A 4-year-old girl is being evaluated for the sudden onset of multiple petechiae and bruises. She is found to have a peripheral leukocyte count of 55,000, 86% of which are small, homogeneous cells that have nuclei with immature chromatin. Indistinct nucleoli are also present. Initial tests on these immature cells are as follows: TdT, positive; PAS, positive; acid phosphatase, positive; and myeloperoxidase, negative. Based on these findings, which of the following in the cell of origin of these immature cells?







A post-mortem of a 4-year-old girl revealed plural petechial hemorrhages on her skin, serous and mucous membranes, large focal hemorrhage in a brain and necrotic tonsillitis. Microscopical study showed multiple cell infiltrates with prevailing lymphocytes in a bone marrow, a liver, a spleen, a thymus, lymph nodes, tonsils and a skin. What is the most likely diagnosis?

@Acute lymphatic leukemia

Chronic lymphatic leukemia

Hodgkin's lymphoma

Follicular non-Hodgkin's lymphoma

Mycosis fungoides


In a 45-year-old patient the ulcerative-necrotic damage of the mucosa of the oral cavity takes place; also the spread lymphadenopathy, slight spleno- and hepatomegaly, diffuse hemorrhages in the skin and mucous membranes were found out. In blood analysis the increasing of leukocytes (to 100 10 per 1 ml) at the account of lymphoblasts takes place. What diagnosis is more probable?

@Acute lymphoblastic leukemia

Chronic myelocytic leukemia

Chronic lymphocytic leukemia


Acute promyelocytic leukemia


The death of a 7-year-old boy was by acute haemorrhagic anaemia, caused by profuse bleeding from the digestive tract. During the pathoanatomic examination following facts were revealed: macroscopically Ė less of blood in the internal organs, the enlargement of different groups of lymphatic nodules, thymomegaly, moderately signified hepatosplenomegaly, brightly red medulla; microscopically Ė hypercellular medulla with monomorphic infiltration of blast cells, diffuse-focal tumour infiltrates in a liver, a spleen, lymphatic nodules, brain tunics and substance. Diagnose the disease.

@Acute lymphoblastic leucaemia

Acute myeloblastic leucaemia

Acute undifferentiated leucaemia

Acute monoblastic leucaemia

Acute plasmoblastic leucaemia


A 4-year-old girl died due to a post-hemorrhagic anemia, resulted from a gastro-intestinal profuse bleeding. An autopsy revealed an anemia of her organs, the enlargement of the different groups of lymph nodes, thymomegaly, mild hepatomegaly, splenomegaly and bright red bone marrow. Microscopical study showed hyper cellularity of a bone marrow with monomorphic blast cells infiltrate, diffuse inflammatory tumor-like infiltrates in a liver, a spleen, lymph nodes, meninges and substance of a brain. What is the most likely diagnosis?

@Acute lymphoblastic leucosis

Acute myeloblastic leucosis

Acute nondifferentiated leucosis

Acute monoblastic leucosis

Acute plazmoblastic leucosis



Date: 2016-03-03; view: 2281

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