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# 54 A 2-year-old girl is being evaluated for progressive swelling of her neck. Physical examination finds a nontender, ill-defined, loculated mass in the left side of her neck. During the workup of this patient, a karyotype reveals that she is monosomic for the X chromosome. Which of the following is the cause of the swelling of this patient’s neck? Bacillary angiomatosis @Cystic hygroma Glomus tumor Nevus flammeus Spider angioma # 55 All the following are the result of melanocytic hyperplasia EXCEPT @Freckle Lentigo Junctionals nevus Blue nevus Spitz tumor # 56 A 35-year-old man present with 0.3-cm flat light brown lesion on his left forearm. The lesion is excised, and microscopy reveal nests of round nevus cells within the lower epidermis is the dermal-epidermal junction. There is no “fusion” present of adjacent nests of nervus cell. Cytologic atypia is not present, nor are nevus cell seen in the superficial or deep dermis. Which of the following is the most likely diagnosis? Compound nevus Dysplastic nevus Halo nevus @Junctional nevus Spitz nevus # 57 The woman on her face skin had a pigmental formation in the form of a nodule which quickly grew. The biopsy is made. Microscopical investigation of biopsy sample revealed fields of spindle- shaped and polymorphic cells which contain a brown pigment. In addition, there were diagnosed numerous mitoses. What is the most likely diagnosis? @ Melanoma Nevus Cancer Papilloma Dermatofibroma # 58 A 46-year-old man gained a bulging black stain on his skin. The stain didn't heal for a long time. Afterwards, the stain became a node, bigger and painful, changed its colour to dark-brown. Histologically: spindle-shaped and polymorphous cells containing brown pigment. What kind of tumour is this? Basalioma @Melanoma Hemangioma Hematoma Carcinoid # 59 An eye of 53-year-old patient, excised at surgery due to neoplasm, presented in pathology department. Gross investigation reveled a 1 x0,4 cm black lesion in the retina. Microscopic appearance of a tumor was characterized by nests of immature cell with eccentric nuclei, prominent macronucleoli and cytoplasm brown pigment. What is the most likely diagnosis? @Melanoma Neurinoma Angiosarcoma Neuroblastoma Ganglioneuroblastoma # 60 A physical investigation of a 60-year-old woman with one year history of a formation on a face revealed a brown skin plaque with irregular form and black impregnations. A histological research of a skin biopsy showed in epidermis and through all derma polymorphic big cells with pathological mitoses, large nucleoli and yellowy-brown pigment in a cytoplasm of many cells. The specified cells grow in a kind of fine groups and also alone. Make a diagnosis. @Melanoma Nevus Papilloma Xeroderma Melanosis # 61 A 75 year old male patient consulted a surgeon about a brown nonhealing ulcer of shin. Examination of biopsy material revealed diffuse growth of polymorphic atypic cells with brown pigment in their cytoplasm. Pearls reaction was negative. There were also a lot of pathological mitoses and foci of tissue necrosis. What is the most probable diagnosis? Skin cancer Local hemosiderosis Trophic ulcer Intradermal nevus @Melanoma # 62 A patient complains on a brown ulcer of leg, that doesn't heal for a long time. During a biopsy: diffuse growth of polymorphous atypic cells. In cytoplasm of those there is a brown pigment. Pearls' reaction is negative. There are a lot of pathological mitoses and nidi of necrosis of the tissue. Name the diagnosis. Skin cancer Local haemosiderosis Intradermal nevus Trophic ulcer @Melanoma # 63 A dark convex macula appeared on the skin of a 46-year-old patient but didn’t disturb him. In course of time it began to enlarge, the pain appeared, the color changed into light brown and a nodule could be palpated. At the histological examination of the removed tissue, spindle and polymorphous cells were revealed, cytoplasm of which had a fulvous pigment. What tumour is meant? Haematoma Basaloma Haemangioma @Melanoma Carcinoid # 64 A 50-year-old woman presented with a pigmented painful skin lesion above the ankle. It had been present for many years but in recent months it had enlarged quite rapidly, its outline got irregularity. Microscopic investigation of a lesion biopsy revealed nests of atypical cells and single cells with eccentric nuclei, prominent macronucleoli and cytoplasmic brown pigment. What is the most likely diagnosis? @Melanoma Basal cell carcinoma Hemangioma. Haematoma. Carcinoid. # 65 A previously healthy 42-year-old man has a skin nodule on his right hand that has become larger and darker with more irregular outlines over the past three months. On physical examination there is a 1.2 cm diameter darkly pigmented and slightly raised nodule on the dorsum of his right hand. No other skin lesions are noted. Several nontender enlarged lymph nodes are palpable in the right axilla. The lesion is excised and microscopic examination shows a neoplasm composed of darkly pigmented polygonal and spindle cells. Which of the following neoplasm’s kind is this one? Leiomyoma Rabdomyoma @Melanoma Metastatic carcinoma Basal-cell carcinoma # 66 The incidence of malignant melanoma of the skin appears to be increasing in the United States. Which of the following is most significant in predicting the clinical behavior following diagnosis? The degree of pigmentation @The level and depth The amount of inflammation The degree of pleomorphism The state of nutrition # 67 An eyeball with tumour like formation was delivered for the histological examination. The formation is located in the vascular tract of the eye with the size 1 x 0,4cm and of black color. Multiple pathological mitoses can be seen in cells. A fulvous pigment is also revealed in the cytoplasm of many cells. What is your diagnosis? @Melanoma Neurinoma Angiosarcoma Neuroblastoma Ganglioneuroblastoma # 68 A 66-year-old woman present with right eye bad vision, ophtalmoscopy revealed a neoplasm of retina which was soon excised, at surgery together with an eye ball. Grossly, a neoplasm was soft, irregular in contour lxl cm in size and had a brown coloring. Under microscope a lesion demonstrated nodular aggregates of infiltrating cells. There cells contained large brown pigment nuclei with chromatin clumped at the periphery of nuclear membrane and prominent nucleoli. Atypical mitoses figures were also revealed. What is most likely diagnosis? @Melanoma Schwannoma Glomus tumor Paraganglioma Angiosarcoma # 60 The most common primary tumor of the heart in adult is the Rhabdomyoma Rhabdomyosarcoma Papillary fibroelastoma Lipoma @Myxoma # 70 A 35-year-old man presents with weight loss, fever, and fatigue. Physical examination finds signs and symptoms of mitral valve disease. Further work-up finds a pedunculated mass in the left atrium. The tumor is resected and histologic sections reveal stellate cells in a loose myxoid background. Which of the following is the most likely diagnosis? Chordoma Fibroelastoma Leiomyoma @Myxoma Rhabdomioma # Organ-specific tumor # 1 The best example of viral oncogenesis in humans is seen with which of the following neoplasms: Retinoblastoma Small cell anaplastic carcinoma of lung T-cell leukemia Prostatic adenocarcinoma @Hepatic carcinoma # 2 A 55-year-old man presented to a hospital with the atelectasis of a right lung's middle lobe, resulted from the obturation of a midlobar bronchus by a node of soft tissues. A bronchoscopy revealed a new growth within an obturation zone. A microscopical investigation of a biopsy sample showed the growths of an atypical glandular epithelium with pathological mitoses, which spread in tissues underneath and a cartilage. What is the most likely disease? @Bronchogenic carcinoma of lungs Dysplasia of epithelium of bronchus Inflammatory polyps Deforming bronchitis Sarcoma of bronchus # 3 All the following tumors may be found arising within the pineal gland EXCEPT Teratoma Pineoblastoma Embryonal carcinoma Choriocarcinoma @Craniopharyngioma # 4 A physical examination of a 22-year-old woman, with few years' history of myasthenia, revealed a big tumor at anterior mediastinum. Histologically a tumor consisted of the oblong (spindle-shaped) cells with oval dark nuclei, which form bands and nests and has little Hassall's bodies. After a surgical removal of a tumor symptoms of a myasthenia have started to disappear progressively. Diagnose a tumor which has etiological and pathogenic connection with a myasthenia. @ Thymoma Adenoma of thyroid gland Adenoma of parathyroid gland Paraganglioma Medulloblastoma # 5 A 60-year-old man with a 90 pack year history of smoking experiences an episode of hemoptysis. A chest radiograph reveals a 5-cm right upper lobe lung mass. A fine needle aspirate of this mass yields cells consistent with small cell anaplastic ("oat cell") carcinoma. On physical examination he has puffiness of the face, some pedal edema, bruises of the skin, and a blood pressure of 165/100-mm Hg. A bone scan shows no metastases. Immunohistochemical staining of the tumor cells is likely to be positive for: Parathormone related peptide Erythropoietin @ACTH Insulin Gastrin # 6 A 32-year-old woman with a history of abortion 8 months earlier presented to the emergency department complaining of uterine bleeding. Examination done by gynecologist revealed a neoplasm of the uterus. Grossly, tumor had a spongy structure with multiple hemorrhages. Microscopically, atypical clear epithelial Langhan's cells and abnormal syncytiotrophoblast cells arranged around maternal blood spaces were detected. What is the most likely diagnosis? @ Choriocarcinoma Squamous cell carcinoma without keratinisation Adenocarcinoma Fibromyoma Hydatidiform mole # 7 A 45-yer-old female examined by her gynecologist due to uterine bleeding. A neoplasm was diagnosed and then removed at surgery department. The uterine lesion presented with huge necrotic and hemorrhagic spongy masses. Microscopic investigation revealed large clear atypical epithelial cells and variety of abnormal dark cells, arranged around material blood spaces. Stroma was not defined. Atypical cells resembled cytotrophoblast and syncytiotrophoblast cells. What is the most likely diagnose? @Choriocarcinoma Invasive hydatidiform mole Adenocarcinoma Cavernous haemangioma. Medullary carcinoma # 8 6 months after delivery a woman had uterine bleeding. Gynecological examination revealed in the uterine cavity a dark-red tissue with multiple cavities that resembled of "sponge". Microscopic examination of the tumour revealed some atypic light epithelial Langhans cells and giant cells of cyncytiotrophoblast in blood lacunas. What tumour is it? @Chorioepithelioma Vesicular mole Squamous cell nonkeratinous carcinoma Fibromyoma Adenocarcinoma # 9 A 39-year-old woman has madescence in the region of mammilla, a small ulcer with inflammatory hyperemia and cutaneous edema. Histologic examination of tissue sampling from this area revealed in the malpighian layer of thickened epidermis atypical cells with light and optically empty cytoplasm, with no intracellular bridges. Such cells were also found in the orifice of big mammal gland ducts. What is the most probable diagnosis? @ Paget's disease Intraductal cancer Epidermoid cancer Melanocarcinoma Basal cell carcinoma # 10 A physical examination of a 39-year-old woman revealed a soaking area by her breast nipple, a superficial ulcer with inflammatory hyperemia and skin edema. A histological research of a biopsy from this area revealed in basal layer of thickened epidermis atypical big cells with light and optically empty cytoplasm, with absence of intercellular bridges. Such cells are found and in the ostium of the big ducts of a gland. What is the most likely diagnosis? @Paget's desease Intraductal cancer Basal cell cancer Epidermoid carcinoma Melanoma # 11 During a routine physical examination, a 49-year-old man is found to have a 2.5-cm “coin lesion” in the upper lobe of his left lung. The lesion is removed surgically, and histologic sections reveal sheets of malignant cells with clear cytoplasm (clear cell carcinoma). Which of the following is the most likely site of origin for this metastatic lung tumor? Appendix Breast @Kidney Pancreas Stomach # 12 A 60-year-old man noticed worsening urinary tract symptoms and thus inquires about screening tests for kidney pathology. Investigation revealed a node 8 cm in diameter at right kidney's apex. After surgery, grossly tumor presented a patchy pattern with hemorrhages and zones of necrosis. Histological study showed large anaplastic tumor cells with abundant foamy cytoplasm and with small central densely staining nucleus. Abnormal mitoses were also found. What is the most likely diagnose? @ Clear -cell carcinoma Clear -cell adenoma Adenocarcinoma Nephroblastoma Acidophilic adenoma with malignization # 13 A 62-year-old man was removed a kidney. At the microscopical examination there was revealed a tumour that looked like a nodule with an approximate diameter 8cm. The tumour tissue is many-coloued with multiple haemorrhage bleedings and necroses when incised. Histologically the tumour consists of light cells that form alveolar and papillar structures. The invasive growth of the tumour is moderate. Many cells have pathological mitoses and hyperchromic nuclei. Diagnose the tumour of the kidney. @Clear cell cancer Clear cell adenoma Adenocarcinoma Nephroblastoma Acidophile adenoma with malignancy # 14 Medical evaluation of a 55-year-old man finds the following laboratory data: increased hematocrit, increased RBC count, increased total red cell mass, normal plasma volume, normal oxygen saturation of hemoglobin, and increased serum erythropoietin. These findings are most characteristic of secondary polycythemia. Which of the following abnormalities is most likely to be present in this individual? Acute gastroenteritis Chronic ulcerative colitis Cyanotic heart disease Polycythemia rubra vera @ Renal cell carcinoma # 15 A 5 5-year-old female is found to have asymptomatic microscopic hematuria. A plain radiograph of the abdomen revealed a neoplasm at her right kidney. A gross investigation of removed kidney revealed a node 8cm in diameter at its upper pole. The cut surface of a tumor presented with multiple hemorrhages and necroses. Histologically, it consists of light cells that form alveolar and papillary structures. The invasive growth of the tumor is moderate. Many cells have hyperchromic nuclei and atypical mitoses figues. What is the most likely diagnosis? @Renal cell carcinoma. Clear cell adenoma. Adenocarcinoma. Nephroblastoma. Acidophilic adenoma with malignancy. # 16 True statements about classic neurofibromatosis (von Recklinghausen’s disease) include all the following EXCEPT Malignant degeneration may occur Hamartomas of the iris are very common @Hemangioblastomas of the brain are associated Acoustic neuroma is associated Pheochromacytomas and meningioma are associated # 17 Examination of a young woman revealed a node-like, soft and elastic homogenous tumour of pinkish-white colour along the acoustic nerve. The tumour contains cell bundles with oval nuclei. Cellular fibrous bundles form rhythmic structures made up by parallel rows of regularly oriented cells arranged in form of a palisade with cell-free homogenous zone (Verocay bodies) between them. What tumour is it? @Neurinoma Neuroblastoma Ganglioneurinoma Ganglioneuroblastoma Malignant neurinoma # 18 Examination of a young woman revealed a tumour up to 3 cm in diameter in form of a knot localized along the acoustic nerve. The tumour is homogenous, soft and elastic, of pink-and-white colour. Microscopically the tumour contains clusters of cells with oval nuclei. Fibrous cell clusters form regular structures made up by parallel rows of regularly oriented cells arranged in form of a palisad e. Zones between the rows of cells are acellular and homogenous (Verocai bodies). What tumour is it? Ganglioneuroma Neuroblastoma Malignant neurinoma Ganglioneuroblastoma @Neurinoma # 19 An elderly man with a 2-year history of right leg amputation presents with 2 cm encapsulated tumor at the area of a past surgical trauma of soft tissue. Histology investigation revealed disordered orientation of mature nerve fiber bundles inter mixed with connective tissue. Higher magnification showed bundles of axons, Schwann cells, fibroblasts and perineurial cells within tumor mass. What is most likely diagnosis? @Neurinoma Neurofibroma Malignant neurinoma Soft fibroma Fibrosarcoma # 20 The man of 45 years has completely lost hearing on the right ear. Physical investigation has not revealed any pathological changes in system of the right acoustic analyzer. The tomography of a brain has revealed a neoplasm, 7 cm in diameter, homogeneous, without precise contours in a site of cerebellopontine angle. Name a neoplasm. @Neurilemmoma Gangliocytoma Astrocytoma Chorioidal papilloma Neuroblastoma # 21 A tumour in a capsule (diameter 2cm) was operative removed from the stump of the lower extremity. Microscopically it consists of spindle monomorphic cells with stick-like nuclei that form palisade structures together with the fibres. What is the most possible tumour? Neurofibroma @Benign neurilemmoma Malignant neurilemmoma Soft fibroma Fibrosarcoma # 22 All the following statements apply to ependymomas EXCEPT that They are the most common type of intraspinal glioma @They are most commonly located in the lateral ventricles Patient may present with headache and papilledema They may require differentiation from choroid plexus papilloma Histologic section display rosettes # 23 True statements about meningiomas include all the following EXCEPT They usually presents clinically with headaches or seizures They constitute about 20 percent of primary brain tumors @They usually display rapid growth They arise from arachnoid cap cells They may be multiple in neurofibromatosis type 2 # 24 The tumor of a brain is diagnosed for the patient with neurologic disturbances. During operation the tumor, which looks like the dense node bound to a firm cerebral membrane, is removed. Histological investigation revealed the neoplasm constructed from endothelium-like cells closely adjoining to each other. What is the most likely diagnosis? @ Meningioma Glioblastoma Anaplastic meningeoma Astrocytoma Neuroblastoma # 25 A 63-year-old woman is hospitalized secondary to markedly decreased vision. She has no history of polydipsia or nocturia. Physical examination finds bilateral sluggish light reflexes and a bitemporal hemianopsia. No papilledema is present, and her urine specific gravity is within normal limits. A CT scan of the head finds a suprasellar mass with calcification. Which of the following is the most likely diagnosis? @Craniopharingioma Germinoma Juvenile pilocytic astrocytoma Medulloblastoma Meningioma # 26 The most frequent of all the following intracranial tumors in adults is Ependymoma Medulloblastoma Meningioma @Glioma Metastasis # 27 A 55-year-old woman is suspected of having a brain tumor because on the onset of seizure activity. Computerized tomograms (CT scan) and skull X-rays demonstrate a mass in the right cerebral hemisphere that is markedly calcific. A high index of suspicion should exist for @Oligodendroglioma Astrocytoma Cerebral lymphoma Metastatic carcinoma Brown tumor # 28 A 44-year-old woman present with the new onset of seizures along with increasing frequency of severe headaches. Her medical history is otherwise unremarkable. Physical examination finds bilateral neurologic defects. Work-up reveals a large, ill-defined, necrotic mass that involves both the right and left cerebral cortex. Histologic sections from this lesion reveal a hypercellular tumor with pseudopalisading of tumor cells around large areal of serpentine necrosis. Numerous atypical nuclei and mitoses are seen. This tumor is best classified as what type of high-grade neoplasm? @Astrocytoma Lymphoma Medulloblastoma Olidodendraglioma Schwannoma # 29 A 38-year-old woman has a seizure while shopping and is taken to the hospital. A scan of a brain demonstrated a poorly circumscribed 5 cm tumor at right parietal lobe. A biopsy of this area contains of increased number of glial cell nuclei and an interening feltwork of file cell processes that give the background a fibrillary appearance. Abnormal mitoses and atypical central nervous system cells were absent within biopsy sample. What is the most likely diagnosis? @Astrocytoma Oligodendroglioma Ganglioneuroma Ependimoma Chorioid papilloma # 30 An 8-year-old boy is noted to have a palpable, firm mass in the region of the right neck after he complains of difficulty swallowing. A head CT scan reveals a 7-cm solid soft tissue mass lateral to the esophagus on the right. Further history indicates that this boy was affected by fetal alcohol syndrome and lie does poorly in school. A biopsy of this mass demonstrates pleomorphic spindle cells that are cytokeratin negative, CD45 negative, and vimentin positive. This mass is most likely to be a (an): Wilms tumor Rhabdomyosarcoma @Neuroblastoma Ewing's sarcoma Malignant lymphoma # 31 A 9-year-old boy who had been suffering from a gait disturbance for several weeks was found to have a posterior fossa mass on CT scan. The most likely cause for these findings is A berry aneurysm Astrocytoma @Medulloblastoma Oligodendroglioma Pseudotumur cerebri # 32 A 5-years-old boy presents with projective vomiting and progressive ataxia. Work-up finds obstructive hydrocephalus due to an infiltrative tumor originating in the cerebellum. Which of the following is the most likely histologic diagnosis for this cerebellar tumor? Ependimoma Glioblastoma multiform @Meduloblastoma Oligodendroglioma Schwannoma # 33 At autopsy a 8-year-old child is found to have a poorly circumscribed tumor of cerebellum. Histologically investigation reveled crowds of small immature cells with hyperchromatic, round-oval nuclei and scant cytoplasm. A few rosettes were also found by pathologist at slide examination. What is the most likely diagnosis in that case? @Medulloblastoma Astrocytoma Metastasis of cancer Metastasis of sarcoma Glioblastoma # 34 The tumour of a brain is diagnosed for the patient with quickly increasing intracranial hypertension. The removed tumor of a parietal -temporal part of brain had a soft consistence and a motley pattern of a cut surface. Histological investigation revealed neoplastic tissue constructed of polymorphic cells with sites of necroses and a hemorrhage. What is the most likely diagnosis? @Glioblastoma Oligodendroglioma Neuroblastoma Astrocytoma Meningioma # 35 Which of the following tumors is characterized by pseudopalisading, necrosis, endoneureal proliferation, hypercellularity, and atypical nuclei? Schwannoma Medulloblastoma Oligodendraglioma @Glioblastoma multiforme Ependymoma # 36 Retinoblastoma, the most common intraocular tumor of children, is associated with all the following EXCEPT Occurrence in both familial and sporadic patterns Unilateral and unifocal sporadic tumors Inactivation of cancer suppressor genes @Poor prognosis even with treatment Frequent histologic occurrence of rosettes # 37 A child is born with a single functional allele of a tumor suppressor gene. At the age of five the remaining normal allele is lost through a point mutation. As a result, the ability to continue the transition from Gl to the S phase of cell cycle is lost. Which of the following neoplasms is most likely to arise via this mechanism: Infiltrating ductal carcinoma of breast Small cell anaplastic carcinoma of the lung @Retinoblastoma of eye Cerebral astrocytoma Chronic myeloid leukemia # Private pathology Anemia. Acute leukaemia. # 1 Intravascular hemolysis results in all the following EXCEPT Elevated plasma hemoglobin (hemoglobinemia) Hemoglobinuria Hemosiderinuria Jaundice @Splenomegaly # 2 A 19 year old patient was diagnosed with chronic acquired hemolytic anemia. What is the leading pathogenetic mechanism of this pathology's development? Hyposmolarity of plasm Toxic hemolysis @Autoimmune hemolysis Intracellular hemolysis Osmotic hemolysis # 3 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 Coombs’ test. Which of the following is the basic pathomechanism that caused this individual’s 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 # 4 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 Raynaud’s 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 # 5 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 # 6 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) # 7 Patient 54 year-old, 5th day after surgical operation. Blood count: Erythrocytes 3,6*1012/l, Hemoglobin 95 g/l, Erythrocyte’s 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 # 8 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 # 9 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 # 10 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 Hemolytic @Iron deficiency Penicious Sickle cell # 11 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 А @Deficiency of iron-containing enzymes Deficiency of vitamin В12 # 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 # 13 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? Megalocytes Ovalocytes Schizocytes Macrocytes @Microcytes # 14 Hereditary microspherocytic hemolytic anemia (Mincovsky-Shoffar disease) was diagnosed in a woman, aged 34. What mechanism caused hemolysis of erythrocytes in the patient? @Membranopathy Enzymopathy Hemoglobinopathy Autoimmune impairment Hypoplasia of bone marrow # 15 As a result of increased permeability of the erythrocyte membrane in a patient with microspherocytic anaemia (Minkowsky-Shauffard disease) cells receive sodium ions and water. Erythrocytes take form of spherocytes and can be easily broken down. What is the leading mechanism of erythrocyte damage in this case? Protein Nucleic @Electrolytic osmotic Acidotic Calcium # 16 Substitution of the glutamic acid on valine was revealed while examining initial molecular structure. For what inherited pathology is this symptom typical? Favism Thalassemia Minkowsky-Shauffard disease @Sickle-cell anemia Hemoglobinosis # 17 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 # 18 A 20 y.o. patient complains of general weakness, dizziness, rapid fatigability. Examination results: Hb- 80 g/l; microscopical analysis results: erythrocytes are deforme D. These symptoms might be caused by: Acute intermittent porphyria @Sickle-cell anemia Parenchymatous jaundice Obturative jaundice Addison's disease # 19 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 individual’s disorder results from the abnormal synthesis of which one of the following substances? Globin @Heme Immunoglobulin Spectrin Trancferrin # 20 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 # 21 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 # 22 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? Fanconi’s anemia Microangiophatic hemolytic anemia @Mmyelophthisic anemia Autoummun hemolytic anemia Aplastic anemia # 23 A year after subtotal stomach resection on account of ulcer of lesser curvature the following blood changes were revealed: anemia, leukocytopenia and thrombocytopenia, color index - 1,3, megaloblasts and megalocytes. What factor deficiency caused the development of this pathology? Hydrochloride acid Mucin Gastrin Pepsin @Castle's factor # 24 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? Pepsin Folic acid Hydrochloric acid Gastrin @Gastromucoprotein # 25 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 В3 @Vitamin В12 Vitamin В2 Vitamin В1 Vitamin В5 # 26 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? @B12 A PP B6 C # 27 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 # 28 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? Iron-deficient Hemolytic Aplastic @B12-folate deficient Posthemorrhagic # 29 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 (Gunter’s 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 # 30 During an examination of oral cavity there is atrophy of mucous membrane found along with red stains (Günter’s glossitis). The sclerae are icteric. Blood test: colour index is higher than one. What kind of anaemia is this? Haemolytic Iron-deficient Acute posthaemorrhagic Chronic posthaemorrhagic @B12-Folate-deficient # 31 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 # 32 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 # 33 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 – megaloblastic anemia Investigation of daily urinary excretion of vitamin Determination of bile excretion of vitamin Determination of patient’s daily requirenment of vitamin Investigation of activity of vitamin-depended enzymes # 34 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 # 35 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? Fanconi’s anemia Leukoerythroblastic anemia @Megaloblastic anemia Myelophthisic anemia Sideroblastic anemia # 36 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 Panmyelophthisis Toxic anemia Acute posthemorrhagic anemia # 37 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) # 38 During a section of a man, who suffered from chronic anaemia, there was found: lemon-yellow skin colour, thin blood, Günter’s glossitis, atrophic gastritis. Liver, spleen and kidneys are thick, brown coloured, marrow is scarlet-red, juicy, looks like a raspberry jelly. What is the most probable diagnosis? @Addison-Birmer's disease Hypoplastic anaemia Aplastic anaemia Inherited haemolytic anaemia Iron-deficient anaemia # 39 A patient with chronic myeloleukemia has presentations of anemy - decrease of erythrocyte number and hemoglobin content, oxyphil and polychromatophil normocytes, microcytes. What pathogenetic mechanism is the main for the development of this anemy? Vitamin В12 deficiency Reduction of erythropoietin synthesis Intravascular erythrocyte hemolysis @Replacement of erythrocytic shoot Chronic hemorrhage # 40 In course of an operation on account of a granuloma in the area of the right upper incisor a patient began to bleed. The hemorrhage was stopped just only 3 hours later. The patient's anamnesis contains information about chronic lymphatic leukemia. What is the most probable cause of hemorrhage? Lymphocytosis Thrombocytopathia Eosinophilia Leukopenia @Thrombocytopenia # 41 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 “dry tap”. 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 # 42 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 # 43 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 patient’s 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 # 44 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 # 45 A patient's blood was analyzed and the decreased erythrocyte’s sedimentation rate (ESR) was discovered. What disease from the listed below is accompanied with decreased ESR? Myocardial infarction Hepatitis Splenomegaly @Polycytemia Vitamin B deficiency # 46 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? Leukopenia Thrombopenia Neutropenia Anemia @Lymphopenia # 47 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) Albumins Cholesterol Glucose Fibrinogen # 48 After the radiactive exposure a patient has stem cells disorder. The regeneration of what cells of friable connective tissue will be damaged? @Macrophages Pericytes Fibroblasts Pigment cells Adipocytes # 49 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 – 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 # 50 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 Pancytopenia Anemia Blast cells in peripheral blood Thrombocytopenia # 51 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 patient’s 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 # 52 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 Gomori’s methenamine-silver stain and is shown in the photomicrograph below. In consideration of the patient’s signs and microscopic evaluations, the prognosis is now complicated by Pseudomonas pneumonia Aspergillus pneumonia @Pneumocystis carinii pneumonia Pneumococcal pneumonia Influenza pneumonia # 53 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? Myeloblasts Monoblasts Megakaryoblasts @Lymphobblasts Erythroblasts # 54 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 # 55 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 Plasmocytosis Acute promyelocytic leukemia # 56 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 – less of blood in the internal organs, the enlargement of different groups of lymphatic nodules, thymomegaly, moderately signified hepatosplenomegaly, brightly red medulla; microscopically – 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 # 57 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 # Chronic leukaemias. Lymphomas. # 1 All the following are known to cause splenomegaly EXCEPT @Sickle cell disease Hodgkin’s disease Chronic lymphocytic leukemia (CLL) Hairy cell leukemia Polycythemia vera # 2 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 # 3 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 # 4 A 62-year-old female patient complains about frequent pains in the region of thorax and vertebral column, rib fractures. A physician suspected myelomatosis (plasmocytoma). Which of the following laboratory indices will be of the greatest diagnostic importance? @Paraproteinemia Hyperalbuminemia Hypoglobulinemia Proteinuria Hypoproteinemia # 5 Examination of a patient who was exposed to the ionizing radiation revealed damage of wight pulp. What cells of white pulp undergo pathological changes? Monocytes @Lymphocytes Tissue basophils Neutrophilic leukocytes Basophilic leukocytes # 6 |