. Topic. 17. Pathophysiology of blood and hemopoietic organs.
1. Anemia, leuko- and thrombocytopenia, color index-1.3, presence of megaloblasts and megalocytes were determined in the laboratory analysis of blood of a patient a year later after he was operated on for subtotal resection of the stomach for the ulcer of lesser curvature of the stomach. What factor deficiency results in these changes? A. Gastromucoprotein*
2. Amino acids replacement in alpha and beta chains of hemoglobin takes place in a number of hemoglobinopathies. Which of them is typical for HbS (sickle-cell anemia)? A. Glycine to serine
Aspartate to lysine
Methionine to histidine
Glutamate to valine*
Alanine to serine
3. Hereditary microspherocytosis (Minkowski-Chauffard disease) was diagnosed in a woman aged 34. What mechanism caused hemolysis of erythrocytes in the patient?
Hypoplasia of bone marrow
4. Megaloblastic anemia was diagnosed in a patient. What substance deficiency may cause the development of this disease?
5. Three years ago a man aged 45 was operated on for stomach resection. After the operation the content of erythrocytes in the blood is 2.0x1012, Hb 85 g/L, color index1.27. What vitamin absorption is impaired that causes the change of erythropoiesis? A. C
6. A patient, carrier of hereditary sickle-cell erythrocytes anomaly, had pneumonia accompanied by hemolytic crisis and development of anemia. What is the main cause of hemolytic crisis in this case?
Mutation of structural gene
Hypoxia caused by pneumonia*
Blood osmolarity change
7. Examining the oral cavity of a patient, a dentist paid attention to the presence of inflammatory-dystrophy process in the mucous membrane (atrophic Hunter's glossitis, atrophic stomatitis). Blood analysis revealed hyperchromic anemia. What factor is a cause of this disease? A. Hypovitaminosis B6
Increase of stomach juice acidity
Hypovitaminosis B12 *
8. A female patient complains of malaise, weakness, breathlessness, rapid fatigability, and dizziness. Her blood test data: erythrocytes-1.8x1012/L, Hb-80 g/L, leukocytes3.2x109/L, color index-1.5. Anisocytosis, poikilocytosis, megaloblasts, megalocytes were found in smear. What is the possible diagnosis?
Iron deficiency anemia
9. A patient, aged 50, complains of a bad appetite, loss of weight, weakness, pain in the stomach area, and eructation. At laboratory examination of him: Hb-2x1012/L, stomach secretion 0.4 l, pH of stomach juice-7. Pernicious anemia is diagnosed in this patient. What compound of gastric juice deficiency is the cause of the disease?
10. Funicular myelosis and hyperchromic anemia developed in a man 7 years later after the stomach resection due to ulcer. What pathogenic mechanism of changes in spinal cord is the most possible one? A. Hypoxia impairment in anemia
Accumulation of methylmalonic acid in cyanocobalamin deficiency*
11. On the seventh day after hemorrhage caused by a trauma, the following was revealed in a patient’s blood: erythrocytes - 2.8x1012/l, Hb - 3.9mmol/l, reticulocytes - 15%, acidophilic and polychromatophilic normoblasts were found in smear. What is the mechanism of appearance of regenerative forms of blood erythrocytes?
Going out of blood deposition
Increase permeability of erythrocyte sprout of bone marrow
Intensification of regeneration of erythroid cells in bone marrow*
Inhibition of maturation of erythroid cells in bone marrow E. Inhibition of synthesis of erythropoietin inhibitor
12. When treating a patient for malaria with primaquine, hemolysis occurs in him. At examination deficiency of Glucose-6-phosphate Dehydrogenase in patient’s erythrocytes was revealed. What metabolic process is impaired in this patient?
Aerobic carbohydrate oxidation
13. B12-folate deficient anemia was diagnosed in a patient aged 55. What hematological index will be the most sensitive for pathogenetic treatment?
Increase of number of erythrocytes
Increase of number of reticulocytes
Reduction of anisocytosis*
Decrease of ESC
Decrease of amount of hemoglobin
14. In a pregnant woman, in the 7th month of pregnancy, anemia begins rising fast. In her blood test: number of erythrocytes is 2.7x1012/L, amount of hemoglobin is 90 g/L, anisocytosis, poikilocytosis, megaloblasts and megalocytes were found, reticulocytes of 0%. What sort of anemia develops in this case?
15. In an infant, who is under an artificial nutrition with cow milk, severe anemia has developed. At the blood count of the infant: number of erythrocytes is 4x1012/L, content of hemoglobin is 68 g/L, reticulocytes of 0%. What kind of anemia developed in the infant? A. Sickle-cell anemia
Inborn hemolytic anemia
16. Predomination of erythroblasts, normoblasts and megaloblasts was revealed in blood analysis of a patient with anemia. The same cells were found in bone marrow. What type of anemia do these changes characteristic for?
B12-folate deficiency anemia*
17. Two years ago a patient was operated on for resection of pyloric portion of the stomach. There is weakness, periodical appearance of dark circles under eyes, breathlessness in this patient. In the blood analysis: HB-70g/L, erythrocytes-
3.3x1012/L, color index-0.7. What erythrocyte changes in the blood smear are the most typical for the given state?
18. Singular oxyphilic normoblasts appeared in the blood of a patient after acute posttraumatic hemorrhage composing 15% of blood volume. On supravital staining 25% of reticulocytes were found. What is the patient anemia according to its ability of regeneration? A. Hyperregenerative*
Hypo- and aregenerative
19. What index of blood analysis is the most typical for beta-thalassemia?
Considerable decrease of erythrocytes and hemoglobin
Erythrocytes with basophilic stippling
Increase of fetal hemoglobin*
Increase of met-hemoglobin
20. A patient had anemia due to profuse blood loss. What blood changes are typical at the beginning of development of acute post-hemorrhagic anemia?
Presence of megalocytes in the blood
Absence of reticulocytes
21. Erythropenia, hyperchromia, normocytes, macrocytes, megalocytes, poikilocytosis were found out in a patient’s blood at examination. What is the cause of this pathology? A. Ascariasis
Deficiency of gastromucoprotein*
Iron deficiency in food
Frequent loss of blood
22. While studying a blood smear different forms of erythrocytes were found. Which of them are regenerative?
23. The presence of agranulocytosis was determined in the blood analysis of a liquidator of accident at Chernobyl atomic power station who had got 5 Gr dose of irradiation. What pathogenetic mechanism is the leading one in its appearance?
Inhibition of leucopoiesis*
Increased penetration of granulocytes into tissues
Increase of leukocytes destruction
Impairment of going out of mature leukocytes from bone marrow
Development of autoimmune process.
24. During the development of acute pulpitis a patient complained of paroxysm of pain in the upper jaw, which is increasing at night, fever. At examination leucocytosis was established in the blood. What kind of leucocytosis is possible in this case?
25. Considerable increase of the number of eosinophils in a unit of blood volume was determined during the examination of a 5 years old boy. What may cause eosinophilia in this patient?
26. In the patient’s blood analysis the number of leukocytes is 250*109/L. What syndrome does this patient have?
Leukopenia D. Leukemoid reaction
27. Leucocytosis was found out in a person who didn’t complain of his health. The cause of this may be that fact that the blood was taken for analysis after:
Rest at a health resort
Considerable use of water
Usage of alcohol
28. Lymphocytosis was revealed in a patient. What diseases may be accompanied by lymphocytosis?
Pertussis, chicken pox*
29. Neutropenia is found out in a patient who has the manifestations of immunodeficiency. What diseases may neutropenia be determined in?
After profuse hemorrhage
Fusarium fungus poisoning*
Insufficiency of sexual gland function
30. Increase of the number of eosinophils was determined in a patient with endocrine pathology during examination. Which of the named diseases may be accompanied by eosinophilia?
31. Functional insufficiency of monocytes is accompanied by immunodeficiency. What BAS produced by monocytes stimulate specific response?
32. Relative neutropenia with degenerative shift was revealed in the blood of a patient with TB during examination. What change of differential blood count corresponds to this state?
Decrease of the number of segmented forms and increase of band forms of neutrophils*
Decrease of lymphocyte number
Increase of monocyte number
Increase of basophil number
Decrease of eosinophil number
33. Neutrophil leukocytosis was revealed in worker during examination. What pathologic condition may neutrophil leukocytosis result from?
Chronic loss of blood
34. A patient aged 32 with massive hemorrhage due to car accident trauma was admitted to the hospital. Pluse-100 beats per min, respiratory rate-22 per 2 min, BP100/60 mmHg. What blood change will be the most characteristic in an hour after hemorrhage? A. Erythropenia
35. During the examination of peripheral blood of a patient aged 42, it was revealed: Hb-80g/L, erythrocytes-3.2 x 1012/L, leukocytes-25 x 109/L, leukocytic formula: basophils-5%, eosinophils- 9%, myeloblasts- 3 %, promyelocytes-8%, neutrophils17%, segmented- 19%, lymphocytes- 3 %, monocytes- 3%. What blood pathology is the most possible in this patient?
Acute myeloblast leukemia
Chronic myelogenous leukemia*
36. The experiment was carried out on a rabbit. The increase of the number of erythrocytes and hemoglobin in the blood due to the stimulation of erythropoiesis by erythropoietin was determined 2 weeks later after the narrowing of renal artery. What increases the formation of erythropoietin?
37. Hemolytic anemia with decrease of osmotic erythrocyte resistance that averaged
0.6-0.5 was revealed in a smear of venous blood during microscopic examination. What substance accumulation in the blood plasma may also indicate the development oh hemolytic anemia?
38. Hypochromia of erythrocytes, micro-, anisocytosis, poikilocytosis, are determined in the blood in case of development of iron deficiency and iron refractory anemia. What index must be determined to carry out differential diagnosis of these anemias?
39. B12 folic deficiency anemia developed in a patient after stomach resection. What color index is typical for this disease?
40. A victim of a car accident has lost much blood. What impairment of general blood volume takes place? A. Simple hypovolemia
41. Excessive flow of estrogens into the blood due to follicle persistence (a state when follicle does not reach complete maturation and ovulation does not take place) often cause uterine bleeding. What anemia may develop in this case?
42. Which of the below named anemias relevant to hemoglobinopathies?
Iron deficiency anemia
Iron refractory anemia
43. Evaluate the blood analysis: erythrocytes 3.10; Hb 90g/L reticulocytes 0.5%. In the smear there are poikilocytes hypochromatic erythrocytes. Blood serum iron is 80 micromol/l. What pathology is this typical for?
Iron deficiency anemia
Sickle cell anemia
Iron refractory anemia*
44. What conditions are accompanied by neutrophilic leukocytosis with shift of differential count to the left?
45. What blood pathology is the presence of Philadelphia chromosomes in the blood cells and bone marrow cells typical for?
Acute myelogenous leukemia
Chronic myelogenous leukemia*
Chronic lymphocyte leukemia
46. Patient M, aged 20 was admitted to the hospital complaining of high temperature, pain in the bones, and hemorrhage from his gums. Blood analysis of this patient shows: erythrocytes-2.5x1012/L; Hb-80g/L; leucocytes-2.0x109/L; thrombocytes-6.0x109/L; differential count: eosinophils-1%; stab neutrophils-1%; segmented neutrophils-10%; lymphocytes-10%; monocytes-3%; blast cells-75%. What pathology is this blood analysis typical for? A. Hodgkin’s disease
47. General amount of leucocytes is 90x109/l. In differential count: eosinophils-1%; basophils-0%; juvenile neutrophils-0%; stab neutrophils-2%; segmented neutrophils20%; prolymphocytes-2%; lymphocytes-70%; Botkin-Gumprecht cells. Cervical, submandibular lymph nodes are enlarged. What pathology is such blood picture typical for?
Acute lymphoblastic leukemia
Chronic lymphocytic leukemia*
Chronic myelogenous leukemia
48. Hypochromic anemia was found out in a patient aged 54, who had a prolonged contact with lead at his work. Treatment with iron preparations for a month didn’t give any effect. The increased amount of iron was determined in blood serum. What is this anemia due to?
Vitamin B12 deficiency
Porphyrin synthesis impairment
Folic acid deficiency
Hypoplasia of red bone marrow*
49. A patient aged 20, has periodically yellowness of sclera and skin that is accompanied by weakness. Minkowski-Chauffard disease is diagnosed. What is the most typical for blood picture in this disease?
50. Posthemorrhagic anemia has developed in a patient with periodical bleeding due to uterus fibromyoma. What type of chronic post hemorrhagic anemia takes place in this case?
Megaloblastic, hyperchromic, hyperegenerative.
Megaloblastic, hypochromic, hyporegenerative.
Erythroblastic, hyperchromic, hyporegenerative.
Erythroblastic, hypochromic, hyperregenerative.
Erythroblastic, hypochromic, hyporegenerative.*
51. A female patient with impairment of menstrual cycle accompanied by prolonged bleeding the blood analysis was made which revealed hypochromia, decrease of reticulocytes, microcytosis. What group does this anemia belong to according to pathogenesis?
B12 folic deficiency anemia
Iron deficiency anemia*
52. Patient R. aged 12 was operated on for acute phlegmonous appendicitis. At the examination of his blood, the amount of leukocytes is 12.109/L. On the blood smear there are: basophils – 0%; eosinophils – 2%; monocytes – 2%; juvenile neutrophils – 0%; stab neutrophils – 30%; segmented neutrophils – 43%; lymphocytes – 23%; monocytes – 0%. Stab (immature) neutrophils have pyknosis of nuclei. There is anisocytosis of neutrophils; some of them have toxic granulation. What form of change of leukocyte blood composition takes place in this case? A. Neutrophilia with degenerative shift to the left.
Neutrophilia with regenerative shift to the left.
Neutrophilia with hyperegenerative shift to the left. D. Leukemoid reaction of neutrophil type.*
E. Neutrophilia with the shift to the right.
53. Which of the below given hematological characteristics corresponds to chronic post-hemorrhagic anemia?
Hyperregenerative, hypochromic with erythroblasts type of bleeding.
Regenerative, hypochromic with erythroblasts type of bleeding.
Hyporegenerative, hypochromic with megaloblasts type of bleeding.
Hyporegenerative, hypochromic with erythroblasts type of bleeding.*
Hyporegenarative, hyperchromic with megaloblasts type of bleeding.
54. A female patient, aged 25, was admitted to the hematological department with complains of the appearance of hemorrhages of different sizes on the body; during menstruation there are uterine bleedings. She has been ill for ten years. Paleness of skin and mucous membranes were determined on examination; there are hemorrhages of different size and color on the upper and lower extremities. Pulse = 100 beats/minute, BP 110/70 mmHg. Blood analysis shows: erythrocytes 3.3*1012 /L, Hb 80g/L, thrombocytes 33*109/L; time of blood coagulation: beginning is at 2nd minute, end is at 6th minute; time of bleeding (according to Duke) - 15 minutes. What is the possible diagnosis? A. Marchiafava-Micheli disease.
B. Thrombocytopenic purpura.* C. Glanzmann's thrombasthenia.
von Willebrand thrombocytopathia
Chronic myelogenous leukemia.
55. Neutrophil leukocytosis is determined in a patient with chronic myelogenous leukemia. Which variant of nuclear shift of differential count to the left is the most typical for chronic myelogenous leukemia?
A. Regenerative B. Degenerative.
Regenerative and degenerative.
56. A patient with atrophic gastritis has vitamin B12 deficiency. What variant of nuclear shift of differential count is most typical for B12 hypovitaminosis? A. Hyper regenerative to the left
Degenerative to the left.
Regenerative and degenerative to the left.
To the right*
Regenerative to the left
57. Hypochromic anemia was diagnosed in a patient on the 7th day after acute hemorrhage. What mechanism is the leading one in its development?
Increase of iron excretion from the organism;
Impairment of globin synthesis;
Increased erythrocyte destruction in the spleen;
Impairment of iron absorption in the intestine;
Increased pen0etration of immature erythrocytes from bone marrow.*
58. Hemiparesis appeared in a patient with acute promyelocytic leukemia. What is the main mechanism of the impairment of CNS in this case?
Intoxication by leukemic cells decay products;
Formation of leukemic infiltrates;*
Impairment of disintoxicational function of the liver;
Increase of thrombogenesis.
59. Acute pain in the lower jaw, swelling of the cheek, temperature of 37.6oC occurred in the patient who had had dental caries for some years. What changes in the patient’s blood may be observed in this case?
60. A patient aged 43 has stomatitis, glossitis, the tongue is crimson color, smooth. Blood analysis revealed: Hb 100 g/l; erythrocytes 2.3x1019/l; color index 1.30. What is the patient’s state due to?
Hypoplasia of red bone marrow
Impairment of porphyrin synthesis
Vitamin B12 deficiency*
61. After resection of small intestine a patient complained of increased fatigability, infringement of taste, fragility of nails, quick decay of dental enamel, and appearance of breathlessness on physical exertion. Which of the below given substances is the source of impairments in the patient’s organism?
B12-folic deficiency anemia
Vitamin D deficiency
Iron deficiency anemia*
62. A female patient took analgin because of toothache. Dark urine, icteric sclera, weakness appeared in her two days later. Which of the causes given below is the most possible one?
Immune hemolytic anemia*
63. A patient with acute pulpitis has an increased body temperature and a number of leukocytes up to 14.109/L, differential count represents: basophils-0%; eosinophils-2%; megakaryocytes-0%; juvenile neutrophils-2%; stab neutrophils-8%; segmented neutrophils-58%; lymphocytes-26%; monocytes-4%. How can you evaluate such changes in blood?
A. Neutrophilic leukocytosis with regenerative shift to the left* B. Neutrophilic leukocytosis degenerative shift to the left
Neutrophilic leukocytosis with hyperregenerative shift to the left
Neutrophilic leukocytosis with shift to the right
64. A patient aged 30 took sulfaethidole for infectious process of mucous membrane in the mouth locally (as powder). Preparation has hemotoxic action and the treatment was complicated by the development of agranulocytosis. At examination it was revealed:
Increase of agranulocytes in the blood;
Decrease of the number of granulocytes in the blood on the background of leukocytosis;
Decrease of the number of granulocytes in the blood on the background of leukopenia;*
Decrease of the number of neutrophilic granules with their simultaneous increase;
Loss of their granules by granulocytes.
65. A women fell ill with purulent stomatitis. What index of complete blood count is characteristic for this disease?
66. It is recommended to perform a clinical examination of blood in an empty stomach.
What compounds of peripheral blood may be changed after taking food?
Decrease in number of platelets
Elevation of number of leukocytes*
Elevation of number of erythrocytes
Increase in content of plasma proteins
Reduction of number of erythrocytes
67. Acute inflammatory disease of upper airways and eyes appears in 45-years-old woman at the period of blossom of grass. Symptoms of this disease are hyperemia, edema, and mucous secretions. What kind of leukocytosis is the most characteristic one for this disease? A. Neutrophilia
68. Enlargement of liver and spleen, anemia, and myeloblasts in peripheral blood were revealed in a patient with acute leukemia. What is the main trait, which allows to distinguish acute myelogenous leukemia from chronic one?
Blast cells in peripheral blood
69. Extraction of a tooth, in a patient with chronic lymphocytic leukemia, was complicated by prolonged bleeding. What may cause the hemorrhagic syndrome in this patient?
70. In blood analysis of 37-years-old woman following data were revealed: content of hemoglobin is 60 g/L, number of erythrocytes is 3.0x1012/L, and color index of 0.6; differential count of leukocytes without any changes; number of platelets is 200x109/L; reticulocytes count of 0.3%; ESR of 18 mm/hour; microcytosis and poikilocytosis of erythrocytes. Indicate the most probable type of anemia according to mechanisms of its development.
Acute post-hemorrhagic anemia
Iron deficiency anemia*
B12-folate deficiency anemia
71. In a patient aged 35 autoimmune hemolytic anemia developed. What index of blood serum is the most increased in this case?
72. A patient addressed a dentist with complaints of affections of mucous membrane of his mouth. During the examination of the patient ulcerous stomatitis with necrosis in center was revealed at him in area of his palate. In the history of disease of the patient recently endued pneumonia and taking of medicines (sulfonamides) were present. After administering treatment the doctor pointed the patient for blood analysis. What pathology from below mentioned does doctor suppose?
Iron deficiency anemia
73. A 40-years-old male patient, who was bitten by snake, was admitted to the hospital. What place does hemolysis occur at in this case?
In hepatic cells
In the spleen
In the bone marrow
In renal parenchyma
74. Myocardial infarction was diagnosed in 65-years-old man. Neutrophilic leukocytosis with left shift is present in the blood of this patient. What factors underlie this phenomenon?
Products of tissue decay*
Elevation of mass of muscular fibers
Disorders of alveolar ventilation
Decrease in glycogen content in the myocardium
Increase of arterial pressure
75. B12 deficiency anemia was diagnosed in a man aged 57 after examination of him. Treatment was administered to this patient. Control blood test in this patient was performed in 3 years. What is the most adequate criterion for enhancement of erythropoiesis?
Increase in number of reticulocytes*
Increase in hemoglobin content
Decrease in color index
Increase in number of leukocytes
76. Patient with chronic subacid gastritis has hypochromic anemia. In the blood smear of this patient agranulocytes, micro- and anisocytosis, and poikilocytosis are revealed. Name this anemia.
Iron deficiency anemia*
Acute post-hemorrhagic anemia
77. Increased concentration of leukopoietins in blood was found in a patient with acute appendicitis. What kind of leukocytosis occurs in these conditions?
78. A patient has deficiency of cyanocobalamin and folic acid that leads to disorder of leucopoiesis. What changes takes place in these conditions?
79. A patient, who was exposed to ionizing radiation, has panmyelophthisis and secondary infections. What changes occur in blood analysis in this case?
80. A patient with leukemia has general number of leukocytes of 120.0x109/L. What kind of leukemia does this patient have?
81. In a woman hypochromic anemia was diagnosed after delivery accompanied by marked bleeding. What pathologic forms of erythrocytes are characteristic ones for this type of anemia?
82. Patient with chronic leukemia has sharply increased temperature, breathlessness, marked muscular weakness at insignificant physical exertion, increased sweating, cough. What mechanism of leukemia influence upon organism underlies complications in this patient?
Immunodeficiency due to functional inability of leukocytes*
Internal bleeding because metastases into vessel wall
Airway obstruction because of development of metastases
83. When examining a blood in a patient, who endued bleeding three days ago, following data was revealed: number of leukocytes is 12x109/L, basophils count is 0%, eosinophils count is 3%, myelocytes count 0%, juvenile neutrophils count is 3%, stab neutrophils count is 12%, segmented neutrophils count is 62%, lymphocytes count 16%, and monocytes count is 4%. What kind of changes of leukocyte differential count takes place in this case?
Neutrophilia with regenerative shift to the left*
Neutrophilia with degenerative shift to the left
Neutrophilia with shift to the right
84. A 40-years-old patient, who was admitted to the surgical department with diagnosis of phlegmona of thigh, had high temperature, tachycardia, and breathlessness. On the blood test of this patient: number of leukocytes is 25x109/L; eosinophils count is 1%, myelocytes count is 1%, juvenile neutrophils count is 15%, band neutrophils count is 25%, segmented neutrophils count is 40%, lymphocytes count 14%, monocytes count is 4%. What kind of shift in differential count is present in this case?
85. What is the cause of intracellular hemolysis?
Genetic infringements of erythrocytes*
Action of hemolytic poison
Infection with hemolytic streptococcus
Transfusion of incompatible blood
86. What kind of disorders of total blood volume appears in case of absolute erythrocytosis?
87. Beta-thalassemia was revealed in a patient, who came from Tunis. The disease was accompanied by hemolysis and jaundice. The disease was diagnosed on the base of presence in blood:
88. During the examination of adolescents that reside in mounting region increase in level of erythrocytes and hemoglobin in peripheral blood was found out. What is the reason for indicated erythrocytosis?
Diseases of lungs
Congenital heart disease
Condensation of blood due to large loss of water
89. Content of hemoglobin and number of erythrocytes significantly decreases in a patient’s blood from time to time. It was found out that such attacks appear after taking some horse beans. What kind of anemia takes place in this case?