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Diseases of haemopoetic and allied systems
1. A 34- year-old male is found to have weakness confusion, other neurologic manifestation and polyuria X-ray examination revealed multifocal destructive bone lesions throughout the skeletal system. Electrophoretic analysis revealed increased level of Ig in the blood and Bence Jones protein in the urine. What is the most likely diagnosis?
A.*Myeloma
B. Acute monocytic leukemia
C. Chronic myeloleukemia
D. Lymphogranulomatosis
E. Histiocytosis
2. A 42-year-old female is admitted to the hospital for treatment a blood disorder. A disease complicated with pneumonia led to lethal outcome. An autopsy revealed hyperplasia of a bone marrow with “pus” – like appearance, splenomegaly (5 kg weight), hepatomegaly (6 kg weight), systemic lymph nodes enlargement. What is the most likely diagnosis?
A* Chronic myeloleukemia
B. Chronic lymphatic leukemia
C. Myeloma
D. Polycytemia vera (erythremia, Osler's disease)
E. Lymphogranulomatosis
3. An elderly male is admitted to the hospital for treatment of humeral bone fructure. His fracture’s area X-ray showed a new growth and lytic zone within lesion. Histological examination of a biopsy revealed abnormal plasma cells. What is the most likely diagnosis?
A. * Myeloma
B. Chronic osteomyelitis
C. Chondrosarcoma.
D. Bone fibrous dysplasia
E. Metastasis of adenocarcinoma
4. At autopsy an elderly female is found to have enlarged groups of a neck, axillary and mediastinal lymph nodes matted together. They were firm and rubbery. The cut surface was gray-white, producing a “fish-flesh” appearance. Microscopy revealed heterogeneous cellular infiltrate wich contained lymphocytes, classic and mononuclear Reed-Berezovsky-Sternberg cells. What is the most likely diagnosis?
A. * Lymphogranulomatosis
B. Chronic lymphatic leukemia
C. Lymphosarcoma
D. Retikulosarcoma
E. Mycosis fungoides
5. A 67-year-old female presented with painless enlargement of lymph nodes. Histological examination of a biopsy sample revealed that the whole lymph node pattern was unclear, with heterogeneous cellular infiltrate. It included abnormal, immature cells admixed with lymphocytes, eosinophils, plasma cells and macrophages. Binucleated Berezovsky-Reed-Sternberg cells, where surrounded by multiple cell types. What is the most likely diagnosis?
A. * Lymphogranulomatosis
B. Acute myeloleukemia
C. Chronic myeloleukemia
D. Mycosis fungoides
E. Tuberculosis
6. A 25-year-old patient presented with peripheral adenopathy, involving a single cervical lymph node. A biopsy sample investigation revealed an unclear node pattern with mixed cellular infiltration. Histologycal study under higher magnification showed numerous variants of Berezovsky-Reed-Stenberg cells, lymphocytes, necrotic area and mild diffuse fibrosis. What is the most likely diagnosis?.
A. * Lymphogranulomatosis
B. Nodular lymphoma
C. Burkitt's lymphoma
D. Lymphocytic lymphoma
E. Chronic lymphatic leukemia
7. A 65-year-old female is noted to be anemic. He serum protein electrophoresis demonstration a large monoclonal Ig G kappa protein. In her bone marrow are increased numbers of atypical plasma cells. Her skull X-ray show multiple lytic areas. What is the most likely diagnosis?
A.* Myeloma
B. Polycytemia vera (erythremia, Osler's disease)
C. Lymphocytic lymphoma
D. Chondrosarcoma
E. Bone fibrous dysplasia
8. A thoracotomy of a 58-year-old woman revealed in her anterior mediastinum the enlarged and soldered together lymph nodes. Microscopical investigation revealed atypical cells with predominance of Hodgkin cells and giant Reed—Berezovsky - Sternberg cells. A sclerosis was absent. What is the most likely diagnosis?
A. *Lymphogranulomatosis with low-spirited development of lymphoid tissue
B. Lymphogranulomatosis with predominance of nodularis sclerosis
C. Lymphogranulomatosis with predominance of lymphoid tissue
D. Lymphosarcoma
E. Mixed-cellular variant of lymphogranulomatosis
9. A tomography revealed enlarged lymphatic nodes. A histological investigation of lymph node’s biopsy showed a circular growths of a connective tissue, which surrounded a granuloma - like formation, made from lymphocytes, plasmocytes and giant double- nuclear cells. What is the most likely diagnosis?
A. *Lymphogranulomatosis
B. Lymphosarcoma
C. Tuberculosis
D. Sarcoidosis
E. Lymphatic leukemia
10. The young man presented to his physician with enlarged neck lymph nodes. A microscopical investigation of a lymph node biopsy sample revealed the lymphoid tissue proliferation with presence of a giant Reed—Berezovsky - Sternberg cells, eosinocytes, zones of necrosis and sclerosis. What is the most likely diagnosis?
A. *Lymphogranulomatosis
B. Chronic lymphatic leukemia
C. Multiple myeloma
D. Lymphosarcoma
E. Histiocytosis
11. A biopsy of the enlarged lymph node was taken. A histological investigation revealed a diffuse growth of lymphoid cells with adding of eosinocytes, atypical histiocytes, solitary giant Reed—Berezovsky - Sternberg cells with two and more nuclei, cell’s necrosis and sclerosis. What is the most likely diagnosis?
A. * Lymphogranulomatosis
B. Lymphatic leukemia
C. Burkett’s lymphoma
D. Sarcoidosis
E. Myeloleukemia
12. An autopsy of a 67-year-old man revealed the systemic enlargement of lymph nodes with formation of tumorous conglomerates. The spleen was also enlarged with a motley pattern of a cut surface. There were plural, tiny, yellowish-white spots on a red background of a spleen’s pulp. What is the most likely diagnosis?
A. * Lymphogranulomatosis
B. Sarcoidosis
C. Lymphosarcoma
D. Carcinoma of lung
E. Lymphatic leukemia
13. Clinical investigation of a patient revealed the enlarged lymph nodes, spleen and liver. A microscopical study of the enlarged cervical (neck) lymph node showed the blurring of its structures and absence of lymphatic follicles. All microscopical views were presented by cells with round nuclei and narrow ring of a basophilic cytoplasm. What is the most likely diagnosis?
A. *Lymphatic leucosis
B. Lymphogranulomatosis
C. Lymphosarcoma
D. Myeloleukemia
E. Multiple myeloma
14. An autopsy of a 35-year-old woman revealed the enlarged spleen, (weight 800gm), liver (weight 4000 gm) and lymph nodes. A bone marrow of a femur diaphysis was juicy (succulent), crimson-red color. Microscopical study of a liver defined dense infiltrates within portal tracts, consisted of immature blood cells. These cells had a round nuclei and narrow ring of a cytoplasm. What is the most likely diagnosis?
A. *Chronic lymphatic leukemia
B. Chronic myeloid leucosis
C. Generalizated form of lymphogranulomatosis
D. Acute myeloblastic leucosis
E. Acute lymphoblastic leucosis
15. A microscopic investigation of the enlarged neck lymph node biopsy revealed the blurring of its structures, plenty of proliferating lymphocytes with adding of solitary giant Reed—Berezovsky - Sternberg cells. What is the most likely diagnosis?
A. *Lymphogranulomatosis, with predominance of lymphatic tissue
B. Lymphogranulomatosis, with exhaustion of lymphatic tissue
C. Mixed cell variant of lymphogranulomatosis
D. Lymphosarcoma
E. Nodular sclerotic variant of lymphogranulomatosis
16. At young men the increased cervical lymph node is removed. Microscopic investigation revealed the altered node’s structure, an absence of lymphoid follicles, sites of a sclerosis and necrosis. The cellular infiltrate is polymorphic with a presence of lymphocytes, eosinocytes, and atypical one-nuclear cells and multinuclear giant cells (Reed—Berezovsky - Sternberg cells). What is the most likely diagnosis?
A. * Lymphogranulomatosis
B. Acute lymphatic leukemia
C. Chronic lymphatic leukemia
D. Burkett’s lymphoma
E. Mycosis fungoides
17. A liver biopsy was taken from a 66-year-old man, with a history of increased quantity of lymphocytes and pro-lymphocytes in his blood. A histological investigation of a liver sample revealed plural accumulations of the mentioned above cells, mainly between hepatic segments. For what disease above listed changes are characteristic?
A. *Chronic lymphatic leukemia
B. Acute lymphatic leukemia
C. Lymphogranulomatosis
D. Chronic persistence hepatitis
E. Hepatocellular carcinoma of liver
18. 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?
A. * Acute lymphoblastic leucosis
B. Acute myeloblastic leucosis
C. Acute nondifferentiated leucosis
D. Acute monoblastic leucosis
E. Acute plazmoblastic leucosis
19. A 14-year-old boy presented to a hospital with enlarged submaxillary and cervical lymph nodes. A biopsy procedure was performed. Microscopical investigation revealed the disorder of a lymph node typical structure, a heterogeneous cellular population with a presence of giant multinuclear cells and plural one-nuclear big cells. There were also eosinocytes, neutrophils and lymphocytes in the cell infiltrate. In addition, sites of necrosis and sclerosis were found. What is the most likely diagnosis?
A. *Lymphogranulomatosis
B. Hyperplasia of lymphatic nodes
C. Granulomatous lymphadenitis
D. Purulent lymphadenitis
E. Non-Hodgkin’s lymphoma
20. A radiological investigation of a man’s head revealed in his maxillary and mandibular bones numerous round defects with smooth walls. A histological study showed osteolysis and osteoporosis accompanied with insufficient bone repair. The laboratory test of the urine detected the Bence Jones protein. What is the most likely diagnosis?
A. *Multiple myeloma
B. Chronic myeloleukemia
C. Chronic erythromyelosis
D. Acute myeloleukemia
E. Acute nondifferentiated leucosis
21. 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?
A. * Nutritional anemia due to vitamine B12 deficiency
B. Asiderotic anemia
C. Acute posthemorrhagic
D. Chronic posthemorrhagic
E. Hemolytic anemia
22. A physical examination of a 42-year-old man revealed enlarged lymph nodes. A histological investigation of a lymph node showed lymphocytes, histiocytes, reticular cells, small and big Hodgkin’s cells, multinuclear Berezovsky -Reed-Sternberg cells (Sternberg-Reed cells) infiltration with solitary necrotic areas. What disease such changes characteristic for?
A. * Lymphogranulomatosis
B. Lymphosarcoma
C. Chronic leucosis
D. Acute leucosis
E. Metastasis of carcinoma of lungs
23. 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 В12.
A. *Pernicious anemia
B. Drepancytic (sickle-cell) anemia
C. Panmyelophthisis
D. Toxic anemia
E. Acute posthemorrhagic anemia
24. 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?
A. *Addison-Biermer anemia
B. Fanconi's (congenital aplastic) anemia
C. Hypoplastic anemia
D. Chronic gastritis (type A)
E. Chronic gastritis (type B)
25. 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?
A. *Acute lymphatic leukemia
B. Chronic lymphatic leukemia
C. Hodgkin’s lymphoma
D. Follicular non-Hodgkin’s lymphoma
E. Mycosis fungoides
26. A post-mortem of a 15-year-old girl revealed enlarged neck, mediastinal and mesenteric lymph nodes, which were integrated in conglomerates. On a cut section, the tissue pattern of the nodes was non-uniform, with foci of necrosis. Microscopical investigation showed the uneven structure of lymph nodes, foci of sclerosis and necrosis. The cell population was also heterogeneous and included uninuclear atypical cells, giant multinuclear atypical cells, a significant amount of eosinocytes and neutrophils, and sparse lymphocytes. What is the most likely form of Hodgkin lymphoma (lymphogranulomatosis)?
A. * Lymphogranulomatosis, mixed cell variant
B. Lymphogranulomatosis, lymphohistiocytic variant
C. Lymphogranulomatosis, nodular sclerosis
D. Lymphogranulomatosis, variant with low-spirited development of lymphoid tissue
E. Hodgkin’s sarcoma
27. 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?
A. *Hypoplastic anemia
B. Megaloblastic anemia
C. Posthemorrhagic anemia
D. Iron deficiency anemia
28. 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?
A. * Hypochromic iron deficiency anemia
B. В12-folic acid deficiency anemia
C. Acute lymphoblast leukemia
D. Sicklemia sickle cell anemia
E. Aplastic anemia
29. 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:
A. * В12-folic acid deficiency anemia
B. Chronic posthemorrhagic anemia
C. Hemolytic anemia .
D. Chronic myeloid leukemia.
E. Aplastic anemia
30. 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?
A. * Aplastic anemia
B. В12-folic acid deficiency anemia
C. Hemolytic anemia
D. Myelodysplastic syndrome
E. Immune cytopenia
31. A patient presented with an infiltrative, plaque-like polymorphic skin rash, which had various contours, sizes and a congested -cyanotic color. The lesions tended to peripheral growth and fusion. A microscopical investigation of a skin biopsy revealed massive lymphocytes’ proliferation, which occupied the entire derma and a hypodermic fatty layer. What is the most likely diagnosis?
A. *Limphoma of skin
B. Systemic lupus erythematosus
C. Mycosis fungoi’des
D. Intradermal nevus
E.
32. A patient has a cluster of matted together dense lymph nodes on his neck. Histological examination of a removed lymph node revealed proliferation of reticular cells, presense of Reed-Sternberg cells. What disease is meant?
A. *Lymphogranulomatosis
B. Myeloblastic leukosis
C. Lymphoblastic leukosis
D. Myelocytic leukosis
E. Lymphocytic leukosis
33. Microscopical examination of an enlarged cervical lymph node revealed blurring of its structure, absence of lymphoid follicles; all the microscopic fields showed cells with roundish nuclei and thin limbus of basophil cytoplasm. It is known from the clinical data that other groups of lymph nodes are also enlarged as well as spleen and liver. What disease might be suspected?
A. *Lymphoid leukosis
B. Myeloid leukosis
C. Lymphosarcoma
D. Multiple myeloma
E. Lymphogranulomatosis