MODULE 2. Class 19. Hemolytic anemia in children.
Hereditary. Acquired. Hemolytic-uremic syndrome
(Gasser's syndrome).
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Pathogenesis of trans immune hemolytic anemia:
a. Interaction of circulating immune complexes with
erythrocyte antigens of the patient
b. Interaction of maternal antibodies with fetal
erythrocyte antigens
c. Interaction of blocking antibodies with fetal
erythrocyte antigens
d. Increased sequestration capacity of the spleen
Коментар
Правильна відповідь: Interaction of maternal
antibodies with fetal erythrocyte antigens
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What causes the destruction of erythrocytes in G-6-FDG
deficiency:
a. Toxic effect on erythrocytes
b. Increasing the sequestration capacity of the spleen
c. Decrease in the number of erythropoiesis
precursors in the bone marrow
d. Hemolysis
e. Delay of erythrocyte maturation in bone marrow
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Правильна відповідь: Hemolysis
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Microspherocytosis is observed in:
a. Decreases in cholesterol and phospholipids in
blood plasma and erythrocyte membrane
b. Absence of spectrin protein in the erythrocyte
membrane
c. Decreases in ATP and 2,3-DFG in erythrocytes
d. Anomalies of rhesus system antigens
Коментар
Правильна відповідь: Absence of spectrin protein in
the erythrocyte membrane
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Laboratory parameters for anemia associated with G-6-
FDG deficiency:
a. Pancytopenia, reticulocytosis, high normoblastosis
b. Anemia, thrombocytopenia, leukocytosis
c. Anemia, planocytosis, severe hypochromia of
erythrocytes
d. Sharp decrease in the number of erythrocytes,
hemoglobin, reticulocytosis, macrocytosis,
normoblastosis
e. Megaloblastoid hematopoiesis
Коментар
Правильна відповідь: Sharp decrease in the number of
erythrocytes, hemoglobin, reticulocytosis, macrocytosis,
normoblastosis
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Stomatocytosis occurs in:
a. Anomalies of rhesus system antigens
b. Changes in cholesterol and phospholipids in blood
plasma and erythrocyte membrane
c. Absence of spectrin protein in the erythrocyte
membrane
d. Primary disruption of membrane protein structure
and increased sodium erythrocyte uptake
Коментар
Правильна відповідь: Primary disruption of membrane
protein structure and increased sodium erythrocyte
uptake
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The thickness of erythrocytes in Minkowski-Schoffar
disease is:
a. 2.5 - 3 microns
b. 0.7 - 1.5 microns
c. 1.5 - 1.9 microns
d. 1.9 - 2.1 microns
Коментар
Правильна відповідь: 2.5 - 3 microns
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A characteristic feature of autoimmune hemolytic
anemia with thermal hemolysins is:
a. Hyperbilirubinemia
b. Decrease in osmotic resistance of erythrocytes
c. Stigmas of dysembryogenesis
d. Excretion of black urine
e. High content of histamine in blood serum
Коментар
Правильна відповідь: Excretion of black urine
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Time of onset of hemolysis due to medication for G-6FDG deficiency:
a. Immediately
b. 48 hours
c. After 2-3 hours
d. During the day
e. 3 - 5 day
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Правильна відповідь: 3 - 5 day
Питання 9
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The main pathogenetic mechanism in hereditary
elliptocytosis:
a. Violation of erythrocyte membrane structure
b. Intoxication
c. Lesions at the level of cells - the precursor of
myelopoiesis
d. Presence of circulating antierythrocyte antibodies
Коментар
Правильна відповідь: Violation of erythrocyte
membrane structure
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Hypovolemic (circulatory) collapse (shock) in SKA - a
manifestation of the crisis:
a. Sequestration
b. Hemorrhagic
c. Aplastic
d. Hemolytic
e. Vase-occlusive
Коментар
Правильна відповідь: Sequestration
Питання 11
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The most effective treatment for Minkowski-Schoffar
disease:
a. Glucocorticoid hormones
b. Transfusions of erythrocyte mass
c. Vitamin therapy
d. Splenectomy
Коментар
Правильна відповідь: Splenectomy
Питання 12
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Target erythrocytes are most characteristic of:
a. Thalassemia
b. Acquired hemolytic anemias
c. B12-deficient anemia
d. Intoxication
e. Minkowski-Schoffar anemia
Коментар
Правильна відповідь: Thalassemia
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Morphology of erythrocytes in Minkowski-Schoffar
disease:
a. Aniso-poikilocytosis
b. Target invisibility of erythrocytes
c. Ovalocytosis
d. Microspherocytosis
e. Acanthocytosis
Коментар
Правильна відповідь: Microspherocytosis
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Color index in Minkowski-Schoffar disease:
a. 0.5 and below
b. 0.8 - 1.05
c. 1.05 - 1.2
d. Below 0, 8
e. 0.5 - 0, 85
Коментар
Правильна відповідь: 0.8 - 1.05
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Osmotic resistance of erythrocytes in hereditary
elliptocytosis:
a. No change
b. Reduced
c. Increased
d. Normal
e. Increases after treatment
Коментар
Правильна відповідь: Reduced
Питання 16
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Picture of blood in Minkowski-Schoffar disease:
a. Normocytosis, decrease in erythrocyte content
b. Anisocytosis, decreased erythrocyte content,
thrombocytopenia
c. Anisocytosis, poikilocytosis, thrombocytosis
d. Macroanisocytosis, poikilocytosis of erythrocytes,
decrease in hemoglobin content
e. Microspherocytosis, anemia, reticulocytosis
Коментар
Правильна відповідь: Microspherocytosis, anemia,
reticulocytosis
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The main pathogenetic factor of Minkowski-Schoffar
disease:
a. Toxic effect on erythrocytes
b. Presence of circulating antierythrocyte antibodies
c. Violation of the structure of the membrane protein
of erythrocytes of the spectrum
d. Hypovitaminosis C
Коментар
Правильна відповідь: Violation of the structure of the
membrane protein of erythrocytes of the spectrum
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Osmotic resistance of erythrocytes in congenital
microspherocytosis:
a. Increased
b. Reduced
c. Normal
d. Without features
e. It changes cyclically
Коментар
Правильна відповідь: Reduced
Питання 19
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The picture of blood in thalassemia:
a. Anemia, microspherocytosis, accelerated ESR
b. Anemia, erythrocyte targeting, aniso-, poikilocytosis,
normoblastosis, leukopenia
c. Pancytopenia, macroanisocytosis, normoblastosis
d. Anemia, normoblastosis, Heinz bodies in
erythrocytes
e. Anemia, erythrocyte hypochromia,
hyperthrombocytosis
Коментар
Правильна відповідь: Anemia, erythrocyte targeting,
aniso-, poikilocytosis, normoblastosis, leukopenia
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Acanthocytosis is observed in:
a. Anomalies of rhesus system antigens
b. Changes in the content of cholesterol and
phospholipids in blood plasma and erythrocyte
membrane
c. Decreases in ATP and 2,3-DFG in erythrocytes
d. Increased intake of sodium ions in the erythrocyte
Коментар
Правильна відповідь: Changes in the content of
cholesterol and phospholipids in blood plasma and
erythrocyte membrane
Питання 21
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The main clinical signs of congenital microspherocytic
anemia:
a. Anemia, skeletal bone lesions, pyelonephritis
b. Megaloblastic anemia, glossitis, optic nerve
damage
c. Anemia, general edema, nuclear jaundice
d. Jaundice, splenomegaly, anemia
e. Macrocytic anemia, intoxication syndrome, hepatitis
Коментар
Правильна відповідь: Jaundice, splenomegaly, anemia
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Dominant clinical manifestations of sickle cell anemia:
a. Hemolytic and vascular-thrombotic crises
b. Hypoxic syndrome
c. Sequestration crises
d. Severe intoxication syndrome
e. Aplastic crises
Коментар
Правильна відповідь: Hemolytic and vascularthrombotic crises
Питання 23
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Osmotic resistance of erythrocytes in hereditary
stomatocytosis:
a. Normal
b. No change
c. Increased
d. Increases with the use of glucocorticoid hormones
e. Reduced
Коментар
Правильна відповідь: Reduced
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Life expectancy of erythrocytes in congenital
microspherocytosis:
a. Normal
b. Abruptly reduced
c. Without features
d. Elongated
e. Reduced during the hemolytic crisis
Коментар
Правильна відповідь: Abruptly reduced
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The main pathogenetic factor in the development of
thalassemia:
a. Disorders of heme synthesis
b. Increased sequestration capacity of the spleen
c. Effect on erythrocytes of circulating immune
complexes
d. Deficiency of glucose-6-phosphate dehydrogenase
activity
e. Hereditary disorder of one of the globin chains
Коментар
Правильна відповідь: Hereditary disorder of one of the
globin chains
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Erythrocyte sizes in Minkowski-Schoffar disease:
a. Up to 7 microns
b. More than 50 microns
c. 2 - 3 microns
d. 5 - 7 microns
e. More than 12 microns
Коментар
Правильна відповідь: 5 - 7 microns
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A 5-year-old girl is brought to the emergency department
because of abdominal pain, vomiting, and diarrhea for 6
days. Her mother says that over the last 24 hours she
has developed a rash and has been urinating less
frequently than usual. One month ago, she had a 3-day
episode of high fever and sore throat that subsided
without medical treatment. She appears weak. Her
temperature is 37.7°C (99.8°F), pulse is 120/min,
respirations are 28/min, and blood pressure is 114/72
mm Hg. Examination shows petechiae on the trunk and
jaundice of the skin. The abdomen is diffusely tender
with no peritoneal signs. Neurological examination
shows no abnormalities. Laboratory studies show:
Hemoglobin 8g/dL, mean corpuscular volume 85 μm3,
Leukocyte count 16,200/mm3, Platelet count
38,000/mm3, Serum: Blood urea nitrogen 43 mg/dL,
Creatinine 2.9 mg/dL, pH 7.0.
Urine dipstick is positive for blood and protein. A blood
smear shows schistocytes and normochromic,
normocytic cells. In addition to supportive treatment,
which of the following is the most appropriate next step
in management of this patient?
a. Diazepam therapy
b. Levofloxacin therapy
c. Unfractionated heparin therapy
d. Hemodialysis
e. Platelet transfusion
f. Eculizumab therapy
g. Plasma exchange therapy
h. Azithromycin therapy
i. Red blood cell transfusions
Коментар
Правильна відповідь: Hemodialysis
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Time of appearance of symptoms of favism:
a. After 48 hours
b. Immediately after the influence of provoking factors
c. In a month
d. After repeated application of provoking factors
e. After 24 years
Коментар
Правильна відповідь: Immediately after the influence
of provoking factors
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The main pathogenetic changes in sickle cell anemia
include all, EXCEPT:
a. Hypoxia
b. Increase in blood viscosity, slowing of blood flow,
blood stasis in capillaries
c. Microinfarctions in organs and tissues
d. Decrease in blood viscosity
e. Hemolysis of erythrocytes
Коментар
Правильна відповідь: Decrease in blood viscosity
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Clinical features of Favism are manifested in:
a. Overdose of glucocorticoids
b. Alcohol intake
c. Vaccinations
d. Eating horse beans after inhaling flower pollen
Коментар
Правильна відповідь: Eating horse beans after inhaling
flower pollen
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Elliptocytosis is observed in:
a. Changes in cholesterol and phospholipids in blood
plasma and erythrocyte membrane
b. Absence of spectrin protein in the membrane of
erythrocytes
c. Decreases in ATP and 2,3-DFG in erythrocytes
d. Increased intake of sodium ions in the erythrocyte
e. Anomalies of rhesus system antigens
Коментар
Правильна відповідь: Decreases in ATP and 2,3-DFG in
erythrocytes
MODULE 2. Class 20. Hypo- and aplastic anemias in
children. Etiopathogenesis. Difficulty criteria. Hereditary
anemias (Fanconi. Estren-Dameshek, BlackfanDiamond). Acquired anemia (acute, subacute, chronic).
Clinic. Diagnosis. Treatment.
Question 1
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A 2-year-old girl from southern China is very pale and
sleepy. The spleen is enlarged to the level of the navel.
Blood test: hemoglobin - 63 g / l, MCV - 55 fl,
reticulocytes - 12%, platelets and leukocytes are normal.
Peripheral blood smear: many target erythrocytes,
polychromasia, basophilic erythrocyte punctuation,
hypochromia. Your preliminary diagnosis?
a. Fanconi's anemia
b. Thalassemia
c. Hemoglobin S
d. Deficiency of glucose-6-phosphate dehydrogenase
Comment
Correct answers: Hemoglobin S, Thalassemia
Question 2
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What type of therapy is most effective for Fanconi-type
anemia?
a. Calcium preparations
b. Glucocorticoid hormones
c. Bone marrow transplant
d. Systematic blood transfusions
e. Glucocorticoid hormones in combination with
erythrocyte transfusions
Comment
Correct answer: Bone marrow transplantation
Question 3
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In 10 days after the transferred SARS the analysis of
blood of a girl of 18 months was as follows: hemoglobin
- 68 g / l, MCV - 78 fl, reticulocytes - 0.1%, leukocytes,
thrombocytes - norm. After peripheral blood smear
pathology was detected. The girl is pale, without visible
jaundice. Your preliminary diagnosis?
a. Autoimmune hemolytic anemia
b. Iron deficiency anemia
c. Deficiency of glucose-6-phosphate dehydrogenase
d. Transient erythroblastopenia of childhood
e. Anemia in inflammatory processes
Comment
Correct answer: Transient erythroblastopenia of
childhood
Question 4
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A 14-year-old girl complains of weakness, loss of
appetite, fever to subfebrile numbers, petechiae,
ecchymoses on the skin, bleeding from the mucous
membranes. The following changes in peripheral blood
were revealed: erythrocytes - 2,0х10 ^ 12 / l, hemoglobin
- 62 g / l, MCV - 110 fl, MCH - 31 pg, reticulocytes - 0,1%,
hematocrit - 22%, leukocytes - 0, 9x10 ^ 9 / l, neutrophils
- 13%, monocytes - 21%, lymphocytes - 66%, platelets 5.0x10 ^ 9 / l. Your preliminary diagnosis?
a. Hemolytic anemia
b. B12-deficient anemia
c. Aplastic anemia
Comment
Correct answer: Aplastic anemia
Question 5
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Tactics for the treatment of mild aplastic anemia:
a. Hematopoietic stem cell transplantation
b. Immunosuppressive therapy
c. The use of colony-stimulating factors
d. Blood transfusion therapy
e. Vitamin therapy
Comment
Correct answer: Immunosuppressive therapy
Question 6
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Myelogram in Diamond-Blackfan anemia is
characterized by:
a. Narrowing of all hematopoietic sprouts
b. Complete disappearance of megakaryocytes
c. Narrowing of a red sprout, disturbance of
granulocyte sprout maturation
d. Normocellular bone marrow with isolated decrease
in erythroid precursors
Comment
Correct answer: Normocellular bone marrow with
isolated decrease in erythroid precursors
Question 7
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The most effective type of therapy for DiamondBlackfan anemia:
a. Antibiotic therapy in combination with vitamin
therapy
b. Constant intake of vitamin B12
c. Systematic transfusions of erythrocyte mass in
combination with glucocorticoids
d. Vitamin and mineral complexes twice a year
e. Constant intake of iron preparations
Comment
Correct answer: Systematic transfusions of erythrocyte
mass in combination with glucocorticoids
Question 8
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Condition of bone marrow in aplastic anemia:
a. Decrease in the content of myelokaryocytes,
increase in the number of reticular and plasma cells
b. Normal content of myelokaryocytes, narrowing of
erythroid hematopoietic sprout
c. Cellular bone marrow, sharp narrowing of erythroid
hematopoietic sprout
d. Decrease in myelokaryocyte content, lymphocytosis,
narrowing of megakaryocyte and erythroid
hematopoietic progenitors
Comment
Correct answer: Decrease in myelokaryocyte content,
lymphocytosis, narrowing of megakaryocyte and
erythroid hematopoietic progenitors
Question 9
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Blood test of an 8-year-old girl is as follows: hemoglobin
- 115 g / l, MCV - 102 fl, reticulocytes - 0.4%, platelets 125x10 ^ 9 / l. The girl is short, has short thumbs, a few
large brown spots on her skin, and attends belowaverage level school. In the smear of peripheral blood
megalocytes were found, some of them are in the form
of tears. Your preliminary diagnosis?
a. Hemolytic anemia
b. Thalassemia
c. Deficiency of glucose-6-phosphate dehydrogenase
d. Fanconi's anemia
e. Iron deficiency anemia
Comment
Correct answer: Fanconi's anemia
Question 10
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Condition of blood at aplastic anemia:
a. Anemia, eosinophilic-basophilic association
b. Anemia, neutropenia, relative lymphocytosis
c. Anemia, monocytosis, eosinophilia
d. Pancytopenia, neutropenia, relative lymphocytosis
e. Anemia, thrombocytopenia, normal lymphocyte
content
Comment
Correct answer: Pancytopenia, neutropenia, relative
lymphocytosis
Question 11
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A 9-month-old boy has signs of SARS. From the history
of the disease - for 5 months the boy was fed with cow's
milk only, he is pale, the following changes in the blood
test: leukocytes - 12.5x10 ^ 9 / l, hemoglobin - 53 g / l,
MCV - 48 fl, reticulocytes - 1.7%, platelets - 780x10 ^ 9 / l.
Your preliminary diagnosis?
a. Anemia in inflammatory processes
b. Glucose-6-phosphate dehydrogenase deficiency
c. Autoimmune hemolytic anemia
d. Transient erythroblastopenia of childhood
e. Iron deficiency anemia
Comment
Correct answer: Iron deficiency anemia
Question 12
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During the preventive inspection of a 14-year-old boy the
following changes in peripheral blood are revealed:
leukocytes, thrombocytes - norm, erythrocytes - 4,05х10
^ 12 / l, hemoglobin - 75 g / l, MCV - 64 fl, MCH - 18.5 pg,
reticulocytes - 2.6%.
Your preliminary diagnosis?
a. Hemolytic anemia
b. B12-deficient anemia
c. Iron deficiency anemia
Comment
Correct answer: Iron deficiency anemia
Question 13
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A 15-year-old girl was diagnosed with systemic lupus
erythematosus. She complains of increased fatigue and
pale skin. In the blood test: hemoglobin 73 g / l, MCV 85 fl, reticulocytes - 3.5%, leukocytes - 3.5x10 ^ 9 / l,
leukocyte formula - 50% - segmental leukocytes, 40% lymphocytes, 10% - atypical lymphocytes. Platelets 125x10 ^ 9 / l. Peripheral blood smear - spherocytes and
coin columns. There is no history of possible blood loss.
Your preliminary diagnosis?
a. Anemia in inflammatory processes
b. Autoimmune hemolytic anemia
c. Deficiency of glucose-6-phosphate dehydrogenase
d. Transient erythroblastopenia of childhood
e. Iron deficiency anemia
Comment
Correct answer: Autoimmune hemolytic anemia
Question 14
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Criteria for severe acquired aplastic anemia (Camitta et
al.) Are all listed, EXCEPT:
a. Platelet count <20000 / μl
b. Reticulocyte level <1% (<40,000 / μl)
c. The level of neutrophils <200 / μl
d. Neutrophil level <500 / μl
e. Bone marrow cellularity <25% (or <50% with nonlymphoid cell content <30%)
Comment
Correct answer: The level of neutrophils <200 / μl
Question 15
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For familial hypoplastic anemia Estren-Dameshek is
characterized by:
a. Pancytopenia, no malformations
b. Normochromic, hyperregenerative anemia
c. Hypochromia of erythrocytes, decreased ferritin
levels
d. Excess methylmalonic acid, macrocyticmegaloblastic anemia syndrome.
e. Pcytopenia, microphthalmia, microcephaly
Comment
Correct answer: Pancytopenia, no malformations
Question 16
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At what age does Fanconi's anemia develop more often?
a. After 20 years
b. In newborns
c. After 15 years
d. In 1 - 3 years
e. From 3 to 14 years
Comment
Correct answer: From 3 to 14 years
Question 17
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A 6-month-old boy has fever and irritability. Blood test:
leukocytes - 20x10 ^ 9 / l, formula - 67% - segmental
forms, 24% - rod-shaped forms, 9% - lymphocytes,
hemoglobin - 90 g / l, MCV-82 fl, reticulocytes - 1%. The
morphology of cells in the peripheral blood smear is
normal, erythrocytes are formed in the form of coin
columns. Your preliminary diagnosis?
a. Anemia in inflammatory processes
b. Transient erythroblastopenia of childhood
c. Iron deficiency anemia
d. Autoimmune hemolytic anemia
e. Deficiency of glucose-6-phosphate dehydrogenase
Comment
Correct answer: Anemia in inflammatory processes
Question 18
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Criteria for partial hematological remission during
immunosuppressive therapy of aplastic anemia:
a. Platelets> 150,000 / μl, hemoglobin> 110 g / l
b. Hemoglobin 80-90 g / l, platelets 10,000-20,000 / μl
c. Hemoglobin 90-110 g / l, platelets 30,000-100,000 /
μl
Comment
Correct answer: Hemoglobin 90-110 g / l, platelets
30,000-100,000 / μl
Question 19
Right
Points 1.00 out of 1.00
Not noticedNote the question
The text of the question
The most probable pathogenetic mechanism of
development of Diamond-Blackfan anemia:
a. Increased urinary excretion of proteins
b. Replacement of glutamic acid globin by valine in the
beta chain
c. Increased anthranilic acid formation
d. Congenital disorders of cellular metabolism in the
use of tryptophan
e. Increase in serum cholesterol
Comment
Correct answer: Congenital disorders of cellular
metabolism in the use of tryptophan
Question 20
Right
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The text of the question
The main diagnostic method for aplastic anemias is:
a. MRI
b. Histology of lymph node points
c. Immunological method
d. Cytomorphological study of peripheral blood
preparations
e. Histology of bone marrow trepanation
Comment
Correct answer: Histology of bone marrow trepanation
Question 21
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The text of the question
Criteria for minimal hematological response in
immunosuppressive therapy of aplastic anemia:
a. Platelets> 150,000 / μl, hemoglobin> 110 g / l
b. Platelets 30,000-100,000 / μl, hemoglobin 90-100 g
/l
c. Hemoglobin 80-90 g / l, platelets 10,000-20,000 / μl
Comment
Correct answer: Hemoglobin 80-90 g / l, platelets 10,000
-20,000 / μl
Question 22
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The text of the question
At what age does Diamond-Blackfan disease most often
develop:
a. Over 5 years
b. 1 month - 1 year
c. 2.5 - 3 years
d. In adolescence
e. 1.5 - 2 years
Comment
Correct answer: 1 month - 1 year
Question 23
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The text of the question
The main signs of aplastic anemia are:
a. Deficiency of vitamin B12 and folic acid
b. Disorders of hemoglobin synthesis
c. Intravascular hemolysis of erythrocytes
d. Intracellular hemolysis of erythrocytes
e. Depression of bone marrow hematopoiesis
Comment
Correct answer: Depression of bone marrow
hematopoiesis
Question 24
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The text of the question
Color index in Fanconi anemia:
a. 1.1 - 1.4
b. 0.7 - 0.85
c. 0.5 - 0.8
d. 0.4 - 0.6
e. 0.82 - 1.05
Comment
Correct answer: 0.82 - 1.05
Question 25
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The text of the question
Criteria for complete hematological remission during
immunosuppressive therapy of aplastic anemia are all
listed, EXCEPT:
a. Platelets> 150,000 / μl
b. Neutrophils> 1500 / μl
c. Hemoglobin> 110 g / L
d. Platelets 30,000-100,000 / μl
Comment
Correct answer: Platelets 30,000-100,000 / μl
Question 26
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The text of the question
Tactics for the treatment of severe / severe aplastic
anemia in the presence of HLA-identical family donor:
a. The use of erythropoietin
b. Hematopoietic stem cell transplantation
c. Immunosuppressive therapy
d. The use of colony-stimulating factors
e. Blood transfusion therapy
Comment
Correct answer: Hematopoietic stem cell transplantation
Question 27
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The text of the question
A 3-month-old boy was admitted to the emergency
department: lethargic, apathetic, 40 ° C (fever). He has
given ampicillin for 2 days. In the analysis of blood:
leukocytes-23,4х10 ^ 9 / l, formula - 56% - segmental
nuclear forms, 24% - rod-nuclear forms, 10% lymphocytes, 10% - atypical lymphocytes; hemoglobin 58 g / l, MCV-81 fl, reticulocytes - 16%, platelets - 230x10
^ 9 / l. Dark-colored urine, erythrocytes were not
detected by urine microscopy. Peripheral blood smear:
several spherocytes, erythrocyte polychromasia,
anisocytosis, poikilocytosis. Bog amounts of Heinz's
bodies were found. Your preliminary diagnosis?
a. Deficiency of glucose-6-phosphate dehydrogenase
b. Fanconi's anemia
c. Autoimmune hemolytic anemia
d. Anemia in inflammatory processes
e. Transient erythroblastopenia of childhood
Comment
Correct answer: Deficiency of glucose-6-phosphate
dehydrogenase
Question 28
Wrong
Scores 0.00 out of 1.00
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The text of the question
Tactics for the treatment of severe / severe aplastic
anemia in the absence of HLA-identical family donor:
a. The use of colony-stimulating factors
b. Blood transfusion therapy
c. Immunosuppressive therapy
d. Hematopoietic stem cell transplantation
e. The use of erythropoietin
Comment
Correct answer: Immunosuppressive therapy
Question 29
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The text of the question
Characteristic picture of bone marrow punctate in
Fanconi anemia:
a. Megaloblastic type of hematopoiesis
b. Irritation of erythroid sprout hematopoiesis,
maturation disorders at the stage of promyelocytes
c. Devastation with a large number of plasma cells
and basophils
d. Irritation of erythroid hematopoietic sprout
Comment
Correct answer: Devastation with a large number of
plasma cells and basophils
MODULE 2. Class 21. Hemorrhagic diseases in children.
Hemophilia. Willebrandt's disease. Acquired
coagulopathy (DIC).
Question 1
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The text of the question
Daily doses of heparin / OD / used for the treatment of
stage I DIC syndrome:
a. 100-300 units / kg
b. 15 units / kg
c. 20 units / kg
d. 0 units / kg
e. 50 units / kg
Comment
Correct answer: 100-300 units / kg
Question 2
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The text of the question
According to the cascade-complex process of blood
coagulation, phase I ends:
a. The formation of thrombin
b. Fibrin formation
c. Formation of prothrombinase
Comment
Correct answer: Formation of prothrombinase
Question 3
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Coagulological diagnosis of the III stage of DIC
syndrome. Everything is typical, EXCEPT:
a. Prolongation of the clotting time
b. Prolongation of prothrombin time
c. Prolongation of APTT
d. Prolongation of thrombin time
e. Reduction of clotting time
Comment
Correct answer: Reduction of clotting time
Question 4
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Hemorrhagic manifestations of hemophilia belong to
the characteristic of the neonatal period, except:
a. Hemorrhages in the joints
b. Bleeding from the umbilical cord
c. Hematomas at the sites of impact
d. Bleeding from teething or injury to the bridle of the
tongue
e. Cephalohematomas
Comment
Correct answer: Hemorrhages in the joints
Question 5
Wrong
Scores 0.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
The activity of VIII / IX coagulation factors in mild
hemophilia is:
a. 5-12%
b. 1-2.99%
c. 3-4%
d. 2-4.9%
Comment
Correct answer: 5-12%
Question 6
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Therapy of acute hemarthrosis is a concentrate of factor
VIII in a dose of:
a. 15-25 IU / kg
b. 30-40 IU / kg
c. 60-80 IU / kg
d. 40-60 IU / kg
Comment
Correct answer: 15-25 IU / kg
Question 7
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The text of the question
The main coagulological disorders in the pathogenesis
of DIC syndrome are:
a. Heparinemia
b. Increased platelet aggregation
c. Thrombocytopenia
d. Decreased platelet aggregation
e. Suppression of the anticoagulant system
Comment
Correct answer: Increased platelet aggregation
Question 8
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The text of the question
Laboratory tests belong to the characteristic of
hemophilia all, EXCEPT:
a. Prolongation of prothrombin time
b. Prolongation of blood clotting time
c. Normal bleeding time
d. Normal prothrombin time
e. Prolongation of activated partial thromboplastin
time (ART)
Comment
Correct answer: Prolongation of prothrombin time
Question 9
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The text of the question
Activity of VIII / IX coagulation factors at moderate
severity hemophilia is:
a. 3-4%
b. 1-2.99%
c. 6-8%
d. 5-12%
Comment
Correct answer: 3-4%
Question 10
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Functional defect of thrombocytes in Willebrand's
disease is shown in:
a. Decreased adhesion
b. Increasing aggregation
c. Decrease in aggregation
d. Increased adhesion
Comment
Correct answer: Decreased adhesion
Question 11
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According to the cascade-complex process of blood
coagulation, phase II ends:
a. The formation of thrombin
b. Fibrin formation
c. Formation of prothrombinase
Comment
Correct answer: The formation of thrombin
Question 12
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The text of the question
Daily doses of heparin used for the treatment of stage 2
DIC syndrome / OD per day /:
a. 50 units / kg
b. 0 units / kg
c. 20 units / kg
d. 100-300 units / kg
e. 15 units / kg
Comment
Correct answer: 50 units / kg
Question 13
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Coagulological diagnosis of the early stages of DIC
includes everything except:
a. Prolongation of prothrombin time
b. Reduction of clotting time
c. Shortening of prothrombin time
d. Shortening of APTT
Comment
Correct answer: Prolongation of prothrombin time
Question 14
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According to the cascade-complex process of blood
coagulation, phase III ends:
a. Formation of prothrombinase
b. The formation of fibrin
c. The formation of thrombin
Comment
Correct answer: The formation of fibrin
Question 15
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Limits of fluctuations in blood clotting time / Lee-White
method / / min./:
a. 1 - 2
b. 2.5 - 5
c. 10.5 - 12.5
d. 5 - 10
e. 9 - 11
Comment
Correct answer: 5 - 10
Question 16
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In type I Willebrand disease we observe:
a. Moderate deficiency of Willebrand factor (vWF)
b. Virtually no Willebrand factor (vWF)
c. Qualitative (structural disorders) of the Willebrand
factor (vWF)
Comment
Correct answer: Moderate deficiency of Willebrand
factor (vWF)
Question 17
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To diagnose hyperheparinemia using thrombin time, it is
necessary to have the data of the following
coagulogram tests:
a. APTT
b. Bleeding time
c. Plasma recalcification time
d. Prothrombin index
e. Fibrinogen content
Comment
Correct answer: Fibrinogen content
Question 18
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Preventive treatment of hemophilia A is carried out with
a concentrate of factor VIII in a dose (Malmõ protocol):
a. 15-20 IU / kg 2 times a week
b. 25-40 IU / kg 3 times a week
c. 25-40 IU / kg 2 times a week
d. 15-20 IU / kg 3 times a week
Comment
Correct answer: 25-40 IU / kg 3 times a week
Question 19
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The text of the question
Inhibitors of activated factors (conversion into inactive
forms - V, XIII) blood clotting includes:
a. Thromboplastin
b. Plasminogen
c. Thrombomodulin protein (C-protein)
d. Proconvert
e. Tumor necrosis factor (TNF)
Comment
Correct answer: Thrombomodulin protein (C-protein)
Question 20
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What type of bleeding is characteristic of DIC syndrome?
a. Petechio-ecchymatous
b. Ematoma
c. Angiomatous
d. Mixed bruise hematoma
e. Vasculitic-purple
Comment
Correct answer: Mixed bruise-hematoma
Question 21
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The activity of VIII / IX coagulation factors in severe
hemophilia is:
a. 5-12%
b. 1%
c. 3-8%
d. 3-4%
Comment
Correct answer: 1%
Question 22
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The text of the question
16. What disorders do not characterize the III stage DIC
syndrome?
a. Hemarthrosis
b. Hemorrhagic skin rash
c. Thrombocytopenia
d. Hypofibrinogenemia
e. Violation of blood clot retraction
Comment
Correct answer: Hemarthrosis
Question 23
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The text of the question
Methods of research of coagulation hemostasis include
all, EXCEPT:
a. Fibrinogen
b. Time of capillary bleeding
c. Blood clotting time
d. Anticoagulation test (ACT)
e. Prothrombin time
f. Activated partial thromboplastin time (APTT)
Comment
Correct answer: Time of capillary bleeding
Question 24
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The text of the question
Hemophilia C is a deficiency of:
a. Factor XI
b. Factor VIII
c. Factor V
d. Factor IX
e. Factor IX and VIII simultaneously
Comment
Correct answer: Factor XI
Question 25
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Markers of intravascular coagulation in DIC are:
a. Soluble complexes of fibrin monomers
b. Protease inhibitors
c. Prothrombinase
d.
e. Calcium ions
Comment
Correct answer: Soluble complexes of fibrin monomers
Question 26
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The text of the question
In coagulation hemostasis there are three successful
live stages:
a. Formation: prothrombinase; antithrombin; fibrin
b. Formation: prothrombinase; thrombin; fibrolysin
c. Formation: transfers; thrombin; fibrin
d. Formation: prothrombinase; thrombin; fibrin
e. Formation: proconvertin; thrombin; fibrin
Comment
Correct answer: Formation: prothrombinase; thrombin;
fibrin
Question 27
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Drugs used to restore hemodynamics in DIC:
a. Paraaminobenzoic acid
b. Acetylsalicylic acid
c. Chimes
d. Rheopolyglucin
e. Polyglucin
Comment
Correct answer: Rheopolyglucin
Question 28
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Most “popular” “target bodies” with DIC:
a.
Spleen
b.
Lungs
c.
Thymus
d.
Liver
e.
Lymph nodes
Comment
Correct answer: Lungs
Question 29
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The following statement is correct:
a.
Plasmin is formed by the interaction of plasminogen
with prothrombinase
b.
The anticoagulant system includes fibrinolysis factors
c.
Factors of the hemostasis system are divided into
groups: coagulation, natural anticoagulants
d.
They exist as independent: the blood coagulation
system and the fibrinolytic system
Comment
Correct answer: The anticoagulant system includes
fibrinolysis factors
Question 30
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The text of the question
Preventive treatment of hemophilia B is a concentrate of
factor IX in a dose (Malmõ protocol):
a.
15-20 IU / kg 2 times a week
b.
15-20 IU / kg 3 times a week
c.
25-40 IU / kg 2 times a week
d.
25-40 IU / kg 3 times a week
Comment
Correct answer: 25-40 IU / kg 2 times a week
Question 31
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The text of the question
Plasma procoagulants are:
a.
Thromboxane
b.
Stewart factor
c.
Serotonin
d.
Accelerin
e.
Retractosyme
Comment
Correct answer: Stewart factor
Question 32
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Limits of bleeding time fluctuations / according to Duke
/:
a.
Up to 5.5 - 7.5 minutes
b.
Up to 15 minutes
c.
Up to 2-5 minutes
d.
10 - 12.5 min
e.
Up to 4.5 - 8.5 minutes
Comment
Correct answer: Up to 2-5 minutes
Question 33
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The text of the question
In type II Willebrand's disease is observed:
a.
Virtually no Willebrand factor (vWF)
b.
Moderate Willebrand factor deficiency (vWF)
c.
Qualitative (structural disorders) of the Willebrand factor
(vWF)
Comment
Correct Answer: Qualitative (structural disorders) of the
Willebrand factor (vWF)
Question 34
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The text of the question
Hemophilia B is deficiency of:
a.
Factor IX and VIII simultaneously
b.
Factor VIII
c.
Factor IX
d.
Factor XI
e.
Factor V
Comment
Correct answer: Factor IX
Question 35
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The text of the question
Hemophilia A is a deficiency of:
a.
Factor VIII
b.
Factor V
c.
Factor IX
d.
Factor IX and VIII simultaneously
e.
Factor XI
Comment
Correct answer: Factor VIII
Question 36
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Prothrombin index is normally equal to:
a.
80-100 mg%
b.
50-80%
c.
80-100%
d.
80-120%
e.
70-100 from.
Comment
Correct answer: 80-100%
Question 37
Wrong
Scores 0.00 out of 1.00
Not noticedNote the question
The text of the question
Daily doses of heparin / OD per day / used in stage III of
DIC syndrome:
a.
0 units / kg
b.
100-300 units / kg
c.
20 units / kg
d.
15 units / kg
e.
50 units / kg
Comment
Correct answer: 0 units / kg
Question 38
There was no answer
Max. score up to 1.00
Not noticedNote the question
The text of the question
Tests to assess the vascular-platelet mechanism of
hemostasis are all EXCEPT:
a.
Thromboplastin time
b.
Aggregometry
c.
Adhesion capacity of platelets
d.
Retraction of a blood clot
e.
Bleeding time
Comment
Correct answer: Thromboplastin time
Question 39
There was no answer
Max. score up to 1.00
Not noticedNote the question
The text of the question
Most often DIC syndrome develops in the following
pathological processes:
a.
Infection
b.
Traumatic shock
c.
Burn shock
d.
Peptic ulcer disease
e.
Sepsis
Comment
Correct answer: Sepsis
Question 40
There was no answer
Max. score up to 1.00
Not noticedNote the question
The text of the question
Quantitative changes of peripheral blood, most
characteristic of DIC syndrome:
a.
Leukocytosis
b.
Increase in the number of erythrocytes
c.
Decrease in erythrocyte count
d.
Thrombocytopenia
e.
Thrombocytosis
Comment
Correct answer: Thrombocytopenia
MODULE 2. Class 22. Hemorrhagic diseases in children.
Thrombocytopenia. ITP. Disorders of vascular
hemostasis. Hemorrhagic vasculitis (Henoch-Schonlein
purpura (HSP)).
Question 1
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The text of the question
A 5-year-old boy is brought to his physician by his
mother for the evaluation of increased bruising for 3
weeks. The mother reports that the patient has also had
two episodes of nosebleeds in the last week that
subsided spontaneously within a few minutes. The boy
was born at term and has been healthy except for an
episode of gastroenteritis 5 weeks ago that resolved
without treatment. The patient is at the 48th percentile
for height and 43rd percentile for weight. He appears
healthy and well nourished. Its temperature is 36.5 ° C
(97.7 ° F), pulse is 100 / min, and its blood pressure is
100/65 mm Hg. There are a few scattered petechiae
over the trunk and back. The remainder of the
examination shows no abnormalities. Laboratory
studies show:
Hemoglobin
12.5 g / dL
Mean corpuscular volume
88 µm3
Leukocyte count
9,000 / mm3
Platelet count
45,000 / mm3
Red cell distribution width
14% (N = 13% -15%)
A blood smear shows no abnormalities. Which of the
following is the most appropriate next step in the
management of this patient?
a.
G Corticosteroid therapy
b.
H Intravenous immunoglobulin therapy
c.
F Observation
d.
E Coomb's test
e.
C Platelet transfusion
f.
A Antiplatelet antibody testing
g.
B Romiplostim therapy
h.
D Splenectomy
Comment
Correct answer: F Observation
Question 2
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The text of the question
A 7-year-old girl is brought to the emergency department
because she has had abdominal pain and vomiting for
the past day. The pain is intermittent, diffuse in nature,
and worse after meals. She does not have loose or
bloody stools. She has had a nonpruritic rash on her
legs and swelling of her ankles for 6 days. She was
treated with oral amoxicillin for a sore throat 2 weeks
ago. Her immunizations are up-to-date. Vital signs are
within normal limits. Examination of the lower
extremities shows non- blanching, raised erythematous
papules. The left ankle joint is swollen and warm, and its
range of motion is limited by pain. Abdominal
examination shows tenderness to palpation in the left
lower quadrant without guarding or rebound. Bowel
sounds are normal. Test of the stool for occult blood is
positive. Laboratory studies show:
Hemoglobin
10.1 g / dL
Leukocyte count
11,800 / mm3
Platelet count
431,000 / mm3
Erythrocyte sedimentation rate
45 mm / h
Serum
Glucose
72 mg / dL
Creatinine
0.9 mg / dL
Which of the following is the most likely diagnosis?
a.
C. Immune thrombocytopenic purpura
b.
E. Acute rheumatic fever
c.
G. Leukocytoclastic vasculitis
d.
B. Drug-induced hypersensitivity syndrome
e.
A. Familial mediterranean fever
f.
D. Meningococcal septicemia
g.
F. Juvenile idiopathic arthritis
Comment
Correct answer: G. Leukocytoclastic vasculitis
Question 3
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The text of the question
A 4-year-old boy is brought to the physician because of
yellowish discoloration of his eyes and skin for 5 days.
He has had generalized fatigue and mild shortness of
breath over the past 2 months. Two weeks ago, he was
treated for a urinary tract infection with antibiotics. His
father has a history of undergoing a splenectomy in his
childhood. Examination shows pale conjunctivae and
jaundice. The abdomen is soft and nontender; the
spleen is palpated 4 to 5 cm below the left costal margin.
Laboratory studies show:
Hemoglobin
9.9 g / dL
Mean corpuscular volume
88 µm3
Mean corpuscular hemoglobin
31.7 pg / cell
Mean corpuscular hemoglobin concentration
37.0% Hb / cell
Leukocyte count
6600 / mm3
Platelet count
233.000 / mm3
Red cell distribution width
24.3% (N = 13-15)
Serum
Bilirubin
Total
12.3 mg / dL
Direct
1.8 mg / dL
Lactate dehydrogenase
401 U / L
Which of the following is the most likely cause of these
findings?
a.
E Defective spectrin in the RBC membrane
b.
A Deficiency of pyruvate kinase
c.
D Deficient glucose-6 phosphate dehydrogenase
d.
F Thrombotic microangiopathy
e.
B Increased hemoglobin S
f.
C Decreased synthesis of alpha chains of hemoglobin
g.
G Decreased CD55 and CD59 in RBC
Comment
Correct answer: E Defective spectrin in the RBC
membrane
Question 4
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The text of the question
A 6-year-old boy was brought to the emergency
department because of colicky abdominal pain and
vomiting for 1 day. He has a history of a sore throat 2
weeks ago. His temperature is 37 ℃ (98.6 ℉), pulse is
100 / min, blood pressure is 90/55, and respirations are
28 / min. Examination of the lower extremities shows
non-blanching raised erythematous papules. The
abdomen is soft and nontender. Bowel sounds are highpitched. Both ankles are swollen and tender; range of
motion is limited by pain. Test of the stool for occult
blood is positive.
Laboratory studies show:
Hemoglobin
13.1 g / dL
Leukocyte count
9800 / mm3
Platelet count
265,000 / mm3
Serum
Glucose
78 mg / dL
Antinuclear antibodies
negative
Urine
Glucose
negative
Protein
negative
Blood
2+
RBC
10-12 / hpf with dysmorphic features
WBC
0-1 / hpf
Ultrasonography of the abdomen shows a portion of the
bowel with alternating echogenic and hypoechogenic
bands in transverse view. Which of the following is the
most likely cause of these findings?
a.
C. Microthrombi occluding the vasculature
b.
G. HLA-associated synovial inflammation
c.
BP-ANCA vasculitis of small vessels
d.
H. Antibodies to plateled glycoproteins
e.
A.Antibodies to type IV collagen
f.
D. Vitello-intestinal duct remnant inflammation
g.
E. Gram-negative cocci infection
h.
F. Deposition of lgA immune complexes
Comment
Correct answer: F. Deposition of lgA immune complexes
Question 5
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The text of the question
A 5-year-old girl was brought to the emergency
department because of abdominal pain, vomiting, and
diarrhea for 6 days. Her mother says that over the last
24 hours she has developed a rash and has been
urinating less frequently than usual. One month ago, she
had a 3-day episode of high fever and sore throat that
subsided without medical treatment. She appears weak.
Her temperature is 37.7 ° C (99.8 F), pulse is 120 / min,
respirations are 28 / min, and blood pressure is 114/72
mm Hg. Examination shows petechiae on the trunk and
jaundice of the skin. The abdomen is diffusely tender
with no peritoneal signs. Neurological examination
shows no abnormalities. Laboratory studies show:
Hemoglobin
8 g / dL
Mean corpuscular volume
85µm3
Leukocyte count
16,200 / mm3
Platelet count
38,000 / mm3
Serum
Blood urea nitrogen
43 mg / dL
Creatinine
2.9 mg / dL
pH
7.0
Urine dipstick is positive for blood and protein. A blood
smear shows schistocytes and normochromic,
normocytic cells. In addition to supportive treatment,
which of the following is the most appropriate next step
in the management of this patient?
a.
G. Azithromycin therapy
b.
F. Eculizumab therapy
c.
E. Hemodialysis
d.
C. Platelet transfusion
e.
A. Diazepam therapy
f.
D. Levofloxacin therapy
g.
I. Plasma exchange therapy
h.
B. Red blood cell transfusions
i.
H. Unfractionated heparin therapy
Comment
Correct answer: E. Hemodialysis
Question 6
Right
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The text of the question
A four-year-old boy is brought to his pediatrician by his
mother for recurrent nosebleeds. The mother reports
that the boy has had five nosebleeds within the past 2
weeks, each lasting between 15 and 20 minutes. The
patient was born at term and has been hospitalized
twice for pneumonia treatment. There is no family
history of serious illness. The patient is at the 8th
percentile for height and the 30th percentile for weight.
Vital signs are within normal limits. Examination shows
a small, thin child with two flat, dark brown areas of
hyperpigmentation across the upper back and a similar
discoloration on the left buttock. There is bilateral
esotropia. Laboratory studies show a hemoglobin
concentration of 9.3 g / dL, mean corpuscular volume of
107 μm3, leukocyte count of 3,800 / mm3, and platelet
count of 46,000 / mm3.
a.
G Vitamin B12 deficiency
b.
D Mutation of glycosylphosphatidylinositol anchor
c.
I Acute lymphoblastic leukemia
d.
B Mutation in WAS protein
e.
E Recent history of NSAID use
f.
A Defect in DNA crosslink repair
g.
H Postviral autoimmune reaction
h.
C Parvovirus B19 infection
i.
F Exposure to benzene-containing solvents
Comment
Correct answer: A Defect in DNA crosslink repair
Question 7
Right
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The text of the question
A 14-year-old Asian girl is brought to the physician
because of a 6-week history of fatigue. During this
period, she has had a 3-kg (6.6-lb) weight loss and
intermittent low-grade fevers. She also reports recurrent
episodes of pain in her left wrist and right knee. She has
no personal history of serious illness. Her aunt has
rheumatoid arthritis. The patient appears pale. Her
temperature is 38 ° C (100.4 ° F). Examination shows
diffuse lymphadenopathy. Oral examination shows
several painless oral ulcers. The left wrist and the right
knee are swollen and tender to touch. The remainder of
the examination shows no abnormalities. Laboratory
studies show a hemoglobin concentration of 10 g / dL, a
leukocyte count of 3,000 / mm3, and a platelet count of
80,000 / mm3. Urinalysis shows excessive protein.
a.
F. Positive pathergy test
b.
G. Elevated serum IgA levels
c.
D. Excessive lymphoblasts
d.
E. Reed-Sternberg cells
e.
A. Anti-citrullinated peptide antibodies
f.
B. Positive monospot test
g.
C. Anti-dsDNA antibodies
Comment
Correct answer: C. Anti-dsDNA antibodies
Question 8
Right
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The text of the question
A 2-year-old boy is brought to the physician for
evaluation of pallor and increasing lethargy for 2 days.
One week ago, he experienced abdominal pain, vomiting,
and bloody diarrhea that have since subsided. The
patient's father states that they returned early from a 6week roadtrip in Mexico because of these symptoms.
His parents have been giving him oral rehydration
solution. His immunizations are up-to-date He appears
pale. His temperature is 38.4 ° C (101.1 ° F), pulse is 130
/ min, respirations are 35 min, and blood pressure is
95/50 mm Hg. Examination shows scleral icterus. The
abdomen is soft and nontender; there is no rebound or
guarding. Bowel sounds are hyperactive. The remainder
of the examination shows no abnormalities. Laboratory
studies show:
Hemoglobin
8.5 g / dL
Mean corpuscular volume
94 µm3
Leukocyte count
18.000 / mm3
Platelet count
45.000 / mm3
Prothrombin time
12 sec
Partial thromboplastin time
34 sec
Serum
Urea nitrogen
28 mg / dL
Creatinine
1.6 mg / dL
Bilirubin
Total
2.5 mg / dL
Direct
0.1 mg / dL
Lactate dehydrogenase
1658 U / L
A blood smear shows schistocytes. Which of the
following is the most likely diagnosis?
a.
D Bacterial sepsis
b.
C Thrombotic thrombocytopenic purpura
c.
A Hepatitis A infection
d.
E Hemolytic uremic syndrome
e.
B Henoch-Schönlein Purpura
Comment
Correct answer: E Hemolytic uremic syndrome
Question 9
Right
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The text of the question
A 14-year-old girl is brought to the physician by her
mother for evaluation of several bruises on her lower
extremities. She has had these bruises for about 6
weeks, and the mother is concerned that she might be
bullied at school. The patient has had increasing fatigue
and paleness over the past several days. She has a
history of recurrent generalized tonic-clonic seizures
treated with carbamazepine. She appears pale and ill.
Her temperature is 37.8 ° C (100.1 ° F), pulse is 115 /
min, and blood pressure is 100/60 mm Hg. The lungs
are clear to auscultation. Examination shows a soft,
nontender abdomen with no organomegaly. There are
several subcutaneous purple spots on her legs
bilaterally. Her hemoglobin concentration is 8.4 g / dL,
leukocyte count is 2,600 / mm3, platelet count is 18,000
/ mm3, and reticulocyte count is 0.3%. Serum electrolyte
concentrations are within normal limits. Which of the
following is the most likely underlying cause of this
patient's symptoms?
a.
E. Adverse effect of medication
b.
F. Adverse effect of medication
c.
B. Immune thrombocytopenic purpura
d.
G. Thrombotic thrombocytopenic purpura
e.
D. Systemic lupus erythematosus
f.
A. Henoch-Schönlein purpura
g.
C. Sickle cell disease
Comment
Correct answer: E. Adverse effect of medication
Question 10
Right
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The text of the question
A 4-year-old girl is brought to the physician because of
pallor and rash for 2 days. She had a 4-day history of
diarrhea and vomiting that subsided two days ago. One
month ago, she had a 3-day episode of high fever,
followed by a rash with bright red discoloration over her
cheeks for two days before subsiding without treatment.
Her vaccinations are up-to-date. She appears pale and
irritable. Her vital signs are within normal limits.
Examination shows petechiae on her trunk and
extremities. Abdominal examination shows diffuse
abdominal tenderness with hyperactive bowel sounds.
The remainder of the exam shows no abnormalities.
Laboratory studies show:
Hemoglobin
8 g / dL
Mean corpuscular volume
82 fL
Leukocyte count
17,000 / mm3
Platelet count
49,000 / mm3
Prothrombin time
12 seconds
Partial thromboplastin time
34 seconds
Serum
Urea nitrogen
42 mg / dL
Creatinine
1.4 mg / dL
Bilirubin
Total
3 mg / dL
Indirect
2.8 mg / dL
Lactate dehydrogenase
300 U / L
Urine
Blood
2+
Protein
2+
A peripheral blood smear shows schistocytes. Which of
the following is the most likely underlying cause of these
findings?
a.
B. Acute lymphocytic leukemia
b.
F. Thrombotic thrombocytopenic purpura
c.
E. Immune thrombocytopenic purpura
d.
C. Parvovirus B19 infection
e.
A. Escherichia coli infection
f.
D. Disseminated intravascular coagulation
Comment
Correct answer: A. Escherichia coli infection
MODULE 2. Class 23. Hemoblastosis.
Lymphogranulomatosis (Hodgkin's disease). Leukemia
Question 1
Right
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The text of the question
Underlying the pathogenesis of leukemia:
a.
Dysfunction of macrophages
b.
Reactive bone marrow changes
c.
Blast cell transformation and suppression of normal
hematopoietic sprouts
d.
The emergence of immune complexes antigen +
antibody
Comment
Correct answer: Blast cell transformation and
suppression of normal hematopoietic sprouts
Question 2
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The text of the question
In the early stages of Hodgkin's lymphoma, the most
characteristic biochemical changes are:
a.
Decrease in total protein level
b.
Increased creatinine levels
c.
Increase in the level of proteins of the acute phase of
inflammation
d.
Increase in bilirubin level
e.
Sharp increase in lactate dehydrogenase level
Comment
Correct answer: Sharp increase in lactate
dehydrogenase level
Question 3
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The text of the question
In leukemia in children, anemic syndrome is associated
with:
a.
Iron deficiency
b.
Hemolysis
c.
Suppression of erythropoiesis
d.
Deficiency of vitamin B12
Comment
Correct answer: Suppression of erythropoiesis
Question 4
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The text of the question
Antimetabolites for the treatment of acute leukemia:
a.
Cyclophosphamide
b.
Methotrexate
c.
Cytarabine
d.
Iphosphamide
Comment
Correct answer: Methotrexate
Question 5
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The text of the question
In which leukemia are the most common signs of
neuroleukemia?
a.
Monoblastic
b.
Erythromyelosis
c.
Megakaryoblast
d.
Lymphoblastic
e.
Myeloblastic
Comment
Correct answer: Lymphoblastic
Question 6
Right
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The text of the question
The Arabic numeral in the clinical classification of
Hodgkin's lymphoma (1, 2, 3, etc.) indicates:
a.
Presence of intoxication
b.
Number of affected extralymphoid organs
c.
No intoxication
d.
The number of affected areas of lymph nodes
e.
Number of extranodal foci
Comment
Correct answer: The number of affected areas of lymph
nodes
Question 7
Wrong
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The text of the question
Histological type of Hodgkin's lymphoma which is
characterized by the following: in addition to
lymphocytes, there are histiocytes, eosinophils,
neutrophils, fibroblasts, plasma cells, areas of sclerosis,
necrosis and Berezovsky-Sternberg cells:
a.
Mixed cell type
b.
Lymphoid depletion
c.
Nodular sclerosis
d.
Lymphoid predominance
e.
Reticular type
Comment
Correct answer: Mixed cell type
Question 8
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The text of the question
To verify the diagnosis of "Hodgkin's lymphoma" it is
necessary to identify the following diagnostic cells in
histological specimens:
a.
Eosinophils
b.
Histiocytes
c.
Berezovsky-Sternberg cells
d.
Lymphocytes
e.
Hodgkin's cells
Comment
Correct answer: Berezovsky-Sternberg cells
Question 9
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The text of the question
The aleukemic form of acute leukemia is characterized
by:
a.
Anemia, thrombocytopenia
b.
Lack of blasts, lymphocytosis
c.
Neutrophilosis
d.
Eosinophilia
e.
Myelocytes, metamyelocytes
Comment
Correct answer: Lack of blasts, lymphocytosis
Question 10
Right
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The text of the question
The letter "E" in the clinical classification of Hodgkin's
lymphoma stands for:
a.
Absence of affected areas of lymph nodes
b.
Presence of affected areas of lymph nodes
c.
Presence of intoxication
d.
No intoxication
e.
Extranodal lesion
Comment
Correct answer: Extranodal lesion
Question 11
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The text of the question
Nodular lymphocyte-predominant Hodgkin lymphoma
(NLPHL) occurs in children of age:
a.
Very rarely
b.
0-2 years
c.
4-6 years
d.
10-14 years
Comment
Correct answer: Very rarely
Question 12
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The text of the question
Histological type of Hodgkin's lymphoma which is
characterized by the following: the drug contains
Berezovsky-Sternbreg cells, fibroblasts, a small number
of lymphocytes:
a.
Lymphoid depletion
b.
Lymphohistiocytic type
c.
Reticular type
d.
Nodular sclerosis
e.
Diffuse sclerosis
Comment
Correct answer: Lymphoid depletion
Question 13
Wrong
Scores 0.00 out of 1.00
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The text of the question
Which of the clinical stages of Hodgkin's lymphoma is
characterized by generalized enlargement of peripheral
lymph nodes:
a.
II
b.
I
c.
III
d.
IV
Comment
Correct answer: IV
Question 14
Right
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The text of the question
Histological type of Hodgkin's lymphoma which is
characterized by the following: the drug contains
lymphocytes, Berezovsky-Sternberg cells, collagen
strands and areas of sclerosis of the correct round
shape:
a.
Nodular sclerosis
b.
Lymphoid predominance
c.
Lymphohistiocytic type
d.
Mixed cell type
e.
Reticular type
Comment
Correct answer: Nodular sclerosis
Question 15
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The text of the question
Leukocytosis is observed in:
a.
Aplasia and hypoplasia of the bone marrow
b.
Radiation sickness
c.
Hypersplenism
d.
Leukemia
e.
All of the above is true
Comment
Correct answer: Leukemia
Question 16
Right
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The text of the question
What does the letter B stand for in the clinical
classification of Hodgkin's lymphoma:
a.
Prevalence of the disease
b.
The presence of extranodal foci
c.
Stage of the disease
d.
Presence of intoxication
e.
Lack of intoxication
Comment
Correct answer: Presence of intoxication
Question 17
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The text of the question
Which of the clinical stages of Hodgkin's lymphoma is
characterized by lesions of two or more areas of lymph
nodes on one side of the diaphragm:
a.
IV
b.
III
c.
II
d.
I
Comment
Correct answer: II
Question 18
Wrong
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The text of the question
Drugs that are not used in the cycle of OPRA
chemotherapy:
a.
Vincristine (oncovin)
b.
Procarbazine (natulan)
c.
Prednisolone
d.
Doxorubicin (adriamycin)
e.
Etoposide
Comment
Correct answer: Etoposide
Question 19
Right
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The text of the question
The letter "S" in the clinical classification of Hodgkin's
disease stands for:
a.
Extranodal lesion
b.
Lesions of the spleen
c.
No intoxication
d.
Presence of intoxication
e.
Bone damage
Comment
Correct answer: Lesions of the spleen
Question 20
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The text of the question
Lymphogranulomatosis is clonal proliferation of the:
a.
Histiocytes
b.
B-cells
c.
Cells of natural killers
d.
T-cells
Comment
Correct answer: B-cells
Question 21
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The text of the question
Which group of lymph nodes is more often involved in
the pathological process in children's and adolescents'
bodies with Hodgkin's lymphoma:
a.
Abdominal lymph nodes
b.
Peritoneal lymph nodes
c.
Inguinal lymph nodes
d.
Cervical-supraclavicular lymph nodes
e.
Inguinal
Comment
Correct answer: Cervical-supraclavicular lymph nodes
Question 22
Right
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The text of the question
What does the letter A stand for in the clinical
classification of Hodgkin's lymphoma:
a.
Stage of the disease
b.
Prevalence of the disease
c.
Lack of intoxication
d.
Presence of intoxication
e.
Number of extranodal foci
Comment
Correct answer: Lack of intoxication
Question 23
Right
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The text of the question
Drugs that are not used in the COPD chemotherapy
cycle:
a.
Prednisolone
b.
Cyclophosphamide
c.
Procarbazine (natulane)
d.
Vincristine (oncovin)
e.
Doxorubicin (adriamycin)
Comment
Correct answer: Doxorubicin (adriamycin)
Question 24
Right
Points 1.00 out of 1.00
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The text of the question
Which of the clinical stages of Hodgkin's lymphoma is
characterized by lymph node involvement on both sides
of the diaphragm:
a.
IV
b.
I
c.
III
d.
II
Comment
Correct answer: III
Question 25
Wrong
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The text of the question
Necrosis of mucous membranes is observed in:
a.
Monoblastic leukemia
b.
Lymphoblastic leukemia
c.
Myeloblastic leukemia
d.
Promyelocytic leukemia
e.
Erythromyelogists
Comment
Correct answer: Erythromyelogists
Question 26
Right
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The text of the question
Enzyme preparations for the treatment of acute
leukemia:
a.
Spirobromine
b.
Hydrea
c.
Panzinorm
d.
L-asparaginase
Comment
Correct answer: L-asparaginase
Question 27
Right
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The text of the question
Histological type of Hodgkin's lymphoma with lymphoid
predominance is characterized by the:
a.
Predominance of Hodgkin's cells
b.
Predominance of blasts, prolymphocytes
c.
Predominance of histiocytes, lymphocytes
d.
Predominance of immunoblasts with the presence of
foci of fibrosis
Comment
Correct answer: Predominance of histiocytes,
lymphocytes
Question 28
Right
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The text of the question
Which of the clinical stages of Hodgkin's lymphoma is
characterized by lymph node involvement in one area:
a.
II
b.
I
c.
III
d.
IV
Comment
Correct answer: I
MODULE 2. Class 24. Diseases of the hypothalamicpituitary system. Growth disorders in children (pituitary
nanism, gigantism)
Question 1
Right
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The text of the question
Normally, the increase in secretion of growth hormone
occurs during these periods:
a.
1 hour after falling asleep
b.
During exercise
c.
After eating
d.
Correct answers: A, B, C
e.
Correct answers: B, C, D
f.
When starving
Comment
Correct answers: Correct answers: B, C, D
Question 2
Right
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The text of the question
A boy, 6.5 years old, was born full-term, with a body
length of 51 cm and a weight of 3250 g. Until the age of
2 he his physical development was typical as of his age.
The growth retardation was noted the age of three. The
examination has shown the following: height - 99 cm,
body weight - 14 kg. X-ray age - 3 years. Hormonal
parameters: free T4 - 10.4 pmol / l (typical normal range:
12-22), TSH - 0.9 μOd / ml (typical normal range: 0.14.05). STH: basal level 0.7 ng / ml (norm 0-10), night
peak - 0.9 ng / ml, after the test with clonidine - 1.1 ng /
ml (typical normal range: more than 10), IGF-1 - 34 ng /
ml (typical normal range: 88-474), cortisol level at 8
o'clock in the morning - 18 mcg / dl (typical normal
range: 5-25). What is the most likely diagnosis of the
patient?
a.
Syndrome of biologically inactive STH (Kowarski
syndrome)
b.
Hypopituitarism (due to Rit-1 gene mutation)
c.
Hypothalamic syndrome
d.
Somatogenous dwarfism
e.
Pangipopituitarism
Comment
Correct Answer: Hypopituitarism (due to Rit-1 gene
mutation)
Question 3
Right
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The text of the question
The introduction of tyroliberin in healthy individuals
leads to:
a.
Correct answers: B, C
b.
Increased STH secretion
c.
Decreased STH secretion
d.
No significant changes in STH secretion
e.
All answers are not correct
Comment
Correct answer: No significant changes in STH secretion
Question 4
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The text of the question
In patients with the syndrome of biologically inactive
growth hormone on the background of STHstimulation tests are characterized by:
a.
Normal STH levels and low IGF-1
b.
Decreased levels of STH and IGF-1
c.
Normal levels of STH and IGF-1
d.
Without special features
Comment
Correct answer: Normal STH levels and low IGF-1
Question 5
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The text of the question
Pangipopituitarism is characterized by:
a.
The presence of signs of hypothalamic syndrome
b.
Tissue resistance to STH
c.
Isolated STH deficiency
d.
Deficiency of pituitary hormones
Comment
Correct answer: Deficiency of pituitary hormones
Question 6
Right
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The text of the question
A typical manifestation of congenital forms of pituitary
dwarfism in children in the first months of life may be:
a.
Correct answers: C, D
b.
Vomiting
c.
Prolonged jaundice
d.
Correct answers: A, B
e.
Cachexia
f.
Hypoglycemia
Comment
Correct answers: C, D
Question 7
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The text of the question
In patients with pituitary dwarfism intellectual
development is:
a.
Characterized by a significant violation
b.
Normal
c.
Characterized by a slight arrearage
Comment
Correct answer: Normal
Question 8
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The text of the question
A 5-year-old child was diagnosed with pituitary dwarfism,
pangipopituitarism. Which hormone deficiency is this?
a.
Somatotropic hormone
b.
Gonadotropic hormones
c.
Thyrotropic hormone
d.
All of the above
e.
Adrenocorticotropic hormone
Comment
Correct answer: All of the above
Question 9
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The text of the question
A 14-year-old girl complains about growth retardation,
lack of secondary sexual characteristics. Her height is
143 cm, she has antimongoloid incision of the eyes, her
neck is wide, she has wing-like folds of the neck and low
line of hair growth on the neck, her shoulder girdle
predominates over the pelvis, mammary glands are
underdeveloped and she has no hair on the bosom.
Uterine hypoplasia was detected. What is the most likely
diagnosis of the patient?
a.
Amenorrhea
b.
Hypogenitalism
c.
Noonan Syndrome
d.
Shereshevsky-Turner syndrome
e.
Dwarfism
Comment
Correct answer: Shereshevsky-Turner syndrome
Question 10
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The text of the question
In most cases, the growth retardation associated with
STH deficiency is diagnosed:
a.
In the first year of life
b.
During puberty
c.
At birth
d.
After 3 years of life
Comment
Correct answer: After 3 years of life
Question 11
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The text of the question
Criteria for the diagnosis of pituitary dwarfism are all
specified, EXCEPT:
a.
Growth retardation greater than -3 δ
b.
Growth rate less than 3 cm per year
c.
Early closure of the epiphyseal zones
d.
Retardation of bone age for 3 years or more
Comment
Correct answer: Early closure of the epiphyseal zones
Question 12
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The text of the question
How does melatonin affect the secretion of pituitary
hormones?
a.
Stimulates the secretion of gonadotropins
b.
Inhibits ACTH secretion
c.
Correct answers: B, C, D
d.
Inhibits the secretion of gonadotropins
e.
Correct answers: A, C, D
f.
Stimulates ACTH secretion
Comment
Correct answer: Inhibits the secretion of gonadotropins
Question 13
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The text of the question
The optimal replacement dose of STH for patients with
pituitary dwarfism is:
a.
Correct answers: B, C
b.
0.03 mg / kg / day
c.
0.2 mg / kg / day
d.
0.02 mg / kg / day
e.
0.04 mg / kg / day
Comment
Correct answer: 0.03 mg / kg / day
Question 14
Right
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The text of the question
At Laron's dwarfism secretion of STH is:
a.
Not violated
b.
Reduced
c.
Increased
Comment
Correct answer: Not violated
Question 15
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The text of the question
In patients with somatotropinoma insulin hypoglycemia
leads to:
a.
Decreased STH levels
b.
Increased levels of STH
c.
The level of STH remains unchanged
Comment
Correct Answer: Decreased STH levels
Question 16
Right
Points 1.00 out of 1.00
Not noticedMark the question
The text of the question
In patients with pituitary dwarfism with a defect of the
Pit1 gene sexual development is:
a.
Accelerated
b.
Violated
c.
Normal
Comment
Correct answer: Normal
Question 17
Right
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The text of the question
The Gonadotropin (GnRH) stimulation test preferably
reflects the functional state of the:
a.
Pituitary gland
b.
Hypothalamus
c.
Ovaries
d.
The pineal gland
e.
Adrenal glands
Comment
Correct answer: Pituitary gland
Question 18
Right
Points 1.00 out of 1.00
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The text of the question
Growth hormone causes all of the following effects,
EXCEPT:
a.
Participates in the synthesis of IGF-1
b.
Stimulates the deposition of fat in the depot
c.
Correct answers: A, D
d.
Anabolic effect
e.
Activates gluconeogenesis
Comment
Correct answer: Stimulates the deposition of fat in the
depot
Question 19
Right
Points 1.00 out of 1.00
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The text of the question
What tests should be performed to assess pituitary
function?
a.
Methopyrone;
b.
Correct answers: B, D
c.
Correct answers: C, D
d.
Thyrotropin;
e.
Gonadotropins
f.
Dexamethasone;
Comment
Correct answers: Correct answers: B, D
MODULE 2. Class 25. Accute & chronic insufficiency of
adrenal glands at children. Ethyiopathogenesis
classification, diagnostic. Differential diagnostic.
Treatment Addison's crisis. Adrenogenital syndrome.
Question 1
Right
Points 1.00 out of 1.00
Not noticedMark the question
The text of the question
Laboratory signs of 21-hydroxylase deficiency:
a.
Elevated levels of 11-deoxycorticosterone
b.
Decreased levels of dehydroepiandrosterone sulfate
c.
Elevated levels of 17-hydroxyprogesterone
d.
Low levels of dehydroepiandrosterone sulfate
e.
Low levels of 17-hydroxyprogesterone
Comment
Correct answer: Elevated levels of 17hydroxyprogesterone
Question 2
Right
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The text of the question
Which of the precursors of aldosterone are produced
exclusively in the glomerular zone of the adrenal cortex?
a.
18-hydroxycorticosterone
b.
Corticosterone
c.
Deoxycorticosterone
Comment
Correct answer: 18-hydroxycorticosterone
Question 3
Right
Points 1.00 out of 1.00
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The text of the question
~ Clinical manifestations of 21-hydroxylase deficiency in
children:
a.
Correct answers: A, D
b.
Short stature
c.
Correct answers: B, C
d.
Signs of salt loss syndrome
e.
Premature sexual development
f.
Delay in sexual development
Comment
Correct answers: B, C
Question 4
Right
Points 1.00 out of 1.00
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The text of the question
The etiological factor of Waterhouse-Frederiksen
syndrome may be:
a.
Meningococcal disease
b.
Correct answers: A, C
c.
Autoimmune lesions of the adrenal glands
d.
Tuberculous lesions of the adrenal glands
e.
Correct answers: B, D
f.
Hemorrhage in the adrenal glands
Comment
Correct answers: Correct answers: B, D
Question 5
Right
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The text of the question
The risk of Addison's crisis is highest when:
a.
Primary hypocorticism
b.
Tertiary hyporcorticism
c.
Secondary hypocorticism
Comment
Correct answer: Primary hypocorticism
Question 6
Right
Points 1.00 out of 1.00
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The text of the question
Secretion of aldosterone during activation of the reninangiotensin system:
a.
Decreases
b.
Does not change
c.
Rising
Comment
Correct answer: Rising
Question 7
Wrong
Scores 0.00 out of 1.00
Not noticedMark the question
The text of the question
Clinical manifestations of 11-beta-hydroxylase
deficiency:
a.
Virile syndrome
b.
A, B
c.
C, D
d.
Hypertensive syndrome
e.
Salt loss syndrome
f.
Antihypertensive syndrome
Comment
Correct answer: A, B
Question 8
Right
Points 1.00 out of 1.00
Not noticedMark the question
The text of the question
How does the rhythm of cortisol secretion change with
decreasing functional activity of the pituitary-adrenal
system?
a.
In the morning the level of cortisol is within
physiological values, but its level is reduced in the
evening
b.
There is an inversion of the rhythm of cortisol secretion
(reduced in the morning, increased in the evening).
c.
Cortisol levels decrease in the morning
Comment
Correct answer: Cortisol levels decrease in the morning
Question 9
Wrong
Scores 0.00 out of 1.00
Not noticedMark the question
The text of the question
What confirms the presence of hypertensive form of
adreno-genital syndrome?
a.
Low plasma renin activity
b.
Elevated adrenaline levels
c.
Hypernatremia
d.
Correct answers: A, B
e.
Hyperkalemia
f.
Correct answers: C, D
Comment
Correct answers: A, B
Question 10
Right
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The text of the question
Which of these hormones are not produced in the
adrenal retina?
a.
Dehydroepiandrosterone
b.
Estradiol
c.
Cortisol
d.
Androsterone
e.
Testosterone
Comment
Correct answer: Cortisol
Question 11
Right
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The text of the question
What are the most common mental changes in patients
with hyporcorticism?
a.
Depressed condition
b.
Neurotic states
c.
Psychosis
d.
Conditions accompanied by arousal
Comment
Correct answer: Depressed condition
Question 12
Right
Points 1.00 out of 1.00
Not noticedMark the question
The text of the question
Conversion of 11-deoxycorticosterone to corticosterone
occurs with the participation of:
a.
21-hydroxylase
b.
11-hydroxylase
c.
17-hydroxylase
Comment
Correct answer: 11-hydroxylase
Question 13
Right
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The text of the question
What is the function of the adrenal cortex characterized
by daily excretion of 17-CS in the urine?
a.
Androgenic
b.
Mineralocorticoid
c.
Glucocorticoid
Comment
Correct answer: Androgenic
Question 14
Wrong
Scores 0.00 out of 1.00
Not noticedMark the question
The text of the question
Indications for the appointment of mineralocorticoids
for the treatment of children with hypertensive form of
adreno-genital syndrome:
a.
Low plasma renin activity
b.
Increased plasma renin activity
c.
Hypokalemia
d.
Correct answers: A, C
e.
Correct answers: B, D
f.
Hyponatremia, hyperkalemia
Comment
Correct answers: Correct answers: A, C
Question 15
Right
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The text of the question
Criteria for the effectiveness of treatment of children of
the first year of life with adreno-genital syndrome are all,
EXCEPT:
a.
Normal blood cortisol levels
b.
Normal levels of 17-hydroxyprogesetron
c.
Normal rate of weight gain
d.
Blood and sodium levels in the blood
Comment
Correct answer: Normal blood cortisol levels
Question 16
Right
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The text of the question
What hormones are produced in the adrenal cortex?
a.
Androsterone
b.
Dehydroepiandrosterone
c.
Estron
d.
Cortisol
e.
Aldosterone
Comment
Correct answer: Cortisol
Question 17
Right
Points 1.00 out of 1.00
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The text of the question
How does the rhythm of cortisol secretion change with
increased functional activity of the pituitary-adrenal
system?
a.
Cortisol levels increase in the morning and especially in
the evening
b.
Cortisol levels increase in the morning and remain within
physiological levels in the evening
c.
Cortisol levels increase in the morning
Comment
Correct answer: Cortisol levels increase in the morning
and especially in the evening
Question 18
Right
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The text of the question
Manifestations of 17alpha-hydroxylase deficiency are all
EXCEPT:
a.
Decreased androgen secretion
b.
Increased secretion of mineralocorticoids
c.
Decreased glucocorticoid secretion
d.
Increased androgen secretion
Comment
Correct Answer: Increased androgen secretion
Question 19
Right
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The text of the question
Manifestations of 11beta-hydroxylase deficiency are all
EXCEPT:
a.
Increased androgen secretion
b.
Decreased secretion of glucocorticoids
c.
Increased secretion of mineralocorticoids
d.
Decreased secretion of mineralocorticoids
Comment
Correct answer: Decreased secretion of
mineralocorticoids
Question 20
Right
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The text of the question
The level of gonadotropins in boys with androsteroma:
a.
Increased
b.
Reduced
c.
Within normal limits
Comment
Correct Answer: Reduced
Question 21
Right
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The text of the question
What is the karyotype of girls with the adrenal form of
adreno-genital syndrome?
a.
46XU / XX
b.
46XX
c.
46XU
d.
45ХО / 46ХУ
Comment
Correct answer: 46XX
Question 22
Right
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The text of the question
Which variant of the distribution of a daily dose of
fludrocortisone in the treatment of children with a
silutrate form of an adreno-genital syndrome is NOT
correct?
a.
At a dose of more than 0.1 mg is divided into 2 doses
b.
6.00 - 50% of the daily dose, at 12.00 - 25%, at 17.00 25%
c.
The entire daily dose is administered in 1 dose
Comment
Correct answer: 6.00 - 50% of the daily dose, at 12.00 -
25%, at 17.00 - 25%
Question 23
Right
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The text of the question
For functional tests to diagnose adreno-genital
syndrome are most often used:
a.
Prednisolone
b.
Dexamethasone
c.
Fludrocortisone
d.
Hydrocortisone
Comment
Correct answer: Dexamethasone
Question 24
Right
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The text of the question
Direct regulators of aldosterone secretion are all,
EXCEPT:
a.
ACTH
b.
The level of potassium in the blood
c.
Blood sodium level
d.
Circulating blood volume
Comment
Correct answer: ACTH
Question 25
Wrong
Scores 0.00 out of 1.00
Not noticedMark the question
The text of the question
Hyperpigmentation of the skin in patients with Addison's
disease is due to:
a.
Lack of glucocorticoids
b.
Trophic disorders of the skin
c.
Correct answers: C, D
d.
Correct answers: A, B
e.
Increased production of proopiomelanocortin
f.
Increased ACTH production
Comment
Correct answers: C, D
Question 26
Right
Points 1.00 out of 1.00
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The text of the question
Hypertension in hyperfunction of the adrenal cortex due
to:
a.
Excess glucocorticoids
b.
Correct answers: A, C
c.
Correct answers: B, D
d.
Hypernatremia
e.
Elevated adrenaline levels
f.
High aldosterone
Comment
Correct answers: Correct answers: B, D
Question 27
Right
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The text of the question
Which of the hormones are mainly produced in the
glomerular zone of the adrenal cortex?
a.
Androstenediol
b.
Aldosterone
c.
Deoxycorticosterone
d.
Cortisol
e.
Dehydroepiandrosterone
Comment
Correct answer: Aldosterone
Question 28
Right
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The text of the question
Which of the violations play a major role in the
development of the Addison crisis?
a.
Insufficiency of mineralocorticoids
b.
Insufficiency of glucocorticoids
c.
Hypovolemia
d.
All designations
Comment
Correct Answer: Insufficiency of mineralocorticoids
Question 29
Right
Points 1.00 out of 1.00
Not noticedMark the question
The text of the question
Sexual development in boys with manifestations of viral
form of congenital hyperplasia of the adrenal cortex:
a.
False premature isosexual
b.
True premature isosexual
c.
False premature heterosexual
Comment
Correct answer: False premature isosexual
Question 30
Right
Points 1.00 out of 1.00
Not noticedMark the question
The text of the question
Girl, 4 years old. Height - 127 cm. Complaints of
premature sexual development in the form of
"adrenarche", incorrect structure of the external genitalia.
Objectively: clitoral hypertrophy, urogenital sinus. X-ray
age - 9 years. Laboratory blood tests: LH - 0.07 IU / ml
(normal to 2), FSH-0.8 IU / ml (normal to 2), estradiol - 8
pg / ml (normal to 30), prolactin - 8 ng / ml (norm 2- 23),
TTH - 1.9 mcOD / ml (norm 0.1-4.5), 17-OHP - 84 ng / ml
(norm up to 2.5), ACTH - 82 pg / ml (norm 10-60). Sex
chromatin - 24%. Karyotype - 46XX. Small
dexamethasone test - positive. What diagnosis can be
made in this case?
a.
Corticoandrosteroma
b.
True idiopathic premature sexual development
c.
Adreno-genital syndrome, virile form, with 21hydroxylase deficiency
d.
Virilizing ovarian tumor
Comment
Correct answer: Adreno-genital syndrome, virile form,
with 21-hydroxylase deficiency
Question 31
Right
Points 1.00 out of 1.00
Not noticedMark the question
The text of the question
How do glucocorticoids affect amino acid metabolism
in peripheral tissues?
a.
Stimulate the release and release of amino acids from
cells
b.
Suppress the transport of amino acids in tissues
c.
Activate the transport of amino acids into tissues
Comment
Correct answer: Stimulate the release and release of
amino acids from cells
Question 32
Right
Points 1.00 out of 1.00
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The text of the question
In the glomerular zone of the adrenal cortex are mainly
produced:
a.
Adrenaline
b.
Cortisol
c.
Dehydroepiandrosterone
d.
Dopamine
e.
Aldosterone
Comment
Correct answer: Aldosterone
MODULE 2. Class 26. Diseases of thyroid gland
(Hyperthyroidism, Hypothyroidism). Diabetes mellitus
Question 1
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
A child of 8 years for two months thirst, polyuria,
nocturnal enuresis, increased appetite, weight loss of 4
kg. The examination revealed hyperglycemia -15 mmol /
liter. What skin lesions are possible in a child?
a.
Petechiae, ecchymoses
b.
Development of elephantiasis
c.
Hyperpigmentation
d.
Depigmentation
e.
Pustular lesions
Comment
Correct answer: Pustular lesions
Question 2
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Criteria for diagnosing diabetes in children:
a.
Correct answers A and C
b.
Fasting blood glucose> 6.1 mmol / L
c.
Randomized blood glucose> 11.1 mmol / L
d.
Fasting blood glucose> 11.1 mmol / L
e.
Randomized blood glucose> 6.1 mmol / L
Comment
Correct answers: Correct answers A and C
Question 3
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
At neonatal screening of congenital hypothyroidism
determination of thyrotropin is carried out:
a.
In capillary blood
b.
In arterial blood
c.
From the mucous membranes of the oral cavity
d.
In the blood from the umbilical cord
e.
In venous blood
Comment
Correct answer: In capillary blood
Question 4
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
At the patient of 10 years, in 10 hours after the
beginning of intensive therapy concerning a ketoacidotic
coma despite decrease in indicators of glycemia to 8.2
mmol / l the general condition worsened: there were
headaches, after the short period of excitement there
was drowsiness, bradycardia, increased blood pressure.
What is the possible reason for the deterioration of the
health of this patient?
a.
Hypokalemia
b.
Hypoglycemia
c.
Insufficient rate of rehydration
d.
Brain edema
e.
Hyponatremia
Comment
Correct answer: Brain edema
Question 5
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Which of the thyroid hormones can be considered a
prohormone?
a.
Thyroglobulin
b.
Thyroliberin
c.
Thyroxine
d.
Reversible triiodothyronine
e.
Triiodothyronine
Comment
Correct answer: Thyroxine
Question 6
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Autoimmune aggression is the basis of most of these
diseases, EXCEPT:
a.
Hashimoto disease
b.
Acute thyroiditis
c.
Diffuse toxic goiter
d.
Primary hypothyroidism
e.
Graves-Bazedow disease
Comment
Correct answer: Acute thyroiditis
Question 7
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Normally, elevated levels of thyrotropin in the blood of
the newborn are observed during:
a.
10 days
b.
3-4 days
c.
30 days
d.
1st day
e.
2 days
Comment
Correct answer: 3-4 days
Question 8
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Replacement therapy of congenital hypothyroidism with
thyroid hormones is carried out:
a.
Only during the neonatal period
b.
Intermittent courses, depending on clinical symptoms
c.
Before and during puberty
d.
Throughout life
e.
Correct answer: A, B
Comment
Correct answer: Throughout life
Question 9
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Features of the clinical course of diffuse toxic goiter in
children:
a.
Correct answers: B, C, D
b.
Chorea-like muscle twitching and muscle weakness
c.
Correct answers: A, E, F
d.
Delay in physical development
e.
Accelerate physical development
f.
Significant enlargement of the thyroid gland
g.
Emotional lability
h.
Lag of bone age from the passport
Comment
Correct answers: A, E, F
Question 10
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
What drugs for children are used to treat hypertension in
diabetes mellitus?
a.
Calcium antagonists
b.
Clonidine
c.
ACE inhibitors
Comment
Correct answer: ACE inhibitors
Question 11
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
In what period of gestation is the bookmark of the fetal
thyroid gland?
a.
From 12 to 14 weeks of pregnancy
b.
After 32 weeks of pregnancy
c.
From 3 weeks of pregnancy
d.
From 20 to 21 weeks of pregnancy
e.
From 6 to 7 weeks of pregnancy
Comment
Correct answer: From 3 weeks of pregnancy
Question 12
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Enlargement of the thyroid gland in patients with diffuse
toxic goiter is due to:
a.
Compensatory hyperplasia of the gland
b.
Increased activity of the sympathetic-adrenal system
c.
Stimulation with thyrotropin
d.
The action of insulin-like growth factor
e.
The action of thyroid-stimulating antibodies
Comment
Correct answer: The action of thyroid-stimulating
antibodies
Question 13
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
For the treatment of hypothyroidism prescribe all these
drugs, EXCEPT:
a.
Tyrosol
b.
Triiodothyronine
c.
Thyrocomb
d.
Levothyroxine
Comment
Correct answer: Tyrosol
Question 14
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
To drugs of short-acting insulin from apply:
a.
Protafan
b.
Humulin HNP
c.
Actropid
Comment
Correct answer: Actropid
Question 15
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
A 9-year-old child with acute bronchitis complains of
thirst, frequent urination. During the examination in the
blood tests the fasting sugar level was 11.5 mmol / l,
the urine sugar level was 2%. Your previous diagnosis?
a.
Type II diabetes
b.
Symptomatic hyperglycemia
c.
Diabetes mellitus
d.
Renal glucosuria
e.
Type I diabetes
Comment
Correct answer: Type I diabetes
Question 16
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
In which pathology of the thyroid gland in children may
be manifested symptoms of epiphyseal dysgenesis?
a.
Sporadic goiter
b.
Diffuse toxic goiter
c.
Congenital hypothyroidism
d.
Nodular goiter
e.
Autoimmune thyroiditis
Comment
Correct answer: Congenital hypothyroidism
Question 17
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Differential diagnosis between neurosis and diffuse
toxic goiter is performed using:
a.
Samples with the absorption of I-131 by the thyroid
gland
b.
Tests with thyrotropin
c.
Samples with potassium perchlorate
d.
Samples with phenobarbital
e.
Triiodothyronine tests
Comment
Correct answer: Triiodothyronine tests
Question 18
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Emergency care for severe hypoglycemia in a child:
a.
10% glucose 1 ml / kg
b.
20% glucose 5 ml / kg
c.
20% glucose 1 ml / kg
d.
Insulin therapy 0.1 IU / kg / hour
e.
10% glucose 5 ml / kg
Comment
Correct answer: 20% glucose 1 ml / kg
Question 19
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
A 16-year-old girl went to the doctor with complaints of
thirst, frequent urination, weight loss. Considers himself
ill for about a month. What laboratory examination
should be performed immediately on the patient?
a.
Analysis of urine for microalbuminuria
b.
Analysis of urine for sugar from daily diuresis
c.
Test for glucose tolerance
d.
Glucosuric profile
e.
Blood sugar test
Comment
Correct answer: Blood sugar test
Question 20
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Determination of thyrotropin concentration in the blood
to diagnose congenital hypothyroidism in full-term
infants is carried out:
a.
Immediately after birth
b.
Immediately after the birth of a child
c.
2 weeks after birth
d.
4-5 days after birth
e.
In the first three days
Comment
Correct answer: 4-5 days after birth
Question 21
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Increased secretion of thyrotropin is characteristic of:
a.
Correct answers: B, D
b.
Primary hypothyroidism
c.
Toxic adenoma
d.
Secondary hypothyroidism
e.
Diffuse toxic goiter
Comment
Correct answer: Primary hypothyroidism
Question 22
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Indicators of lipid metabolism in patients with
hypothyroidism are characterized by:
a.
High levels of high-density lipoprotein cholesterol
b.
Correct answers: A, D
c.
Low levels of low density lipoproteins
d.
Hypercholesterolemia
e.
High triglycerides
Comment
Correct answers: A, D
Question 23
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Informative test for the differential diagnosis between
primary and secondary hypothyroidism are:
a.
Determination of thyrotropin levels in the blood
b.
Determination of tyroliberin levels in the blood
c.
Determination of blood T3 and T4 levels
d.
Test with tyroliberin
e.
Small dexamethasone
Comment
Correct answer: Determination of thyrotropin levels in
the blood
Question 24
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Differential diagnosis of endemic goiter from sporadic
goiter is based on:
a.
Ultrasound of the thyroid gland
b.
Determination of blood T4 level
c.
Determination of blood TSH levels
d.
Scanning of the thyroid gland
e.
Determination of daily urinary iodine excretion
Comment
Correct answer: Determination of daily urinary iodine
excretion
Question 25
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Congenital hypothyroidism is characterized by all the
signs, EXCEPT:
a.
Reduced body weight
b.
Mucinous edema of the skin
c.
Goiter
d.
Prolonged jaundice
e.
Lag in psychomotor development
Comment
Correct answer: Reduced body weight
Question 26
Right
Points 1.00 out of 1.00
Не поміченоВідмітити питання
The text of the question
Laboratory signs of subclinical thyrotoxicosis:
a.
Correct answers: A, B
b.
Elevated levels of T3 and T4
c.
Normal thyrotropin levels
d.
Correct answers: C, E
e.
Low or suppressed thyrotropin levels
f.
Normal levels of T3 and T4
Comment
Correct answers: Correct answers: C, E
Question 27
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The text of the question
In what period of gestation does the fetal thyroid gland
begin to function?
a.
From 12 to 14 weeks of pregnancy
b.
From 3 to 4 weeks of pregnancy
c.
From 20 to 21 weeks of pregnancy
d.
From 6 to 7 weeks of pregnancy
e.
After 32 weeks of pregnancy
Comment
Correct answer: From 12 to 14 weeks of pregnancy
Question 28
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Scores 0.00 out of 1.00
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The text of the question
Characteristic feature of endemic goiter:
a.
Correct answers: B, D
b.
Normal level of total T4 at low free T4
c.
Low urinary iodine excretion (less than 50 mcg per day)
d.
Increased excretion of iodine in the urine
e.
Correct answers: A, B
f.
Normal level of total T3 at low free T4
Comment
Correct Answer: Low urinary iodine excretion (less than
50 mcg per day)
Question 29
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Points 1.00 out of 1.00
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The text of the question
Among insulin analogues has the longest lasting effect
a.
Levemir
b.
Novomix
c.
Lantus
Comment
Correct answer: Lantus
Question 30
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The text of the question
Determination of thyrotropin levels to diagnose
congenital hypothyroidism in premature infants is:
a.
4-5 days after birth
b.
In the first three days
c.
Immediately after the birth of a child
d.
On day 7-14 after birth
e.
Immediately after birth
Comment
Correct answer: On day 7-14 after birth
Question 31
Right
Points 1.00 out of 1.00
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The text of the question
What disorders of immune parameters are most often
found in patients with diffuse toxic goiter?
a.
Correct answers: B, C, D
b.
Correct answers: A, D, E
c.
Increased number of B-lymphocytes
d.
Decreased number of B-lymphocytes
e.
Increased number of T-helpers
f.
Reduced number of T-suppressors
g.
Elevated levels of immunoglobulins G
Comment
Correct answers: Correct answers: B, C, D