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Task №1

1. Clinical blood test: red blood cells - 1,8х1012/l, Hb – 62 g/l, coloure index - 1,0, rethyculocytes - 0,2%, platelets - 36х109/l, leukocytes-1,2х109/l, bas. 2%, segm. 38%, lymph. – 48%, mon. – 12%. ESR-52 mm/h.

Right answer: Aplastic anemia (pantcytopenia, rethykulocytopenia). Sternal punktion is indicated for diagnosis clarification).

2. Clinical urine test: amount - 100 ml; relative gravity 1009 g/l; color is brick-red; transparency is turbid; the reaction is poorly-acid; albumin - 0,166 g/l; epithelium  flat and kidney, leukocytes -- 5-6 in f/vр; changed erythrocytes - 2-3 in f/vр; unchanged erythrocytes – 2 - 3 in f/v; casts are epitheliums, red blood cells; mucus - in a two-bit quantity; salts - urate +++.

Right answer: Gouty nephropaty: brick color and turbidity due to urate present.

3. Koprological investigation: stule informed, pappy, greyish-white color, rotten smell, the reaction is acid, mucus and pus is not exposed, the reaction to blood is negative. Microscopically: fat acids and soaps – 25 - 26 in f/vр, neutral fat – 0 - 1 in f/v, muscle fibres – 0 - 1 in f/v, undigested cellulose – 2 - 3 in f/v, overcooked cellulose – 4 - 5 in f/v, starch – 7 - 8 in f/v, leukocytes – 5 - 6 in f/v, the eggs of intestinal worms aren’t exposed.

Right answer: The changes in koprogramme are characteristic for gepatogenic dyspepsia, that meets at icterus, heavy hepatitis, cirrhosis.

4. Creatinine and urea blood test: creatinine – 2,2 mmol/l; urea - 6,4 mmol/l.

Right answer: Increase level of creatinine.

5. Immunological blood test:

Patient I., 19 y. Clinic: Kvinke’s edema, recidive forme.

Absolute amount of lymphocyts

(N: 1,7-2,0 g/l)

1,9

 

СD3

(N: 35-50%)

32

 

 T(СD8+)

(N: 15-20%)

16

 

T(СD4+)

(N: 30-40%)

30

 

СD4+/СD8+

(N: 1,5-2)

1, 9

 СD20 (B-lymphocyts)

(N: 20-30)

22

 

Ig A

(N: 1,5-4 g/l)

3,8

 

IgM

(N: 0,7-1,5 g/l)

0,9

 

IgG

(N: 7-20 g/l)

18

 

IgЕ

(N: 70-120 ED)

90

Fagocytic activity

(N: 60-80%)

72

Fagocytic number

(N: 4-10)

4,3

NBT-test spontaneous

(N: 8-30)

9

NBT-test stimulated

(N: 30-60)

6

CIC

(N: 80-120 odes.)

100

Title of normal antibodies

(N: 1:8-1:32)

1:16

Title of complement

(N: 0,02-0,08)

0,04

С1

(N:)

ß

С3

(N:)

N

Right answer: Primary immunodeficit with complement (С1 inhybition - ß).

 

Task №2

1. Clinical blood test: red blood cells - 1,9х1012/l, Hb - 68 g/l, coloure index - 1,0, rethyculocytes - 34%, platelets - 320х109/l, leukocytes - 12,7х109/l, bas. - 1%, eos. - 2%, yang - 1%, bas. - 20%, segm. - 62%, lymph. – 11%, mon. – 3%. ESR – 72 mm/h.

Right answer: Hemolytic anemia (normochromic anemia, rethyculocytosis, leukocytosis with change leukocytic formula to the left, ESR sharply increases)

2. Clinical urine test: amount - 100 ml; relative gravity 1018 g/l; color is straw-yellow; transparency is turbid; reaction is poorly-alkaline; albumin - 0,33 g/l; flat epithelium – 7 - 8 in f/v; kidney epithelium – 4 - 6 in f/v; leukocytes – 15 - 20 in f/v; changed erythrocytes – 2 - 3 in f/v; unchanged - absent; epithelial, leukocyte, erythrocyte casts; mucus - great quantity, bacteries – 320000/ml

Right answer: Acute pyelonephritis: hematuria, leukocituria, bacteriuria, cylindruria, proteinuria, kidney epithelium, mucus.

3. Pleural fluid investigation: liquid is turbid, festering with unpleasant smell, specific gravity – 1034 g/l, albumin – 40 g/l, the Rivald’s test is positive, glucose level – 1,4 mmol/l, expressed neutrophil leukocitosis.

Right answer: Pleurliquid characteristic for empyemy of pleura.

4. Koagulogramme: prothrombin index – 90%; fibrinogen A – 3 g/l; fibrinogen B   is negative; time of blood coagulation (by Ly-White) – 8 min.; time of bleeding (by Dyuk) – 3 min.; tolerance plasma to heparin – 11 c.; hemathocrit – 46%. Right answer: norm. 

5. Gastric juse investigation:

empty stomach portion of gastric content volume - 100 ml, consistency - viscid, free hydrochloric acid - 20 mmol/l, general acidity - 50 mmol/l, microscopically- a lot of mucus;

I phase of secretion (bazal secretion) is volume of gastric content 160 ml/h, free hydrochloric acid - 50 mmol/l, general acidity - 70 mmol/l; pepsin concentration - 40 g/l.

ІІ phase (stimulated secretion by submaximal dose of histamin 0,008 mg/kg) is volume of gastric content 200 ml/h, free hydrochloric acid 100 mmol/l, common acidity 120 mmol/l, microscopically – a lot of mucus, 8-10 leukocytes in f/v. Right answer: Selective hyperacydity.


Task №3

1. Clinical blood test: red blood cells - 2,8х1012/l, Hb – 70 g/l, coloure index - 0,75, rethyculocytes-1,5%, platelets-270х109/l, leukocytes-6,2х109/l, eos. -2%, bas.5%, segm. 60%, lymph. – 27%, mon. – 6%. Anysocytosis, erythrocytes hypochromy, ESR – 15 mm/h.

Right answer: Irondefisit anaemia (hypochromy, decline of the coloure index)

2. Clinical urine test: amount - 100 ml; relative gravity 1028 g/l; color - „meat pigwashes”; transparency is turbid; reaction is neutral; glucose - absent; albumin - 3,5 g/l; keton bodies - absent; flat epithelium - absent; kidney epithelium – 3 - 4 in f/v; leukocytes – 5 - 6 in f/v; changed erythrocytes covere hole f/v; erythrocyte and gialin casts.

Right answer: Acute glomerulonefryt: makrohematuria, massive proteinuria, high closeness.

3. Pleural fluid investigation: liquid is turbid with an intensive yellow color, specific gravity – 1032 g/l, albumin – 40 g/l, Rivald’s test is positive, glucose level – 2,15 mmol/l. Microscopically: red blood cells – 4000 in 1 mm3, leukocytes – 2000 in 1 mm3, neutrophil leukocitosis.

Right answer: Pleural fluid is characteristic for exsudate.

4. Proteinogramme: common protein – 64 g/l, albumin – 45 g/l (65%), globulin -20 g/l (35%), α1 – 4 (), α2 – 18 g/l, b – 15 g/l, γ – 24 g/l, fibrinogen – 6 g/l.

Right answer: Increase level of α2, γ globulins and fibrinogen that is characteristic for pneumonia.

5. Duodenal juse investigation:

I phase is a transparent yellow bile, volume – 15 ml, duration of stage - 35 min., single epithelial cells, 3 - 4 leukocytes in f/v;

ІІ phase is duration 10 mines.

ІІІ phase (portion “А”) is a darkly-yellow bile, specific gravity 1010 g/l, reaction weak alkaline, volume – 3 ml, duration of stage - 5 min.., 6-7 epithelial cells, 4 - 5 leukocytes in f/v are microscopically exposed, bylyrubynat calcium and cholesterol in the two-bit amounts.

IV phase (portion “В”) is the turbid bile of olive, specific gravity 1050 g/l, reaction weak alkaline, volume – 15 ml, duration of stage - 50 min.; microscopically: a lot of mucus,  30-40 prismatic epithelial cells, 40 - 50 leukocytes in f/v, a lot of bylyrubynata calcium, cholesterol, “sand”, crystals of fat acids in great quantity.

V phase (portion “С”) is the yellow color of bile, specific gravity 1007 g/l, the reaction is alkaline, volume – 20 ml, duration of stage - 20 min., microscopically:  4 - 5 shallow prismatic epithelium cells, 4 - 5 leukocytes in f/v, bylyrubynat calcium and cholesterol in the two-bit quantity.

Right answer: There is inflammatory process in a gall-bladder, characteristic the presence of mucus, plenty of leukocytes, epithelial cells, a lot of bylyrubynata calcium, cholesterol, “sand” and crystals of fat acids great quantity in the portion “В”.


Task №5 (4)

1. Clinical blood test: red blood cells - 1,8х1012/l, Hb - 62 g/l, coloure index - 1,0, rethyculocytes - 0,2%, platelets - 36х109/l, leukocytes - 1,2х109/l, bas. - 2%, segm. - 38%, lymph. – 48%, mon. – 12%. ESR – 52 mm/h.

Right answer: Aplastic anemia (pancytopenia, rethykulocytopenia. Sternal punktsion is indicated for clarification of diagnosis).

2. Clinical urine test: amount - 100 ml; relative gravity – 1018 g/l; color – „meat pigwashes”;  transparency is turbid; the reaction is neutral; glucose - absent; albumin - 1 g/l; flat epithelium - absent; kidney epithelium -  3 - 4 in f/v; leukocytes – 2 - 3 in f/v; red blood cells fresh – 30 - 40 in f/v; erythrocyte, hyaline, grainy casts.

Right answer: Acute glomerulonephritis: hematuria, proteinuria, high closeness, cylindruria.

3. Koprological investigation: stule informed, foamy, yellow color, contains the undigested particles of garden trucks, a smell is acid, mucus and pus isn’t exposed, reaction to blood is negative. Microscopically: muscle fibres – 0 - 1 in f/v, undigested cellulose – 18 - 20 in f/v, overcooked cellulose – 16 - 18 in f/v, starch – 15 - 16 in f/v, leukocytes – 1 - 2 in f/v, the eggs of intestinal worms aren’t exposed.

Right answer: Informed, foamy stule with undigested particles of garden trucks, acid smell, macroscopic amount of undigested cellulose and starch is characteristic for fermenting dyspepsia.

4. Proteinogramme: common protein – 100 g/l, albumins – 55 g/l, globulins – 35 g/l, α1 – 4 g/l, α2 – 10 g/l, b – 13 g/l, γ – 18 g/l, fibrinogen – 6 g/l.

Right answer: Increase level of common protein, amounts of albumins, globulins characteristic for myelom disease.

5. Stomach pH-metry:

pH - Units

Amount of measuring points

0,9 – 1,2   (5)

0

1,3 – 1,5   (4)

4

1,6 – 2,2   (3)

10

2,3 – 3,5   (2)

4

3,6 - 6,9    (1)

1

7,0 – 7,5   (0)

1

At all the points 20.

Right answer: Basic hyperacidity, moderate, selective.

 


Task №7 (5)

1. Clinical blood test: red blood cells - 1,75х1012/l, Hb - 74 g/l, coloure index - 1,3, rethyculocytes - 0,2%, platelets - 120х109/l, leukocytes - 3,2х109/l, bas. - 1%, eos. - 3%, bas. - 4%, segm. - 58%, lymph. – 26%, mon. – 10%. Anisocytosis: makrocytes, hyperchromic red blood cells, ESR – 32 mm/h.

Right answer: В12-deficite anaemia (makrocytosis, hyperchromia, trombo- and leukopenia, increase of the coloure index).

2. Clinical urine test: amount - 100 ml; relative gravity – 1005 g/l; color is straw-yellow; transparency is turbid; the reaction is poorly-alkaline; albumin - 0,066 g/l; flat epithelium – 5 - 6 in f/v; kidney epithelium- 1 - 2 in f/v; leukocytes – 8 - 10 in f/v; changed erythrocytes – 4 - 5 in f/v; epithelial, leukocytic and erythrocytis casts; mucus - in a two-bit; salts - phosphates; bacteries - cocci in a two-bit. Note: uroprotein Tamm-Khorsfall.

Right answer: Chronic pyelonephritis: leukocituria, bacteriuria, low relative gravity, cylindruria, proteinuria, kidney epithelium, mucus.

3.Pleural fluid investigation: liquid is transparent with a yellow color, odourless, specific gravity – 1012 g/l, albumin – 15 g/l, Rivald’s test negative, glucose level – 3,68 mmol/l. Microscopically: red blood cells – 500 in 1 mm3, leukocytes – 250 in 1 mm3, two-bit of mesothelial cells.

Right answer: Pleural fluid is characteristic for transsudate.

4.Proteinogramme: common protein – 80 g/l, albumin – 35 g/l, globulin – 45 g/l, α1 – 2 g/l, α2 – 16 g/l, b – 17 g/l, γ – 28 g/l, fibrinogen - 5,0 g/l.

Right answer: Increase level of α2, b, γ globulins and fibrinogen is characteristic sign of rheumatic fever.

5. Duodenal juse investigation:

I phase is a transparent yellow bile, volume – 20 ml, duration of stage - 40 min., single epithelial cells, 5 - 6 leukocytes in f/v;

ІІ phase is absent;

ІІІ phase (portion “А”) is a darkly-yellow bile, specific gravity 1012 g/l, reaction weak alkaline, volume – 5 ml, duration of stage - 4 min.., 6 - 7 epithelial cells, 5 - 6 leukocytes in f/v are microscopically exposed, bylyrubynat calcium and cholesterol in the two-bit amounts.

IV phase (portion “В”) is the turbid bile of olive, specific gravity 1005 g/l, reaction is alkaline, volume – 60 ml, duration of stage - 30 min.; microscopically: 7 - 8 prismatic epithelial cells, 10 - 12 leukocytes in f/v, bylyrubynata calcium, cholesterol, crystals of fat acids in the two-bit quantity.

V phase (portion “С”) is the yellow color of bile, turbid, a lot of mucus, specific gravity 1015 g/l, the reaction is alkaline, volume – 25 ml, duration of stage - 30 min., microscopically:  20 - 30 shallow prismatic epithelium cells, 40 - 50 leukocytes in f/v, bylyrubynat calcium and cholesterol in the two-bit quantity.

Right answer: There is inflammatory process in the intrahepatic bilious channels (changes in the portion “С” – 5 phase of the duodenal sounding. Abesense of the second phase is characteristically for the Oddie’s sphyncter atony.


Task №8 (6)

1. Clinical blood test: red blood cells - 3,1х1012/l, Hb – 94 g/l, coloure index - 0,89, rethyculocytes - 1,2%, platelets - 760х109/l, leukocytes - 154х109/l, bas. - 6%, eos. - 6%, mon. – 11%, yang - 12%, bas. - 24%, segm. - 30%, lymph. – 7%, mon. – 3%. ESR - 32mm/h.

Right answer: Chronic myeloleucemia, chronic phase (moderate anemia, hyperthrombocytosis, hyperleukocytosis with change leucositic formula to myelocyts).

2. Clinical urine test: amount - 100 ml; relative gravity – 1010 g/l; color is straw-yellow;  transparency is transparent; the reaction is poorly-acid; glucose - absent; albumin - 0,33 g/l; epithelium flat - absent; kidney - absent; leukocytes – 2 - 3 in f/v; red blood cells changed – 5 - 6 in f/v; unchanged – 1 - 2 in f/v; erythrocyte and hyaline casts.

Right answer: Chronic glomerulonephritis: proteinuria, mycrohematuria, cylindruria.

3. Koprological investigation: stule informed, duck color, a smell is putrid, the reaction is alkaline, mucus and pus isn’t exposed, the reaction to blood is negative. Microscopically: neutral fat great quantity, fat acids cover hole f/v, muscle fibres are unchanged – 10 - 12 in f/v, undigested cellulose – 10 - 12 in f/v, overcooked cellulose – 6 - 8 in f/v, starch – 23 - 24 in f/v, leukocytes – 1 - 2 in f/v, the eggs of intestinal worms aren’t exposed.

Right answer: The changes in koprogramme are typical for pancreas secretory insufficiency.

4. Proteinogramme: common protein – 70 g/l, albumins – 40 g/l, globulins – 20 g/l, α1 -4 g/l, α2 – 15 g/l, b – 18 g/l, γ – 16 g/l, fibrinogen - 5,0 g/l.

Right answer: ­ α2, ­ g-глобулинов, ­ fibrinogen are signs characteristic for Reuter disease.

5. Immunological blood test:

Patient S., 49 y.: Autoimmune hepatitis

Absolute amount of lymphocytes

(N: 1,7-2,0 g/l)

1,9

 

СD3

(N: 35-50%)

31

 

T(СD8+)

(N: 15-20%)

15

 

T(СD4+)

(N: 30-40%)

46

 

СD4+/СD8+

(N: 1,5-2)

3, 1

 СD20 (B-lymphocyts)

(N: 20-30)

19

 

Ig A

(N: 1,5-4 g/l)

2,0

 

IgM

(N: 0,7-1,5 g/l)

1,0

 

IgG

(N: 7-20 g/l)

24

 

IgЕ

(N: 70-120 ED)

80

Fagocytic activity

(N: 60-80%)

63

Fagocytic number

(N: 4-10)

4,0

NBT-test spontaneous

(N: 8-30)

10

NBT-test stimulated

(N: 30-60)

30

CIC

(N: 80-120 odes.)

170

Title of normal antibodies

(N: 1:8-1:32)

1:16

Title of complement

(N: 0,02-0,08)

0,04

Right answer: Autoimmune syndrome (increase CD4+; СD4+/СD8+, CIC, IgG)


Task №9 (7)

1. Clinical blood test: red blood cells-2,95х1012/l, Hb – 88 g/l, coloure index - 0,89, rethyculocytes - 1,6%, platelets - 72х109/l, leukocytes - 72х109/l, bas. - 2%, eos.- 4%, mon. – 9%, yang cells - 11%, bas. - 17%, segm. - 20%, lymph. – 4%, mon. – 1%, blasts - 32%. ESR - 64mm/h.

Right answer: Chronic myeloleukosis, blast krisis (anemia, thrombocytopenia, hyperleukocytosis with a change leukocytic formula to blasts cells).

2. Clinical urine test: amount - 100 ml; relative gravity– 1024 g/l; color is straw-yellow; transparency is transparent; the reaction is poorly-acid; glucose - absent; albumin - 0,066 g/l; ketone bodies - absent; urobylyn - absent; flat kidney epithelium  - 1 - 2 in f/v; leukocytes – 1 - 2 in f/v; red blood cells - absent.

Right answer: Proteinuria - isolated insignificant proteinuria.

3. Koprological investigation: stule informed, greyish-white color, smell is musty,  reaction is acid, mucus and pus isn’t exposed, the reaction to blood is negative. Microscopically: fat acids and soaps bits – 25 - 26 in f/v, neutral fat – 0 - 1 in f/v, muscle fibres – 0 - 1 in f/v, undigested cellulose – 2 - 3 in f/v, overcooked cellulose – 4 - 5 in f/v, starch – 7 - 8 in f/v, leukocytes – 5 - 6 in f/v, the eggs of intestinal worms aren’t exposed.

Right answer: The changes in koprogramme are characteristic for gepatogenic dyspepsia, that meets in patients with obturativ icterus, heavy hepatitis, cirrhosis.

4. Proteinogramme: common protein – 75 g/l, albumin – 30 g/l, globulin – 45 g/l, α1 – 8 g/l, α2 – 10 g/l, b – 10 g/l, γ – 16 g/l, fibrinogen - 5,2 g/l.

Right answer: increase level of globulins, for amount of b-2 globulins, fibrinogen, that is characteristic signs for rheumatoid arthritis.

5. Koagulogramme: prothrombin index – 90%; fibrinogen A  – 2,8 g/l; fibrinogen B   is negative.; time of blood coagulation (by Ly-White) – 2 h. 40 min..; time of bleeding (by Dyuk) – 3 min.; tolerance plasma to heparin – 40 c.; hematocryt – 40 %. Right answer: Haemophilia. Significant increase time of blood coagulation and normal index time of bleeding.

 


Task №10 (8)

1. Clinical blood test: red blood cells - 3,0х1012/l, Hb - 100 g/l, coloure index - 1,0, rethyculocytes - 2,2%, platelets - 120х109/l, leukocytes - 98х109/l, bas. - 1%, segm. - 7%, lymph. – 90%, mon. – 2%. Anisocytosis, Botkin - Gumpreht shades - great quantity, ESR - 20 mm/h.

Right answer: Chronic lympholeukemia (leukocytosis with absolute lymphocytosis, Botkin - Gumpreht shades).

2. Clinical urine test: amount - 100 ml; relative gravity – 1012 g/l; color is straw-yellow; transparency is transparent;  reaction is poorly-acid; glucose - absent; albumin - 0,099 g/l; bile acids - absent; flat epithelium – 5 - 6 in f/v; kidney epithelium – 2 - 3 in f/v; leukocytes – 3 - 4 in f/v; changed erythrocytes – 4 - 5 in f/v; unchanged erythrocytes - absent; leukocyte, erythrocyte, hyaline casts.

Right answer: Chronic glomerulonephritis: microhematuria, cylindruria, proteinuria.

3. Koprological investigation: stule informed, grey color, putrid smell, reaction aciditic,. mucus, pus isn’t exposed, reaction to blood is negative. Microscopically: changed muscle fibres – 20 - 22 in f/v, undigested cellulose – 18 - 20 in f/v, overcooked cellulose – 16 - 18 in f/v, starch – 15 - 16 in f/v, fat acids and soaps –  great quantity, neutral fat - absent, leukocytes – 20 - 22 in f/v, the eggs of intestinal worms aren’t exposed.

Right answer: The changes in koprogramme are characteristic for enteral dyspepsia.

4. Proteinogramme: common protein – 80 g/l, albumins – 39 g/l, globulins – 38 g/l, α1 – 3 g/l, α2 – 15 g/l, b – 11 g/l, γ – 20 g/l, fibrinogen - 4,1 g/l.

Right answer: Increase  level of globulins, α2 and γ, fibrinogen - characteristic signs for bronchial astma.

5. Immunological blood test:

Patient Т., 34 y. Acute myocarditis

Absolute amount of lymphocytes

(N: 1,7-2,0 g/l)

2,1

 

СD3

(N: 35-50%)

51

 

 T(СD8+)

(N: 15-20%)

13

 

T(СD4+)

(N: 30-40%)

42

 

СD4+/СD8+ (YRY)

(N: 1,5-2)

3,2

 СD20 (B- lymphocytes)

(N: 20-30)

22

 

Ig A

(N: 1,5-4 g/l)

5,8

 

IgM

(N: 0,7-1,5 g/l)

0,2

 

IgG

(N: 7-20 g/l)

24

 

IgЕ

(N: 70-120 ED)

130

Fagocytic activity

(N: 60-80%)

72

Fagocytic number

(N: 4-10)

4,3

NBT-test spontaneous

(N: 8-30)

9

NBT-test stimulated

(N: 30-60)

28

CIC

(N: 80-120 odes.)

160

Title of normal antibodies

(N: 1:8-1:32)

1:16

Title of complement

(N: 0,02-0,08)

0,04

Right answer: The autoimmune syndrome (increase CD4+; СD4+/СD8+, CIC, insignificant increase IgE).


Task №12 (9)

1. Clinical blood test: red blood cells - 6,5х1012/l, Hb - 192 g/l, coloure index - 0,88, rethyculocytes - 1,3%, platelets - 450х109/l, leukocytes - 11,4х109/l, bas. - 1%, eos. - 2%, bas. - 18%, segm. - 55%, lymph. – 17%, mon. – 7%. ESR-1 mm/h. Right answer: Erythremia (pancytosis, sharply slow ESR).

2. Clinical urine test: amount - 100 ml; relative gravity  – 1028 g/l; color is straw-yellow; transparency is transparent; the reaction is poorly-acid; glucose ++; albumin - 0,099 g/l; ketone bodies +; flat epithelium – 3 - 4 in f/v; kidney epithelium- 1 - 2 in f/v; leukocytes – 3 - 4 in f/v; changed erythrocytes – 2 - 3 in f/v; unchanged erythrocytes- absent; epithelial, leykocyte and erythrocyte casts. Right answer: Diabetic nephropaty: insignificant proteinuria, kidney epithelium, glucose, ketone bodies.

3. Koprological investigation: stule informed, umber color, smell is putrid, the reaction is alkaline, mucus and pus isn’t exposed, reaction to blood is negative. Microscopically: unchanged muscle fibres– 30 - 35 in f/v, undigested cellulose – 1 - 2 in f/v, overcooked cellulose – 6 - 8 in f/v, starch – 1 - 2 in f/v, leukocytes – 1 - 2 in f/v, the eggs of intestinal worms aren’t exposed.

Right answer: The changes in koprogramme are characteristic for putrid dyspepsia.

4. Biochemical blood test: general bilirubin - 48 mkmol/l, direct - 10 mkmol/l, indirect - 38 mkmol/l, AlAT - 0,5 mmol/h*l, AsAT - 0,3 mmol/h*l, γ - glutamyltranspherase - 5,3 mmol/h/l.

Right answer: Prehepatic hyperbilirubinemia - indirect hyperbilirubinemia (hemolis sign).

5. Spinal liquid investigation: Spinal liquid has serose character with opalestsentia, Pande’s reaction - (+++), albumin 6,6 g/l, glucose - 1,2 mmol/l, cytosis – 670/3, lymphocytes prevails (82%). Bakterioscopy: bacteries tuberculiosis.

Right answer: Tuberculiosis meningitis.

 


Task №13 (10)

1. Clinical blood test: red blood cells-1,35х1012/l, Hb – 58 g/l, coloure index - 1,28, rethyculocytes - 0,1%, platelets - 90х109/l, leukocytes - 3,0х109/l, eos. - 2%, bas. - 4%, segm. - 60%, lymph. – 23%, mon. – 11%. Anysocytosis: hyperchromia of red blood cells, Zholy bodies, Kebot rings, ESR - 38 mm/h.

Right answer: В12-deficite anemia (increase erythrocyte coloure index, Zholy bodies and Kebot rings).

2. Clinical urine test: amount - 100 ml; relative gravity – 1015 g/l; color is dark; transparency is  transparent; reaction is acid; glucose - absent; albumin - 0,066 g/l; ketone bodies - absent; urobilin - absent; bilirubin +++; bilious acids +; flat epithelium – 1 - 2 in f/v; kidney epithelium - absent; leukocytes – 3 - 4 in f/v; changed erythrocytes – 2 - 3 in f/v.

Right answer: Obturatory tipe of icterus: dark color of urine due to bilirubin without urobilinogen.

3. Sputum analysis: amount 15 ml, mucus-festering character, leukocytes – 30 - 40 in f/v, macrofages – 8 - 10 in f/v, erythrocytes – 1 - 2 in f/v, epithelial  (cylindrical) cells – 1 - 2 in f/v. Bacteries tuberculiosis aren’t exposed.

Right answer: sputum is typical for acute bronchitis.

4. Biochemical blood test: general bilirubin - 64 mkmol/l, direct bilirubin - 11 mkmol/l, indirect bilirubin - 53 mkmol/l, AlAT - 0,6 mmol/h/l, AsAT - 0,5 mmol/h/l, γ - glutamyltranspherase - 4,8 mmol/h*l.

Right answer: Prehepatic hyperbilirubinemia - indirect hyperbilirubinemia (hemolis sign).

5. Immunological blood test:

Patient, 47 y.: System lupus erhytematosus

Absolute amount of lymphocyts

(N: 1,7-2,0 g/l)

1,9

 

СD3

(N: 35-50%)

31

 

T(СD8+)

(N: 15-20%)

15

 

T(СD4+)

(N: 30-40%)

46

 

СD4+/СD8+

(N: 1,5-2)

3, 1

 СD20 (B-lymphocyts)

(N: 20-30)

19

 

Ig A

(N: 1,5-4 g/l)

2,0

 

IgM

(N: 0,7-1,5 g/l)

1,0

 

IgG

(N: 7-20 g/l)

24

 

IgЕ

(N: 70-120 ED)

80

Fagocytic activity

(N: 60-80%)

63

Fagocytic number

(N: 4-10)

4,0

NBT-test spontaneous

(N: 8-30)

10

NBT-test stimulated

(N: 30-60)

30

CIC

(N: 80-120 odes.)

170

Title of normal antibodies

(N: 1:8-1:32)

1:16

Title of complement

(N: 0,02-0,08)

0,04

Right answer: Autoimmune syndrome (increase CD4+; СD4+/СD8+, CIC )


Task №14 (11)

1. Clinical blood test: red blood cells - 4,12х1012/l, Hb – 130 g/l, coloure index - 0,9, rethyculocytes - 1%, platelets - 250х109/l, leukocytes - 0,9х109/l, bas. - 1%, segm. - 19%, lymph. – 70%, mon. – 10%. ESR – 40 mm/h.

Right answer: Agranulocytosis (significant diminishment of leukocytes amount, neutropenia, relative lymphocytosis).

2. Clinical urine test: amount - 100 ml; relative gravity– 1015 g/l; color is dark; transparency is  transparent; reaction is acid; glucose - absent; albumin - 0,066 g/l; ketone bodies - absent; urobylyn - absent; bilirubin ++; bile acids +; flat epithelium – 1 - 2 in f/v; kidney epithelium - absent; leukocytes – 3 - 4 in f/v; changed erythrocytes 2 - 3 in f/v.

Right answer: Obturative icterus - dark color of urine due to bilirubin without of urobilin.

3. Sputum analysis: amount 25 ml, green color, leukocytes – 40 - 50 in f/v, eosinophils – 1 - 2 in f/v, macrophages – 10 - 12 in f/v, erythrocytes– 10 - 12 in f/v, epithelial cells – 1 - 2 in f/v, mixed microflora. Bacteries tuberculiosis isn’t exposed.

Right answer: Sputum is typical for a chronic bronchitis.

4. Biochemical blood test: general bilirubin - 123 mkmol/l, direct bilirubin - 52 mkmol/l, indirect bilirubin - 71 mkmol/l, AlAT - 2,4 mmol/h*l, AsAT - 1,7 mmol/h*l, γ-glutamyltranspherase - 8,3 mmol/h*l.

Right answer: Hepatic (parenhymathose) hyperbilirubinemia, cytolis (increase enzymes activity - AlAT, AsAT), holestatic syndrome (increase γ-glutamyltranspherase activity) (high active hepatitis).

5. Spinal liquid investigation: grey color, transparency is turbid, Pande’reaction - (+++), albumin - 33,3 g/l, glucose - 1,4 mmol/l, cytosis – 7846/3. Cellular composition: lymphocyts – 4%, neutrophyls –96%. Bakterioscopy: gramm-negative diplococcuses.

Right answer: Menyngococcal meningitis.

 


Task №16 (12)

1. Clinical blood test: erythrocytes - 3,9х1012/l, Hb – 120 g/l, coloure index - 1,0, rethyculocytes - 1%, platelets - 320х109/l, leukocytes - 12,7х109/l, bas. - 1, eos. - 2, yang cells - 1, bas. - 20, segm. - 62, lymph. – 11, mon. – 3. ESR-42 mm/h.

Right answer: Active inflammatory process (leukocytosis with change leukocytic formula to the left, increase ESR).

2. Clinical urine test: amount 100 ml, relative gravity 1015 g/l, color brown-green transparency – transparent, reaction - acid glucose – absent, albumin 0,033 g/l, ketone bodies – absent, urobilin +++, bilirubin +++, bile acids +, flat epithelial cells – 1 - 2 in f/v, kidney epithelial cells – absent, leukocytes 1 - 2 in f/v, erythrocytes 1 - 2 in f/v.

Right answer: Hepatic or hemolytic icterus: dark color of urine both due to bilirubin and urobilin.

3. Sputum investigation: amount 15 ml, ferruginous, viscid, contains the clots of fibrin, leukocytes – 35 - 40 in f/v, macrophages – 8 - 10 in f/v, erythrocytes – 20 - 25 in f/v, epithelial cells – 10 - 12 in f/v, hematoidin crystals – 2 - 3 in f/v, hemosideryn granules – 4 - 6 in f/v, pneumococces – 25 - 30 in f/v. Bacteries of tuberculiosis isn’t exposed.

Right answer: Sputum is typical for viral pneumonia.

4. Biochemical blood test: general bilirubin - 357 mkmol/l, direct bilirubin - 137 mkmol/l, indirect bilirubin - 220 mkmol/l, AlAT - 2,5 mmol/h*l, AsAT - 2,1 mmol/h*l, γ - glutamyltranspherase - 8,7 mmol/h*l, tymole test - 12,0 IU.

Right answer: Hepatic (parenhymatosis) hyperbilirubinemia, cytolis (increase enzymes activity - AlAT, AsAT), holestatic syndrome (increase γ - glutamyltranspherase activity), mesenhymal-inflammatory syndrome (increase of tymole test) (high active hepatitis).

5. Duodenal juse investigation:

I phase is a transparent yellow bile, volume – 15 ml, duration of stage - 35 min., single epithelial cells, 3 - 4 leukocytes in f/v;

ІІ phase is duration 10 mines.

ІІІ phase (portion “А”) is a darkly-yellow bile, specific gravity 1010 g/l, reaction weak alkaline, volume – 3 ml, duration of stage - 5 min.., 6-7 epithelial cells, 4 - 5 leukocytes in f/v are microscopically exposed, bylyrubynat calcium and cholesterol in the two-bit amounts.

IV phase (portion “В”) is the turbid bile of olive, specific gravity 1050 g/l, reaction weak alkaline, volume – 15 ml, duration of stage - 50 min.; microscopically: a lot of mucus,  30-40 prismatic epithelial cells, 40 - 50 leukocytes in f/v, a lot of bylyrubynata calcium, cholesterol, “sand”, crystals of fat acids in great quantity.

V phase (portion “С”) is the yellow color of bile, specific gravity 1007 g/l, the reaction is alkaline, volume – 20 ml, duration of stage - 20 min., microscopically:  4 - 5 shallow prismatic epithelium cells, 4 - 5 leukocytes in f/v, bylyrubynat calcium and cholesterol in the two-bit quantity.

Right answer: There is inflammatory process in a gall-bladder, characteristic the presence of mucus, plenty of leukocytes, epithelial cells, a lot of bylyrubynata calcium, cholesterol, “sand” and crystals of fat acids great quantity in the portion “В”.


Task №17 (13)

1. Clinical blood test: red blood cells - 3,6х1012/l, Hb – 96 g/l, coloure index - 0,8, rethyculocytes - 3%, platelets - 12х109/l, leukocytes - 7,8х109/l, bas. - 1%, eos.-1%, bas. - 7%, segm. - 63%, lymph. – 20%, mon. – 85%. ESR - 24 mm/h.

Right answer: Thrombocytopenic purpure (significant diminishment amount of platelets, moderate posthemorragic anaemia).

2. Clinical urine test: amount - 100 ml; relative gravity – 1028 g/l; color is yellow; transparency is transparent; reaction is neutral; glucose 0,02 g/l; albumin - 0,166 g/l; ketone bodies +++; flat epithelial cells - absent; -; kidney epithelial cells – 1 - 2 in f/v; leukocytes – 2 -3 in f/v; changed erythrocytes – 4 - 5 in f/v; unchanged erythrocytes - absent; erythrocitic and hyaline casts.

Right answer: Diabetic nephropaty: insignificant proteinuria, kidney epithelium, glucose, ketone bodies.

3. Sputum investigation: amount 5 ml, transparent, glassy, leukocytes – 30 - 40 in f/v, eosinophyls – 8 - 10 in f/v, erythrocytes– 1 - 2 in f/v epithelial cells– 1 - 2 in f/v, the Kurshman spirals – 2 - 3 in f/v, the Sharko-Leyden crystals – 4 - 6 in f/v. Bacteries of tuberculiosis isn’t exposed.

Right answer: Glassy sputum with increase amount of eosinophils eozynophils, Kurshman and Sharko-Leydena crystals typical for bronchial asthma.

4. Biochemical blood test: common bylyrubyn - 75 mkmol/l, direct bilirubin - 15 mkmol/h/l, indirect - 60 mkmol/l, AlAT - 0,6 mmol/h/l, AsAT - 0,4 mmol/h/l, γ - glutamyltranspherase - 5,1 mmol/h/l.

Right answer: Prehepatic hyperbilirubinemia - indirect hyperbilirubinemia (hemolis sign).

5. Immunological blood test:

Patient G., 21y. Clinic: Allergic rynitis, frequent respiratore virus infections.

Absolute amount of lymphocytes

(N: 1,7-2,0 g/l)

1,3

 

СD3

(N: 35-50%)

46

 

 T(СD8+)

(N: 15-20%)

11

 

T(СD4+)

(N: 30-40%)

27

 

СD4+/СD8+

(N: 1,5-2)

2,5

 СD20 (B-lymphocyts)

(N: 20-30)

22

 

Ig A

(N: 1,5-4 g/l)

4,0

 

IgM

(N: 0,7-1,5 g/l)

1,3

 

IgG

(N: 7-20 g/l)

18

 

IgЕ

(N: 70-120 ED)

150

Fagocytic activity

(N: 60-80%)

42

Fagocytic number

(N: 4-10)

4,1

NBT-test spontaneous

(N: 8-30)

10

NBT-test stimulated

(N: 30-60)

29

CIC

(N: 80-120 odes.)

90

Title of normal antibodies

(N: 1:8-1:32)

1:16

Title of complement

(N: 0,02-0,08)

0,06

С3

(N:)

N

С4

(N: )

N

Right answer: The immunopathologic infective-allergic syndrome (decline absolute amount of lymphocytes their supressor activity, low index of fagocytic activity and increase level of Ig Е).


Task №19 (14)

1. Clinical blood test: red blood cells - 4,12х1012/l, Hb - 130g/l, coloure index - 0,9, rethyculocytes - 1%, platelets - 250х109/l, leukocytes - 0,9х109/l, bas. - 1%, segm. - 19%, lymph. – 70%, mon. – 10%. ESR - 40 mm/h.

Right answer: Agranulocytosis (diminishment amount of leukocytes, neutropenia, relative lymphocytosis).

2. Clinical urine test: amount - 100 ml; relative gravity – 1024 g/l; color is yellow; transparency is transparent; reaction is poorly-alkaline; glucose - absent; albumin - 0,99 g/l; leukocytes – 3 - 5 in f/v; changed erythrocytes - absent; unchanged erythrocytes - absent; hyaline and grainy casts; mucus. Note: positive reaction to Benz-Jons protein.

Right answer: Myelom disease: proteinuria due to Benz-Jons protein.

3. Sputum investigation: amount 25 ml, mucous-festering-blood character, contains snatches of pulmonary tissue, leukocytes – 10 - 15 in f/v, elastic fibers – 8 - 10 in f/v, red blood cells – 30 - 35 in f/v, epithelial cells – 10 - 12 in f/v, atypical cells – 20 - 22 in f/v.

Right answer: Sputum is typical for lung cancer.

4. Biochemical blood test:  common bilirubin - 145 mkmol/l, direct bilirubin - 104 mkmol/l, indirect bilirubin - 41 mkmol/l, AlAT - 0,7 mmol/h/l, AsAT - 0,5 mmol/h/l, γ -- glutamyltranspherase - 9,7 mmol/h/l, alkaline phosphatase - 4,3 mmol/h/l.

Right answer: Subhepatic (obturative) hyperbilirubinemia (prevalence of con’ugative fraction), holestatic syndrome (increase activity glutamyltranspherase and alkaline phosphatase).

5. Gastric juse investigation:

empty stomach portion of gastric content volume - 250 ml, contains a lot of particles of meal, free hydrochloric acid 5 mmol/l, general acidity 20 mmol/l, microscopically are muscle fibres, corns of starch, vegetable cellulose, abundant candides.

I phase of secretion (bazal secretion) is volume of gastric content 130 ml/h, free hydrochloric acid - 12 mmol/l, general acidity - 20 mmol/l; microscopically - 8-10 cylindrical epithelial cells.

ІІ phase (stimulated secretion by submaximal dose of histamin 0,008 mg/kg) is volume of gastric content 100 ml/h, free hydrochloric acid 30 mmol/l, common acidity 50 mmol/l.

Right answer: The state of gastric secretion is estimated as hypoacydity.

 


Task №23 (15)

1. Clinical blood test: red blood cells - 2,95х1012/l, Hb - 88g/l, coloure index - 0,89, rethyculocytes - 1,6%, platelets - 72х109/l, leukocytes - 72х109/l, bas. - 2%, eos. - 4% mon. – 9%, yang cells -11%, bas. - 17%, segm. - 20%, lymph. – 4%, mon. – 1%, blast cells – 32%. ESR- 64 mm/h.

Right answer: Chronic myeloleukosis, blast krisis (anemia, thrombocytopenia, hyperleukocytosis with change leukocytic formule to blast cells).

2. Clinical urine test: amount - 100 ml; relative gravity – 1015 g/l; color is rose;  transparency - is transparent; reaction is poorly-acid; albumin - 0,066 g/l; flat epithelial cells – 30 - 40 in f/v; kidney cells - absent; leukocytes – 6 - 8 in f/v; changed erythrocytes - absent; unchanged erythrocytes – 30 - 40 in f/v; salts - oksalats +++.

Right answer: Kidney colic: hematuria due to fresh red blood cells, rose color of urine, oksalats, flat epithelium.

3. Koprological investigation: stule informed, foamly, yellow color, contains undigested particles of garden trucks, smell is acid, mucus and pus isn’t exposed, reaction to blood is negative. Microscopically: muscle fibres – 0 - 1 in f/v, undigested cellulose – 18 - 20 in f/v, overcooked cellulose – 16 - 18 in f/v, starch – 15-16 in f/v, leukocytes – 1 - 2 in f/v, the eggs of intestinal worms aren’t exposed.

Right answer: Stule informed, foamly, with undigested particles of garden trucks, acid smell, increase amount of undigested cellulose and starch are characteristic for fermentic dyspepsia.

4. Ion blood test: sodium - 126 mmol/l; potassium - 3,0 mmol/l; calcium - 2,0 mmol/l.

Right answer: Decline all electrolytes level.

5. Koagulogramme: prothrombin index – 64%; fibrinogen A  – 3,8 g/l; fibrinogen B   is negative.; time of blood coagulation (by Ly-White) – 15 mines.; time of bleeding (by Dyuk) – 2 mines.; tolerance plasma to heparin – 10 c.; hemathocrit – 42%.

Right answer: Decline of prothrombin index. Meets at diseases of liver, reception for indirect anticoagulants.

 


Task №25 (16)

1. Clinical blood test: red blood cells 6,5х1012/l, Hb-192 g/l, colour index - 0,88, rethyculocytes - 1,3%, platelets - 450х109/l, leukocytes-11,4х109/l, bas. - 1%, eos. - 2%, drum-stick - 18%, segm. - 55%, lymph. - 17%, mon. - 7%. ESR -1 mm/h

      Right answer: Erythremya (pancytosis, sharply slow ESR).

2. Clinical urine test: amount - 100 ml, relative gravity – 1015; color is straw-yellow; transparency is turbid; the reaction is poorly-acid; glucose absent; albumine - 0,166 g/l; flat epithelium - 6-8 in f/v; kidney epithelium - 2-3 in f/v; leukocytes cover all feeld of vision, lymphocytes  > 60%; changed erythrocytes – 7 - 8 in f/v; unchanged absent; leukocyte, hyaline and granular casts.

     Right answer: Kidney tuberculosis: lymphocyte tipe pyuria, proteinuria,

     hematuria.

3. Pleural fluid investigation: liquid is turbid, festering with an unpleasant smell, specific gravity – 1034 g/l, albumine – 40 g/l, Ryvald's test is positive, glucose level – 1,4 mmole/l, expressed neutrophile leukocytosis.

     Right answer: Pleurliquid characteristic for pleura empyem.

4. Ion blood test: sodium - 134 mmol/l; potassium - 4,28 mmol/l; calcium - 2,39 mmol/l.

     Right answer: Norm.

5. Spinal liquid investigation: color is greenish, transparency is turbid, Pande’s reaction - (++++), albumine - 6,6 g/l, glucose - 1,1 mmol/l, cytosis – is not added to the count. Cellular liquid composition: lymphocytes – 6%, neutrophils –94%. Bakteryoscopy: grammpositive cocci.

     Right answer: Pneumococcal meningitis, severe curse.


                                           Task №26 (17)

1. Clinical blood test: red blood cells - 1,65х1012/l, Hb-48 g/l, colour index - 0,87, rethyculocytes - 0,5%, platelets-20х109/l, leukocytes-75х109/l, Blusts-85%, drum-stick - 2%, segm. - 5%, lymph. - 5%, mon. - 3%. ESR - 75 mm/h.

      Right answer: Acute leukosis (anaemia, thrombocytopenia, blustaemia,

      hyperleukocytosis, leukemic failure).

2. Clinical urine test: amount - 100 ml, relative gravity – 1028 g/l; color is straw-yellow; transparency - is transparent; the reaction - is poorly-acid; glucose – (+++); albumine - absent; ketone bodies – (++); urobiline – (+); bilirubin - absent; bilious acids - absent; flat epithelium - 1-2 cells in f/v; kidney epithelium - absent; leukocytes - 2-3 in f/v; erythrocytes - absent.

     Right answer: Diabetes melitus: glucose, ketone bodies without kidnei’s chenges.

3. Koprological investigation: stule informed, foamy, grinish, contains the undigested particles of garden trucks, smell is acid, mucus and pus isn’t exposed, reaction to blood is negative. Microscopically: muscle fibres – 0 - 1 in f/v, undigested cellulose – 18 - 20 in f/v, overcooked cellulose – 16 - 18 in f/v, starch – 15 - 16 in f/v, leukocytes – 1 - 2 in f/v, the eggs of intestinal worms aren’t exposed.

Right answer: Informed foamy stule with undigested particles of garden trucks, acid smell, macrocopic amount of undigested cellulose and starch is characteristic for fermenting dyspepsia.

4. Ion blood test: sodium - 124 mmol/l; potassium - 4,6 mmol/l; calcium - 2,46 mmol/l.

     Right answer: Hyponatriaemia.

5. Immunological blood test:

Patient S., 40 y., with rheumatoid arthritis.

Absolute amount of lymphocytes

(N: 1,7-2,0 g/l)

1,9

 

СD3

(N: 35-50%)

31

 

T(СD8+)

(N: 15-20%)

15

 

T(СD4+)

(N: 30-40%)

46

 

СD4+/СD8+

(N: 1,5-2)

3, 1

 СD20 (B-lymphocytes)

(N: 20-30)

19

 

Ig A

(N: 1,5-4 g/l)

2,0

 

IgM

(N: 0,7-1,5 g/l)

1,0

 

IgG

(N: 7-20 g/l)

24

 

IgЕ

(N: 70-120 UN)

80

Fagocytic activity

(N: 60-80%)

63

Fagocytic number

(N: 4-10)

4,0

NBТ-test spontaneous

(N: 8-30)

10

NBТ-test stimulated

(N: 30-60)

30

CIC

(N: 80-120 UN)

170

Title of normal antibodies

(N: 1:8-1:32)

1:16

Title of complement

(N: 0,02-0,08)

0,04

Right answer: Autoimmune syndrome (increase CD4+; СD4+/СD8+, CIC).


Task №27 (18)

1. Clinical blood test: red blood cells - 3,6х1012/l, Hb – 96 g/l, colour index - 0,8, retyculocytes – 3 %, platelets - 12х109/l, leukocytes-7,8х109/l, bas. - 1%, eos. - 1%, drum-stick - 7%, segm. - 63%, lymph. - 20%, mon. - 8%, ESR - 24 mm/h.

Right answer: Thrombocytopenic purpure (sharp diminishment amount of platelets, moderate cronic post-hemorragic anaemia).

2. Clinical urine test: amount - 100 ml. Relative gravity – 1015 g/l; color is straw-yellow; transparency - is  transparent; reaction - is acid; glucose - absent; albumine - 0,066 g/l; bile acids - absent; flat epithelium - 6-8 in f/v; kidney epithelium - 3-4 in f/v; leukocytes cover all feeld of vision, primary lymphocytes; changed erythrocytes 7 - 8 in f/v; unchanged - absent; leukocyte, hyaline and erythrocyte casts.

Right answer: Kidney tuberculosis. Lymphosite type pyuria, proteinuria, hematurya.

3. Pleural fluid investigation: liquid is transparent with a lemon-yellow color, odourless, specific gravity – 1012 g/l, albumine – 15 g/l, Ryvald's test is negative, glucose level – 3,68 mmol/l. Microscopically: red blood cells – 500 in 1 mm3, leukocytes – 250 in 1 mm3, a two-bit of mezothelial sells

Right answer: Pleural fluid is characteristic for transsudata.

4. Ion blood test: sodium - 140 mmol/l; potassium - 4,0 mmol/l; calcium - 2,25 mmol/l.

Right answer: Norm.

5. Stomach pH-metry:

pH - Units

Amount of measuring points

0,9 – 1,2   (5)

0

1,3 – 1,5   (4)

8

1,6 – 2,2   (3)

6

2,3 – 3,5   (2)

3

3,6 - 6,9    (1)

2

7,0 – 7,5   (0)

1

At all the points 20.

Right answer: Basic hyperacidity, moderate, selective.

 


Task №29 (19)

1. Clinical blood test: red blood cells-1,9х1012/l, Hb-68 g/l, coloure index - 1,0, rethyculocytes - 34%, platelets - 320х109/l, leukocytes-12,7х109/l, bas. -1%, eos. -2%, yang - 1%, drum-stick - 20%, segm. - 62%, lymph. - 11%, mon. - 3%, ESR – 72 mm/h.

Right answer: Hemolytic anemia (normochromic anemia, rethyculocytosis, leukocytosis with a change to the left, accelerated ESR).

2. Clinical urine test: amount - 100 ml, relative gravity – 1005 g/l; color is greenish; transparency - is transparent; reaction is poorly-acid; glucose – (+); flat epithelium - 1-2 in f/v; leukocytes - absent; changed erythrocytes - absent; unchanged erythrocytes - absent; oxalat salts – (+).

Right answer: Chronic kidney falure: low specific gravity. Glucose presents in resalt of reabsorbtion violance.

3. Koprological investigation stule informed, umber color, smell is putrid, reaction is alkaline, mucus and pus isn’t exposed, the reaction to blood is negative. Microscopically: unchanged muscules fibres – 30 - 35 in f/v, undigested cellulose – 1 - 2 in f/v, overcooked cellulose – 6 - 8 in f/v, starch – 1 - 2 in f/v, leukocytes – 1 - 2 in f/v, the eggs of intestinal worms aren’t exposed.

Right answer: The changes in koprogramme are characteristic for putrid dyspepsia.

4. Creatinine and urea blood test: creatininee – 9 mmol/l; urea - 22,5 mmol/l.

Right answer: Chronic renal falure ІІІ st.

5. Immunological blood test:

Patient F., 50 y.: Chronic recidive urticaria, exacerbation.

Absolute amount of lymphocyts

(N: 1,7-2,0 g/l)

3,9

 

СD3

(N: 35-50%)

49

 

T(СD8+)

(N: 15-20%)

12

 

T(СD4+)

(N: 30-40%)

31

 

СD4+/СD8+

(N: 1,5-2)

2,6

 СD20 (B-lymphocyts)

(N: 20-30)

22

 

Ig A

(N: 1,5-4 g/l)

2,0

 

IgM

(N: 0,7-1,5 g/l)

1,0

 

IgG

(N: 7-20 g/l)

27

Fagocytic activity

(N: 60-80%)

70

Fagocytic number

(N: 4-10)

4,8

NBТ-test spontaneous

(N: 8-30)

9

NBТ-test stimulated

(N: 30-60)

27

CIC

(N: 80-120 odes.)

170

Title of normal antibodies

(N: 1:8-1:32)

1:16

Title of complement

(N: 0,02-0,08)

0,04

Right answer: Allergic tipe of immunity (increase absolute lymphocyte amount, СD4+/СD8+, Ig G, CIC; decline of supressor lymphocyte activity)


Task №30 (20)

1. Clinical blood test: red blood cells-1,75х1012/l, Hb-74 g/l, coloure index - 1,3, rethyculocytes - 0,2%, platelets - 120х109/l, leukocytes-3,2х109/l, bas.- 1%, eos. – 3%, drum-stick – 4%, segm. – 58%, lymph. – 26%, mon. – 10%. Anyzocytosis: makrocytes, hyperchromic erythrocytes, ESR – 32 mm/h.

Right answer: В12 deficite anaemia (makrocytes, hyperchromic erythrocytes, thrombo- and leukopenia,  increase coloure index).

2. Clinical urine test: amount - 100 ml, relative gravity – 1018 in f/v; color is straw-yellow; transparency - is turbid; reaction is poorly-alkaline; albumin - 0,33 g/l; flat epithelium – 7 - 8 in f/v; kidney – 4 - 6 in f/v; leukocytes – 15 - 20 in f/v; changed erythrocytes – 2 - 3 in f/v; unchanged - absent; epithelial, leukocyte, erythrocyte casts; mucus - great quantity.

Right answer: Acute pyelonephritis: hematuria, leykocyturia, bacteryuria, cylindruria, proteinuria, kidney epithelium, mucus.

3. Sputum analysis: amount - 50 ml, a color is grey, character is mucous, leukocytes – 2 - 3 in f/v, epithelium is cylindrical 2 - 3 in f/v, eosinophyls – 2 - 3 in f/v, bacteries tuberculiosis aren’t exposed. Dust of earth-flax, „asbestine bodies”. Right answer: Analysis of sputum is character for asbestosis.

4. Creatinine and urea blood test: creatynine – 6,5 mmol/l; urea - 12,4 mmol/l. Right answer: Chronic renal falure ІІ st.

5. Spinal liquid investigation: color is normal, transparency - is transparent, Pande’s reaction - (+), albumin - 0,99 g/l, glucose - 2,5 mmol/l, cytosis – 630/3. Predominance of elements: lymphocytes – 82%, neutrophyles – 18%.

Right answer: Meningitis serose.

 

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