Clinical manifestations of acute leukemia. Acute leukemia

Option 1.

1. Main cause of acute leukemia
1) bacterial infection
2) physical inactivity
3)stress
4) chromosomal abnormalities

2. Sternal puncture is performed during diagnosis
1) myocardial infarction
2) leukemia
3)pneumonia
4) liver cirrhosis

3. Syndromes are observed with leukemia
1)painful, dysuric
2)hypertensive, nephrotic
3) hyperplastic, hemorrhagic
4)painful, dyspeptic

4. Hyperleukocytosis up to 200x109/l is observed with
1) leukemia
2) pyelonephritis
3)pneumonia
4) rheumatism

5. Leukemic “failure” in the blood test is observed when
1) hemophilia
2) acute leukemia
3) chronic lymphocytic leukemia
4) chronic myeloid leukemia

6. With chronic lymphocytic leukemia, there is an increase
1)liver, spleen, heart
2) liver, spleen, lymph nodes
3) spleen, heart, kidneys
4) spleen, heart, thyroid gland

7. Used in the treatment of leukemia
1) antibiotics, vitamins
2) diuretics, sulfonamides
3) nitrofurans, analgesics
4) cytostatics, glucocorticosteroids

8. A plant whose alkaloid has a cytostatic effect
1) marshmallow
2) barberry
3)periwinkle
4)cornflower

9. Medicine plant origin having a cytostatic effect
1) azathioprine
2) berberine
3) vinblastine
4) cyclophosphamide

10. Antibiotic with a cytostatic effect
1) ampicillin
2) penicillin
3) rubomycin
4) tetracycline

Tests on the topic: “Acute leukemia.”

Option - 2.

1. If a patient has anemia, thrombocytopenia, blastosis in the peripheral blood, then you should think:

1) About erythremia

2) About aplastic anemia

3) About acute leukemia

4) O V-12 deficiency anemia

2. What type of acute leukemia is typical? early onset DIC syndrome?

1) acute lymphoblastic leukemia

2) acute promyelocytic leukemia

3) acute monoblastic leukemia

4) erythromyelosis

3.What is the criterion for complete clinical and hematological remission in acute leukemia?

1) The number of blasts in the sternal punctate is less than 5%

2) The number of blasts in the sternal punctate is less than 2%

4.At what stage of acute leukemia is cytostatic therapy used in the consolidation phase?

1) relapse

2) remission

3) expanded stage

4) terminal stage

5. In what organs can leukemic infiltrates appear in acute leukemia?

1) Lymph nodes

2) Spleen

6. The myelogram in acute leukemia is characterized
1. reduction of erythropoiesis
2. hypercellularity
3. blastosis
4 decrease in the number of megakaryocytes
5. increase in the number of megakaryocytes

7. Ionizing radiation has a primary causal significance in:

1) chronic lymphocytic leukemia;

2) lymphosarcoma;

3) lymphogranulomatosis;

4) acute myeloid leukemia;

5) multiple myeloma.

8. Classification of leukemia is based on:

1) clinical picture of the disease;

2) anamnestic data;

3) degree of maturity of the cellular substrate of the disease;

4) the patient’s life expectancy;

5) the effectiveness of the therapy.

9. If you suspect acute leukemia, you must do the following:

1) lymph node biopsy;

2) sternal puncture;

3) puncture of the spleen;

4) reticulocyte count;

5) Ultrasound of the liver and spleen.

10. The division of leukemia into acute and chronic is based on:

1) the nature of the course of the disease;

2) age of patients;

3) the degree of inhibition of normal hematopoietic germs;

4) the degree of anaplasia of hematopoietic tissue elements;

5) duration of the disease.

Sample answers to the topic: “Acute leukemia.”

Option 1

Option 2

Situational task on the topic: “Acute leukemia.”

Task – 1.

Exercise:

Problem 2

A paramedic is called to the house of patient S., 25 years old, who complains of pain in the throat, bones, severe weakness, headache, fever up to 40 degrees, nose bleed. I got sick a week ago.
Objectively: temperature 39.5C. General state heavy. The skin is hot on palpation, and there are pinpoint hemorrhages on the chest and limbs. From mouth putrid smell. The tongue is coated with a dark coating. Tonsils are enlarged. There is a purulent overlay. Soreness is noted flat bones when tapping. Vesicular breathing. Percussion sound is pulmonary. NPV 26 per minute. Heart sounds are muffled and rhythmic. Heart rate 120/min. Blood pressure 100/70 mm Hg. The abdomen is soft, slightly painful. The liver is 3 cm below the costal arch, the spleen is palpated at the edge of the costal arch.

Tasks
1. Formulate and justify the presumptive diagnosis.
2. Name the necessary additional research.
3. List possible complications.
4. Determine your tactics in relation to the patient, tell us about the principles of treatment, prognosis and prevention of the disease.
5. Demonstrate the technique of IM injections.

TASK - 3.

A 25-year-old patient has had an increase in body temperature to 38 0 C for 2 weeks, bleeding gums, and sore throat when swallowing. On examination: pallor of the skin and mucous membranes, petechial hemorrhagic rash on the skin of the lower extremities. The spleen is palpated 3 cm from the hypochondrium. In the pharynx there are ulcers covered with fibrinous plaque.

In the blood test: er. - 2.2x10 9 /l, Hb - 79 g/l, thrombus. - 22.0x10 9 /l, lake. - 30.0x10/l, blast cells - 62%, segm. - 24%, lymph. - 12%, mon. - 2%, ESR - 51 mm/hour.

1. Your presumptive diagnosis.

2. What activities are necessary to clarify it. What changes do you expect when conducting these studies?

3. What stages of treatment does the patient need to undergo?

Problem 4

A 19-year-old patient complains of nosebleeds, lethargy, fever, pain in the lower limbs. The child's general condition is serious. Pale, sweaty, hepatosplenomegaly, lymphadenopathy. On the skin of the extremities and torso, a hemorrhagic rash is observed in the form of single asymmetrical, polychrome, polymorphic ecchymoses. In the blood test: er. - 2.9x1012 /l, Hb - 68 g/l, tr. - 25x109 /l, leuk. - 128x109 /l, blasts - 34%, segment. -42%, lymph.-17%, mon.-7%, ESR - 58 mm/hour

1.Your presumptive diagnosis.

2. What measures are necessary to clarify it. What changes do you expect when conducting these studies?

3.What stages of treatment does the patient need to undergo?

Task No. 5.

The patient died due to symptoms acute disorder cerebral circulation. An autopsy revealed necrotizing tonsillitis, extensive hemorrhage in the right parietotemporal region, and multiple petechial hemorrhages on the skin, mucous and serous membranes. Noted moderate increase liver and spleen. The bone marrow of flat and tubular bones was red and juicy with gray areas.

1. Diagnose the disease.

2. What studies need to be carried out to clarify the type of disease?

3. What caused the cerebral hemorrhage?

appear as if suddenly

among full health. In fact, it develops unnoticed or subacutely. Observed at

When a patient is admitted to a hospital, a severe symptom complex essentially means an already developed

phase of the disease (thus it is not acute onset disease, or rather, the “sharp end” of it).

The onset has no pathognomonic manifestations. Most often the disease develops

subacutely, over several weeks, and is characterized by gradually increasing general weakness,

fatigue, loss of body weight, unmotivated increase in body temperature. Some

less often, leukemia debuts acutely and occurs with a clinical picture of acute pneumonia, tonsillitis, or other

infectious disease. Often the first manifestation of the disease is hemorrhagic

syndrome (subcutaneous hemorrhages, nasal, uterine bleeding). In some patients

diagnosed during a routine blood test, when there are no complaints at all (preventive

inspection). It must be remembered that the onset of acute leukemia can be almost any

(hypertrophic gingivitis, stomatitis, migratory thrombophlebitis, sudden loss consciousness or

paraparesis in neuroleukemia, etc.).

Although the symptoms of the advanced stage are very diverse and cover almost all the most important

systems of the body, however, the main clinical picture is clearly outlined and typical, it consists of 6

main syndromes: 1) hyperplastic, 2) hemorrhagic, 3) anemic, 4) intoxication,

5) syndrome secondary immunodeficiency, 6) ulcerative-necrotic syndrome.

Hyperplastic syndrome manifests itself as a moderate and painless increase

lymph nodes, slight enlargement of the spleen, liver (2-3 cm from under the edge of the costal arch).

Skin leukemic infiltrates (leukemia) may appear in the form of reddish-bluish plaques.

Hyperplastic syndrome is associated with diffuse proliferation of blast cells, this is a manifestation

extramedullary damage to lymph nodes, spleen, liver.

Anemic syndrome is manifested by dizziness, weakness, shortness of breath, tachycardia,

pallor skin, a decrease in hemoglobin and red blood cells (sometimes to critical numbers: Hb -

30 g/l, red blood cells 0.82 x 10!2/l). Anemia in acute leukemia is caused by:

1) inhibition of the erythroid germ of hematopoiesis in the bone marrow (this mechanism is clearly

manifests itself in acute non-lymphoblastic leukemia);

2) loss of red blood cells due to bleeding;

3) autoimmune hemolysis of erythrocytes, which is decisive in acute

lymphocytic leukemia (occurs with moderate jaundice, reticulocytosis, positive Coombs test).

Hemorrhagic syndrome manifests itself as hemorrhagic rashes on the skin and mucous membranes

membranes from single pinpoint and small-spotted to extensive hemorrhages and profuse

bleeding (nasal, uterine, gastrointestinal, etc.). The syndrome is caused by thrombocytopenia,

often very significant (hemorrhagic manifestations begin with a decrease in platelet levels

below 20 x 109/l). The causes of thrombocytopenia are:

1) inhibition of the megakaryocyte lineage of hematopoiesis;

2) loss of platelets due to bleeding;

3) destruction of platelets due to autoimmune processes;

4) consumption of platelets in disseminated vascular coagulation syndrome

Another reason hemorrhagic manifestations a patient with leukemia develops disseminated intravascular coagulation

syndrome due to consumption of blood clotting factors. Most often this process develops when

promyelocytic acute leukemia, since the release of promyelocyte granules due to their high

thrombogenicity triggers the coagulation cascade.

Intoxication syndrome is manifested by profuse sweating, weakness, low-grade fever

temperature, loss of body weight. This syndrome is caused by the breakdown of tumor cells due to

causing substances that cause a pyrogenic reaction and intoxication to enter the bloodstream.

Secondary immunodeficiency syndrome is observed in 80-85% of patients and is dangerous,

difficult-to-control complication. The most numerous group of infectious complications

bacterial origin, including pneumonia, sepsis, purulent processes. Last time

Severe infectious complications of viral and fungal origin have increased. Cause

immunodeficiency consists of granulocytopenia and inferiority of the lymphocytic immune system.

Ulcerative-necrotic syndrome is explained by leukemic infiltration of the submucosal layer,

malnutrition, tissue breakdown, formation of ulcers and necrosis. Sometimes ulcerative

necrotic changes in the oral cavity. Necrosis of the esophagus, stomach, small and large intestines is possible.

20% of patients develop paraproctitis.

Extramarrow manifestations of the disease include lesions nervous system due to

tumor metastasis to meninges, the substance of the brain and nerve trunks that serves

complication of any leukemia. The clinical picture of neuroleukemia develops gradually and consists of

increased symptoms intracranial pressure and local symptoms: meningoencephalic

syndrome ( headache, nausea, vomiting, stiff neck, Kernig sign),

pseudotumorous, dysfunction of cranial nerves, damage to peripheral nerves.

In all cases, when spinal tap high blast cytosis is detected (over 10 in 1 μl

cerebrospinal fluid).

The development of leukemic infiltration of the myocardium is indicated by the appearance of cardiac

insufficiency. It is preceded by dullness of heart sounds, decreased ECG voltage and negative

T waves, myocardial hypertrophy.

Lung damage - leukemic pulmonitis is characterized by the appearance of a dry cough,

increased temperature, dry wheezing. On the radiograph - the appearance of local enlargement

pulmonary pattern, small or large focal shadows. Specific infiltration is less common

pleura with effusion in pleural cavity. Diagnosis of this condition is difficult and complicated

necessity differential diagnosis with bacterial pneumonia.

When examining peripheral blood in patients with acute leukemia, the following are revealed:

hematological signs:

1) change in the number of leukocytes within a fairly wide range: from 0.1 x 109/l to 180 x 109/l;

2) the appearance of blast cells in the blood (at early stages blast cell diseases can still

absent in the peripheral blood, but there are already enough of them in the bone marrow; in peripheral blood

this time there is a decrease in all blood cells);

3) a decrease in the number of mature cells of the myeloid lineage in the absence of transitional forms

(“leukemic failure” - hiatus leukemicus);

4) in acute non-lymphoblastic leukemia, immature granulocytes can be detected:

promyelocytes, myelocytes, metamyelocytes, but their number is small (no more than 10%);

5) anemia varying degrees heaviness;

6) thrombocytopenia (observed in more than 90% of cases, while significant - less than 50

x 109/l - in more than half of them).

During puncture examination bone marrow almost always detect dozens

percentage of blast cells - main diagnostic value has detection in the myelogram

more than 20% blast cells. A trephine biopsy (puncture of the iliac crest) is also performed.

These studies must be carried out before starting cytostatic therapy!

Once a diagnosis of acute leukemia has been made, it is necessary to determine its variant, since

Their treatment varies significantly. Three methods are used for differentiation - morphological,

cytochemical, cytogenetic (see classification).

Diagnostic criteria for acute leukemia:

1) the presence of relevant clinical syndromes;

2) the appearance of blast cells in the blood;

3) availability in general analysis blood "leukemic failure";

4) changes in white blood are combined with increasing anemia;

5) bone marrow is characterized by total or subtotal blast replacement (more

20% blasts).

Differential diagnosis is carried out with various hemoblastoses, infectious

mononucleosis, systemic diseases connective tissue(systemic lupus erythematosus,

other vasculitides).

Examples of diagnosis formulation

Acute lymphoblastic leukemia first attack, acute phase.

2. Acute myeloblastic leukemia from VI.2006. remission.

3. Acute lymphoblastic leukemia from VI.2005, the first relapse from X.2007.

For successful treatment the patient should be hospitalized in a hematological department

a hospital with conditions for chemotherapy. Established diagnosis is an indication

to the start of cytostatic therapy, since without treatment average duration patients' lives

is 3 months. Late diagnosis or wait-and-see tactics lead to a sharp deterioration

forecast.

The concept of cytostatic therapy for leukemia is based on two principles:

1) in the bone marrow there are simultaneously leukemic ones (sharply predominant in number)

and normal hematopoietic cells;

2) a necessary condition to obtain remission and restore normal

hematopoiesis is the eradication (destruction) of the leukemic cell clone, inevitably

accompanied by deep depression of hematopoiesis (agranulocytosis, thrombocytopenia and anemia).

It is known that proliferating cells successively go through 2 phases of mitosis

cycle: mitosis, the shortest, occupies 1% of the time of the entire mitotic cycle (lasting about 1 hour);

interkinesis, which consists of a postmitotic phase (G1), or a postmitotic rest phase, a phase

cell DNA synthesis (S), lasting 20-40 hours. In the premitotic phase (G2) lasting about 2 hours.

the cell contains a tetrashyoid amount of DNA. Total duration mitotic cycle

power cells for about 80 hours.

Based on the effect on cell kinetics, all cytostatic drugs can be conditionally

divided into two groups: 1) cycle-specific - they can act in one or several phases

mitosis; 2) non-cyclospecific - chemical substances whose action manifests itself regardless of

cycle. The latter disrupt the DNA structure of the cell at any functional stage (rest,

proliferation). These are mainly alkylating compounds.

It has been established that prednisolone promotes the accumulation of power cells in the G1 phase and at the beginning of

DNA synthesis, creating favorable conditions for effective action drugs that are most active in

S-phase. Vincristine is the only drug that destroys cells in the mitotic phase. This stage does not last

more than an hour, and the mitotic cycle time is 3 days. Therefore, frequent administration of the drug is not indicated, since

due to the lack of target cells in the mitotic phase, it will have a toxic effect on

healthy tissue. The concentration of the drug is maintained for 3 days. Optimal administration of the drug is one

once a week. Resting cells, previously considered not subject to cytostatic effects,

can serve as targets for cyclophosphamide and asparaginase. This data forms the basis for creating

programs (combination of cytostatics indicating the dose and frequency of administration) for the treatment of acute leukemia.

Treatment of acute lymphoblastic and non-lymphoblastic leukemia is fundamentally different, although

The stages of therapy are the same.

They include induction of remission, which begins immediately after establishment

diagnosis according to the program corresponding to the variant of leukemia, and ends with confirmation of remission with

using bone marrow puncture, lumbar puncture and clinical examination.

The next stage is the consolidation of remission, which involves consolidating what has been achieved

antitumor effect. This stage is the most aggressive and high-dose in terms of cytostatic

drugs. The goal of this period is to eliminate leukemia cells as completely as possible,

remaining after induction of remission.

Prevention of neuroleukemia - applies to all periods of treatment (induction

remission, consolidation, maintenance treatment). During the induction period, control is performed

diagnostic lumbar puncture followed by prophylactic administration cytostatic drugs

intrathecally (dexamethazone - 4 mg, cytarabine - 30 mg, methotrexate - 15 mg). Frequency

lumbar puncture depends on the chosen treatment program.

Maintenance therapy is carried out during remission of the disease. Its main goal is

in restraining control of the leukemia clone. It is carried out regardless of the type of leukemia.

captopurine 60 mg/m2 per day and methotrexate 20-30 mg/m2 once every 5 days. Therapy is interrupted at

during the first year once a month, in the next two years - once every three months intensively

courses of polychemotherapy.

The basis for the treatment of acute lymphoblastic leukemia of the “standard risk” group is

German polychemotherapy protocol HOELZER 1988 “Standard risk” group - patients who are not

having no adverse prognostic factors. “High risk” group - having

at least 1 risk factor. Risk factors include: age of patients over 35 years, baseline

leukocytes more than 30 x 109/l, initial leukopenic level of leukocytes less than 1.5 x109/l, absence

remission on the 28th day of therapy.

The most widely used treatment for acute non-lymphoblastic leukemia is

program “7+3” or “5+2”. This program uses cytarabine at a dose of 100 mg/m~ daily

for 7 or 5 days and rubomycin at a dose of 45 mg/m2 day for 3 or 2 days.

Accompanying therapy includes treatment of infectious complications. With them

connected up to 70% deaths in patients with acute leukemia. The most common complications

bacterial origin (sepsis, acute pneumonia, local infections), and about 2/3 of them

caused by gram-negative flora. In 15-20% they are caused by viruses (herpes, cytomegalovirus).

The frequency of fungal infections is 25-70%. To prevent infectious complications

antibiotics are used wide range, antifungal, antiviral drugs.

IN last years Myelocytokines began to be used to combat neutropenia. To them

include granulocyte colony-stimulating factor (filgrastim, lenograstim), granulocyte-

macrophage colony-stimulating factor (sargramostim). Myelocytokines are

polypeptides that accelerate the formation and maturation of neutrophils, eosinophils and monocytes.

The use of these drugs allows you to stimulate granulocytopoiesis and reduce the duration

critical neutropenia, reduce the number of life-threatening infectious complications that

Leukemia – tumors from hematopoietic tissue with primary localization in the bone marrow. Tumor cells easily enter the peripheral blood, giving its characteristic picture.

The basis for the isolation of acute leukemia is not the time factor (duration of the disease), but the morphological characteristics of tumor cells and their appearance in the peripheral blood. Thus, the diagnosis of acute leukemia can only be made on the basis of a hematological study.

Tumor cells in all acute leukemias are characterized by large sizes and a large nucleus, occupying almost the entire cell.

Clinical picture

Manifestations of acute leukemia can be very diverse, so they can be presented in the form of the following “big” syndromes.

Tumor intoxication syndrome: increased body temperature, weakness, sweating, weight loss. The presence of these complaints gives rise to the assumption that infectious diseases(sepsis, tuberculosis, etc.), systemic diseases connective tissue, chronic leukemia, lymphomas, including lymphogranulomatosis, and other tumors.

Leukemic proliferation syndrome (reproduction and growth of tumor cells): bone pain, heaviness and pain in the left and right hypochondrium, detection of enlarged lymph nodes by the patient. This syndrome can be detected with a more detailed examination of the patient:

– enlarged lymph nodes, often cervical, on one or both sides, painless, dense in consistency;

– mildly expressed enlargement of the spleen: the spleen is dense, painless or slightly sensitive, protrudes from under the costal margin by 3–6 cm;

– enlarged liver: dense, sensitive, palpated 2–4 cm below the costal margin.

In the presence of damage to other organs, there may be a wide variety of complaints (headache, joint pain, shortness of breath, cough, persistent “sciatica”, abdominal pain, vomiting, diarrhea, itchy skin, increase skin sensitivity etc.), which give reason to assume independent diseases of various organs.

When the skin is affected, dense infiltrates are found on the skin of a pinkish or light brown color, usually of a multiple nature.

In case of lung damage, phenomena of difficulty in conducting air through the tracheobronchial tree are observed (weakening of breathing, prolongation of exhalation, dry wheezing), focal changes(decreased breathing or hard breathing, dry and wet rales). However, to distinguish specific leukemic lung damage from bacterial pneumonia, which often complicates the course of acute leukemia, can be difficult.

With myocardial damage, a slight expansion of the heart, an increase in heart rate, muffled heart sounds are detected, in severe cases– symptoms of heart failure.

Damage to the gastrointestinal tract may manifest itself as pain in the stomach area.

When the central nervous system is affected, it is found meningeal symptoms, dysfunction of cranial nerves, decreased muscle tone and other symptoms.

Anemic syndrome: pallor of the skin, weakness, dizziness, “flickering spots” before the eyes, shortness of breath when physical activity, decrease blood pressure, palpitations, headache, tinnitus and other complaints associated with insufficient blood oxygen saturation. These complaints can give reason to assume any form of anemia (iron deficiency, B 12 deficiency, hemolytic, aplastic, etc.).

Hemorrhagic syndrome: skin hemorrhages, bleeding gums, nosebleeds. Such complaints can occur with various hemorrhagic diathesis.

Patients often associate the appearance of complaints with the “flu” or respiratory disease. There may be an indication of contact with various pathogenic factors ( radiation therapy, impact chemical substances, radiation, taking cytostatic drugs, etc.). It should be emphasized that in acute leukemia these syndromes can either be absent and give the impression of well-being, or be mild. One syndrome may predominate, e.g. high fever or a slight increase in temperature without signs of growth of tumor cells in the organs. All this makes the above symptoms very conditional. clinical picture acute leukemia. The diagnosis can be made only by the presence of tumor cells in the blood and bone marrow.

Stages of flow.

I. Initial – can only be assessed retrospectively.

II. Advanced – with clinical and hematological manifestations of the disease.

1. First attack.

2. Relapse of the disease.

3. Second relapse, etc.

III. Terminal – no effect from the procedure specific therapy, inhibition of normal hematopoiesis.

Phases of the disease .

1. Aleukemic (without the release of tumor cells into the blood).

2. Leukemic (with the release of tumor cells).

Diagnostics

The presence of acute leukemia in a patient is determined by examining peripheral blood and bone marrow aspirate.

The main criterion is the presence of tumor cells in the blood. These cells are found in blood smears in quantities from 5–10 to 80–90%. In the aleukemic phase of acute leukemia, tumor cells in the blood are single or absent. In these cases, the diagnosis is made based on the results of a bone marrow puncture test, which reveals a significant increase in the content of such cells (from 30% to 90%).

For any unclear or protracted disease, it is necessary to carry out a blood test; only this can reveal signs of acute leukemia.

The main condition for successful treatment of acute leukemia is the earliest possible start.

The main goal of therapy is to free the body from pathological cells, which is achieved by using large quantity chemotherapy drugs with different mechanisms of action.

The combination of drugs is made depending on the form of acute leukemia and the age of the patient.

Promising treatment methods, such as bone marrow transplantation and immunotherapy methods, can be included in the complex of therapeutic interventions for acute leukemia.

Infectious complications of acute leukemia are very serious, and therefore active therapy with broad-spectrum antibiotics must be carried out in a timely manner and in sufficient doses. Prevention of infectious complications is careful care of the skin and mucous membrane of the oral cavity, placing patients in special aseptic rooms, and sterilizing the intestines with antibiotics.

With the development of hemorrhagic diathesis, transfusion of platelets (1-2 times a week) or fresh whole blood is necessary.

During the treatment the following can be achieved:

1) complete clinical and hematological remission (no complaints, normal or close to normal blood test);

2) partial clinical and hematological remission (improvement of condition, slight changes in the blood with an increase in mature cells, disappearance or sharp decrease in the number of tumor cells in the blood and bone marrow aspirate);

3) recovery (a state of complete clinical and hematological remission with a disease-free course for 5 years or more).

Prevention

There is no primary prevention of acute leukemia. Secondary prevention comes down to careful monitoring of the patient’s condition and proper implementation anti-relapse therapy. Patients with acute leukemia are registered at the dispensary.

Answers below.

1. THE BASIS OF THE DIVISION OF LEUKEMIA INTO ACUTE AND CHRONIC IS:

• Nature of the disease
• Age of patients
• The degree of inhibition of normal hematopoietic germs
• The degree of anaplasia of hematopoietic tissue elements

1. THE CONCEPT OF “TUMOR PROGRESSION” OF LEUKEMIA MEANS:

• More complete flow
• Progression of the process
• Emergence of new autonomous, more pathological cell clones
• All answers are correct

1. THE PHILADELPHIA CHROMOSOME (T(9;22)) CAN BE DETECTED BY CYTOGENIC ANALYSIS WHEN:

• Lymphogranulomatosis
• Chronic myeloid leukemia
• Acute lymphoblastic leukemia
• Chronic lymphocytic leukemia
• Correct 2 and 3

1. PREVENTION OF NEUROLEUKIMIA IS CARRIED OUT WITH:

• Acute leukemia
• Lymphogranulomatosis
• Hematosarcoma
• Histiocytosis X
• Correct 1 and 2

1. FOR THE DIAGNOSIS OF CHRONIC LYMPHOLIC LEUKEMIA, THE FOLLOWING PERCENTAGE OF LYMPHOCYTES IN THE MYELOGRAM IN COMBINATION WITH OTHER SIGNS IS SUFFICIENTLY RELIABLE:

• More than 10
• More than 20
• Over 30
• More than 40
• More than 50

1. CHRONIC LYMPHOLIC LEUKEMIA HAS TO BE DIFFERENTIATED WITH:

• Non-Hodgkin's lymphomas
• Infectious mononucleosis
• Hapten agranulocytosis
• Acute leukemia

1. INCREASED SENSITIVITY TO INFECTIOUS COMPLICATIONS IN PATIENTS WITH CHRONIC LYMPHOLIC LEUKEMIA IS ASSOCIATED WITH:

• Hypogammaglobulinemia
• Hyperleukocytosis
• Defects of the immune response (impaired interaction between T and B lymphocytes)
• Correct 1 and 2
• There is no correct answer

1. THE FOLLOWING CYTOSTATIC PROGRAM IS IN THE THERAPY OF THE TUMOR FORM OF CHRONIC LYMPHOLEYXIS:

• Prednisolone + large doses chlorobutine

1. NEXT BLOOD PICTURE: LEUKOCYTOSIS 80 THOUSAND. IN 1 ML WITH LYMPHCYTOSIS (80%), MODERATE NORMOCHROMIC ANEMIA, NORMAL PLATELET COUNT, AND IN THE BONE MARROW LYMPHOID ELEMENTS UP TO 70%, CHARACTERISTIC FOR:

• Acute leukemia
• Chronic lymphocytic leukemia
• Lymphogranulomatosis
• Multiple myeloma
• Chronic monocytic leukemia

1. IN THE ADVANCED STAGE OF CHRONIC MYELOLEUKEMIA, THE CLINIC OF ASTHENIC SYNDROME APPEARS AT A MINIMUM LEVEL OF LEUKOCYTES IN THE PERIPHERAL BLOOD (×10 9 L):

1. TERMINAL STAGE CHRONIC MYELOLEUCEMIA IS CHARACTERISTIC:

• The emergence of additional new mutant subclones within the main tumor clone, incapable of differentiation, but continuously proliferating, displacing the original differentiating cell clone
• The morphology of blood cells and bone marrow does not differ from that in the advanced stage
• Neuroleukemia is not common
• Partial refractoriness to myelosan
• All of the above

12.IF THE ADVANCED STAGE OF CHRONIC MYELOLEUKEMIA IS SUSPECTED ACCORDING TO PERIPHERAL BLOOD ANALYSIS, IT IS NECESSARY TO EXCLUDE:

• Sepsis
• Systemic lupus erythematosus
• Lymphogranulomatosis
• Cancer metastases to the bone marrow
• Correct 1 and 4

1. PATIENTS WITH CHRONIC LYMPHOLIC LEUKEMIA MAY HAVE:

• Cryoglobulinemia
• Paraproteinemia
• Alpha-1-antitrypsin deficiency
• Correct 1 and 2
• Correct 1 and 3

1. IN ADVANCED STAGE CHRONIC MYELOLEUKEMIA, THE CHARACTERISTIC FEATURES OF PERIPHERAL BLOOD ANALYSIS ARE:

• Increase in the number of lymphocytes
• Left shift to metamyelocytes
• Basophil-eosinophil association
• The appearance of cells such as plasmablasts
• Correct 2 and 3

1. FOR THE DIAGNOSIS OF CHRONIC MONOCYTIC LEUKEMIA BY PERIPHERAL BLOOD PICTURE, THE LEADING IMPORTANCE IS:

• Leukocytosis
• Absolute monocytosis
• Left shift in the blood formula
• The ratio of mature and immature granulicits

1. THE MOST ACCEPTABLE THERAPEUTIC TACTICS IN END-STAGE CML IS:

• Monotherapy with myelobromol
• Prednisolone monotherapy
• Leukocytaphyresis sessions
• Irradiation of the spleen
• Polychemotherapy (VAMP, “7+3”, vincristine + rubomycin + prednisone, etc.)

1. THE MOST CHARACTERISTIC CLINICAL AND HEMATOLOGICAL MANIFESTATION OF TERMINAL STAGE CML IS ALL OF THE FOLLOWED EXCEPT:

• The appearance of leukemias on the skin
• Decrease in the % of band segmented neutrophils due to an increase in the % of myelocytes and promyelocytes
• Pancytopenia varying degrees severity
• Refractoriness to myelosan

Subject: Acute leukemia

1. THE MOST COMMON CLINICAL SYNDROME AT THE BEGINNING OF ACUTE LEUKEMIA IS:

• Ossalgia
• Neurological disorders
• Asthenic condition
• Hemorrhagic syndrome

1. HYPERPLASTIC GINGIVITIS IS CHARACTERISTIC FOR THE FOLLOWING VARIANT OF ACUTE LEUKEMIA:

• Myelomonoblastic
• Promyelocytic
• Low percentage
• Plasmablastic

1. DIAGNOSIS OF VARIANTS OF PULMONARY LEUKEMIA IS BASED ON:

• Cytochemical characteristics of blasts and their immunophenotyping
• Anamnestic data
• Characteristic morphological features blasts with conventional light microscopy
• Response to therapy
• Correct 2 and 4

1. CLASSIFICATION OF LEUKEMIA IS BASED ON:

• Clinical picture of the disease
• Anamnestic data
• Degree of maturity of the tumor cell substrate
• Life expectancy of the patient
• Response to therapy

1. WHEN IDENTIFYING FORMS OF ACUTE LEUKEMISES USE:

• Cytochemical method
• Immunomorphological method
• Cytogenetic method
• All listed methods

1. INCREASED TEMPERATURE IN HEMATOSARCOMAS IS EXPLAINED BY:

• Tumor proliferation
• Cell decay
• Infectious complications
• For all the above reasons

1. THE DECISIVE DIFFERENCE OF A MALIGNANT TUMOR FROM A BENIGN TUMOR IS:

• Rate of increase in tumor mass
• Secretion of abnormal proteins
• Presence of metastases
• Presence of tumor progression

1. THE MAIN CYTOLOGICAL FEATURE OF BLAST IN ACUTE LEUKEMIA IS

• Irregular cell shape
• Multi-core
• A large number of nucleoli of unequal size
• Delicate mesh core structure
• Correct 3 and 4

1. IDENTIFICATION OF FORMS OF ACUTE LEUKEMIA IS BASED ON:

• Lymph node biopsy
• Sternal puncture
• Splenic puncture
• Determination of the number of reticulocytes

1. IDENTIFICATION OF FORMS OF ACUTE LEUKEMIA IS BASED ON:

• Histochemical method and immunophenotyping
• Cytological methods
• Combination of clinical data and cytochemical methods

1. DIAGNOSIS OF ACUTE LEUKEMIA THE FOLLOWING CLINICAL SYMPTOMS HAVE INDEPENDENT SIGNIFICANCE:

• Increasing “unreasonable” weakness
• Shortness of breath, dizziness, hemorrhagic syndrome
• Increased body temperature
• Enlarged lymph nodes, spleen, liver
• None of the above

1. MYELOBLAST IS DISTINCTED BY THE FOLLOWING MORPHOLOGICAL CHARACTERISTICS:

• Delicate mesh core structure
• Presence of nucleoli in the nucleus
• Basophilic cytoplasm with azurophilic inclusions
• All answers are correct

Benchmark

Topic: Acute leukemia

Topic: Chronic leukemia (lymphocytic leukemia and myeloid leukemia)

ANEMIA: HEMOLYTIC, APLASTIC.

1.HYPOCHROMIC MICROCYTES ARE CHARACTERISTIC FOR ALL THE FOLLOWING CONDITIONS EXCEPT:

• Iron deficiency anemia;
• Thalassemia major;
• Thalassemia minor;
• G-6-PD deficiency.

2. THE DIAGNOSIS OF IRON DEFICIENCY ANEMIA CAN BE ESTABLISHED USING ALL OF THE DATA LISTED EXCEPT:

• Absence of iron in stained bone marrow biopsy;
• Low serum ferritin levels;
• Hypochromia and microcytosis with specific clinical data;
• Response to iron therapy within 1 month;
• Detection of megaloblasts in bone marrow examination

3.SHILLING TEST IS:

• Study of iron absorption in the intestines, used in the diagnosis of iron deficiency anemia.
• Determination of blood concentration folic acid, used for differential diagnosis megaloblastic anemia.
• Quantitative determination of vitamin B 12 in urine, necessary in the diagnosis of B 12 deficiency anemia.
• Study of cyanocobalamin absorption gastrointestinal tract by its amount excreted in the urine, which is the leading diagnostic test only for diagnosing vitamin B 12 deficiency anemia.
• Detection of malabsorption of cyanocobalamin in the gastrointestinal tract by its amount excreted in the urine, confirming the diagnosis of B 12 deficiency anemia.

4.WHAT COMBINATION OF SIGNS IS CHARACTERISTIC FOR VITAMIN B 12 DEFICIENCY ANEMIA?

• Hypochromic anemia, funicular myelosis, the presence of antibodies to the parietal cells of the stomach. Positive test Shilling.
• Megaloblasts in peripheral blood, dystrophic changes in tissues, AT internal factor Kasla, bone marrow hematopoiesis deficiency.
• Hyperchromic macrocytic anemia, hepatosplenomegaly, funicular myelosis, tendency to thrombus formation.
• Pancytopenia, malabsorption syndrome, splenomegaly, koilonychia.
• Hyperbilirubinemia, reticulocytosis, megalocytes in the peripheral blood, red cyanosis.

5. WHICH OF THE FOLLOWING DISORDERS IS MOST CHARACTERIZED BY INCREASED HbA 2 LEVELS?

• Sickle cell anemia.
• B- Thalassemia.
• G-6-PD deficiency.
• Unstable hemoglobin disease.

5) α- Thalassemia.

6. WHICH OF THE FOLLOWING HEMOLYTIC ANEMIA IS CAUSED BY AN INTRACELLULAR DEFECT?

• Hereditary spherocytosis.
• Sickle cell anemia.
• Autoimmune hemolytic anemia.
• Anemia due to G-6-PD deficiency.

7. THE PRESENCE OF HEMOLYSIS IS INDICATED BY ALL CLINICAL MANIFESTATIONS EXCEPT:

• Absence of decreased serum haptoglobin;
• Increased number of reticulocytes;
• Elevated levels of serum LDH;
• Microcytosis of erythrocytes;
• Shortening the lifespan of red blood cells.

8. ALL OF THE FOLLOWING IS CHARACTERISTIC FOR SEVERE FORMS OF THALASSEMIA, EXCEPT:

• Microcytic hypochromic anemia;
• Splenomegaly
• Disturbances in the synthesis of globin chains;
• Splenectomy as the primary treatment.
• Anomalies of the facial skull

9. HbS VIOLATION INDICATES:

• Early postnatal period;
• Sickle cell anemia.
• Sideroblastic anemia;
• Carbon monoxide poisoning

1. SICKLE CELL ANEMIA IS CHARACTERIZED BY ALL OF THE FOLLOWING EXCEPT:

• Development of severe anemia within 2 months of life;
• Hand-foot syndrome;
• Splenomegaly;
• Hypofunction of the spleen

11.WHAT OF THE FOLLOWED IS NOT CHARACTERISTIC OF FANCONIA ANEMIA?

• Hematological disorders in infancy.
• Pancytopenia
• Skeletal abnormalities
• Chromosome fragility

EXPLANATION. EACH QUESTION (QUESTIONS 12-16,17-20) IS PRECEDED BY A POSSIBLE ANSWER (NOSOLOGICAL UNIT) INDICATED BY A NUMBER. FOR EACH QUESTION, CHOOSE THE MOST APPROPRIATE ANSWER INDICATED BY A LETTER. EACH ANSWER CAN BE SELECTED ONCE. MORE THAN ONE TIME OR DO NOT CHOOSE AT ALL.

QUESTIONS 12-16

• Iron deficiency anemia.
• At 12 – deficiency anemia.
• Autoimmune hemolytic anemia.
• Minkowski–Shoffar anemia.
• Aplaic anemia.

12. ACUTE ONset WITH INCREASING TEMPERATURE, JAUNDICE; SPLENOMEGALY, RETICULOITOSIS.

13. HYPOCHROMIC ANEMIA, REDUCED FERRITE LEVEL IN BLOOD SERUM, ERYTHROID GROWTH HYPERPLASIA.

14. USE OF CHLORAMPHENICOL IN ANAMNESIS; HEMORRHAGIC SYNDROME; REDUCED CELLULARITY.

15.MEGALOBLASTIC TYPE OF HEAT POOSIS; INCREASED FERRIN LEVEL IN THE BLOOD, NEUROLOGICAL SYMPTOMATICS.

16. JARNISH, SPLENOMEGALY, REDUCED OSMOTIC RESISTANCE OF erythrocytes.

17. FOR THE TREATMENT OF THALASSEMIA THE following are used:

• Desferal
• Blood transfusion therapy
• Treatment with iron supplements
• Folic acid

18. AFTER SPLENECTOMY IN A PATIENT WITH HEREDITARY SPHEROCYTOSIS:

• There are no serious complications
• Thrombocytopenic syndrome may occur
• Thrombosis of pulmonary and mesenteric vessels may occur
• There is no increase in platelet count above 200,000

19.WHAT OF THE STATEMENTS IS TRUE WITH RESPECT TO THE DIAGNOSIS OF AUTOIMMUNE HEMOLYTIC ANEMIA?

• The hemagglutination test is more informative for the diagnosis of hemolytic autoimmune anemia.
• Unit – hemagglutination test – mandatory feature autoimmune hemolytic anemia.

20.IF A PATIENT HAS BLACK URINE, YOU MAY THINK:

• About Marknafava-Michelia anemia
• About Imerslund-Gresbeck syndrome
• About aplastic anemia
• About hereditary spherocytosis

21. FOR WHICH DISEASE THROMBOTIC COMPLICATIONS ARE PARTICULARLY CHARACTERISTIC:

• Hereditary spherocytosis
• Thalassemia
• Sickle cell anemia
• G-6-PD deficiency

22. INTRAVASCULAR HEMOLYSIS:

• Never happens normally
• Characterized by an increase in the level of indirect bilirubin
• Characterized by increased levels of direct bilirubin
• Characterized by hemoglobinuria

23.ANURIA AND RENAL FAILURE IN HEMOLYTIC ANEMIA:

• Never arises
• Occurs only in hemolytic-uremic syndrome
• Always occurs
• Characteristic of intracellular hemolysis
• Characteristic of intravascular hemolysis

24. THE MOST INFORMATIVE STUDY FOR THE DIAGNOSIS OF HEMOLYTIC ANEMIA ASSOCIATED WITH MECHANICAL DAMAGE TO RED CELLS BY ENDOCORDIAL PROSTEMS IS:

• direct Coombs test
• indirect Coombs test
• Determination of the life expectancy of labeled erythrocytes of a patient
• determining the lifespan of labeled donor erythrocytes

25. YOU CAN SUSPECT CHORLOADY AGLUTININE DISEASE BY THE PRESENCE OF:

• Raynaud's syndrome
• moderate anemia
• reduced ESR
• 1 blood group

26. SPHEROCYTOSIS ERYTHROCYTOSIS:

• Occurs in Minkowski-Choffard diseases
• Characteristic of B 12 - deficiency anemia
• Is a sign of intravascular hemolysis

1. AFTER SPLENECTOMY FOR HEREDITARY SPHEROCYTOSIS:

• Red blood cells are not detected in the blood
• Thrombocytosis occurs
• Thrombocytomy occurs

1. THE PATIENT HAS PANCETOPINIA, INCREASED BIORUBIN LEVELS AND AN ENLARGEMENT OF THE SPLEN YOU CAN ASSUME:

• Hereditary ferocytosis
• Thallosymia
• At 12 – deficiency anemia
• Markiava-Makeli disease
• Autoimmune pancytopenia

29. THE MOST INFORMATIVE METHOD FOR DIAGNOSIS OF AUTOIMMUNE ANEMIA IS:

• Determination of osmotic resistance of erythrocytes
• Hemagglutination test unit
• Determination of complement in serum

30. INTRACELLULAR HEMOLYSIS IS CHARACTERISTIC FOR:

• Hereditary spherocytosis
• Marchiafava-Micelli diseases
• Gilbert's disease

31.HERIDINARY SPHEROCYTOSIS IS CHARACTERISTIC:

• Pallor
• Zosinophilia
• Enlarged spleen
• Nocturnal hemoglobinuria

32. INTERNAL CASTLE FACTOR:

• Formed in the fundamental part of the stomach
• Formed in the duodenum

1. Which of the following statements regarding the diagnosis of acute leukemia is correct:

a) the tumor substart is mature cells

b) the tumor substart is maturing cells

V) the substart of the tumor is immature, blast cells

2. LYMPHOADENOPATHY IS UNDERSTANDED:
a) lymphocytosis in peripheral blood;
b) high lymphoblastosis in the sternal punctate;
V) enlarged lymph nodes.

3. Acute myeloblastic leukemia is characterized by:
a) more than 5% of lymphoblasts in the sternal punctate;

b) the presence of gingivitis and necrotizing tonsillitis, more than 30% myeloblasts in the bone marrow;

c) hyperleukocytosis, thrombocytosis, significant enlargement of the liver and spleen.

4.WHAT FACTORS ARE THE BASIS OF THE PATHOGENESIS OF ACUTE
LEUKEMIA:

a) radial

b) chemical

c) chromosomal

d) formation of a pathological clone

d) all of the above

5. IF WHAT SIGN IS PRESENT DIAGNOSIS OF ACUTE LEUKEMIA?
IS IT BECOMING OBVIOUS?

a) anemia

b) ulcerative-necrotic lesions

c) enlarged lymph nodes

G) blastemia in peripheral blood and bone marrow

6. Patient, 36 years old. Suddenly there was weakness, fever, and headache. Diagnosed with "Flu". Within a few days the temperature returned to normal and the patient felt well. In the blood Hb is 131 g/l, er. 1.5 10 12 /l, leuk. - 21.9·10 9 /l, leuk., myeloc. - 1%, young - 10%, p. - 12%, village - 28%, eoz. - 2%, lymph. - 44%, mon. - 3%, ESR - 12 mm/h.
a) chronic lymphocytic leukemia

b) acute lymphocytic leukemia

c) lymphogranulomatosis

d) lymphocytoma

d) leukemoid reaction

7. A 44-year-old patient has been experiencing weakness for a month and a temperature of up to 37.8°C. Was treated with antibiotics without effect. Paleness of the skin. Otherwise no special features. In the blood: Hb - 90 g/l, er. -3.0·10 12 /l, leuk. - 3.3·10 9 /l, ESR - 40 mm/h, thrombus. - 100·10 9 /l. What study is most important to clarify the diagnosis?

A) sternal puncture

b) level determination serum iron in blood

c) counting the leukocyte formula

d) stool analysis occult blood

d) irrigoscopy

8. A 27-year-old patient presented with multiple petechial hemorrhages on the skin and mucous membranes. In the blood: Hb - 100 g/l, er. - 3.1·10 12 /l, leuk. - 41·10 9 /l. There is a leukemic failure, a blood clot. - 15·10 9 /l, ESR - 46 mm/h. Diagnosis?

a) hemophilia

b) leukemoid reaction

V) acute leukemia

d) aplastic anemia

d) all of the above

9. A 37-year-old patient presented with weakness, sore throat, petechial hemorrhages on the skin and mucous membranes. In Hb - 90 g/l, er. - 2.1·1012/l, leuk.- 61·109/l. There is a leukemic failure, lymphoblasts - 70%, thrombus. - 30·10 9 /l, ESR - 56 mm/h. Diagnosis?

A) chronic leukemia,

b) leukemoid reaction

V) acute lymphoblastic leukemia

d) aplastic anemia

d) all of the above

10. A 32-year-old patient has been experiencing fever up to 38°C for a month, resistant to antibiotics, and hyperhidrosis. Revealed: increase cervical lymph nodes, neutrophilic leukocytosis, increased ESR to 50 mm/hour. What should be chosen to verify the diagnosis:

A) lymph node biopsy;

b) sternal puncture;

c) trial prescription of nonspecific anti-inflammatory therapy;

d) trial administration of corticosteroids.

11. When treating a patient with acute myeloblastic leukemia with drugs
choice is:

a) prednisolone;
b) cytosar, rubomycin “7+3”;

c) cyclophosphamide;

d) myelobromol.

12. When treating a patient with acute lymphoblastic drugs
choice is:
A) Helzer protocol;

b) cytosar, rubomycin “7+3”;

c) cyclophosphamide;

d) myelobromol.

13. In the treatment of NEUROLEUKEMIA they use the following drugs:
choice is:
A) dexamethasone, methotrexate, rubomycin;

b) Helzer protocol;

c) cytosar, rubomycin “7+3”;

d) cyclophosphamide;

e) myelobromol.

14. A patient with chronic myeloid leukemia receiving myelosan experiences a rapid increase in symptoms of intoxication, debilitating sweats, pain in the bones, joints, and abdomen. There are 45% blasts in the peripheral blood, which positions are correct?

A) The patient has a blast crisis.

b) The cause of the deterioration of the condition is an overdose of myelosan.

c) It is necessary to increase the dose of myelosan.

d) Treatment with cytostatics is indicated, as in acute leukemia.

e) Severe blastemia is characteristic of terminal stage

chronic myeloid leukemia.

15. A 54-year-old man complains of weakness, sweating, weight loss, and a sensation of a foreign body in the left half of the abdomen. The skin and mucous membranes are pale. Lymph nodes are not enlarged. An enlarged, painful spleen is palpated. Hb-100 g/l, er-3.5 10 12 /l, color. indicator 0.9, platelets 380-10 9 /l leukemia. - 230-10 9 /l, basophils - 5.5%, eoz. - 9%, promyelocytes - 2%, myelocytes - 2%, metamyelocytes - 20.5%, pal. - 15%, seg. - 12%, lymph - 8.5%, ESR - 20 mm/h. Which positions are correct?

A) The most likely diagnosis is chronic myeloid leukemia.

b) Activity needs to be determined alkaline phosphatase leukocytes

c) Karyological research is uninformative,

d) Possible development of infiltrative and thrombotic complications

d)Eosinophilic-basophilic association of chronic myeloid leukemia.

16. Which method is the most informative for confirming myeloproliferative syndrome in chronic myeloid leukemia:

a) Leukocyte blood count, b) Sternal puncture,

V ) Trepanobiopsy of bone marrow,

d) Puncture lymph node,

e) Liver puncture.

17. Which is the most common clinical symptom chronic lymphocytic leukemia:

a) Fever.

b) Bleeding.

V)Enlarged lymph nodes.

d) Enlarged liver.

d) Enlarged spleen.

18. A sharp increase in leukocyte formula granulocytes and the appearance of a small number of immature forms is more often observed with:

a) Chronic myeloid leukemia.

b) Acute blood loss.

V)Acute inflammatory process.

d) Chronic lymphocytic leukemia.

d) Acute leukemia.

19. A 52-year-old patient has been experiencing pain in the left hypochondrium for a year and a half. Upon examination, small hemorrhages were found on the skin, an enlarged spleen protruding 7 cm from under the edge of the costal arch. Blood test: Hb-100 g/l, leukocytes -50x10 9 /l (myeloblasts -1%, promyelocytes - 1%, neutrophilic myelocytes - 3%, neutrophilic metamyelocytes - 8%, neutrophilic band - 12%, segmented -55%, eosinophils -5%, basophils - 2%, lymphocytes - 12%, monocytes -1%). Probable diagnosis:

a) Thrombophlebitic sppenomegaly.

b) Abscess of the spleen.

V) Chronic myeloid leukemia.
d) Liver cirrhosis.

d) Acute leukemia.

a) Antibiotics.

b) Cytostatic drugs.

c) Corticosteroids.

d) Fibrinolytic drugs.

e) Continue observation.

20. Which variant of peripheral blood parameters is more typical for the advanced stage of chronic lymphocytic leukemia?

a) Leukopenia with granulocytopenia.

b) Slight leukzoitosis, neutrophilia with a shift to the left;

c) Hyperleukocytosis, granulocytosis with a left shift to myelocytes and promyelocytes.

21. Which of the following diseases is more typical?
leukocytosis up to 300,000 - 400,00 x 10 9 /l?

a) Chronic myeloid leukemia.

b) Multiple myeloma.

G)Chronic lymphocytic leukemia.

c) Erythremia.

e) Osteomyelofibrosis.

22. In chronic lymphocytic leukemia, all of the following occur, except:

a) Splenomegaly.

b) Hepatomegaly.

c) Enlarged lymph nodes.

d) Leukocytosis with absolute lymphocytosis.

e) Myelosan is the drug of choice.

1c) 2c) 3b) 4e) 5d) 6e) 7a) 8c) 9c) 10a) 11b) 12a) 13a) 14a) 15a)b)e) 16c) 17c)18c) 19 c)b) 20 d) 21 g ) 22 g)