Krok 2 Practice Combined Booklets Practice

Question: 1/200

A patient with Morgagni-Adams-Stokes syndrome has fainted when walking up the stairs. The skin is pale, the pupils are dilated, tonoclonic spasms are observed, rib cage is immobile. Make the diagnosis:

Therapy

2018

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Laboratory values

Complete blood count

Laboratory value

Normal reference range

Erythrocyte count

Male: 4.3 − 5.9 · 10¹²/L

Female: 3.5 − 5.5 · 10¹²/L

Hemoglobin, blood

Male: 135-175 g/L
Female: 120-160 g/L

Color index

0.85 - 1.05

Reticulocyte count

0.5 - 1.5%

Platelet count

150 − 400 · 10⁹/L

Leukocyte count

4.0 − 9.0 · 10⁹/L

Basophils

0 − 0.065 · 109/L (0-1%)

Eosinophils

0.02 − 0.30 · 10⁹/L (0.5 - 5.0%)

Band neutrophils

0.04 − 0.30 · 10⁹/L (1 - 6%)

Segmented neutrophils

2.0 − 5.50 · 10⁹/L (47 - 72%)

Monocytes

0.09 − 0.60 · 10⁹/L (3 - 11%)

Lymphocytes

1.2 − 3.0 · 10⁹/L (19 - 37%)

Erythrocyte sedimentation rate (ESR)

Male: 0 - 15 mm/h
Female: 0 - 20 mm/h

Hematocrit

Male: 41 - 53%
Female: 36 - 46%

Biochemical blood analysis (Metabolic panel)

Laboratory value

Normal reference range

Total proteins

60-78 g/L

Albumin

35-50 g/L (52-65%)

Globulin:

23-35 g/L (35-48%)

α₁-Globulin

2-4 g/L (4.2-7.2%)

α₂-Globulin

5-9 g/L (6.8-12%)

β-Globulin

6-11 g/L (9.3-15%)

γ-Globulin

11-15 g/L (15-19%)

IgD

0 - 0.15 g/L

IgG

6.5-15 g/L

IgM

0.4-3.45 g/L

IgA

0.76-3.90 g/L

IgE

0-380 kU/L

Total Bilirubin

2-17 mcmol/L

Indirect (unconjugated) Bilirubin

2-17 mcmol/L

Direct (conjugated) Bilirubin

0-5 mcmol/L

Triglycerides

0.59-1.77 mmol/L

Total cholesterol

3.9-6.2 mmol/L

Total cholesterol

3.9-6.2 mmol/L

High-density lipoproteins (β-Lipoproteins)

<4.2 mmol/L

Low-density lipoproteins (α-Lipoproteins)

0.8-1.8 mmol/L

Low-density lipoproteins (α-Lipoproteins)

0.8-1.8 mmol/L

Glucose, blood

3.3-6.1 mmol/L (fasting)

Glycated hemoglobin

Iron, blood

9-30 mcmol/L

Potassium, plasma

3.5-5.0 mmol/L

Sodium, plasma Calcium, plasma 0.75-2.5 mmol/L

136-145 mmol/L

Calcium, plasma

0.75-2.5 mmol/L

Magnesium, plasma

0.75 - 1 mmol/L

Phosphorus (inorganic), serum

0.646-1.292 mmol/L

Chloride, blood

95-105 mmol/L

Urea, serum

3.33 - 8.32 mmol/L

Creatinine

53 - 106 mcmol/L

Uric acid

Male: 0.12-0.38 mcmol/L
Female: 0.12-0.46 mcmol/L

Lactate dehydrogenase (LDH)

45-90 U/L

α-Amylase (diastase), blood

25-125 U/L

Aspartate aminotransferase (AST)

15-40 U/L

Alanine aminotransferase (ALT)

10-40 U/L

Phosphatase (alkaline)

30-115 U/L

Coagulogram

Laboratory value

Normal reference range

Prothrombin time 80-100%

(< 12 seconds)

Fibrinogen

2-4 g/L

Partial thromboplastin time (activated)

< 28 seconds

Lee-White coagulation time

5-10 minutes

Bleeding time (Duke method)

< 4 minutes

Acid-base balance

Laboratory value

Normal reference range

pH arterial blood

7.35-7.45

Pco2 arterial blood

33-45 mm Hg

Po2 arterial blood

75 - 105 mm Hg

Bicarbonate, blood (HCO₃)

22-28 mmol/L

Other blood values

Laboratory value

Normal reference range

Cortisol, serum

230 -750 nmol/L

Osmolality, serum

275 - 295 mOsmol/kg H2O

Thyroid-stimulating hormone, serum or plasma

0.5-5 mIU/L

Thyroxine (T4), serum

65-155 nmol/L

Thyroid-stimulating hormone, serum or plasma

0.5-5 mIU/L

Triiodothyronine (T3), serum

1.77 - 2.43 nmol/L

Ferritin, serum

Male:15-200 mcg/L
Female: 12-150 mcg/L

Thymol turbidity test

<5 U

C-reactive protein (CRP)

<6 mg/dL

Antistreptolysin 0 (ASL0)

250 U

Antistreptohyaluronidase (ASH)

250 U

Urine

Laboratory value

Normal reference range

Urine specific gravity

1.016-1.022

Nechiporenko’s test: leukocytes

< 2 · 10⁶/л

Nechiporenko’s test: erythrocytes

< 1 · 10⁶/л

Proteins, total

<45.0 - 75.0 mg/24 h (<0.033 g/L)

Calcium

2.5 - 7.5 mmol/24 h

Creatinine clearance

Male: 97 - 137 mL/min
Female: 88 - 128 mL/min

Oxalate

90 - 445 mcmol/L

17-Ketosteroids (17-KS)

Male: 27.7 - 79.7 mcmol/24 h
Female: 17.4 - 55.4 mcmol/24 h

17-Hydroxycorticosteroids

(17-OCS) 5.5 - 27.6 mcmol/24 h

α-Amylase (diastase), urine

28-160 U/L

List of abbreviations

ACTH => Adrenocorticotrophic hormone
ADP => Adenosine diphosphate
ALT, ALAT => Alanin aminotranspherase
ALV => Artificial lung ventilation
AP => Arterial (blood) pressure
AST, AspAT => Aspartat aminotranspherase
ATP => Adenosine triphosphate
ВСG => Bacillus Calmette-Guérin
BP => Blood (arterial) pressure
CK => Creatine kinase
CNS => Central nervous system
СоА => Coenzyme A
CRP => C-reactive protein
CT => Computed tomography
COX => Cyclooxygenase
DIC => Disseminated intravascular coagulation
DTP (DPT) => Diphtheria-tetanus-pertussis vaccine
EDTA => Ethylenediamine tetra-acetic acid
ELISA => Enzyme-linked immunosorbent assay
ENT => Ear, nose, and throat (as a department in a hospital)
EPR (ER) => Endoplasmic reticulum
ESR => Erythrocyte sedimentation rate
EV => Enterovirus
FC => Functional class
GABA => Gamma aminobutyric acid
Hct Ht => Hematocrit
HDL => High-density lipoproteins
HR => Heart rate
IDL => Intermediate-density lipoproteins
IU => International unit
IUPAC => International Union of Pure and Applied Chemistry
LDH => Lactate dehydrogenase
LDL => Low-density lipoproteins
LOX => Lipoxygenase
MAO => Monoamine oxidase
MRI => Magnetic resonance imaging
NSAID => Nonsteroidal anti-inflammatory drug
PE (PATE) => Pulmonary embolism (Pulmonary artery thromboembolism)
PSA => Prostate-specific antigen
RBC => Red blood count
RR => Respiratory rate
SES => Sanitary-and-epidemiologic station
STD => Sexually transmitted disease
STI => Sexually transmitted infection
T/l => Trillion/liter
TABT => Typhoid-paratyphoid A and B plus tetanus toxoid vaccine
TMJ => Temporomandibular joint
TSH => Thyroid-stimulating hormone
TU => Tuberculin unit
URTI => Upper respiratory tract infection
V/f => Vision field
VLDL => Very-low-density lipoproteins
WBC => White blood count
WPW => Wolff-Parkinson-White syndrome