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1)A S-year-old child was brought to the hospital with complaints of frequent episodes of acute
abdominal pain, chest pain, bone pains and recurrent lung infections. On examination, the
Child looked pale and had a chronic non healing ulcer on his left foot. He was investigated ang
the peripheral smear image is provided to you
1. What is your diagnosis?
2. What are the other investigations done to confirm diagnosis?
3. What is the underlying pathogenesis?
4. How would you manage this patient?
1A) The prioealde is ot above oe fs stoltle cell ameytla ab
peAtpreol blood. shows siclle shaped elle and wlth
ints of acute abdominal palm , ch a palin, bene pats &
Heeussent lung infecttons.
eae electHophorests
Selle Cll Halt test a | DNA testing
3 Pyonatal 4
yo Mi ot mtd disease €s
mn in HbS, baste oo: fe Mr0 (Nyelepetoddass): ative
~ Sudan Bark & & mopar
ONSE (Nen~ epoctitie extorase) mopntive
fda phosphate : tooal pestivtty fr leukembe blasts tn ALL
Jrownudnophunotyplong :
>in pne-B & pme-T coll | lasts — Tesumbncl deextynueleo tic
fs bes Wie tromsteage ‘Tat 4
2 pre—& col type : pesttive te pam-B vell aveuikoss CD19, 10, 9a
3 phe- T ted “type pesttive tor (D1, 2,345, 4
4AVALL fe aleuattied umdoH Non — bodeldvs bmphonnas —B Acs é
FAR clanitiention: — * “4 aoe
L, > mall umitoum aalls
Le ~ dane, vaniod eolh (heteregewous population)
“os
an
oe DHS, 6)A 60 year old male patient presented to hospital with complaints of bone pain, Fatigue,
n, he was pale. X-ray revealed punched Out
frequent infections and headache. On examinatio
inino was also raised. Hb wa9 10g
defects in bone, Serum calcium was raised. Serum creatit
Bone marrow was done and image is provided to you:
acegh ore ee
eee of j
os
oa 30)
Py OT)
1. What is the diagnosis?
2. Describe the various morphological features.
3. What is the criteria for diagnosis?
4. What are the other conditions mimicking this disease?
1A) bouod on the hictet i mesemt, vith bene palm Gue to
jusrptiey), tatt aL, pall (duo to amumita), pumehod (eSioug tn
bene, ee geoin Loleiuim and tmima levels, the
probable diogwects fs ‘rultiple onuolerna .
2A) OSSEOUS LESPONS: Newmal bene mesow fs 2 by soft,
elatomous, Hoddizh — ey Salmons , +f oeto.d, ia de Beat)’
use balopeel: oly.
> Nypervellulasity, myeloma wll (7 1074) a0 seem cnteneccplal
EXTRAOSSEOUS LESIONS :
2) blood.: Atypical pltsinacr arte im blood, mevoclrsemte , meme -
fe pai mated poullone fevmation ue to iypontcaly
be
cod. , olevectod ESA 226 Hd TY Velbrealion of Rome Younes puctoins prcelpttated fan Ut oF
hve £m ebeiteatng ot Taw - MOEN psc pe tudor cass
frye loud by mulitmusleate fil celle #010 2 ala ei
teal staime:
Periodic atta tid ui) &taim a, of PAS
positive raesitat 6 fiod i Hiv)
\ yeloponoxidaxc) : ee
Black @; ce.
e a specltic: ceronase) : 8
phatase ; oal positiv tm loukowtic blasts in ALL
reg * :
.° e~T 20 paphebluce : Tisuniimal- door mucleotid,
: C t tuametoace (Tat)
fpere FO" paum—B toll mrasikers 0D, CD10, LOAe
A400 wurden mon—edgtimis Iyrmphewas : B “ALLS
es... ae rr
umiterun Alls
e, vatlied, a population)
ul etn
6
T-ALL
th jonths. Col
T)A 40 year old lady complained of white discharge P/V ee a bes ie
©xamination revealed a growth on cervix which was bleeding on touch. She al plained of
loss of appetite and weight. oy
&. What is the diagnosis based on the microscopic picture provide
}. What is the classification used and elaborate?
My?
©. What are the various morphological patterns grossly and microscopically’
2
d. What are the risk factors associated in its etiopathogenesis’
a) it fs a mse of bruasive squamous cell dancorema.
b) The classification system used ts Bethea
soe lm, tor
el leg
Sn Bethesda Sasa the viiteia wed fs ;
> Specinnen adoquacy
2 Gromeuad chanactentrction {0 type of sme
~ Intephetation | goaults
ae ee fo tonto epithelial lesion of mratignamey
alas EEE
|ulzonated lexton | elovated qromulan
o%,.
E Polypeta, modular | wlheonatod Woh,
wth imtiltnation into sunroundding
; a Hisie subtypes 1b, 1.
he ene.
nfstony of HGPL
Trtemousse G higher Letetime 8)A 45-year-old lady complained of fever, fatigue, lethargy, bleeding gums and Menorthagis,
She gave a history of frequent episodes of upper respiratory tract infections. On examination
she had sternal tendemess , gum hypertrophy and mild hepatosplenomegaly. Hb was 7 guy
WBC count was 1 20000/cmm. Platelet count was 30000/cmm.
Peripheral smear image is provided to you
1. What is your diagnosis? Why?
2. Classify the disease.
3. Describe the peripheral smear and bone marrow findings
4. What are the special investigations to confirm the diagnosis?
1A) The (robable ee fs aeute myeletd lia ctmer Hhe
patient has isto of sent opisodes ot UTE amd toveh
dus to imtection. :
amesmnia. —> pallet a
dle momitestaty F ‘
ediona I ation — bleeding quyns , murrotahages ,
, theombocytopenia ; tence et
230 FAR | Old rome
Mimtmally at
ted AML
Mo
on Lom IL
ne eon whi
M
Mp
Meloblast defeat mueloay theomatin 2-4 mucleet, voluminous
ee ype ou Hodn eon, monoblact -feldod , tobulated
aun Mods -
2,
a Nt sof blast tn bene masdow ,
ta psa hs, sangeet Ceduccd to
Spestal, awestign tens:
sun amusoumidae > My, Me Lenckerntta,
uvtic arid - AML 4 + a
a
alee "4 '
9) A 55 year old male with comorbidities developed sepsis, and acute onset of oliguria, nausea
& fatigue, followed by abrupt increase in serum creatinine of 2.8mg/dl. in a span of few days,
CUE shows epithelial cells: 15-20/ hpf, WBC-6-7/ hpf, RBC: 2-3/hpf
1) What is the probable diagnosis?
2) What are the various causes leading to this disease?
3) What are the various biochemical investigations that can be performed ?
4) What are the clinical manifestation?
1A) The probable diagrotts fe Acute Renal Fatlune.
2A) Couper of Acute Rewal Falluse :
Pivots (ounietien due to’ baci '
AGL locer Like dlasahea , vomiting , excore cbuseste
~ Umpained Landis et ticiomey due to M2, shock
~ Vasodilotion due Lo sepsis, amaphilaste ete.
3) Bicchomieal tests that tam be pertowmed ue :
Remal tection test, Uke oy sosuem “Abate
AER a ae
of BUN -
ee Se Ausea amd uste acts, levee 10) A 65 year old male with history of diabetes for past 20 years with poor contr amg
diabetic retinopathy, presented with proteinuria, puifiness of face, edema of fe te
Creatinine: Smg/al. With € GER of 30mI_min/1.73m2, ne
1) What could be the probable diagnosis ? x
2) What are the causes ? } ‘
3) What is the implication of low GFR? ;
4) What is the associated pathology ?
- eS
1A) The probable te fe chuenle momal taflune olue to
diabetic mi
2A) Couser of cherie monal tale!
A Unnoric lermonclonephattts
5 Polyeystte tdmey dPzoase
Ahsonic mntecttont
© oMabetes — Diabotte mephropathy
=) Hy pextemion
~ hemal obstauction
9 Alport aipadstome ails [as
H)a3 a
G0 ngldi T4-4.0 megidi, TSH-5.6 mIUA. throughout her pregnancy, Chiig’s Photog
ne child's mother thyr
has failure to thrive and the child's mot! roid hor
year old child has fail TON lal
13 OFAC
shownbelow
1) What is the probable diagnosis ?
2) Describe the clinical features in this condition
3) Enumerate causes that lead to this condition.?
4) What is the underlying pathophysiology.?
ety my
1A) The probable ee fg Nigel to hppo -
thysotdiasm im mothe.
8A) Ciniieol features ot hypottyetabin :
Childvem Adult
> stunted Howth
~» fatto
severe momtal hetudatien By i ie
~) poor feeding ‘siege cosa
>abmemal bene grouse s an
otitckoned facial teatures i wight pin
236 4 putty face
~» muscle woalmey
YD heanemys
@ Secapdany CAL
~ Pitultiany | Hypotoalamnie
peopled
~ Congenital hpopituitfaatson
> Pituttiany MNUHALS
Gheehum's Gyronome) 13) A 41-year-old woman who works as & tattoo artist has had increasing malaise and naugeq
for the past 2 weeks, On physical examination, she has icterus and mild right upper quadrant
tendemess. Laboratory studies show serum AST of 79 U/L, ALT of 86 U/L, total BITUBIN of 3.3
mg/dl, and direct bilirubin of 2.8 mg/dL. She continues to have malaise for the next year ~
liver biopsy is done, and the biopsy specimen shows minimal portal bridging fibrosis
(a) What is your probable diagnosis.
(b) Write the histomorphology of that condition. ?
(c) What are the complications of the above condition?
(a) What are all the Etiological factors leading to this disease 7
14) Based on the sax,
Ul years, tattoo antist => malatse, mausea tor past @ weeks”
prysical ex ion > fetes, ail. ant
lab studies > AST= F4U/L 1
ALT 2 esufk © ‘
Total bUirubin » 3:3 ov [AL 1
Divwet dinar i Sia 4
Tho probable ahogrneste fs Ciownle Hopalttis .
2A)The histomorphelogy of above tendition ts
~ Pierowneal mecrosie | Interface Hopatitts
Portal trot letens
4 Lntmalebulan lesions
Zz Boiidging Mecnests
240 14) Three weeks after a meal at the Trucker’s Cafe, a 26-year-old man develops malgigg
fatigue, and loss of appetite. He notes passing of dark urine, On physical examination, he hag
mild scleral icterus and right upper quadrant tenderness. Laboratory studies show serum Agy
of 62 U/L and ALT of $8 U/L. The total bilirubin concentration Is 3.9 mg/dL, and the direcy
bilirubin concentration is 2.8 mg/dL. His symptoms abate over the next 3 weeks. On returning
to the cafe, he finds that it has been closed by the city’s health department
(a) What is your probable diagnosis?
(b) What are al the etiological factors for this condition?
{c) Which serological test result is most likely to be positive in this case.
(d) What are the clinical outcomes of this condition
IA) Cased on the care, seomanfo. malate, tatique, loss of
appetite , dank urine.
Physical examination — antl
hy : Atom lebenis, aah Upp
Lob studlos — soawm AST = 62 OfL (mead : ¢— 33, oft)
stuum MT SE oft leumal : 84-3 0/1)
Total Biloulin = 3.9 mat
Dinect Lupubin . 2. ¢ argldk rerral £0-Smmaldl)
Hepatitis A
2A) Eficlogieal fasten :
i) Hopedtitls—A fintectton — 4 weobe dis-us )
a)Neptitis—-B infection — 19 cock, 60-190 5 »)
8) Hype ¢ tatection > + coecks Go- 40 days)
4) Hepatitis —D fentection —5 & woeeke (S959 ap >
5) Hepttts -£ tmtedton > &-¢ woo ng és-60 dls) nanoly.
; aly! $i) Vostouk Nepatotsiopte visser ares
> Hegattite 4
=) Hopatitts B
=) Hepast tts cc
=> Hepattrte D
~ Heparttis &
posonal centart sus 2 On overenouding,
t hygiene and, sambtasy conditions.
plien et t2oxen, tentawinated foods ith poor fe
16) A 4 week old infant presents to the Neonatology OPD with poor feeding, feyg, ne
increasingdrowsiness.
G.S.F findings as follows:
Naked eye appearance - Clear.
C.S.F pressure - 140mm H,0.
Cells - 40 cells / ul
Proteins - 60 mg/dl
Glucose - 60mg /dl
@) _ Based on C.S.F findings and case history what is the type of meningitis,
b) How does the naked eye appearance differ between various types of meningitis
©) Whatis the cell count in C.S.F from a healthy adult?
d) Which cell is seen predominantly in this type of meningitis?
a) CaLed on the Cor Findings amd, tase Vistouy 1 Ie
vinol mending.
5) Naked oe Oppeasannes im vaslous types of mentite
% Ractowial Care = ean | tatb ld | purulent
R Vinal age 2 Fel ny tuabid
*® Tubomlous umndrrorgl Us > tabi | eaga tum tetymattors
o) im a Wealthy adutt, soll cout im coe fe ons
din visal te, the prederntnant sll eS
fyonphocy tes:
yi
246 ¥ in the
17)A 19 year old second year MBBS student ae high grade
experiencing severe headache, neck pain, nausea, Iritabilty, DiGh @
figidity since 2 days.
—G.S.E findings were as follows:
Naked eye appearance - Turbid.
[Link] pressure - 190mm H:0.
Cells - 10,000 /ul.
Proteins - 100 mg/dl.
Glucose - 20 mg/dl.
@.) Based on case history and C.S.F findings and what is the type of meningitis?
b.) How does the naked eye appearance suggest the underlying cause of meningitis?
¢.) How does glucose content in C.S.F vary in different types of meningitis?
4.) Which cell predominates in this type of meningitis?
a) Baked on the saco iste and car Hondiongs, tt te
ee rer a,
2) Sine the maked oye appentamee oF CoE fe turbid,
ft eupgects bockerfial ergs
2 Ractortal mentn the > dossionrod,
Viral mominattiz > mermal
Tubousuleur grieve ~ dow cased dicintepcatlen myecaad pacts
tell dearth § mociotts of oadine Hus
Z
L Biochemical KG chamges
testattond man kor Dae oo
: > bwerted T-vave
Mocromial marion for diagnos of. MPt
9) sabilac plotting
2 topentaa
> Cie Me activity
eo pred lobin
Cl MB arg
ee
| Doin tay 21):)?
v ia
» mort sonsttlve amd spefiic
FO bog ek dumatten Im a}
i Hifeh ae . 20)65 years old woman presented with chief complaints of dyspnoea and abdomingy
distension, Ascitic tap was performed and 6 mi of pele yellow, colored fluid was collected. {tg
Functional Tests were deranged.
transparent and no coagulum is formed. Liver
Questions.
1. Which of the terms exudate/transudate is applicable for the above mentioned scenario?
2. Describe the pathophysiology?
3. What is the specific gravity of this ascitic fluid-high or low?
4, What are the other conditions where the similar fluid characteristics are seen?
IA) "the eum ttamudote ‘2 applicable for the above mentinned
dhe Scenanfo.
RA) Thowe s acumulation ef anclltc} abdominal tuld, due
fo tneased hydvectatte presroe and doekoased colloidal
Cumolle prorsuae.
Nuduostatic tual ox the tid out toem ve
com d emt %mto Peticite space. Colléfd oxmotic a:
dooms tlufd imto vowculan compartment.
Cine thee fe ‘rerenred. hnydorectale prtessune asad
dacreared colloid eumotic proseuo, luPd cdot
tn the Entewstitum. shieg tio —
2A) The opecitte aavity of auctdhe flukd ? :
aie ie astitic fluid 's tou) due to
A) Congestive a Pl i
crsthoste ane some of the othom an ost
aintilan flutd dnataceuisties ase sco,
ee r coca a g Met nan 1020
am Simglal me 14 Io
me ar blood ee :
8 no clot tedmed rn
DW highocytes & 0
