A 5 year old child presented with fatigue, bone pain and painless cervical and axillary

lymphadeno pathy. O/E: pallor and diffuse pctcchiac.

INVESTIG ATIONS:
Hb: 8.9 gm%
Total Leucocyte count: 45,750 cells/cumm
Platelet count: 25,000 cells/cumm

PERIPHER AL SMEAR GIVEN BELOW:

Answer the following questions:

1. What is the diagnosis?

2. Which cytochemica l stain will be positive in the above case?

Answers:

1. Acute lymphoblastic leukaemia

2. Positive for Periodic Acid Schiff stain
 °K
i------::;;;;:;;;;:;:--r-A :,,A~Sl I INSTITUTE OF MEDICAL SCIENCES AND RESEARCH
CENTRE
'
II MBBS PRACTICALS
DEPARTMENT OF PATHOLOGY
CI IART FOR DISCUSSION

Male patient aged about 10 years presented with fever, malaise, headache,
vomiting and neck rigidity.
Lumbar, puncture was done.

CSF- pressure - 200mm ofH2O

Appearance- clear, cob)web formation on standing
Cell count- 400cells/cumm
Cell type- lymphocytes are the predominant cells
Glucose- 35mg/dl
Protein- 110 mg/dl

Questions
A- What is the probable diagnosis?
B- What are indications for lumbar puncture?
C- Mention the complications of lumbar puncture.

A- Tuberculous meningitis.
B- Diagnostic-pyogenic, viral tubercular, & fungal meningitis, sub-arachnoid
haemorrhage
Therapeutic- introduction of drugs, spinal anaesthesia.
C- Introduction of infection, brain stem herniation. post- spinal anaesthesia
headache
 AKASH INSTITUTE OF MEDICAL SCIENCES AND RESEARCH
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DEPAR TMENT OF PATHOLOGY
CHART FOR DISCUSSION

6 years old girl presented with pain abdomen, joint pains and pain in the fingers
and toes (on& oft) since 5 years. Past history of jaundice is present, with
Hepatosplenomegaly
O/E- Mild pallor is seen. No icterus. Hepatosplenomegaly+

Investigations done: -
Hb-8gm %
Reticulocyte count-8.0 %

Peripheral smear: - Shows marked anisocytosis and poikilocytosis with plenty of sickle
cells along with target cells and a lymphocyte.
Platelets appear adequate.

1. What is the diagnosis?

2. What are other specific tests to diagnose the above condition?
3. What are the complications?

I. Sickle cell Anaemia

2. Sickling test & Hb electrophoresis for HbS
3.vaso -occlusive crisis, sequestration crisis, Aplastic crisis, Haemolytic crisis
 AKASH INSTITU TE OF MEDICAL SCIENCES AND RESEARCH
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11 MBBS PRACTICALS
DEPARTMENT OF PATHOLOGY
CHART FOR DISCUSSION

55 yr old male presented with bone pain, recurrent infections and fracture of
lumbar spine.

Investigations done: -
Hb- 10gm%
TC - 6000 cells/cum m
DC - P30% L70%
ESR- 120mm/hr
Platelet count- 2 lakhs/cumm

Peripheral smear: - RBCs show marked rouleaux formation

WBC: -Mild neutropenia. No immature forms seen.
Platelets: -Adequate.
Bone marrow:
Suppression of normal marrow elements with bone marrow plasmacytosis of 60%

I. What is the diagnosis?

2. What is the characteristic urinary finding you expect in this case?
3. What is the investigation to confirm the diagnosis?

I .Multiple Myeloma
2.Bence - Jones protein
3. Serum protein electrophoresis show a distinct M-baod.
Female patient aged 43 years presented with a history of dizziness,
vomiting, fever, headache and neck stiffness. Lumbar puncture was
done.

CSF pressure: 200mmofH2O

Appearance: Slightly Turbid
Cell count: 90 cells/ cumm
Cell type: "
lymphocytes are the predominant cells
Glucose: ~g/dl
Protein: 90mg/dl

Answer the following questions:

1. _What is the probable diagnosis?

2. What are the sites for lumbar puncture in adults and infants?
3. What are the contraindications for lumbar puncture?

Answers:

1. Viral meningitis
2. Adults: L3 - L4 vertebra. Children: L4- L5 vertebra
3. Contraindications: Bleeding diathesis, Cardio-respiratory compromise, Infection at the
site of needle insertion, Raised ICT, Brain tumour.
PA 16.6

7 years old boy,. oth_crwb c health y presented with svdd...~ ,, ~ ~ ,,,.~

,
fever. ?n ex~mmat1on he has jaund ice and '>C ,ere f.KYe
anaem
, ;y. 8: ~.-,,,.-··---
. . b.ia, .rct1culocyto sis and increa sed WB r.., <·count. ._
b111ru m 1s 5mg/d l.

Answer the following questions:

1. What is the diagno sis?

2. Classi fy this condit ion

Answers:
1. Haem olytic Anaem ia
2. Classi ficatio n of Haem olytic Anaem ia:
Acquired:
A. Antib ody:lm muno haemo lytjc anaem ias
1. Autoi mmun e haemo lytic anaem ia (AIHA)
i) Warm antibo dy AIHA
ii) Cold antibo dy AIHA
2 . Drug induce d immu nohae molyt ic anaem ia
3. Isoim mune haemo lytic anaem ia
B. Mech anica l traum a:Mic roang iopath ic haemolytic anzemi::.
C. Direc t toxic effect: Malar ia, bacter ial, infection and other a:::er.:s
D. Acqui red red cell membrane abnormalities: Par o~ ~ . . r.
haemo globin uria (PNH )
E.Sple nomeg aly
Hereditary:
A. Abnor maliti es of red cell membrane
1. Hered itary sphero cytosi s
2. Hered itary ellipto cytosi s
3. Hered itary stoma tocyto sis
B. Disor ders of red cell interior
1. Red cell enzym e defect s (Enzy mopat hies)
i) Defec ts in the hexos e monop hosph ate shunt: G6PD defid cnq
'-~ ~
ii) Defec ts in the Embd en-Meyerho f (or gJycolytic) patni\'\~y: ;1~1:-
defici ency
2. Disor ders of haemo globin (Haem oglob inopat hies)
i) Struct urally abnor mal haemo globins: Sickle syndromes- ~e-It
haemo globin opath ies .
ii) Reduc ed globin chain synthesis: Thala ssaenu as
 \~\"' ' L INSTm.ITEOFL\ ED CALSCIEXCES 1XD RES
CE\ltRE
ll tilBB~ PRACflCALS
DBPARThffiNTOFPAlliOLOGY
CHARTFORDISCU~ 0~

llistory:-35yr female pr~-cntf."d TI itb. "hite discharge pu ,,agi:c.a.

Cytological smear (PAP' ,,,is taten 1rom '""1~·~ 3l fomix.. e{'uJt..~-tix.. ffi+?TICf"tt-WT:iF-,+Si.1c - ~
zone and presented. fur interpretation.

,. _..
t • il
t
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' 'C.

1. Descn"be the cytomorphological features of lhe aboTe slide.

2.. What is the diagnosis?

1 -Smear shows superficial, intermediate and endocenicaJ cells ina background o f ~

2.Intlammatory smear
 AK/\S 11 INSTITI JTH OF MEJJJ(,;\L ',( J J,f 1 ,.J/, / lJ 1
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24 year old prcscntl'd wiCh Jntllor, j~undkc ~nd 11pJwH,rn ~~ 1y ..

Invci:itigaL.km', d( Jflt:: •
I lb- 6g,rn%,
TC- 80(J(Ju;.JJ~/curtirn
DC- p ..37 %t L-G<J %, J,. r;;'r,,
MCV- 70 fl
MC! IC·-40 gm/di
SpeciaJ inve&tigatfon~
Reticuloe,-yte count--8%
Unconjugated bilirubfri incrca::;.C111/J :uJg/rH
Osmotic fragility -inc,rcaoo<l

. e

Peripheral smear
RBC: - Show moderate anisopoiki]ocytosis. Microcytic RBCs without central Pall<1r-
spheIOC)tes predominate. Many polychromatophilic cells and nucleated RBCt arc se<,-r1.
\\13C:-Total count appears normal. Lymphocytes predominate.
Platelets: - were ade uate

I. What is your diagnosis?

2. What is the characteristic RBC anomaly seen in the Peripheral smear?
3. What other investigation can be done to confirm the diagnosis?
4. What is the basic molecular pathology seen in this condition?

l. Hereditary spherocytosis
2. Spherocytes
3. Increased osmotic fragility test & negative for Direct coomb's test
(A negative Direct coomb's test rules out auto immune hemolytic anemias)
4. Molecular defect in RBC cytoskeleton protein -spectrin deficiency and ankyrin
abnormality.
Semen analysis:

Period of abstinence: 3 days

Amount: 3 ml

Appearance: Grey white

Liquefaction: 15 minutes

pH: 8.0

Sperm count: 10 millions/ml

Motility: >60% of sperms are actively motile

Morphology: >65 % of sperms are of normal

Answer the following questions:

1. What is the diagnosis?

2. Mention the indications for semen analysis?

Answers:

1. 0 ligospermia
2. Indications:
• Assessment of fertility / infertility
• Determine the effectiveness of vasectomy
• Determine the suitability of semen for artificial insemination
• Medicolegal purpose: In alleged rape cases, vaginal pool smears are examined to
detect sperms
A 20 year old male presented with a history of bleeding gums.

INVESTIGATIONS:
Hb: 8gm%
Total Leucocyte count: 92,000 cells/cumm
Platelet count: 70,000 cells/cumm

PERIPHERAL SMEAR GIVEN BELOW:

Answer the following questions:

1. What is the diagnosis?

3. What are thecytochemical stains used in the above case?
2. What percentage of blasts should be seen in acute leukemias?
3. What is the cytogenetic abnormality seen in AML M3?

Answers:

1. Acute Promyelocytic Leukaemia (AML M3)

2. Myeloperoxidase (MPO), Sudan Black B
3. As per FAB classification: at least 30% blasts in bone marrow
As per WHO classification: at least 20% blasts in bone marrow
4. Cytogenetic abnormality in AML M3: t(15;17)(q22;ql2), PML-RARA
 AKAS H INSTIT UTE O F MEDIC AL SCIEN CES AND RESEAPCJ 1
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lI MBBS PRACTICALS
DEPAR TMENT OF PATHO LOGY
CHAR T FOR DISCU SS ION

Male aged 15 years presented with high grade fever, headache, and septica emi~
Lumba r puncture was done

CSF- Pressure- 280mm of H 2O

Appearance-turbid
Cell count- 800cells/cumm
Cell type- ·Neutrophils are the predominant cells
Glucose- 25mg/dl
Proteins- 120mg/di

Questions - ---..)
A- What is the probable diagnosis?
B- What are the other investigations that can be 'done?
C- What are the indications for lumbar puncture?
D- Mentio n the complications of lumbar puncture?

A - Pyogenic meningitis.
B- Gram's stain ofCSF smear and blood culture.
C-Diag nostic- pyogenic,viral,tubercular,fungal meningitis and sub-ara chnoid
haemorrhage
Therapeutic-introduction of drugs, spinal anaesthesia.
D- Introduction of infection, brain stem herniation, post- spinal anaesthesia
headache.
 AKA SH INST ITUT E OF MED ICAL SCIE NCES AND RESE
ARCH
CENT RE
II MBB S PRAC TICA LS
DEPA RTM ENT OF PATH OLOG Y
CHA RT FOR DISC USSI ON

7 Year old child presented with jaundice, pallor and Hepa

tosplenomegaly

Investigations done: -
Hb- 4gm%
MCV - 50 fl
MCH - 18pg
TC- 10,000cells/cumm
DC- N-37%, L-63%
Platelets-3Lakhs/cumm
Special investigations: -
Reticulocyte count -8%
Unconjugated bilirubin-4.0 mg/dl
X-ray skull show s hair on end
appearance

Peripheral smear: -
RBCs: - show marked anisopoikilocytosis and hypochromia.
Microcytes, target cells.
ovalocytes and other poikilocytes with polychromatophilic
cells seen. Few nucle ated
RBCs noted.
WBCs: -total count -With in Norm al Limits. Lymphocytes predo
minate
Platelets: -adequate

1. What is your diagnosis?

2. List out the relevant lab investigation.

I. Thalassaemia ,there are two types alpha & beta(beta is more

comm on in India)
2. Hb electrophoresis &osmotic fragility test
 A 40 year old fema le presented with a post-coital bleeding.

.,,.
Cervical smear given below for interpretation (papanicolaou x 400)

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•
• si •
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CJ

,, ~
• st: ~. !Ill
tl!t ~
w,,~ ". W

tP
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'le
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~-~I>
Gt~ '
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~
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~f?'w ... ft ii C' ~ •
8
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• ($~-fl'., i
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Answer the following questions:

I. What is the diagnosis?

2. What are the other investigations that should be done in the above condition?
3. What are the risk factors for the development of the above condition?

Answers:

I. Squamous Cells Carcinoma

2. Schiller's test, Cone Biopsy, Recombinant DNA Hybridization for HPV, Molecular
studies, circulating tumor specific antigen and antibodies.
3. Risk factors:
• Early age of sexual activity,
• Multiple sexual partners,
• Persistent HPV infections with high risk types of oncogenic virus,
• High risk male sexual partners.
40 year old female presented with dyspnoea, cough and wheeze.
Examine the given peripheral smear and report.
18 year old female complains of generalized weakness, lethargy and
tiredness. Gives history of menorrhagia. Examine the given peripheral
smear and report.
25 year old female complains of w eakness an d tiredness. On
examination patient had glossitrs and c:;, gt., ~~ ,torr. atatis. Examine the
given perir'-•..:ral smear and report.
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