Pathology LRR PART2

Dr Preeti Sharma
MBBS Gold Medallist
MD Gold Medallist
23ʳᵈ
 286
24

e
Q. A 4-year-old boy is brought to the physician because of a large, painful boil on
his left knee. He has a history of repeated infections with Candida, Staphylococcus,
and Klebsiella since the age of 14 months. Laboratory studies show an abnormal
eat

II
result from the nitroblue tetrazolium reduction test. Cultures of the fluid from the
boil grow Staphylococcus aureus.
Which of the following intracellular defense mechanisms is most likely absent in this
patient?

a. Hydrolytic enzymes CGD

PHI
b. Lysozymes
c. Myeloperoxidase
d. NADPH oxidase

1
Q. A 10-year-old male presents with a history of recurrent infections, easy
bruising, and light sensitivity. On physical examination, he is noted to have
fair skin, light-colored hair, and nystagmus. Laboratory investigations reveal
prolonged bleeding time and the presence of large, coarse cytoplasmic
granules in peripheral blood cells. Genetic testing confirms a mutation in
the LYST gene. Which of the following normal cellular processes is most
likely defective in this patient?
a. Endocytosis

c.
of
b. Phagosome-lysosome fusion
Rolling and adhesion
d. Apoptosis

C HE DI A K
 Disease Defect Clinical features
LEUKOCYTE
ADHESION DEFECT 0
Beta 2
V c delayed shedding
Integrin
1
I Recurrent infections
LEUKOCYTE
ADHESION DEFECT 20Lewis X
Sialyl
Bombay BG 9,1
Ahhhh B H
02

BRUTON’S HYPO- BOYS

IgG
Ig
GAMMAGLOBULIN B CELL DEFECT
EMIA BTK GENE esp
DEFECTIVE
DEFECT
opsonisation
CHEDIAK HIGASHI
O
LYST GENE
Albinism k
HemÉnh De
SYNDROME DEFECT
some
Immunity
CHRONIC NADPH OXIDASE
GRANULOMATOUS
DISEASE P site 5
e DHR
 CHEDIAK HIGASHI SYNDROME LYST
gene
defect

Silvery Gray
Hair
Coarse
granules
 f sff

I
V
Councilmaggy.BG Hepatitis viral esp Hcv

Bodies
Denk
Mallory Hyaline Int filament CK 8 18
Composition

Seen in NEW NALD ALD

INDIAN Indian childhood cirrhosis
Not seen w Wilson disease
A α AT def
Inently EIIEE as.is
α
DNA
electrophoresis 0

000
normal
necrosis
B Step Ladder apop
c necrosis apop
smearing
A 45 YEAR OLD female patient complaints of being hit of the chest by a football while
passing by a garden 4 weeks back. Initially her left breast was tender and swollen. But
over the weeks the tenderness has subsided however, she now notices a lump in the
periareolar region which is firm to hard in consistency. Radiological investigations
reveal calcific deposits. Based on the phenomenon above which of the following
statement is false about calcific deposits?

A.
B.
C.
Can be seen in fat necrosis
Stains positive for alcian blue hiiiii
First site of calcium deposition is mitochondria T
always IST
except go
mito
m
D.
0 O
Calification seen in dead tissues is known as dystrophic calcification T

Breast Trauma
fat
necrosis
fat
cat 2
 I
0
000
0

necrosis
coag S's ve necros
said
08
organshF app

CaseyUS
Necrosis

Histopt
Egal
 0
yd

Necrosis
ftp.fynoid Necrosis
Calcific deposits
Breast RHD Aschoff
omentum SLE
MHTN
MELANIN
Masson fontana schmore stain
Yan
just affagra HMB 45 DIPA oxidase
PERL'S PRUSSIAN BLUE
HEMOSIDERIN
Fe
LIPOFUSCHIN
PERINUCLEAR OILRED 0 2N
LIPID
old ages RED 0 SBB
OIL
GLYCOGEN
PAS Diastase SENSITIVE
CALCIUM

Rhodazine Rubeanic auct

COPPER

RRR RHODA MTB

 Peel's

HEMOSIDERIN
ELAMIN SCHMORL
If A

LIPOFUSCHIN
CIclear E

Perinuclear
C in
00
 kala
ALIZARIN EDS VON OSSA
OR RED SUDAN BLACK
Zara
MINUTE amt Cat
LIPID FAT Calcium

fatty liver ossa

Calcein
Q) 54 year old male patient presented with a pigmented lesion
measuring 4x3cm on the right cheek. Biopsy of the lesion shows
-
presence of atypical cells with prominent nucleoli. Mitotic figures
are noted. Histopathological diagnosis of malignant melanoma is
made. Which of the following stains cannot be used for the
diagnosis?
A) Masson fontana
B) Schmorl’s stain
C) HMB45
D) Masson trichrome
 Red

Blue MRD
MASSON TICHROME

Muscle Red
Blue scars
Collagen
Nucleus Blue Black
 Q. Which of the following disease is associated with storage of
nonfunctional protein in hepatocytes?

A.
B.
Alpha 1 antitrypsin deficiency
Tay-Sachs disease ISD
PAS DI
C. Familial hypercholesterolemia
D. Wilson disease

Cu Pink

Whippley's PAST ER
 H MAT def AR
x childhood onset
8
0 Liver Ady Pat fame
Cushosis p
α AT Chr 4
genePIMM
normal genotype
carrier PIMZ
dizeaze Pizz
A 27 year old woman presented with multiple bilateral cervical that were gradually
increasing in size over 6 months. On examination multiple lymph nodes are
palpable in the cervical region with largest measuring 5.5cm. Similar multiple
nodules are noted on both arms as well. FNAC is performed from the largest
lymph node and shows the image attached below. Based on the morphology,
which of the following is the most likely diagnosis?
Etiology unknown
A. Tubercular etiology
B. LCH

Is
C. Reactive process
D. Rosai Dorfman Disease

Sinus
Histiocytosis
Massive
 M MDS MPN
A ACH PYI
R Rosai Dorfman Disease
C CLL

an
Nokilling
Structure marked by the arrow in the given
histopathological image is derived from?

A. B cell
B. T cell
C. Macrophages fused't
D. Fusion of epithelial cells
Q. A 5-year-old child presents with a high fever, cough, coryza, and fever 3C
conjunctivitis. A few days later, the child develops a maculopapular rash
that starts on the face and spreads to the trunk and extremities. Laboratory
investigations show lymphopenia and elevated levels of measles-specific
IgM antibodies. A biopsy of the skin lesion is performed, and histological
examination reveals the following findings:
Which type of multinucleated giant cells is most likely seen in the skin
biopsy?

MEASIEST
a. Langhans giant cells
b. Reed-Sternberg cells
c. Warthin-Finkeldey giant cells
d. Touton giant cells
 A Yet
me
ANGHANS Efes EExes
I ftp
TB
gg owl eye
measie

WIRE
GC FIELDEY

t.IE j Iisn
m
 D
Disease characterised by fever with lymphadenopathy, following a cat scratch.
Which of the following histopathological images correspond best with the
scenario?
a b c d
The granuloma shown below is associated with
which of the following diseases?
PYI
A. Coxiella burnetii
B. Q fever
C. Allopurinol
D. All of the above
 Doughnut Granuloma
Q fevercoxiella
Allopminol f homa
cat
LGV scratchy
DURCKGRANULOMIDimaa
cerebmhar.io
PF

stain
Eatin
Q) Which of the following is false with respect to amyloid
1) has properties of starch
IPROTEIN IKE
2) beta pleated sheet configuration on electron microscopy
IT
3) diameter 7.5-10nm on electron microscopy
4) stains salmon pink with Congo red on light microscopy
Hgr
Options
A) 1,4
B) 1,3,4
C) 1 only
D) 2 only
 O O
Sadik Polansingminsuff
Apple Green
Birefringence
CONGO RED
 DISEASE AMYLOID
2
Chronic Inflammation
all except chronic
Bronchitis
Cancers
AA
Familial Mediterranean Fever wild normal
Medullary Carcinoma Thyroid Acal DM APP
Systemic Senile Amyloidosis

Familial Amyloidotic
Polyneuropathy

11am_
Alzheimer's Diseases
Af
88 Hemodialysis Apr
Multiple Myeloma
10 FTClight
 g
ORGAN Site
MIC Kidney MESANGIUM

f Heart SUBENDOCARDIUM
Liver SPACE OF DISSE
Spleen red pulp

I
Spleen white pulp
Skin
ff.gg sh budema

GIT ORGANOMEGALY
Joints CTS median N
Blood Vessels
SUBENH.FI
Q. A 25-year-old male presents to the clinic with concerns about his physical
appearance and fertility. On examination, he is found to have tall stature,
long limbs, gynecomastia (enlarged breasts), and reduced body hair. He
mentions that he has always struggled with learning and has experienced
difficulties in school. To further evaluate his condition, a karyotyping test is
performed, and the following image is obtained:
Based on the provided karyotyping image, which of the following genetic
abnormalities is most likely present in this patient?
a. Down syndrome 1 2 3 4 5
b. Turner syndrome
c. Klinefelter syndrome
6 7 8 9 10 11 12
d. Edwards syndrome

471 4
shortest
 Diagnosis Of Genetic Disorders
Karyotyping Phase metaphase

fixative

G Q

1
banding banding

GIEMSA stain 4ᵗʰ QUINACRINE stain

 I
Methanol
FIXATIVE
KI typing 1
2442 Glacial AA

EN
CIRI COMPLEX
g
stigma FINE

CARNEY IYAD 41ST Paraganglooma

Pulmonary chondroma

CARNEY STRATAKIS Sx 91ST

GP Para an lionia
Find the incorrect match with regard
to disease and trinucleotide repeat?
1.Fragile x syndrome CGG
2.Myotonic dystrophy CAG
I
3.Huntington disease CAG HUNTING e
4.Friedreich’s ataxia GAA
TEND Exon
 Fragile X syndrome
CLINICAL FEATURES Fifty CGG 555
PK FYE 55 200 FX
7200 FXS
Long face fine
C
ñ
L

n
Most chararacteristic macro orchidisin

asis.EC
 T
MYOTONIC DYSTROPHY
T u

Hatchet
U jacies

G repeat
cannot teem
grip
Christmas Tree cataract
15 year old male presents with a typical facial profile of long face,
large mandible and large years. Mother gives history of dropping out
of school owing to extremely poor grades. On physical examination,
testes are enlarged. Genetic testing is advised on the basis of a
similar condition reported in one of the distant cousin. The following
finding is noted in the X chromosome when grown the cells are

o
grown on a folate deficient medium. Which of the PCR methodology
is best suited For the diagnosis of this disorder?

811
1.Sanger sequencing
2.Amplicon length analysis
3.pyrosequencing
4.GWAS
BRAFUGOO E

nynf

a
y
•Sanger sequencing GOLD STD PCR PCR
•SBPE- single base primer extension PV JAK2 VE
as_ HCLBRAFV o
•Pyrosequencing
montaininated xcenshmn.rs yo
•Amplicon length analysis sggg
D
•qPCR quantitative PCR/ Real time PCR
kg copy numbers
0
•Reverse transcriptase PCR RNA Virus COVID
•GWAS- genome wide association study
o o

Po
eg study
Which of the following immunofluorescnece patterns best
D
correspond to CREST syndrome? anti Tennomeric Ab

a
b
0
H 00 H Periph N
ANA

Higgs Antibodies against RNA

Antibodies against Antibodies
chromatin, histone, anti against anti Nucleolar
dsDNA
I dsDNA

speckled S O centromeric
if

Most common
Anti- centromeric
Antibodies against CE
anti Sm, anti Ro, anti antibody
La
SLE
Most sensitive
Most specific III smith Ab
Both sensitive and specific anti dsDNA Ab

tiision
Neonatal lupus
Drug induced lupus

S
00008H I P DRUGS

SJOGREN Sx 91 Is BETH
GERONERMA Limited anti centromeric Ab
to Diffuse anti Topoisomerase As
 Ng
O
H P dsDNA

N RNA
S
MI
 B
89

Ag
117

Fishnet
Yest Buns f
BP Linear Ribbon Roof
 Bone marrow aspirate
needles
Salah Needle BII
1
Dyside screw

Klima long
Needle

MIC PSIS
asis obese
CHI a
O O
Q. Which of the following steps will not be included in the staining protocol of the
image shown below?

a. Adding stain new methylene blue

b. Adding stain brilliant cresyl blue
c. Mixing of equal quantities of blood and supravital stain in a test tube
d. Methanol fixation
 I
REECE cell stain NO
methanol
FIXATION
Ribosomal supravital
New methylene Blue
i egBrilliant
cresy BE
Igramles
RC 0 5 2 adult
re
g RCX.LI 4 rmai
Q. A 43-year-old Caucasian female complaining of reduced energy and fatigue
is found to have hypochromic, microcytic anemia. Her past medical history is
significant for stable angina treated with metoprolol and aspirin. Iron
supplementation is prescribed. Several weeks later, a peripheral blood smear
demonstrates numerous enlarged red blood cells that appear blue on
Wright-Giemsa stain. Special stain for the same cells is shown below. What is
the composition for the same?

a. Hemoglobin precipitates
b. Nuclear membranes
c. Ribosomal RNA 0

d. Histones
Q. A 32-year-old female presents for a routine physical examination. Her CBC
shows the following:

a. Iron - deficiency anemia

Thalassemia
MÉ
Hb 9 g/dL, MCV 72, RBC 6.4, RDW 12.8%. What is the most likely diagnosis?
80 too ft
b.
MEHE 3323791dL
c. Megaloblastic anemia
Autoimmune hemolytic anemia
RDW variation in size
d.
11.5 14.51
IDA ThatMinor
13 Mentzer 413 ThalEfemia

0010085 RDW 00000000

33.59cm
A 5-year-old child was bought to the outpatient department by his mother with the
complaint of inactivity and difficulty in weight gain. On history taking, it was found
that they have a relative with some “blood illness”. On physical examination, the
child is underweight for his age, and pallor is positive on the skin, arms and
conjunctiva. The doctor ordered Hb electrophoresis, and HBA2 was found to be
3.9percent. What is the diagnosis?

TIE.si
a. Beta thalassemia trait
b. Sickle cell anaemia BT casymp
1
c. Hereditary spherocytosis
d. G6PD deficiency
 I
A patient presents with increased serum ferritin, decreased TIBC,
increased serum iron, % saturation increased. Most probable diagnosis is
______________________?

SIDEROBLASTICANI
A 49-year-old woman known case of rheumatoid arthritis presented to the emergency
department with complaints of exertional shortness of breath, malaise, and easy
fatigability for the past three months. Complete blood counts revealed haemoglobin:
7.7 gm/dL, mean corpuscular volume (MCV): 78 fL, mean corpuscular haemoglobin
(MCH):23 pg, total white cell count: 9.0 × 10 9/L, and platelet count: 227 × 109/L.
Serum iron is reduced and serum ferritin increased. What is the most probable
diagnosis?
ac
a. Iron deficiency anaemia
b. Anaemia of chronic disease
c. Thalassemia minor
d. Lead poisoning

underlying
cause
ANEMIA FEATURES
MICROCYTIC
HYPOCHROMIC
S
0
I T A
00 LeadL

poll

Koilonychia IDA Anemia of chronic

0 0SIDEROBLASTIC
Feature I disease ANEMIA
die
Serum Iron
IEPCIDIN
Transferrin
Saturation
Travel
Ferritin

storage to
TIBC
Top
Total iron binding
capacity S D
Anemia Of Chronic Disease
 Fte
A patient presents with increased serum ferritin, decreased TIBC,
increased serum iron, % saturation increased. Most probable diagnosis is
sideroblastic anemia. Which of the following peripheral smear
findings best correspond to the same?
a
 Romanowsky s
stain
00 4 9 8
00 0 G6PD
Heinz Bodies
t Pappenheimer denatured Hb
HEY Bodies
B
Fe
Megal
An Sideroblastic
An
Post splenectomy
 Q. A 10-year-old Afro-American boy presents to the emergency department. On
physical examination, the patient has hepatosplenomegaly and skull X-ray
as shown below. Laboratory findings show reduced hemoglobin, elevated
lactate dehydrogenase (LDH), and red blood cells as observed in the
peripheral blood smear given below. Which of the following is the most
appropriate treatment for this patient?
a. Hydroxyurea therapy
HbF 102
b. Eculizimab
c. Phosphodiesterase-5 inhibitors
d. Monoclonal antibody therapy

SC on hypoxia
a

36
G in welcome
 in crew out
Hair on end
1
SCA
That

sickle Drepanocyte
27 year old primigravida shows the following blood
picture on peripheral smear analysis. How will you
investigate the patient further?

EE.
a. Osmotic fragility testing- hereditary spherocytosis
b. Coombs tests- AIHA
c. G6PD testing- ELISA
d. Flow cytometry- PNH

16 year old boy presents with jaundice and splenomegaly.

There is a history of similar complaints in the elder
brother as well as mother indicating an autosomal
dominant inheritance in the family. The following blood
picture is seen on peripheral smear analysis. How will you
investigate the patient further?
 HEREDITARY SPHEROCYTOSIS
i

It msn.EE y ii removed
SPREEN

G6PD deficiency
B splenectomy
Prophylactic
Heinz Body yn
violet
crystal

MIHA
Helmet
288 fragmented RBC schistocytes
45 RBKHemolytics
tretic 0
00
R1

11 5
511
14
Q. A 24-year-old caucasian woman presented to her primary care physician for
evaluation of new coffee - coloured urine noticed intermittently over the past five
days. Her last menstrual cycle was two weeks ago, and they have been occurring
regularly. There is no history of fever, melena, or hemoptysis. Her vital signs were
unremarkable. On initial evaluation, CBC, urinalysis, and renal ultrasound were
normal and urine pregnancy test was negative. A few days later, she developed
jaundice with abdominal pain. Repeat testing at that time showed the following: WBC
count 3600/mm3, hemoglobin 4g/dl, platelet count 189,000/mm3, MCV 75 fl, RDW 28,
reticulocyte count 10.9 %, total serum bilirubin 7.5 mg/dl, indirect bilirubin 5.5 mg/dl.
The urinalysis showed hemoglobinuria. Flow cytometry of peripheral blood showed
absent expression of CD55 and CD59 on 78% of red blood cells. Based on the flow
cytometry results, what do you think is most appropriate drug to use in this condition
a. Rituximab
b. Alemtuzumab
781
c. Eculizumab PNHiacquired
d. Mepolizumab
Flowcytoi.DUal pop
Meningococcal 055 59
vaccine prophylaxis 55 59
NM A C W Y
vaccine
all
protect alg
except
CASE OF RED COLOR URINE
PNH Thrombosis
acquired
etmk
PASSED AT NIGHT?
DISEASE ? DEFECT? piaaagen.ee

PNH GPI anchors defect

9 PNH
155
Rx Eculizimab DIAGNOSTIC TEST?

Tommy En
ELIER sin
stain
CD55 DAF Control
CD59 MIRD complement
 Ey
8
80
 CHAPTER- WBC
N 00 __________________
3-5 nuclear lobes
55 HS megaton
O

L lymphocyte
__________________ N

m e
__________________ marini
M O Kidney shaped
nucleus

E
J
E This
__________________
Orange granules
Allergy
TParasitic
Spectacle nucleus

Basophil
__________________ Tin CML
3
0 Blue black granules
 mast cell
Basophil
special stain TOIB

Tolblueiafertstaftvoluti gric.DI
th
 atypical

Cell Downey cells

Appearance Ballerina skirt App
nfection EBV
Q) A 15-year-old boy presented with one boy history of bleeding gums,
subconjunctival bleed and purpuric rash. Investigation revealed the
following results.

artist
Hb-6.4gm/dL; TLC-26,500/mm3, Platelet 35000 mm3; Prothrombin time -20
sec with a control of 13sec, partial thromboplastin time-50 sec.
Peripheral smears was suggestive of acute myeloblastic leukemia. Which of
the following is the most likely?
a) AML M2 a
b) AML M3
c) AML M4
d) AML M5
Tissue infiltration
c Idiot Testes
AML Gum HT skin
Rf
CREEK
AML Mz APML

15 7 PML RARA fusion

B ATRA Avs Trioxide

Only leukemia a w DIC

 men
Q. 55 year old patient presents with dragging sensation of the abdomen and
0 fever. The CBC shows hyper leucocytosis. Bone marrow aspirate has been

on.fr
shown below. Based on the information provided which of the following
statement is incorrect ?

a. 210kD fusion protein is diagnostic for the disease

High LAP score
b.
low
c. Platelet count can be markedly elevated in the accelerated phase
d. Pseudogaucher cells may be noted one

Garden
Party
0 college girl
000
shiftified
CML
9 22 Ph Cr
Bcr Abi
IOC
gene
FISH
Interphase cells
Ber Abl fuse
190 KD ALL
210 KD ML
230KD CNL
 Alkaline NAP
Neutrophil phosphatase
Tye Kaliniphosphatase hAI
40 100
440
77100
Lakes henkamoid An Yh
p Preg
furrophilia
Down's Sx
 CRUMPLED
TISSUE PAPER

Gaucher cell
ensrosinase
def
Q. Which of the following does not take origin from the area labelled below?

Naive B CLL SIL

a. Hairy cell leukemia
b. Follicular lymphoma
c. DLBCL FL BL DLBCL
d. Burkitt’s lymphoma
memory HCL
Plasma MM
 1424
Ha
7 memory
7
fgf.mn
IPlasmam
Mantle
unchallenged F
a
ILL
HL POST GC B cell
In a patient presenting with cervical lymphadenopathy and a
positive t(11;14) result, which of the following markers
should be utilized to confirm the diagnosis?
A. CD10
w
B. CD200
C. Sox11

D
D. Cyclin D1
1. A,B
2. B,D
3. A,C

o
4. C,D
 GENETICS
teen teen

Enga
8 evenNo
11 14
FE.IM
Burkitt's L
me t

18 14 cyclin D1
8 22 SOX 11
2 8
11 18
48 207 MZL
AMLMZ
 MARKERS
CLL SLC MCL MIL

CD 5

CD 23

10200 t

nnd
k67 100
Burkit'sL
Lymphoma Origin and genetics
Follicular lymphoma
Diffuse large B cell
lymphoma
Burkitt’s lymphoma
Jac
Mantle cell lymphoma
II a sox 11 c
Marginal zone lymphoma
51231200 200
Hairy cell leukemia 4341 8 0
BM B FRIED
Hodgkin’s lymphoma I egg

Myco tasimeter HCL

droglioOn

Malassezia Seminoma Dys

fieful
 so
00 800
EBI Tx
AFRICAN CHILD BMA BMB
Vacuolation
JAW SWELLING mysky
oil fedo MY
c
f
small cell lung
emye lung
• SPECIALeuroblastoma
STAIN?
Myc
What is the color of the vacutainer that contains sodium fluoride?
a. Red
b. Grey
c. Blue
d. Yellow
t.fi
additive
antico
gf of
 K2ED
8 10 times
mixing

fEEEE
WHITE
ÉLEf É T.nl
9fning
Trace
elements
PER CFS
Retic Count
Blood Bank ESR wintrobe
BG 9m8cm HbA1c heated d
 uses
of
ABG
eparin

GRAY
K oxalate
Anticoag
Additive Naf
Use Glucose all
 Blue
Light
21 EISODIUM CITRATE
Anticoag 3
• Black CAP
Use studies
coag
ESR westregren

Trisod
Black
Use automated ESR
es
 OF SERUM

SEARATOR

REFER
30min
ORANGE
5 mins
188min

Houriones
fsqserom_ Enzymes
HET
 SEQUENCED

OP LIGHT RED YELLOW GREEN 444T 9

Light ray
Blue
Sterile
Microbio
culture
Q. What is the storage temperature and shelf life of Fresh Frozen Plasma (FFP)?

a. Storage temperature: 4°C; Shelf life: 35 days

c.
0
b. Storage temperature: -30°C; Shelf life: 1 year
Storage temperature: 20-24°C; Shelf life: 5 days
d. Storage temperature: Varies; Shelf life: Not applicable

FFP CMOPI
VWF F8
ND F 13
Hema
F1
 Component Temperature Shelf life

Whole blood/ PRBC

ACD 3W To
RDefrigeratorCPD 3W 219
2 6 C CPD A 5w 35A
CPSAGM 6W 429

PRP
Platelet rich plasma 20 24 C
5
days

cryptFFP Offator 1
18 C
I
Fresh frozen plasma
I year