1.
A 55-year-old male presented at the OPD with complaints of bone pain more in
lower back and long bones, generalised weakness, malaise, bleeding from the
gums, headache,nausea.
Bone marrow picture and x-ray lumbosacral region of the patient is shown
below.
1. What is the diagnosis and describe the smear?
2. What are the different types of cells and inclusions seen?
3. What is the classical urine finding?
4. What is the electrophoresis finding?
5. Write the classification of this disorder?
2.
A 10-year-old boy attended the opd with complaints of passing cola-coloured
urine for past 1 month duration. He also complained of reduced urinary output
and swelling over periorbital region.
1. What is the diagnosis?
2. What is the etiology for this condition?
3. Mention the 2 other disease in the same spectrum?
4. What are the microscopic findings in this condition?
5. What is the special investigation for the diagnosis of this condition?
3.
A 60 year male presented with high grade fever, altered sensorium and neck
stiffness.
CSF cytology for interpretation
1. What is the diagnosis and mention the most common causative organism
for this condition?
2. What are the biochemical changes in this condition?
3. In which infection cobweb appearance of CSF is seen.
4. What is xanthochromia and in which condition it is seen?
5. Name some investigations for the diagnosis of the condition.
4.
A 3 years old male child presented with pallor, icterus and history of severe pain
in abdomen and lower limbs. CBC showed Hb- 4.5 g/dl, WBC – 19000/cumm,
Platelets – 150000/cumm. Peripheral smear was done.
1. What is your diagnosis?
2. What is the genetic defect that leads to this condition?
3. What are the peripheral smear findings?
4. What are the associated crises of this condition?
5. What are the diagnostic tests?
SICKLE CELL ANEMIA
A 3 years old male child presented with pallor, icterus and history of severe pain
in abdomen and lower limbs. CBC showed Hb- 4.5 g/dl, WBC – 19000/cumm,
Platelets – 150000/cumm. Peripheral smear was done.
1. What is your diagnosis?
2. What is the genetic defect that leads to this condition?
3. What are the peripheral smear findings?
4. What are the associated crises of this condition?
5. What are the diagnostic tests?
Answers:
1. Sickle cell anemia
2. Point mutation in 6th codon of β globin gene that leads to substitution of
valine for glutamic acid.
3. Sicke cells, Reticulocytosis, Howell jolly bodies.
4. Vaso occlusive crisis, Aplastic crisis, sequestration crisis
5. Peripheral smear, sickling test, Hb electrophoresis, NESTROFT.
MULTIPLE MYELOMA
A 55-year-old male presented at the OPD with complaints of bone pain more
in lower back and long bones, generalised weakness, malaise, bleeding from
the gums, headache,nausea.
Bone marrow picture and x-ray lumbosacral region of the patient is shown
below.
1.What is the diagnosis and describe the smear?
2.What are the different types of cells and inclusions seen?
3.What is the classical urine finding?
4.What is the electrophoresis finding?
5.Write the classification of this disorder?
ANSWERS:
1. Multiple Myeloma. The marrow shows plasmacytosis >10% with
neoplastic cells having deeply basophilic cytoplasm, eccentrically placed
nuclei with perinuclear hof/clearing
2. Mott cells, flame cells. Cytoplasmic inclusions- Russell bodies, intranuclear
inclusion- Dutcher bodies
3. Bence Jones protein
4. M band in electrophoresis of urine or serum sample
5. Plasma cell myeloma, solitary plasmacytoma of bone, smoldering
myeloma, monoclonal gammopathy of uncertain significance(MGUS)
NEPHRITIC SYNDROME
A 10-year-old boy attended the OPD with complaints of passing cola-coloured
urine for past 1 month duration. He also complained of reduced urinary output
and swelling over periorbital region.
1.What is the diagnosis?
2.What is the etiology for this condition?
3.Mention the 2 other disease in the same spectrum?
4.What are the microscopic findings in this condition?
5.What is the special investigation for the diagnosis of this condition?
ANSWERS:
1. Nephritic syndrome
2. Immune complex mediated following streptococcal infection, SLE.
3. Rapidly progressive crescentic glomerulonephritis, Goodpasteur
syndrome,
non streptococcal acute glomerulonephritis
4. Enlarged hypercellular glomeruli with infiltration by leucocytes,
endothelial and mesangial cell proliferation, and crescent formation in
severe cases.
5. Immunofluroscence microscopy shows granular deposits of Ig G and C3 in
mesangium and along glomerular basement membrane.
ACUTE PYOGENIC MENINGITIS
A 60 year male presented with high grade fever, altered sensorium and neck
stiffness. CSF cytology for interpretation.
1. What is the diagnosis and mention the most common causative organism
for this condition?
2. What are the biochemical changes in this condition?
3. In which infection cobweb appearance of CSF is seen.
4. What is xanthochromia and in which condition it is seen?
5. Name some investigations for the diagnosis of the condition.
ANSWERS
1. Acute pyogenic meningitis since many neutrophils are seen in the
cytology.
Causative agents: Streptococcus pneumonia, Niesseria meningitides,
Hemophilus influenza
2. In Acute pyogenic meningitis CSF glucose level decreases(<40mg/dl) and
protein level increases(50-1500mg/dl).
3. Tuberculous meningitis
4. Xanthochromia is yellowish discoloration of CSF seen in subarachnoid
hemorrhage.
5. Biochemical analysis, CSf cytology, Grams stain, Ziehl Neelsen smear,
culture, PCR, direct wet mount and electrophoresis.
