PATHOLOGYCLI

NICALTABLEQUESTI
ONS

(
Tot
al:
4Mar
ks)

1)A20yearol
dfemalepresentswit
hnausea,vomit
ingandpai
nint
hel
owerabdomen(
RIF)
f
ort
helast2daysalongwithfev
erandleukocyt
osis.

a)Whati
sthepr
obabl
edi
agnosi
s?

b)Dr
awal
abel
l
eddi
agr
am oft
hebi
opsyoft
heaf
fect
edor
gan.

2)A70y earol
dmal
epr
esentswit
hPr
uri
ti
sanddeepy
ell
owdi
scol
our
ati
onofur
ine.USG
showedmassint
hepancr
eas.

a)Gi
vey
ourdi
agnosi
s.

b)Suggestnecessar
yinv
est
igat
ion.

3)A 5y
earmal
echi
l
dpr
esent
swi
thspl
eenomegal
yandmal
arpr
omi
nence.

a)Whati
syourpr
obabl
edi
agnosi
s?

b)I
mpor
tantf
indi
ngsi
ntheper
ipher
alsmear
?

c) Whataboutmar
rowi
ronst
ain?

4)A70y earol
dmalecomeswi
thsev
erebackacheandmul
ti
plesmal
lost
eocy
ticl
esi
onsi
n
skul
landhighESR.

a)Whati
sthedi
agnosi
s?

b)Ur
inar
yfi
nings?

c) Bonemar
rowpi
ctur
eoft
hiscase.

5)An18yearol
dmalepr
esent
swi
thmul
ti
pleenl
argedl
ymphnodeswi
thonedi
schar
ging
si
nusi
ntheneck.

a)Whati
sthepr
obabl
edi
agnosi
s?

b)Apar
tfr
om t
hebi
opsy
,whati
nvest
igat
ioncanbedonei
nthi
scase?

c) Namet
woneopl
ast
icl
esi
onsoft
hel
ymphnode?

6)Mi
ssRi
ta,
a7y
earf
emal
echi
l
d’sur
ineexami
nat
ionr
epor
trev
eal
edt
hef
oll
owi
ngdet
ail
s:

Col
our
-Smoky
 Speci
fi
cGr
avi
ty-1.
028

Pr
otei
n-pr
esent

Sugar
/Ket
onebodi
es-NI
L

Mi
croscopi
cexami
nat
ion-manyRBCs,
Puscel
l
s,Epi
thel
i
alcel
l
sandRBCcast
s.

a)Whati
sthemostpr
obabl
edi
agnosi
s?

b)Ex
plai
nther
easonf
orchangesofdi
ff
erentpar
amet
ers.

7)A56y earol
dfemalepr
esentswit
hpost
-menopausal
bleedi
ng.Onexami
nat
ion,
her
cer
vixwasfoundtobeunhealt
hy.

a)Whati
sthel
i
kel
ydi
agnosi
s?

b)Whatf
act
orsar
eimpor
tantt
ocauset
hedi
sor
der
?

c) Dr
awal
abel
l
eddi
agr
am oft
hebi
opsy
.

8)A46y earol
dfemalesuf
feri
ngfr
om r
ecurrentatt
acksofuri
nar
ytracti
nfect
ionf
orthe
l
ast15y ear
s.Herbl
oodureaandcr
eati
ninelevel
sarehighandcomplai
ningofgross
weakness.

a)Whati
sthepr
obabl
edi
agnosi
s?

b)Ex
plai
ntheexpect
edphy
sical
findi
ngsi
nherur
ine.

c) Wr
it
ethegr
ossf
eat
ureoft
heaf
fect
edki
dney
.

9)A 5y
earol
dbabypr
esent
swi
thOl
i
gur
iaanswel
l
ingofherf
acef
or4day
s.

a)Whati
sthepr
obabl
edi
agnosi
s?

b)Whataret
heexpect
edphy
sical
,chemi
cal
andmi
croscopi
cfi
ndi
ngsofur
ineoft
his
pat
ient
?

10)A50y earmal
epresentswit
hdraggi
ngsensat
ioni
ntheabdomenwi
thhuge
spl
eenomegal
y,progr
essiv
eanemia.

a)Whati
sthepr
obabl
edi
agnosi
s?

b)Wr
it
ethechr
omosomal
abnor
mal
i
ties.

c) Wr
it
etheper
ipher
albl
oodpi
ctur
eoft
hiscase.

11)A 3yearchi
l
dpr
esent
swi
thpal
or,
hepat
ospl
eenomegal
yandt
heper
ipher
alsmear
shows:
 Hb-5gm%

TLC-
14,
500

DC:
N-20,
L-75,
E-02,
M-03

TPC-1.
5lakhs

RBC-
hypochr
omi
cwi
thmar
kedani
sopoi
ki
locy
tosi
s

Tar
getcel
l
s+

Nor
mobl
ast
s-12/
100WBC

a)Whati
syourpr
ovi
sional
diagnosi
s?

b)Whatf
urt
hert
est
stoper
for
m adef
ini
tedi
agnosi
s?

12)Wr
it
etheX-
li
nkedr
ecessi
vedi
sor
der
s(any4)
.Wher
ear
etheabnor
mal
i
ties?

13)A25yearol
dpresent
edwithf
ev er
,yell
owdiscol
our
ati
onofski
nanduri
ne,
fort
hel
ast10
day
s.Li
verwasenlar
gedandtender.Test
sforHepat
it
isAwasposi
ti
ve.

a)Fi
ndi
ngsofLFT

b)Chemi
cal
exami
nat
ionofur
ine

ANSWERS

1.
a)Pr
obabl
edi
agnosi
s:Acut
eappendi
cit
is

1.
b)Seehi
stol
ogydi
agr
am

2.
a)Obst
ruct
ivej
aundi
ceduet
ocar
cinomaofheadofpancr
eas

2.
b)I
nvest
igat
ions:

i
. ALT

i
i
. AST

i
i
i. GGT

i
v. ALP:
Highl
yel
evat
edi
nObst
ruct
iveJaundi
ce

3.
a)Thal
assemi
a
3.
b)Fi
ndi
ngsi
nper
ipher
alsmear
:

i
. Ani
socy
tosi
s,poi
ki
locy
tosi
s

i
i
. Mi
crocy
tosi
s,hy
pochr
omi
a

i
i
i. Tar
getcel
l
sposi
ti
ve

i
v. Basophi
l
icst
ippl
i
ng

v
. Fr
agment
edr
edcel
l
s

v
i. El
evat
edr
eti
cul
ocy
tecount

3.
c)Mar
rowi
ronst
ain:
blue-
viol
et,
duet
oHemosi
der
osi
s.

4.
a)Mul
ti
plemy
eloma

4.
b)BenceJonespr
otei
nsexcr
eat
edi
nhi
ghamount
s.

4.
c)Bonemar
rowpi
ctur
e:

i
. I
ncr
easednumberofpl
asmacel
l
s(30%)

i
i
. Pl
asmabl
ast
swi
thv
esi
cul
arnucl
earchr
omat
inandpr
omi
nentnucl
eol
us

i
i
i. Bi
zar
remul
ti
nucl
eat
edcel
l
smaypr
edomi
nat
e.

5.
a)Tuber
cul
arl
ymphnode(
Tuber
cul
arl
ymphadeni
ti
s)

5.
b)Ot
heri
nvest
igat
ions:
Tuber
cul
i
nsensi
ti
vi
tyt
estandZNst
aini
ngofl
ymphnodedi
schar
ge.

5.
c.i
)Hodgeki
n’
sLy
mphoma

5.
c.i
i
)Bur
kit
t’
sLy
mphoma

6.
a)Nephr
it
icSy
ndr
ome

6.b)Immunecompl
exmediat
edgl
omer
ularbasementmembr
anei
njur
y.Col
ouri
ssmoky
/col
a
colouredduet
ohemat
uri
a.

7.
a)Cer
vical
Car
cinoma

7.
b)Imp.Fact
orst
ocauset
hisdi
sor
derare:
HPVI nfect
ion(hi
ghri
skty
pes-
16&18),
Smoking,
Havi
ngaweakenedImmuneSyst
em,Chlamydi
aInfecti
on,Obesi
ty,
UseofOral
Cont
racept
ives.

7.
c)SeeHi
stol
ogydi
agr
am

8.
a)Py
elonephr
it
is
8.
b)Ur
inar
yfi
dings:
Pyur
ia(
leukocy
tes)
.Leukocy
tecast
sri
chi
nNeut
rophi
l
s(puscast
s)

8.
c)Gr
ossf
eat
uresofaf
fect
edKi
dney
:

i
. Pat
chyi
nter
sti
ti
alsuppur
ati
vei
nfl
ammat
ion

i
i
. I
ntr
atubul
araggr
egat
eofneut
rophi
l
s

i
i
i. Tubul
arnecr
osi
s

9.
a)Nephr
oti
cSy
ndr
ome(
NCD-mor
ecommoni
nchi
l
dren)

9.b)Ur
inar
yfi
ndings:
Heavyprotei
nuri
a( >3.
5g/
day )
,par
ti
cul
arl
yal
bumi
nar
ia,
Lipi
dur
ia(
freef
at
cell
sandovalf
atbodiesseen)
.Gross:foamyurine.

10.
a)CML

10.
b)Reci
procal
tr.
ansl
ocat
ionofchr
omosomenuber9and22.

10.
c)Per
ipher
albl
oodpi
ctur
e:

i
. El
evat
edpr
opor
ti
onsofeosi
nophi
l
sandbasophi
l
s

i
i
. Abundantwr
inkl
ed,
greenbl
uecy
topl
asm cal
l
edseabl
uehi
stocy
tes.

i
i
i. Leukocy
tosi
s,of
tenexceedi
ng1,
00,
000cel
l
s/cmm

11.
a)Thal
essemi
a

11.
b)Bl
oodt
est
sandX-
rayst
udi
es

12)Thedi
ff
erentX-
li
nkeddi
sor
der
sal
ongwi
tht
hei
rabnor
mal
i
tiesar
e:

i
. Redgr
eencol
ourbl
i
ndness:
Genet
ic

i
i
. Hemophi
l
iaA:
Mut
ati
oni
nFact
orVI
IIgene

i
i
i. DuchenneMuscul
arDy
str
ophy
:Mut
ati
oni
nDy
str
ophi
ngene

i
v. X-
li
nkedI
cht
hyosi
s:Her
edi
tar
ydef
ici
encyofSt
eroi
dSul
fat
ase

13.
a)Fi
ndi
ngsofLFT:
Incr
easedALT,
AST andAl
kal
i
nePhosphat
ase.

13.
b)Ant
i-
HAVI
gM Ant
ibodi
esbyELI
SA