Clinical Case Based Questions in Pathology

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  1. 40 y/o male.
    1. C/O: –
      1. Dragging sensation on left side of abdomen
      2. Fatigue
    2. O/E-
      1. Pallor
      2. Massive splenomegaly
    3. Hemogram-
      1. Total WBC: 1.7 lakh/mm3
    4. Karyotyping-
      1. Chromosomal Translocation
    5. Questions-
      1. Likely diagnosis?
      2. Etiopathogenesis?
      3. Blood and bone marrow picture of various stages of this disease.
      4. Enumerate various differential diagnosis
      5. Chromosomal/Molecular alteration observed in this condition?
  2. 60 y/o male.
    1. C/O in lower extremity-
      1. Oedema
      2. Redness
      3. Warmth
      4. Pain
    2. O/E-
      1. Superficial venous dilation
      2. Palpable firm nodularity.
    3. A few days later-
      1. Sudden shortness of breath
      2. Syncope
    4. H/O-
      1. Hospitalised and immobilised for 45 days due to surgery
      2. Discharged 1 week ago prior to current visit.
    5. Questions-
      1. Probable diagnosis?
      2. Risk factors?
      3. Pathogenesis?
      4. Various types and morphology?
      5. Fate/Outcomes?
  3. 8y/o male.
    1. C/O-
      1. Fatigue
      2. Pallor
      3. Mild jaundice
    2. O/E per abdomen-
      1. Mild hepatosplenomegaly
    3. Lab-
      1. Moderate anemia
      2. Microcytic hypochromic blood picture
      3. Target cells
      4. Polychromatophils
      5. Basophilic stippling
    4. Questions-
      1. Diagnosis?
      2. Etiopathogenesis and types?
      3. Lab investigations needed?
      4. Enumerate DDs of microcytic hypochromic blood picture on peripheral smear.
  4. 70 y/o male.
    1. C/O-
      1. Generalised lymphadenopathy
    2. Lab-
      1. WBC > 1 lakh
      2. DC: lymphocytosis
    3. Questions-
      1. Diagnosis?
      2. Discuss lab findings.
  5. 40 y/o female.
    1. C/O-
      1. Moon face
      2. Truncal obesity
      3. Hirsutism
      4. Amenorrhea
      5. Easy bruising
    2. Questions-
      1. Name associated conditions
      2. Risk factors/causes.
      3. Pathophysiology
      4. Lab investigations needed to support the diagnosis.
  6. 53 y/o male truck driver.
    1. C/O-
      1. Fever
      2. Weight loss
      3. Generalised lymphadenopathy
      4. Chronic diarrhoea
      5. Recurrent nasopharyngeal infections
    2. Questions-
      1. Identify clinical scenarios
      2. Risk factors
      3. Enumerate other related opportunistic infections.
  7. 49 y/o man.
    1. C/O right calf-
      1. Swelling
      2. Pain
      3. Edema
      4. Redness
      5. Warmth
    2. H/O-
      1. Major surgery
      2. Immobilised for 30 days
      3. Discharged 1 week prior.
    3. Questions-
      1. Probable diagnosis?
      2. Etiopathogenesis?
      3. Associated risk factors?
      4. Various types and associated morphology.
      5. Fate/outcome.
  8. 50 y/o male.
    1. C/O-
      1. Frequent constipation
      2. Abdominal pain.
    2. O/E abdomen, pelvis MRI-
      1. Mass in sigmoid colon
      2. Diffuse metastatic disease in right and left lobe of liver
      3. Retroperitoneal lymphadenopathy
    3. Questions-
      1. Define neoplasia.
      2. Benign Vs Malignant neoplasm
      3. Define carcinogenesis
      4. Viral carcinogenesis
      5. Metastatic cascade
      6. Routes of spread of tumor.
  9. 35 y/o female-
    1. C/O-
      1. Weakness
      2. Gradual onset of pallor
      3. Beefy red tongue
      4. Paraesthesia
      5. Altered visual defects
    2. Lab-
      1. Hb: 8.2 g/dl
      2. MCV: 104fl
      3. WBC: 3500/ mm3
      4. Platelet: 90,000/mm3 and reduced
      5. Vit B12: reduced
    3. Questions: –
      1. Identify the condition
      2. Etiopathogenesis
      3. Peripheral smear findings
      4. Bone marrow findings
      5. Additional lab findings to arrive at the diagnosis.
  10. 35 year old female.
    1. C/O-
      1. Fatigue
      2. Weakness
      3. Glossitis.
    2. O/E-
      1. Knuckle pigmentation
      2. Peripheral neuropathy.
    3. Questions-
      • (a) What is provisional diagnosis and why?
      • (b) Write the aetiopathogenesis of the condition.
      • (c) Discuss the different laboratory investigation to confirm the diagnosis
  11. A 40 year old male.
    1. C/O-
      1. Massive splenomegaly.
    2. Lab-
      1. Total leukocyte count was I, 40, 000 cell/cm3.
      2. LAP score zero
    3. Questions-
      • (a) What is your diagnosis?
      • (b) What is peripheral smear findings?
      • (c) What is chromosomal abnormality?
  12. A 60 years old male.
    1. C/O-
      • Cough
      • dyspnea
      • Intermittent hemoptysis for 3 months
      • Loss of weight and appetite
    2. Known smoker for 25 years
    3. CT Scan-
      • Mass in left lung
    4. Questions-
      • Probable diagnosis?
      • Etiopathogenesis of this condition
      • Write in detail about classification and histomorphological features
      • Discuss about the paraneoplastic syndromes associated with it.
  13. A 60 year old postmenopausal woman.
    1. Friable mass in cervix that bleeds on touch.
      1. What is your diagnosis?
      2. Discuss about etiopathogenesis and morphological features of this condition. 
  14. A 52 year Old woman.
    1. c/o-
      1. Lump in her left breast
    2. O/ E-
      1. 3cm firm to hard irregular immobile mass in the upper outer quadrant of the left breast.
    3. Histopathology-
      1. Malignancy with metastatic axillary lymph nodes.
    4. Questions-
      1. Define neoplasia & tabulate the important differences between benign malignant tumour
      2. Describe in detail about the event of invasion & metastasis.
      3. Describe in detail about the modalities for lab diagnosis of the respective case to arrive the diagnosis.
  15. A 70 year old male.
    1. C/O-
      1. Low back pain
      2. Fatigue.
    2. X-ray –
      1. Punched out Iytic lesion in the pelvis and vertebra.
    3. Questions-
      1. What is your diagnosis?
      2. Discuss the pathogenesis, clinical features and lab investigations of the above condition.
  16. A 40 year old vegetarian female.
    1. C/O-
      1. Beefy tongue
      2. Peripheral numbness.
    2. Enumerate the lab findings.
  17. A 14 year old boy.
    1. C/O-
      1. Swelling over lower thigh.
    2. X-ray-
      1. Lytic and sclerotic lesion along with Codman’s triangle in the metaphysis of distal femur with lifting of the periosteum.
    3. Questions-
      1. What is the most likely diagnosis and why?
      2. Discuss on the etiopathogenesis of this entity?
      3. Describe the gross and microscopic features.
      4. Classify the bone tumours.
  18. 30 year old lady.
    1. C/O-
      1. Painless, 2cm breast lump
    2. O/E-
      1. Firm
      2. Well defined
      3. Freely mobile
    3. Mammography-
      1. BIRAD-III score
    4. Questions-
      1. Diagnosis?
      2. Microscopic features of the lesion
  19. 30 year old barefoot farmer.
    1. C/O-
      1. Pallor & generalised weakness for 3months.
      2. Dysphagia of gradual onset later
      3. Spoon shaped nails.
    2. Stool examination-
      1. Hookworm ova.
    3. Questions-
      1. Underlying disorder?
      2. Peripheral blood smear?
      3. Bone marrow changes?
  20. 5 year old child brought by mother.
    1. C/O-
      1. Persisting pale look.
      2. Stunted growth
      3. Prominent forehead and cheek.
    2. O/E-
      1. Pallor
      2. Splenomegaly
    3. X-Ray-
      1. Hair on end appearance of skull
    4. Questions-
      1. Diagnosis?
      2. Pathogenesis?
      3. Classification?
      4. Clinical features?
      5. Lab findings.
  21. 70 year old man.
    1. C/O-
      1. Generalised lymphadenopathy
    2. Lab-
      1. Total WBC: > 1 lakh
      2. Differential Count- Lymphocytosis
    3. Questions-
      1. Diagnosis?
      2. Lab findings?
  22. 15 year male.
    1. C/O-
      1. Fleeting type of joint pain involving major joints with redness and swelling.
    2. H/O-
      1. Sore throat
    3. O/E-
      1. CVS-systolic murmur present.
    4. Questions-
      1. What is your diagnosis?
      2. Etiopathogenesis?
      3. Diagnostic criteria
      4. Morphological changes of the above condition.
  23. 10 year boy .
    1. C/O-
      1. Pain and progressive swelling around the right knee joint for 2 months
      2. Not relieved by rest.
    2. Local examination-
      1. Shows diffuse hard swelling around the knee joint.
    3. X-ray-
      1. Expanded osteolytic mass in the lower femur.
    4. Questions-
      1. What is your diagnosis?
      2. Write the etiopathogenesis
      3. Laboratory findings
      4. Morphology of the above condition.
  24. 30 year old male.
    1. C/O-
      1. High degree of fever
      2. Chest pain
      3. Cough with expectoration 
      4. Leukocytosis.
    2. Questions-
      1. What is diagnosis?
      2. Describe the morphology of lesion.
      3. Add a note on its complications
  25. 9 years old child admitted-
    1. C/O-
      1. Sudden onset of severe chest pain
      2. Backpain
      3. Abdominal pain
      4. Complaints of fatigue.
    2. Investigations:
      1.  H6-6.5g/dl
      2. MCV-991
      3. HCT-19%
      4. Total count – 12000/ml
      5. Platelet Count: 1.4c/ml.
    3. Reticulocytosis & Peripheral smear –
      1. Crescent shaped RBC’s often with elongated & pointed ends.
    4. Questions-
      1. Probable diagnosis
      2. Etiopathogenesis
      3. Lab diagnosis.
  26. A 52 y/o women.
    1. C/O –
      1. Lump in her left breast.
    2. O/E-
      1. 3cm firm to hard irregular immobile mass in the upper outer quadrant of the left breast.
      2. Malignancy with metastatic axillary lymph nodes.
    3. Questions-
      1. Modalities for lab diagnosis of the respective case to arrive the diagnosis.
  27. 7 year old boy –
    1. C/O-
      1. Anemia
      2. Jaundice
      3. Growth retardation.
    2. X-ray-
      1. Skull showed ‘hair-on-end’ appearance.
    3. Hemoglobin electrophoresis-
      1. Revealed increase in HbF levels.
    4. Questions-
      1. What is the most probable diagnosis and why?
      2. Describe the pathophysiology of this condition
      3. Discuss the hematological, biochemical and other laboratory findings of this condition.
  28. 32 year old man-
    1. C/O-
      1. Anemia has increased MCV.
      2. Peripheral smear showed macro-ovalocyte RBCs and hypersegmented polymorphs.
    2. Questions-
      1. Most likely findings in his bone marrow study?
  29. A 55 year old male –
    1. C/O-
      1. Acute onset chest pain radiating to neck
      2. Profuse sweating.
    2. ECG-
      1. ST wave elevation.
    3. Questions-
      1. What is the probable diagnosis? Give reasons.
      2. Discuss the laboratory investigations in this?
      3. What is the etiopathogenesis of the condition?
      4. Describe the sequential morphological changes expected in the primary organ affected?
      5. Enumerate the complications. 
  30. A 60 year old lady.
    1. C/O-
      1. Altered sensorium.
    2. H/O-
      1. Polyuria
      2. Polyphagia
      3. Polydipsia.
    3. O/E-
      1. Breath has a fruity odour.
    4. Question-
      1. Urinary findings
      2. Kidney pathology.
  31. A male child aged 3 years
    1. C/O-
      1. Cervical and axillary lymphadenopathy
      2. WBC total count of 1.2 lakh.
    2. Questions-
      1. What is your diagnosis?
      2. Classify the disease
      3. Discuss in detail about laboratory findings
      4. Prognosis.
  32. A 14/F
    1. C/O-
      1. Anemia
      2. Splenomegaly
      3. Jaundice
    2. H/O-
      1. Sibling being affected.
    3. Peripheral smear was diagnostic.
    4. Questions-
      1. What is your diagnosis?
      2. The disease is grouped under which category of diseases
      3. Pathogenesis
      4. Morphology
      5. Complications 
  33. 10/M
    1. C/O-
      1. Fleeting type of joint pain involving major joints with subcutaneous nodules.
    2. H/O-
      1. Sore throat
    3. ECG-
      1. Prolonged QR interval.
    4. Questions-
      1. What is your diagnosis?
      2. Etiopathogenesis.
      3. Clinical features
      4. Morphological features.
  34. 50y/F
    1. C/O-
      1. Lower abdominal mass
    2. Intra operative findings-
      1. Unilocular ovarian cyst measuring 15 X 10 cm with 500ml serous fluid
    3. Questions-
      1. Classification of above conditions.
      2. Morphological features.
  35. 60/M
    1. H/O-
      1. Low back pain for 6months
    2. X-Ray-
      1. Multiple lytic lesions in lumbar spine.
    3. Serum electrophoresis-
      1. Prominent M- band
    4. Questions-
      1. Diagnosis?
      2. Classification.
      3. Etiopathogenesis.
      4. Morphology
      5. Lab Investigations.
  36. 42 year old male alcoholic-
    1. C/O-
      1. Fatigue
      2. Numbness
      3. Tingling sensation of lower limbs.
    2. Question-
      1. What is your diagnosis?
      2. Discuss about the laboratory findings of the above conditions.
  37. 54/F.
    1. H/O-
      1. Painless lump in right breast and increasing in size
    2. O/E-
      1. Lump was firm to hard in consistency
      2. Fixed to tissue
    3. USG-
      1. BIRAD IV
    4. Question-
      1. Diagnosis
      2. Classification
      3. Morphology
      4. Investigations
  38. 58/M.
    1. C/O-
      1. Sudden onset of chest pain
      2. Sweating
    2. H/O-
      1. Diabetes
      2. Smoker
    3. Question-
      1. Diagnosis
      2. Needed Investigations
  39. 40/M-
    1. C/O-
      1. Massive splenomegaly
    2. Lab-
      1. Total count- >1lakh per cu mm
      2. LAP – Zero
    3. Question-
      1. Probable diagnosis
      2. Peripheral smear picture
      3. Bone marrow picture
      4. Cytogenic abnormalities
  40. 50/M-
    1. C/O-
      1. Severe chest pain
      2. Sweating
      3. Reduced blood picture
      4. Palpitation
    2. H/O-
      1. Diabetes
    3. Questions-
      1. Risk factors
      2. Morphology
      3. Microscopic Changes
      4. Complications.
  41. 50/F
    1. C/O-
      1. Fixed, immobile lump in upper outer quadrant of left breast.
    2. Questions-
      1. Diagnosis
      2. Etiopathogenesis
      3. Classification
      4. Describe the morphology of the most common types.
  42. 65/F-
    1. C/O-
      1. Bleeding per vaginum
      2. Foul smelling discharge
    2. Questions-
      1. Diagnosis?
      2. Etiopathogenesis?
      3. Morphological types?
      4. Prognostic factors?
      5. Screening methods.
  43. 45/F.
    • C/O-
      • Easy fatigability
    • O/E-
      • Massive Splenomegaly
    • Peripheral Blood-
      • Hb 6.5 g/dl
      • Total WBC 2.5 lakh/ml
    • Differential Count-
      • 5% Blast with prominent nucleoli
      • Fair number of myelocyte, metamyelocytes and band cells.
    • Questions-
      • Diagnosis
      • Etiopathogenesis, peripheral blood picture and various stages.
      • Cytochemistry in diagnosis of various leukemias.