QUIZ 1 (Acute Suppurative appendicitis)

1. What organ was removed at surgery?

Vermicular Appendix
2. Give a brief description of gross and microscopic appearance of
the organ removed
Gross: The appendix is swollen, red with prominent vessels and
covered with a thin film of purulent exudate
Microscopy: The mucosa is focally ulcerated; the lumen and the
wall of the appendix contain acute inflammatory cells (neutrophils)
3. What is the most likely diagnosis?
Acute Suppurative appendicitis

QUIZ 2 (Lobar pneumonia)

1. Give a brief description of gross and microscopic appearance of

the organ removed
Gross: Lower lobe appears grey-brown, dry, solid and airless due to
accumulation of the inflammatory exudate (consolidation)
Microscopic: Alveolar spaces are filled with neutrophils,
macrophages and fibrin (fibrinosuppurative exudate)
2. What is the most likely diagnosis?
Lobar pneumonia (grey hepatisation phase)
3. Name the important complications
• abscess formation due to tissue destruction and necrosis;
• empyema spread of infection to the pleural cavity;
• bacteremic dissemination

QUIZ 3 (Pulmonary Tuberculosis)

1. Give a brief description of gross and microscopic appearance of

the organ removed
Gross: Whole of Upper lobe of the lung (below the apical region)
shows patchy consolidation with a few small cavitary lesions;
Microscopic: Section shows lung with two well defined epithelioid
granulomas with giant cells;
2. What is the most likely diagnosis? And how will you confirm it?
Progressive Pulmonary Tuberculosis; Confirmed by the
demonstration of Acid fast bacilli in Sputum (in living person) or in
tissues with culture; PCR amplification of M. tuberculosis DNA allow
rapid diagnosis.
3. Name the immunological basis of this condition
Immunological basis of this disease is cell mediated immunity
/hypersensitivity (type 4 hypersensitivity) mediated by TH 1 cells.
QUIZ 4 (Acute Lymphoblastic Leukaemia - ALL)

1. Describe the cells in peripheral blood.

Large, uniform cells with scanty agranular cytoplasm, large nucleus
having coarse chromatin and one to two nucleoli
2. What special stain is useful in identifying the cell?
Periodic acid – Schiff stain (PAS stain) is useful in identifying
lymphoblast
3. What is the most likely diagnosis?
Acute Lymphoblastic Leukaemia (ALL)
4. Name two cytogenetic abnormalities associated with this condition
• Hyperdiploidy (>50 chromosomes) is the most common
• Balanced T(12;21) or t(9;22)

QUIZ 5 (Acute Proliferative Glomerulonephritis)

1. What is the likely diagnosis?

Acute Proliferative (Poststreptococcal, Postinfectious)
Glomerulonephritis
2. What is the immunological basis of this condition?
It is an immune complex mediated disease. Its immune complex
nature is supported by:
• Elevated titers of antibodies against one or more
streptococcal antigens [?pyogenic exotoxin B (SpeB) and its
zymogen precursor (zSpeB)] are present in a great majority of
patients
• Low serum complement levels are compatible with activation
of the complement & its consumption
• granular immune deposits in the glomeruli (IF),
3. What do you find on microscopic examination of urine?
Dysmorphic red blood cells and RBC casts are characteristically
seen

QUIZ 6 (Peptic Ulcer Disease with duodenal ulcer)

1. What is the most likely diagnosis?

The most likely diagnosis in this case is Peptic Ulcer Disease with
Duodenal ulcer
2. Name the organism associated with this condition
85 to 100% of cases with duodenal ulcer are associated with
Helicobacter Pylori infection
3. Name two important complications
In addition to intractable pain, frank bleeding from the ulcer and
perforation are important complications
QUIZ 7 (Hodgkin Lymphoma)

1. Describe the gross appearance of the excised specimen.

An enlarged lymph node with fairly uniform grey-tan cut surface
(fish flesh like appearance)
2. How do you classify this condition?
1. Classical subtypes
a. Nodular sclerosis
b. Mixed cellularity
c. Lymphocyte-rich
d. Lymphocyte depletion
2. Lymphocyte predominance
3. What immunological markers will be useful in this condition?
CD 15, CD 30 (For classical types) and CD 20 for lymphocytic
predominance

QUIZ 8 (Small Cell Carcinoma of the Lung)

1. What is the most likely diagnosis?

Small Cell Carcinoma of the Lung
2. What additional clinical history would provide a clue regarding the
possible cause this condition?
History of Smoking; 99% of Small cell carcinomas occur in smokers
3. How do you explain the clinical manifestations?
It is due to paraneoplastic syndrome. Small cell carcinomas are
known to be associated with Cushing’s syndrome due to excessive
production of ACTH like substance; 1% to 10% of all Lung
carcinomas can be associated with several paraneoplastic
syndromes;

QUIZ 9 (Malaria)

1. Describe the peripheral smear

Many of the RBCs contain one to two ring and accole forms of
hemoparasite plasmodium falciparum
2. What is likely cause of patient’s intermittent fever?
Malaria, caused by the intracellular parasite Plasmodium
3. What are the different types?
Plasmodium vivax (benign tertian fever)
P. ovale,
P. malariae (benign quartan fever)
P. falciparum (malignant tertian fever)
QUIZ 10 (Renal Cell Carcinoma - Adenocarcinoma of the Kidney)

1. Describe characteristic gross and microscopic features of this

condition
Gross: usually sharply defined spherical masses of variable size
commonly affecting the poles, composed of bright yellow-gray-
white tissue with foci of hemorrhagic discoloration
Micro: Composed of round or polygonal cells with abundant clear
or granular cytoplasm arranged in solid or trabecular or tubular
pattern
2. What is the most likely diagnosis?
Renal Cell Carcinoma (Adenocarcinoma of the Kidney)
3. Name the risk factors
Smoking, obesity, exposure to asbestos, tuberous sclerosis,
hypertension etc

QUIZ 11 (Squamous cell carcinoma cervix)

1. Describe the morphological feature useful in making the diagnosis?

Nests and tongues of malignant squamous epithelium forming
keratin or epithelial pearls and invading the underlying stroma
2. What organism is implicated in its causation?
Human Papilloma Virus, predominantly subtypes 16 (60% of cases)
and 18 (10 % of cases). There are 15 high oncogenic risk HPVs that
are currently identified.
3. Classify its precursor lesion.
Precursor lesions are
a. Low grade squamous intraepithelial lesion (LSIL or CIN I)
b. High grade squamous intraepithelial lesion (HSIL or CIN II/III)

QUIZ 12 (Schwannoma or neurilemmoma)

1. What microscopic feature is useful in making the diagnosis?

The “nuclear-free zones” termed Verocay bodies that lie between
the regions of nuclear palisading
2. What is the likely diagnosis?
Schwannoma or neurilemmoma
3. What is the nature of this lesion and why?
This lesion is a benign tumour of the Schwann cells. They are well-
circumscribed, encapsulated masses that are attached to the
nerve but can be separated and excised. They do not show any
features of malignancy and malignant change is extremely rare.

QUIZ 13 (Barrett Oesophagus)

1. What is the most likely diagnosis?
Barrett Oesophagus
2. Describe the pathogenetic mechanism
Barrett esophagus is a complication of chronic gastro-oesophageal
reflux disease (GERD). It is characterized by intestinal metaplasia
within the esophageal squamous mucosa. It is an example of
adaptational response of squamous mucosa to the continued
presence of highly acidic reflux fluid.
3. What is the long-term complication of this process?
The long-term complication in Barrett esophagus is that it confers an
increased risk of oesophageal adenocarcinoma.

QUIZ 14 (Crohn disease)

1. Describe the characteristic gross and microscopic features.

Gross: sharply delineated segmental involvement (skip lesions),
cobblestone appearance of the mucosa, stricture and fissures
Micro: Crypt abscess, deep ulcers, pyloric and paneth cell
metaplasia (colon), non-caseating granulomas, distortion of
mucosal architecture
2. What is the most likely diagnosis?
Crohn Disease (inflammatory Bowel Disease – IBD)
3. What are the common complications of this disease?
Iron deficiency anaemia, malabsorption, Stricture, perforation,
fistulae and adenocarcinoma

QUIZ 15 (Amyloidosis)

1. What is the nature of this material?

Amyloid
2. Name the main precursor substances
Immunoglobulin light chain (AL), Serum amyloid associated protein
(SAA), beta-2 microglobulin, transthyretin and Beta amyloid
3. How do you classify this condition?
a. Systemic (generalized) amyloidosis
i. Immunocyte dyscrasias with amyloidosis (primary
amyloidosis)
ii. Reactive systemic amyloidosis (secondary amyloidosis)
b. Hereditary amyloidosis
c. Systemic senile amyloidosis
d. Localized amyloidosis

QUIZ 16 (Benign cystic Teratoma)

1. What is the likely diagnosis?
Benign cystic Teratoma (Dermoid cyst of the ovary)
2. What is the nature of this lesion and how do you define it?
It is a benign tumour arising from totipotential germ cells capable of
expressing tissues derived from more than one or all the three germ
layers. In benign cystic Teratoma, ectodermal derivatives such as
skin, hair, sebaceous glands are predominantly expressed often with
cartilage, bone, neural tissue etc
3. Mention other sites where similar lesions occur.
Commonest sites of Teratoma are Ovary and testis. Other sites are
sacrococcygeal region, pineal body, mediastinum and
retroperitoneal region.

QUIZ 17 (Seminoma)

1. Describe the characteristic microscopic appearance?

The cells are large, round to polyhedral in shape with a distinct cell
membrane, a clear cytoplasm and a large, central nucleus with
one or two prominent nucleoli; the cells are divided into vague
lobules by delicate septa infiltrated by sparse lymphocytic
infiltration
2. What is the likely diagnosis?
Seminoma
3. Mention which markers will be useful in this condition.
Seminoma cells are diffusely positive for c-KIT, OCT4, and placental
alkaline phosphatase (PLAP)

QUIZ 18 (Fibrocystic change breast))

1. What is the likely diagnosis?

Fibrocystic changes
2. What is the nature of this lesion?
It consists of a group of non-proliferative benign morphological
changes induced by cyclical hormonal changes
3. Describe the principal morphologic changes
There are three principal morphologic changes:
(1) Cystic change, often with apocrine metaplasia;
(2) Fibrosis; and
(3) Adenosis.

QUIZ 19 (Rheumatic heart disease)

1. What is the likely diagnosis?

 Rheumatic heart disease
2. What is underlying mechanism for these findings?
Acute rheumatic fever is an immunological disease. Antibodies
directed against the M proteins of group A streptococci and CD4+
T cells specific for streptococcal peptides have been shown to
cross-react with self-antigens in the heart. Damage to heart may be
the result of both antibody- and T cell–mediated reactions
3. Describe the microscopic lesion found in this case
Distinctive lesions in the heart are Aschoff bodies, which consist of
plump activated macrophages called Anitschkow cells
(“caterpillar cells”) along with foci of lymphocytes (primarily T cells).
The macrophages may become multinucleated.

QUIZ 20 (Invasive ductal carcinoma)

1. What is the likely diagnosis?

Invasive Ductal Carcinoma NOS
2. What additional investigations are indicated?
Demonstration of Estrogen receptor (ER), Progesterone receptor
(PR) and HER2/neu
3. And why?
Useful in predicting the outcome and response to therapy:
a. ER positive & HER2 negative tumours have good prognosis &
respond to hormonal therapy
b. Triple negative (ER,PR, HER2) tumours are generally aggressive
c. HER2 positive tumour have poor prognosis but respond to
Herceptin therapy

QUIZ 21 (Iron deficiency anaemia)

1. Describe the peripheral smear

Microcytic (low MCV; RBC smaller than lymphocyte nucleus)
hypochromic RBCs with anisocytosis (high RDW), with many
elliptocytes and leptocytes
2. What additional investigations are required to make the diagnosis?
Investigations include Serum iron, transferrin saturation percent,
serum ferritin, serum hepcidin, bone marrow iron (all are reduced),
and iron binding capacity (increased)
3. What is the likely diagnosis?
Iron deficiency anaemia

QUIZ 22 (Acute myeloid leukaemia)

1. Describe the peripheral smear

 Smear shows predominantly normocytic normochromic RBCs with
minimal anisocytosis. There are three blasts having large nucleus
with finely dispersed chromatin and 1 to 2 nucleoli. One of the blasts
contains a needle shaped azurophilic inclusion in its pale blue
cytoplasm (Auer rod). Platelets appear reduced.
2. What additional investigations are indicated?
Bone marrow examination, cytochemistry (peroxidase, PAS and
esterase) and cytogenetic studies
3. What is the likely diagnosis?
Acute myeloid leukaemia M2

QUIZ 23 (Hereditary Spherocytosis)

1. Describe the peripheral smear

Smear shows predominantly normocytic normochromic RBCs with
anisocytosis, many spherocytes and polychromatophilic cells. Total
count and platelet count appears to be normal from the CBC
2. What additional investigations are indicated?
Serum bilirubin, reticulocyte count and osmotic fragility; The first two
test provide evidence for haemolysis while increased osmotic
fragility is diagnostic
3. What is the likely diagnosis?
Hereditary spherocytosis

QUIZ 24 (Megaloblastic anaemia)

1. Describe the smear

Marrow smear shows several intermediate and late megaloblasts,
one giant stab cell and a couple of macropolycytes. Late
megaloblasts show several Howell-Jolly bodies within their
cytoplasm
2. What additional investigations are indicated?
Serum B12 level, Schilling test for B12 absorption, test for
methylmalonic aciduria and test for autoantibodies.
3. What is the likely diagnosis?
Megaloblastic anaemia possibly due to vitamin B12 deficiency

QUIZ 25 (Chronic myeloid leukaemia)

1. Describe the smear

 Smear shows normocytic normochromic RBCs. There is leukocytosis
with shift to the left. There are a few myelocytes, metamyelocytes
and stab cells. Basophils are increased. Platelets are high normal
2. What additional investigations are indicated and why?
Leucocyte alkaline phosphatase score to differentiate it from
leukemoid reaction, cytogenetic studies to demonstrate t (9; 22),
and bone marrow examination to rule out accelerated phase
3. What is the likely diagnosis?
Chronic myeloid leukaemia

QUIZ 26 (Myeloma)

1. What are the principal findings in peripheral & bone marrow

smears?
Peripheral smear shows rouleaux formation of RBCs; Bone marrow
shows increased plasma cells which appear immature and often
binucleated.
2. What is the likely diagnosis?
Myeloma
3. What are the diagnostic criteria for this condition?
a. Presence of an M-component in serum and/or urine; plus
b. Clonal plasma cells in the bone marrow and/or a documented
clonal plasmacytoma; plus
c. One or more related organ or tissue impairment (ROTI):
• (CRAB)Calcium elevation; Renal insufficiency; Anaemia;
Bone disease

QUIZ 27 (Chronic lymphocytic leukaemia)

1. Describe morphologic abnormality in the smear

Smear shows normocytic normochromic RBCs. There is
lymphocytosis with a few smudge (smear) cells. The lymphocytes
resemble normal small lymphocytes. Platelets are adequate
2. What is the likely diagnosis?
Chronic lymphocytic leukaemia
3. How do you stage this condition?
Binet staging: Stage A: no anemia, no thrombo-cytopenia, fewer
than 3 lymphoid areas enlarged
Stage B: no anemia, no thrombo-cytopenia, 4 or more lymphoid
areas enlarged
Stage C: anemia (HGB < 10 g/dl) or platelet count <100 x 109 /L
QUIZ 28 (Fibroadenoma)

1. What is fine needle aspiration cytology and why is it a useful test?

 FNAC is a diagnostic procedure in which a thin, hollow needle is
inserted into superficial lumps or masses to extract cells for
microscopic examination after appropriate staining. FNAC is very
safe and less traumatic procedure than biopsy. It provides enough
information in many clinical situations to make biopsy unnecessary.
2. What is the likely diagnosis?
Fibroadenoma
3. What cytological features are helpful in making the diagnosis in this
case?
Compact, cohesive clusters of bland ductal cells along with stromal
bipolar bare nuclei are diagnostic of benign breast disease

QUIZ 29 (Papillary carcinoma thyroid)

1. What is the likely diagnosis?

Papillary carcinoma of thyroid
2. What cytological features are helpful in making the diagnosis in this
case?
Cytological features include intra-nuclear cytoplasmic pseudo-
Inclusions (pseudo-nucleoli), nuclear grooving, optically clear nuclei
(orphan Anne eye-like appearance), and papillary structures
3. What is the prognosis?
Papillary thyroid cancers have an excellent prognosis, with a 10-
year survival rate in excess of 95%. Between 5% and 20% of patients
have local or regional recurrences, and 10% to 15% have distant
metastases.

QUIZ 30 (Squamous cell carcinoma – PAP)

1. What is the likely diagnosis?

Squamous cell carcinoma
2. What cytological features are helpful in making the diagnosis in this
case?
Pleomorphic caudate or tadpole-shaped cells and “fiber” cells;
Nuclei are hyperchromatic, opaque, or pyknotic with coarse
irregular chromatin and parachromatin clearing; Nucleoli are
variable; dense orangeophilic cytoplasm with distinct cell borders;
Tumor diathesis and inflammation is generally present.
3. Name any 3 predisposing factors
a. Multiple sexual partners; b. persistent high-risk HPV infection; c.
high parity
QUIZ 31 (LSIL)

1. What is the likely diagnosis?

Low grade squamous intraepithelial neoplasia (LSIL) with HPV effect
2. What cytological features are helpful in making the diagnosis in this
case?
Singly dispersed or groups of cells with abundant cytoplasm and a
dense perinuclear clearing or halo (koilocytosis); Nucleus is at least 2
to 3 times the size of an intermediate cell nucleus, hyperchromatic
with irregularly granular chromatin and irregular nuclear contours;
Usually no conspicuous nucleoli
3. What are the possible clinical outcomes of this lesion?
Spontaneous regression is seen in approx 57% of cases; progression
to CIN 2, 3 in 11% of cases; carcinoma may develop in 0.3%;

QUIZ 32 (ASC-US)

1. What is the likely diagnosis?

ASC - US
2. What cytological features are helpful in making the diagnosis in this
case?
Superficial and intermediate squamous cells with enlarged round
slightly hyperchromatic nuclei (2 to 3 times the size of an
intermediate cell nucleus) with smooth contour; Cytoplasm may
show a vague cytoplasmic cavitation; slight increase in N: C ratio
3. What follow up procedures/investigations are recommended?
Subsequent high-grade squamous intra-epithelial lesions (HSIL) are
found in 5–17% of cases; Management strategies include repeat
Pap test, human papillomavirus (HPV) test, and direct colposcopy.

QUIZ 33 (HSIL)

1. What is the likely diagnosis?

High grade squamous intra-epithelial lesion (HSIL)
2. What cytological features are helpful in making the diagnosis in this
case?
Cells appear singly, in sheets, or in syncytial fragments; with high N:
C ratios; Cells resemble parabasal or basal cells; Nuclei are three
times the size of intermediate cell nuclei, hyperchromatic with
irregular granular chromatin and prominent nuclear convolutions;
Cytoplasm is “immature,” dense or lacy, and delicate;
Inconspicuous nucleoli
3. What follow up procedures/investigations are recommended?
Colposcopic examination, biopsy, HPV DNA analysis
QUIZ 34 (Osteosarcoma)

1. What is the likely diagnosis?

Osteosarcoma
2. Describe the characteristic morphological features of this lesion?
 Grossly, big bulky tumors that is gritty, gray-white, with areas of
hemorrhage and cystic change. The tumor destroys the surrounding
cortices and produce soft-tissue masses.
Micro: The tumor cells vary in size and shape and have large
hyperchromatic nuclei. Bizarre tumor giant cells and mitoses are
common. Characteristically, the tumor cells produce bone/osteoid
3. List the most common sites of its occurrence?
50% of tumours occur around knee joint; 15% in the region of hip
joint; 10% in shoulder region and 8% in head & neck region.

QUIZ 35 (Cirrhosis of the Liver)

1. What is the likely diagnosis?

Cirrhosis of the liver
2. What are the causative factors?
The most common causes are alcoholic liver disease & hepatitis C.
Others include hepatitis B, autoimmune processes (autoimmune
hepatitis, primary sclerosing cholangitis, Primary biliary cirrhosis),
biliary obstruction, Wilsons’s disease, haemochromatosis, non-
alcoholic steatohepatitis etc
3. Describe the characteristic morphological features of this lesion? List
the important complications?
Morphological features are a. bridging fibrosis, b. regenerating
parenchymal nodules and c. loss of architecture.
Complications include progressive liver failure, portal hypertension
and hepatocellular carcinoma

QUIZ 36 (Aplastic Anaemia)

1. What is the likely diagnosis?

Aplastic Anaemia
2. Name the major causes of this condition
In 65% of cases it is idiopathic; other causes include chemicals (e.g.
benzene), drugs (e.g. chloramphenicol), radiation, viral infections
(e.g. hepatitis virus, CMV) or inherited causes (Fanconi’s anaemia)
3. What is the pathogenesis?
Two major mechanisms have been invoked: an extrinsic, immune-
mediated suppression of marrow progenitors; and an intrinsic
abnormality of stem cells
QUIZ 37 (Malignant Melanoma)

1. What is the likely diagnosis? And why?

 Malignant Melanoma; It is pigmented lesion exhibiting cytological
features of malignancy. Besides, clinical history (recent
enlargement, itching, family history) are strongly suggestive
2. What are the predisposing factors?
The two most important predisposing factors are inherited genes
and sun exposure. It is estimated that 10% to 15% of melanomas are
familial, and many (but not all) of these also have dysplastic nevi.
3. List the important prognostic factors
(1) tumor depth; (2) number of mitoses; (3) evidence of tumor
regression; (4) the presence and number of tumor infiltrating
lymphocytes (TILs); (5) gender; and (6) location

QUIZ 38 (Diabetic nephropathy)

1. What is the likely diagnosis?

Diabetic Nephropathy (nodular glomerulosclerosis, KW lesion)
2. What are the biochemical change in blood & urine?
Most likely findings include, hyperglycemia, hypoalbuminaemia,
hyperlipidaemia, massive proteinuria and glycosuria
3. What is the underlying mechanism of this lesion?
Excessive formation of Advanced Glycosylation End products (AGE)
and activation of Protein kinase C lead to diabetic micro-
angiopathy. In capillaries, including those of renal glomeruli, plasma
proteins such as albumin bind to the glycated basement
membrane, accounting in part for the basement membrane
thickening that is characteristic of diabetic nephropathy.

QUIZ 39 (positive for malignant cells – ascitic fluid)

1. What is the likely interpretation?

Positive for malignant cells from an adenocarcinoma
2. What is the significance of SAAG?
The difference between the serum and ascites albumin
concentration (albumin gradient or SAAG) is thought to directly
reflect the colloid osmotic pressure gradient and, indirectly, the
degree of portal hypertension. Patients with gradients of >1.1 g/dL
have portal hypertension while patients with gradients of <1.1 g/dL
do not. The accuracy of such determinations is 97%.6
3. What additional investigations are recommended?
All investigations necessary to establish the nature of primary lesion -
CT scan, endoscopy, ultrasound and MRI; IHC on the smear
QUIZ 40 (tubular adenoma)

1. What is the nature of this lesion?

Pedunculated tubular adenoma - colon
2. Name the syndromes which could predispose this individual to
colonic cancer?
Some of the syndromes which predispose to colonic cancer include
Familial adenomatous polyposis (FAP), Gardner syndrome, Turcot
syndrome, hereditary non-polyposis colorectal cancer (HNPCC)
syndrome (Lynch syndrome)
3. What genes are likely to play a role?
FAP and related conditions are associated with mutations in
Adenomatous Polyposis Coli (APC) gene; HNPCC is caused by
inherited mutations in genes that encode proteins responsible for
the detection, excision, and repair of errors that occur during DNA
replication (mismatch repair genes)
ANSWERS
Chart 41-EOSINOPHILIA
1. What is the prominent cell type seen in the smear and likely diagnosis?
Describe the morphology.(2m)
a. The prominent cell type seen in the smear are Eosinophils and
diagnosis is eosinophilia.
b. Morphology of an eosinophil:9-15 microns, with coarsely granular
cytoplasm containing prominent primary purple granules and
secondary red orange, Bilobed nucleus, moderately condensed
chromatin and indistinct nucleolus.
2. What are the causes for this abnormality?(2m)
Allergic drug reactions, parasitic infestations, extrinsic asthma, hay
fever, extrinsic allergic alveolitis, haematological malignancies like
CML, Hodgkins disease, eosinophilic leukemia.
3. Name one microorganism associated with this abnormality.(1m)
Parasites can lead to eosinophilia- Filaria/Toxocariasis/Ascaris
lumbricoides/Strongyloides

CHART 42 - SPLENOMEGALY WITH GAUCHER’S CELL

1. Comment on CBC (1m)-CBC shows pancytopenia

2. Identify the cell(1m)-Gaucher’s cell
3. Final complete diagnosis-Storage disorder(1.5m) – Gaucher’s disease
4. Causes of massive splenomegaly (1.5m)– Hairy cell leukemia,
Leishmaniasis, Myeloproliferative diseases, Malaria,

CHART- 43-NEUTROPHILIA
1. The CBC shows increase in WBC count with Neutrophilic leukocytosis.The
other parameters are within normal range.(2m)
2. The cells identified are NEUTROPHILS having multilobated nucleus(3-5
lobes) with cytoplasm showing coarse purplish toxic granules.(1.5m)
3. Acute bacterial infections, acute liver failure, neutrophilic leukaemoid
reactions (1.5m)
CHART 44-LEIOMYOMA UTERUS
1. Leiomyoma(0.5m)
2. Benign tumor(0.5)
3. Gross : Well circumscribed, homogenous, grey white, whorling appearance
noted.
Microscopy : Interlacing fascicles of smooth muscle cells seen with areas of
hyalinization.(2m)
4. Benign smooth muscle tumor. Sub mucosal (arising from
endometrium),Intra-mural(arising from myometrium), Subserosal (arising
from the serosal aspect).(2m)
CHART 45-LIVER METASTASIS
1. Gross : Multiple Grey white well circumscribed nodular lesions noted.
Microscopy : Liver parenchyma shows few atypical cells with basophilic
cytoplasm and large, hyperchromatic nuclei with increased nuclear
cytoplasmic ratio.(2m)
2. Metastatic deposits in the liver.(0.5m)
3. Malignant lesion.(0.5)
4. Hematogenous, lymphatic, direct spread.(1.5m)
5. Sentinal lymph node is the first node into which the tumor drains.(0.5m)

CHART 46 -PLEOMORPHIC ADENOMA

1. Clinical diagnosis - pleomorphic adenoma(0.5m)

2. Morphology (2m)
a. Gross – encapsulated well demarcated rounded tumour. Cut surface is
grey white with myxoid and chondroid areas
b. Microscopy – Have epithelial component forming ducts and irregular
strands and Mesenchymal element, chondromyxoid stroma (stroma
resembling cartilage)
3. Nature is benign(0.5m)
4. Investigations – Ultrasonography, FNAC(1m)
5. Complications – Can become malignant, carcinoma ex pleomorphic
adenoma. Recurrence in case of incomplete excision, facial nerve
compression(1m)
 CHART-47-COAGULATIVE NECROSIS
A. Coagulative Necrosis. The necrotic cells in the myocardium appear eosinophilic
and anucleate with preserved architecture surrounded by Inflammatory
infiltrate.(1.5m)
B. CAUSE-Ischemia/Loss of blood supply.(0.5m)
C. Heart, Renal.(1+2m)
TYPES OF NECROSIS- Caseous necrosis – eg. Tuberculosis, Fat necrosis – eg.
Acute pancreatitis, Liquifactive necrosis eg.brain

CHART- 48
1. LIQUIFACTIVE NECROSIS
Grossly, the affected area in brain is soft with liquefied centre containing
necrotic debris and cyst. Microscopically, the cystic space contains necrotic
cell debris and macrophages filled with phagocytosed material. (3m)
2. Any 2 necrosis- Coagulative necrosis – eg. Myocardial infarction, renal
infarction, Caseous necrosis – eg. Tuberculosis, Fat necrosis – eg. Acute
pancreatitis, traumatic fat necrosis of breast(2m)

CHART-49-IMMUNE THROMBOCYTOPENIC PURPURA

1. ITP(1m)
2. Bone marrow biopsy shows increase in number of Megakaryocytes(1m)
3. Etiology-ACUTE-most often in children after viral infection
Chronic-primary or preexisting conditions (lupus, HIV/B cell
neoplasm)(2m)
4.Platelet autoantibodies to platelet membrane glycoprotein complexes IIb-
IIIa or Ib-IX.(1m)
CHART 50-VON WILLEBRAND DISEASE
1. Hemoglobin reduced, low hematocrit, normal platelet count , normal
PT with prolonged APTT reduced.
The ritocetin dependent platelet aggregation is reduced which is the
plasma level of active VWF (1m)
2. Von willebrand disease(1m)
3. Type 1 and Type 2- Autosomal dominant disorder ; type 3- Autosomal
recessive disorder .(1.5m)
4. Von willebrand factor stabilizes factor VIII. because of deficiency of
VWF , there occurs a secondary decrease in factor VIII levels and causes
bleeding.(1.5m)
CHART 51-DOWN SYNDROME
1. Karyotyping shows Trisomy 21.
Clinical features: Stunded growth, Mental retardation, Webbed neck, Low set
ears, Single transverse palmar crease (2m)
2. Down syndrome (1m)
3.Cardiac complications (2m): Atrial septal defect, Ventricular septal defect,
Patent ductus arteriosis, Tetrology of fallot
Heamatological complications:
Polycythemia, macrocytosis, thrombocytopenia, leucopenia, leukemoid reaction
Transient Acute myeloid leukemia (AML)
CHART 52 - TORTION TESTIS
1. Morphology(2m)
a. GROSS FEATURES- enlarged and congested testis, with
hemorrhage,with or without necrosis. Twisting of the spermatic cord
b. MICROSCOPIC FEATURES – Prolonged torsion causes ischemic
changes and necrosis of the testes and epidydimis. The vessels
become dilated and engorged with blood
2. Diagnosis-Torsion testis (1m)
 3. Mechanism-Torsion of testis causes causes sudden cessation of venous
drainage and arterial supply to the testis usually following sudden muscular
effort / physical trauma .(2m)
CHART 53 - FATTY CHANGE LIVER
1. Morphology (1m)
a. GROSS : The liver in fatty change is grossly enlarged with atense,
glistening capsule and rounded margins .The cut surface is yellow and
greasy to touch.
b. MICROSCOPY : Presence of numerous lipid vacuoles in the
cytoplasm of hepatocytes.
2. 2 causes (1m): obesity ,congenital hyperlipidemia, alcoholic liver disease,
Starvation ,Acute fatty liver in late pregnancy, chronic illnesses
3. Mechanism (1m)
In fatty liver, intracellular accumulation of triglycerides occurs due to defect
in the normal fat metabolism
4. Special stains : sudan black , oil red O(1m)
5. 4 endogenous substances that get accumulated in the body (1m): fat, proteins
, glycogen,
Accumulation of abnormal substances -eg: in storage diseases, accumulation
of pigments eg : melanin ,lipofuscin, hemosiderin

CHART 54-TURNER SYNDROME

1. Chromosomal abnormality- This is a 45,X karyotype, consistent with Turner

syndrome(monosomy X) (1m)
2. Anomalies may include cystic hygroma (abnormal ectatic lymphatics in the
posterior neck)Aortic coarctation and "streak ovaries"(ovaries become
severely atrophic and fibrous) (1.5m)
3. Clinical features in survivors- Short stature, lymphedema of neck &
extremities, broad chest, widely spaced nipples,
Primary amenorrhea, failure of development of secondary sexual characters.
(1.5m)
4. Short stature comes from loss of both copies of the short stature homeobox
gene(SHOX) on the X chromosome which affects height. (1m)
CHART 55 - DIRECT COOMBS TEST
1. Direct coombs test(1m)

2. Red cells of the patient are washed with normal saline (to remove unbound
antibodies) and antihuman globulin reagent is added. Agglutination of red
cells indicates positive test. This test indicates antibodies or complement or
both attached to red cell(2m)

3. 1.For diagnosis of Hemolytic disease of newborn

2.For diagnosis of autoimmune hemolytic anemia

3.For investigation of hemolytic transfusion reactions

4. Investigation of drug induced red cell sensitization (2m)

CHART 56 - INDIRECT COOMBS TEST

1. Identify the test-Indirect coombs test(1m)
2. Principle- Patient’s serum is incubated with red cells (donor/screening) to
allow binding of antibodies in the serum to red cell antigens. After washing
of red cells in saline antihuman globulin is added, agglutination indicates
positive test. This test detects antibodies in serum directed against red cell
antigens. (2m)
3. Indications (2m)
a. To detect anti Rh antibodies in Rh negative mothers
b. Compatibility testing
c. Screening and identification of unexpected antibodies in serum
CHART 57- SICKLE CELL ANEMIA
1. Identify the RBC abnormality(1m)
The peripheral smear shows sickle cells
2. Give your diagnosis based on both figures(1m)
Sickle cell anaemia
3. Name the tests to Diagnose the disease(2m)
Sicking test,Hb electrophoresis and High performance liquid
chromatography (HPLC)
4. Name two crisis in the disease(2m)
a. Aplastic crisis
b. Acute sequestration
c. Vaso-occlusive
d. Hyper- hemolyic
CHART-58-FRESH FROZEN PLASMA
1. Give any TWO Indications of transfusion of FFP - Multiple coagulation factor
deficiency, Liver disease, DIC, Warfarin overdosage, TTP (1m)
2. Preparation of FFP -The plasma is seperated from whole blood by centrifugation
and rapidly frozen at-25 degree or lower temperature (1m)
3. shelflife of FFP - 1 year when stored below-25 degree Celsius (1m)
4. Composition of cryoprecipitate -Factor VIII, Von Willebrand factor, Fibrinogen,
Factor XIII (2m)
CHART-59- GEL CARD TEST
1. Gel card(1m)
2. USES-Forward & Reverse blood grouping(1m)
3. Three blood group system-ABO, MNS, Duffy, P , Lewis, Kidd, Kell.(1.5)
4. Any 3 methods of blood grouping-Slide method, tube, gelcard, microplate(1.5)
CHART 60-TRIPLE BLOOD BAG
1. Triple blood bag. It is used to separate whole blood into three components of
red blood cells ,platelets, plasma through centrifugation and extraction(2m)
2. Any 2 anticoagulants- CPD, CPDA, SAGM(1m)
3. Any two Infections transmitted-HIV, Hepatitis B, C, Syphilis, Malaria(1m)
4.Any 2 components separated from whole blood- Packed cell, Platelet, FFP,
cryoprecipitate(1m)

CHART 61- HEMOLYTIC TRANSFUSION REACTION

1. Diagnosis- Acute Hemolytic transfusion reaction(1m)
2. Cause (2m)
Transfusion of incompatible blood due to incorrect labelling of blood bag
or incorrect identification of patient or because of errors in blood
grouping or cross matching.
3. Preventive measures- Avoid clerical error by proper labelling of blood
sample and blood bag and proper identification of patient. Compatibility
testing especially grouping and cross matching should be performed.(2m)

CHART 62-PLATELET BAG

1. Two indications-Bleeding due to decreased platelet production, bleeding due to
functional abnormalities of platelet(2m).
2 .Shelf life of platelets- 5 days(1m)
3. Stored at 20-24degree celsius with continuous agitation(1m)
4.5000/µl(1m)
CHART-63-PACKED RED CELLS
1. Two indications-Severe Anaemia, Acute massive blood loss (1m)
2. Preparation-Packed red blood cell is prepared by centrifugation or by
sedimenting overnight at 2-6 degree Celsius(2m)
3. Storage-2-6 degree celsius and 35 days in CPDA(1m)
4. Hb by 1 gm and hematocrit by 3%(1m)
CHART 64-ANTISERA
1. Antisera used for ABO blood grouping(1M)
2. Forward (cell) and Reverse (serum) blood grouping(1m)
3. Bombay blood group individuals have anti H antibody as they lack H
antigen(1.5)
4. Landstieners law- If the individuals possess the antigen in the red cells the
corresponding antibody will be absent in the serum(1.5)