Clinical Case- based Questions

Dr. S. Karthik. MD.,

Professor Pathology
General pathology & Hematology
 Feb-2009
• 40 years male H/o chronic fatigue, weight loss since 6
months. O/E pallor, marked splenomegaly+, laboratory
report shows Hb 10 g%, TC 215000/cu.mm. Platelets 4
lakhs/cu.mm.

Answer the following:

a) What is your diagnosis?
b) What is common genetic abnormality?
c) Blood and Bone Marrow findings to confirm your
diagnosis?
d) Prognosis of the condition?
 August-2011
• 40 yrs female c/o loss of weight, huge
splenomegaly with peripheral blood white blood
cell count of more than 1 lakh /cu.mm.

a. What is the probable diagnosis?

b. What are the characteristic peripheral smear
findings?
c. What is the course of the disease?
d. What is the chromosomal abnormality involved?
 March 2022
• 40 years male with splenomegaly on
investigations had total count of 1,20,000
cells/ mm3 and peripheral smear showed
predominance of myeloid precursors.
• What is your diagnosis?
• Draw diagram of peripheral smear?
• What is the common genetic event in this
condition?
 July 2023
• 30/Male presented with massive
splenomegaly. His total count was 2,35,000
cells per mm3 with preponderance of
Neutrophilic precursors. Platelet count was
1,80,000 cells per mm3 .
• a) What is your diagnosis?
• b) What is the molecular basis of this disease?
c) Write about the morphological features in
this condition. Classify myeloproliferative
neoplasms
CHRONIC MYELOID LEUKEMIA
 Feb-2011
• A 70 year old women admitted with worsening anemia
and pathological fracture of the Humerus had an ESR of
120mm in 1 hour. Her peripheral smear showed
increased rouleaux formation. X-ray of skull showed
multiple punched out osteolytic lesions.

a. What is the most probable diagnosis? Write briefly on

the etiopathogenesis of this disease.
b. Describe the Bone Marrow Changes in this disease.
c. Enumerate the common laboratory investigations for
this disease.
d. Enlist the complications of this disease.
 Feb-2012
• 60 yrs male presented with normocytic
normochromic anaemia, pathological fracture
femur and proteinura. X ray skull revealed
punched out lesions in the calvarium and
peripheral smear studied show rouleaux
formation.

a) What is your probable diagnosis?

b) Discuss in detail the molecular pathogenesis,
morphology and clinical features of above said
disorder.
 March 2022
• 60 years male presented with low back ache.
He had multiple lytic lesions of bones on
skeletal survey. Serum electrophoresis and
bone narrow was done to establish diagnosis.
• What is your diagnosis?
• What are the findings in bone narrow and
electrophoresis?
MULTIPLE MYELOMA
 August-2013
a) 23 yrs female presented with oral ulcers,
malar rash, photosentivity and non-erosive
arthritis involving both knees. Laboratory
investigations show persistent proteinuria and
leucopenia. What is your probable diagnosis?

b) Discuss in detail the pathogenesis and

morphology of kidney affected by the above
disorder
 July 2023
• 25 years female presented with malar rash on
the face, fever, painful joints of fingers.
• a) What is your diagnosis?
• b) Write about the pathogenesis and diagnosis
of the disease.
SYSTEMIC LUPUS ERYTHEMATOSUS
 Feb-2014
• 40 yr old male presented with h/o fever,
vomiting and diarrhoea. Patient had
temperature of 103 F. Weak rapid pulse,
hypotension, tachypnoea, cold, clammy,
cyanotic skin. Blood culture gram negative
bacterial infection positive.

(a) What is your diagnosis?

(b) Explain the pathogenesis and morphology.
 February 2023
• 35years old male presented with rapid pulse,
cold clammy skin, tachypnoea with
hypotension admitted in emergency ward.
History of fever for more than 1 week with
increased total WBC Count.
• a) What is your diagnosis?
• b) Write in detail about the pathogenesis,
morphology and how will you evaluate this
condition?
SEPTIC SHOCK
 March 2022
• 25 years male RTA victim presented with rapid
pulse, cold clammy cyanotic skin, tachypnea
and landed in emergency ward in unconscious
state.
• What is the diagnosis?
• Classify the disease write in detail about the
pathogenesis, morphology evolution of the
disease.
SHOCK
 August 2022
• 30 years female immediately after delivery
went into sudden circulatory failure. She had
profuse bleeding per vaginum and from
venepuncture sites.
• What is your diagnosis?
• What is the Pathophysiology? How will you
investigate this patient?
• Septic shock progressing to Disseminated
Intravascular Coagulation (DIC)
 Aug-2014
• a) A 12 year boy weighing 70 kgs, doesn’t play
any outdoor games and is always in front of
his play station with lot of snacks besides him.

What is he having? What are the methods to

assess it?
b) What is the etiopathogenesis? Enumerate the
complications?
OBESITY
 March 2022
• 50 / male vegetarian, presented with pallor,
paresthesia of extremities O/E he had beefy
tongue.
• What is your diagnosis?
• How will you investigate this patient further
and establish the diagnosis.
• Classify RBC disorders according to etiology.
MEGALOBLASTIC ANEMIA
(Vitamin-B12 Deficiency)
 July 2023
• 30 years female presented with menorrhagia.
She has pallor, koilonychia.
• What will be the hematological findings in this
patient?
Iron deficiency anemia
 March 2022
• 10 years female was administered an
analgesic injection IM and immediately
collapsed.
• What is the type of reaction? What is the
Pathogenesis of this reaction?
Type-1 hypersensitivity reaction
 March 2022
• 10 years male presented with evening raise of
temperature, neck nodes. His father was
treated for cough with expectoration for 6
months.
• What is your diagnosis?
• Write about pathogenesis morphology of this
illness.
Tuberculous Lymphadenitis
 March 2022
• 30 years male presented with fever with rigors
he had H/o dark coloured urine after
admission and also had cloudy consciousness.
• What is the diagnosis?
• What is the role of peripheral smear in
diagnosis?
Complicated Plasmodium Falciparum infection
(Cerebral malaria & Black water Fever)
 August 2022
• 1 year male child was brought with loss of
vision and mass lesion of the eyeball. There
was a family H/o sarcoma of the long bone in
the sibling.
• What is your diagnosis? What is the molecular
mechanism involved in this family.
• Describe the normal cell cycle and how this
gene affects cell cycle, Name 3 other genes
involved in familial syndromes.
• Retinoblastoma with Ostesosarcoma
• Tumour suppressor gene- RB gene mutation
 August 2022
• 50 years male who was a diabetic has
developed an ulcer in the foot of size 6 x 4 cm.
His last toe was covered with necrotic slough.
• What is your diagnosis? What is the
pathogenesis and pathology involved in this
complication?
Gangrenous Necrosis
 August 2022
• 8 years female child was hailing from a poor
family and was found to have loss of muscle
mass and subcutaneous fat; she was
emaciated.
• What is your diagnosis?
• How will you categorize nutritional disorders?
Protein Energy Malnutrition-
Marasmus
 July 2023
• 3 years male child had frontal bossing, pigeon
chest, bowing of legs.
• What is the underlying dietary deficiency?
• What are the metabolic changes due to the
deficiency?
• If seen in adults what is the clinical
manifestation?
RICKETS
 August 2022
• 20 years male following antibiotic intake had
total leukocyte count of 1200 cells / mm3 and
absolute neutrophil count of 120 cells.
• What is your diagnosis? What is the
pathogenesis of this condition?
Absolute Neutropenia
(Agranulocytosis)
 August 2022
• 20 years female had hematocrit of 20%,
reticulocytosis, hyperbilirubinemia, peripheral
smear revealed anisopoikilocytosis and target
cells.
• What is the pathophysiology of this disease?
 February 2023
• 8 years old girl presented with malaise and
fatigue. On examination yellowish sclera with
hepatosplenomegaly noted. Family history
revealed similar complaints in her sibling also.
Her Hemoglobin level is 7.8 g/dl. X-Ray skull
showed “crewcut” appearance.
• a) What is your diagnosis?
• b) Write in detail about etiopathogenesis,
morphology and laboratory investigations
needed to confirm the diagnosis.
Thalassemia
Systemic Pathology
 August-2008
• 40 year female presents with post coital
bleeding and foul smelling discharge per
vagina. She lost 15% wt in 2 months, with loss
of appetite.

a. What is your diagnosis ?

b. What etiopathogenesis of this condition?
c. What are the morphological features?
 Feb-2020
• A 60 year old postmenopausal anorexic,
cachectic woman has an ulcerated and friable
cervix that bleeds on touch. These features were
accompanied by foul smelling vaginal discharge.
a) What is your diagnosis?
b) Discuss in detail the aetiopathogenesis and
morphological features of your diagnosis.
c) Enlist the investigations that will enable
diagnosis
CARCINOMA CERVIX
 Feb-2009
• 20 years female H/o pain, swelling, tenderness over lower
end of right femur since 3 months. Suddenly developed
breathlessness during her treatment and died, clinical
autopsy conducted.

Answer the following:

a) What is your diagnosis?
b) Mention two investigations to arrive at diagnosis?
c) Aetio-pathogenesis of the lesion?
d) Gross and Microscopic picture of the lesion?
e) Mention two autopsy confirmed lesions leading to death?
PULMONARY EMBOLISM
(Fat/Thrombo-embolism)
 August-2009
• A 35 years, old man was admitted with history of
painless cervical and axillary lymphadenopathy.
He had history of loss of weight, fever and night
sweating and was found to have cutaneous
anergy. No hepatosplenomegaly.

a) What is your most probable diagnosis?

b) Give the classification of the condition.
c) Describe the morphology of any two types.
HODGKINS LYMPHOMA
 Feb-2010
• A 50 years old man collapses suddenly while
climbing the stairs with severe chest pain and
profuse sweating.

a) What is your clinical diagnosis?

b) Discuss the aetiopathogenesis of the
condition.
c) What are the complications that may follow
the condition?
 Feb-2011
• A 50 year old man with complains of severe chest
pain and sweating.

a) What is the most possible diagnosis for this

patient?
b) Enlist the risk factors and discuss in detail the
etiopathogenesis and complications of this
disease.
c) Enlist the biochemical tests and their role in
diagnosis of this disease.
 August-2013
• 47 yrs old male presented with acute onset of
dyspnea, profuse sweating and chest pain
radiating to the left shoulder. Lab investigation
revealed elevated troponin – T.

• What is your diagnosis, pathogenesis and

morphology of the condition?
 August-2015
• 50 years / Male admitted in emergency care
with chest pain, profuse sweating and Rapid
pulse. What is your diagnosis?

• Describe the Etiopathogenesis, Morphology

and Complications of the above mentioned
disease.
 February 2017
• 75 year male presented with dyspnea and
sweating of sudden onset. He is a known
hypertensive and diabetic for 15 years. On
examination he has weak pulse.

• What is diagnosis?
• Write about pathogenesis of the above
disorder
• Write in detail about the morphological
changes that occur.
 February 2022
• A 56 years male experienced a prolonged
chest pain-stabbing in nature, radiating to the
jaw and left arm and associated with profuse
sweating.
a. What is your diagnosis?
b. Discuss in detail about the pathogenesis
c. Add a note on morphology of involved organ.
 August 2022
• 45 years old male, known smoker and
alcoholic with complaints of chest pain
presented to the emergency ward. His ECG
was abnormal.
• a) What is your diagnosis?
• b) Write in detail about pathogenesis and
morphology of the disease. Write a note on
the investigations needed.
 February 2023
• 50 years male sudden death, autopsy of the
heart revealed gray white area in left
ventricle.
• What is the diagnosis? What are the
morphological changes in heart during
autopsy to identify the age of lesion?
MYOCARDIAL INFARCTION
 August-2010
• A 12 year old boy presented with fever,
oliguria and high coloured urine. He had sore
throat three weeks back.

i) What is your probable diagnosis?

ii) Describe the etiopathogenesis of the
condition
iii) What are the relevant investigations?
 August-2012
• 8 yr Old boy with old scar of scabies skin
lesions, with history of Haematuria, Oliguria
and Puffiness of face.

(a) What is your probable diagnosis.

(b) Etiopathogeneisis and laboratory

investigations.
 Feb-2016
• A 3yrs old child was hospitalized for the
complaints of fever and passing smoky urine.
The child had recovered from sore throat a
week ago. What is your diagnosis?

• Describe the etiopathogenesis, morphology

and laboratory findings of this condition.
August-2006
 February 2023
• A 5 years old male child presented with
oliguria, fever, nausea, and cola-colored urine.
He had a history of sore throat two weeks
before.
a) What is the likely diagnosis in this case?
b) Describe the pathogenesis and morphology
of involved organ.
c) Add a note on morphology of rapidly
progressive glomerulonephritis.
ACUTE POST-STREPTOCOCCAL
GLOMERULONEPHRITIS
 August-2011
• Thirteen year old female child had massive
edema with puffiness of face with decreased
urine output.

a. What is the most probable diagnosis ?

b. What can be the most probable renal
pathology in this child ?
c. Write in detail about minimal change disease.
 NEPHROTIC SYNDROME
MINIMAL CHANGE DISEASE (LIPOID NEPHROSIS)
 March 2022
• 35 years female presented with fever with
rigors, urine examination revealed plenty of
pus cells and granular cast.
• What is the pathogenesis of this condition?
Acute Pyelonephritis
 Feb-2012
• 44 year old nulliparous women presented with
hard, fixed, non-tender mass of about
6x4x4cm in the upper outer quadrant of right
breast with axillary lymphadenopathy.

a. What is your probably diagnosis.

b. Discuss in detail the prognostic & predictive
factors of your diagnosis.
 Feb 2018
• 55 year old post menopausal women
presented with hard lump 6 x 6 cm in upper
outer quadrant of left breast. FNA – revealed
cluster of pleomorphic cells.
a) What is your clinical diagnosis?
b)Discuss the etiopathogenesis, molecular
mechanism of carcinogenesis of the disease.
c)Discuss about prognostic and predictive
factors of the disease.
 March 2022
• 55 years female presented with a hard lump in
the right breast.
• Enlist the risk factors. Describe the molecular
classification, pathogenesis and morphology
of the above condition.
• Add a note on prognostic factors.
 August 2022
• 55 years female presented to the surgical OP
with complaints of swelling in Right side
breast, on examination the swelling was hard
and fixed. Needle core biopsy was taken.
• a) What is your diagnosis and classify the
lesion?
• b) Write about the morphology and
prognostic factors of the lesion.
CARCINOMA BREAST
 Feb-2013
• 50 Yr old Male with painless, firm Testicular
swelling, with loss of testicular sensation.

(a) What is your probable Diagnosis.

(b) Discuss classification and Etiopathogenesis.
 March 2022
• 40 years male presented with testicular mass.
What is your differential Diagnosis? Draw the
microscope findings is this condition.
Testicular Tumor
 Feb-2014
• A sixty year old male presented with anaemia,
loss of weight, persistent abdominal pain,
abdominal distension and vomiting. Upper GI
endoscopy and biopsy done.

a. What is the probable diagnosis?

b. Discuss the etiopathogenesis and morphology
of the disease.
August-2007
 March 2022
• 55 years male C/o weight loss and dyspepsia,
endoscopy revealed an ulcerative lesion
antrum.
• What is your diagnosis? Describe the
morphologic classification and microscopic
findings.
Gastric Carcinoma
 February 2023
• 30 years male presented with heart burns and
dyspepsia. A breath test and biopsy were
ordered to confirm the diagnosis.
• What is your diagnosis? Write about the
morphology and complications of this disease.
H.pylori Chronic Gastritis
 August-2014
a) 65/M presented with bleeding PR.
Colonoscopy revealed a hard mass in
rectosigmoid. What is your diagnosis?

b) Discuss the various neoplasms arising in

rectosigmoid, in detail about morphological
types and staging system.
Feb-2008
 July 2023
• A 60 years old male smoker, presented to OPD
with complaints of altered bowel habits with
bleeding per rectum and abdominal pain.
Patient was referred to surgical oncologist and
he suggested endoscopic biopsy.
• a) What is your probable diagnosis?
• b) Write in detail about etiopathogenesis and
morphology of this lesion.
Carcinoma- Colon
 August 2022
• 40 years obese female complaints of severe
abdominal pain radiating to the right shoulder.
Ultrasound was done and she was advised
Cholecystectomy by the surgeon.
• What is your diagnosis and write in detail
about the condition.
Acute Calculous Cholecystitis
 August 2022
• 30 Years male with recurrent history of cough
and sneezing, without fever. Cough relieved
after taking bronchodilators.
• What could be the cause and write about the
pathogenesis and morphology.
Bronchial Asthma
 March 2022
• 50 years male smoker C/o dyspnea his PET
revealed FEV1 / FVC ratio of 0.5. He had barrel
shaped chest.
• What is your diagnosis? What is the etiology
and pathogenesis for this disease?
Emphysema
 February 2023
• 55 years male chronic smoker had persistent
productive cough for 3 months. He had similar
episode last year too.
• In which group of disorders you will
categorize them.
• Write briefly about the pathogenesis &
morphology.
Chronic Bronchitis
 August 2018
• A 50 year old male presents with cough,
dyspnoea, and intermittent haemoptysis for
two months along with loss of weight and
appetite. He is a chronic smoker for the past 3
decades. CT chest revealed mass lesion in the
right lobe of lung.
a) What is your probable diagnosis?
b) Discuss in detail the classification,
morphological features and the Paraneoplastic
syndromes associated with it.
BRONCHOGENIC CARCINOMA
 February 2023
• 50 years male presented with polyuria,
polydipsia his HbA1c was 8.2. He also had
oliguria and puffiness of face.
• What is your diagnosis?
• What is the pathogenesis of the underlying
disease and its complications? What are the
investigations required to confirm?
Diabetes Mellitus
 March 2022
• 30 years female presented with diarrhea,
weight loss, protruding eye balls and
thyromegaly.
• What is the pathogenesis and morphology of
the above condition?
Hyperthyroidism (Graves Disease)
 August 2022
• 25 Years female presented with midline
swelling neck, FNAC showed a cystic
malignant neoplasm and admitted for surgery.
• What is your diagnosis and write about the
nuclear findings of the lesion.
 February 2023
• 20 years female presented with solitary
thyroid nodule. Microscopy revealed Orphan
Annie appearance of nuclei.
• What is your diagnosis? Describe the
Morphology of this condition.
Papillary Carcinoma Thyroid
Feb-2007
 February 2023
• 15 years male presented with lytic lesion
lower end of femur. X-Ray revealed codman’s
triangle and sun ray appearance.
• What is your diagnosis?
• What are the genetic alterations associated
with this condition? Describe the morphology
of this lesion.
• Classify bone tumors and add a note on
imaging findings in various bone tumors.
 July 2023
• 18 years old male visited ortho OPD with complaints
of pain and swelling around right knee for past 3
months. On evaluation, X-ray showed ill defined
lesion at the distal end of femur and increased levels
of alkaline phosphatase in blood. Biopsy was taken.
• a) What is your probable diagnosis?
• b) Write in detail about the etiology and patho-
morphology of the lesion.
• c) Comment about the radiological features of this
lesion.
Osteosarcoma
 March 2022
• 30 years female with lytic lesion in distal Ulna
and X-ray revealed soap bubble appearance.
• What is your diagnosis? Morphology of this
condition.
Giant Cell Tumour of Bone
(Osteoclastoma)
 March 2022
• 50 years male alcoholic presented with
jaundice. How will you investigate this
patient? What is the effect of alcohol on liver?
Morphology and clinical features and
complications of alcoholic liver disease.
Alcoholic liver disease
 February 2023
• 30 years male presented with yellowish
discolouration of conjunctiva. He had history
of blood transfusion (Multiple units) in the
recent few months following RTA as an
emergency. How will you investigate the
patient?
Post-Transfusion Viral Hepatitis
(Hep-B,C,D)
 August 2022
• 80 years male presented with history of
dysuria and urgency of urine. USG shows
enlarged prostate with increased PSA level.
• What are the morphological findings in this
condition?
Prostatic Carcinoma
 February 2023
• 45 / male presented with cauliflower like
growth in the penis? He also had multiple
inguinal nodes. What is your diagnosis?
Describe the microscopic appearance. What
are the preneoplastic conditions?
Carcinoma Penis
 February 2023
• 15 years female presented with unilateral
ovarian mass. Gross examination of the mass
revealed hair in it.
• What is your diagnosis? What is the
morphology? It belongs to which group of
ovarian lesions. Enumerate the other lesions
in this group.
Mature Cystic Teratoma
(Dermoid Cyst)
 July 2023
• A 10 years old male child presented to
pediatric OPD with complaints of fever for the
last 10 days with projectile vomiting and
irritable mood.
• What is your diagnosis? What are the
mandatory investigations needed to diagnose
this condition?
Meningitis
Thank You