Clinical pathology spots for final MBBS. With some sample questions & answers to guide medical students.

1. Yapa Wijeratne
MBBS

2. • Knowledge for everyone.
• Please note that this slides are not complete. I tried my best to give
an general idea of pathology spots in final MBBS.
• Medicine is an ever-changing science. As new research and clinical
experience broaden our knowledge, changes in treatment and drug
therapy are required. I have checked with sources believed to be
reliable to provide information that is complete and generally in
accord with the standards accepted at the time of preparation.
However, in view of the possibility of human error or changes in
medical sciences readers are encouraged to confirm the information
contained herein with other sources.

3. 1
1. Identify this.
2. What is the
measurement
taken?
3. State the ratio of
citrate used in the
investigation

4. 11. Westergen’s tube
2. ESR- Erythrocyte sedimentation rate
3. Tri Sodium citrate : blood = 0.4 : 1.6
(ml)
• Tri Sodium Citrate is the anticoagulant for ESR; for
this 1 volume of citrate is mixed with 4 volumes of
blood.
• Normal ranges
• 0–10mm/h for male 18–65 years.
• 1–20mm/h for female 18–65 years.
• Upper limits of normal increase by 5–10mm/h for
patients >65 years.
• Other factors e.g. Hct influence the ESR.
• Should be regarded as semiquantitative.
• Marked elevations are clinically significant.
• Modest elevations can be more problematic to
interpret

5. 2
• This patient presented with history of fever
& productive cough.

6. • What is this microscopy slide stain?
– Gram/ Lugol’s iodine
• What is the possible organism?
– Strep pneumonia
• What is the next investigation ?
– Culture & ABST

7. 3
• Patient awaiting liver biopsy. What are the
essential investigations?
– Clotting profile-
• BT/ CT
• PT/INR
– Full blood count

8. 4
• Liver enzyme report
• Total bilirubin
• Direct ↑
• What are the possibilities?
– Obstructive jaundice

9. 5
• Serum electrolyte report
• Na 135.
• K very high 7.
• Why?
– Hemolysed sample.
• Where is the problem?
– Sampling error

10. 6
• Collecting samples
• Urine culture: sterile bottle, midstream
urine following clean meatus
• TB sputum: early morning 3 samples of
sputum for Acid fast bacilli

11. 7
• UFR
– Appearance- mild turbid,
– Protein ++,
– RBC 10-15/hpf,
– Red cell cast +
• Which part of the tract?
– Upper urinary tract
• One disease which can cause this?
– Glomerular nephritis

12. 8
• What is the blood group?
– A negative
• What other investigations you would have
to do if this sample has been taken from a
pregnant mother in 2nd trimester?
– Unexpected antibody level

15. 9
• Interpret
– WBC/DC- 15x109/l
– Neutrophils- 20%
– Lymphocytes- 70%
• Possibilities?
– viral fever
• What anemia: normocytic normochromic

16. 10
• Dengue pt PLT 5x109
• Bottle fully filled.
• Why wrong?

17. 11
• What is the anemia this patient is having
– HB ↓
– MCV ↓
– MCH ↓
– MCHC
– Hypochromic microcytic anemia
• What is the appropriate next investigation?
– Blood picture
• What are the conditions?
– Iron deficiency anemia
– Thalassemia trait

18. Hypochromic microcytic anaemia
Differential diagnosis
• Iron deficiency anaemia
• Thalassaemia trait
• Anaemia of chronic disorder
• Sideroblastic anaemia

19. IDA Bthaltrait ACD SA
BP Pencil
shaped
poikilocytes
Irregularly
contracted
cells
Rouloux
formation
NL
Dimorphic
film
MCV Decreased Decreased Decreased Decreased
MCH Decreased Decreased Decreased Decreased
MCHC Decreased Normal
RCC low Increased
Anisocy. +++ No No dimorphic
S.ferritin low normal high Very high
Iron frag neg pos pos increased
Iron
N’blast
neg pos neg sideroblast

20. 12
• CSF report
– Red color gradually disappearing
• Interpret
– Traumatic tap
• What sample is sent for sugar, culture
• What other sample needed at the time of
lumbar puncture? RBS

21. • If the sample is blood stained due to traumatic tap
• Use the least blood stained specimen for full protein and
cell analysis.
• Use more blood stained samples for other analysis.
• If only one sample is available for analysis
• First do culture and ABST (to avoid contamination) and
smear
• Do protein and cells
• If no sample is collected into a S bottle inform the lab
and send the sample immediately to the lab so they will
process the specimen quickly for sugar analysis

22. • CSF microscopy of patient found
unconscious.
• Red cells are seen
• Diagnosis?
– SAH

23. 13
• Calculate BT

24. 14
• Child with facial puffiness. Urine
sulphosalicylic test result is as follows
• Interpret
– Heavy proteinuria +4
• 2 conditions
– Nephrotic syndrome
– UTI
– Pre-eclampsia
– Diabetic nephropathy

25. 15
• Name the container for following
investigations
• FBC
• Liver enzymes
• Electrolytes
• APTT

27. • What are the sample collection methods
for following tests
1. PT
2. APTT
3. Serum Ca

28. • PT – blood drained in one reaction
– Sodium citrate : Blood = 0.2ml :1.8ml
• APTT – plastic container ( glass – reduce APTT)
– Sodium citrate : Blood = 0.2ml :1.8ml
• Serum Ca – plane bottle immersed on HCl
overnight & dry, no tourniquet.

29. 16
• State the method of delivering the sample
1. Pap smear-
1. 95% alcohol
2. Muscle biopsy-
1. fresh sample covering with a gauze. NO
preservatives. Immediately to the path lab
3. Solitary thyroid nodule:
1. 23 G 10cc in 95% alcohol

30. 17
• Blood sample for sugar was collected to a
plain tube.
• Identify the abnormality
• What is the cause?

31. 18
• Alcoholic patient. Low prn & Ca+2.
• Interpret his FBC
• How to treat?

32. 1. What is the likely
diagnosis? Give
with reasons
2. What are the other
tests can be done
to confirm the
diagnosis?

33. Thalassaemia major
• Hb Low
• Blood picture: Target cells, normoblasts,
irregularly contracted cells, poikylocytosis
• Haemoglobin electrophoresis: Increased
Hb F
• Both parents are carriers
• Alkali denaturation test: increased Hb F

34. β thalassaemia major: note bizarre red cells with
marked anisopoikilocytosis

35. CML
• 27 year old male presented
with WB Anaemia, weight loss,
night sweats &
Splenomegaly.Blood picture
shown. His WBC/DC was very
high.
• What is the
diagnosis?

36. Peripheral blood film in CML: note large numbers of
granulocytic cells at all stages
of differentiation.

37. 1.Identify three
types of cells in
the slide?
2.Identify the
parasite
precisely?

39. 37
38
39
40
41
temperature°c
1 2 3 4 5
Following temperature chart belongs to a patient who has the blood
picture shown.
What is the diagnosis?

41. in pus
in culture media
A & B are two smears taken
from pus & culture media from
same organism.
1. Identify the stain?
2. Identify the possible organism?
A
B

42. Following ova in microscope given.
1. Identify?
2. What is the stain
used?

43. Fertilized egg-round shape,
corticated outer shell
Embryonated egg -less
pronounced cortication of outer
shell, mature embryo
Ascaris lumbricoides eggs

44. 1. Identify?
2. State the mode of
transmission.

45. • Know the eggs of
• Ascaris
• Trichuris
• Pin worm
• Hook worm
• Ascaris- slide stain- iodine

46. • This is a blood picture of a 8 yrs old male child
treated with nitrofurantoin for UTI who developed
haematuria after the treatment.
1. What is the diagnosis?
2. What are the tests available for confirm the
diagnosis?

47. Blood film:
chronic renal
failure with burr
(irregular
shaped) cells.

50. • Blood film of a 17
year old female
patient.
• What is the
diagnosis?
– Iron deficiency
anaemia:
• Give reasons
– Pale red cells with
pencil cell (top left).

51. • Blood picture of megaloblastic anemia

53. • Temperature chart of
a surgical patient is
given with regular
spikes.
• List two causes.

54. • A –ve
• Investigate cord blood for,
1. Hb%
2. Retic count
3. Bilirubin
4. Grouping & DT
5. Coomb’s test - Direct

56. Acid base balance
• Normal
blood gas
values
PH 7.34-7.44
PCo2
4.4-5.8kpa
35-45 mmHg
Po2
10-13.3kpa
80-100mmHg
HCo3 20-30mmol/l
SBC 20-30mmol/l
ABE/SBE -2.5-2.5mmol/
Sat 95-98%
TCo2 22-32mmol/l
Hb 12.5-17.5g/100ml

57. Simple scheme for interpretation
• Look at pH-acidosis or alkalosis
• Look at PCo2 – determine the respiratory
component
• Look at standard bicarbonate /BE –
determine the metabolic component
• Look at Hb
• Look at Po2 and Fio2

58. Interpret following blood gas analysis
• Hb 18.2
• PH 7.275
• PCo2 12.98 ( 45)
• Po2 4.44 (33)
• HCO3 44
• SBC 33.9
• ABE 11.4
• SBE 15.8
• Sat 55.1%
• Compensatory respiratory acidosis

60. Interpret following blood gas analysis
• Hb 13.2
• PH 7.081
• PCo2 2.76 ( 20.7)
• Po2 14.10(105.7)
• HCO3 5.9
• SBC 8.4
• ABE -23.5
• SBE -22.4
• Sat 95%
• metabolic acidosis with respiratory compensation
• Diabetic ketoacidosis

61. Interpret following blood gas analysis
• Hb 9.7
• PH 7.532
• PCo2 3.83( 28.7)
• Po2 4.44(33)
• HCO3 23.7
• SBC 25.7
• ABE 2.0
• SBE 1.4
• Sat 67.2%
• Acute respiratory alkalosis & low po2- hypoxia

62. Interpret following blood gas analysis
• Hb 8.0
• PH 7.46
• PCo2 2.59 ( 19.42)
• Po2 13.49(101)
• HCO3 13.8
• SBC 17.2
• ABE -8.9
• SBE -9.3
• Sat 98%
• Metabolic alkalosis with respiratory compensation
• Aspirin overdose ?

63. • Urine microscopy. Identify
– Granular cast
• What other investigation would you
request?
– U culture + ABST

66. • What is this investigation?
– Rothera’s test
• What does it indicate?
– Urine ketone body positive
• What are the conditions that gives above
result?
– DKA/ ketotic hypoglycemia
– Hyperemesis
– Starvation

68. • What is this investigation?
– Benedict’s test
• How do you perform?
– 2.5ml of Benedicts reagent + 4 drops of urine
• What does it indicate?
– Urine reducing substances positive
• What are the conditions that gives above
result?
– Glucose
– Aspirin
– Nalidixic acid
– Cephalosporins

70. • How do you collect urine for specific
gravity?
– Early morning, mid stream
• Name 2 instances urinary specific gravity
increase?

71. • Urine bottles. What are the uses?
– Can with acetic acid: 24 hour collection-
• Protein excretion
• Wilson’s disease- 24 hour urinary excretion of
copper
– Early morning sample- specific gravity
(orthostatic proteinuria, TB
– Culture- mid stream

72. • Urine sample of a 45
year old man was tested
are following substances
were observed.
1. Identify the substances?
2. Give a diagnosis?
Fouchet’s Earlich’s

73. • Urine sample of a 25
year old man was tested
are following substances
were observed.
1. Identify the substances?
2. Fouchet’s- bilirubin + if
greenish blue (normal-
colorless)
3. Ehrlich- urobilinogen + if
distinct red color
(normal- pink)
4. Give a diagnosis?
Fouchet’s Earlich’s

74. • Urine electrophoresis results were given.
1. Identify A & B diseases
2. List two other investigations for each disease
+ +
A B

77. • Electrophoresis film of a patient who came with chronic
back pain. What is the diagnosis?
– Multiple myeloma
• What type of paper is used?
– Cellulose acetate
• What other 2 investigations would you request?
– Skeletal survey ( skull+ mandible, CXR, pelvis, long
bones)
– Urine Bence Jones Protein

78. • Path form filling. What are the must?
• For blood picture- pallor, LNE,
hepatosplenomegaly

79. • Advices for
• SFA
• Stool for occult blood testing?
– No meat diet for 3 days

80. • MI diagnosis
• Troponin I levels

81. • Histopathology report forms
• Bone marrow biopsy-
• What are those large cells?
• Megakaryocytes