Case:
Name: Ramesh Kapur Age and Sex: 5 years, Male.
History: Puffy faces, anasarca, frothy urine.
Urine report:
Chemical: Protein: Present (++++)
Lipid: Present (++)
Questions:
1. What may be the possible diagnosis ?
2. What are the 2 important blood/serum findings in this case?
3. Mention any 4 causes of this condition.
4. What is the most significant urinary microscopic finding in this case ?
Case:
Name: John Abraham Age and Sex : 60 years, Male
History/Complaints: Easy fatigability, weight loss, weakness, early fullness after meals and dragging
upper abdominal pain.
USG abdomen: Massive splenomegaly.
Blood report:
Hemoglobin : 10 g/dl
TLC: 1,50,000 cells / [Link]
DLC: Myeloblasts : 01% Myelocytes: 21%
Metamyelocytes : 12 % Neutrophils : 40%
Lymphocytes: 11% Eosinophils: 09%
Monocytes: 01% Basophils: 05%
Questions:
1. What is the patient likely to be suffering from ?
2. By what tests do you confirm the above condition ?
3. What are the phases of this disease?
4. What is leukemoid reaction?
Case:
Name: Nirav Sinha Age and Sex: 58 years, male
History/Complaints: Recurrent infection, easy fatigability, bone pain and renal failure.
Blood report:
Hemoglobin: 8 gm/dl
PBS: Increased rouleaux formation
Serum Ig G: 4.5 gm/dl (Normal : <3 gm/dl)
Urine: Bence-Jones protein present.
X ray: Punched out osteolytic lesions in the skull and vertebrae.
Questions:
1. What is the diagnosis in this case?
2. What would be the bone marrow findings?
3. What is Bence Jones protein?
4. What is significant finding on serum protein electrophoresis?.
Case:
Name: Dilip Kumar Age and Sex: 34 years, Male
History/Complaints: Fever, headache, malaise, mental confusion and vomiting. Increased CSF pressure
noted during lumbar puncture.
CSF report:
PHYSICAL : Appearance- Slightly turbid, cob-web coagulum on standing.
Microscopic : Cell count – 250 cells/[Link]
Questions:
1. What is the patient likely to be suffering from?
2. What is the causative organism of the disease ?
3. What changes in the biochemical parameters would you expect in this condition ?
4. What type of cells do you expect in microscopical examination of CSF ?
Case:
Name: Aruna Goenka Age and Sex: 8 years and Female
History/Complaints: Pallor, Jaundice with frontal bossing, prominent facial bones and splenomegaly.
Blood report:
Hemoglobin: 6 gm/dl Reticulocyte count : 15%
PBS:
RBC: Marked aniso-poikilocytosis with hypochromic microcytosis, target cells,
polychromatic macrocytes, basophilic stipling, leptocytes and nucleated RBCs.
WBC: Total and differential counts are within normal limits.
Platelets: Low on smear.
Questions:
1. What is your impression about this case?
2. What are the various types of this disorder?
3. What other two tests would you perform to confirm the above diagnosis
4. Name two other conditions where you find microcytic hypochromic anemia ?
Case:
Name: Mansur Ali Age and Sex: 60 years and Male
History/Complaints: Easy fatigability, anorexia, weight loss, generalized lymphadenopathy and
spleniomegaly of gradual onset.
Blood report:
Hemoglobin: 12 gm/dl
TLC : 1,20,000 cells / [Link]
DLC : Neutrophils : 15 % Eosinophils : 01 %
Lymphocytes : 83 % Monocytes : 01 %
PBS : Abundunt smudge cells seen,
Bone marrow report: Infiltration by aggregates of small lymphocytes.
Questions:
1. What is the patient likely to be suffering from?
2. What are Smudge cells?
3. Which proportion of lymphocytes are affected (B cells or T cells) in this case?
4. What are other causes of lymphocytosis (Name at least 4 causes).
Case:
Name: Shahid Akmal Age and Sex: 10 years, male
History/ Complaints: Migratory arthritis of large joints following a history of fever and sore throat 2
weeks back.
Blood report:
Leukocytosis and raised ESR
TLC : 16000 cells/[Link]
ESR: 80 mm in 1 hour
CRP : Elevated.
Questions:
1. What is the provisional diagnosis ?
2. What is the etiology ?
3. What are the 2 investigations you want to perform ?
4. What are the complications of this disease ?
Case:
Name: Sudipto Banerjee Age and Sex: 27 years, Male
History / Complaints: Fever, Head ache, photophobia, neck stiffness and high CSF pressure noted during
lumbar puncture.
CSF report:
Physical: Appearance: Turbid and bulky coagulum.
Microscopic: Cell count: 1200 cells / [Link]
Questions:
1. What is the patient likely to be suffering from?
2. What are the causative organisms of the disease ?
3. What biochemical changes would you expect in this case?
4. What type of cells do you expect in microscopical examination of CSF ?
Case:
Name: Debasis Roy Age and Sex: 9 years, Male
History/ Complaints: Fever, facial edema, oliguria, tonsillitis and hypertension.
Urine report:
Physical : Appearance: Hazy and smoky red
Specific gravity: 1028
Sediment: Present
Chemical: Protein: Present (+)
Microscopic: Epithelial cells: Plenty
RBC: 8-10 cells / hpf
Casts: Hyaline, epithelial and RBC cast
Questions:
1. What is the patient likely to be suffering from ?
2. Which micro organism is responsible for the condition ?
3. What laboratory test would you do to confirm the diagnosis ?
4. What are the other common causes of hematuria ?
Case:
Name: Narendra Banerjee Age and Sex : 38 years, male
History / Complaints : Low grade fever with evening rise of temperature , dyspnea, hemoptysis, and
weight loss.
Chest X Ray : In the lung fields, there are bilateral patchy infiltrates, a cavitary lesion with sarrounding
calcifications. Bilateral pleural effusion also seen.
Questions:
1. What is the provisional diagnosis?
2. What is the causative agent for this disease ?
3. Name other 4 body sites / organs that can be affected by this disease .
4. How will you confirm the diagnosis ?
Case:
Name: Prabhat Dolui Age and Sex: 52 years and Male
History / Complaints: A chronic alcoholic complaints of recurrent attacks of hematemesis,
gynaecomastia and gradual swelling of abdomen. Ascites was detected on clinical examination.
Blood report:
S. AST (SGOT) : 200 IU / L
S. ALT (SGPT): 100 IU / L
Questions:
1. What is the probable diagnosis ?
2. What are the common laboratory tests done in such a case ?
3. What are the etiologies in this case ?
4. What are the complications of this case ?
Case:
Name: Jibon Dey Age, Sex : 55 years, Male
History / Complaint: Lethargy, Frequent attacks of fever and cough, gum bleeding.
Blood report :
HB : 8.0 gm / dl
TLC : 1,20,000 / [Link]
Differential count : Blast : 45 %
Neutrophil : 40%
Lymphocyte : 12 %
Monocyte : 1 %
Eosinophil : 2 %
Basophil : 0 %
Platelets : 15000 / [Link]
Questions:
1. What is your provisional diagnosis ?
2. What are the points in favour of your diagnosis ?
3. How can you differentiate between a myeloblast and a lymphoblast by looking at
morphology ?
4. What are the cytochemical tests you may do to support your diagnosis ?