SYSTEMIC PATHOLOGY CHARTS

Chart 14: Acute Rheumatic Fever

Chart 15: Acute Myocardial infarction with cardiogenic shock
Chart 16: Pulmonary Tuberculosis
Chart17: Pneumonia
Chart 18: Lung carcinoma/Bronchogenic carcinoma
Chart 19: Carcinoma stomach
Chart 20: Peptic ulcer
Chart 21: Carcinoma colon
Chart 22: Nephritic syndrome - PSGN
Chart 23: Nephrotic syndrome - MCD
Chart 24: Renal cell carcinoma
Chart 25: Acute pyogenic meningitis
Chart 26: Acute viral meningitis
Chart 27: Tuberculous meningitis
Chart 28: Acute viral hepatitis
Chart 29: Cirrhosis with portal hypertension
Chart 30: Obstructive jaundice due to gallstones
Chart 31: Carcinoma cervix
Chart 32: Carcinoma breast
Chart 33: Fibroid uterus / leiomyoma uterus
Chart 34: Hypothyroidism – Hashimoto’s thyroiditis
Chart 35: Hyperthyroidism – Grave’s disease
Chart 36: Type 1 DM with Diabetic ketoacidosis (DKA)
Chart 37: Osteosarcoma
 CHART 14
A 10-year-old male child was brought to the hospital by his mother with the complains of
migrating joint pain and swelling of the involved joint. On enquiry, the child had an upper
respiratory tract infection (sore throat) and fever 3 weeks back. On examination a
subcutaneous nodule was found on the extensor aspect of right elbow. On auscultation,
the heart sounds were weak with tachycardia.

Questions
What is the most probable diagnosis? (1mark)
Acute Rheumatic Fever

What is the etiology of this condition? (1mark)

Group A beta hemolytic streptococcal infection (GABHS)

Describe the Diagnostic criteria of this condition? (2mark)

Modified Jones criteria

What is the characteristic microscopic finding seen in the heart of this condition? (1mark)
Aschoff bodies & Anitschkow cells
A. For All Patient Populations with Evidence of Preceding Group A
Streptococcal Infection
Diagnosis: initial ARF 2 major manifestations or 1 major plus 2 minor
manifestations
Diagnosis: recurrent ARF 2 major or 1 major and 2 minor or 3 minor
B. Major Criteria
Low-risk populations®
Moderate- and high-risk populations
Carditis® Carditis
• Clinical and/or subclinical • Clinical and/or subclinical
Arthritis Arthritis
• Polyarthritis only • Monoarthritis or polyarthritis
• Polyarthralgia®
Chorea Chorea
Erythema marginatum Erythema marginatum
SC nodules SC nodules
C. Minor Criteria
Low-risk populations Moderate and high-risk populations
Polyarthralgia Monoarthralgia
Fever (≥38.5°C) Fever (≥38°C)
ESR ≥60 mm in the first hour and/ or ESR ≥30 mm/h and/or CRP
CRP ≥3.0 mg/dL* ≥3.0 mg/dLa
Prolonged PR interval, after accounting Prolonged PR interval, after accounting for age
for age variability (unless carditis is a variability (unless carditis is a major criterion)
major criterion)
 CHART 15
A 56-year-old diabetic, hypertensive male was rushed to the hospital following sudden
onset of an episode of crushing substernal chest pain of 4 hours duration that radiated to
the left arm. It was accompanied by profuse sweating and vomiting. On examination he
was found to have weak rapid thready pulse and BP was 60/40 mm Hg. ECG showed ST
segment elevation and serial measurements showed elevated serum CK-MB & TroponinT
levels. He received advanced life support measures and died on 2nd day.

Questions
What is the most probable diagnosis? (1mark)
Acute Myocardial Infarction With Cardiogenic Shock

What is the most probable cause? (1mark)

Coronary Atherosclerosis with acute plaue change (M/C), Coronary emboli,
Coronary vasospasm without coronary atherosclerosis

What will be the microscopic finding of heart in this case? (1mark)

coagulative necrosis with Acute inflammatory reaction composed of neutrophils

Mention any 4 complications of this condition. (2mark)

Left ventricular failure and cardiogenic shock, Arrhythmias, Myocardial rupture,
Ventricular aneurysm, Mural thrombus, Pericarditis, etc
 CHART 16
A 40 year old male complains of fever with evening rise of temperature, night sweats,
weight loss and chronic productive cough with hemoptysis on and off for 4 months.
Sputum examined for the causative agent was positive. His X-ray chest showed right
upper lobe cavitation.

Questions
What is the most probable diagnosis? (1mark)
Tuberculosis
Mention the special stain used for the diagnosis. (1mark)
ZN
What is the microscopic finding of the lung lesion? (1mark)
Granuloma
Mention any 2 complications of this condition. (1mark)
Fibrosis, Cavity, Disseminated infection.
Which is the principle mediator for the pathogenesis of this condition?(1mark)
IFN-gamma
1. maturation of the phagolysosome - exposing the bacteria to a lethal acidic,
oxidizing environment.
2. expression of inducible nitric oxide synthase — nitric oxide (NO). combines with
other oxidants to create reactive nitrogen intermediates,.
3. mobilizes antimicrobial peptides (defensins) against the bacteria.
4. stimulates autophagy, a process that sequesters and then destroys damaged
organelles and intracellular bacteria such as M. tuberculosis.
 CHART 17
A 45 year old male complains of fever with chills and rigors, fatigue, increasingly severe
productive cough with rusty sputum for the last 5 days. On examination, coarse
creptitations were heard on lower lobe of left lung. He was treated in the hospital and
completely recovered.
Questions
What is the most probable diagnosis? (1mark)
Pneumonia

How will you classify the above condition? (1mark)

Broncho pneumonia & Lobar pneumonia

Mention any 4 etiological agents for this condition. (2marks)

Streptococcus pneumoniae, Hemophilus influenzae, Klebsiella pneumoniae, Staph
aureus, Pseudomonas aeruginosa, Mycoplasma pneumoniae.

Mention any 2 complications of this condition. (1mark)

Lung abscess, empyema, disseminated infection- meningitis, endocarditis,
suppurative arthritis.
 CHART 18
A 65-year-old male complains of persistent productive cough of 1 year duration. He had
episodes of intermittent blood in the sputum for the last 2 months. He also complains of
progressive loss of weight and appetite for 1 month. He was a chronic smoker, smoking
about 20 cigarettes/day for the last 25 years. On examination he was pale and there was
clubbing of fingers. On auscultation, breath sounds are absent on right upper lobe.
Imaging showed a mass in the upper lobe of right lung.
Questions
What is the most probable diagnosis? (1mark)
Carcinoma Lung

Mention any 4 histological types of this condition. (2marks)

Adenocarcinoma, SCC, Small cell carcinoma , Large cell carcinoma

Mention any 2 molecular abnormalities seen in this condition?

(1mark)
EGRF, KRAS, ROS, ALK

Mention any 2 paraneoplastic syndromes associated with this condition. (1mark)

hypercalcemia (PTH-related peptide), SCC
Cushingsyndrome (ACTH), SIADH,
Clubbing & Hypertrophic pulmonary osteoarthropathy,
Neuromuscular syndromes - myasthenia, peripheral neuropathy, polymyositis,
Small cell carcinoma
Coagulation abnormalities - migratory thrombophlebitis, DIC, non bacterial
endocarditis. Adenocarcinoma
 CHART 19
A 65 years old male presented with H/O on & off epigastric pain, abdominal fullness,
vomiting along with episodes of coffee coloured vomitus, loss of weight, fatigue and
weakness of six months duration. On examination, left supraclavicular lymph node was
enlarged. Upper GI endoscopy showed an ulcero-proliferative growth in the antrum of
stomach.

Questions
What is the most probable diagnosis? (1mark)
Gastric carcinoma

List any 2 cause for this condition. (1mark)

Chronic [Link] infection, High intake of Smoked & Salted food, HNPCC, Familila
gastric carcinoma syndrome, Li- Fraumeni.

Mention any 2 histological subtype of this condition. (1mark)

Adenocarcinoma ( including Poorly cohesive carcinoma), Mucinous carcinoma,
Papillary adenocarcinoma, Neuroendocrine carcinoma

What is linitis plastica? (1mark)

Diffuse infiltrative gastric adenocarcinoma which gives the stomach a shrunken
"leather bottle" appearance with extensive mucosal erosion and a markedly
thickened gastric wall.

What is the significance of the left supraclavicular lymphadenopathy? (1mark)

Supraclavicular (Virchow) node (Troisier's sign) indicates distant metastasis or
clinical stage 4b indicating poor prognosis
 CHART 20
A 38-year-old executive male complains of epigastric pain, heart burn and dyspepsia for
the last 1 year. The pain used to occur 2 to 3 hours after a meal and is relieved if he takes
antacids. There is no weight loss. He recovered of this illness after few days of treatment
with drugs and life style modification. He felt better and discontinued treatment. Three
weeks later, the epigastric pain recurs. He underwent upper GI endoscopy and found to
have lesion in the lesser curvature of stomach and the lesion was biopsied.

Questions
What is the most probable diagnosis? (1mark)
Peptic ulcer disease (Gastric ulcer)

List any 2 cause for this condition. (1mark)

H. pylori infection, Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin,
Cigarette smoking, Alcohol, Zollinger-Ellison syndrome, Ingestion of chemicals,
corticosteroids, stress

What are the microscopic findings of the lesion. (2marks)

ULCER with typically four layers (Askanazy zones)
i. Necrotic zone: It is the most superficial zone.
ii . Superficial exudative zone: It consists of fibrinopurulent exudates with
predominantly neutrophilic inflammatory infiltrate.
iii. Granulation tissue zone: It consists of granulation tissue infiltrated with
mononuclear leukocytes.
iv. Zone of cicatrization: It consists of fibrous tissue or collagenous scar which
forms the base of the ulcer and may show chronic inflammatory cells.

Mention any 2 complications of this condition. (1mark)

Bleeding, Perforation, Pyloric obstruction (gastric outlet obstruction), malignant
transformation
 CHART 21
A 60 years old male presented with H/O altered bowel habits, constipation, few episodes
of hematochezia, loss of weight, fatigue and weakness of six months duration.
Colonoscopy showed an ulcero-infiltrative growth at the rectosigmoid colon.

Questions
What is the most probable diagnosis? (1mark)
Colorectal carcinoma
List any 2 precursor lesions/syndromes for this condition.
Familial adenomatous polyposis (FAP), Hereditary nonpolyposis colorectal cancer
(HNPCC), MYH-associated polyposis, Inflammatory Bowel Disease

Mention the two major molecular pathway and any two genes associated with this
condition? (2marks)
Adenoma-carcinoma Sequence(APC/ß-catenin Pathway):
Inactivation of APC tumor suppressor gene, K-RAS mutations, SMAD2 and SMAD4
(tumor suppressor gene) mutations, Mutation of TP53
Microsatellite Instability Pathway: six mismatch repair (MMR) genes have been
identified hMSH2, hMSH6, hMLH1, hMLH3, hPMS1 and hPMS2

Mention any 2 histological subtype of this condition. (1mark)

Adenocarcinoma, Mucinous adenocarcinoma, Signet-ring cell carcinoma, Medullary
carcinoma, Micropapillary carcinoma, Adenosquamous carcinoma, Undifferentiated
carcinoma, Neuroendocrine carcinoma
 CHART 22
A 10 year old boy presented with short history of fever, reduced urine output and passage
of cola coloured urine. He had a history of sore throat 2 weeks back.
On examination: BP- 150/100 mmg, periorbital edemat.
Urine output - 200ml/ 24 hrs
Urine examination:
Albumin +, 24 hrs urine protein - 1.4 gm.
Microscopy - RBCs +++ with dysmorphic RBCs, RBC casts present.

Questions
What is the most probable diagnosis?
Post Streptococcal GN

What is the etiology of this condition?

Post Streptococcal GN - Group A beta hemolytic streptococcus

Enumerate any two other causes of this syndrome.

RPGN (crescentric GN), IgA nephropathy, MPGN, Dense deposit disease

What will be the blood (serum) findings in this case?

Increased ASO titre and reduced compliment level (low C3)

What are crescents?

Proliferation of parietal epithelial cells +/ inflammatory cells
 CHART 23
A 5 year old female child presented with generalized edema. No H/0 fever.
On examination: anasarca +, mild pallor.
Investigations
Urine examination: Albumin ++++, Sugar - nil, Microscopy - oil droplets and oval fat bodies
seen, 24 hrs urine protein - 5.2 gm.
Serum protein- 3.8 gm/di
Serum albumin - 1.9 gm/ dl

Questions

What is the most probable diagnosis? (1mark)

Nephrotic syndrome

Mention any two causes of this syndrome. (1mark)

MCD, FSGS, Membranous,MPGN etc

Mention any 2 complications of this syndrome. (1mark)

Infections, thromboembolic complications

What will be the electron microscopic finding of kidney in this case? (1mark)
Effacement of foot process of visceral epithelial cells (podocytes)

Mention any one method used to quantitative estimation of 24

hrs urine protein. (1mark)
Esbach's albuminometer method, turbidimetric methods, biuret reaction, and
immunologic methods
 CHART 24
A 59 years male presented with weakness, fatigability, weight loss, right sided lumbar pain
and passage of blood in the urine, not associated with pain. He was chronic smoker.
On examination: palpable ballotable mass in the right lumbar region.
Urine microscopy: RBCs 20-30/HPF, Atypical cells +++.
Questions
What is the most probable diagnosis? (1mark)
Renal cell carcinoma

Name any one syndrome associated with this condition? (1mark)

Von Hippel Lindau, Birt-Hogg-Dube, Hereditary leiomyomatosis & RCC

Mention any four histological types of this condition. (2mark)

Clear cell RCC, Chromophobe, Papillary, Collecting duct carcinoma, Medullary RCC

Mention any two paraneoplastic syndromes associated with this condition. (1mark)
Polycythemia, hypercalcemia, hypertension, Cushing syndrome, eosinophilia,
amyloidosis.
 CHART 25
A 25 year old male presented with complaints of fever, headache and altered sensorium.
He had past history of chronic ear discharge.
On examination: neck rigidity present, systemic examination within normal limits.
CSF findings:
Appearance: turbid
Opening pressure - 220 mm of H20
Total count - 8500/cumm
DLC - Neutrophils 90%, Lymphocytes 10%
Glucose - 25 mg/dl
Protein - 180 mg/ di
Chloride - 650 mg/di

Questions
Interpret the abnormal CSF findings (2marks)

What is the most probable diagnosis? (1mark)

Acute Pyogenic meningitis

Mention the causative agent. (1mark)

Neisseria meningitides - adolescents & young adults
Streptococcus pneumoniae & Listeria monocytogens - older adults
[Link] & group B streptococcus - Neonates

What are the investigations required to confirm the diagnosis?

(1mark)
CSF analysis
 CHART 26
An 8 year old child presented with fever, headache, vomiting, neck stiffness, excessive
sleepiness and photophobia. Lumbar puncture was done
CSF findings:
Appearance: clear
Opening pressure - 200 mm of H20
Total count - 500/cumm
DLC - Neutrophils 02%, Lymphocytes 98%
Glucose- 55 mg/ di
Protein - 50 mg/di
Chloride - 750 mg/di

Questions
Interpret the abnormal CSF findings (2marks)

What is the most probable diagnosis? (1mark)

Acute Viral meningitis

Mention the causative agent. (1mark)

Entero viruses, HIV, Measles, Influenza species

What are the investigations required to confirm the diagnosis?

(1mark)
CSF analysis
 CHART 27
A 40 year old male patient presented with headache, fever, malaise along with mental
confusion and vomiting. He had a past history of chronic cough for 2 years and two
episodes of hemoptysis.
On examination: neck rigidity [Link] puncture was done
CSF findings:
Appearance: turbid (cob web formation on standing)
Opening pressure - 200 mm of H20
Total count - 600/cumm
DLC - Neutrophils 10%, Lymphocytes 90%
Glucose- 35 mg/di
Protein - 350 mg/di
Chloride - 500 mg/dl

Questions
Interpret the abnormal CSF findings (2marks)

What is the most probable diagnosis? (1mark)

Tubercular meningitis

Mention the causative agent. (1mark)

Mycobacterium tb

What are the investigations required to confirm the diagnosis? (1mark)

 CHART 28
A 27-year old male presents with complaints of fever, generalized weakness, mild right
upper abdominal pain and passing dark yellow coloured urine since past 10 days.
Examination shows icterus and mild hepatomegaly. Investigations: Total bilirubin - 4.4
mg/di, Direct bilirubin - 2.3 mg/di, Indirect bilirubin - 2.1 mg/dI, AST -
1550 U/L, ALT - 585 U/L, ALP - 100 U/L, GGT - 40 U/L, Total protein - 6.8 g/dl Albumin=
3.6 g/dl. Serology revealed HBsAg - positive, HBeAg - positive and IgM Anti HBc
Antibodies positive.

Questions
What is the type of jaundice based on the interpretation of the liver function tests? (1mark)
Hepatic jaundice

Interpret the viral serology and what is the diagnosis based on the interpretation? (2marks)
Acute viral hepatitis with Hepatitis B virus

Enumerate any two other causes of this type of jaundice. (1mark)

Autoimmune hepatitis, drug induced hepatitis, genetic disorders- Wilson’s,
hemochromatosis, alpha1 - AT deficiency.

Mention any two complications associated with this condition? (1mark)

Fulminant hepatitis, cirrhosis, HCC
 CHART 29
A 41 year old male, chronic alcoholic presented with upper gastrointestinal bleed in the
emergency. On examination: pallor+, icterust, palmar erythemat, ascitest, mild
splenomegaly. UGI Endoscopy: esophageal varices. Total bilirubin - 2.1 mg/di, Direct
bilirubin - 2.3 mg/dl, Indirect bilirubin - 2.1 mg/dl, AST - 250 U/L, ALT - 85 U/L, Alkaline
phosphatase - 90 U/L, GGT - 320 U/L, Total protein - 4.5 g/dl Albumin= 2.6 g/di

Questions
What is the type of jaundice based on the interpretation of the liver function tests? (1mark)
Hepatic

What is the complete diagnosis? (2marks)

Hepatic jaundice due to cirrhosis with portal hypertension

What will be the gross and microscopic findings of liver in this patient? (2marks)
Cirrhosis is characterized by transformation of the entire liver into regenerative
parenchymal nodules surrounded by fibrous bands
 CHART 30
A 48 year old obese female with H/O of recurrent mild right hypochondrial discomfort and
pruritus, now develops right upper abdominal pain. Examination reveals icterus, right
upper quadrant pain and sharp tenderness & respiratory arrest on inspiration in the right
hypochondrial region. Investigations show: Total bilirubin=7.0 mg/dl, Direct bilirubin=6.0
mg/dl, Indirect bilirubin= 1.0 mg/di, AST=52 U/L, ALT=59 U/L, Alkaline phosphatase=720
U/L. USG
-gallbladder wall thickening, edema with echogenic structures and posterior acoustic
shadowing.

Questions
What is the type of jaundice based on the interpretation of the liver function tests? (1mark)
Obstructive/ Post Hepatic

What is the most probable diagnosis? (1mark)

Obstructive jaundice due to gall stones.

Enumerate any two other causes of this type of jaundice.(1mark)

CBD obstruction, pancreatic malignancy, peri-ampullary Ca

What will be the urinary findings in this patient and mention the test done to detect it?
(2marks)
a. Bilirubin - Present - foam test, Gmelin’s test, Lugol iodine test, Fouchet’s test,
Ictotest tablet test, and reagent strip test.
b. Urobilinogen - Absent - Ehrlich’s aldehyde test and reagent strip test.
 CHART 31
A 48 year-old woman complains of brownish, foul-smelling vaginal discharge for the last 6
months. She also gives history of postcoital spotting. On per vaginal and per speculum
examination, the cervix showed 3 cm ulceroproliferative growth which bleeds on touch.

Questions
What is the most probable diagnosis? (1mark)
Carcinoma cervix

What is the etiology of this condition? (1mark)

HPV

Enumerate the precursor lesion. (1mark)

LSIL (CIN I), HSIL (CIN II & CIN III)

What will be microscopic feature of this condition? (1mark)

Tongues and nests of Tumor cells with desmoplastic stromal response.
Koilocytic change in superficial layer

Mention the screening program? (1mark)

Exfoliative cervical cytology / Pap smear
 CHART 32
A 55 year old female came to surgical outpatient department for a lump in her left breast
noticed 1 month back. On examination, a 2.5 cm, firm to hard irregular mass was palpable
in the upper outer quadrant of left breast. There are no overlying skin lesions. Two axillary
lymph nodes were palpable. FNAC confirmed the clinical diagnosis and left mastectomy
was done.

Questions
What is the most probable diagnosis? (1mark)
Carcinoma breast

Mention any two genes associated with this condition. (1mark)

BRCA 1, BRCA 2, TP53, PTEN

Mention any 2 histological subtype of this condition. (1mark)

Invasive ductal carcinoma, Invasive Lobular Ca, Mucinous Ca, Tubular Ca,
Inflammatory Ca.

Enumerate any 4 prognostic factors of this condition. (2marks)

Tumor spread (i.e., anatomic stage)
Tumor biology (ER and HER2 expression, tumor subtype, proliferation).
Proliferation
Special histologic types - mucinous - good prognosis
Gene expression profiling.
Response to neoadjuvant chemotherapy
 CHART 33
A 40 year old female presented with menorrhagia and dysmenorrhea of 3 months duration.
On examination uterus was enlarged and pelvic scan showed multiple well circumscribed
lesion in the myometrium. Hysterectomy was done. The cut surface of myometrium
showed multiple well circumscribed grey white mass with whorled appearance.

Questions
What is the most probable diagnosis? (1mark)
Leiomyoma

Mention the types of this condition. (1mark)

Intramural, submucosal, subserosal

What will be microscopic feature of this condition? (1mark)

Bundles of smooth muscle cells.

Mention any two secondary changes associated with this condition. (1mark)
Hemorrhage, Necrosis, Calcification, Degeneration ( hyaline, myxoid, cystic & red
degeneration )

What is the malignant counterpart this condition? (1mark)

Liomyosarcoma
 CHART 34
A 35 year old female presented with painless symmetric enlargement of thyroid gland for
last 1 year. She also complains of weight gain, lethargy, constipation, hypomenorrhea and
cold intolerance. On examination: Thyroid gland enlarged.
Investigations
TSH - 15 mU/L (normal 0.5-5 mU/L).
T3 - 50 ng/dl (normal 80-180 ng/di).
T4 - 2.5 kg/dl (normal 5-12.0 mg/di).
Radioactive iodine uptake 5% (normal 10-30%).

Questions
What is the clinical diagnosis? (1mark)
Hypothyroidism

Mention the most probable cause of this condition? (1mark)

Autoimmune thyroiditis

Mention any other blood/serum analysis done to arrive at the diagnosis. (1mark)
Anti-thyroid antibodies (TPO)

What will be the histological finding of thyroid in this patient? (2marks)

Atrophic thyroid follicles with sheets of mononuclear inflammatory infiltrate
containing lymphocytes, plasma cells, and macrophages with well-developed
germinal centers
 CHART 35
A 32 years female complains of weight loss, nervousness, irritability, insomnia,
menorrhagia and heat intolerance along with enlargement of thyroid gland for last 5
months. On examination, she had proptosis with lid retraction, pretibial non-pitting edema,
tachycardia and fine tremor.
Investigations
T3 - 290ng/dl (normal 80-180 ng/di).
T4- 18 g/di (normal 5-12.0 mg/dl).
TSH - 0.1 mU/L (normal 0.5-5 mU/L).
Radioactive iodine uptake 40% (normal 10-30%).

Questions
What is the clinical diagnosis? (1mark)
Hyperthyroidism

Mention the most probable cause of this condition? (1mark)

Grave’s disease

Mention any two different antibodies involved in the pathogenesis of above mentioned
disease. (2marks)
Thyrotropin receptor Ab, Thyroglobulin Ab, TPO Ab, Thyrotrophin binding inhibitory
Ig

What will be the histological finding of thyroid in this patient? (1marks)

Hyperplastic thyroid follicles with papillary infoldings.
 CHART 36
A 16 year old male with H/O polyuria, polyphagia and polydipsia on regular medication
was brought to the emergency with loss of consciousness.
On examination: thin built, tachycardia, tachypnea and acidotic breathing (Kussmaul's
breathing) present.
Investigations
Random Blood Sugar - 550 mg/di
Arterial blood pH - 7.1 (normal 7.4)

Questions
Mention the clinical complication and the condition associated? (2marks)
Type 1 DM with Diabetic ketoacidosis (DKA)

Mention any two other complications associated with this condition. (1mark)
Hyperosmolar hyperglycemic nonketotic syndrome, Hypoglycemia, Macrovascular
disease, micro vascular diseases, increased susceptibility to infections.

What will be the urinary finding in this patient and name the test done to detect it. (2marks)
Glucosuria - Benedict / dipstick
Ketonuria - Rothera / dipstick
 CHART 37
An 18-year-old male presented to orthopedic department with a complaint of pain and
progressive swelling around his right knee for the past 3 months. Physical finding showed
a diffuse hard swelling with local pain over the area of the distal right femur. An X-ray of
the right knee showed an ill-defined mass involving the metaphyseal region of the distal
right femur with elevation of the adjacent periosteum. A bone biopsy specimen was
obtained and it confirmed the provisional clinical diagnosis.

Questions
What is the most probable diagnosis? (1mark)
Osteosarcoma

Mention the types of this condition. (1mark)

Primary and Secondary (Pagets, infarction & radiation)

What will be microscopic features of this condition? (2marks)

Malignant tumor cells producing unmineralized osteoid or mineralized bone along
with abundant mitosis, extensive necrosis and vascular invasion.

Mention the classical radiological finding in this case. (1mark)

Codman triangle
SYSTEMIC PATHOLOGY CHARTS
Chart 14: Acute Rheumatic Fever
Chart 15: Acute Myocardial infarction with cardiogenic shock
Chart 16: Pulmonary Tuberculosis
Chart17: Pneumonia
Chart 18: Lung carcinoma/Bronchogenic carcinoma
Chart 19: Carcinoma stomach
Chart 20: Peptic ulcer
Chart 21: Carcinoma colon
Chart 22: Nephritic syndrome - PSGN
Chart 23: Nephrotic syndrome - MCD
Chart 24: Renal cell carcinoma
Chart 25: Acute pyogenic meningitis
Chart 26: Acute viral meningitis
Chart 27: Tuberculous meningitis
Chart 28: Acute viral hepatitis
Chart 29: Cirrhosis with portal hypertension
Chart 30: Obstructive jaundice due to gallstones
Chart 31: Carcinoma cervix
Chart 32: Carcinoma breast
Chart 33: Fibroid uterus / leiomyoma uterus
Chart 34: Hypothyroidism - Hashimoto's thyroiditis
Chart 35: Hyperthyroidism - Grave's disease
Chart 36: Type 1 DM with Diabetic ketoacidosis (DKA)
Chart 37: Osteosarcoma