CHARTS-SP.ppt

CHARTS Department of Pathology, Hassan Institute of Medical Sciences, Hassan.  Chart - 1 An 8-year-old female child was taking insulin injections for IDDM for the last 4 years. The child developed a respiratory tract infection, following whi...

CHARTS Department of Pathology, Hassan Institute of Medical Sciences, Hassan.  Chart - 1 An 8-year-old female child was taking insulin injections for IDDM for the last 4 years. The child developed a respiratory tract infection, following which she started having nausea, vomiting and altered consciousness and finally developed coma. BLOOD INVESTIGATIONS : Hb – 10 gm% TLC – 15,000 / cumm. DLC – Neutrophils 89% Band forms 6% Lymphocytes 5% Blood Glucose - 480 mg/dl. Blood Urea - Normal. CSF : Findings within normal limits. URINE : Benedict’s Test - Positive (++++). Rothera’s Test - Positive. What is your diagnosis?  Chart - 2 A 40-year-old female has deep yellow coloration of eyes and complains of colicky pain in right hypochondrium with vomiting and pruritis for the last 4 months. Stools was clay coloured. URINE : Color - Deep yellow Albumin - + Sugar - Absent Urobilinogen - Absent Bile salts - Present Bile pigment - Present What is your diagnosis?  Chart - 3 An 18-year-old male presented with yellowish discolouration of skin with fatigue. He had history of Intermittent Jaundice. ON EXAMINATION : icterus was present. Spleen was enlarged. His father also had similar complaints. INVESTIGATIONS : Hb - 8 gm% MCV - 70 fl. MCH - 30 pg. MCHC - 40 gm/dl. Reticulocyte count - 8% Osmotic fragility - Increased. Chart – 3 ….. contd Peripheral smear – given below: What is your diagnosis?  Chart - 4 A 68-year-old male came with complaints of pain in lower back. He also had weakness and lethargy. On examination, multiple localised tender areas were present in the bones. INVESTIGATIONS: BLOOD : Hb - 6 gms % ESR - 150 mm at the end of 1 hr. PS Findings - Marked rouleux formation is seen. URINE - Protein - +++. Sugar – Nil. Micro – NAD.  Chart 4..contd. X – ray of the skull – What is your diagnosis?  Chart - 5 A female patient aged 32 years came with dyspnoea on exertion, palpitations and generalized weakness for the last 3 months. She also had history of irregular, heavy menstrual cycles since last 6 months. On examination severe pallor was present. INVESTIGATIONS: BLOOD : Hb - 5 gms % TC - 8,400 cells / cumm. ESR - 70 mm after 1 hr. Reticulocyte count - 1% Platelet count - 3.5 lakh/cumm. MCV - 50 fl. MCH - 18 pg. MCHC - 25 gm%. Chart - 5 Peripheral smear: What is your diagnosis?  Chart - 6 A 40-year-old male presented with easy fatiguability and weakness. On examination massive splenomegaly was present. Pallor was present. INVESTIGATIONS: BLOOD : Hb - 8 gms %. TC - 2,40,000 cells/cumm. DC - Myeloblast - 01% Promyelocyte - 03% Myelocyte - 35% Meta Myelocyte - 05% Basophils - 11% Band form - 20% Segmented Neutrophil - 25% Platelet count - 600,000 /cmm. What is your diagnosis?  Chart - 7 A 60-year-old man was being examined as a part of general health check up. He had no health complaints. INVESTIGATIONS: BLOOD : Hb - 12 gms% TC - 80,000 cells/Cmm. DC - Lymphocytes - 90% Neutrophils - 10% PS Findings - RBCs are normocytic and normochromic. Most of the WBCs are mature-looking small lymphocytes. Platelets were with in normal limits. What is your diagnosis?  Chart - 8 A 15-year-female admitted with complaints of bleeding from nose since 15 days. H/O menorrhagia since 15 days. No H/O Diabetes/ tuberculosis /Hypertension. On examination : Pallor - ++. No cyanosis/edema/lymphadenopathy. CVS, RS –NAD. Per abdomen – Liver palpable 2 cm. Spleen not palpable. INVESTIGATIONS: BLOOD : Hb - 6.1 gms% TC - 81,000 cells/Cmm. DC - Blast cells - 68 % Lymphocyte - 27 % Neutrophil - 05% Platelet count - 40,000 cells/cumm. MCV - 83 FL. MCH - 25.8 pg. MCHC - 31% Cytochemistry: Blasts for Myeloperoxidase - positive What is your diagnosis?  Chart - 9 A 12-year-old male child was brought to the hospital with history of Swelling all over the body since 8 months. Paleness and puffiness of face were present since 1 month. INVESTIGATIONS: BLOOD : Hb - 8.2 gms % TC - 9,200 cells/cmm. ESR - 35 mm after 1 hr. BIOCHEMISTRY : Total Plasma Proteins -3.7 gms/dl. Plasma Albumin - 1.7 gms/dl. BUN – 20 mg% Serum creatinine – 0.6 mg% URINE : Albumin - ++++ Sugar - Nil. Microscopy - NAD. What is your diagnosis?  Chart - 10 A 6-year-old female child complained of severe headache and fever for last 5 days. On Examination ear discharge was seen on left side. Lumbar puncture was performed. C.S.F. ANALYSIS 01. Pressure - Greatly increased. 02. Appearance - Turbid. 03. Proteins - 500 mg/dl. 04. Glucose - 20 mg/dl. 05. Cells - 5,000 cells/Cmm (95% neutrophils) What is your diagnosis?  Chart - 11 A 60-year-old obese female admitted with c/o increased frequency of urination and increased appetite since 1 month. She c/o breathlessness for the last 2 days. O/E – Obese, afebrile, conscious and well oriented. Pulse – 112/min. R.R.-44/min. B.P.-130/80 mmHg. Pallor - +. Systemic examination – CVS, CNS, P/A – NAD. R.S – bilateral basal crepts. INVESTIGATIONS : Hb – 10 gm% TLC – 11,000 /cumm. DLC – Poly – 80%, Ly – 20% ESR – 25 mm at end of 1 hour. Blood sugar (random) - 398 mg % URINE – Albumin – nil - Sugar - +++ - Ketones bodies – Present. - Micro – NAD. What is your diagnosis?  Chart - 12 A 16-year-old male admitted with C/O decreased urine output since 8 days. He also had Nausea and vomiting and swelling of feet since 15 days. He gave history of sore-throat 1 month before. O/E – Patient is Conscious, febrile, well-oriented. Pulse – 102/min., RR- 26/min., BP – 140/90 mm Hg. Pallor - ++. Edema feet – + + (Pitting type). Systemic exam – CVS, RS - , P/A - NAD. INVESTIGATIONS - Hb – 7.6 gm %. TLC – 7800/cumm. DLC – Poly – 70%, Lympho – 30% Blood Urea – 245 mg % Serum Creatinine – 10.6 mg % Serum proteins – 7.1 gm % Urine – Alb - + Sugar – nil Microscopy – 3-4 pus cells / hpf - 2-6 Epithelial cells /hpf. - numerous RBCs with RBC casts present. What is your diagnosis?  Chart - 13 A 53-year-old lady was admitted to the emergency ward in a semiconscious state. The relatives told that she had abnormal behavior since last 15 days. She was a known case of NIDDM for the last 12 years. O / E – Patient was not responding to oral commands. Afebrile, Pulse- 96/min. BP-140/90 mm Hg. Pallor- + Systemic examination – NAD. INVESTIGATIONS : Hb - 8 gm% ESR - 60 mm at the end of 1 hour. Blood sugar– 292 mg% Blood Urea – 133.8 mg% Serum creatinine – 8.7 mg% URINE – Albumin - + Sugar - + Micro – 3-4 pus cells /hpf - 1-2 Epithelial cells /hpf. What is your diagnosis ?  Chart - 14 A 21-year-old medical student was admitted with H/O Pain in abdomen, vomiting, decreased appetite and yellowish discoloration of urine since 15 days. O/E – He was conscious , afebrile. Pulse -90/min., RR- 22/min., BP- 110/70 mmHg. Icterus -++ Systemic examination – CVS, RS- NAD. Per abdomen- Liver palpable (2 cms below costal margin) and tender. No splenomegaly. INVESTIGATIONS : Hb-11 gm% TLC – 22,000 /Cmm. DLC – Poly : 80 %, Ly:20% Serum Bilirubin -12.8 mg%, SGOT- 88 IU/L SGPT- 92 IU/L. Blood Sugar - 107 mg% Serum Proteins - 8.9 gm%, Serum Albumin – 4.2 gm% What is your diagnosis?  Chart - 15 A 30 year old lady came to the physician with the complaints of emotional instability, nervousness and palpitations for the last 3 months. She also had menstrual disturbances. On examination: she was poorly built and nourished. Pallor ++. Fine tremors were seen in the hands. Systemic examination – CVS- Tachycardia and cardiomegaly present. RS, CNS - NAD. The thyroid gland was moderately enlarged. Suspecting a thyroid disease, the physician ordered thyroid function tests. The results were as follows : Serum T4 =20 μg/dl. ( N = 5-12 μg/dl) Serum T3 =260 ng/dl. (N = 70-190 ng/dl) Serum TSH = 0.2 μU/ml. (N = 0.4- 5.0 μU/ml) What is your diagnosis?  Chart - 16 A 9-year-old boy came to the hospital with complaints of spontaneous skin bleeding, weakness and high degree fever. On examination, Cervical and axillary lymph nodes were palpable on both sides. Oral examination revealed severe thrush. Moderate hepatomegaly was present. BLOOD : Hb - 6 gms % TC - 1,10,000 cells/Cmm. DC - Blast cells - 85% Lymphocytes - 12% Neutrophils - 3% Platelet count - 50,000 /Cmm. PS Findings - RBCs are normocytic and normochromic. Blasts - have scanty agranular cytoplasm. Nucleus has dense chromatin and indistinct nucleoli (