MNJ07-001
* A six-year-old child investigated for increasing pallor, peripheral blood examination was done that is shown below:

1. Name the intracellular inclusion seen m this blood film
2. Name the condibons in which 1t is seen (Write 3 at least).

Answer

MNJ07-002
* (2014 Exam):

1. Identify the abnormality pomted in the given PBF (Peripheral blood film).
2. Give 2 differential diagnosis.

Answer

MNJ07-003
* PBF of an 8-year-old child was investigated and pathologist inform you about the satellitism of platelets in PBF:

1. Describe platelet satellitism.
2. What 1s its clinical sigmficance?
3. Next step 1n evaluation in these patents.

Answer

MNJ07-004
Bone marrow aspirate of an 18-month-old child witha history of hypertonicity, aspiration pneumonia and hepatosplenomegaly: See the film and answer the following questions:

1. Describe the findings and write the diagnosis.
2. Give 2 clinical differential diagnosis.
3. Management

Answer

MNJ07-005
A 4-year-old male child presents with fever, hepatosplenomegaly, lymphadenopathy and petechial rash over body, bone marrow was done:

• 1, Whats this cell and type of malignancy?

2. Write down 4 prognostic factors (favorable).

Answer

MNJ07-006
* A 10-year-old male boy from Bihar, presents with complaints of prolong fever, weight loss and hepatosplenomegaly. Bone marrow was done in film below:

[ Blood Film 87 |

1. Identify the bone marrow abnormality and write the possible diagnosis.
2. What are diagnose test for this disease?
3. ..Write treatment with two new drugs.

Answer

MNJ07-007
* A7-month-old male child was brought from Abbottabad with complaints of loose stools and fever off and on for the last 6 months. On examination, he had hepatomegaly 10 cm, splenomegaly 5 cm, delayed milestones, and fundoscopy showed cherry-red spots:

1. What 1s diagnosis of this bone marrow and clinical scenario?
2. Write the inheritance of this disease.
3. Enzyme defect responsible for this.

Answer

MNJ07-008
*

1. Identify the slide A and B
2. Write down the treatment for both A and B.

Answer

MNJ07-009
* 1 Identify slide A, B, C and D.

2. Write down steps for gram and acid fast staimng.

Answer

MNJ07-010
* Exam 2014:

Match

• A. Renal disease
• B Thalassemia
• C. Pernicious anemia
• D G6PD deficiency
• E Myelofibrosis
• F Liver disease

1. Spur cell
2. Burr cell
3. Target cell
4. Cabot ring
5. Bite cell
6. Teardrop cell
   a. Renal disease
   c. Pernicious anemia

Answer

MNJ07-011
* Peripheral smear:

rs Blood Film 89 ]

1. What is the diagnosis?
2. What is the drug of choice for the prevention of painful episodes?
3. What are measures for the primary prevention of stroke in these children?
4. What are the antibiotics of choice in acute chest syndrome?
5. What type of renal malignancy is common in this condition?

Answer

MNJ07-012
* 1-year-old child with high fever and convulsions:

• 1, What does the smear show?

2. What association will you suspect in chnical examination with this blood filrr
3. Whats the likely cause of the symptoms?
4. Which orgamsm is responsible?
5. How could you have prevented this infection?

Answer

MNJ07-013
* Exam 2013, 2014:

• * Neurological
• * Metabolic
• * Hepatic
• * Endocrinal

1. Describe the cells seen.
2. Name one condition each from following category in which these cells are seen:

Answer

MNJ07-014
* A 10-year-old girl presents with fatigue and tingling sensation from last one month, on examination pallor was presents with murmur, all other examination was normal, PBF is given below:

1. Describe this peripheral smear
2. Diagnosis the condition and give 6 differential diagnoses of macrocyte
3. Define this abnormality of neutrophil and write down 4 causes of it.

Answer

MNJ07-015
*

1. Identify cell and write condition it is seen in
2. What are clinical features of this condition?

Answer

MNJ07-016

• An 8-year-old boy presented with pain in throat with difficulty in respiration 1 day. Throat examination showed palatal weakness with white patch on tonsil
  • 1. Name two common complications in this situation.
  • 2. What is the name of stain in the slide?
  • 3. Write differential diagnosis of white patch on tonsil.

1. Name two common complications in this situation.
2. What is the name of stain in the slide?
3. Write differential diagnosis of white patch on tonsil.

Answer

MNJ07-017
Blood Film 91

1. Name the spot
2. What are these chambers used for A and B (blood cells)?
3. If doing CSF cytology for WBCs, which chambers are used for this purpose?

Answer

MNJ07-018

ANSWERS

• Ans. 1. 1. Cabot ring
  • 2. Lead poisoning

Pernicious anemia (vit B₁₂ deficiency)

Hemolytic anemias

• Ans. 2. 1. Basophilic stippling ** this question can be asked along with X-ray knee of lead poisoning.
  • Thalassemia, vit B₁₂ deficiency
    • Lead poisoning
  • The desferal therapeutic index or porter index is defined as mean daily dose of desferrioxamine in mg/kg, divided by serum ferritin. This is useful in thalassemia patient.
    • This is calculated every 6 months in paitents receiving desferrioxamine.
    • Porter index should not exceed 0.025 in order to minimize sensorineural hearing loss.
• Ans. 3. 1. Platelet satellitism: Platelet clustering around neutrophils in the presence of EDTA
  • 2. Pseudothrombocytopenia
  • 3. Repeat platelet count in citrate sample
• Ans. 4. 1. Two macrophages are shown which have a fibrillar, crumpled appearing cytoplasm and eccentric nuclei, consistent with Gaucher cells This seen in Gaucher disease.
  • 2. Niemann-Pick, MPS (Mucopolysaccharidosis)
  • 3. Enzyme replacement (60 $\mu /kg/m^2$ ): Cerezyme (imiglucerase for injection) is indicated for long-term enzyme replacement therapy.
• Ans. 5. 1. Blast cell: L₃ type—Burkitt's lymphoma
  • 2. Age (>1 year, <10 years)

Hyperdiploidy

T 4:11 to 12:21

Low TLC at the time of diagnosis

• Ans. 6. 1. LD bodies in bone merrow-kala azar
  • 2. Diagnosis—bone merrow, NNN media culture (Novy McNeal-Nicolle Media)
  • Sodium stibogluconate—20 mg/kg/day for 1 month and amphotercin B 1 mg/kg/day for 1 month

New drug-pentamidine and amofostine

• Ans. 7. 1. The foamy appearing cell with a small nucleus is a macrophage containing lysosomes filled with sphingolipid. The patient has Niemann-Pick disease
  • 2. AR disease
  • 3. Absence of lysosomal sphingomyelinase.
• Ans. 8. 1. Trophozoites forms Schuffner stippling—Plasmodium vivax
  • 2. Plasmodium falciparum with >80% infected RBC.

Treatment A-Chloroquine for 3 days with 14 days primaquine

B—Artesunate for 3 or 7 days with single day primaquine

• Ans. 9. 1. A = Gm cocci B = AF bacıllı C = Gm + cocci D = Gm bacıllı
  • 2. Gram staining

Blood Film 93 |

Ziehl-Neelsen technique

• * Heat and dry Fix the smear
• * Add strong carbol fuchsin
• * Heat approximately for 5 mins. Do not boil
• * Decolorise the smear with 20% sulfuric acid
• * Wash with water
• * Counterstam with methylene blue

Steps of gram staining.

• * Heat fixation of smear
• * Apply crystal violet stain (primary stain)
• * Flood with gram iodine for 10 sec
• * Decolorise the smear with 95% ethyle alcohol
• * Wash with water immediately
• * Counter stain with basic fuschin/safranin for 15 sec

Ans. 10. 1. Hypercellular—megaloblashe anemia

• . Normal
• : Hypocellular BM—aplastic anemia
• Ans. 11, 1. F, 2A, 3.B, 4C, 5. D, 6 E

Ans. 12. 1. Sickle cell anemia.

Time averaged mean maximum blood flow (TAMM) 1s more than 200 cm/sec to maintain Hb 5 levels less than 30%

• . Third generation cephalosporin.
• . Renal medullary carcinoma.
• Howell-Jolly bodies (nuclear fragments of condensed DNA)
  • . Absence of spleen
  • . Bacterial meningitis
  • . Streptococcus pneumoniae
  • . Pneumococcal conjugate vaccine

Acanthocytosis (spur)

. Conditions

Ans. 15. (Must know)

• Ae Megaloblastic anemia

Macrocyte

Vit By deficiency, hypothyroidism, orotic aciduna, and aplastic anemia Chronic liver disease, Diamond-Blackfan syndrome

• Causes-vitamin B₁₂ deficiency, IDA, uremia, hydroxycarbamide treatment
• Ans. 16.1. Chédiak-Higashi cells in Chédiak-Higashi syndrome
  • 2. Partial oculocutaneous albinism and recurrent infection

Ans. 17. 1. Diphtheria

• · Myocarditis

• Neuroparalysis

• Both leading to hypoxia

• · Upper airway obstruction

• · Strep. throat

• · Exudative tonsillitis

• · Infectious mononucleosis

Ans. 18. 1. Neubauer chamber

Ans. 19.1. Acanthocytosis

• TGL
• Absent B lipoproteins

1. Identify the abnormality in RBC.
2. This child has chronic diarrhea with foul smelling stool. What is the possible diagnosis?
3. Which vitamin deficiency in these children is associated with neurological symptom?
4. Which lipid abnormalities are characteristics?
5. What is the fundus finding?
6. What is the mode of inheritance?
7. Lead poisoning
8. Pseudothrombocytopenia
9. Repeat platelet count in citrate sample
10. Niemann-Pick, MPS (Mucopolysaccharidosis)
11. Enzyme replacement (60 $\mu /kg/m^2$ ): Cerezyme (imiglucerase for injection) is indicated for long-term enzyme replacement therapy.
12. Age (>1 year, <10 years)
13. Diagnosis—bone merrow, NNN media culture (Novy McNeal-Nicolle Media)
14. AR disease
15. Absence of lysosomal sphingomyelinase.
16. Plasmodium falciparum with >80% infected RBC.
17. Gram staining
18. Hydroxyurea.
19. Transcranial Doppler—blood velocity of ICA
20. Macrocyte, hypersegmented neutrophil
21. Presence of one or more netrophil with 6 lobe or 5 or more cell with 5 lobe among 100 segmented nutrophils
22. Partial oculocutaneous albinism and recurrent infection
23. Complications
24. Albert stain
25. Differential diagnosis
26. A-WBC and B for RBCs and platelets
27. All 9 corners
28. Abetalipoproteinemia
29. Vitamin E
30. Cholesterol
31. Retinitis pigmentosa
32. Autosomal recessive

Answer