Chart K H Patil no 2 cahrats for examination

Charts

1. What is the diagnosis? What is the expected histologic finding of the condition described above In direct immunofluorescence (DIF) testing, which pattern is most commonly observed in the given diseased Which of the following antibodies is most commonly associated with the pathogenesis of above diseased The given disease affects which of the following layers of the skln ?

2. CASE 14 A 10-year old male patient presented wit h swelling in the face, legs and scrota l region . He had recent history of pharyngiti s illnes s 8 days before hi s complaint s started, had a diarrhea (up to 3— 4 times a day) few days before hi s presentation and urinary output was reduced. On physica l examination, his body weight and height were in the 25— 50t h percentile, his blood pressure wa s 135/80 mmH g . He had pretibial 2+ edema and diffuse edema in th e palpebraes, pubic regio n and scrotal region. At presentation, urinalysi s finding s wer e as follows : pH : 5, density : 1020, protein 3+ , erythrocyte 3+ , leukocytes 1+. Urinary microscopi c examination showed abundant erythrocytes, 4— 5 leukocytes . The other laboratory tests were as follows: urea : 195 mg/dL, seru m creatinine: 2.58 mg/dL. Renal Biopsy and immunoflourescence image given below. C3 protein

3. CASE - 21 2 5 years old femal e wit h 7months of gestation comes to emergency department with symptoms of breathlessness and easy fatiguability. On examination, she was pale, icteric and had pansystolic murmur on auscultation . Investigations revealed Hemoglobin — 6g/dL, MCV- 68fL,MCHC — 30@dL, MCH — 26 pg . Ultrasound abdomen showed absence of spleen and a single live intrauterine pregnancy of 27 weeks gestation. Following are the peripheral smear image and Hemoglobin electrophores is findings. What are the findings on peripheral smear? Interpret Hb electrophoresis List the mutations associated with the above conditio n What are the complications of the above condltion7

4. CASE- 12 A 3 8-year- old North Indian woman presente d with a history of lower extremity edema, fatigue, and weight loss of 3 kg in 4 weeks. Physical examination revealed erythematous skin lesions over the face and the Neck. Laboratory investigations showed lymphopenia, low C3 and C4 complement levels, positive antinuclear antibodies, anti- dsDNA antibodies, and anti- SSA/Ro antibodies. Renal function tests showed normal serum creatinine and nephrotic proteinuria. Renal Biopsy showed increase cellularity in glomeruli. Im munofluorescence image given below. 1 .What is the e tiop thoge ne sis and m icroscop ic p a tt 2 F ns of this d isease? 2. Interp r et the im mu n ofluor esce nce image findin gs7

5. CASE -17 A 69-year- old woman with a past history of low back pain, hypertension, and hyperlipidemia presented with a chief complalnt of a dorsal ulnar- sided leh hand- wrist mass that had been growlng slowly over the previous10years.The mass had become progressively more painful over time, being particularly tender when she wore a watch. No history of preceding trauma or constitutional symptoms. On examination, there was a small palpable mass that was semi- flrm and not mobile; quite tender to palpation was noted. X- Ray showed marked osteoarthritic changes. Surgical excision of the mass was done.

6. CASE - 18 A 66 year female presented with paroxysmal right hypochondrial pain since 6months, The day before the visit, the patient presented with worsening of upper abdomen pain accompanied by nausea and vomiting. Also, patient experienced loss of appetite and weight loss over 5 kg in past 6 months. Abdominal ultrasound suggested thickening of the gallbladder wall. CT scanning of upper abdomen showed marked signal abnormality in the gallbladder. Patient underwent surgical treatment. Interpret the H&E images and IHC findings How do you grade the tumor

7. CASE 24 A 27- yearold man came in to your clinic due for yellowish discoloration of skin and sclerae. Past history revealed several blood transfusions during his childhood. No significant family history. Patient is conscious coherent, oriented to time, place and person. He is fairly nourished, pale- looking and moderately jaundiced. On examination: BP = 130/90 mmHg, RR = 22 bpm, HR = 98 bpm, T= 37.8°C. Abdomen examination - Slightly globular, splenomegaly + Hgb = 9 g/L Hct = 27 % RBC - 3.8x10" WBC - 6200cells/mm’ MCV = 75 ug MCHC = 40 g/dL Reticulocyte count - 6.5% Direct antiglobulin test— Negative Interpret the peripheral smear Image. Interpret the osmotic fragility test Image.

8. CASE 1S A 73 years old Indo- African female presented to the emergency department with sudden onset shortness of breath with no associated chest pain. She had a longstanding history of heart failure with echocardiogram (ECHO) demonstrating a left ventricular ejection fraction (LVEF) of 40%. Complete blood count and comprehensive metabolic panel were within normal limits. Serum protein electrophoresis demonstrated moderate hypoproteinemia and hypoalbuminemia with no monoclonal spike (M spike). Urine immunofixation was negative for immunoglobulin light chain. There was a significant elevation for N- terminal pro b- type natriuretic peptide (NT- ProBNP) - 12914 pg/mL (Normal < 125 pg/mL).Immunoflourescence image given. What is the ae tiopathogenesis and special stains used to identify this condition Interpret Immunofluorescence findings ?

9. CASE - 22 16 year s old female came wit h complaint s of easy fatiguability, joint pains and mild jaundice. On examination , she wa s pale , icteric and spleen was not palpable. Investigations revealed hemoglobin of 7.7g/dL, leucocytosis (22,000/cumm) and thrombocytopenia. Red cell indice s wer e on lowe r limi t wit h MC V — 78fL , MCHC — 30g/dL, MCH — 28pg. RDW- CV — 22. Iron studies were normal. Peripheral blood smear an d Hb electrophoresis showed the following findings. What are the findings on peripheral smear7 Interpret Hb electrophoresis List the mutation associated with the above condition? What are the complications of the above condition