Day 9/10 | TEN ON TEN 4.0 | #inicet #fmge #neetpg

Added: 2026-05-15

[00:00:01]Hi everyone, welcome to day nine of the 10 on 10 series and we are going to have 10 one liner quick discussion for pathology. Now let's start with the first one where I've taught you that this is we know for a fact this is the Kimmelstiel-Wilson lesion. So you will get a history where the HbA1c levels are uncontrolled indicating towards diabetes mellitus and then they'll ask you the other name of KW lesion which is nodular glomerulosclerosis.

[00:00:23]I mean I can see the glomerulus over here which is obvious. The pink color sclerotic material is seen but it is arranged in the form of nodules and hence the name. If you want to confirm that the special stain is PAS positivity. The second is going to be identifying the cardiomyopathy. Over here I can see that in between the cardiac fibers there is a pink material which is identified outside the cardiac cells. So whenever pink for a protein which is extracellularly deposited tells me about amyloid. Amyloidosis is the most common cause of restrictive cardiomyopathy. If you wanted to confirm it you could see it on an Congo red stain where you would see apple green birefringence. The third set of disorders are identifying the intestinal pathology where there is fatty stools and as soon as I say PAS positive macrophages in the lamina propria it's a giveaway for Whipple's disease which is caused by a bacteria Tropheryma whipplei and that is why we are getting that PAS positivity. PAS gives a pink color as you can see and these are macrophages which have eaten that bacteria. They are seen in the lamina propria. Next we come to again a case of diarrhea but this diarrhea is also associated with a skin manifestation that is dermatitis herpetiformis which gives me a big hint towards celiac disease. Celiac disease is the one that is associated with which HLA polymorphisms? DQ2 DQ8 polymorphism and anyone who consumes gluten that is barley, rye, oat and wheat will have a problem with this. Now the criteria that we have in medicine for celiac disease is going to be the Marsh criteria which is also a question and I hope you remember the DGDD that these patients have diarrhea in in the duodenum is affected most commonly. The skin manifestation is dermatitis herpetiformis and the treatment of DH is going to be Dapsone. Moving on to the fourth one where you have to identify tumor markers for all ovarian tumors.

[00:02:07]For surface epithelial tumors it is CA 125. For dysgerminoma in the ovary and seminoma counterpart in testis it is going to be LDH and PLAP. For yolk sac tumor it is of course alpha-fetoprotein.

[00:02:19]For choriocarcinoma it is beta hCG. And for granulosa cell tumor I hope you've not forgotten the 99-year-old granny. So if the CD marker is asked, it is CD 99.

[00:02:29]And she is inhibited, remember calling the ex story? So Call-Exner bodies are seen and that is inhibited. Never call your ex, so inhibin is the tumor marker.

[00:02:38]Moving on to the fifth one, identifying all the intestinal ulcers that they can ask you in the exam. When they say the longitudinal versus transverse ulcer, long the way you wear a tie, so that is going to be a longitudinal ulcer. And then TB is going to show you a transverse ulcer. When they ask you about flask-shaped ulcers that is amoebic, so Entamoeba histolytica. When they say skip lesions with serpiginous ulcers, so that kind of a serpiginous is going to be seen with Crohn's disease.

[00:03:04]And when they say ulcers along with pseudopolyps, so there are ulcers with pseudopolyp, ulcer with pseudopolyp, that is indicative of ulcerative colitis. Moving on to the sixth one, last revision of all the iron profile studies. In iron deficiency anemia it's a deficiency, so iron is low.

[00:03:20]The transport of transferrin is also low. The bank account of storage of ferritin is also low. As a result, the overall hunger or the total iron binding capacity is going to be more. On the other hand, if there is an iron overload, that is sideroblastic anemia, the iron is more, the traveling transferrin saturation is more, the bank account ferritin will have more. As a result, the hunger is going to be decreased. Now coming to anemia of chronic disease where they always tell me about chronic disease rheumatoid arthritis. Because of that, the interleukin 6 that is released, that is going to result in a release of a very important molecule from the liver called hepcidin. And hepcidin is an inhibitor.

[00:03:57]It will not let you absorb any iron. So, iron goes down, the travel partner goes down, but what is actually increasing is going to be the bank account of the storage. So, ferritin levels are more, and that is how initially both of iron deficiency and AOCD look the same. But when I saw the bank account, is where I could make the difference. Now, if ferritin is a lot of iron in the ferritin, overall the hunger in anemia of chronic disease is going to go down.

[00:04:21]Moving on to the seventh where you have to identify the leukemia. Whenever the blast count is going to be more than 20%, I know for a fact it's an acute leukemia. Now, which acute leukemia? ALL or AML? PAS positivity tells me lymphoblast. So, this is going to be ALL. And Auer rods tells me myeloblast.

[00:04:38]So, this one will be AML. Then if I say there is an adult with atypical cells showing crisscross Auer rods, that is nothing but an indication of the cells. Lots of Auer rods which are seen with AML M3. Which is the only leukemia where death can happen because of DIC, that is also known as AML M3. And which is the only leukemia which has nothing to do with radiation, that is going to be CLL. Well, in yesterday's session on stains, I was teaching you which is the leukemia in which the LAP score.

[00:05:06]Remember, the normal LAP score is between 40 to 100, but a low LAP score is going to be seen in case of CML.

[00:05:12]Coming to the eighth set of one liners where you have to identify the lymphoma.

[00:05:16]I'll start with the easiest one which is starry sky and Burkitt's lymphoma, always associated with or in most cases associated with Epstein-Barr virus. That is why you get an African child with a jaw swelling, the classical photo which you know. Then let's talk about Reed-Sternberg cells which indicates me towards Hodgkin's lymphoma. If they say the usual 15-30 positivity, that's going to be the classical Hodgkin's lymphoma.

[00:05:38]Whereas if they say that 15-30 is not positive, it's the other markers like CD20 and 45 positive, that is non-classical Hodgkin's lymphoma. I hope you remember that is nothing but nodular lymphocyte predominant Hodgkin's lymphoma NLPHL and the type of RS cells that you see over there are going to be the popcorn RS cells.

[00:05:58]Moving on to the ninth one, you've got a set of tests. You have to match it with the respective disease. Before that, you should be knowing what does bleeding time measure? It measures platelet. What does prothrombin time measure?

[00:06:09]Prothrombin time is learned as pet, so that is an indication of the extrinsic factor or the extrinsic pathway. So, extrinsic pathway is going to be factor seven and three and APTT measures intrinsic pathway which was learned as tenny. Tenny for 12, 11, nine, and eight. So, first let's me look at let me look at the platelet disorder. In ITP, it's the platelet count which has gone down. So, primarily what will get affected will only be the bleeding time.

[00:06:33]Look at this first situation where I can see that the bleeding time is increased because the platelet count is going down and everything else is normal, so this fits very well. Now, let's talk about hemophilia. Whether I say hemophilia A which is a factor eight deficiency or hemophilia B which is a factor nine deficiency, both of these would be the intrinsic pathway and involving APTT.

[00:06:53]So, only APTT is supposed to increase and everything else should remain normal, so I've got the next match also.

[00:06:59]So, automatically what we are left with is this combination of von Willebrand disease which is a deficiency of the von Willebrand factor. Now, that's a kind of a dual pathology. If von Willebrand factor is not there, the platelets will not work properly which means that the bleeding time will increase. If von Willebrand factor is not there, factor eight will also not work properly which means the APTT is going to increase and that leaves me with a normal PT and I've got all the matches correctly. Moving on to the last one that you have, a final revision of all the temperatures on which you store the blood products in the blood bank. Red blood cell, anything with red blood cell which includes the whole blood also is put in a refrigerator which has a temperature of 2 to 6 degrees, like a routine refrigerator in your home. Now, when you talk about platelets, that is kept at a 20 to 24° C. I showed you in the instrument class the platelet agitator, so they have to be constantly kept in agitation, and the shelf life will be 5 days. For fresh frozen plasma, the frozen word tells me that the temperature has to be in minus, and if you freeze it at minus 18 and below, you will have a shelf life of 1 year. That wraps up all the one liners that we had.

[00:08:03]I'll be meeting you tomorrow with a similar set of one liners, which we will have for microbiology. But before that, I have a small little homework for you, and that is for red blood cells, I didn't tell you the shelf life. So, quickly let me know that if I have used anticoagulants ACD, CPD, CPDA, and SAGM, what would be the shelf life of blood that we would have in all of these anticoagulants? And that's your only homework for the day. See you tomorrow with the last set of revision of 10 one liners for microbiology.