Day 6/10 | TEN ON TEN 5.0 |

[00:00:01]Hi everyone, welcome to day six of the 10 on 10 series. No homework answers for today because I didn't give you any on the previous day, but yes, going forward today onwards, I will be giving you homework and I hope by now you've also gone through the L R R PDFs as I told you to. Well, today we have 10 images coming our way. The first two, three I've kept them as normal images of organs which you should also be knowing.

[00:00:22]So, identify the organ over here. This is the thyroid gland. The basis of identifying them was the thyroid follicles that I can see. What is it filled with? The pink color material that is colloid. And outside the thyroid follicles, the bunch of cells are the parafollicular C cells. What are they famous for releasing if I read physiology? They release calcitonin. And on the basis of this now I get to know from the thyroid follicles all the cancers arise. So, whether you say papillary carcinoma or you say follicular carcinoma or even if you talk about rare ones like anaplastic carcinoma, every carcinoma of thyroid arises from here. But from the parafollicular C cells, the medullary carcinoma thyroid arises. That is why the tumor marker of MCT is calcitonin.

[00:01:04]That is why the amyloid of MCT is amyloid of calcitonin type that is A cal. Moving on to question two, which is also identify the organ. This is a previous year FMG question. This is the glomerulus. The outer covering of course is the Bowman's capsule. And inside this entire tuft that you see filling it up, that is known as the capillary tuft.

[00:01:24]This is where all the urine formation occurs. The filtration membrane is going to be there. Let's move on to question three, which is a radiology spotter of a bone tumor. You can see the classical sunburst appearance and that is known as osteosarcoma. It is a bone forming tumor as the name only tells us. And that's again a spotter that you should be knowing. Also, what is not shown over here? This is also famous for showing you the famous Codman triangle which you've seen in radiology. Coming on to question four is a microbiology spotter.

[00:01:52]They've asked you, what is the test that we are doing over here? This is the Kirby-Bauer disk diffusion test. Why am I doing this test? As in that's the next question. What is the use? This is done for knowing whether the bacteria is sensitive, reacting to the antibiotic or not. So, for antibiotic sensitivity, I do it. So, these that are put over here are different antibiotic disks. That is why it is called as disk diffusion agar or disk diffusion test. And depending on whether the antibiotic will kill, like over here in all these places, I think the antibiotic has cleared the bacteria so nicely. So, there's an empty zone around it. This means all these antibiotics are working. This is antibiotic sensitivity being there. But my question is what agar is this? This is certainly not blood agar. It doesn't look red. The name of the agar, if a short form had to be written, it would be written as CAMHA. But they might write the full form also. It is cation-adjusted Mueller-Hinton agar. They might just write Mueller-Hinton agar. They might write cation-adjusted Mueller-Hinton agar or just a CAMHA. Anything of which would work. This is the agar being used.

[00:02:51]Moving on to question number five. This looks like an oven. So, of course, it is a hot air oven. How hot is it? What is the temperature? 160° for 2 hours I have to keep things inside it for it to get sterilized. What all can you keep inside it? Anything that is made up of glass.

[00:03:06]How do you close the glass? You close it with cotton swabs. So, they can also be sterilized in here. And apart from that, remember the song, other than glass and cotton swab, anything that is greasy, oily, liquidy, dusty. Repeating, greasy, oily, liquidy, dusty tells me greasy material, oils, or liquid paraffin, or dusting powder. So, anything greasy, oily, liquidy, dusty can be put in a hot air oven. What is the control? Any Bacillus or Clostridium spore can be used. For example, Bacillus subtilis, Bacillus atrophius, or Clostridium tetani. Now, coming to question six. It is obviously a purple or a lavender Vacutainer. They are asking you the anticoagulant, which is K2EDTA. EDTA is the anticoagulant and the use. Every routine test. This is the bread and butter of a pathologist. So, every test like CBC, peripheral smear, reticulocyte count, ESR by which method? By Wintrobe method is going to be done using EDTA tube. Whereas I taught you in the day two of the images that if ESR is being done through the Westergren pipette, then you'll be doing using the light blue Vacutainer which is going to have trisodium citrate as the anticoagulant.

[00:04:11]And then that is Westergren where Wintrobe if it's being used then you are using EDTA. I have another question.

[00:04:17]Where which diabetes test should be done in this? Because I know that diabetes means glucose. And all glucose testing is done in gray, but there is an exception of glycated hemoglobin because in that you're measuring not just glucose, but also hemoglobin. So that is a test of diabetes which is done the one that tells you three monthly control of sugar or glucose that is done in the purple Vacutainer. Other than that, all glucose, fasting uh glucose, postprandial glucose, all glucose testing is done in gray.

[00:04:45]Moving on to question seven. They've shown you a blood product. Let us read it. It is something to do with the uh blood bank storing platelets. So they've asked you what is the storage condition?

[00:04:54]What temperature? They've also written it if you were smart enough somewhere near to a higher temperature, a room temperature. So 20 to 24° is the temperature at which platelet-rich plasma is stored and the shelf life is only going to be five days. Another point to note is that platelets have to be kept inside a machine called a platelet agitator because agitator will constantly keep moving the platelets so that they don't make a blood clot.

[00:05:17]Moving on to question eight. I've got a report over here of a 14-year-old boy with a knee pain and a knee swelling, knee joint swelling. Basically, they will not give you a history of trauma, but they're wanting to tell you that maybe the trauma went unnoticed. The child got hurt, but it was not such severe, uh you know, fall or maybe he didn't realize while playing in the garden that he got hurt. And that has resulted very little trauma has resulted in bleeding into the joint. That is why the knee joint is swollen and painful.

[00:05:43]Hemarthrosis, that will be one big hint towards hemophilia. The boy history also is quite predominant because whether I talk about hemophilia A or B, they are X-linked recessive disorders and they tend to be occurring more commonly in boys. Now coming to hemophilia A, which is factor 8 deficiency, hemophilia B, which is factor 9 deficiency, both factor 8 and 9 belong to the intrinsic pathway. Intrinsic pathway is measured by the parameter that is APTT and if I look in this particular report, only APTT was prolonged. That tells me either it is hemophilia A or B, which I will get to know by measuring the factor 8 and 9 levels. Everything else has come out to be normal over here and just a quick recap, the platelet count, if the platelet count, I'm saying if the platelet count would have been less, which parameter would have been increased? Platelets are measured using the bleeding time. Similarly, if intrinsic pathway of the coagulation pathway is to be measured, I use APTT and if extrinsic pathway has to be measured, we use PT. We had learned PT is measuring the extrinsic pathway. So APTT is measuring the intrinsic pathway and platelet count, if anything wrong with the platelet, it's always the bleeding time increase. So if there is a case of dengue fever and the platelet count is going down, you know that the bleeding time will increase. Moving on to question 9. 9 and 10 are pretty similar with regard to this technique.

[00:06:59]Only the peripheral smear will change.

[00:07:01]So here, if you look at this peripheral smear, they are all different looking cells. They are not looking the same at all and what technique is this? This is some chromosomal study because FISH has been given. If every cell is looking different from the other, it means it's a garden party appearance. Garden party means we are dealing with shift to left or college girl appearance. All cells are different from the others. I think it is a case of CML. The investigation of choice in CML, you want to look out for the Philadelphia chromosome. That is why you have done FISH. Although the examiner will write and I didn't, just so that you couldn't get a hint, one will be labeled as ABL, one will be labeled as BCR and then you can see green and red, but over here, the green and red are fusing. That is what is translocation 922 or Philadelphia.

[00:07:42]Moving on to the last question that we have, again you have another fish image and you have some cell. Here the cell has changed. Can you see the crisscross appearance of the Auer rods? Auer rods means it's an AML and crisscross appearance of Auer rods tells me that it's classically an AML M3. AML M3 is diagnosed again with the classical translocation 15 17. So let's assume this was one gene called PML and the other was another gene called RARA. So the fusion of PML RARA is what has been shown with the arrow over here. What are these cells which are showing me the crisscross appearance of Auer rods?

[00:08:14]These are known as the cells. And that is exactly what I feel you will have a problem with. That for which leukemia do I have to do FISH? Like in CML you were dealing with Philadelphia chromosome. Anyway chromosome study comes you do FISH. In AML M3 chromosome study comes you do FISH. So that is why in tomorrow's session I'll be dealing with the most important 10 investigation of choices that you have to know. But for that time being, these are the 10 questions that we've done. The only thing that you will be telling me in the homework today is with regard to this AML M3. Clinically this is the only leukemia that can cause something clinically which can cause death of the patient. And AML M3 is the only leukemia that can cause it. This is question homework one for you. Homework two for you is very simple that what is the treatment because this treatment of AML M3 is different from the others. That's what you'll be telling me and that wraps up day six. I'll be meeting you tomorrow with the homework answers. And tomorrow's entire, you know, the theme of tomorrow's session at 10:00 will be 10 important investigation of choices that you have to know for path and micro. So see you soon.