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Hmatology

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  • 1. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 1 Visit for more www.dnbpediatrics.com OSCE PEDIATRICS HEMATOLOGY
  • 2. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 2 Station 1  This is the peripheral smear of a 12 year old female child who presented with pancytopenia. Also shown is the bone marrow picture of this child. Kindly give the diagnosis
  • 3. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 3 Answer Station 1  Megaloblastic anemia
  • 4. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 4 Station 2  What ancillary tests will you do to clinch the diagnosis? Give any two.
  • 5. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 5 Answers Station 2  LDH  S. Bilirubin  Vit B12 level  S. Folic Acid levels
  • 6. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 6 Station 3  What are the recommended dosages for the treatment of Vitamin B 12 and Folic Acid deficiency
  • 7. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 7 Answers Station 3  Vitamin B12: Intramuscular 100-200 mcg biweekly or 1000 mcg weekly x 4 to 8 weeks, followed by oral dose of 100 mcg per day.  Folic acid: 0.5 to 1 mg or more daily; 5 mg per week will also be effective. To be given for 4-8 weeks.
  • 8. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 8 Station 4  This is the peripheral smear of a patient who came with purpuric spots and hemoglobin of 10, mildly hypochromic microcytic picture. Identify the cell shown
  • 9. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 9 Answer Station 4 Giant Platelets
  • 10. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 10 Station 5  This is the peripheral smear of a 4 year old child who presented with a Hb of 10gm/dL, TLC 9000, Platelet 30,000 and no organomegaly or lymphadenopathy. The child had purpura but no significant bleed. Was stable. Parents are well educated and live in Delhi.  What will be the drug to treat this patient?  Will you do a bone marrow in this patient?
  • 11. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 11 Answers Station 5  No treatment is required. Just observation  No need for bone marrow
  • 12. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 12 Station 6  Kindly counsel the parents of this child
  • 13. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 13 Answers Station 6  Introduces himself and tries to make the parents comfortable.  Talks about the disease ITP  Talks about the possibility of any other disease  Talks about the need for injury prevention  Tells about the warning signs when they have to report to the hospital  Talks about the self limiting nature of the disease
  • 14. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 14 Station 7  Hb 10  MCV 58  MCH 23  MCHC 32  RBC Count 5.4  RDW 13.5  P/Smear As shown
  • 15. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 15 Questions Station 7  Kindly comment on the peripheral smear and identify the cell shown.  Give your probable diagnosis in the patient with the above indices and P/Smear
  • 16. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 16 Station 8 1. Identify the spot (Arrow) 2. Name the agents used to stain this cell
  • 17. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 17 Answers Station 8  Myeloblast with 3 prominent nuclei  Stains- Myeloperoxidase, Non specific esterase and Sudan black
  • 18. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 18 Station 9 A 5 yr boy c/o pallor and passing dark-colored urine. Three days prior the patient had low-grade fever and dry cough. Initial CBC revealed a Hemoglobin level of 4.5 g/dL, an Hct of 14%, a WBC count of 9,100/mm3. (N76%, L14%, M8%, E1%) and a platelet count of 372,000/mm3. The patient had been diagnosed with Hemoglobin H disease since 18 months of age. He had received 2 blood transfusions when he had fever and acute anemia. Both parents are thalassemia carriers. Physical examination: Temp- 38.3 C, Markedly pale Heart: Syst. ejection murmur grade II/VI at lt upper sternum Abdomen: Splenohepatomegaly
  • 19. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 19 Station 9 (contd)  What is the diagnosis?  What may be the trigger for this crises?
  • 20. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 20 Answers Station 9  Hb H/Hb CS disease with hemolytic crisis
  • 21. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 21 Station 10  2 yr old child was evaluated for anemia and found to have a reticulocyte count of 20% and a PCV of 25%.  Calculate the Reticulocyte production index taking maturation time as 2 days and assuming a normal PCV of 0.45  What does this signify? (In terms of production rate)
  • 22. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 22 Answers Station 10  RPI- Reticulocyte % x Observed PCV(0.25)  Maturation time x Normal PCV (0.45)  It comes = 5.5  It signifies that production has increased to 5.5 times
  • 23. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 23 Station 11 18 month old child with pallor and cutaneous markers at the back with an abnormal skeletal profile. P/S was consistent with macrocytic anemia and pancytopenia.
  • 24. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 24 Questions Station 11  What is the most probable diagnosis?  Name the cutaneous marker.  What malignancies are expected in this patient?
  • 25. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 25 Answers Station 11  Fanconi anemia  Café au lait spot  Acute leukemia
  • 26. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 26 Station 12  Identify the spot with arrow?  Define it
  • 27. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 27 Answer Station 12  Band cell  It’s a cell of neutrophil (Leukocyte) series in which the nucleus appears to be folded and the joining isthmus of the two lobules is > 1/3rd of the maximum width of the largest lobule
  • 28. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 28 Station 13  Give the full form of SQUID and what it is best used for?  Give the full form of NESTROF and what it is used for?  What is the principle used in NESTROF test?
  • 29. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 29 Answer Station 13  SQUID- Super-conducting Quantum Interference Device & Provides the most accurate and best- validated non-invasive method for measuring liver iron  NESTROF- Naked Eye Single Tube Red Cell Osmotic Fragility Test and it is usefull in screening for beta-thalassaemia and some of the common haemoglobinopathies  The principle of NESTROF is based on the limit of hypotonicity which the red cell can withstand.
  • 30. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 30 Station 14  This child has a history of polyuria, frequent otitis media and bone pains  What is the most probable diagnosis?  Name of the epidermis layer where this cell is found?  What does it contain?
  • 31. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 31 Answer Station 14  Langerhans cell Histiocytosis  Prickle layer  Birbeck granules
  • 32. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 32 Station 15  Identify the spot in the marrow  What is the treatment for this? Name two drugs
  • 33. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 33 Answer Station 15  LD Body  Amphotericin B & Sodium Stibogluconate, Multifosein
  • 34. © 2003 By Default! A Free sample background from www.awesomebackgrounds.com Slide 34 www.dnbpediatrics.com