Pathology and Pediatrics.

Question 1

What are the types of laboratory samples?

Answer 1

1: Blood samples
A.Venous, easiest and phlebotomy to acquire venous sample commonly veins of antecubital fossa.
B. Arterial, measure arterial blood gases O2, CO2 and pH.
C. Capillary, pediatric and bed side tests commonly in fingertips and heel.
2. Urine, stool, sputum, nasal discharge.
3. Ascitic, synovial, pleural and csf.
4. Seminal and prostatic fluids.
5. Brochoalveolar lavage, tissues for culture.
6. Swabs for nasopharynx, oral cavity, vagina and wounds.
7. Any unknown collection of fluid and abscess.
8. Bone marrow.

Question 2

What are the general rules before sampling ?

Answer 2

1) The appropriate container is ready
2) Proper labelling of the sample container with full patient data (full name, hospital number, ward, ….), type of sample (blood, body fluid,…), and the required tests. In clinical laboratories, where information system is applied, barcoded label with the previous date in addition to unique sample number is used for labelling the samples.
3) The clinician/nurses must ensure proper patient preparation prerequisites before sampling (e.g., fasting patient, 2 hours after drug therapy in case of therapeutic drug monitoring, etc.). Clinical pathologists provide the clinician with these data.
4) The appropriate transport container is available

Question 3

Causes of errors related to sample collection procedure?

Answer 3

Pre collection:
1.Failure to adhere to proper patient preparation according to the requested test
2.Failure to adhere to proper timing in sampling
3.Vigorous activity before sample collection affect results of some tests
During collection:
1. Prolonged tourniquet pressure results in haemo-concentration.
2.Excessive negative pressure when drawing blood into syringe results in hemolysis.
3.Using incorrect type of tube for blood collection
Handling of sample:
1. Insufficient or excess anticoagulant
2. Inadequate mixing of blood with anticoagulant.
3. Error in patient and/or specimen identification results in mix up of results
4. Inadequate specimen storage conditions affect the result of some tests
5. Delay in transport to laboratory affects the result of some tests

Question 4

Why might the lab reject a sample?

Answer 4

 The request does not contain the appropriate data.
 The sample tube is inappropriate for the requested tests.
 The Sample is not appropriately identified i.e., no name on tube.
 The sample shows a visible clot in a supposedly anticoagulated sample.

Question 5

What is a test panel

Answer 5

It is a group of tests that are routinely ordered to determine the status of a major body organs
Usually on a blood sample

Question 6

Example of test panels

Answer 6

1. Liver Panel – used to screen, detect, evaluate, and
   monitor acute and chronic liver inflammation, liver disease and/or damage. It includes Total ,direct bilirubin, total protein, albumin, and liver enzymes [AST, ALT, and ALP].
2. Renal Panel – contains tests such as creatinine, urea,
   uric acid , estimated glomerular filtration rate (eGFR) to evaluate kidney function.
3. Thyroid Function Panel – used to evaluate thyroid gland function, diagnose thyroid
   disorders, and follow up of treatment. It includes TSH, FreeT4, Free T3, T4, T3.

Question 7

Criteria of accurate lab report?

Answer 7

 Patient identifiers (full name, age, sex, hospital number).
 Requester name
 Date and time of analysis.
 Test name, result, measuring unite, and reference interval.
 Result interpretation (where required and appropriate).
 Name of Clinical pathologist who released the report and date of release.

Question 8

What is reference range and importance?

Answer 8

Its a statistically derived numerical range obtained by testing a sample from individuals assumed to be healthy.

This range represent the expected values in 95% of healthy population. This means that an abnormal result does not always indicate the presence of pathological process, nor a normal result indicates its absence. However, the more abnormal a result, that is, the greater its difference from the limits of the RI, the greater is the probability that it is related to a pathological process.

Question 9

What is a critical value and its importance?

Answer 9

Value that is so far out of range as to represent a pathophysiological state that is life threatening and requires immediate appropriate
intervention.

1- White blood cell count (WBCs) <2x109/L & >30 x109/L.
2-Platelets <20 x109/L & >1000x109/L.
3- Hemoglobin <5 g/dl & >20 g/dl
4- Bilirubin (newborn) >15 mg/dl.
5- Sodium < 120 mmol/L & ˃150mmol/L.

Question 10

What is a delta check

Answer 10

Delta check is a process to detect discrepancies in patient test results (that is not related to the patient clinical condition) prior to reporting by comparing current patient values to previous ones.

Question 11

Onset of condition types

Answer 11

Sudden (Secs to mins)
Acute (Hours to few days)
Gradual (Within 1-2 weeks)
Chronic (Within weeks and months)

Question 12

What is a good negative history is taken to?

Answer 12

-Rule in or rule out involvement of a system
-Identify the nature and etiology of the disease pattern
-Assess the severity and complications

Question 13

Past history taken?

Answer 13

A. Perinatal
- Antenatal period (Illness, infection, iatrogenic and irradiation)
- Birth (Gestational age, birth weight, delivery, complications, place and mode of birth
-Neonatal (Illness, jaundice or any discoloration and admission to NICU.
B. Past history of:
-Medical illnesses, allergies and current medications.
-Major surgical illness (Operations/dates)
-Trauma fractures and lacerations
-Previous hospital admission (Dates/diagnosis)
C. Immunization (Specific and up to date)
D. Developmental history
E. Diabetic history
-Type of food?
- Satisfied after breast feeding or not
-intake and conc of artificial feed
-Frequency of feeding
-Special dietary requirements ?

Question 14

Cardiac symptoms in infants

Answer 14

Difficulty of breathing
Recurrent lower respiratory tract infection
Cyanosis on crying
Collapse due to obstructed blood supply.
Failure to thrive.
Dysmorphic feature

Question 15

Cardiac symptoms in older children

Answer 15

Difficulty of breathing
Palpitations Cyanosis
Squatting position
Chest pain
Syncope (Fainting or passing out)
cyanosis

Question 16

Cardiac symptoms associated with heart failure

Answer 16

Low COP symptoms:
 Easy fatigue
 Anginal pain
 Dizziness & giddiness
 Syncopal attack
Systemic Congestive symptoms
 Dyspepsia
 Generalized edema.
 Upper GIT pain
 Enlarged tender liver
Lung cong. symptoms:
1) In infancy:
 poor feeding,
 growth retardation,
 recurrent chest infections
2) In older children:
 cough,
 dyspnea on exertion,
 or hemoptysis
Cyanosis:
 Etiology mentioned before

Question 17

Causes of chest pain in children

Answer 17

Non cardiac causes (common)
 Musculoskeletal as myositis.
 Traumatic pain (accidental, abuse)
 Costochondritis (Tietze syndrome)
 Bronchopulmonary pain as in
- Asthma
- Pneumonia
- Pleurisy, pneumothorax & embolism
 Gastroesophageal reflux

Cardiac causes (rare)
 Infections: Pericarditis.
 Coronary artery disease► infarction or
ischemia due to:
-Coronary artery anomalies
-Sickle cell disease
 Structural abnormalities:
-Hypertrophic cardiomyopathy
-Severe aortic or pulmonary
stenosis.
 Arrythmias: supraventricular
tachycardia

Dysmorphic features
 Common AV canal, ASD, and VSD are common in children withDown syndrome.
 Coarctation of the aorta is more common in children with Turnersyndrome.
 Aortic incompetence is seen more in those with Marfan syndrome.

Question 18

Dyspnea occurs due to?

Answer 18

 Upper airway narrowing like stridor or foreign body.
 Lower airway narrowing as asthma or bronchiolitis.
 Lung disease as pneumonia
 Pleural disease as pleural effusion or pneumothorax

Question 19

Abdominal symptoms (GIT)

Answer 19

Gastrointestinal system
 Upper GIT symptoms:
1) Altered appetite: anorexia or polyphagia.
2) Halitosis (bad odour of the mouth)
3) Vomiting: bilious or not, projectile or not…
4) Regurgitation (effortless return of food from the stomach to the mouth)
5) Haematemesis (vomiting of blood)
6) Dysphagia (difficult swallowing)
7) Odynophagia (painful swallowing)
8) Dyspepsia (abdominal discomfort)

 Abdominal mass or swelling due to
1) Ascites
2) Organomegaly
3) Abdominal mass

 Lower GIT symptoms
1 Abdominal pain:
2 Bloating or abdominal distension:
3 Diarrhoea: means passage of > 3 waterymotions /day
4 Constipation: generally, as infrequentdefecation, painful defecation, or both.
5 Stool incontinence
6 Bleeding per rectum

Question 20

Abdominal symptoms (genitourinary system)

Answer 20

1) Dysuria (painful micturition)
2) Urinary frequency or urgency
3) Enuresis (absence of bladder control)
4) Loin pain
5) Gross hematuria
6) Scrotal swelling: painful or painless

Question 21

Abdominal symptoms (Hepatobiliary system/Hematological system/Edema)

Answer 21

1) Jaundice
2) Tremors
3) Change of colour of urine and stool.
4) Skin manifestation

1) Pallor
2) Bleeding
3) LN swelling

1) Renal,
2) Hepatic.
3) Nutritional

Question 22

Most common pediatric neurological symptoms?

Answer 22

1) Headache
2) Paralysis
3) Seizure
4) Abnormal movements
5) Coma
6) Cr N lesions

Question 23

Common causes of headache are:

Answer 23

1) Migraine or tension headache
2) Analgesic abuse
3) Meningitis
4) Intracranial space occupying lesion.
5) Secondary to systemic illness.

Question 24

Abnormal movements include:

Answer 24

1. Hyperkinetic movement disorders
    Tremor: rhythmic, fine amplitude flexion-extension movements ofthe distal extremity.
    Myoclonus: quick, non-stereotyped jerks around a segment of thebody.
    Athetosis: slow, sinuous movement with pronation of the distal extremity.
    Chorea: rapid, semi-purposive, non-stereotyped movements of aproximal segment of the
   body.
    Tics: highly stereotyped and repetitive movements.
2. Hypokinetic movement disorders: as parkinsonism (in adults)

Question 25

Causes of lymphadenopathy

Answer 25

infectious
1) bacterial
 acute :typhoid and septicemia
 chronic : TB. Brucellosis
2) viral : EBV or CMV infection
3) protozoal : Malarial or Toxoplasmosis

non infectious
1) immunological
 SLE
 Rheumatoid Arthritis
 Drugs :sulfa drugs
2) Malignancy
 Leukemia
 Lymphoma
 Neuroblastoma

Question 26

Types of blood containers used for sampling?

Answer 26

• Light blue capped tubes: contain Na citrate as an anticoagulant. Used for coagulation testing (PT, PTT and coagulation factor assay).
• Red capped tubes: empty tubes without adding any anticoagulant material which are used in serology and some routine samples.
• Yellow capped tubes: contain a clot activator which cause blood to clot quickly and serum gel separator that separates blood cells from serum, allowing the clear serum to be removed easily for testing after centrifugation. Used for the same purposes as the red capped tubes but not for PCR testing.
• Green capped tubes: contain Na or lithium heparin. Used for cytogenetic analysis sampling.
• Purple capped tubes: contain EDTA as an anticoagulant Used for CBC, reticulocyte counting, and for HbA1c estimation.
• Grey capped tubes: contain K oxalate as an anticoagulant and Na fluoride, which acts as sample preservative, that preserve glucosein whole blood by inhibition of glycolysis by the red cells, which would subsequently cause false-low glucose level. Used for glucose testing

Question 27

Clubbing Causes

Answer 27

-Cardiac (Congenital cyanotic heart disease)
-Chest (Suppurative lung disease)
-Git (Liver disease)
-thryotoxicosis, HL, familial
-asymetrical in differential cyanosis

Question 28

How to detect clubbing

Answer 28

-Window test (No space is clubbing)
-Lovibond angle (Clubbing >180, Normal <160)
-Distal phalangeal finger depth to interphalangeal finger depth (DPD>IPD is clubbing).

Question 29

Grading of clubbing

Answer 29

1:Softening of nail bed
2:Loss of angle between nailbed and skinfold
3:Increased convexity of nail fold (Parrot peak appearance)
4:Thickened distal phalanx with drumstick appearance
5: Drumstick with hypertrophic osteoarthropathy.