INI-CET 2018 — Pathology

Q: Which of the following tubes contain sodium fluoride as an anti-coagulant?

Gray-top tube. ***a. Gray-top tube*** - The **gray-top tube** contains **sodium fluoride** and **potassium oxalate** as anticoagulants. - Sodium fluoride acts as both an **anticoagulant** and an **antiglycolytic agent**, preserving glucose concentration by inhibiting glycolysis. - This tube is the **standard choice for glucose testing** in clinical laboratories. *b. Green-top tube* - The **green-top tubes** contain **heparin** (either sodium, lithium, or ammonium heparin) as an anticoagulant. - These tubes are used for various tests including **plasma chemistry** and some hormone assays, but not for glucose preservation with sodium fluoride. *c. Pink-top tube* - The **pink-top tube** generally contains **EDTA** (ethylenediaminetetraacetic acid) and is specifically designed for **blood bank** tests due to its special labeling and anticoagulant properties for cross-matching. - While it contains an anticoagulant, it is not sodium fluoride and is not used for glucose measurement. *d. Blue-top tube with yellow checkerboard pattern* - While some manufacturers may use different labeling systems, the **standard tube for sodium fluoride** is the gray-top tube, not the blue-top with checkerboard pattern. - Blue-top tubes typically contain **sodium citrate** and are used for coagulation studies (PT, PTT, INR). [Practice more Pathology PYQs on OnCourse]

Q: A patient presents with intermittent fever, no weight loss and enlarged retroperitoneal lymph nodes. Peripheral smear is normal. Gross sample and its histopathology slide is shown below. Comment on the diagnosis.

Castleman disease. ***Castleman disease*** - The image shows **"lollipop lesions"** or **"onion-skinning"** of follicles with **regressed germinal centers** and prominent mantle zones, characteristic of the hyaline-vascular variant of Castleman disease. - Clinical features like **intermittent fever** and **enlarged retroperitoneal lymph nodes** with **no weight loss** can be seen in Castleman disease, particularly the unicentric type. *Non-Hodgkin's lymphoma* - This would typically show effacement of the normal lymph node architecture by a **monotonous proliferation of atypical lymphocytes**. - While it can cause lymphadenopathy and fever, the specific histological features presented do not align with typical non-Hodgkin's lymphoma. *Angiolymphoid hyperplasia* - Characterized by **multiple vascular channels** lined by plump endothelial cells with **lymphoid infiltrates**. - It often presents as subcutaneous nodules, usually in the head and neck region, and lacks the follicular changes seen here. *IgG4 related disease* - Histologically, this disease is characterized by a **dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells**, storiform fibrosis, and obliterative phlebitis. - While it can cause lymph node enlargement, the specific follicular changes in the image are not typical of IgG4-related disease. [Practice more Pathology PYQs on OnCourse]

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Which of the following tubes contain sodium fluoride as an anti-coagulant?

A patient presents with intermittent fever, no weight loss and enlarged retroperitoneal lymph nodes. Peripheral smear is normal. Gross sample and its histopathology slide is shown below. Comment on the diagnosis.

INI-CET 2018 - Pathology INI-CET Practice Questions and MCQs

Question 1: Which of the following tubes contain sodium fluoride as an anti-coagulant?

A. Gray-top tube (Correct Answer)
B. Green-top tube
C. Pink-top tube
D. Blue-top tube with yellow checkerboard pattern

Explanation: ***a. Gray-top tube*** - The **gray-top tube** contains **sodium fluoride** and **potassium oxalate** as anticoagulants. - Sodium fluoride acts as both an **anticoagulant** and an **antiglycolytic agent**, preserving glucose concentration by inhibiting glycolysis. - This tube is the **standard choice for glucose testing** in clinical laboratories. *b. Green-top tube* - The **green-top tubes** contain **heparin** (either sodium, lithium, or ammonium heparin) as an anticoagulant. - These tubes are used for various tests including **plasma chemistry** and some hormone assays, but not for glucose preservation with sodium fluoride. *c. Pink-top tube* - The **pink-top tube** generally contains **EDTA** (ethylenediaminetetraacetic acid) and is specifically designed for **blood bank** tests due to its special labeling and anticoagulant properties for cross-matching. - While it contains an anticoagulant, it is not sodium fluoride and is not used for glucose measurement. *d. Blue-top tube with yellow checkerboard pattern* - While some manufacturers may use different labeling systems, the **standard tube for sodium fluoride** is the gray-top tube, not the blue-top with checkerboard pattern. - Blue-top tubes typically contain **sodium citrate** and are used for coagulation studies (PT, PTT, INR).

Question 2: A patient presents with intermittent fever, no weight loss and enlarged retroperitoneal lymph nodes. Peripheral smear is normal. Gross sample and its histopathology slide is shown below. Comment on the diagnosis.

A. Non-Hodgkin's lymphoma
B. Castleman disease (Correct Answer)
C. Angiolymphoid hyperplasia
D. IgG4 related disease

Explanation: ***Castleman disease*** - The image shows **"lollipop lesions"** or **"onion-skinning"** of follicles with **regressed germinal centers** and prominent mantle zones, characteristic of the hyaline-vascular variant of Castleman disease. - Clinical features like **intermittent fever** and **enlarged retroperitoneal lymph nodes** with **no weight loss** can be seen in Castleman disease, particularly the unicentric type. *Non-Hodgkin's lymphoma* - This would typically show effacement of the normal lymph node architecture by a **monotonous proliferation of atypical lymphocytes**. - While it can cause lymphadenopathy and fever, the specific histological features presented do not align with typical non-Hodgkin's lymphoma. *Angiolymphoid hyperplasia* - Characterized by **multiple vascular channels** lined by plump endothelial cells with **lymphoid infiltrates**. - It often presents as subcutaneous nodules, usually in the head and neck region, and lacks the follicular changes seen here. *IgG4 related disease* - Histologically, this disease is characterized by a **dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells**, storiform fibrosis, and obliterative phlebitis. - While it can cause lymph node enlargement, the specific follicular changes in the image are not typical of IgG4-related disease.