Download MGR (The Tamil Nadu Dr. M.G.R. Medical University) MBBS (Bachelor of Medicine and Bachelor of Surgery) 2nd Year Pathology Syllabus
I) GOAL
The broad goal of the teaching of undergraduate student in Pathology is to provide the students with a
comprehensive knowledge of the mechanisms and causes of disease, in order to enable him/her to
achieve complete understanding of the natural history and clinical manifestations of disease.
II) SPECIFIC LEARNING OBJECTIVES
a)
Knowledge
At the end of the course, the student should be able to:
1. Describe the structure and ultra structure of a sick cell
2. Mechanisms of cell degeneration.
3. Cell death and repair and be able to correlate structural and functional alterations.
4. Describe the mechanisms and patterns to tissue response to injury such that she/he can
appreciate the patho-physiology of disease processes and their clinical manifestations.
5. Explain the patho-physiological processes which govern the maintenance of homeostasis
and mechanisms of their disturbance and the associated morphological and clinical
manifestations.
6. Correlate normal and altered morphology (gross and microscopic) of different organ
systems in common diseases including neoplasia to the extent needed for the understanding
of disease processes and their clinical significance.
7. Develop an understanding of neoplastic change in the body in order to appreciate the need
for early diagnosis and its role in the management of neoplasia.
b) Skills
At the end of the course, the student should be able to:
1. Describe the rationale and principles of technical procedures of the diagnostic laboratory tests
2. Interpretation of the results
3. Perform simple bed-side tests on blood, urine and other biological fluid samples
4. Draw a rational scheme of investigations aimed at diagnosing and managing patients with common
disorders
5. Understand biochemical/physiological basis of tests to understand the disturbances that occur as a
result of disease in collaboration with pre-clinical departments.
6. Understand the need and methodologies for proper interpersonal relationships between the
diagnostic wing and patient care wing of the hospital.
7. Understand the need for quality control in such tests.
c) Integration
At the end of training he/she should be able to integrate the knowledge of
1. Normal tissue morphology,
2. Causes of Disease,
3. Relationship of various causative factors (social, economic and environmental),
4. Tissue changes due to such diseases,
5. Effect of such changes on the patients well being,
6. Easy, Accurate and Low Cost Methods of Diagnosis of such diseases
7. Long term implications of the disease on the patient and community.
8. Natural history of such diseases as prevalent in India, especially in the local region of the
Teaching Hospital.
II. TEACHING METHODOLOGY AND TEACHING HOURS
No Teaching Method
Detailed
Minimal Number of Hours
Time
to be Dedicated
Distributio
n
1 Didactic
Lectures
110 Hours
a. General Pathology
40
Hours
b. Systemic Pathology
40
Hours
c. Hematology
15 Hours
d. Clinical Pathology
15
Hours
2 Practical
Demonstrations
100 Hours
a. General Pathology
20
Hours
b. Systemic Pathology
50
Hours
c. Hematology
10 Hours
d. Clinical Pathology
20
Hours
Integrated Teaching (Horizontal and
3
vertical)
40 Hours
a. Systemic Pathology
30
Hours
b. Hematology
10 Hours
4
Clinical Interaction & Lab Work
20 Hours
Clinical Pathology
8
Hours
Blood Banking
3 Hours
Cytology
3 Hours
Histopathology
3 Hours
Autopsy & Museum
3 Hours
5
Short Term Student Research
10 Hours
6
Internal Assessment Tests
20 Hours
Theory
12 Hours
Practicals
6 Hours
Communicative Skills Assessment
2 Hours
(Viva Voce & OSPE)
TOTAL
300 Hours
NB: Each lecture class will be of one hour duration only
Each practical class will be for 2 hours duration only
Clinical interaction to include case studies, clinicopathological correlation, and
performance and interpretation of relevant laboratory tests
III.THEORY SYLLABUS
A. Introduction to Pathology
Must Know
a. Role of a pathologist in a hospital and importance in diagnosis.
b. Ethics and the pathologist
c. Safe laboratory practices including universal precautions and disposal of biomedical waste
Desirable to Know
a. History of pathology with special mention of pioneers
0
b. Evolution of pathology with special mention of the role of autopsy in development of modern
1
pathology and its present day importance.
c. The cell in health and disease
Cellular housekeeping and cell signalling,
d. Signal transduction pathways
e. Cytoskeleton and cell-cell Interactions
B. Cell injury and Adaptations:
Must Know
a. Causes and mechanisms of cell injury and the macroscopic and microscopic features of
reversible and irreversible cell injury
b. Definition and types of necrosis and characteristics of each type of necrosis with examples
c. Apoptosis : definition, examples, , morphological changes and its difference from necrosis
d. Definition of gangrene ,different types of gangrene with morphology and examples
e. Adaptations ? Definitions of hyperplasia, hypertrophy, atrophy, metaplasia, dysplasia,
hypoplasia with examples. Differences between hypertrophy and hyperplasia, atrophy and
hypoplasia
f. Calcification ? Types and Importance
Desirable to Know
Mechanism of apoptosis
Nice to Know
a. Basics of Cellular Ageing
b. Necroptosis
C. Inflammation & Repair
Must Know
a. Acute inflammation: Definition of acute inflammation and its causes
b. Vascular phenomena of inflammation
c. Cellular phenomenon chemotaxis, phagocytosis and formation of exudates
d. Chemical mediators of inflammation with special reference to histamine, complement,
arachidonic acid metabolites, coagulation cascade
e. Clinical features , morphological types and outcome of acute inflammation with examples
f. Chronic inflammation: Definition, examples, morphology and cells of chronic inflammation
with emphasis on epithelioid cells & giant cells
g. Granuloma: definition pathogenesis & description of a granuloma with special emphasis on
tuberculous granuloma Other types of granulomas: Syphilis, Sarcoidosis and Leprosy and
foreign body
h. Giant cells different types, morphology & examples
i. Tissue repair, regeneration and fibrosis
j. Cell cycle and different types of cells
k. Normal cell growth and Regeneration
l. Repair : role of collagen, formation and morphology of granulation tissue, angiogenesis
and fibrosis
m. Wound healing first and second intention
n. Factors affecting wound healing
o. Complications of wound healing
p. Healing in bone and specialized tissue
Desirable to Know
a. Cytokines, interleukins, mononuclear phagocytic system
b. Mechanisms of microbial killing
Nice to Know
a. Steps in angiogenesis
b. Role of growth factors and extracellular matrix
D. Hemodynamic disorders, thromboembolism and shock
Must Know
a. Hyperemia and congestion: definition and morphology
b. Normal hemostasis: mechanism and pathways
c. Thrombosis : definition, pathogenesis, causes, morphology and fate
d. Differences between thrombophlebitis and phlebothrombosis
e. Differences between antemortem thrombus and postmortem clot
f. Embolism & Infarction: definition, types and pathogenesis with examples
g. Oedema : definition, types, pathogenesis with examples
h. Differences between transudate and exudate
i. Shock: definition, types, pathogenesis, clinical manifestations and examples
Desirable to Know
a. Role of endothelium in coagulation and hypercoagulable state
Nice to Know:
a. Antiphospholipid syndrome
b. Anticoagulant proteins
E. Neoplasia
Must Know
a. Definition of neoplasia (Willis' definition), classification and nomenclature
b. Characteristics of benign and malignant neoplasms
c. Differences between benign and malignant neoplasms and carcinoma and sarcoma
d. Spread of a malignant tumor, routes of spread with examples, mechanisms of spread
e. Metastasis : Definition, mechanisms and significance
f. Carcinogenesis: Physical, chemical & biological carcinogens and their mechanisms
of action
g. Molecular basis of carcinogenesis and role of TP53 and RB1 genes
h. Clinical features and staging and grading of neoplasia
i. Laboratory diagnosis of neoplasia
Desirable to Know
a. Epidemiology of cancer
b. Pre-cancerous lesions
c. Hallmarks (physiological properties) of cancer cells
d. Systemic changes due to neoplasia and paraneoplastic syndromes
e. Multistep carcinogenesis and progression of cancer
f. Occupational cancers
Nice to know
a. Knudson's two-hit hypothesis
b. Genetic changes in cancer
c. Tumour markers
d. Host defences against cancer
e. Tumour-like lesions ? hamartoma and choristoma
F. Genetic disorders ?
Must know
a. Basic facts about the human genome; structure of DNA and chromosomes
b. Mutations : definition, types
c. Classification of genetic disorders
d. Single gene (Mendelian) disorders
e. Patterns of inheritance of autosomal dominant, autosomal recessive and X- linked recessive
disorders.
f. At least one example each of autosomal dominant, autosomal recessive and X-linked recessive
disorders.
g. Cytogenetic disorders
h. General features
i) Parts of a chromosome and types of chromosomes
ii) Numerical disorders of autosomes? Down syndrome
iii) Numerical disorders of sex chromosomes _ Turner and Klinefelter syndromes
iv) Structural abnormalities of chromosomes
v) At least one example of a microdeletion syndrome
vi) Indications for genetic analysis
vii) Multifactorial disorders ? at least two examples of these disorders.
Nice to know
a. Human genome project
b. Fragile X syndrome
c. Genomic imprinting disorders
d. Storage disorders: Classification ; lysosomal & glycogen storage disorders
e. Laboratory diagnosis of genetic disorders : karyotyping, fluorescence in situ hybridisation,
DNA
microarrays, polymerase chain reaction, RFLPs, VNTR analysis, linkage analysis, genome-
wide association studies, Southern blotting, DNA sequencing.
G. Immune diseases
Must know
a. Types of immunity
b. Immune mediated injury ? causes and types of hypersensitivity reactions,
c. Autoimmune disorders: mechanism and pathology of systemic lupus erythematosus.
d. HIV infection and AIDS :pathogenesis, clinical manifestations, diagnosis, and pathology
including opportunistic infections , diagnostic procedures and handling of infected materials
and health education.
Desirable to know
a. Cells and tissues of the immune system
b. Normal immune responses
c. Immunologic tolerance
d. Mechanisms of autoimmunity
e. Amyloidosis
f. Graft rejection
Nice to know
a. Primary immunodeficiency disorders
b. Other autoimmune disorders
c. Graft versus host disease
H. Environmental and nutritional diseases
Must Know
a. Effects of tobacco and alcohol,
b. Injury produced by ionizing radiation: morphology and effects of radiation on organs
Desirable to know
a. Vitamin deficiency syndromes including rickets and osteomalacia
b. Protein energy malnutrition
c. Other nutritional diseases
d. Obesity
e. Thermal injury
f. Electrical injury
g. Occupational (industrial and agricultural) exposure
Nice to know
a. Lead poisoning
b. Mercury poisoning
c. Diet and cancer
d. Injury due to therapeutic drugs
e. Effects of (non therapeutic) drug abuse
I. Infectious diseases:
Must know
a. Mycobacterial diseases: tuberculosis and leprosy
b. Bacterial diseases: pyogenic infections , typhoid, diptheria, bacillary dysentery, syphilis
c. Fungal and opportunistic infections
d. Parasitic diseases: malaria, filaria, amoebiasis, cysticercosis, hydatid , kala azar.
Desirable to know
a. General host factors
b. Polio, herpes, rabies, measles, rickettsial, chlamydial infections
Nice to know
a. General principles of microbial pathogenesis
b. Transmission and dissemination of disease
c. Mechanisms of microbial injury
d. Agents of bioterrorism
e. Immune evasion by microbes
J. Hematology:
Must Know
a. Haematopoiesis and microscopy of normal marrow
b. Definition and classification of anemia
c. Iron deficiency anemia : causes, pathogenesis, clinical manifestations and lab diagnosis
d. Megaloblastic anemia : causes, pathogenesis, clinical manifestations and lab diagnosis
e. Aplastic anemia : causes, pathogenesis, clinical manifestations and lab diagnosis
f. Classification of haemolytic anemia : Clinical features, pathogenesis, pathology and laboratory
diagnosis of Hereditary spherocytosis, sickle cell anemia and thalassemia,
g. Non neoplastic white cell disorders : Leukopenia, agranulocytosis, leukocytosis, leukemoid
reaction and infectious mononucleosis,
h. Classification of leukemia (FAB & WHO)
i. Acute myeloid and acute lymphoblastic leukemia
j. Chronic myeloid leukemia and chronic lymphocytic leukemia,
k. Myeloma
l. Physiology of haemostasis and thrombosis
m. Disorders of haemostasis and thrombosis :
i) Haemophilia A and B,
ii) von Willebrand disease,
iii) Disseminated intravascular coagulation
iv) Idiopathic thrombocytopenic purpura
Blood groups and Blood Transfusion
a. Blood groups and their clinical significance
b. Determination of blood groups
c. Significance of reverse grouping and cross-matching
d. Blood donation, collection, preservation, tests performed
e. Indications for blood transfusion
f. Transfusion reactions and transfusion associated infections
g. Rational use of blood including component therapy
Desirable to know
a. Anemia of chronic disease
b. G6PD deficiency
c. Myelodysplastic syndromes
d. Immunophenotype and karyotype findings in acute and chronic leukemias
e. Laboratory tests of haemostasis and thrombosis
Nice to Know
a. Paroxysmal nocturnal haemoglobinuria
b. Immune haemolytic anaemia
c. Pure red cell aplasia
d. Haemolytic uremic syndrome and thrombotic thrombocytopenic purpura
e. Myeloproliferative neoplasms
f. Prognostic features of leukemias
g. Other plasma cell dyscrasias
h. Heparin-induced thrombocytopenia
i. Coombs test
K. Cardiovascular Pathology
Must
know
a. Atherosclerosis: Definition, risk factors, etiopathogenesis, gross and microscopic description,
complications and clinical correlations.
b. Aneurysms
c. Hypertension: Relate the mechanisms of the disease to the clinical course and sequelae.
d. Cardiac failure
e. Ischaemic heart disease and myocardial infarction: Incidence, risk factors, pathogenesis,
morphological changes, clinical course, complications and investigations.
f. Infective endocarditis: Pathogenesis, morphology, differential diagnosis of cardiac vegetations
g. Cardiomyopathies ? Recognize the disorders as part of differential diagnosis in primary
myocardial disease.
h. Pericardial Diseases: Pericarditis - Aetiology and basic morphology of different forms
Desirable to know
a. Thrombophlebitis
b. Aortic dissections
c. Superior vena cava syndrome
d. Congenital heart disease: Correlate the anatomical malformations of disorders to the clinical
consequences of the disease.
e. Rheumatic heart disease: Incidence, etiopathogenesis, morbid anatomy, histopathology,
lesions in other organs, clinical course and sequelae.
f. Tumours of heart: Classification & Morphology
Nice to know
a. Vasculitides : infectious and non infectious
b. Metabolism of cholesterol, HDL, LDL
c. Pathology of vascular interventions ? stenting and vascular replacement
d. Myocarditis
L. Respiratory Pathology
Must know
a. Pulmonary tuberculosis
b. Pneumonias: Aetiology, classification, gross, histopathology of different forms and
complications.
c. Lung Abscess and Bronchiectasis: Etiopathogenesis, morphological appearances and
complications.
d. Chronic obstructive lung diseases: Chronic bronchitis and emphysema - pathogenesis,
definition of chronic bronchitis, morbid anatomy and cardiac sequelae, types of emphysema,
e. Occupational lung diseases: Types, etiopathogenesis, gross anatomical differences between
different forms and sequelae; names of different types of pneumoconiosis; pathology of coal
worker's pneumoconiosis, asbestosis and silicosis
f. Pulmonary vascular disorders: pulmonary embolism, infarction, and edema
g. Tumours of lung: Classification, aetiology, gross appearances, histology of
important forms, natural history, pattern of spread
h. Non -neoplastic lesions of pleura
Desirable to know
a. Pulmonary hyperpertension : Classification, Etiopathogenesis, morphological appearances and
complications
b. Chronic interstitial (restrictive, infiltrative) lung diseases: Classification, etiopathogenesis,
morphological appearances and complications; differences between obstructive and restrictive
lung diseases.
c. Pneumonia in the immunocompromised host
d. Acute respiratory distress syndrome
e. Atelectasis
f. Pathology of carcinoid tumour
g. Para-neoplastic syndromes and secondary pathology.
h. Tumours of upper respiratory tract: Nasopharyngeal carcinoma,carcinoma larynx
Nice to know
a. Basic pathology of atypical pneumonia
b. Fungal pneumonias
c. Mesothelioma
M. Gastro Intestinal Pathology:
Must know
a. Oral cancer : etiopathogenesis, gross and histopathological descriptions.
b. Barrett esophagus
c. Carcinoma oesophagus: etiopathogenesis, morphological features
d. Esophageal varices
e. Gastritis and peptic ulcer : Definition of peptic ulcer, etiological factors, gross and
microscopic appearances and sequelae ;etiology and types of gastritis; helicobacter pylori and
chronic gastritis ; differences between benign and malignant gastric ulcers
f. Gastric tumours: Classification, morbid anatomy and histopathology
g. Ulcers of intestines: Etiology, morphological appearances of typhoid, tuberculous and
amoebic ulcers and bacillary dysentery ; differential diagnosis of different forms of ulcers;
differences between primary and secondary intestinal tuberculosis.
h. Causes of intestinal obstruction
i. Idiopathic inflammatory bowel disease: Enumerate similarities and differences between
Crohn's disease and ulcerative colitis.
k. Appendicitis
l. Intestinal polyps
m. Carcinoma colon.
n. Hepatic failure
o. Jaundice and cholestasis
p. Viral hepatitis: Etiology, clinical source and enzymology, salient histological features and
sequelae.
q. Alcoholic liver disease: Pathogenesis, morphological manifestations and correlation with
clinical features
r. Liver abscess
s. Cirrhosis: Classification, etiopathogenesis, morphology and differential diagnosis and
complications
t. Tumours of liver: Etiopathogenesis and pathology of hepatocellular carcinoma and metastatic
carcinoma
u. Cholecystitis: Clinical features and morphology
v. Gall stones : classification , etiopathogenesis, pathology and complications
Desirable to know
a. Classification of salivary gland tumours; pathology of pleomorphic adenoma.
b. GI Lymphomas : Classification, etiological factors, gross and microscopic appearances
c. GI stromal tumours.
d. Carcinoid tumours of GIT.
e. Wilson disease
f. Acute and chronic pancreatitis : etiopathogenesis and pathology; complications
Nice to know
a. Malabsorption syndromes
b. Hirschprung disease
c. G.I. infections in immunocompromised individuals
d. Neuroendocrine tumours
e. Meckel's diverticulum
f. Primary biliary cirrhosis
g. Metabolic disorders such as haemochromatosis, alpha-1 antitrypsin deficiency
h. Non-alcoholic steatohepatitis.
i. Benign tumours of liver: Haemangioma, Hepatocellular adenoma
j. Tumours of gall bladder : Cholangiocarcinoma , Gross types
k. Tumours of pancreas: Adenocarcinoma and endocrine tumours.
N. Diseases of Kidney:
Must know
a. Nephrotic syndrome and nephritic syndrome : Integrate clinical and pathological features of
this disorder.
b. Glomerulonephritis: Acute streptococcal glomerulonephritis, crescentic glomerulonephritis,
chronic glomerulonephritis
c. Diabetic glomerulosclerosis
d. Renal failure: Definitions, criteria, aetiology, systemic manifestations and investigations;
etiopathogenesis & morphology of acute tubular necrosis, acute and chronic renal failure,
e. Urinary tract infection : Acute pyelonephritis, chronic pyelonephritis, tuberculous
pyelonephritis - etiology, pathogenesis, morphological features and clinical correlations
f. Chronic kidney disease and end-stage kidneys
g. Urinary tract obstruction : Calculi - etiopathogenesis & morphology; hydronephrosis - ?
etiopathogenesis & morphology
h. Renal tumours: Renal cell carcinoma, Wilms tumour : Morphology and clinical course
Desirable to know
a. Pathogenesis of glomerular disease
b. Malignant hypertension
c. Adult and infantile polycystic kidney disease
d. Urinary bladder tumours
Nice to know
a. Interstitial Nephritis
b. Lupus nephritis
c. Renal amyloidosis
d. Acute papillary necrosis: etiopathogenesis & morphology
e. Renal changes associated with hypercalcemia & hyperparathyroidism.
f. Other glomerulopathies, IgA nephropathy
O. Pathology of Male Genital Tract:
Must know
a. Penis ? carcinoma and premalignant lesions
b. Testis ? classification of tumours, clinical course and pathology of seminoma
c. Prostate ? Benign prostatic hyperplasia
d. Hydrocoele
Desirable to know
a. Torsion of testis
b. Cryptorchidism
c. Orchitis and epididymitis
d. Genital tuberculosis
e.Adenocarcinoma prostate
Nice to know
a. Pathology of other testicular tumours
P. Pathology of Female Genital Tract:
Must know
Cervix
a. Chronic cervicitis with squamous metaplasia
b. Cervical intraepithelial neoplasia (dysplasia) and role of cytological screening.
c. Carcinoma cervix
Uterus
a. Endometrial Hyperplasia and polyps
b. Endometrial Carcinoma
c. Endometriosis
d. Adenomyosis,
e. Leiomyomas
Ovary
a. Classification of tumours
b. Mucinous and Serous tumours, Dysgerminoma, Teratoma, Krukenberg tumour
Diseases
of
pregnancy
a. Ectopic pregnancy
b. Hydatidiform mole
c. Choriocarcinoma
Desirable to know
a. Congenital abnormalities of uterus
b. Prolapse
c. Endometritis
Nice to know
a. Paget disease of vulva
b. Sarcoma botryoides of vagina
c. Haematocolpos / haematometra
d. Salpingitis and pelvic inflammatory disease
e. Genital infections ? herpes, genital tuberculosis,
f. Dysgenetic gonads and their significance.
g. Liquid-based cytology.
h. Other ovarian tumours ? Granuloasa cell tumour, Grem cell tumours, other surface epithelial
tumours.
Q. Pathology of Breast:
Must know
a. Fibrocystic disease
b. Classification of breast tumours
c. Fibroadenoma,
d. Carcinoma breast: Pathology of in situ and invasive carcinoma, not otherwise specified
(NOS, NST) ? aetiopathogenesis and prognostic factors
Desirable to know
a. Duct papilloma and phyllodes tumour
b. Other types of carcinoma ? mucinous (colloid), medullary, papillary carcinoma
c. Carcinoma male breast,
Nice to know
a. Gynaecomastia
b. Molecular subtypes in breast carcinoma ? only the names
c. HER-2-neu in breast carcinoma
R. Pathology of Lymphoreticular System:
Lymph nodes
Must know
a. Tuberculous lymphadenitis, filarial lymphadenitis and non specific lymphadenitis
b. Metastatic tumours
c. Non Hodgkin lymphomas : Classification; pathology of diffuse large cell lymphoma, Burkitt
lymphoma
d. Hodgkin lymphoma : Classification and morphology of all subtypes.
e. Differences between Hodgkin and non Hodgkin lymphomas.
f. Ann Arbor staging of lymphomas.
Desirable to know
a. Basic concepts of immunohistochemistry of lymphoid cells ? one or two markers for each
type
of cell.
b. Names of at least two high-grade and low-grade non Hodgkin lymphoma
c. Follicular lymphoma and mantle cell lymphoma
Nice to know
a. Current WHO Classification of lymphoid neoplasms
b. Extranodal lymphomas
c. Adult T cell leukemia/lymphoma
d. Mycosis fungoides
Spleen
Must know
a. Causes of splenomegaly
b. Pathology of chronic venous congestion,
c. Splenic infarction
Desirable to know
a. Pathology of spleen in malaria and kala azar,
Nice to know
a. Common neoplasms ? lymphomas , haemangiomas, chronic myeloid leukemia
b. Rupture spleen
Thymus
Nice to know
a. Thymomas and Myasthenia gravis.
b. Invasive and non-invasive thymoma
c. Thymic hyperplasia
d. Other anterior mediastinal tumours? germ cell tumours
S. Pathology of Skin
Must know
a. Premalignant lesions
b. Tumours of skin : Basal cell carcinoma, squamous cell carcinoma, malignant melanoma.
c. Naevi ? intradermal, junctional and compound naevi
d. Skin lesions in leprosy
Desirable to know
a. Molluscum contagiosum
b. Verrucae(warts)
Nice to know
a. Bullous lesions of skin? Classification and morphological features :pemphigus, pemphigoid
b. Immunofluorescence in dermatopathology
c. Chronic inflammatory dermatitis : Psoriasis, lichen planus
d. Epidermal cyst, pilar cyst, seborrheic keratosis
T. Bone & Joints and and Soft Tissue
Must Know
a. Osteomyelitis: Pyogenic osteomyelitis, pathogenesis, pathology and complications.
Tuberculous osteomyelitis and psoas abscess
b. Bone tumours: Classification : pathology of osteogenic sarcoma, chondrosarcoma, giant cell
tumour, Ewing's tumour, myeloma and metastatic tumours
c. Soft tissue tumours: Classification; pathology of lipoma, fibroma, haemangioma,
neurofibroma, schwannoma, leiomyoma,
Desirable to know
a. Arthritis - osteoarthritis and rheumatoid arthritis, septic arthritis, gout;
b. Chronic synovitis,
c. Other infections : Mycetoma, syphilis
Nice to know
a. Metabolic bone disorders: Brown tumour of hyperparathyroidism, rickets, osteomalacia
b. Avascular necrosis,
c. Aneurysmal bone cyst, fibrous dysplasia, Paget disease.
d. Soft tissue sarcomas: classification and histopathology
U. Central Nervous System, Peripheral Nervous System & Muscle:
Must Know
a. Pyogenic meningitis and brain abscess
b. Tuberculous meningitis and tuberculoma
c. Cysticercosis
d. Role of CSF examination in meningitis
e. Cerebral infarction: Gross and microscopic features
f. Tumours of the CNS: Pathology of meningioma, schwannoma, astrocytoma, glioblastoma,
Medulloblastoma; metastatic tumours
g. Subarachoid hemorrhage, Epidural haemorrhage, Intracranial aneurysm
Desirable to know
a. Cerebral edema, herniation and hydrocephalus
b. Hypertensive encephalopathy
c. Venous sinus and cortical vein thrombosis
d. Watershed infarcts
e. Cerebral malaria ? aetiological agent, basic pathology
f. Hydatid cyst
g. Alzheimer disease
Nice to know
a. Morphological features and differential diagnosis of encephalitis.
b. Amoebic meningoencephalitis ? aetiological agent, basic pathology
c. Viral meningitis
d. HIV infection in the CNS
e. Molecular basis of gliomas and its impact on diagnosis and prognosis
f. Syndromes associated with brain tumors
g. Cerebral lymphomas
h. Neurodegenerative disorders
i. Diseases of myelin
j. Congenital malformations
k. Prion disease
l. Myopathies: Differential diagnosis of common muscle disorders.
V. Endocrinology
Must know
a. Diabetes mellitus: Classification, pathogenesis of system involvement, sequelae and
complications.
b. Hypothyroidism and Hyperthyroidism
c. Thyroiditis, Colloid goiter, Multinodular goiter
d. Differential diagnosis of thyroid nodules and diffuse thyroid enlargement
e. Classification of tumours of thyroid; pathology of papillary carcinoma thyroid
Desirable to know
a. Graves disease
b. Other thyroid tumours
c. Parathyroid, adrenal and pituitary hypofunction and hyperfunction .
d. Tumours of parathyroid, adrenal ,including pheochromoctyoma, and pituitary
Nice to know
a. Adrenalitis ? etiopathogenesis, pathology, classification and complications,
b. Multiple endocrine neoplasia syndromes- names and components
W. Perinatal and Pediatric Pathology
Must know
a. Hydrops fetalis
b. Hemolytic disease of newborn: Etiopathogenesis, pathology, and complications
c. Childhood tumours: Neuroblastoma, retinoblastoma, wilms tumour, embryonal
rhabdomyosarcoma
Desirable to know
a. Perinatal infections
b. Neonatal respiratory distress syndrome and hyaline membrane disease ? etiopathogenesis,
pathology and complications.
c. Cystic fibrosis ? etiopathogenesis, pathology, diagnosis and prognosis.
Nice to know
a. Pathology of prematurity: Necrotising enterocolitis; sudden infant death syndrome
b. Terms used to describe errors in morphogenesis
X. Developments in Pathology:
Desirable to know
a. Immunohistochemistry
b. Immunoflourescence
Nice to know
a. Flow cytometry
b. Fluorescence in situ hybridisation
c. Image analysis & digital morphometry
d. Methods of molecular diagnosis
e. DNA microarray technology and sequencing
IV. PRACTICAL SYLLABUS
The Clinical Pathology teaching is to be done as [a] bed-side and / or hospital laboratory-based demonstrations
and evaluation sessions. [b] Departmental practical classes of 2 hours duration each.
The Clinical Pathology classes shall be drawn from the time allotted in the first clinical year ? clinical posting
schedules.
The individual institutions could modify the classes and have their own schedule. These are only
guidelines and suggestions
Clinical Pathology postings to be included in clinical posting schedule - 15 days.
The students to be taught theoretical aspects, demonstration of various tests and they will be introduced
to the equipments and instruments in the clinical pathology laboratory
The tests which they have to perform during the examination could be included in the regular 2 hour
practical classes in the afternoon, to give enough time for practice, so that the students become
proficient in performing these tests.
On completion of Clinical Pathology Postings, the students need to know both theoretical aspects and
practical aspects. They should have enough exposure to the various tests performed in the clinical
pathology laboratory.
The procedures to be demonstrated and practiced are:
A) Clinical Pathology ? Blood
1 Anticoagulants and their use ? Practice
2 Drawing of blood, preparation of smears and staining of smears ? Practice
3 Using the microscope ? Practice
4 Differential Leucocyte Count of blood smears ? Practice
5 Reporting of peripheral smear ? Practice
6 Hemoglobin estimation by acid hematin method ? Practice
7 Blood grouping ? ABO & Rh ? Practice
8 ESR by Westergren pipette ? demonstration
9 Total count of WBC, RBC and Platelets by Neubauer chamber ? demonstration
10 Hemoglobin estimation by Drabkin's method ? demonstration
11 PCV by Wintrobe's tube ? Demonstration
12 Bleeding time, clotting time, prothrombin time, APTT ? Demonstration
13 Osmotic fragility test, coombs tests and sickle test ? Demonstration
14 Use of automated cell counters and coagulation analysers ? Demonstration
15 Reporting peripheral blood and bone marrow ? typical stained slides to be provided (List
appended Table2A)
B) Clinical Pathology ? Urine and Body Fluids
1 Urine ? assessment of the physical characters, to measure specific gravity and pH? Practice
2 Urine ? chemical tests for Protein, Reducing substances, blood, bile salts, bile pigments and
Ketone bodies? Practice
3 Use of different stix and their interpretation ? Demonstration
4 Microscopic examination of urine ? Demonstration
5 Automated Urine Analysis ? Demonstration
6 CSF ? Demonstration of cell types in a normal CSF sample and a case of meningitis
7 Ascitic and Pleural Fluids ? Demonstration of cell types
8 Semen Analysis ? Demonstration
C)
Histopathology and Cytopathology
1 Preservation and Transport of Specimens ? Demonstration
2 Laboratory Techniques in Histopathology ? Demonstration
3 Laboratory Techniques in Cytopathology : FNAC, Pap Smears, Fluid Cytology? Demonstration
4 H & E staining and other special staining ? Demonstration
5 Demonstration of Histopathology slides along with tutorial classes in general and systemic
pathology ? typical stained slides to be provided (see list in Appended Table 1)
6 Demonstration of Cytology slides along with tutorial classes in general and systemic pathology
? typical stained slides to be provided (see list in Appended Table 2A)
7 Demonstration of Gross Specimens along with tutorial classes in general and systemic pathology
? typical specimens to be provided (see list in Appended Table 2B)
D) ) Histopathology and Cytopathology Exercise
1. Each students is instructed to accompany five surgical samples from operation theatre in which
he is posted in the concerned hospital.with the concurrence of the surgical and allied specialities
department
2. He is to ensure the tissue sample( biopsy/resected) is transported in adequate formalin along with
complete details of the patient :- (Name , age , unit,I.P. Number, nature of tissue,) in the sample and
request form with the signature of the concerned unit assistant.
3. Specimen should be submitted to the pathology reception, there the Pathology Number to be
noted, sample followed up in the Histopathology processing lab ,till the concerned slides are ready.
4. the slides shall be viewed along with the concerned professor and to make entries in his/her
record
5.
This exercise is to ensure that students are educated and oriented regarding collection,
transporting, processing and diagnosis of a human tissue.
6. The students has to observe 5 FNAC procedure and familiarize himself/herself with the
processing, staining, interpretation of the slide and make entries in his/her record.
Students shall be evaluated according to this exercise
LISTS OF SLIDES AND SPECIMENS FOR HISTOPATHOLOGY, CYTOLOGY, HEMATOLOGY
AND GROSS SPECIMENS HAVE BEEN APPENDED HEREWITH.
These lists are only a guideline of the minimal requirements.
Table 1 : HISTOPATHOLOGY SLID
NO. DIAGNOSIS
NO. DIAGNOSIS
1.
FATTY CHANGE LIVER
26.
INTESTINAL TUBERCULOSIS
2.
ACUTE
APPENDICITIS
27.
STOMACH ? CHRONIC PEPTIC ULCER
3.
GRANULATION
TISSUE
28.
LIVER ? HEPATOCELLULAR
CARCINOMA
4.
LUNG
?
CVC
29.
LIVER
CIRRHOSIS
5.
LIVER ? CVC
30
KIDNEY ? CHRONIC PYELONEPHRITIS
6.
SPLEEN
?
CVC
31
KIDNEY ? RENAL CELL CARCINOMSA
7.
ARTERY ? RECENT / ORGANISED
32
KIDNEY ? WILMS TUMOUR
THROMBUS
8.
KIDNEY / SPLEEN INFARCT
33
BENIGN PROSTATIC HYPERPLASIA
9.
MADURA MYCOSIS - SKIN
34
TESTIS ? SEMINOMA
10.
TUBERCULOUS LYMPHADENITIS
35
UTERUS ? LEIOMYOMA
11
LEPROMATOUS LEPROSY ? SKIN
36
UTERUS ? ADENOMYOSIS
12
TUBERCULOID LEPROSY ? SKIN
37
PRODUCTS OF CONCEPTION
13.
ACTINOMYCOSIS ABSCESS
38
BREAST ? FIBROADENOMA
14
LOBAR PNEUMONIA
39
BREAST ? CARCINOMA
15
SKIN ? PAPILLOMA
40
HODGKIN / NON HODGKIN LYMPHOMA
16
SQUAMOUS CELL CARCINOMA
41
HASHIMOTO THYROIDITIS
17
ADENOCARCINOMA COLON
42
THYROID ? COLLOID GOITRE
18
LIPOMA
43
THYROID ? PAPILLARY CARCINOMA
19.
SKIN ? CAPILLARY
44
BONE ? OSTEOGENIC SARCOMA
HAEMANGIOMA
20
CAVERNOUS HAEMANGIOMA
45
BONE ? CHONDROMA
21
BENIGN CYSTIC TERATOMA
46
BONE ? OSTEOCLASTOMA
(DERMOID CYST)
22
LYMPH NODE ? METASTASIS
47
BRAIN ? MENINGIOMA
23
AORTA ? ATHEROSCLEROSIS
48
SOFT TISSUE ? SCHWANNOMA
24
LUNG ? BRONCHIECTASIS
49
SKIN ? MALIGNANT MELANOMA/
NAEVUS
25.
LUNG ? FIBROCASEOUS
50
SKIN - BASAL CELL CARCINOMA
TUBERCULOSIS
Table 2A: HEMATOLOGY & CYTOLOGY SLIDES
N
DIAGNOSIS
NO.
DIAGNOSIS
O.
1.
ACUTE MYELOID LEUKEMIA
11.
BLOOD SMEAR WITH MICROFILARIA /
(AML) ? Blood/ Bone marrow
PLASMODIUM
2.
ACUTE
LYMPHOBLASTIC
12.
FNAC BREAST ? FIBROADENOMA
LEUKEMIA (ALL) ? Blood/ Bone
marrow
3.
CHRONIC MYELOID LEUKEMIA
13.
FNAC BREAST ? DUCTAL CARCINOMA
(CML ) CHRONIC PHASE ? Blood/
Bone marrow
4.
CHRONIC
LYMPHOCYTIC
14.
FNAC LYMPH NODE ?
LEUKEMIA (CLL) ? Blood
GRANULOMATOUS LYMPHADENITIS
5.
PLASMA CELL MYELOMA ? Bone
15.
FNAC LYMPH NODE ?METASTATIC
marrow
DEPOSIT
6.
NEUTROPHILIA ? Blood
16.
FNAC THYROID ? COLLOID GOITRE
7.
EOSINOPHILIA ? Blood
17.
FNAC THYROID ? PAPILLARY
CARCINOMA
8.
LYMPHOCYTOSIS
?
Blood
18.
PAP SMEAR WITH HSIL/ SQUAMOUS
CELL CARCINOMA
9.
IRON DEFICIENCY ANAEMIA ?
19.
ASCITIC FLUID ? POSITIVE FOR
Blood
MALIGNANCY ( ADENOCARCINOMA )
10.
MACROCYTIC ANAEMIA ? Blood
.
DIAGNOSIS
DIAGNOSIS
DIAGNOSIS
PLEOMORPHIC ADENOMA
GUT: RENAL CELL
GP: INFARCT KIDNEY
SALIVARY GLAND
CARCINOMA
GP: FATTY CHANGE LIVER CARCIN OMA LARYNX
THYROID ? ADENOMA
GP: DRY GANGRENE FOOT GIT: AMOEBIC COLITIS
HASHIMOTO'S THYROIDITIS
GP: WET GANGRENE
GIT: POLYPS
MULTINODULAR GOITRE
GIT: ADENOCARCINOMA ?
GP: INFARCT INTESTINE
PAPILLARY CARCINOMA
COLON
GP: CASEOUS NECROSIS
GIT: ILEUM TYPHOID ULCER
MEDULLARY CARCINOMA
BONE: OSTEOGENIC
GP: CVC LUNG/SPLEEN
GIT: AMOEBIC LIVER ABSCESS
SARCOMA
GP: ACUTE APPENDICITIS
GIT: LIVER ? CIRRHOSIS
BONE: EWING SARCOMA
GP: ABSCESS KIDNEY /
GIT: HEPATOCELLULAR
BONE: CHRONIC
LIVER /LUNG
CARCINOMA
OSTEOMYELITIS
GP: MYCETOMA FOOT
GIT: LIVER METASTASIS
BONE: OSTEOCLASTOMA
GIT: OESOPHAGUS
CNS: MENINGIOMA /
GP: LIVER ? CVC
CARCINOMA
GLIOMA
CVS: AORTA ? ATHEROMA GIT: CHRONIC GASTRIC ULCER CNS: HAEMORRHAGE / CVA
CVS: THROMBUS ARTERY
GIT: STOMACH ? CARCINOMA
L/RET: TB LYMPHADENITIS
/ VEIN
CVS: VENTRICULAR
GIT: INTESTINE ULCER - TB*
L/RET: LYMPHOMA
HYPERTROPHY
CVS: HEART HEALED
SKIN ? MALIGNANT
GIT: STRICTURE INTESTINE
INFARCT
MELANOMA
CVS: RHEUMATIC
GUT: WILMS TUMOUR
SST: PAPILLOMA SKIN
CARDITIS*
GUT: CARCINOMA URINARY
CVS: MITRAL STENOSIS *
SST: SQUAMOUS CELL CA
BLADDER
CVS: AORTIC STENOSIS *
GUT: SCC PENIS
SST: LIPOMA
CVS: BACTERIAL
GUT: SEMINOMA TESTIS
BREAST FIBROADENOMA
ENDOCARDITIS *
BREAST ? DUCTAL
CVS: PERICARDITIS *
GUT: TERATOMA TESTIS
CARCINOMA
BREAST ? PHYLLODES
RS: LUNG MILIARY TB
GUT: UTERUS LEIOMYOMA
TUMOUR
RS: FIBROCASEOUS TB
GUT: ADENOMYOSIS
RS: LOBAR /
GUT: ENDOMETRIAL POLYP
*OPTIONAL,IF AVAILABLE
BRONCHOPNEUMONIA
RS: BRONCHOGENIC
GUT: CERVICAL POLYP
CARCINOMA
RS: LUNG ? ABSCESS
GUT: CARCINOMA CERVIX
GUT: CYSTADENOCARCINOMA
RS: FIBROCASEOUS TB
OVARY
GUT: SHRUNKEN GRANULAR
RS: LUNG CVC
KIDNEY
RS: METASTASIS LUNG
GUT: KIDNEY STONES
V. REFERENCES
Text Books:
a) Robbins Pathological Basis of Disease ? Kumar, Abbas & Fausto VIII Ed
b) Oxford text book of Pathology Vol. I, II & III
c) Pathology by Rubin and Farber
d) Pathology Illustrated by Reid, Roberts and Macduff
VI. THEORY AND PRACTICAL EXAMINATION
Theory ? Pathology - Total 40 Marks
:
Theory EXAMINATION
Exam. Category
No. of Questions
Marks
1. Essay
1 x 10 marks
10
2. Brief answers
6 x 4 marks
24
3. Very Short answers
6 x 1 marks
6
----
Total 40
----
The above pattern is to be implemented from 2018 February Exam session onwards
Practicals ? Pathology - Total 40 Marks
-
Peripheral
Smear
-
5
marks
Urine
Examination
-
5
marks
Spotters : Hematology
-2 marks (2 slides)
Cytology
- 2 marks (2 slides)
Histopathology
- 6 marks (6 slides)
OSPE : Chart (one)
- 1 marks
Gross (2 specimen)
- 2 marks
Blood Grouping/Hemoglobin
- 2 marks
--------------
Total:
25
Marks
-------------
VIVA VOCE (Includes instruments)
15 Marks
OSPE chart could be prepared based on guidelines given below for problem based learning.
Guidelines to prepare Modules for Problem Based Learning
a. A brief history with clinical findings, reports of investigations done and imaging if required
for that
particular case .
b. Questions on the diagnosis / differential diagnosis
c. Etiopathogenesis of the relevant lesion and / or classifications.
d. Macroscopic / morphological changes in the relevant organ systems.
e. Microscopic features: FNAC / peripheral blood smear / bone marrow / histopathology /
immunohistochemistry.
f. Other laboratory investigations including molecular testing as relevant: principles and
methodology of performing the tests. Differential diagnosis of the interpretations.
g. Mention the complications.
h. Prognostic factors as relevant (eg., for malignant neoplasms)
i. Significance of diagnosis and its therapeutic relevance.
Some examples are given below:
PBL ? CYTOLOGY
a. A 25-year-old female presented with a thick curdy white discharge per vaginum and itching.
Speculum examination showed thick discharge and congested vagina.
b. What test needs to be done to evaluate this patient.
PAP smear kit
c. What are the kits/instruments used to do the test.
? Pap smear kit
- Endocervical brush
-Ayres spatula
- Slides
- Fixatives
d. How are the smears transported
- In a Coplin jar with alcohol fixatives / spray fixatives.
f. What are the latest methods in evaluating these smears.
- Liquid-based cytology
- Thin prep
g. Place pictures of the smear from the patient with description and diagnosis: Smear shows a
mixture of superficial squamous cell, intermediate cells, endocervical cells in an inflammatory
background of polymorphs. Psuedohyphal forms and hyphal forms of candida are seen.
h. What are the stains used to demonstrate the organisms
? Pap stains H & E
- MGG
- Pap
i. Name a special stain which can be used to confirm the diagnosis
-
PAS
j. Name two predisposing factors
-
Diabetus
mellitus
-
Pregnancy
- OCP
k. What are the other infections that can be indentified in a cervical smear
- Trichomonas vaginalis
- Gardnerella vaginalis
- TB
l. What are clue cells
- They are seen in bacterial vaginosis and are vaginal squamous epithelial cells
covered by gram negative bacilli such as Gardnerella
m. What are tadpole cells and where do you see them
- Squamous cell carcinoma cervix
n. What is the Bethesda system and its classification.
It is used to report Pap smears from the cervix or vagina. It ensures that everyone who reports
these smears uses the same terminology. For example, it uses the following terms to classify
abnormal squamous cells : low-grade or high-grade squamous intra-epithelial lesions (LSIL or
HSIL) ; atypical squamous cells of undetermined significance (ASC-US) ; carcinoma.
Terminology has also been described for other cells in the smear.
PBL NEOPLASM
A 20- year-old female presented with a solitary nodule in the left lobe of the thyroid. Imaging
indentified a 1 cm cold nodule with specks of calcification. Patient later underwent total
thyroidectomy with neck node dissection.
1. What is the probable diagnosis/differential diagnosis?
Hyperplastic nodule in a goitre, adenoma, papillary carcinoma
2. What are tests used to confirm the diagnosis?
FNAC, Histopathology.
3. What are the indications for FNAC thyroid?
Solitary nodule / multinodular goiter / Hashimoto thyroiditis / neoplasms
4. What is the size of the bore of the needle used for FNA of the thyroid?
23 G
5. How do you position the patient?
Patient lies down on his /her back with neck hyperextended by using a pillow beneath the
neck
6. How do you fix the smears?
If H & E ? alcohol
If MGG ? no fixation ; air dried
7. How are the smears transported?
In Coplin jars with fixative for H & E.
8. What do you use to write the hospital / laboratory number on the slide with smear?
Diamond pencil
9. What does the FNA of a nodule with papillary carcinoma show?
- Papillary clusters with anatomical borders
- Ground-glass nuclei intranuclear inclusions.
- Psammoma bodies
- Chewing gum colloid.
10. Name 2 other conditions which show intranuclear inclusions.
- Hyalinizing trabecular adenoma
- Medullary carcinoma.
11. Where else do you see psammoma bodies?
Meningioma
Papillary serous cystadenocarcinoma of the ovary
12. What is a psammoma body?
Rounded, concentrically lamellated masses due to dystrophic calcification. Provides
evidence of
papillary carcinoma thyroid.
13. What does the histopathology of the lesion disclose?
Papillary structures lined by cuboidal epithelium with crowded, overlapping nuclei
showing
nuclear grooves and intra nuclear inclusions. The papillae enclose fibrovascular cores.
14. Why is neck dissection done?
Papillary carcinoma spreads via lymphatics to the cervical nodes
15. What are the different modes of metastasis in other
neoplasms Lymphatic / Blood/ Transcoelomic
16. Mention the molecular changes associated with this
tumour RET /PTC rearrangements.
VII. INTERNAL ASSESSMENT (40 Marks)
Theory
? 20 Marks
Practical
? 15 Marks
Record ?
5
Marks
---------------
Total
- 40 Marks
---------------
The above sub-clause VII has been substituted in terms of syllabus and the same is as under:
VII. INTERNAL ASSESSMENT (30 Marks)
Theory
? 15 Marks
Practical
? 10 Marks
Record ?
5
Marks
---------------
Total
- 30 Marks
---------------
The following are guidelines. The topics to be assessed are as follows.
General Pathology and Haematology:
1. Inflammation and repair
2. Haemodynamic disorders
3. Infectious diseases
4. Neoplasia
5. Genetics, Immunologic disorders
6. Environmental and nutritional disorders, diseases of infancy and childhood
7. Diseases of blood, lymph nodes, spleen,thymus
Systemic Pathology:
1. Respiratory system, Cardiovascular system
2. Gastrointestinal system, Hepatobiliary system
3. Urinary system
4. Male and female genital system
5. Endocrine system
6. Musculoskeletal system and skin
7. Nervous system.
6 tests may be conducted for theory during first week of December, February, April, June, August,
October followed by model exam ? 2 in No. Paper I & II in December. For Practical 3 tests may be
conducted in February, June, October followed by Model exam in December.
VIII MEDICAL ETHICS AND CRRI ORIENTATION
Medical ethics is included in the curriculum as part of both theory and practical syllabus.
Students to be taught basic medical ethics, create awareness and sensitized to the ethical issues involved.
CRRI orientation to be done with the following guidelines.
1.
Should know the correct method of writing request for specific laboratory tests.
2.
Should be trained in sample collection of blood, urine, body fluids, CSF ? method of collection,
anticoagulants and preservatives to be used, proper transportation to the laboratory.
3.
Should know proper labelling and method of transportation of biopsy specimens with proper
fixatives.
4.
To be sensitized about inadequate and unsatisfactory samples for laboratory investigation and
rejection criteria of such samples.
XI INTEGRATED TEACHING
From the integrated teaching of other basic sciences, student shall be able to describe the
regulation and integration of the functions of the organs and systems in the body and interpret the
anatomical basis of disease processes.
Topic for Integration
1. Tuberculosis
-
Horizontal Integration with Microbiology and Pharmacology
2. Leprosy
- Horizontal Integration with Microbiology and Pharmacology
3. Diabetes Mellitus
- Vertical integration with Anatomy, Physiology, Microbiology,
Pharmacology, Medicine
4. Myocardial Infarction - Vertical Integration with Anatomy, Physiology, Pharmacology,
Medicine
Note: The above are examples and suggestions. Other topics may be included by individual institutions
RECORD
Record should be followed as recommended by the University
This post was last modified on 02 July 2021