OBJECTIVES

A MBBS student at the end of training in Pathology will be able to:

Understand the concepts of cell injury and changes produced thereby in different tissues and organs and the body’s capacity for healing.

Understand the normal homeostatic mechanisms, the derangements of these mechanism and the effects on human systems.

Understand the etiopathogenesis, the pathological effects and the clinico-pathological correlation of common infectious and non-infectious diseases.

Understand the concept of neoplasia with reference to the etiology, gross and microscopic features, diagnosis and prognosis in different tissues and organs of the body.

Correlate normal and altered morphology (gross and microscopic) of different organ systems in different diseases to the extent needed for understanding of disease processes and their clinical significance.

Have a knowledge of common immunological disorders and their resultant effects on the human body.

Have an understanding of the common haematological disorders and the investigations necessary to diagnose them and determine their prognosis.

Perform and interpret in a proper manner the basic clinico-pathological procedures.

Know the principles of collection, handling and dispatch of clinical samples from patients in a proper manner.

COURSE CONTENTS

(A) General Pathology

Introduction to Pathology

Cell Injury

Cell injury: Causes and Mechanism: Ischemic, Toxic.

Reversible cell injury : Types, morphology: Swelling, vacuolation, hyaline, fatty change.

Irreversible cell injury : Types of Necrosis

Amyloidosis and Calcification

Calcification : Dystrophic and Metastatic

Amyloidosis : classification, Pathogenesis, Morphology

Inflammation and Repair

Acute inflammation : Features, causes, vascular and cellular events.

Morphologic variants of acute inflammation

Inflammatory cells and Mediators

Chronic inflammation : Causes, types, nonspecific and Granulomatous with examples

Wound healing by primary and secondary union, factors promoting and delaying the process

Healing at specific sites including bone healing

Circulatory Disturbances

Edema : Pathogenesis and types

Chronic venous congestion : Pathogenesis and changes in Lung, Liver, Spleen

Thrombosis and Embolism : Formation, Fate and Effects

Infarction : Types, common sites, Gangrene

Shock : Pathogenesis, Types, Morphologic changes

Derangements of Fluid and electrolyte imbalance

Growth Disturbances and Neoplasia

Atrophy, Hypertrophy, Hyperplasia, Hypoplasia, Metaplasia, Malformation, Agenesis, Dysplasia

Neoplasia : Classification, Histogenesis, Biologic Behaviour : Benign and Malignant; Carcinoma and Sarcoma

Malignant Neoplasia : Grades and Stages, Local and distant spread

Carcinogenesis : Environmental carcinogens, chemical, viral, occupational, Heredity and cellular oncogenes

Tumour and Host Interactions : Systemic effects including paraneoplastic syndromes, Tumor immunology

Laboratory diagnosis : Cytology, Biopsy, Tumor markers

Immunopathology

Immune system : organisation, cells, antibodies and regulation of immune responses.

Hypersensitivity : types and examples, Antibody and cell mediated tissue injury with examples.

Primary immunodeficiency

Secondary Immunodeficiency including HIV Infection

Auto-immune disorders like systemic lupus erythematosis; organ specific and non-organ specific such as polyarteritis nodosa, Hashimoto’s disease.

Tumor Immunity

Organ transplantation : Immunologic basis of Rejection and Graft versus host reaction

Infectious Diseases

Mycobacterial Diseases : Tuberculosis and Leprosy

Bacterial diseases : Pyogenic, Typhoid, Diphtheria, Gram negative infection, Bacillary dysentery, Syphilis

Viral : Polio, Herpes, Rabies, Measles; Rickettsial, Chlamydial infection

Fungal diseases and opportunistic infections

Parasitic Diseases : Malaria, Filaria, Amebiasis, Kala-azar, Cysticercosis, Hydatid

AIDS : Aetiology, modes of transmission, diagnostic procedures and handling of infected material and health education.

Miscellaneous Disorders

Autosomal and sex-linked disorders with examples

Metabolic disorders

Protein energy malnutrition and vitamin deficiency disorders

Radiation Injury

Disorders of Pigment and Mineral metabolism such as bilirubin, melanin, hemosiderin

(B) Systemic Pathology

Cardiovascular Pathology

Rheumatic fever and Rheumatic Heart Disease : Pathogenesis, Morphology and effects

Infective Endocarditis : Causes, Pathogenesis and Morphology

Atherosclerosis and Ischemic Heart Disease; Myocardial Infarction

Diseases of blood vessels other than atherosclerosis

Hypertension and Hypertensive Heart Disease

Congenital Heart Disease : ASD, VSD, Fallot’s Bicuspid aortic valve, PDA

Pericarditis and other pericardial diseases

Cardiomyopathy

Respiratory Pathology

Structure of Bronchial tree and alveolar walls, normal and altered lung function; concept of obstructive and restrictive lung disorders

Inflammatory diseases of bronchi : chronic bronchitis, bronchial asthma, bronchiectasis, chronic obstructive lung disease

Pneumonias : Lobar, Broncho, Interstitial

Pulmonary suppuration including lung abscess : Etiopathogenesis and Morphology

Pulmonary Tuberculosis : Primary and Secondary, Morphologic types including pleuritis

Emphysema : Types, pathogenesis

Atelectasis and Hyaline Membrane Disease

Tumors : Benign; Carcinoid, Malignant; Squamous cell, Oat cell, Adeno, etiopathogenesis.

Occupational lung disorders : anthracosis, silicosis, asbestosis, mesothelioma

Urinary Tract Pathology

Renal structure, basis of impaired function, urine analysis

Glomerulonephritis : Classification, Primary Proliferative and Non Proliferative

Secondary Glomerulonephritis : SLE, Purpura, Polyarteritis, Amyloidosis, Diabetes

Nephrotic Syndrome

Acute Renal Failure : Acute tubular and cortical necrosis

Progressive renal failure and end stage renal disease

Pyelonephritis, Reflux Nephropathy, Interstitial Nephritis

Renal tumors : Renal cell carcinoma, Nephroblastoma

Renal vascular disorders, kidney changes in Hypertension

Urinary bladder : cystitis, carcinoma

Urinary Tract Tuberculosis

Urolithiasis and Obstructive Uropathy

Renal Malformations : Polycystic kidneys

Pathology of the Gastro-Intestinal Tract

Oral Pathology : Leukoplakia; Carcinoma oral Cavity and Esophagus

Salivary gland tumors : Mixed, Adenoid cystic, warthin’s

Peptic ulcer : etiopathogenesis and complications; gastritis: types

Tumors of stomach : Benign; Polyp, Leiomyoma, Malignant; Adenocarcinoma, Lymphoma

Inflammatory diseases of small intestine : Typhoid, Tuberculosis, Crohn’s, Appendictis

Inflammatory diseases of appendix and large intestine : Amoebic colitis, Bacillary dysentery, Ulcerative Colitis

Ischemic and Pseudomembranous enterocolitis, diverticulosis

Malabsorption : Celiac disease, Trophical sprue and other causes

Tumours and Tumor like condition of the large and small intestine : Polyps, Carcinoid, Carcinoma, Lymphoma

Pancreatitis

Pancreatic tumors : Endocrine, Exocrine and periampullary

Hematopathology

Constituents of blood and bone marrow, Regulation of hematopoiesis

Anaemia : classification and clinical features; clinical and lab. approach to diagnosis

Nutritional anaemias : Iron deficiency anaemia, Folic Acid/Vit B 12 deficiency anaemia including pernicious anaemia

Hemolytic Anaemias : Classification and invesgiation

Hereditary hemolytic anaemias : Thalassemia, sickle cell anaemia

Hereditary hemolytic anaemias : hereditary spherocytosis, G-6-PD deficiency

Acquired hemolytic anaemias

Hemolytic Anaemias : Autoimmune, Alloimmune, Drug induced Microangiopathic and Malaria

Aplastic Anaemia, PNH and Myelodysplastic syndrome

Hemostatic disorders : Platelet deficiency; ITP, Drug induced, secondary

Coagulopathies : Coagulation factor deficiency; hemophilia, DIC and anticoagulant control

Leukocytic disorders : Leukocytosis, leukopenia, leukemoid reaction

Acute and chronic Leukemia : Classification, Diagnosis

Myeloproliferative disorders : Polycythemia, Myelofibrosis

Multiple myeloma and dysproteinemias

Blood transfusion : grouping and cross matching, untoward reactions, transmissible infections including HIV and hepatitis

Liver and Biliary Tract Pathology

Jaundice : Types, Pathogenesis and Differentiation

Hepatitis : Acute and Chronic, Etiology, Pathogenesis and Pathology

Cirrhosis: Etiology, Postnecrotic, Alcoholic, Metabolic, Pathology, Morphology (Macronodular, Micronodular, Mixed), complications

Portal Hypertension : Types including non-cirrhotic portal fibrosis and Manifestations

Tumors of Liver : hepatocellular and metastatic carcinoma, tumor markers

Concept of hepatocellular failure

Diseases of the gall bladder : Cholecystitis, Cholelithiasis, Carcinoma

Lymphoreticular System

Lymphadenitis : nonspecific, Granulomatous

Hodgkin’s and Non-Hodgkin’s Lymphomas : Classification, Morphology

Diseases of the spleen : Splenomegaly causes and effects

Thymus : Dysgenesis, Atrophy, Hyperplasia, Neoplasia

Reproductive System

Diseases of cervix : cervicitis, cervical carcinoma, etiology, types and cytologic diagnosis

Hormonal influences and histological appearances of different phases of menstrual cycle and the abnormalities associated with it

Diseases of uterus : endometritis, endometrial hyperplasia and carcinoma, adenomyosis, smooth muscle tumors

Trophoblastic disease : Hydatidiform mole, Choriocarcinoma

Diseases of the breast : Mastitis, abscess, Fibrocystic disease, Neoplastic lesions : Fibroadenoma, Carcinoma, Phyllodes tumor

Prostate : Nodular Hyperplasia and Carcinoma

Ovarian and testicular tumors

Carcinoma of penis

Pelvic inflammatory diseases including salpingitis

Genital Tuberculosis

Osteopathology

Bone – general considerations, reactions to injury and healing of fractures

Osteomyelitis : Acute, Chronic, Tuberculous, Mycetoma

Metabolic diseases : Rickets/Osteomalacia, Osteoporosis, Hyperparathyroidisism

Tumors : Primary, Osteosarcoma, Osteoclastoma, Ewing’s Sarcoma, Chondrosarcoma; Metastatic

Arthritis : Rheumatoid, Osteo and tuberculous

Endocrine Pathology

Scope of endocrine control and investigations

Diabetes Mellitus : Types, Pathogenesis, pathology

Nonneoplastic lesions of thyroid : Iodine deficiency goiter, autoimmune thyroiditis, thyrotoxicosis, myxedema

Tumors of thyroid – adenoma, carcinoma : Papillary, Follicular, Medullary, Anaplastic

Adrenal diseases : Cortical hyperplasia, atrophy, tuberculosis, tumors of cortex and medulla

Parathyroid hyperplasia and tumors and Hyperparathyroidism

Pituitary tumors

Multiple endocrine neoplasia

Neuropathology

Structural Organization, specific cell types, and reaction patterns

Inflammatory disorders : Pyogenic and tuberculous meningitis, brain abscess, tuberculoma

CNS tumors – primary : glioma and meningioma (excluding histopathology) and metastatic

CSF and its disturbances : cerebral edema, raised intracranial pressure

Cerebrovascular diseases : Atherosclerosis, thrombosis, embolism, aneurysm, Hypoxia, Infarction and Hemorrhage

Peripheral neuropathies and demyelnating disorders

   Diseases of muscles

Traumatic lesions of CNS

(C) Practicals

Identify and interpret the gross and/or microscopic features of common disorders as given above.

Perform with accuracy and reliability basic haematological procedures such as haemoglobin estimation, total and differential WBC count and peripheral blood smear staining, examination and report.

Calculate the indices and interpret the relevant significance.

Perform the basic laboratory haematological tests like bleeding time and clotting time

Perform a complete examination of the urine and detect any abnormalities

Grouping and cross matching of blood

Collect and dispatch clinical samples from patients in a proper manner

Interpret abnormal biochemical laboratory values of common diseases.

TEACHING AND LEARNING METHODOLOGY

Department stresses on teaching basic fundamentals of the disease process and the applied aspects relevant to the clinical subjects.

General Pathology

Taught with the help of Didactic lectures on specific topics, followed by Practicals pertaining to that topic. Besides microscopic examination, fresh specimens obtained at autopsy or surgical operations are shown.

Systemic Pathology

The following tools are employed:

Didactic lectures: discussing a particular topic at length in an one hour lecture

Paraclinical seminars: are conducted by a combined team of pathologist and a clinician who discuss the pathophysiology and clinical aspects of the particular disease entity.

Case studies: The significant and common diseases are discussed in the form of a representative clinical case in which the clinical features, the course of the disease in that particular patient and relevant laboratory investigations are discussed by a clinical faculty in an interactive manner in small groups. This is followed by demonstration of the gross and microscopic features of the disease in that case by the pathologist. This is followed by clinico-pathologic correlation.

Practicals

Deals with demonstration of gross, and/or microscopic features of the disease entities. v) Clinical case demonstration

Patients of a particular disease are demonstrated to the students by a clinical faculty in the ward, discussing the clinical features in the patient which provides them a real-life experience of studying a disease as it presents in a patient.

By a combination of above modalities/tools, student learns applied aspects of the disease process.

TEXT-BOOKS RECOMMENDED

Robbin’s Pathologic Basis of Diseases

Text-Book of Pathology by Harsh Mohan

Roitt’s Essential Immunology

Walter and Israel’s General Pathology

EXAMINATION AND MARKS DISTRIBUTION

 

Total Marks	:	300
Internal Assessment	:	150
Professional Examination	:	150

Internal Assessment: Five assessments in theory and practical are held as given below

 

		Theory	Practical	Viva
III Semester	Mid Term	15	11	4
	End Term	15	11	4
IV Semester	Mid Term	15	11	4
	End Term	15	11	4
V Semester	End Term	15	11	4
	Total	75	55	20

 

Professional Examination
Theory	Paper I	37.5	Marks
	(General Pathology and Hematopathology)
	Paper II	37.5	Marks
	(Systemic Pathology)
Practicals		55.0	Marks
Viva		20.0	Marks

Theory Papers : Comprise of various types of MCQ (Single Response, Multiple True-false, Matching, Reason-Assertion, Multiple Completion) and Short Answer Questions (SAQ).

Practicals : include Conventional urine examination, Hematology exercises and Objective StructuredPractical Examination (OSPE).