Revised Scheme for Second Professional MBBS University Examination in Pathology (to be implemented from 2010 Regular Examinations)

A.      Written Paper:

Paper I – General Pathology & Hematology

Paper II – Systemic Pathology & Clinical Pathology

 Scheme of Theoretical Examination in Pathology.

 Paper :  1. [General Pathology / Haematology]

               Q1. Problem questions (without alternative)                      10 Marks.           

Q2. Comment on ; any two out of three ;                           2 X 5 = 10

                       There shall be conceptual questions on general Pathology/ Haematology.  e.g.

1.       Difference between difference by primary and secondary intention in wound healing.

2.       Retic count is important in diagnosis of anaemia.

            Q3. Pathogenesis / Differentiation / Blood or Bone marrow picture etc (any two out of three: )                  2 X 5 = 10  

           Q4. Short notes (any two out of four)                        2 X 5 = 10  

 Paper : II  [ Systemic  Pathology   [ Investigative Pathology]

                Q1. Same as above

                Q2. Same as above

                Q3. Pathogenesis / investigations/ interpretations etc.

                Q4. Short notes as above.

 B.   Oral/Viva:

There will be two tables with 7 ½ marks in each table                                Marks will be 15 (7 ½ x 2)

                Table I – General and Systemic Pathology

                Table II – Hematology and Clinical Pathology                         

C.         Practical:

 Scheme of Practical Examination in Pathology.

 Q1. Exercise on Peripheral Blood Smear                                4 Marks

 Q2. Exercise on Urine (2 Tests at least)                                  4 Marks

 Q3. Exercise on Blood group / ESR / TLC / Hb estimation        4 Marks

 Q4. Exercise on Histopathology slide (identification of description of the

       Changes therein)            4 Marks

Q5. Exercise on Problem based card (interpretation Questions therein)   4 Marks

 Q6. Exercise on Spotting 6 items (1/2 marks each)                      3 Marks

                           (2 specimens + 2 slides + 2 instruments)

 Q7. Practical Exercise book                                                                                                                2 Marks

                (Should be properly signed by appropriate teachers)

 Distribution of Internal Assessment marks:         Total marks – 30

                         Theory – 15                                         Practical – 15

    Class-tests(Continuous I.A.) = 7.5                                               Item cards (Continuous I.A.) = 7.5

1^st Periodical I.A. – 40                                           1^st Periodical I.A. – 25

2^nd Periodical I.A. – 40                                           2^nd Periodical I.A. – 25

  3^rd Periodical I.A. – 40                                        3^rd Periodical I.A. – 25

    Total – 120                                                                         Total – 75

 120/16  = 7.5                                                            10% of 75 = 7.5

Question pattern for Periodical Internal Assessment examination:

 A.  Theory :    One paper of 40 marks                          Time – 2 hrs.

                1. One clinical problem-oriented question                      10 marks

                2. Two short-answer questions (2-3 segments)      10 x 2 = 20 marks

                3. Five short notes                    2x 5 = 10 marks

 B.      Practical (including Oral):

C.     1^st Periodical I.A. exam.                                            25 marks

q  Instruments (two)                                           5 x 2 = 10

q  Peripheral blood smear staining                        5

q  Any two of the following three tests  5x2  = 10

     ( ESR, TC, Hb estimation)

2^nd  Periodical I.A. exam.                                          25 marks

q  Urine examination (two)                    5 x 2 = 10

q  Problem card                                                      5

q  Blood grouping                                                5

q  Instrument                                                      5

3^rd  Periodical I.A. exam.                                          25 marks

q  Urine examination                                                5

q  Peripheral blood smear                                    5

q  Blood grouping / ESR         /TC                           5

q  Problem card & its interpretation                         5

q  Identification                                                         5

(4 HP & 1 Hematology slide)

 SYLLABUS for Second Professional M.B.B.S. course in PATHOLOGY

The Syllabus for the 2^nd Professional MBBS Course in Pathology is based on the Curriculum prescribed by the Medical Council of India

A)   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.

B)   OBJECTIVES

a)       Knowledge

At the end of the course, the student should be able to :-

(1)           describe the structure and ultrastructure of a sick  cell, mechanisms  of   cell degeneration, cell death and repair  and  be able to correlate structural and functional alterations.

(2)      explain the pathophysiological processes which govern the maintenance  of homeostasis, mechanisms of their disturbance  and the morphological and clinical manifestations associated with it.

(3) .     describe the mechanisms and patterns to tissue response to injury  such that  she/he  can appreciate the pathophysiology of disease processes  and their clinical manifestations.

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

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 and interpretation of the results;

(2)            perform the simple bed-side tests on blood, urine and other biological fluid samples;

(3)            draw  a  rational  scheme  of  investigations  aimed  at diagnosing and managing the cases of common disorders;

(4)     understand  biochemical/physiological  disturbances   that occur  as a result of disease in collaboration with pre  clinical departments.

c)       Integration

       At  the end of training he/she should be able  to  integrate the  causes of disease and relationship of different  etiological factors  (social, economic and environmental) that contribute  to the natural history of diseases most prevalent in India.

Lecture classes: 100 hours

Each Lecture class will be of one hour duration. The important aspects of each topic are given below

General Pathology:

A]  Cell injury and adaptations-       (7 classes)

§ Causes & Mechanism of cell injury

§ Macroscopic and microscopic features of reversible & irreversible cell injury

§ Definition and types of necrosis - characteristics of each type of necrosis with example

§ Apoptosis - definition, examples, its mechanism, morphological changes and its difference from necrosis

§ Definition of gangrene - different types with morphology and examples

       B]  Acute Inflammation-            (6 classes)

§ Definition of acute inflammation and its causes

§ Vascular phenomenon of inflammation

§ Cellular phenomenon - chemotaxis, phagocytosis and formation of exudate

§ Chemical mediators of inflammation - list, histamine, complement, arachidonic acid metabolites, brief mention of coagulation cascade

§ Morphological types of acute inflammation with examples

§ Clinical & hematological manifestations and outcome of acute inflammation

      C]   Chronic Inflammation and granuloma -           ( 4 classes)

§ Chronic inflammation - definition, examples, morphology, cells of chronic inflammation with emphasis on epithelioid cells & giant cells

§ Granuloma- definition pathogenesis & description of a granuloma with special emphasis on tuberculous granuloma

§ Other types of granuloma - Syphilis, Sarcoidosis, Leprosy

§ Giant cells - different types, morphology & examples

       D]   Tissue repair, regeneration and fibrosis -          ( 6 classes)

§ Cell cycle and different types of cells

§ Normal cell growth

§ Regeneration - role of growth factors and extracellular matrix

§ Repair - role of collagen, granulation tissue, angiogenesis and fibrosis

§ Wound healing - first and second intention

§ Factors affecting wound healing

§ Complications of wound healing

§ Healing in bone and specialized tissue

       E]   Hemodynamic disorders, thrombosis and shock -          ( 10 classes)

§ Hyperemia and congestion - definition and morphology

§ Normal hemostasis - mechanism and pathways

§ Thrombosis - definition, pathogenesis, causes, morphology and fate

§ Differences between Thrombophlebitis and Phlebothrombosis

§ Differences between Thrombus and Clot

§ Embolism & Infarction

§ Oedema - definition, types, pathogenesis with examples

§ Differences between Transudate and Exudate

§ Shock - definition, types, pathogenesis, clinical manifestations and examples

        F]   Storage disorders and Amyloidosis -                 ( 3 classes)

§ Classification of storage diseases

§ Familial hypercholesterolemia, Lysosomal storage disease, Glycogen storage disease - an overview

§ Amyloidosis - definition, classification, pathogenesis, staining, clinical manifestations

        G]   Disorders of Growth -          ( 2 classes)

§ Definitions of Hyperplasia, Hypertrophy, Atrophy, Metaplasia, Dysplasia, Hypoplasia with examples.

§ Differences between - Hypertrophy and Hyperplasia, Atrophy and Hypoplasia

        H]   Neoplasia -            ( 10 classes)

§ Definition (Willis') and classification

§ Characteristics of a malignant neoplasm

§ Differences between - Benign and Malignant neoplasm, Carcinoma and Sarcoma

§ Spread of a malignant tumor - Routes with example, Mechanism of spread

§ Carcinogenesis - what is a carcinogen? Why carcinogenesis is a genetic event?

§ Different types of carcinogens and their mechanism of action

§ Molecular biology and genetics of carcinogenesis

§ Systemic changes due to neoplasia - paraneoplastic syndrome

§ Diagnosis of neoplasia

       I]      Metabolic disordersm-        ( 6 classes)

§ Jaundice - definition, bilirubin metabolism, classification, lab. Diagnosis,

§ Diabetes Mellitus - Definition, Classification, Physiology of insulin metabolism, Pathophysiology, Complications, Diagnosis

§ Gout - definition, classification, pathophysiology, diagnosis

       J]     Others -   (10 classes)

§ Genetics and chromosomal disorders - DNA structure, mutations, Mendelian disorders, chromosomal structural alterations, karyotype, cytogenetic disorders, diagnosis of genetic diseases

§ Immune diseases - Hypersensitivity reactions, graft rejection,

§ Autoimmune disorders - mechanism, SLE, Rheumatoid arthritis

§ Immunodeficiency conditions - overview

§ AIDS - pathophysiology, clinical manifestations, diagnosis

§ Environmental pathology - tobacco, alcohol, air pollution

§ Radiation pathology -

Hematology:

       A]    Red Cell disorders -              ( 12 classes)

§ Definition, Classification of anemia- morphological & etiological

§ Iron deficiency anemia - causes, pathogenesis, clinical manifestations and lab diagnosis

§ Megaloblastic anemia - causes, pathogenesis, clinical manifestations and lab diagnosis

§ Aplastic anemia - causes, pathogenesis, clinical manifestations and lab diagnosis

§ Hemolytic anemia - causes, pathogenesis, clinical manifestations and lab diagnosis

§ Thalassemia- types, pathogenesis, genetics, clinical features, lab diagnosis

§ Structural hemoglobinopathies - Sickle cell disease, G6PD deficiency

§ Other red cell disorders - polycythemia

       B]     Leucocyte disorders -         ( 8 classes)

§ Definition, Classification of Leukemia(FAB & WHO)

§ Acute leukemia - causes, morphology, diagnosis

§ Chronic leukemia - causes, morphology, diagnosis

§ Leukemoid reaction - types, morphology, differentiation from leukemia

§ Myelodysplastic syndrome - definition, classification and morphology

§ Benign disorders - leucocytosis, leucopenia etc.

       C]     Bleeding disorders -             ( 6 classes)

§ Thrombocytopenia - causes, common types, approach for lab diagnosis

§ ITP - causes, types, lab diagnosis

§ Coagulation disorders - causes, approach for lab diagnosis

§ Hemophilia - cause, types, lab diagnosis

§ DIC - causes, pathogenesis, features

        D]    Other hematological diseases - ( 4 classes)

§ Plasma cell disorders

§ Hematological manifestations of some important diseases

        E]     Blood groups and Blood Transfusion - ( 6 classes)

§ Different blood groups and their Clinical significance

§ Determination of blood groups

§ Significance of reverse grouping and cross-matching

§ Blood donation - collection, preservation, tests performed

§ Indications of Blood Transfusion

§ Transfusion reactions - diagnosis

§ Rational use of blood - including component therapy

Practical classes – 80 hours

Each practical class will be of 2 hours duration. The procedures to be demonstrated and practiced are:-

                A]  Hematology

1.       How to draw blood – demonstration

2.       Anticoagulants and their use

3.       Drawing of blood film – practice

4.       Staining (Leishman) – practice

5.       Focussing the slide under microscope and identification of cells – practice

6.       ESR by Westergreen pipette – practice

7.       Total count of WBC by Neubauer chamber – practice

8.       Packed cell volume by Wintrobe’s tube – demonstration

9.       Hemoglobin estimation  by acid hematin method – practice

10.    Hemoglobin estimation by Drabkin’s method – demonstration

11.    Bleeding time and Clotting time – demonstration

12.    Prothrombin time – demonstration

13.    Bone marrow – demonstration of stained slides – normal, ITP , Megaloblastic anemia

14.    Blood grouping – ABO & Rh – practice

B]   Clinical Pathology

1.       Urine – noting the physical characters, how to measure specific gravity – practice

2.       Urine – chemical tests for Protein, Reducing substances and Ketone bodies- practice

3.       Use of different stix and their interpretation - demonstration

4.       Microscopic examination of urine – practice

5.       CSF – demonstration of cell type in a normal CSF sample and a case of pyogenic meningitis

C]   Histopathology & Cytopathology

1.       Techniques of histopathology & Cytopathology (including FNAC) – demonstration

2.       H & E staining and other special staining – demonstration

3.       Demonstration of HP & Cytology slides  – along with tutorial classes in systemic pathology

D]  Problem cards – along with tutorial classes in systemic pathology

 Tutorial classes – 120 hours

Entire systemic pathology will be learned in tutorial classes along with demonstration of HP slides and problem-based learning with the help of problem cards

Syllabus for 1^st Periodical I.A. examination:

                Theory -  General Pathology upto Disorders of growth (Item A to G)

                Practical -  Hematology upto hemoglobin estimation (Item 1 to 10)

Syllabus for 2^nd  Periodical I.A. examination:

                Theory – Rest of General Pathology (Item H. I. J), Hematology (Item A, B, C)

                Practical – Rest of Hematology (Item 11-13), Clinical Pathology (Item 1-5)

                                       Problem cards on Hematology and Clinical Pathology

Syllabus for 3^rd Periodical I.A. examination:

                Theory -  Systemic Pathology

                Practical – Histological & Cytological techniques (including stains), HP slides (spotting)

                                                Problem card on systemic pathology

Practical Note Book will have to be submitted during Item and Part clearance

Model Question for 2^nd Prof. MBBS Exam. In Pathology

Time : 2 hours                                                     Paper – I                                                               Total marks – 40

There are four groups of questions. Answer each group in separate answer papers provided.

Group – A

1.  A male child of 2 years age presents with recurrent swelling of knees which occur even after trivial trauma. The family history shows that his maternal uncle also suffered from same conditions.

a)       What may be the possible diagnosis ?

b)       How will you proceed to investigate this patient to come to a diagnosis ?     1+9=10

Group – B

2. Define shock. Enumerate the major types of shock that we encounter in our day to day practice Describe the pathogenesis of shock in burns.                    2+2+6=10

Or

                                Define necrosis. Enumerate different morphological types of necrosis with two examples each. How necrosis differs from apoptosis ?             2+5+3=10

 Group – C

3.   Define neoplasia. Enumerate different types of carcinogens with two examples each. Explain with example that carcinogenesis is a multi-step phenomena.       2+4+4=10

                                                                                        Or

      Mention the criteria for diagnosis of Diabetes Mellitus. Describe the pathogenesis of Type 2 Diabetes. What is glycosylated Hemoglobin ?         4+4+2=10

                                                   Group – D

4.   Write short notes (any five of the following)                   5x2 = 10

a)       Significance of Reticulocyte count

b)       Poikilocytosis

c)       Peripheral blood smear findings in Chronic Myeloid Leukemia

d)       Phlebothrombosis

e)       Neutrophilic Alakaline Phosphatase

f)        Definition and two examples of Metaplasia

Paper – II

Time : 2 hours                                                                     Total marks – 40

There are four groups of questions. Answer each group in separate answer papers provided.

 Group – A

1.        A 45-year-old man was rushed to the hospital following an episode of crushing substernal chest pain with breathing difficulty. An urgent ECG was done which showed elevation of ST segment with deep Q wave.

   a)   What may be the possible diagnosis ?

c)       What other investigations will you suggest for evaluation of this case ?

d)       Enumerate the common complications that may arise in this case           1+7+2 = 10

Group – B

2.       Classify Glomerulonephritis. Describe the morphological changes in the kidney in a child of 10 years of age suffering from Nephrotic syndrome                 4+6 =10

Or

Enumerate the viruses that can cause hepatitis. Discuss the significance of serological study in a case of hepatitis B. Enumerate the common complications of hepatitis B infection                 2+6+2=10

                                                                   Group – C

3.       Classify lung tumors. Describe the morphological changes in any one of them. Enumerate the steps of investigations to arrive at a diagnosis.         3+4+3=10

                                                                                        Or

      Enumerate the morphological types of gastric carcinoma. Describe the Microscopical features of any one of them. What are the common sites of spread of a gastric carcinoma ? Enumerate the steps of diagnosis in a suspected case of gastric cancer.      2+3+2+3 =10

                                                 Group – D

4.   Write short notes (any five of the following)                   5x2 = 10

a)       Involucrum

b)   Ghon’s focus

c)   CSF in pyogenic meningitis

d)   Morphology of Dermoid cyst of ovary

e)   PSA

f)   Reed-Sternberg cell

Model Problem Cards:

I. 

                Name:                     Mrs. S. Tarafdar

                Age:                        22 years          Sex:                               Female

                Address:                32/1 AJC Bose Road, Kolkata – 14

                                                                Report on examination of urine

                Physical:                                Appearance:         Hazy

                                                                Sp. Gravity:          Q. I.

                                                                Odour:                   Fishy

                                                                Sediment:              Present

Chemical:                             Reducing subst.    Nil

                                                                Protein:                  Present  

                                                                Ketone bodies:     Nil

Microscopical:                     Epithelial cells:     3-4 cells / HPF

                                                                Pus cells:                                10-15 cells / HPF

                                                                RBC:                                      2-3 cells / HPF

Casts:                                     Nil

Crystals:                                Nil

Signature

    ______________________________________________________________

Q1.  What is the patient likely to be suffering from?                                                    1

Q2.  What would be the specific gravity of urine in this case and why ?                  1

Q3.  How will you confirm the cause leading to this condition ?                                1             

Q4.  What is the appearance of the kidney if the patient suffers for a prolonged time ? 1

II.            Name:                    P. Mudi

                Age:                        12 years Sex:                        Female

                                                Report of examination of Blood

Hemoglobin:                        9 g/dL

ESR:                                       12 mm at 1 hr.

TLC:                                      8600/Cu. mm

DLC:                                      Neutrophil             53 %

                                                Lymphocyte         39 %

                                                Monocyte             03 %

                                                Eosinophil             05 %

RBC:                                      Microcytic hypochromic

                                                Anisocytosis +

                                                Poikilocytosis +

Platelets:                                Adequate

                                                                                                Signature

Q1.          What is the clinical condition of this patient ?               1

                Q2.          Mention two common causes that may lead to such blood picture.                         1

                Q3.          Enumerate further tests you would like to do to come to a definite diagnosis        1

                Q4.          If you examine the stool of this patient what pertinent findings may be present ?                1

III.

                Name:                    Hafiz Mondal

                Age:                        15 years                

Sex                         Male

                                Patient is referred from the ENT OPD of NRS Medical College for

                        FNAC of neck glands

                                                Report on examination of FNAC of cervical lymph node

                                Smears show necrotic material and epithelioid cells in aggregate

                                                                                                Signature

                Q1.          What is the provisional diagnosis ?                                                                        1

                Q2.          How will you confirm the diagnosis ?                                                                    1

                Q3.          Draw a labeled diagram of microscopic features of such lymph node    2

IV

                Name:                    T. Ali

                Age:                        24 years

                Sex:                        Male

                                                                Report on examination of CSF

                Physical:                Appearance:         Hazy

                                                Pressure:                Coming out in jet flow

                Chemical:             Glucose:                20 mg/dL

Protein:  75 mg/dL

                Microscopical:     Total cell count:   350 cells/cu mm

                                                                                                                                                Signature                              

Q1.          What is the condition this patient is suffering from ?                                                   1

                Q2.          What type of cells do you expect in microscopical examination of CSF ?              1

                Q3.          What are the clinical features of this condition ?                                                          1

                Q4.          What further examination you would do to find out the cause ?                              1

Item Card

Marks to be computed for continuous Internal Assessment in Practical = Marks obtained / 20 =

Complete/Incomplete

Counter Signature                                                                               Signature of HOD