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) 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 marks in each table Table I General and Systemic Pathology Table II Hematology and Clinical Pathology Practical: Scheme of Practical Examination in Pathology. Q1. Exercise on Peripheral Blood Smear Q2. Exercise on Urine (2 Tests at least) Q3. Exercise on Blood group / ESR / TLC / Hb estimation Q4. Exercise on Histopathology slide (identification of description of the Changes therein) 4 Marks Q5. Exercise on Problem based card (interpretation Questions therein) Q6. Exercise on Spotting 6 items (1/2 marks each) (2 specimens + 2 slides + 2 instruments) 4 Marks 3 Marks 1 4 Marks 4 Marks 4 Marks Marks will be 15 (7 x 2) 2 X 5 = 10

Q7. Practical Exercise book (Should be properly signed by appropriate teachers)

2 Marks

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 1st Periodical I.A. 40 1st Periodical I.A. 25 nd 2 Periodical I.A. 40 2nd Periodical I.A. 25 3rd Periodical I.A. 40 3rd 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. 1st Periodical I.A. exam. 25 marks Instruments (two) 5 x 2 = 10 Peripheral blood smear staining 5 Any two of the following three tests 5x2 = 10 ( ESR, TC, Hb estimation) 2nd Periodical I.A. exam. 25 marks Urine examination (two) 5 x 2 = 10 Problem card 5 Blood grouping 5 Instrument 5 rd 3 Periodical I.A. exam. 25 marks Urine examination 5 Peripheral blood smear 5 Blood grouping / ESR /TC 5 Problem card & its interpretation 5 Identification 5 (4 HP & 1 Hematology slide)

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

The Syllabus for the 2nd 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 :2

(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 3

 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 4

 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 Wintrobes tube demonstration 9. Hemoglobin estimation by acid hematin method practice 10. Hemoglobin estimation by Drabkins 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 5

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 System Topics Specimens HP slides Cardio-Vascular Heart failure Mitral stenosis Rheumatic heart disease Atheroma aorta Valvular heart disease Lt. ventricular hypertro. Atherosclerosis Fibrinous pericarditis Myocardial infarction Hypertensive heart dis. Infective endocarditis Pericarditis Respiratory Pneumonia Lobar pneumonia Tuberculosis of lung Pulm. Tuberculosis Bronchiectasis Emphysema COPD Bronchial asthma, Emphysema Bronchiectasis, Emphysema, Chr. Pulm. Tuberculosis Bronchitis fibrocaseous & miliary Bronchogenic carcinoma Bronchogenic carcinoma Gastro-Intestinal Salivary tumors- PSA Peptic ulcer Pleomorphic sal. Esophageal carcinoma Gastric carcinoma adenoma Peptic ulcer Typhoid ulcer of S.I. Adenocarcinoma Gastric carcinoma Tubercular ulcer of S.I. TB intestine Intestinal ulcers Colorectal cancer Acute appendicitis Chrons disease & Ulcerative colitis Colorectal cancer Renal Glomerulonephritis an overview Granular contracted kid. Clear cell carcinoma with nephritic & nephrotic syndrome, Large white kidney Pyelonephritis Hydronephrosis Renal arteriosclerosis Real cell carcinoma Hydronephrosis Adult polycystic kidney Renal cell carcinoma Bone Pyogenic Osteomyelitis Osteomyelitis-sequestrum Osteogenic sarcoma Tubercul. Osteomyelitis TB spine Giant cell tumor Classification of bone tumors Osteogenic sarcoma Osteogenic Sarcoma, Euings Giant cell tumor Sarcoma Giant cell tumor Osteoporosis & Rickets Female Genital Endometrium in health and disease Fibroid uterus Proliferative endo. TB, Menorrhagia, Hormone Carcinoma cervix Secretory endo. Uterine leiomyoma Dermoid tumor of ovary Leiomyoma Cervical carcinoma Mucinous Ovarian tumors -overview cystadenoma Hepato-Biliary Viral hepatitis Micro-nodular cirrhosis Portal cirrhosis 6

Female Breast

Male Genital

Lymph Node

Endocrine Skin

Fatty liver Portal cirrhosis Hepatic failure Hepatocellular carcinoma Metastatic deposit in liver Gall stones Non-neoplastic diseases an overview Fibroadenoma Carcinoma breast Carcinoma penis Testicular tumors classification, Seminoma BHP Prostatic carcinoma an overview Reactive hyperplasia- an overview TB lymph node Metastatic lymph node Hodgkins disease NHL an overview Thyroid Goitre Hashimotos thyroiditis Addisions disease Melanoma Basal cell carcinoma Soft tissue tumors an overview

Fatty liver Metastatic liver Gall stones

Fatty liver Chr. Cholecystitis

Carcinoma breast

Fibroadenoma Duct carcinoma Seminoma Benign hyperplasia of Prostate Meatstatic deposit TB lymph node

Carcinoma Penis Seminoma of testis Benign hyperplasia of Prostate

Colloid goiter Papilloma Melanoma Basal cell carcinoma Lipoma Capillary hemangioma Cavernous hemangioma

Soft Tissue

Central Nervous System

Meningitis pyogenic & Tuberculous CNS tumorsan overview Meningioma

Syllabus for 1st 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 2nd 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 3rd 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 2nd Prof. MBBS Exam. In Pathology 7

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 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 8 1+7+2 = 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 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. 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. Group D 4. Write short notes (any five of the following) a) Involucrum b) Ghons focus c) CSF in pyogenic meningitis d) Morphology of Dermoid cyst of ovary e) PSA f) Reed-Sternberg cell 5x2 = 10 2+3+2+3 =10 3+4+3=10 2+6+2=10

Model Problem Cards: I. Name: Age: Address: Mrs. S. Tarafdar 22 years Sex: Female 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. Q2. Q3. Q4. II. What is the patient likely to be suffering from? What would be the specific gravity of urine in this case and why ? How will you confirm the cause leading to this condition ? What is the appearance of the kidney if the patient suffers for a prolonged time ? 1 1 1 1

Name: Age:

P. Mudi 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. Q2. Q3. Q4. What is the clinical condition of this patient ? 1 Mention two common causes that may lead to such blood picture. 1 Enumerate further tests you would like to do to come to a definite diagnosis 1 If you examine the stool of this patient what pertinent findings may be present ?

1 10

III. Name: Age: Sex Hafiz Mondal 15 years 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. Q2. Q3. What is the provisional diagnosis ? How will you confirm the diagnosis ? 1 Draw a labeled diagram of microscopic features of such lymph node 2 1

IV Name: Age: Sex: Physical: Chemical: T. Ali 24 years Male Report on examination of CSF Appearance: Pressure: Glucose: Protein: Hazy Coming out in jet flow 20 mg/dL 75 mg/dL 350 cells/cu mm Signature

Microscopical: Total cell count:

Q1. Q2. Q3. Q4.

What is the condition this patient is suffering from ? What type of cells do you expect in microscopical examination of CSF ? What are the clinical features of this condition ? What further examination you would do to find out the cause ?

1 1 1 1 11

Item Card Name: Topic Part I: Hematology 10 10 10 10 10 10 10 Roll No. Total Marks Year: Marks obtained Signature of teacher

1. Blood collection, anticoagulants, staining 2. TC, DC & ESR 3. Hb estimation, 4. PCV, Red cell indices, Morphological classification of anemia 5. BT, CT, P Time 6. CML, CLL, Eosinophilia, Marrow puncture needle 7. Blood grouping & Rh typing Part II: Clinical Pathology

1. Urine: Physical & Chemical tests 2. Urine: Microscopical examination 3. L. P. needle and CSF study Part III: Histopathology & Cytopathology

10 10 10

1. Histological techniques including staining 2. Histopathology Non-tumors 3. Histopathology - Tumors 4. Cytology: Exfoliative & FNAC Part IV: Immunopathology

10 10 10 10

1. Pregnancy test in urine & other immunological testsd

10 150

Marks to be computed for continuous Internal Assessment in Practical = Marks obtained / 20 = Complete/Incomplete Counter Signature Signature of HOD

12