Pathology

COURSE CONTENTS

• Knowledge: At the end of the course, the student shall be able to :
• Describe the structure of a sick cell, mechanisms of cell degeneration, cell death and repair and be able to Correlate structural and functional Alterations.
• Explain the pathophysiological process which governs the maintenance of fluid and homeostasis, the mechanisms of their disturbance and the morphological and clinical manifestations associated with it.
• Describe the mechanisms and patterns of tissue response to injury so that he/she can appreciate the pathophysiology of disease processes and their clinical manifestations.
• Correlate normal and altered morphology (gross and microscopic) of different organ systems in common diseases to the extent needed for an understanding of disease processes and their clinical significance.

SYLLABUS

II. M.B.B.S. PATHOLOGY SYLLABUS

(PRACTICAL – BY STUDENT, DEMONSTRATION – BY FACULTY)

1. HEMATOLOGY

Introduction to Pathology

• Bone marrow aspiration, Biopsy and cellular details Practicals
• Clinical Pathology Introduction. Demonstration :
• Demonstration: Bonemarrow aspiration Instruments, Bonemarrow slides – normal.

 2. R.B.C. DISORDERS – ANAEMIAS, CLASSIFICATION AND LABORATORY INVESTIGATIONS

• Iron deficiency anaemias & Sideroblastic anaemias.
• Megoloblastic anaemias
• Hemolytic anaemias – Congenital and Acquired
• Aplastic anaemias and Symptomatic Anaemias.
• Polycythemia

Practicals

• Perform Hb, R.B.C. Count
• Iron deficiency anaemia view the slide & record
• Macrocytic anaemia view the slide & record
• Megaloblastic marrow view the slide & record
• Aplastic marrow, Peripheral smear study, view the slides & record.

3. Demonstrations

• P.C.V.
• Sickle cells
• Thalassemia – Peripheral smear
• Spherocytic anaemia
• Haemoglobin Electrophoresis
• Reticulocytes
• Heinz bodies
• Leukopenia, agranulocytosis and Leukocytosis
• Leukemias & Multiple myeloma

Practicals

• Total W.B.C. count Differential count
• Neutrophilia Eosinphilia AML, ALL, CML, CLL

Demonstrations

• Guidance and questions Cytochemical stains

4. COAGULATION DISORDERS

• Vascular disorders
• Platelets disorders
• Coagulation factor deficiency

Practicals

• Platelet counts

Demonstration

• Bleeding time, Clotting time.

5. BLOOD GROUP, BLOOD BANKING SYSTEM AND
TRANSFUSION REACTIONS

Practicals

• Blood group & RH Factor

Demonstration

• Blood Bank
• Blood Bank Working Pattern

6. LYMPH NODES

• Specific and nonspecific lymphadenitis
• Lymphomas

Practicals

• Lymphomas – specimen
• Lymphomas – slides
• Secondary deposits (specimen) & slide

Demonstration

• Guidance

7. SPLEEN

• Splenomegaly

Practicals

• CVC Spleen – Specimen & slide CML Spleen, Gauchers spleen – specimen Amyloidosis spleen (Amyloidosis)

Demonstration

Guidance General Pathology

8. a). CELL INJURY AND CELLULAR ADAPTATIONS

• Etiologic factors and mechanisms, hypoxia, oxygen radical injury and hyperexis, chemical agents, radiation, Immunological mediators, infectious agents and genetic factors.

Practical :(Student)

Introduction to Histopathology and cytology Laboratory & Museum. Cloudy swelling kidney – specimen & slide.

Demonstration : (Faculty activity)

Guidance slides

b). Reversible and irreversible cell injury and intracellular accumulations, Pathological calcifications.

• Adaptation to cell injury, Atrophy, hypertrophy, hyperplasia, hypoplasia, metaplasia and dysplasia.

Practicals

• Fatty change – Liver specimen & slide

Demonstration

• Guidance – Pathological calcification – specimen

9. INFLAMMATION

• Patterns of inflammation, acute responses and chronic responses. Humoral and cellular participants of humoral inflammation elements, blood-borne cells, and stromal elements.

Demonstrations

• Abpscess – Liver or Lung – Specimen

10. MOLECULAR BASIS FOR INFLAMMATORY EVENTS 

• Chemical mediators, vascular, cellular and molecular events of inflammation, regulation of inflammation.

Practicals

• Acute appendicitis Specimen and slides
  Chronic inflammation, Tuberculous granuloma, Foreign body granuloma slides.

Demonstrations

• Abscess – Liver or Lung – Specimen Guidance with slides

11. Repair and regeneration

components of repair and regeneration reactions, cells of the repair process. Mechanism of repair. Regeneration and healing in specific organs. E.g. Fracture Healing.

Practicals 

• Granulation tissue

Demonstrations:

Guidance

12. GENETICS:

Introduction to Medical genetics

13. HEMOSTASIS AND THROMBOSIS.

• Normal hemostasis, abnormal hemostasis – Vascular defects, Platelet defects, defect of coagulation proteins, disseminated intravascular coagulation.
  Thrombosis

Practicals 

• Venous thrombus specimen, Organisation of thrombus slides.

Demonstrations 

• Thrombus in the left atrium, Coronary arteries

14. CIRCULATORY DISTURBANCE

• Edema, hyperemia and congestion, shock, embolism, infarction and gangrene

Practicals 

• Filarial leg – specimen, CVC – Liver, Lung, Spleen – specimen and slides.
• Embolus – Pulmonary – Specimen, Infarction – Heart, Lung, Specimen and Gangrene foot – Specimen.

Demonstrations 

• Pulmonary oedema – Specimen and slide, Shock – kidney specimen. Gangrene intestine.

15. NEOPLASIA

• Definition & Tumour Nomenclatures. Characteristics of Neoplastic Cells. Aetiology of Neoplasia. Demographic and Familiar aspects of Cancers. Laboratory Diagnosis.

Practicals 

• Benign – Lipoma, Leiomyoma, capillary and cavernous angioma schwannoma. Cystic Teratoma – Ovary, Squamous papilloma, Villous papilloma, Adenomatous polyp – Intestine, Chondroma.
• Malignant – squamous Cell carcinoma, Chondrosarcoma, Osteosarcoma, Malignant Melanoma – All specimens and slides. Metastatic Deposit – Lymph node, Cytology – Malignant Cells.

Demonstrations 

• Dysplasia F.N.A.C. – Positive slides – Guidance and slides Cytology PAP Skin.

16. IMMUNO PATHOLOGY 

• Immune responses, Atopic and Anaphylactic reactions, Cytotoxic reactions, complex immune reactions, and delayed granulomatous hypersensitivity reactions.
• Autoimmunity and Autoimmune diseases. Primary Immunodeficiencies, Acquired Immunodeficiency Syndrome &Amyloidosis.

Practicals 

• Amyloid – Liver, Spleen, Kidney Specimens

Demonstrations 

Guidance and Slides

17.NUTRITIONAL DEPRIVATION DISEASES & RADIATION INJURIES

• Protein calorie Malnutrition and Vitamin deficiencies.

18. INFECTIOUS DISEASES

• Bacterial Diseases – Gram +ve gram-negative infections Typhoid, Tuberculosis, Leprosy, Syphilis, Fungal Diseases, Protozoal Diseases – Amoeba, Malaria.

Practicals

• Actinomycosis, Maduramycosis Specimens and slides. Syphilis – Gumma.
• Tuberculous lymphadenitis Tuberculosis – Lung primary complex and adult Tuberculous. Leprosy -Lerpromatous & Tuberculoid.
• An amoebic abscess (LIVER) and ulcer intestine, Malarial – Spleen, Specimens.

Demonstrations 

Guidance and Slides

SYSTEMIC PATHOLOGY

19. VASCULAR SYSTEM 

• Atherosclerosis, Arteriosclerosis and Aneurysms.

Practicals 

• Atherosclerosis – Aorta – Specimen and slide. Aortic Aneurysms – Syphilitic and Atherosclerotic- Specimen.

Demonstrations 

• Slides and Guidance.

20. PATHOLOGY OF HEART 

• Rheumatic Heart Disease, Bacterial Endocarditis, Myocardial Infarction, Hypertensive Heart Disease, Tumours of the Heart & Blood Vessels.

Practicals 

• Rheumatic mitral stenosis, Bacterial endocarditis, Myocardial Infarction, Hypertensive Cardiac Hypertrophy- Specimens.

Demonstrations 

• Left Atrial myxoma specimen.

21. PATHOLOGY OF LUNG 

• Bronchial Asthma, Pneumonia – Bronchial & Lobar, Interstitial Pulmonary Tuberculosis, Bronchiectases and lung abscess, Pnemoconiosis, Tumours of Lungs and Pleura.

Practicals 

• Labour pneumonia – Red & Grey hepatization, Bronchiectasis Lung abscess, pulmonary tuberculosis, Emphysema – specimen & slide, Bronchogenic carcinoma, Secondary deposit lung – specimen.

Demonstrations 

• Guidance with slides.

22. PATHOLOGY OF GASTRO-INTESTINAL TRACT

• Pleomorphic Adenoma of the salivary gland, Carcinoma Esophagus, peptic ulcer, gastric polyps, and gastric carcinoma. Idiopathic inflammatory bowel diseases, Tumours of small and large intestines.

Practicals 

• Mixed Tumors – salivary gland specimen & slide, carcinoma oesophagus -specimen. Gastric ulcer and carcinoma – specimen & slide Ulcers of the small intestine – typhoid Chron’s large intestine amoebic ulcer, carcinoma small & large intestines.

Demonstrations 

• Guidance with slides

23. LIVER, BILIARY TRACTS AND PANCREAS

• Hepatitis, Cirrhosis, Tumours of the liver
  Cholecystitis, Gall stone, Tumour of gall bladder
  Acute Pancreatitis

Practicals 

• Cirrhosis – liver specimen with slides
• Hepatoma – specimen with slides
• Gallstone – specimen

Demonstrations 

• Guidance

24. KIDNEY

• Glomerulonephritis
• Nephrotic Syndrome

Practicals 

• Contracted kidney specimen
• Chronic nephritis specimen

Demonstrations 

• Guidance Tubule – interstitial diseases
• Nephrosclerosis, Renal calculi
• Tumours of the kidney and the urinary bladder

Practicals 

• Chronic pyelonephritis specimen & slides
  Transitional cell carcinoma specimen and slides

Demonstrations 

Guidance

25. GENITAL SYSTEM MALE 

• Carcinoma penis and premalignant lesions, tumours of the testis. Prostate -benign hypertrophy and tumours.

 Practicals

• Carcinoma penis – specimen and slides
• Seminoma specimen and slides
• B.H.P. specimen and slides 

Demonstrations 

• Guidance E.S.T.
• Malignant Teratoma
• Carcinoma Prostate

26. GENITAL SYSTEM – FEMALE

• Carcinoma – cervix & Premalignant lesion, tumours of the body of the uterus
• Endometriosis
• Ovarian tumours
• Trophoblastic tumours

Practicals

• Carcinoma – Cervix specimen, fibroid uterus slides
• Carcinoma endometrium slide
• Endometrium proliferative/ slide
• Endometrium secretory / slide
• Serous cystadenoma – specimen & slide
• Musinous cystadenoma specimen & slide
• Papillary serous carcinoma specimen
• Dysgerminoma
• Dermoid cyst

Demonstrations

• Guidance with slides

27. BREAST

• Tumours of the breast

Practicals 

• Fibroadenoma breast specimen & slide
• Infiltrating ductal carcinoma specimen & slide

Demonstrations 

• Guidance / other types of breast carcinoma.

28. ENDOCRINE

• Thyroid/thyroiditis, goitre and tumours of thyroid Phaeo chromocytoma and Neuroblastoma. Pancreas – diabetes and tumours MEN

Practicals 

• Colloid goitre specimen / slide Toxic goitre specimen / slide Follicular adenoma specimen / slide Papillary carcinoma specimen / slide

29. SKIN

• Premalignant lesions and tumours.

Practicals 

• Basal cell carcinoma specimens and slides Squamous cell carcinoma specimens and Malignant melanoma specimens and slides.

Demonstrations: Guidance

30. SKELETAL SYSTEM 

• Osteomyelitis, bone tumours.

Practicals 

• Osteogenic sarcoma, giant cell tumour, Ewings sarcoma – Specimens and slides.

Demonstrations 

• Guidance

31. CENTRAL NERVOUS SYSTEM 

• Meningitis, tumours.

Practicals 

• CSF in meningitis – chart.
• The student’s activity includes frequent symposia & group discussions, internal assessment tests, model practical, and viva. C.P.C. discussion modules with the association of corresponding clinical faculty.
• Post-mortem demonstration – 10 can be integrated with the forensic department.

Skills

At the end of the course, the student shall be able to

• 1. Describe the rationale and principles of technical procedures of the diagnostic laboratory tests and interpretation of the results :
• 2. Perform simple bedside tests on blood, urine and biological fluids samples.
• 3. Draw a rational scheme of investigations aimed at diagnosing and managing the causes of common disorders.
• 4. Understand biochemical / Physiological disturbances that occur due to disease in collaboration with preclinical departments.

Teaching & Learning Methods 

• Structured interactive sessions
• Small group discussion
• Practical, including demonstrations
• Problem-based exercises
• Written case scenario
• Self-learning tools
• Interactive learning
• e-modules