Pathology, Pharmacology and Physiology. Three pillars of medicine.

My seniors to
ld me that, a good doctor is that person who knows these three subjects well. Ev
en though my opinion differs a bit, it is a fact that these three non clinical s
ubjects are important as far as understanding general medicine (the toughest cli
nical subject) is concerned. This article is supposed to give a detailed descrip
tion of the important topics in pathology. For other subjects, please read my ar
ticle on My Second Year MBBS Experience.
Yes. Pathology can be really difficult for the undergraduates. Not because of th
e concepts, but because of the amount of facts that a student has to mug up to c
onstruct a good answer on the answer sheet. Examiners are infamous for setting q
uestions from that disease which a doctor will never see in life. The diseases t
hat a doctor sees every day in his clinic have no place in the question papers.
Gene mutations and microscopic features make the examiner happy, not the clinica
l features. So after second year the student will land up in second year syndro
me (diagnosing a small skin color change as some rare malignant neoplasm).
Robbins, the standard textbook in pathology for undergraduates consists of 10 ge
neral pathology and 19 systemic pathology chapters. It will take two days, if an
undergraduate wants to read all the 470 pages of general pathology. But only 10
questions will be asked. The student would have studied 90% of the portion, but
the questions could still come from the rest 10%.So on the day before the exam
the student will be in dilemma to whether read Robbins or to switch to some prep
aratory manual books. Preparatory manuals have given everything in point wise. S
o students feel easy to remember. But the greatest disadvantage of that is that
it is not false proof. So here I enumerate those topics from which I used to get
questions for the exams in my college. These are all must know topics. If you s
tudy these topics and relevant diagrams from Robbins, good marks are assured.
GENERAL PATHOLOGY
Cell Injury
Hypertrophy, hyperplasia, atrophy and metaplasia can come as short answer questi
ons. The difference between any two is also a must know question. So is apoptosi
s and necrosis. Morphological types of necrosis and pathways of apoptosis will m
ake a five marks question. Apoptosis as such is a long question. Difference betw
een apoptosis and necrosis and dystrophic and metastatic calcifications are the
favorite questions of examiners. Free radical in injury, reperfusion injury and
endogenous pigments (lipofuscin, melanin, hemosiderin) are infrequent, but can b
e asked.
Acute and Chronic inflammation
Reading vascular and cellular events and mediators of acute inflammation will ke
ep you in safe zone. Outcomes of acute inflammation can be expressed well in an
swer sheet using diagram given in the Robbins. Morphologic patterns of acute inf
lammation and granulomatous inflammation can also be asked. Don t attend any viva
voce or written exam without understanding granuloma well (don t ask me why. My pr
ofessor told so).
Regeneration and repair| Hemodynamic disorders
.
.
Repair and regeneration was a special topic because despite of the massive size,
only 2 questions used to come from that chapter. When granulation tissue is ask
ed, make a histological diagram also. Difference between healing by primary and

secondary intensions is very important. Edema, Shock (septic), DIC and Embolism
are long questions. Must know topics from this chapter also include differentiate
between questions which are white and red infarct, arterial and venous thrombi,
ante mortem and post mortem clot.
Genetic Disorders| Disease of Immune system
Lysosomal storage disorders, Turners syndrome, Klienfilters syndrome, Down syndr
ome and genomic imprinting are important short notes. SLE, RA, Sjorgren syndrome
, tolerance and transplant rejection can come as short notes.SLE used to consume
my valuable working hours by virtue of its massive size. All types of hypersens
itivities are important. The differentiate between question is Central and periphe
ral tolerance.
Neoplasia
You should be well versed with all the terminologies like polyp, choristoma, ham
artoma etc. Laboratory diagnoses of cancer and paraneoplastic syndromes were my
professional exam long question. Chemical mediators, oncoviruses, tumor antigen
and tumor markers are short notes. Invasion and metastatic cascade can decide wh
ether you can proceed to next year or not. Differentiate between questions inclu
de benign and malignant neoplasm & initiators and promoters.p53 and RB are rare
questions.
Infectious diseases| Nutritional diseases | Diseases of Infancy
Don t sit in the examination hall without reading Leprosy and T.B . Differentiate
between Tuberculoid and Lepromatous leprosy consumed my 3 marks in my profession
al exam. Since you are an Indian, you are expected to know tuberculosis well and
it can be asked in pathology, microbiology, medicine, pediatrics and gynecology
(practically anywhere)Vitamin A and D deficiencies are important(Professors don t
like B and C). Neuroblastoma, Cystic fibrosis and Wilms tumor can make your life
difficult.
doc.sarathrs@gmail.com