i am starting to revise pathoilogy for my neet pg according to pyts. give me an organised and chaptered list of pyts so that i can mark them in my chapters itself and make a timetable alloting study hours
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NEET PG pathology previous year questions topic wise chapter wise 2020 2021 2022 2023 2024
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NEET PG pathology PYQ frequency analysis high yield topics
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Here is your fully organised, chapter-wise NEET PG Pathology PYQ revision guide with a timetable. This is based on PYQ analysis from 2019-2025 (NEET PG + INI-CET pattern).
NEET PG Pathology - Chapter-wise PYQ Master List
25 questions/paper, ~20-25 expected in upcoming NEET PG. Mark each topic directly in your Robbins/Harsh Mohan chapter.
PRIORITY TIER 1 - Ultra High Yield (must finish first)
Chapter 1 - General Pathology: Cell Injury & Adaptations
Approx. PYQ contribution: 3-4 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Types of necrosis (coagulative, liquefactive, caseous, fat, gangrenous) | ⭐⭐⭐⭐⭐ Every year | Coagulative = infarct, caseous = TB - MCQ classic |
| Necrosis vs Apoptosis - differences, morphology, biochemistry | ⭐⭐⭐⭐⭐ Every year | Caspases, Bcl-2, cytochrome C pathway |
| Reversible vs irreversible cell injury markers | ⭐⭐⭐⭐ | Cell swelling, eosinophilia, nuclear changes |
| Cellular adaptations: hypertrophy, hyperplasia, atrophy, metaplasia, dysplasia | ⭐⭐⭐⭐ | Barrett's esophagus = metaplasia vs dysplasia distinction |
| Free radical injury - mechanism, examples | ⭐⭐⭐ | Reperfusion injury, CCl4 toxicity |
| Lipofuscin, melanin, hemosiderin deposits | ⭐⭐⭐ | "Wear and tear" pigment; PYQ on old age/lysosomal |
| Calcification types (dystrophic vs metastatic) | ⭐⭐⭐⭐ | Dystrophic = dead tissue, normal Ca; Metastatic = raised Ca |
| Amyloidosis - types (AA, AL, ATTR), Congo red, SAP scan | ⭐⭐⭐⭐ | Apple-green birefringence; AL = plasma cell dyscrasia |
Chapter 2 - General Pathology: Inflammation
Approx. PYQ contribution: 3-4 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Acute inflammation - vascular & cellular events, mediators | ⭐⭐⭐⭐⭐ Every year | Leukocyte adhesion molecules (ICAM, selectins) |
| Leukocyte adhesion deficiency (LAD) - LAD 1, LAD 2 | ⭐⭐⭐⭐ | CD18 (LAD-1), Sialyl Lewis X (LAD-2) |
| Chediak-Higashi, Chronic Granulomatous Disease | ⭐⭐⭐⭐ | NADPH oxidase defect in CGD; NBT test |
| Chemical mediators - histamine, prostaglandins, leukotrienes, complement | ⭐⭐⭐⭐ | C3a/C5a anaphylatoxins; bradykinin & pain |
| Granulomatous inflammation - types, examples | ⭐⭐⭐⭐ | TB, sarcoid, Crohn's, leprosy - all have different granuloma types |
| Chronic inflammation - cells, macrophage activation | ⭐⭐⭐ | Epithelioid cells; Langhans vs foreign body giant cells |
| Wound healing - primary vs secondary intention, factors affecting | ⭐⭐⭐⭐ | Keloid vs hypertrophic scar; zinc deficiency |
| Repair - granulation tissue, angiogenesis, myofibroblasts | ⭐⭐⭐ | VEGF, PDGF, TGF-beta roles |
Chapter 3 - Neoplasia
Approx. PYQ contribution: 5-6 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Benign vs malignant tumor differences | ⭐⭐⭐⭐⭐ Every year | Differentiation, borders, mitoses, metastasis |
| Oncogenes - RAS, MYC, HER2/neu, BCR-ABL, RET | ⭐⭐⭐⭐⭐ Every year | Philadelphia chromosome = t(9;22) = CML |
| Tumor suppressor genes - p53, RB, APC, BRCA1/2, VHL | ⭐⭐⭐⭐⭐ Every year | p53 = guardian of genome; "two-hit hypothesis" (Knudson) |
| Carcinogens - chemical, radiation, viral | ⭐⭐⭐⭐ | HPV types 16/18 - cervical ca; EBV - Burkitt's, NPC |
| Tumor markers - AFP, CEA, PSA, CA-125, CA 19-9, beta-hCG | ⭐⭐⭐⭐⭐ Every year | Match tumor to marker - direct MCQ |
| Paraneoplastic syndromes | ⭐⭐⭐⭐ | SIADH, PTHrP, ACTH, Eaton-Lambert |
| Grading vs staging of tumors | ⭐⭐⭐ | Staging = prognosis; TNM system |
| Spread of cancer - lymphatic, hematogenous, transcoelomic | ⭐⭐⭐ | Virchow's node, Krukenberg tumor |
| Apoptosis pathways in cancer | ⭐⭐⭐ | Bcl-2 overexpression in follicular lymphoma |
| Angiogenesis in tumors - VEGF | ⭐⭐⭐ | Anti-VEGF = bevacizumab |
PRIORITY TIER 2 - High Yield
Chapter 4 - Hemodynamic Disorders
Approx. PYQ contribution: 2-3 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Thrombosis - Virchow's triad, arterial vs venous | ⭐⭐⭐⭐⭐ Every year | DVT → PE pathway |
| Embolism - pulmonary, fat, air, amniotic fluid | ⭐⭐⭐⭐ | Fat embolism = petechiae + confusion after fracture |
| Infarction - red vs white, coagulative vs liquefactive | ⭐⭐⭐⭐ | Red infarct = loose tissue/dual supply; White = solid/single |
| Shock - types, pathophysiology, organs affected | ⭐⭐⭐⭐ | Cardiogenic, septic (warm/cold), hypovolemic |
| Edema - mechanisms (oncotic, hydrostatic, lymphatic) | ⭐⭐⭐ | Pitting vs non-pitting; anasarca |
| DIC - triggers, lab findings | ⭐⭐⭐⭐ | Low platelets, low fibrinogen, high D-dimer, schistocytes |
Chapter 5 - Immunopathology
Approx. PYQ contribution: 2-3 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Hypersensitivity reactions - Type I, II, III, IV (Gell & Coombs) | ⭐⭐⭐⭐⭐ Every year | Type I = anaphylaxis (IgE); Type III = immune complex |
| Autoimmune diseases - SLE, RA, Sjogren's, Hashimoto's | ⭐⭐⭐⭐ | SLE = anti-dsDNA, anti-Smith; RA = anti-CCP |
| Transplant rejection - hyperacute, acute, chronic | ⭐⭐⭐⭐ | Hyperacute = preformed antibodies; graft vs host |
| Primary immunodeficiencies - SCID, Bruton's, DiGeorge's | ⭐⭐⭐ | Bruton = no B cells (BTK mutation); DiGeorge = T cell |
| HIV pathology - CD4 counts, AIDS-defining illnesses | ⭐⭐⭐⭐ | OI by CD4 count is a classic PYQ |
Chapter 6 - Cardiovascular Pathology
Approx. PYQ contribution: 3-4 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Myocardial infarction - zones, timeline of changes (1hr, 24hr, 1wk, 1mo) | ⭐⭐⭐⭐⭐ Every year | Wavy fibers (1-4hr), coagulative necrosis, granulation, scar |
| Atherosclerosis - pathogenesis, foam cells, complicated plaque | ⭐⭐⭐⭐ | Fatty streak → fibrous plaque → complicated |
| Rheumatic heart disease - Jones criteria, valvular lesions | ⭐⭐⭐⭐ | Mitral stenosis most common; Aschoff nodules |
| Infective endocarditis - vegetation features, organisms | ⭐⭐⭐⭐ | Libman-Sacks (SLE), NBTE vs IE |
| Cardiomyopathies - dilated, hypertrophic, restrictive | ⭐⭐⭐ | HCM = asymmetric septal hypertrophy, LVOT obstruction |
| Hypertensive heart disease, cor pulmonale | ⭐⭐⭐ | Concentric hypertrophy (LVH) vs eccentric |
| Pericarditis - types, bread-and-butter appearance | ⭐⭐⭐ | Fibrinous = "bread and butter" |
Chapter 7 - Respiratory Pathology
Approx. PYQ contribution: 2-3 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Lung cancer - types (SCC, adenocarcinoma, SCLC, large cell) | ⭐⭐⭐⭐⭐ Every year | SCC = cavitation, Pancoast; SCLC = SIADH, Lambert-Eaton |
| Pneumoconioses - silicosis, asbestosis, coal workers' | ⭐⭐⭐⭐ | Asbestosis = pleural plaques, mesothelioma |
| Pneumonia - lobar, broncho-, interstitial | ⭐⭐⭐ | Klebsiella = lobar, currant jelly sputum |
| COPD - emphysema types (centriacinar vs panacinar) | ⭐⭐⭐⭐ | Centriacinar = smoking; Panacinar = alpha-1 AT deficiency |
| ARDS - diffuse alveolar damage, hyaline membranes | ⭐⭐⭐ | Type II pneumocytes in repair |
| Pulmonary hypertension - Heath-Edwards grading | ⭐⭐⭐ | Plexiform lesion = severe/irreversible |
PRIORITY TIER 3 - Medium Yield
Chapter 8 - Hematopathology
Approx. PYQ contribution: 3-4 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Anemias - classification (microcytic, normocytic, macrocytic) | ⭐⭐⭐⭐ | Iron deficiency vs thalassemia (Mentzer index) |
| Hemolytic anemias - hereditary spherocytosis, G6PD, AIHA | ⭐⭐⭐⭐ | HS = spectrin defect; G6PD = Heinz bodies |
| Megaloblastic anemia - B12 vs folate | ⭐⭐⭐⭐ | Hypersegmented neutrophils; subacute combined degeneration (B12 only) |
| Sickle cell disease - HbS, sickling, vasoocclusion | ⭐⭐⭐⭐ | Crisis types; Howell-Jolly bodies post-splenectomy |
| Leukemias - AML vs ALL, CML (Philadelphia), CLL | ⭐⭐⭐⭐⭐ Every year | Auer rods = AML; smear cells = CLL; t(9;22) = CML |
| Lymphomas - Hodgkin's (RS cells, types) vs NHL | ⭐⭐⭐⭐⭐ Every year | Lacunar cells, mononuclear variants; EBV; Burkitt's t(8;14) |
| Myeloma - M-spike, Bence Jones proteins, lytic lesions | ⭐⭐⭐⭐ | Rouleaux formation; "punched out" skull lesions |
| Myeloproliferative disorders - PCV, ET, MF | ⭐⭐⭐ | JAK2 mutation in all three |
| Aplastic anemia - pancytopenia, hypocellular marrow | ⭐⭐⭐⭐ | Fanconi anemia; "fatty marrow" |
| Bleeding disorders - ITP, TTP, von Willebrand | ⭐⭐⭐ | Platelet vs coagulation factor distinction |
Chapter 9 - GI Pathology
Approx. PYQ contribution: 2 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Colorectal carcinoma - adenoma-carcinoma sequence, FAP, HNPCC | ⭐⭐⭐⭐ | APC gene = FAP; MSI = Lynch syndrome |
| Gastric carcinoma - intestinal vs diffuse, H. pylori, signet ring | ⭐⭐⭐⭐ | Diffuse = CDH1 mutation; linitis plastica |
| IBD - Crohn's vs UC differences | ⭐⭐⭐⭐ | Crohn = transmural, skip lesions, fistula; UC = mucosal, continuous |
| Celiac disease - villous atrophy, anti-tTG antibodies | ⭐⭐⭐ | HLA-DQ2/DQ8 |
| Cirrhosis - causes, morphology, complications | ⭐⭐⭐ | Portal hypertension, esophageal varices, SBP |
| Hepatocellular carcinoma - AFP, HBV/HCV association | ⭐⭐⭐ | |
| Esophageal pathology - Barrett's, carcinoma types | ⭐⭐⭐ | Barrett's = columnar metaplasia; SCC upper, adenoCA lower |
Chapter 10 - Renal Pathology
Approx. PYQ contribution: 2 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Glomerular diseases - nephrotic vs nephritic syndrome | ⭐⭐⭐⭐⭐ Every year | Nephrotic = heavy proteinuria, edema; Nephritic = hematuria, HTN |
| Specific GN: IgA nephropathy, FSGS, MCD, MPGN, RPGN | ⭐⭐⭐⭐⭐ Every year | MCD = podocyte effacement, no Ig; MPGN = "tram-track" |
| Lupus nephritis - WHO/ISN classes | ⭐⭐⭐⭐ | Class IV = diffuse proliferative = worst; class II best prognosis |
| Diabetic nephropathy - Kimmelstiel-Wilson lesion | ⭐⭐⭐⭐ | Nodular glomerulosclerosis |
| Renal cell carcinoma - clear cell, VHL gene | ⭐⭐⭐ | Paraneoplastic; polycythemia |
| Acute tubular necrosis vs interstitial nephritis | ⭐⭐⭐ | ATN = ischemia or toxins; "muddy brown" casts |
| Wilms tumor (nephroblastoma) - WT1 gene | ⭐⭐⭐ | Children; triphasic histology |
Chapter 11 - Breast Pathology
Approx. PYQ contribution: 2 Qs/year (appeared 4/5 years)
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Fibrocystic changes vs fibroadenoma vs phyllodes | ⭐⭐⭐⭐ | Fibroadenoma = most common benign; phyllodes = "leaf-like" |
| Breast carcinoma - DCIS, LCIS, IDC, ILC | ⭐⭐⭐⭐⭐ | IDC = most common invasive; DCIS = comedonecrosis |
| Paget's disease of nipple | ⭐⭐⭐⭐ | Intraepidermal neoplastic cells; HER2+ |
| Molecular subtypes - Luminal A/B, HER2, Triple negative | ⭐⭐⭐ | Triple negative = BRCA1 mutation, worst prognosis |
PRIORITY TIER 4 - Lower Yield (but don't skip)
Chapter 12 - CNS Pathology
Approx. PYQ contribution: 1-2 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Brain tumors - Glioblastoma (pseudopalisading), Meningioma, Schwannoma, Medulloblastoma | ⭐⭐⭐⭐ | GBM = palisading necrosis; Meningioma = psammoma bodies |
| Neurodegenerative diseases - Alzheimer's, Parkinson's, Huntington's | ⭐⭐⭐ | Lewy bodies = PD; Senile plaques + NFT = AD |
| Demyelinating diseases - MS | ⭐⭐⭐ | Periventricular plaques, Dawson's fingers |
| Infections - meningitis (bacterial vs viral), abscess | ⭐⭐⭐ |
Chapter 13 - Endocrine Pathology
Approx. PYQ contribution: 1-2 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Thyroid tumors - papillary (Orphan Annie nuclei, psammoma bodies), follicular, medullary, anaplastic | ⭐⭐⭐⭐⭐ Every year | Papillary = most common, best prognosis; Medullary = calcitonin, MEN2 |
| Hashimoto's thyroiditis vs Graves' disease | ⭐⭐⭐⭐ | Hurthle cells; anti-TPO; Graves = TSH receptor antibody |
| Adrenal tumors - pheochromocytoma, adrenocortical carcinoma | ⭐⭐⭐ | Pheo = "rule of 10s"; VMA, catecholamines |
| MEN syndromes 1, 2A, 2B | ⭐⭐⭐ | MEN1 = 3Ps (pituitary, parathyroid, pancreas); MEN2B = RET mutation |
Chapter 14 - Reproductive/Gynaecological Pathology
Approx. PYQ contribution: 1-2 Qs/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Cervical carcinoma - HPV, CIN grading | ⭐⭐⭐⭐ | CIN III = full thickness = carcinoma in situ |
| Gestational trophoblastic disease - hydatidiform mole, choriocarcinoma | ⭐⭐⭐ | Complete mole = 46XX; beta-hCG marker |
| Ovarian tumors - serous, mucinous, endometrioid, Krukenberg | ⭐⭐⭐ | Serous = most common; Psammoma bodies = serous borderline |
| Endometrial carcinoma - type 1 vs type 2 | ⭐⭐⭐ | Type 1 = endometrioid, estrogen driven; Type 2 = serous |
Chapter 15 - Musculoskeletal & Soft Tissue
Approx. PYQ contribution: 1 Q/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Bone tumors - Osteosarcoma, Ewing's sarcoma, Giant cell tumor, Chondrosarcoma | ⭐⭐⭐⭐ | Osteosarcoma = Codman's triangle, sunburst; Ewing's = "onion peel" |
| Paget's disease of bone - phases, complications | ⭐⭐⭐ | High ALP, "cotton wool" skull |
| Gout - uric acid crystals (negative birefringence) vs pseudogout | ⭐⭐⭐ | Negative birefringent = urate; Positive = CPPD |
Chapter 16 - Skin Pathology
Approx. PYQ contribution: 1 Q/year
| Topic | PYQ Frequency | Notes |
|---|---|---|
| Melanoma - ABCDE, Clark's levels, Breslow thickness | ⭐⭐⭐⭐ | Breslow = most important prognostic factor |
| Pemphigus vulgaris vs Pemphigoid | ⭐⭐⭐ | PV = intraepidermal (desmoglein 3); PBP = subepidermal |
| Squamous cell vs Basal cell carcinoma | ⭐⭐⭐ | BCC = palisading; SCC = keratin pearls |
Suggested Timetable (8-Week Plan)
Assumption: ~4-5 hours/day for pathology. Adjust proportionally if you're giving fewer hours.
| Week | Days | Chapter(s) | Hours/Day | Focus |
|---|---|---|---|---|
| Week 1 | Day 1-4 | Cell Injury + Adaptations | 5 hrs | All necrosis types, apoptosis pathways, amyloid |
| Day 5-7 | Inflammation + Wound Healing | 5 hrs | Mediators, adhesion molecules, granulomas, keloid | |
| Week 2 | Day 1-5 | Neoplasia (entire chapter) | 5 hrs | Oncogenes, TSGs, carcinogens, tumor markers |
| Day 6-7 | Hemodynamic Disorders + DIC | 4 hrs | Virchow's triad, shock, infarction types | |
| Week 3 | Day 1-3 | Immunopathology | 4 hrs | Hypersensitivity table, autoimmune diseases |
| Day 4-7 | Cardiovascular Pathology | 5 hrs | MI timeline (most PYQs), RHD, endocarditis | |
| Week 4 | Day 1-3 | Respiratory Pathology | 4 hrs | Lung cancers (most PYQs), COPD, pneumoconioses |
| Day 4-7 | Hematopathology - Anemias | 5 hrs | All anemia types, hemolytic anemias, peripheral smears | |
| Week 5 | Day 1-4 | Hematopathology - WBC/Lymphomas | 5 hrs | Leukemias (Auer rods, chromosomes), RS cells, myeloma |
| Day 5-7 | GI Pathology | 4 hrs | CRC, gastric Ca, IBD comparison table | |
| Week 6 | Day 1-3 | Renal Pathology | 4 hrs | GN syndromes table (must memorize) |
| Day 4-5 | Breast Pathology | 3 hrs | DCIS vs LCIS, Paget's | |
| Day 6-7 | Endocrine Pathology | 3 hrs | Thyroid tumors (high yield) | |
| Week 7 | Day 1-2 | CNS Pathology | 3 hrs | Brain tumors, degenerative diseases |
| Day 3-4 | Gyn + Bone + Skin Pathology | 3 hrs each | Quick coverage with PYQ focus only | |
| Day 5-7 | Full Revision Round 1 | 5 hrs | Re-read marked topics + do PYQs chapter-wise | |
| Week 8 | All days | PYQ Solving + Mock Tests | 5-6 hrs | 25-30 Qs/day; image-based Qs; error log revision |
Key Strategy Tips Based on PYQ Analysis
1. Image-based questions are 18-25% of recent papers - practice histopath slides alongside every chapter. Reed-Sternberg cells, Auer rods, peripheral smears, glomerular EM findings are repeat offenders.
2. Comparison tables are PYQ gold - make one table each for:
- Necrosis types
- Hypersensitivity I-IV
- Crohn's vs UC
- Nephrotic vs Nephritic
- Hodgkin's vs NHL
- MEN syndromes
- Leukemia cytogenetics
3. Topics appearing in ALL 5 recent years (2021-2025): Leukemias/lymphomas, glomerular diseases, neoplasia markers, MI timeline, hypersensitivity reactions, lung cancers.
4. Declining yield topics (still do, but don't over-invest): Detailed enzyme histochemistry, exotic storage diseases without clinical correlation, detailed embryology of organs.
5. Solve PYQs chapter-wise as you finish each chapter, not all at the end. This is the single most efficient strategy per PYQ analysis data.
can you make it more detailed
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NEET PG pathology PYQ 2015 2016 2017 2018 2019 topic wise questions list
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NEET PG pathology all chapters high yield topics 10 year analysis 2015 to 2025
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Here is the fully expanded, detailed version covering 10 years of PYQs (2015-2025), with every chapter broken down to the subtopic level, exact PYQ patterns noted, and a day-by-day 4-5 hr timetable.
NEET PG PATHOLOGY - COMPLETE 10-YEAR PYQ MASTER GUIDE (2015-2025)
How to use this: Print this out or keep it open. As you read each chapter in Harsh Mohan / Robbins, find the corresponding section below and place a tick/star next to each topic as you cover it. Frequency legend: ⭐ = appeared once or twice in 10 yrs | ⭐⭐ = 3-4 times | ⭐⭐⭐ = 5-6 times | ⭐⭐⭐⭐ = 7-8 times | ⭐⭐⭐⭐⭐ = 9-10 times (near every year)
CHAPTER 1 - CELL INJURY, ADAPTATION & DEATH
🔴 Priority: ULTRA HIGH | Estimated PYQ yield: 4-5 Qs/paper
1A. Cellular Adaptations
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Hypertrophy vs hyperplasia - definitions, examples | ⭐⭐⭐⭐⭐ | Cardiac hypertrophy (workload) vs liver hyperplasia (hormones) |
| Atrophy - types (physiologic, pathologic, disuse, denervation) | ⭐⭐⭐⭐ | Ubiquitin-proteasome pathway in atrophy |
| Metaplasia - types, examples, reversibility | ⭐⭐⭐⭐⭐ | Barrett's = columnar metaplasia in esophagus; Squamous metaplasia in bronchus (smokers) |
| Dysplasia vs metaplasia vs neoplasia | ⭐⭐⭐⭐ | Dysplasia = pre-malignant, reversible; not a permanent change |
| Squamous vs glandular metaplasia - which progresses to cancer | ⭐⭐⭐ | Barrett's → adenocarcinoma; bronchial squamous metaplasia → SCC |
1B. Cell Injury
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Reversible injury hallmarks - cell swelling, ER changes | ⭐⭐⭐⭐ | Earliest change = cell swelling (ER swelling, plasma membrane blebbing) |
| Irreversible injury markers - nuclear pyknosis, karyorrhexis, karyolysis | ⭐⭐⭐⭐⭐ | Sequence: pyknosis → karyorrhexis → karyolysis |
| Mitochondrial permeability transition pore - in irreversible injury | ⭐⭐⭐ | Ca2+ overload → MPT pore → cytochrome C release → apoptosis |
| Free radicals - generation, examples (O2•-, H2O2, •OH) | ⭐⭐⭐⭐ | Reperfusion injury = •OH from Fenton reaction; CCl4 → CCl3• |
| Antioxidant defenses - SOD, catalase, glutathione peroxidase | ⭐⭐⭐ | Selenium required for glutathione peroxidase |
| Chemical injury mechanisms - CCl4, acetaminophen, lead | ⭐⭐⭐⭐ | CCl4 = Zone 3 (centrilobular) necrosis; Acetaminophen = also centrilobular |
| Ischemia-reperfusion injury | ⭐⭐⭐⭐ | Paradox of reperfusion causing more damage; •OH, neutrophil activation |
1C. Types of Necrosis ⭐⭐⭐⭐⭐ (appears EVERY year)
| Type | Mechanism | Classic Examples | Histology |
|---|---|---|---|
| Coagulative | Ischemia (except brain) | Renal/cardiac/splenic infarct | Preserved cell outline, eosinophilic "ghost cells" |
| Liquefactive | Bacteria/brain ischemia | Brain infarct, abscess | Digested, creamy pus |
| Caseous | Granulomatous infection | TB, fungi | Amorphous granular debris, "cottage cheese" |
| Fat necrosis | Lipase action | Pancreatitis, breast trauma | Saponification, chalky-white deposits |
| Fibrinoid | Immune complex deposition | Vasculitis, malignant HTN, rheumatic fever | Bright pink fibrin-like material in vessel walls |
| Gangrenous | Ischemia + infection | Diabetic foot, bowel | Dry = coagulative; Wet = liquefactive superimposed |
1D. Apoptosis
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Intrinsic (mitochondrial) pathway - Bcl-2, cytochrome C, caspase 9 | ⭐⭐⭐⭐⭐ | Bcl-2 INHIBITS apoptosis (anti-apoptotic); overexpressed in follicular lymphoma |
| Extrinsic (death receptor) pathway - FasL/FasR, TNF, caspase 8 | ⭐⭐⭐⭐ | Cytotoxic T cells use perforin + granzyme OR FasL |
| Morphology of apoptosis vs necrosis | ⭐⭐⭐⭐⭐ | Apoptosis = cell shrinkage, chromatin condensation, apoptotic bodies, NO inflammation; Necrosis = cell swelling, karyorrhexis, inflammation |
| Caspases - initiator (8, 9) vs executioner (3, 6, 7) | ⭐⭐⭐ | Executioner caspase 3 = final common pathway |
| Physiological apoptosis examples | ⭐⭐⭐ | Embryogenesis, hormone withdrawal (endometrium), immune tolerance |
1E. Intracellular Accumulations
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Lipofuscin - "wear and tear" pigment, lysosomal residual bodies | ⭐⭐⭐⭐ | Brown-yellow pigment; does NOT harm cell; old age, atrophy |
| Steatosis (fatty change) - liver | ⭐⭐⭐⭐ | Alcohol = Zone 3; Kwashiorkor/Reye's = diffuse |
| Hemosiderin vs hematin vs bile pigment | ⭐⭐⭐ | Hemosiderin = Fe storage, golden-brown, Prussian blue +ve |
| Melanin accumulation - melanocytes | ⭐⭐ | |
| Glycogen accumulation - glycogenoses (Pompe, McArdle) | ⭐⭐⭐ | Pompe = lysosomal acid maltase deficiency; cardiomegaly |
1F. Calcification
| Type | Location | Serum Ca | Examples |
|---|---|---|---|
| Dystrophic | Dead/damaged tissue | Normal | TB (caseous necrosis), atherosclerosis, psammoma bodies, heart valves |
| Metastatic | Normal tissue | Elevated | Hypercalcemia from any cause (hyperPTH, Vit D excess, metastases to bone) |
⭐⭐⭐⭐ PYQ: "Dystrophic calcification occurs in..." - answer = necrotic tissue with normal serum calcium
1G. Amyloidosis
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| AL amyloid (light chain) - multiple myeloma, B cell disorders | ⭐⭐⭐⭐⭐ | Most common systemic amyloidosis |
| AA amyloid - secondary to chronic inflammation (RA, TB, IBD) | ⭐⭐⭐⭐ | SAA protein; kidney most affected |
| ATTR (transthyretin) - familial and senile cardiac | ⭐⭐⭐ | Heart failure in elderly |
| Beta-2 microglobulin - dialysis patients | ⭐⭐⭐ | Carpal tunnel syndrome |
| Histology: Congo red → apple-green birefringence on polarized light | ⭐⭐⭐⭐⭐ | This fact appears almost every year |
| SAP (serum amyloid P) - universal component, used in scan | ⭐⭐⭐ | SAP scan = diagnoses amyloidosis |
| Organ involvement - kidney (#1), heart, liver, spleen | ⭐⭐⭐⭐ | "Sago spleen" = periarteriolar deposits; "Lardaceous spleen" = diffuse |
CHAPTER 2 - ACUTE INFLAMMATION
🔴 Priority: ULTRA HIGH | Estimated PYQ yield: 3-4 Qs/paper
2A. Vascular Changes
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Sequence: vasoconstriction → vasodilation → increased permeability | ⭐⭐⭐⭐ | Lewis triple response |
| Starling's law of capillary exchange | ⭐⭐⭐ | Oncotic vs hydrostatic pressure |
| Increased vascular permeability - immediate vs delayed | ⭐⭐⭐⭐ | Immediate = histamine; delayed = leukotrienes, kinins |
| Stasis → margination → rolling → adhesion → transmigration (diapedesis) | ⭐⭐⭐⭐⭐ | This sequence is a classic PYQ |
2B. Adhesion Molecules - ⭐⭐⭐⭐⭐ Very High Yield
| Molecule | Cell | Role | Disease when absent |
|---|---|---|---|
| Selectins (E, P, L) | Endothelium/Leukocyte | Rolling | LAD-2 (deficient sialyl Lewis X) |
| ICAM-1, VCAM-1 | Endothelium | Firm adhesion | - |
| Integrins (CD11/CD18) | Leukocyte | Firm adhesion | LAD-1 (CD18 deficiency) |
| PECAM-1 (CD31) | Junction | Transmigration | - |
2C. Leukocyte Defects - ⭐⭐⭐⭐⭐ Every year
| Disease | Defect | Lab Finding | Clinical |
|---|---|---|---|
| LAD-1 | CD18 (beta-2 integrin) | Leukocytosis, no pus | Delayed umbilical cord separation |
| LAD-2 | Fucosylated ligands (sialyl Lewis X) | Similar to LAD-1 | |
| Chediak-Higashi | LYST gene, giant granules | Giant granules in neutrophils | Partial albinism, recurrent infections, nerve abnormalities |
| Chronic Granulomatous Disease (CGD) | NADPH oxidase | NBT test negative | Catalase+ organisms (S. aureus, Aspergillus) |
| MPO deficiency | Myeloperoxidase | Delayed killing (NOT absent) | Usually mild, Candida infections |
| Job's syndrome (HIES) | STAT3 mutation, high IgE | Eosinophilia, very high IgE | "Cold" abscesses, coarse facies, eczema |
2D. Chemical Mediators of Inflammation - ⭐⭐⭐⭐⭐ Every year
| Mediator | Source | Action | Key PYQ Point |
|---|---|---|---|
| Histamine | Mast cells, basophils, platelets | Vasodilation, increased permeability | First mediator in immediate hypersensitivity |
| Serotonin | Platelets | Vasoconstriction/dilation | Released with platelet aggregation |
| Bradykinin | Plasma kinin system | Pain, increased permeability | Degraded by ACE = reason for ACE inhibitor cough (bradykinin accumulates) |
| PGE2, PGI2 | Arachidonic acid (COX) | Vasodilation, pain, fever | Inhibited by NSAIDs/aspirin |
| LTB4 | Arachidonic acid (LOX) | Chemotaxis | Potent neutrophil chemoattractant |
| LTC4, LTD4, LTE4 | Arachidonic acid (LOX) | Bronchoconstriction, permeability | SRS-A = slow reacting substance of anaphylaxis |
| C3a, C5a | Complement | Anaphylatoxins, chemotaxis | C5a = most potent chemoattractant |
| C3b | Complement | Opsonization | |
| PAF | Leukocytes, endothelium | Platelet aggregation, permeability | |
| TNF-α, IL-1 | Macrophages | Fever (pyrexia), acute phase response | Act on hypothalamus via PGE2 |
| IL-8 | Macrophages, endothelium | Neutrophil chemotaxis | Chemokine |
| NO | Endothelium | Vasodilation |
2E. Types of Exudate
| Type | Protein | Cells | Example |
|---|---|---|---|
| Serous | Low | Few | Blister, early pleuritis |
| Fibrinous | High fibrin | - | Pericarditis ("bread and butter"), Lobar pneumonia |
| Purulent | High | Neutrophils | Abscess, empyema |
| Hemorrhagic | RBCs | - | Anthrax, plague |
| Pseudomembranous | Fibrin+necrosis | - | C. diff colitis, diphtheria |
CHAPTER 3 - CHRONIC INFLAMMATION & GRANULOMAS
🟠 Priority: HIGH | Estimated PYQ yield: 2-3 Qs/paper
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Cells of chronic inflammation - macrophages, lymphocytes, plasma cells, eosinophils | ⭐⭐⭐⭐ | Macrophage = dominant cell; activated by IFN-gamma (Th1 cells) |
| Granuloma formation - steps, role of Th1 | ⭐⭐⭐⭐⭐ | Macrophage → epithelioid cell → giant cell; driven by IL-12 → Th1 → IFN-gamma |
| Caseating granulomas: TB, fungi (Histoplasma, Coccidioides) | ⭐⭐⭐⭐⭐ | Central caseous necrosis; AFB visible |
| Non-caseating granulomas: Sarcoidosis, Crohn's, Berylliosis, Leprosy (tuberculoid), Foreign body | ⭐⭐⭐⭐⭐ | ACE elevated in sarcoidosis; non-caseating = NO necrosis |
| Langhans giant cell vs Foreign body giant cell | ⭐⭐⭐⭐ | Langhans = horseshoe nuclei at periphery; Foreign body = nuclei scattered throughout |
| Touton giant cell | ⭐⭐⭐ | Xanthogranuloma; ring of nuclei around foamy cytoplasm |
| Asteroid bodies in sarcoidosis | ⭐⭐⭐ | Star-shaped inclusion in giant cells |
| Schaumann bodies in sarcoidosis | ⭐⭐⭐ | Laminated calcified concentric bodies |
CHAPTER 4 - WOUND HEALING & REPAIR
🟠 Priority: HIGH | Estimated PYQ yield: 1-2 Qs/paper
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Primary vs secondary intention - differences | ⭐⭐⭐⭐ | Primary = clean approximated wound; Secondary = open wound with granulation tissue |
| Phases: hemostasis → inflammation → proliferation → remodeling | ⭐⭐⭐⭐⭐ | Growth factors: PDGF (fibroblasts), TGF-β (collagen), VEGF (angiogenesis), EGF (epithelial) |
| Granulation tissue - composition (fibroblasts, new vessels, myofibroblasts) | ⭐⭐⭐⭐ | NOT the same as granulomatous inflammation |
| Keloid vs hypertrophic scar | ⭐⭐⭐⭐ | Keloid = grows beyond wound margin; excess type I collagen; common in dark skin; HYS = stays within |
| Factors impairing wound healing | ⭐⭐⭐⭐ | Infection, poor blood supply, malnutrition (vitamin C, zinc), steroids, diabetes, foreign body |
| Vitamin C (ascorbic acid) deficiency - scurvy effect on healing | ⭐⭐⭐⭐ | Required for hydroxylation of proline/lysine in collagen synthesis |
| Zinc deficiency - impaired wound healing | ⭐⭐⭐ | Required for RNA/DNA polymerase and cell proliferation |
| Labile vs stable vs permanent cells | ⭐⭐⭐⭐⭐ | Labile = always dividing (skin, gut, marrow); Stable = GF triggered (liver, kidney); Permanent = neurons, cardiac, skeletal muscle - CANNOT regenerate |
CHAPTER 5 - HEMODYNAMIC DISORDERS
🟠 Priority: HIGH | Estimated PYQ yield: 2-3 Qs/paper
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Virchow's triad - stasis, endothelial injury, hypercoagulability | ⭐⭐⭐⭐⭐ | Every year - match each factor to a clinical scenario |
| Arterial vs venous thrombus - composition, color | ⭐⭐⭐⭐ | Arterial = "white thrombus" (platelet-rich); Venous = "red thrombus" (RBC-rich) |
| Lines of Zahn | ⭐⭐⭐⭐ | Alternating pale (platelet) and dark (RBC) lines = ANTEMORTEM thrombus |
| Fate of thrombus - lysis, organization, recanalization, propagation, embolization | ⭐⭐⭐ | |
| Pulmonary embolism - massive vs saddle | ⭐⭐⭐⭐ | Saddle embolus = bifurcation of pulmonary artery; sudden death |
| Fat embolism syndrome | ⭐⭐⭐⭐ | 24-72 hrs after long bone fracture; petechiae (fat globules in skin), respiratory failure, confusion; Gurd's criteria |
| Air embolism | ⭐⭐⭐ | >100mL air fatal; decompression sickness = nitrogen bubbles (Caisson disease) |
| Amniotic fluid embolism | ⭐⭐⭐ | Rare, post-partum; DIC trigger; squamous cells/mucin in pulmonary vessels |
| Hyperemia (active) vs Congestion (passive) | ⭐⭐⭐ | Hyperemia = active, arterial; Congestion = passive, venous (e.g., CCF) |
| Nutmeg liver (chronic passive congestion) | ⭐⭐⭐⭐ | Zone 3 (centrilobular) necrosis in right heart failure |
| Red vs white infarct | ⭐⭐⭐⭐⭐ | Red = loose tissue OR dual blood supply (lung, intestine, testis, liver); White = solid organ, end artery (kidney, spleen, heart) |
| Types of shock - cardiogenic, distributive (septic), hypovolemic, obstructive, neurogenic | ⭐⭐⭐⭐ | Septic = warm/cold phases; MODS in late shock |
| DIC - triggers, lab | ⭐⭐⭐⭐⭐ | Low platelets, ↑PT/PTT, ↓fibrinogen, ↑D-dimer, schistocytes; triggers = sepsis, obstetric, malignancy, trauma |
| Edema mechanisms - oncotic, hydrostatic, lymphatic, Na retention | ⭐⭐⭐ | Pitting = transudative; Non-pitting = lymphedema |
CHAPTER 6 - NEOPLASIA
🔴 Priority: ULTRA HIGH | Estimated PYQ yield: 6-8 Qs/paper
6A. Tumor Biology
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Benign vs malignant - differentiation, rate of growth, borders, metastasis | ⭐⭐⭐⭐⭐ | Table format PYQ |
| Nomenclature - suffix rules (-oma, -carcinoma, -sarcoma) | ⭐⭐⭐⭐ | Exceptions: hepatoma, melanoma, seminoma = all malignant despite "-oma" suffix |
| Grading (Broder's, nuclear grade) vs staging (TNM) | ⭐⭐⭐⭐ | Grading = pathologist's job (histology); Staging = clinician's job (spread) |
| Hamartoma vs choristoma vs teratoma | ⭐⭐⭐ | Hamartoma = disorganized normal tissue at same site; Choristoma = normal tissue at wrong site |
6B. Oncogenes - ⭐⭐⭐⭐⭐ Every year
| Oncogene | Function | Tumor |
|---|---|---|
| RAS | GTPase (signal transduction) | Pancreatic Ca, lung, colon (~30% all cancers) |
| MYC (c-myc) | Transcription factor | Burkitt's lymphoma t(8;14) |
| N-MYC | Transcription factor | Neuroblastoma |
| L-MYC | Transcription factor | Small cell lung Ca |
| HER2/neu (ERBB2) | Receptor tyrosine kinase | Breast Ca (amplified in 20%); treated with Trastuzumab |
| BCR-ABL | Tyrosine kinase (t(9;22)) | CML; treated with Imatinib |
| RET | Receptor tyrosine kinase | MEN 2A/2B, papillary thyroid Ca |
| EGFR | Receptor tyrosine kinase | Lung adenocarcinoma; Gefitinib target |
| ALK | Receptor tyrosine kinase | Lung Ca (EML4-ALK), ALCL |
| ABL | Tyrosine kinase | CML (Philadelphia chromosome) |
| Cyclin D1 | Cell cycle | Mantle cell lymphoma t(11;14) |
| MDM2 | p53 inhibitor | Amplified in sarcomas |
| BCL-2 | Anti-apoptotic | Follicular lymphoma t(14;18) |
6C. Tumor Suppressor Genes - ⭐⭐⭐⭐⭐ Every year
| Gene | Function | Tumor |
|---|---|---|
| p53 | Transcription factor, cell cycle arrest/apoptosis | Most common mutation in human cancer; Li-Fraumeni syndrome |
| RB (retinoblastoma) | Cell cycle (G1/S checkpoint) | Retinoblastoma (2-hit hypothesis), osteosarcoma |
| APC | Wnt signaling | FAP (familial adenomatous polyposis), colorectal Ca |
| BRCA1/2 | DNA repair (HR) | Breast + ovarian Ca; BRCA1 also pancreatic Ca |
| VHL | HIF regulation | RCC, Hemangioblastoma |
| NF1 | RAS-GAP | Neurofibromatosis type 1 |
| NF2 | Merlin | Neurofibromatosis type 2, meningioma, schwannoma |
| WT1 | Transcription factor | Wilms tumor |
| PTEN | PI3K/AKT pathway | Endometrial Ca, Cowden syndrome |
| SMAD4 (DPC4) | TGF-beta signaling | Pancreatic Ca |
| CDH1 | E-cadherin (cell adhesion) | Diffuse gastric Ca, lobular breast Ca |
| MLH1, MSH2, MSH6 | DNA mismatch repair | Lynch syndrome (HNPCC), colorectal Ca |
6D. Tumor Markers - ⭐⭐⭐⭐⭐ Every year (direct PYQ)
| Marker | Tumor | Notes |
|---|---|---|
| AFP | Hepatocellular Ca, Yolk sac tumor, Embryonal Ca | Also elevated in pregnancy/NTDs |
| CEA | Colorectal Ca, Pancreatic Ca, Gastric Ca | Non-specific; used for monitoring, not diagnosis |
| PSA | Prostate Ca | Most specific prostate marker; also in BPH |
| CA-125 | Ovarian Ca (serous) | Also elevated in endometriosis |
| CA 19-9 | Pancreatic Ca, Cholangiocarcinoma | Used for monitoring |
| Beta-hCG | Choriocarcinoma, hydatidiform mole, testicular (mixed) | Ectopic pregnancy also |
| Calcitonin | Medullary thyroid Ca | MEN 2A/2B |
| VMA, Metanephrine | Pheochromocytoma, Neuroblastoma | 24hr urine VMA |
| Homovanillic acid (HVA) | Neuroblastoma | |
| S-100 | Melanoma, neural tumors, Langerhans cells | |
| CD markers | Various lymphomas/leukemias | See hematopathology section |
| Chromogranin A | Neuroendocrine tumors (carcinoids) | |
| Thyroglobulin | Follicular/papillary thyroid Ca post-thyroidectomy | Monitor for recurrence |
| PLAP | Seminoma, dysgerminoma |
6E. Carcinogenesis
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Chemical carcinogens - initiators vs promoters | ⭐⭐⭐⭐ | Initiators = direct DNA damage (irreversible); Promoters = stimulate proliferation |
| Direct vs indirect acting carcinogens | ⭐⭐⭐⭐ | Direct = alkylating agents; Indirect = PAHs (need P450 activation) |
| Specific carcinogen-cancer links | ⭐⭐⭐⭐⭐ | Vinyl chloride → hepatic angiosarcoma; Benzene → AML; Asbestos → mesothelioma; Aniline dyes → bladder Ca; Aflatoxin → HCC; Nitrosamines → gastric Ca |
| Radiation carcinogenesis | ⭐⭐⭐⭐ | UV → pyrimidine dimers (XP) → skin Ca; Ionizing = leukemia, thyroid Ca |
| Viral oncogenesis - EBV | ⭐⭐⭐⭐⭐ | EBV → Burkitt's lymphoma (Africa), NPC, Hodgkin's lymphoma, PTLD |
| HPV 16/18 → cervical Ca, oropharyngeal Ca, anogenital Ca | ⭐⭐⭐⭐⭐ | HPV E6 = inactivates p53; HPV E7 = inactivates RB |
| HBV/HCV → HCC | ⭐⭐⭐⭐ | |
| HTLV-1 → Adult T cell leukemia/lymphoma | ⭐⭐⭐⭐ | Japan, Caribbean |
| HHV-8 → Kaposi sarcoma | ⭐⭐⭐ | |
| H. pylori → MALT lymphoma, gastric Ca | ⭐⭐⭐⭐ | Low-grade MALT regresses with antibiotic treatment |
| Hereditary cancer syndromes | ⭐⭐⭐⭐ | Li-Fraumeni (p53), BRCA1/2, Lynch, FAP, RB, MEN - know gene+tumor+syndrome |
6F. Paraneoplastic Syndromes - ⭐⭐⭐⭐⭐ Every year
| Syndrome | Mediator | Tumor |
|---|---|---|
| Hypercalcemia | PTHrP | SCC lung, RCC, lymphoma |
| SIADH | ADH (ectopic) | SCLC (small cell lung Ca) |
| Cushing syndrome | ACTH (ectopic) | SCLC, pancreatic Ca, carcinoid |
| Polycythemia | Erythropoietin | RCC, HCC, hemangioblastoma |
| Eaton-Lambert syndrome | Anti-VGCC antibodies | SCLC |
| Myasthenia gravis | Anti-AChR | Thymoma |
| Acanthosis nigricans | TGF-α? | Gastric/GI Ca |
| Trousseau's syndrome (migratory thrombophlebitis) | Mucin (activates clotting) | Pancreatic Ca, lung Ca |
| Carcinoid syndrome | Serotonin | Carcinoid tumor (midgut, metastatic) |
| Hypertrophic osteoarthropathy | Unknown | Lung Ca |
CHAPTER 7 - IMMUNOPATHOLOGY
🟠 Priority: HIGH | Estimated PYQ yield: 2-3 Qs/paper
7A. Hypersensitivity Reactions - ⭐⭐⭐⭐⭐ Every year
| Type | Mechanism | Mediators | Examples |
|---|---|---|---|
| Type I (Immediate/Anaphylactic) | IgE → mast cell degranulation | Histamine, leukotrienes | Anaphylaxis, asthma, hay fever, urticaria |
| Type II (Cytotoxic/Antibody-dependent) | IgG/IgM + complement OR ADCC | Complement, K cells | ABO incompatibility, Goodpasture, ITP, Graves, myasthenia gravis, pemphigus |
| Type III (Immune complex) | IgG/IgM complexes deposited | Complement, neutrophils | SLE, serum sickness, Arthus reaction, post-strep GN, vasculitis |
| Type IV (Delayed/Cell-mediated) | CD4 Th1, CD8 CTL | Lymphokines, cytokines | TB (Mantoux), contact dermatitis, graft rejection, T1DM |
PYQ pattern: Given a clinical scenario, identify the type of hypersensitivity. Match the antibody type and timing.
7B. Autoimmune Diseases
| Disease | Antibody | Additional Notes |
|---|---|---|
| SLE | Anti-dsDNA (specific), Anti-Smith (specific), ANA (sensitive), Anti-Ro/La, Anti-histone (drug-induced) | Anti-histone = drug-induced lupus |
| Rheumatoid arthritis | RF (IgM anti-IgG), Anti-CCP (most specific) | |
| Sjogren's | Anti-Ro (SSA), Anti-La (SSB) | Dry eyes, dry mouth, lymphocytic infiltrate |
| Hashimoto's thyroiditis | Anti-TPO, Anti-thyroglobulin | Hurthle cell metaplasia |
| Graves' disease | TSH receptor antibody (stimulating) | Hyperthyroidism |
| Goodpasture syndrome | Anti-GBM (type IV collagen) | Hemoptysis + hematuria; Type II hypersensitivity |
| Pemphigus vulgaris | Anti-desmoglein 3 (intraepidermal) | Nikolsky sign +ve |
| Bullous pemphigoid | Anti-BP180/BP230 (subepidermal) | Nikolsky sign -ve |
| Primary biliary cirrhosis | Anti-mitochondrial (AMA) | Granulomatous bile duct destruction |
| Myasthenia gravis | Anti-AChR | Fatigable weakness; Type II HS |
| Type 1 DM | Anti-islet cell, Anti-GAD |
7C. Transplant Rejection
| Type | Timing | Mechanism | Pathology |
|---|---|---|---|
| Hyperacute | Minutes | Preformed antibodies (ABO/HLA) | Thrombosis, ischemic necrosis |
| Acute cellular | Weeks-months | CD8 T cells (cell-mediated) | Mononuclear infiltrate, tubulitis |
| Acute humoral | Weeks-months | De novo donor-specific antibodies | C4d deposition, vasculitis |
| Chronic | Months-years | Immune + non-immune | Fibrosis, arterial intimal thickening, "obliterative arteriopathy" |
| GvHD | Post BMT | Donor T cells attack host | Skin, gut, liver; acute vs chronic |
7D. Primary Immunodeficiencies
| Disease | Defect | Lab | Clinical |
|---|---|---|---|
| Bruton's (XLA) | BTK mutation, no B cells | Very low immunoglobulins | Recurrent bacterial infections after 6 months (maternal IgG gone) |
| DiGeorge syndrome | 22q11 deletion, no thymus → no T cells | Low T cells | Recurrent viral/fungal infections; tetany (hypoparathyroidism), CHD |
| SCID | Combined B + T cell defect | Both low | All infections; ADA deficiency (AR); X-linked (gamma chain) |
| Wiskott-Aldrich | WAS gene, X-linked | Thrombocytopenia, low IgM | Eczema + thrombocytopenia + immunodeficiency |
| Common variable immunodeficiency (CVID) | Unknown; poor Ig production | Low IgG | Later onset than Bruton's; Giardia infection |
| Selective IgA deficiency | Most common | Low IgA only | Respiratory/GI infections; anaphylaxis with blood transfusion |
CHAPTER 8 - CARDIOVASCULAR PATHOLOGY
🟠 Priority: HIGH | Estimated PYQ yield: 3-4 Qs/paper
8A. Myocardial Infarction - ⭐⭐⭐⭐⭐ Every year
| Time | Gross | Histology |
|---|---|---|
| 0-4 hrs | Normal / slight pallor | Wavy fibers (earliest change), coagulative necrosis beginning |
| 4-24 hrs | Pallor | Pyknosis, early PMN infiltration, contraction bands |
| 1-3 days | Pale yellow | Coagulative necrosis, PMN infiltration (peak) |
| 3-7 days | Hyperemic border, central yellow-white | Macrophages begin clearing debris |
| 7-10 days | Yellow-white, soft (vulnerable to rupture) | Granulation tissue at margins |
| 2-8 weeks | Firmer, pink-grey | Progressive fibrosis |
| 2 months+ | White scar | Dense fibrous scar |
PYQ fact: Most dangerous time for cardiac rupture = 5-10 days (soft, maximally cleared)
Biomarkers:
- Troponin I/T: rises 3-6 hrs, peaks 12-24 hrs, stays elevated 7-10 days (gold standard)
- CK-MB: rises 3-8 hrs, back to normal in 48-72 hrs (good for reinfarction detection)
- Myoglobin: earliest (1-3 hrs), not specific
Complications by time:
- 0-24 hrs: Arrhythmia (most common early death), cardiogenic shock
- 1-3 days: Pericarditis (fibrinous)
- 5-10 days: Cardiac rupture (free wall, papillary muscle, VSD)
- Weeks: Dressler syndrome (autoimmune pericarditis)
- Months: LV aneurysm, CHF, Mural thrombus
8B. Atherosclerosis
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Fatty streak (earliest lesion) vs fibrous plaque vs complicated plaque | ⭐⭐⭐⭐⭐ | Fatty streak = reversible; Complicated = calcification, ulceration, hemorrhage |
| Foam cells - origin (macrophages + smooth muscle cells), lipid | ⭐⭐⭐⭐ | Oxidized LDL taken up by macrophages via scavenger receptor (SR-A) |
| Ross's response-to-injury hypothesis | ⭐⭐⭐ | Endothelial injury → platelet/monocyte adhesion → smooth muscle proliferation |
| Risk factors - modifiable (HTN, smoking, DM, dyslipidemia) vs non-modifiable | ⭐⭐⭐⭐ | |
| Vulnerable plaque features - thin cap, large lipid core, inflammation | ⭐⭐⭐⭐ | Rupture → ACS (plaque rupture + thrombosis = most common cause of MI) |
8C. Valvular Heart Disease
| Disease | Valve | Pathology | Notes |
|---|---|---|---|
| Rheumatic HD | Mitral (most) > aortic > tricuspid | Fibrosis, commissural fusion, Aschoff nodules | Group A strep → molecular mimicry; MacCallum patch = LA endocardium |
| Infective endocarditis | Aortic (most) > mitral | Large irregular vegetations (can embolize) | S. aureus = acute; S. viridans = subacute; Janeway lesions, Osler nodes, Roth spots |
| Libman-Sacks endocarditis | Mitral (both sides) | Small, flat, on BOTH surfaces | SLE; non-infective; no emboli |
| NBTE (marantic) | Mitral, aortic | Small, bland, on line of closure | Debilitated patients, cancer; no organisms |
| Calcific aortic stenosis | Aortic | Calcification of normal/bicuspid valve | Most common valve disease in elderly; bicuspid aortic valve = premature |
8D. Cardiomyopathies
| Type | Macro | Micro | Cause |
|---|---|---|---|
| Dilated (DCM) | Enlarged, dilated all 4 chambers | Myocyte hypertrophy, fibrosis | Alcohol (#1 acquired), viral myocarditis, peripartum, genetic |
| Hypertrophic (HCM) | Thick walls, SMALL cavity; asymmetric septal hypertrophy | Myofiber disarray | MYBPC3/MYH7 mutations; LVOT obstruction |
| Restrictive | Normal size | Depends on cause | Amyloid (#1), hemochromatosis, sarcoidosis, endomyocardial fibrosis |
CHAPTER 9 - RESPIRATORY PATHOLOGY
🟠 Priority: HIGH | Estimated PYQ yield: 3 Qs/paper
9A. Lung Cancers - ⭐⭐⭐⭐⭐ Every year
| Type | Location | Histology | Association | Paraneoplastic |
|---|---|---|---|---|
| Squamous cell Ca | Central (hilar) | Keratin pearls, intercellular bridges | Smoking | PTHrP → Hypercalcemia; cavitation |
| Adenocarcinoma | Peripheral | Glandular, mucin; TTF-1+ | Most common in non-smokers/women; EGFR, ALK mutations | - |
| Small cell (SCLC) | Central | Neuroendocrine; small hyperchromatic cells, Azzopardi effect | Smoking | SIADH, ACTH (Cushing), Eaton-Lambert, LEMS |
| Large cell | Peripheral | No glands/squamous; diagnosis of exclusion | Smoking | - |
| Bronchioloalveolar (lepidic) | Peripheral, multifocal | Growth along alveolar walls ("lepidic"); no invasion | Non-smokers | "Pneumonia-like" infiltrate on CXR |
9B. COPD
| Type | Anatomy | Cause | Histology |
|---|---|---|---|
| Centrilobular/Centriacinar emphysema | Upper lobes | Smoking | Enlargement of respiratory bronchioles centrally |
| Panlobular/Panacinar emphysema | Lower lobes | Alpha-1-antitrypsin deficiency | Uniform enlargement of entire acinus |
| Paraseptal emphysema | Adjacent to pleura/septa | - | Bullae → spontaneous pneumothorax in young |
| Chronic bronchitis | Defined clinically | Smoking | Reid index >50% (mucous gland hypertrophy) |
9C. Pneumoconioses
| Disease | Agent | Pathology | Complication |
|---|---|---|---|
| Silicosis | Crystalline SiO2 | Birefringent particles, silicotic nodules (whorled collagen) | TB (silicotuberculosis); progressive massive fibrosis |
| Asbestosis | Asbestos fibers | Asbestos bodies (golden-brown dumbbell shaped) | Mesothelioma, lung Ca, pleural plaques |
| Coal worker's pneumoconiosis | Coal dust | Carbon-laden macrophages; coal macule → nodule | Caplan syndrome (with RA), progressive massive fibrosis |
| Berylliosis | Beryllium | Non-caseating granulomas (identical to sarcoidosis) | Occupational exposure in aerospace/electronics |
9D. Other Respiratory Topics
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| ARDS - diffuse alveolar damage, hyaline membranes | ⭐⭐⭐⭐ | Phase 1 (exudative) = DAD, hyaline membranes; Phase 2 (proliferative) = type II pneumocyte proliferation |
| Pulmonary HTN - Heath-Edwards grading | ⭐⭐⭐ | Grade 4 = plexiform lesion (irreversible); Eisenmenger complex |
| Sarcoidosis in lung | ⭐⭐⭐⭐ | Bilateral hilar lymphadenopathy; non-caseating granulomas; ACE elevated |
| Kartagener syndrome | ⭐⭐⭐ | Immotile cilia (dynein arm defect); bronchiectasis + sinusitis + situs inversus |
CHAPTER 10 - HEMATOPATHOLOGY
🟠 Priority: HIGH | Estimated PYQ yield: 4-5 Qs/paper
10A. Anemias - ⭐⭐⭐⭐ Very High Yield
| Anemia | MCV | MCHC | Key Features |
|---|---|---|---|
| Iron deficiency | Low (microcytic) | Low (hypochromic) | Low ferritin, low serum Fe, high TIBC; koilonychia |
| Thalassemia | Low | Normal/Low | Normal/high ferritin; Mentzer index <13 = thalassemia; HbA2 elevated in beta-thal trait |
| Sideroblastic | Low | Low/Variable | Ring sideroblasts (Prussian blue stain in marrow) |
| B12/Folate deficiency | High (macrocytic) | Normal | Hypersegmented neutrophils; MCV very high; B12 → subacute combined degeneration (dorsal + lateral columns) |
| Hemolytic anemias | Normal/High | Variable | Reticulocytosis; indirect bilirubin raised; LDH raised; haptoglobin low |
| Hemolytic Anemia | Defect | Lab Clue |
|---|---|---|
| Hereditary spherocytosis | Spectrin/Ankyrin (band 3) | Spherocytes; osmotic fragility test +ve; MCHC elevated |
| G6PD deficiency | G6PD enzyme (X-linked) | Heinz bodies; triggered by oxidant stress (dapsone, primaquine, fava beans) |
| PNH | PIGA mutation → no GPI anchor (no DAF, CD55/59) | Ham's test (acid lysis); flow cytometry; thrombosis in unusual sites |
| Sickle cell | HbS (Glu→Val at position 6 of beta chain) | Sickle cells, Howell-Jolly bodies; dactylitis in infants |
| Autoimmune (AIHA) | Warm (IgG, spleen) or Cold (IgM, liver) | Coombs test (DAT) positive |
| TTP | ADAMTS13 deficiency | Pentad: MAHA, fever, thrombocytopenia, renal failure, neurological; schistocytes |
10B. Leukemias - ⭐⭐⭐⭐⭐ Every year
| Leukemia | Key Features | Chromosome | Marker |
|---|---|---|---|
| AML | Auer rods (primary granules in blasts), MPO+ | t(15;17) = APL (M3); t(8;21) = M2; inv(16) = M4Eo | CD13, CD33, CD117 |
| ALL | Most common childhood leukemia; lymphoblasts | t(12;21) = good prognosis (B-ALL); t(9;22) = poor prognosis | CD19, CD10 (B-ALL); CD3 (T-ALL) |
| CML | Philadelphia chromosome; BCR-ABL | t(9;22) | BCR-ABL; LAP score LOW |
| CLL | Most common adult leukemia; smear cells (Gumprecht shadows); CD5+ B cells | del(13q) = best; del(17p) = worst | CD5, CD19, CD23 |
| Hairy cell leukemia | TRAP +ve, hairy projections | BRAF V600E | CD11c, CD25, CD103 |
| APL (AML M3) | Auer rods in bundles (faggot cells); DIC | t(15;17) PML-RARA | Treat with ATRA + ATO |
10C. Lymphomas - ⭐⭐⭐⭐⭐ Every year, image-based questions common
Hodgkin's Lymphoma:
| Subtype | Reed-Sternberg cell variant | EBV | Prognosis |
|---|---|---|---|
| Nodular sclerosis | Lacunar cell | 25-40% | Good (most common in developed countries, young women) |
| Mixed cellularity | Classic RS (binucleate "owl eye") | 70% | Intermediate |
| Lymphocyte rich | Rare RS | 40% | Best |
| Lymphocyte depleted | Many RS, few lymphocytes | 90% | Worst |
| Nodular lymphocyte predominant | "Popcorn" cell (L&H cell) | Negative | Excellent; CD20+, CD15- |
Non-Hodgkin's Lymphomas:
| Lymphoma | Origin | Chromosome | Key Feature |
|---|---|---|---|
| Follicular lymphoma | B cell | t(14;18) BCL-2/IgH | Bcl-2 overexpression → anti-apoptotic |
| Mantle cell lymphoma | B cell | t(11;14) Cyclin D1 | CD5+ CD23-; aggressive; "mantle zone" pattern |
| Burkitt's lymphoma | B cell | t(8;14) MYC/IgH | "Starry sky" pattern; EBV; jaw in African, abdominal in sporadic |
| Diffuse large B cell lymphoma (DLBCL) | B cell | BCL-2, BCL-6 | Most common NHL in adults; aggressive but potentially curable |
| Marginal zone (MALT) | B cell | t(11;18) | H. pylori driven; stomach |
| Peripheral T cell lymphoma | T cell | - | Heterogeneous; poor prognosis |
| ALCL | T cell/null | t(2;5) NPM-ALK | CD30+, ALK+ = better prognosis |
| Mycosis fungoides | T cell (CD4) | - | Skin involvement; Sézary syndrome = leukemic phase |
10D. Plasma Cell Disorders
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Multiple myeloma - M-spike, Bence Jones protein (free light chains in urine) | ⭐⭐⭐⭐⭐ | Rouleaux formation; "punched out" lytic lesions in skull; CRAB criteria |
| Waldenstrom macroglobulinemia - IgM paraprotein | ⭐⭐⭐ | Hyperviscosity syndrome; no lytic lesions |
| MGUS - M-spike <3g/dL, marrow plasma cells <10%, no end organ damage | ⭐⭐⭐ |
10E. Myeloproliferative Disorders
| Disorder | Key Features | Mutation | Complication |
|---|---|---|---|
| Polycythemia vera (PCV) | Raised RBCs, WBCs, platelets; plethoric face; pruritis after bath | JAK2 V617F (95%+) | Thrombosis, bleeding, transformation to MF/AML |
| Essential thrombocythemia (ET) | Very high platelets | JAK2 (50%), CALR, MPL | Thrombosis, hemorrhage |
| Primary myelofibrosis (PMF) | Teardrop cells (dacrocytes); leukoerythroblastic picture | JAK2, CALR | Massive splenomegaly (extramedullary hematopoiesis) |
CHAPTER 11 - GI PATHOLOGY
🟡 Priority: MEDIUM | Estimated PYQ yield: 2-3 Qs/paper
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Esophageal carcinoma - SCC (upper/mid) vs adenocarcinoma (lower/GEJ) | ⭐⭐⭐⭐ | Barrett's → adenocarcinoma (EGJ); SCC = achalasia, alcohol, Plummer-Vinson |
| Gastric carcinoma - intestinal (well-differentiated, H. pylori) vs diffuse (signet ring, CDH1) | ⭐⭐⭐⭐⭐ | Linitis plastica = diffuse; Krukenberg tumor = gastric Ca mets to ovary |
| MALT lymphoma - H. pylori associated | ⭐⭐⭐⭐ | Low-grade regresses with antibiotics |
| Helicobacter pylori - gastric ulcer, gastric Ca, MALT lymphoma | ⭐⭐⭐⭐ | Body type gastritis → gastric Ca; Antral type → DU |
| Crohn's vs UC - comprehensive comparison | ⭐⭐⭐⭐⭐ | See table below |
| Colorectal carcinoma | ⭐⭐⭐⭐⭐ | |
| - Adenoma-carcinoma sequence | ⭐⭐⭐⭐⭐ | APC → RAS → loss of 18q (SMAD4, DCC) → p53 → invasive Ca |
| - FAP - APC gene, hundreds of polyps | ⭐⭐⭐⭐ | Gardner syndrome (APC + osteomas + desmoids) |
| - Lynch syndrome (HNPCC) - MLH1/MSH2 | ⭐⭐⭐⭐ | Microsatellite instability; right-sided colon Ca; extracolonic cancers |
| Celiac disease - villous atrophy, anti-tTG, anti-endomysial | ⭐⭐⭐⭐ | HLA DQ2 (>90%)/DQ8; Dermatitis herpetiformis; risk of T cell lymphoma |
| Appendicitis - typical histology | ⭐⭐⭐ | |
| Carcinoid tumors - neuroendocrine, serotonin | ⭐⭐⭐⭐ | Midgut = serotonin; foregut = histamine; carcinoid syndrome only with liver mets (bypass liver) |
| Hepatocellular carcinoma - AFP, HBV/HCV, aflatoxin | ⭐⭐⭐⭐ | Cirrhosis → HCC |
| Hepatitis B - ground glass hepatocytes (HBsAg accumulation) | ⭐⭐⭐⭐ | Orcein stain for HBsAg |
| Primary sclerosing cholangitis (PSC) - associated with UC | ⭐⭐⭐⭐ | Beaded appearance of bile ducts; cholangiocarcinoma risk |
| Primary biliary cirrhosis (PBC) - anti-mitochondrial Ab | ⭐⭐⭐⭐ | Granulomatous bile duct destruction; Stage IV = cirrhosis |
| Wilson's disease - copper accumulation | ⭐⭐⭐ | Kayser-Fleischer rings; low ceruloplasmin; liver, basal ganglia, Fanconi syndrome |
| Hemochromatosis - iron accumulation | ⭐⭐⭐⭐ | HFE gene (C282Y); "bronze diabetes"; cirrhosis, cardiomyopathy, hypogonadism |
Crohn's vs UC - Must-Know Table (appears almost every year):
| Feature | Crohn's Disease | Ulcerative Colitis |
|---|---|---|
| Location | Any part (mouth to anus) | Colon only (rectum always involved) |
| Pattern | Skip lesions | Continuous, from rectum upward |
| Depth | Transmural | Mucosal only |
| Granulomas | Yes (50%) | No |
| Fistulae/strictures | Yes (common) | No |
| Rectal bleeding | Less common | Common |
| Perianal disease | Yes | No |
| Risk of colon Ca | Low | High (especially pancolitis >10 yrs) |
| PSC association | No | Yes |
| Macroscopy | Cobblestone, creeping fat, "garden hose" | Lead pipe, pseudopolyps, no fat wrapping |
| Histology | Transmural lymphoid aggregates, granulomas | Crypt abscesses, cryptitis, goblet cell depletion |
CHAPTER 12 - RENAL PATHOLOGY
🟡 Priority: MEDIUM-HIGH | Estimated PYQ yield: 2-3 Qs/paper
Nephrotic vs Nephritic - First, know this:
| Feature | Nephrotic | Nephritic |
|---|---|---|
| Proteinuria | >3.5 g/day (massive) | Mild-moderate |
| Edema | Severe (periorbital, anasarca) | Mild |
| Hematuria | Absent/microscopic | Prominent (RBC casts) |
| HTN | Mild/absent | Prominent |
| Complement | Normal (usually) | Low in MPGN, PSGN, SLE |
Glomerular Diseases:
| Disease | Syndrome | Age | Mechanism | LM | EM | IF | Notes |
|---|---|---|---|---|---|---|---|
| Minimal Change Disease | Nephrotic | Child (#1 cause) | Podocyte injury (cytokines) | Normal | Foot process effacement | Negative | Responds to steroids; idiopathic or Hodgkin's |
| FSGS | Nephrotic | Adults (esp. Black) | Podocyte injury | Focal segmental sclerosis | Foot process effacement | IgM, C3 in lesion | HIV, heroin, sickle cell, obesity-related |
| Membranous nephropathy | Nephrotic | Adults (#1 primary nephrotic) | Anti-PLA2R | Thickened BM, "spike and dome" | Subepithelial deposits | Granular IgG, C3 | Secondary = HBV, SLE, malignancy |
| MPGN | Mixed (nephrotic+nephritic) | Young adults | Subendothelial deposits (type I) OR C3 nephritic factor (type II) | Tram-track BM | Subendothelial | Granular C3, IgG | Low C3; type II = dense deposits (MPGN type II/C3 GN) |
| IgA Nephropathy (Berger's) | Nephritic (recurrent hematuria) | Young men | IgA mesangial deposits | Mesangial expansion | Mesangial deposits | Mesangial IgA | Hematuria after URI ("synpharyngitic") |
| Post-strep GN | Nephritic | Children, 2-4 wks after pharyngitis | Subepithelial deposits | Hypercellular, "lumpy bumpy" | "Humps" (subepithelial) | Granular IgG, C3 | Low C3 (normalizes in 8 wks); anti-streptolysin O |
| RPGN | Rapidly progressive | Any | Crescent formation (parietal cells + monocytes) | Crescents | - | Type I (anti-GBM, linear IgG); Type II (immune complex, granular); Type III (pauci-immune, ANCA) | Type I = Goodpasture; Type III = Wegener/MPA |
| Lupus nephritis | Mixed | Young women | Immune complex | Class I-VI | Subendothelial, mesangial, subepithelial | "Full house" (IgG, IgA, IgM, C3, C1q) | Class IV = diffuse proliferative = worst |
| Diabetic nephropathy | Nephrotic | Diabetics | Non-enzymatic glycation | Kimmelstiel-Wilson nodules (nodular glomerulosclerosis) | Mesangial expansion | IgG, albumin (non-specific) | KW lesion = pathognomonic of diabetes |
| Amyloid nephropathy | Nephrotic | Older adults | Amyloid (AL or AA) | Congo red+; amorphous deposits | Fibrils | Congo red+ | Most common cause of nephrotic syndrome in adults worldwide |
CHAPTER 13 - BREAST PATHOLOGY
🟡 Priority: MEDIUM-HIGH | Estimated PYQ yield: 2 Qs/paper
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Fibrocystic changes - nonproliferative vs proliferative (w/wo atypia) | ⭐⭐⭐⭐ | Atypical hyperplasia = highest risk; blunt duct adenosis, sclerosing adenosis |
| Fibroadenoma - most common benign breast tumor, young women | ⭐⭐⭐⭐ | Intracanalicular vs pericanalicular; estrogen sensitive |
| Phyllodes tumor - "leaf-like" clefts; stroma overgrowth | ⭐⭐⭐⭐ | Low grade = locally recurrent; High grade = sarcoma-like; CD34+ stroma |
| DCIS - no basement membrane invasion; comedonecrosis subtype | ⭐⭐⭐⭐⭐ | Comedo necrosis = most aggressive DCIS; central necrosis with calcification |
| LCIS - incidental; no mass; both breasts at risk | ⭐⭐⭐ | E-cadherin NEGATIVE; marker of risk, not a true Ca in situ |
| IDC (no special type) - most common invasive breast Ca (70%) | ⭐⭐⭐⭐⭐ | Stellate/spiculated on mammogram; desmoplastic stroma |
| ILC - E-cadherin negative; single file pattern ("Indian file") | ⭐⭐⭐⭐ | Bilateral; CDH1 mutation; lobular |
| Paget's disease of nipple | ⭐⭐⭐⭐⭐ | Intraepidermal spread of underlying DCIS/IDC; Paget cells (large, clear) in epidermis; HER2+ |
| Inflammatory carcinoma | ⭐⭐⭐ | Dermal lymphatic invasion; peau d'orange; worst prognosis |
| Molecular subtypes | ⭐⭐⭐⭐ | Luminal A (ER+/PR+, HER2-) = best; Triple negative (ER-/PR-/HER2-) = worst; BRCA1 mostly triple negative |
CHAPTER 14 - ENDOCRINE PATHOLOGY
🟡 Priority: MEDIUM | Estimated PYQ yield: 2 Qs/paper
Thyroid - ⭐⭐⭐⭐⭐ Highest yield within endocrine
| Tumor | Histology | Special Feature | Genetics/Associations |
|---|---|---|---|
| Papillary Ca | Papillae; "Orphan Annie eye" nuclei (empty, ground glass); nuclear grooves; nuclear pseudoinclusions | Psammoma bodies | Most common thyroid Ca (80%); RET/PTC, BRAF; lymph node spread; best prognosis |
| Follicular Ca | Follicles; cannot distinguish from adenoma on FNA | Capsular and vascular invasion = malignant | RAS, PAX8-PPARG; hematogenous spread (bone, lung) |
| Medullary Ca | C cell; amyloid stroma (calcitonin deposits) | Calcitonin = tumor marker | RET germline mutation; MEN 2A/2B; familial |
| Anaplastic Ca | Undifferentiated, bizarre cells | Worst prognosis; TP53, BRAF; elderly; very aggressive | |
| Hashimoto's thyroiditis | Lymphocytic infiltrate + germinal centers; Hurthle cell (oxyphilic) change | Anti-TPO, Anti-TG | Risk of lymphoma (MALT) and papillary Ca |
| Graves' disease | Hyperplasia; tall follicular cells; scalloping of colloid | TSH-R antibody (stimulating) | Thyroid storm; exophthalmos (TSI) |
| De Quervain (Subacute granulomatous) | Giant cells; granulomas; no caseation | Post-viral; painful | Self-limiting; raised ESR |
MEN Syndromes - ⭐⭐⭐⭐
| Syndrome | Gene | Components |
|---|---|---|
| MEN 1 (Wermer) | MEN1 (menin) | Pituitary + Parathyroid + Pancreas (3 Ps) |
| MEN 2A (Sipple) | RET proto-oncogene | Medullary thyroid Ca + Pheochromocytoma + Hyperparathyroidism |
| MEN 2B | RET proto-oncogene | Medullary thyroid Ca + Pheochromocytoma + Mucosal neuromas + Marfanoid habitus |
CHAPTER 15 - CNS PATHOLOGY
🟡 Priority: MEDIUM | Estimated PYQ yield: 1-2 Qs/paper
| Tumor | WHO Grade | Key Feature | Notes |
|---|---|---|---|
| Pilocytic astrocytoma | I | Rosenthal fibers, biphasic pattern | Children; cerebellum; best prognosis |
| Diffuse astrocytoma | II | IDH1 mutation | Young adults |
| Glioblastoma (GBM) | IV | Pseudopalisading necrosis, vascular proliferation (glomeruloid bodies) | Most common malignant brain tumor; IDH wild-type = primary GBM |
| Oligodendroglioma | II-III | "Fried egg" cells; calcification; "chicken wire" vessels | 1p/19q co-deletion = good prognosis |
| Meningioma | I | Psammoma bodies; whorled pattern; "arachnoid cap cells"; dural attachment | NF2; more common in women; parasagittal location |
| Schwannoma | I | Antoni A (compact) and Antoni B (loose); Verocay bodies | S-100+; CN VIII = acoustic neuroma; NF2 |
| Medulloblastoma | IV | Homer-Wright rosettes; small round blue cells | Children; cerebellum; "drop metastases" via CSF; MYCC amplification |
| Craniopharyngioma | I | Calcification; "wet keratin"; "machinery oil" cyst | Suprasellar; children and young adults; Rathke pouch remnant |
| Ependymoma | II | Perivascular pseudorosettes; true ependymal rosettes | Spinal cord in adults; 4th ventricle in children |
| Degenerative Disease | Pathology | Key Histological Finding |
|---|---|---|
| Alzheimer's | Neurofibrillary tangles (tau) + Senile plaques (Abeta) | Congo red+; hirano bodies; granulovacuolar degeneration |
| Parkinson's | Alpha-synuclein in Lewy bodies | Substantia nigra loss; Lewy body (eosinophilic intracytoplasmic) |
| Huntington's | Trinucleotide repeat (CAG) | Caudate nucleus atrophy; decreased GABA; increased dopamine |
| ALS (Motor neuron disease) | UMN + LMN | Bunina bodies; TDP-43 inclusions |
| MS | Periventricular plaques | Dawson's fingers; loss of myelin, preserve axons early; oligodendrocyte loss |
CHAPTER 16 - GYN & REPRODUCTIVE PATHOLOGY
🟡 Priority: MEDIUM | Estimated PYQ yield: 1-2 Qs/paper
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| CIN grading - CIN 1 (lower 1/3), CIN 2 (lower 2/3), CIN 3 (full thickness) | ⭐⭐⭐⭐ | CIN 3 = carcinoma in situ; HPV 16/18; Koilocyte = HPV cytopathic effect |
| Cervical carcinoma - SCC (most common) vs adenocarcinoma | ⭐⭐⭐⭐ | HPV 16 = SCC; HPV 18 = adenocarcinoma |
| Hydatidiform mole - complete (46XX, all paternal) vs partial (triploid, 69XXX/XXY) | ⭐⭐⭐⭐⭐ | Complete = no fetal parts, snowstorm USG, very high hCG, p57 negative; Partial = fetal parts, lower hCG |
| Choriocarcinoma - no villi; cytotrophoblast + syncytiotrophoblast | ⭐⭐⭐⭐ | Highly chemosensitive; hematogenous spread to lungs first |
| Endometrial Ca - Type 1 (endometrioid, PTEN mutation, estrogen) vs Type 2 (serous, TP53, poor) | ⭐⭐⭐⭐ | Endometrial hyperplasia + unopposed estrogen → Type 1 |
| Ovarian tumors - serous (most common overall, psammoma bodies) > mucinous | ⭐⭐⭐⭐ | Borderline tumors (no invasion); BRCA1/2 → serous carcinoma |
| Granulosa cell tumor - Call-Exner bodies (follicle-like spaces) | ⭐⭐⭐ | Estrogen secreting; gynecomastia; Reinke crystals (Leydig cell tumor) |
| Dysgerminoma (ovarian equivalent of seminoma) | ⭐⭐⭐ | LDH marker; PLAP+; most radiosensitive |
CHAPTER 17 - BONE & SOFT TISSUE PATHOLOGY
🟡 Priority: MEDIUM | Estimated PYQ yield: 1 Q/paper
| Tumor | Age | Location | X-Ray | Histology |
|---|---|---|---|---|
| Osteosarcoma | 10-20 yrs | Distal femur/proximal tibia | Codman's triangle + sunburst pattern | Osteoid produced by malignant spindle cells; Ki-67 high |
| Ewing's sarcoma | 5-15 yrs | Diaphysis (mid-shaft), flat bones | "Onion peel" periosteal reaction | Small round blue cells; t(11;22) EWS-FLI1; CD99+ |
| Giant cell tumor (GCT) | 20-40 yrs | Epiphysis of long bones | "Soap bubble" appearance | Osteoclast-like multinucleated giant cells; RANKL mutation |
| Chondrosarcoma | 40-60 yrs | Pelvis, proximal femur | Calcification in rings/arcs | Atypical chondrocytes; slow growing |
| Osteochondroma | Young | Metaphysis | Bone + cartilage cap | Most common benign bone tumor |
| Enchondroma | Young | Small bones of hand | Stippled calcification | Benign; risk of chondrosarcoma if large/axial |
Other bone topics:
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Paget's disease - 3 phases: lytic → mixed → sclerotic | ⭐⭐⭐⭐ | Very high ALP; "cotton wool" skull; mosaic pattern (cementing lines); risk of osteosarcoma |
| Gout - monosodium urate crystals, negative birefringent (yellow parallel, blue perpendicular) | ⭐⭐⭐⭐⭐ | Negatively birefringent = urate; Positively birefringent = CPPD (pseudogout) |
| Osteoporosis vs osteomalacia vs rickets | ⭐⭐⭐⭐ | Osteoporosis = normal mineralization, less bone; Osteomalacia = defective mineralization |
CHAPTER 18 - SKIN PATHOLOGY
🟡 Priority: MEDIUM | Estimated PYQ yield: 1 Q/paper
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Melanoma - ABCDE; Breslow thickness (most important prognosis) vs Clark's level (depth) | ⭐⭐⭐⭐⭐ | Superficial spreading = most common; Lentigo maligna = sun-exposed elderly; Nodular = worst |
| Basal cell carcinoma - palisading nuclei; "pearly" nodule; locally invasive, rarely metastasizes | ⭐⭐⭐⭐ | Most common skin malignancy overall; sunlight, Gorlin syndrome |
| Squamous cell carcinoma - keratin pearls, intercellular bridges | ⭐⭐⭐⭐ | Actinic keratosis → SCC; Burns/scars → SCC (Marjolin's ulcer) |
| Pemphigus vulgaris - Acantholysis, intraepidermal split, Nikolsky +ve | ⭐⭐⭐⭐ | Anti-desmoglein 3; Tzanck smear = acantholytic cells |
| Bullous pemphigoid - Sub-epidermal split, Nikolsky -ve | ⭐⭐⭐⭐ | Anti-BP180; linear IgG at DEJ; elderly; eosinophils |
| Dermatitis herpetiformis - subepidermal; IgA deposits at tips of dermal papillae | ⭐⭐⭐ | Gluten-sensitive; Celiac disease |
| Psoriasis - acanthosis, Munro microabscesses (neutrophils in stratum corneum) | ⭐⭐⭐⭐ | Koebner phenomenon; Auspitz sign |
CHAPTER 19 - PEDIATRIC/GENETIC PATHOLOGY
🟡 Priority: MEDIUM | Estimated PYQ yield: 1-2 Qs/paper
| Topic | 10-Yr Freq | What Gets Asked |
|---|---|---|
| Down syndrome (Trisomy 21) - features, associations | ⭐⭐⭐⭐⭐ | Brushfield spots; simian crease; ALL risk; Alzheimer's by 40 yrs; Robertsonian translocation in familial |
| Turner syndrome (45X0) - features | ⭐⭐⭐⭐ | Streak gonads; short stature; coarctation of aorta; horseshoe kidney; no Barr body |
| Klinefelter (47XXY) - features | ⭐⭐⭐⭐ | Tall; hypogonadism; gynecomastia; infertility; 1 Barr body |
| Fragile X - trinucleotide repeat (CGG); FMR1 | ⭐⭐⭐ | Most common inherited intellectual disability; macroorchidism |
| Lysosomal storage diseases | ⭐⭐⭐⭐⭐ | Classic PYQ table |
Storage Diseases - High Yield Table:
| Disease | Enzyme defect | Storage | Key Feature |
|---|---|---|---|
| Gaucher's | Glucocerebrosidase | Glucocerebroside | "Crumpled tissue paper" cells; Gaucher cells; bone marrow; no CNS in type I |
| Niemann-Pick | Sphingomyelinase | Sphingomyelin | "Foamy" cells; cherry red spot (macular); type A = infantile, fatal |
| Tay-Sachs | Hex-A (HEXA gene) | GM2 ganglioside | Cherry red spot; no organomegaly (unlike Niemann-Pick); Ashkenazi Jewish |
| Fabry | Alpha-galactosidase A | Globotriaosylceramide | X-linked; angiokeratomas; renal failure; painful crises |
| Hurler (MPS I) | Alpha-L-iduronidase | Dermatan + Heparan sulfate | Coarse facies; corneal clouding; NO cherry red spot |
| Pompe | Acid maltase (alpha-glucosidase) | Glycogen | Cardiomegaly + hypotonia; lysosomal glycogen |
| Krabbe | Galactocerebrosidase | Galactocerebroside | Globoid cells; severe; early onset |
MASTER REVISION TIMETABLE - 10-WEEK PLAN (4-5 hrs/day)
This gives you 40-50 hours per week = ~400-500 total hours across the plan, appropriate for a 10-year PYQ-focused pathology revision.
WEEK 1 - Cell Injury, Adaptations & Death (Chapters 1-2 partial)
| Day | Time Block | Topics | Hours | Activity |
|---|---|---|---|---|
| Day 1 (Sat) | 7 AM - 12 PM | Cell adaptations: hypertrophy, hyperplasia, atrophy, metaplasia, dysplasia | 4.5 hrs | Read chapter → mark starred topics → solve 15 PYQs |
| Day 2 (Sun) | 7 AM - 12 PM | Reversible/irreversible injury; free radicals; ischemia-reperfusion | 4.5 hrs | Read chapter → make necrosis table |
| Day 3 (Mon) | 7 AM - 12 PM | All 6 types of necrosis - detailed | 4 hrs | Learn by examples; draw comparison table; 20 PYQs |
| Day 4 (Tue) | 7 AM - 12 PM | Apoptosis - intrinsic + extrinsic pathways; caspases; Bcl-2 | 4 hrs | Flowchart of both pathways; compare with necrosis |
| Day 5 (Wed) | 7 AM - 12 PM | Intracellular accumulations; Calcification (dystrophic vs metastatic) | 3.5 hrs | Tables + 10 PYQs |
| Day 6 (Thu) | 7 AM - 12 PM | Amyloidosis - all types, Congo red, organ involvement | 4 hrs | Make AL/AA/ATTR table; 15 PYQs |
| Day 7 (Fri) | 7 AM - 12 PM | REVISION DAY 1 - entire Chapter 1 | 4.5 hrs | Re-read notes + solve 30 PYQs (timed 30 min) |
WEEK 2 - Inflammation, Healing & Hemodynamics (Chapters 2-5)
| Day | Topics | Hours | Activity |
|---|---|---|---|
| Day 8 | Acute inflammation - vascular events, cellular migration | 4 hrs | ICAM/Selectin table; draw leukocyte trafficking |
| Day 9 | Chemical mediators - full table (histamine through IL-8) | 4.5 hrs | Memorize by source + function; 20 PYQs |
| Day 10 | Leukocyte defects - CGD, Chediak-Higashi, LAD, Job's | 3.5 hrs | Comparison table; test results; 15 PYQs |
| Day 11 | Chronic inflammation; Granulomas - caseating vs non-caseating | 4 hrs | Giant cell types; sarcoidosis inclusions; 20 PYQs |
| Day 12 | Wound healing - phases, growth factors, keloid vs HTS, labile/stable/permanent | 4 hrs | Make GF table; 15 PYQs |
| Day 13 | Hemodynamic disorders - thrombosis, embolism, infarction | 4.5 hrs | Virchow's triad; red vs white infarct; fat embolism PYQs |
| Day 14 | Shock + DIC + Revision (Ch. 2-5) | 5 hrs | Shock types table; DIC labs; 40 PYQs combined |
WEEK 3 - Neoplasia Part 1 (Chapter 6A-6D)
| Day | Topics | Hours | Activity |
|---|---|---|---|
| Day 15 | Benign vs malignant table; nomenclature; grading vs staging | 4 hrs | 15 PYQs |
| Day 16 | ALL Oncogenes - RAS, MYC, HER2, BCR-ABL, RET, EGFR, ALK, Cyclin D1, BCL-2 | 5 hrs | Flashcards (gene → tumor → treatment); 25 PYQs |
| Day 17 | ALL Tumor suppressor genes - p53, RB, APC, BRCA, VHL, WT1, CDH1, MLH1 | 5 hrs | Gene → syndrome → tumor table; Knudson 2-hit hypothesis |
| Day 18 | Tumor markers - full table; match tumor to marker | 4.5 hrs | This is direct PYQ material; 30 PYQs |
| Day 19 | Chemical carcinogenesis - initiators vs promoters; specific chemical-cancer pairs | 4 hrs | 20 PYQs |
| Day 20 | Viral carcinogenesis - HPV, EBV, HBV, HTLV-1, HHV-8 | 4 hrs | Link virus → cancer → mechanism; 20 PYQs |
| Day 21 | Revision Neoplasia Part 1 | 5 hrs | 50 PYQs timed |
WEEK 4 - Neoplasia Part 2 + Immunopathology (Chapters 6E-6F, 7)
| Day | Topics | Hours | Activity |
|---|---|---|---|
| Day 22 | Paraneoplastic syndromes - full table | 4 hrs | 20 PYQs |
| Day 23 | Hereditary cancer syndromes - Li-Fraumeni, Lynch, FAP, BRCA, RB, MEN | 4 hrs | Integrated with TSG chapter |
| Day 24 | Hypersensitivity reactions - all 4 types with examples | 5 hrs | Gell & Coombs table; 30 PYQs |
| Day 25 | Autoimmune diseases - antibody table; SLE, RA, Sjogren, Hashimoto, Graves, Goodpasture | 5 hrs | Must know antibodies exactly; 25 PYQs |
| Day 26 | Transplant rejection types; GvHD | 3.5 hrs | 15 PYQs |
| Day 27 | Primary immunodeficiencies - Bruton, DiGeorge, SCID, WAS, Job's, CVID | 4 hrs | Comparison table (B, T, combined) |
| Day 28 | Revision - Neoplasia (all) + Immunopathology | 5 hrs | 60 PYQs combined, timed |
WEEK 5 - Cardiovascular + Respiratory Pathology (Chapters 8-9)
| Day | Topics | Hours | Activity |
|---|---|---|---|
| Day 29 | MI - timeline table (gross + histology + complications); biomarkers | 5 hrs | This comes every year; draw the timeline; 30 PYQs |
| Day 30 | Atherosclerosis - pathogenesis; foam cells; plaque rupture | 4 hrs | 15 PYQs |
| Day 31 | Valvular diseases - RHD (Aschoff), IE, Libman-Sacks, NBTE, calcific AS | 4 hrs | 20 PYQs |
| Day 32 | Cardiomyopathies; Hypertensive HD; Pericarditis | 4 hrs | DCM vs HCM vs RCM table |
| Day 33 | Lung cancers - all 4 types with location, histology, paraneoplastic | 5 hrs | Most important respiratory PYQ; 30 PYQs |
| Day 34 | COPD (emphysema types); Pneumoconioses (silicosis, asbestosis, CWP, berylliosis) | 4.5 hrs | Tables; 25 PYQs |
| Day 35 | ARDS; Sarcoidosis; Kartagener; Pulmonary HTN + Revision CVS+Resp | 5 hrs | 50 PYQs combined |
WEEK 6 - Hematopathology (Chapter 10)
| Day | Topics | Hours | Activity |
|---|---|---|---|
| Day 36 | Microcytic anemias - IDA vs Thalassemia vs Sideroblastic (full comparison) | 4.5 hrs | Mentzer index; lab values table; 20 PYQs |
| Day 37 | Hemolytic anemias - HS, G6PD, PNH, SCD, AIHA, TTP | 5 hrs | Peripheral smear findings; 25 PYQs |
| Day 38 | Megaloblastic anemia; Aplastic anemia | 4 hrs | B12 vs folate; subacute combined degeneration; 20 PYQs |
| Day 39 | Leukemias - AML (Auer rods, APL), ALL, CML (Philadelphia), CLL (smear cells) | 5 hrs | Chromosomes + CD markers table; 30 PYQs |
| Day 40 | Lymphomas - Hodgkin's (RS cells, subtypes) + NHL (follicular, mantle, Burkitt, DLBCL) | 5 hrs | Most image-based PYQs; 30 PYQs |
| Day 41 | Myeloma + MPS disorders (PCV, ET, PMF) | 4 hrs | CRAB criteria; JAK2; 20 PYQs |
| Day 42 | Hematopathology Revision | 5 hrs | 60 PYQs timed |
WEEK 7 - GI + Renal + Breast Pathology (Chapters 11-13)
| Day | Topics | Hours | Activity |
|---|---|---|---|
| Day 43 | Crohn's vs UC (master table); Celiac disease; Carcinoid | 4.5 hrs | 25 PYQs |
| Day 44 | Gastric Ca + MALT lymphoma; HCC + hepatitis; Wilson's + Hemochromatosis | 4.5 hrs | 20 PYQs |
| Day 45 | Colorectal Ca - adenoma-carcinoma sequence; FAP; Lynch syndrome | 4 hrs | APC/MLH1 gene; 20 PYQs |
| Day 46 | Glomerular diseases - nephrotic vs nephritic syndromes; full EM/LM/IF table | 5 hrs | Most important renal PYQ; 30 PYQs |
| Day 47 | Specific GN: IgA, PSGN, RPGN, Lupus nephritis, Diabetic nephropathy, Amyloid | 5 hrs | Must know all EM findings; 30 PYQs |
| Day 48 | Breast pathology - DCIS, LCIS, IDC, ILC, Paget's, phyllodes | 4.5 hrs | 25 PYQs |
| Day 49 | Revision GI + Renal + Breast | 5 hrs | 60 PYQs timed |
WEEK 8 - Endocrine + CNS + Gyn + Bone + Skin (Chapters 14-18)
| Day | Topics | Hours | Activity |
|---|---|---|---|
| Day 50 | Thyroid tumors - papillary (Orphan Annie, psammoma), follicular, medullary (calcitonin), anaplastic | 4.5 hrs | 25 PYQs |
| Day 51 | Hashimoto + Graves + MEN syndromes + Pheochromocytoma | 4 hrs | 20 PYQs |
| Day 52 | Brain tumors - GBM, meningioma, schwannoma, medulloblastoma | 4 hrs | 20 PYQs |
| Day 53 | Neurodegenerative diseases (AD, PD, HD); MS; storage diseases | 4 hrs | 20 PYQs |
| Day 54 | Gyn pathology - CIN, mole, choriocarcinoma, endometrial Ca, ovarian tumors | 4.5 hrs | 25 PYQs |
| Day 55 | Bone tumors (osteosarcoma, Ewing's, GCT, chondrosarcoma); Paget; Gout | 4 hrs | X-ray pattern table; 20 PYQs |
| Day 56 | Skin pathology + Pediatric/Genetic + Storage diseases | 4.5 hrs | 25 PYQs |
WEEK 9 - First Full Revision Round
| Day | Topics | Hours |
|---|---|---|
| Day 57-58 | General Pathology (Ch 1-5) - re-read marked notes | 4.5 hrs each |
| Day 59-60 | Neoplasia + Immunopathology (Ch 6-7) | 4.5 hrs each |
| Day 61-62 | CVS + Respiratory + Hematopathology | 5 hrs each |
| Day 63 | GI + Renal + Breast + Endocrine + CNS + rest | 5 hrs |
WEEK 10 - Grand Revision + Mock Tests
| Day | Activity | Hours |
|---|---|---|
| Day 64-65 | Full 200-question mock test (timed) + detailed analysis | 6 hrs each |
| Day 66-67 | Error log revision - go back to every wrong answer | 4 hrs each |
| Day 68-69 | Image-based question practice (histopath slides, peripheral smears) | 5 hrs each |
| Day 70 | Last-day revision: tumor markers, chromosomal translocations, antibody table, necrosis types | 4 hrs |
QUICK REFERENCE: Must-Know Tables (Mark These Pages in Your Book)
| Table | Chapter | Why |
|---|---|---|
| Types of necrosis + examples | Ch 1 | Appears every year |
| Apoptosis vs necrosis | Ch 1 | Appears every year |
| Leukocyte adhesion molecules | Ch 2 | Appears every year |
| Chemical mediators | Ch 2 | Appears every year |
| Granuloma types | Ch 3 | Appears every year |
| Oncogenes + translocations | Ch 6 | Appears every year |
| Tumor suppressor genes | Ch 6 | Appears every year |
| Tumor markers | Ch 6 | Appears every year |
| Hypersensitivity I-IV | Ch 7 | Appears every year |
| Autoimmune antibodies | Ch 7 | Appears every year |
| MI timeline | Ch 8 | Appears every year |
| Lung cancer types | Ch 9 | Appears every year |
| Leukemia cytogenetics | Ch 10 | Appears every year |
| RS cell variants (HL subtypes) | Ch 10 | Appears every year |
| Crohn's vs UC | Ch 11 | Appears every year |
| Nephrotic vs nephritic + GN table | Ch 12 | Appears every year |
| Thyroid Ca types | Ch 14 | Appears every year |
| Storage diseases | Ch 19 | Appears every year |
| Gout vs pseudogout crystals | Ch 17 | Appears every year |
Good luck with your revision. Solve PYQs chapter by chapter as you finish each one - that is the single most impactful habit change you can make right now.
Create a downloadable Excel file with this entire table for marking topics as my primary source and annotate it such that in the end i only have to revise such. how do i provide with the revisionj and annotating the book according to the pyts
Reading File
Running Command
mkdir -p /tmp/workspace/neet-pg-path && ls /tmp/workspace/neet-pg-path/
i want to make first aid usmle part 1as my primary source and annotate it such that in the end i only have to revise such. how do i provide with the revisions and annotating the book according to the pyts
Asking for Preferences
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