MBBS 2nd Phase Pathology - Important Questions & Topics

GENERAL PATHOLOGY

1. Cell Injury, Necrosis & Apoptosis (Most Important Chapter)

• Describe the causes and mechanisms of cell injury. Explain reversible and irreversible cell injury with morphological changes.
• Classify necrosis. Describe the types of necrosis with examples and their morphological features.
• Compare and contrast Necrosis vs Apoptosis (causes, morphology, mechanism, fate of cell).
• Describe the intrinsic and extrinsic pathways of Apoptosis.

• Free radical injury (mechanism, sources, scavengers)
• Ischemia-reperfusion injury
• Caseous necrosis
• Gangrenous necrosis
• Fat necrosis
• Liquefactive necrosis
• Coagulative necrosis
• Lipofuscin (wear-and-tear pigment)
• Morphological changes in apoptosis
• Cellular swelling (cloudy swelling)

• 4 nuclear changes in necrosis (pyknosis, karyorrhexis, karyolysis, ghost outline)
• Biochemical markers of reversible vs irreversible injury

2. Cellular Adaptations

• Hypertrophy vs Hyperplasia (definitions, types, examples)
• Physiological vs pathological hypertrophy
• Atrophy - causes and mechanisms
• Metaplasia - definition, examples, significance
• Dysplasia

• Physiological hypertrophy: pregnant uterus, skeletal muscle with exercise
• Pathological hypertrophy: cardiac hypertrophy in hypertension
• Physiological hyperplasia: female breast at puberty
• Pathological hyperplasia: endometrial hyperplasia
• Metaplasia: Barrett's esophagus (columnar replacing squamous), squamous metaplasia in bronchus of smokers

3. Intracellular Accumulations & Calcifications

• Dystrophic vs metastatic calcification (differences, causes, examples)
• Pathological calcification
• Hemosiderin - causes of deposition (hemochromatosis, hemosiderosis)
• Amyloid - types, staining (Congo red, apple-green birefringence)
• Fatty change (steatosis) - liver

4. Inflammation (Very High Yield)

• Describe the vascular and cellular events in acute inflammation.
• Classify and describe the mediators of inflammation with their effects.
• Describe the types of chronic inflammation. Compare acute vs chronic inflammation.
• Describe the morphological types of inflammation (serous, fibrinous, suppurative, granulomatous).

• Granulomatous inflammation (types, examples: TB, sarcoidosis, leprosy)
• Chemical mediators of inflammation: histamine, serotonin, prostaglandins, leukotrienes, complement, cytokines
• Neutrophil emigration - steps (rolling, adhesion, transmigration, chemotaxis, phagocytosis)
• Complement system (classical vs alternate pathway)
• Opsonization
• Healing by primary and secondary intention
• Factors affecting wound healing
• Keloid vs hypertrophic scar

5. Repair & Healing

• Labile, stable, and permanent cells
• Angiogenesis
• Granulation tissue
• Primary vs secondary intention healing
• Keloid
• Factors delaying wound healing

6. Neoplasia (Most Important Chapter for Theory)

• Classify tumors. Describe the differences between benign and malignant tumors.
• Describe the spread of malignant tumors (local invasion, lymphatic, hematogenous, transcoelamic).
• Write about tumor markers with examples and clinical applications.
• Describe the molecular basis of cancer (oncogenes, tumor suppressor genes, apoptosis evasion).
• Carcinogenesis - chemical, radiation, viral.

• Oncogenes vs proto-oncogenes
• Tumor suppressor genes (p53, Rb) - functions and role in cancer
• Paraneoplastic syndrome
• Metastasis - steps and routes
• Grading vs staging of tumors
• Tumor markers: CEA, AFP, PSA, CA-125, CA 19-9, beta-hCG
• Carcinoma in situ
• Hamartoma vs choristoma
• Angiogenesis in tumors

7. Immunity & Immunopathology

• Classify hypersensitivity reactions. Describe Type I (anaphylaxis) in detail.
• Describe the pathogenesis of autoimmune diseases. Give examples.
• Write about HIV/AIDS - pathogenesis and immunological defects.

• Type II hypersensitivity with examples (hemolytic transfusion reaction, Goodpasture syndrome)
• Type III hypersensitivity (immune complex - SLE, serum sickness)
• Type IV (delayed type/cell mediated - contact dermatitis, TB skin test)
• Amyloidosis - classification (AL, AA), organs involved, Congo red stain
• SLE - pathogenesis and lab findings (anti-dsDNA, anti-Smith)
• Graft rejection types (hyperacute, acute, chronic)

HAEMATOLOGY

• Classify anemia. Describe the pathogenesis and laboratory findings of iron deficiency anemia.
• Describe the pathogenesis, clinical features, and lab findings of hemolytic anemia.
• Write about leukemia - classify and describe AML/CML/ALL/CLL.

• Iron deficiency anemia (lab: low MCV, low serum iron, high TIBC, low ferritin)
• Megaloblastic anemia (causes, peripheral smear: hypersegmented neutrophils, macro-ovalocytes)
• Sickle cell anemia (HbS, pathogenesis, vaso-occlusion)
• Thalassemia (alpha vs beta, HbA2 raised in beta)
• G6PD deficiency (Heinz bodies, episodic hemolysis)
• Aplastic anemia (causes: radiation, chloramphenicol, fanconi)
• Polycythemia vera
• Hemophilia A vs B
• DIC (disseminated intravascular coagulation) - pathogenesis, lab findings
• Multiple myeloma (Bence Jones protein, lytic bone lesions, M-spike)
• Hodgkin's vs non-Hodgkin's lymphoma
• Reed-Sternberg cells
• CML - Philadelphia chromosome t(9;22), BCR-ABL
• Reticulocyte count and significance
• PCV/hematocrit - significance

SYSTEMIC PATHOLOGY

Cardiovascular

• Atherosclerosis - pathogenesis (fatty streak → fibrous plaque → complicated lesion)
• Myocardial infarction - zones, lab markers (troponin, CK-MB), complications
• Infective endocarditis - vegetations, organisms
• Rheumatic heart disease - pathogenesis, Aschoff body
• Hypertensive heart disease

Respiratory

• Pneumonia - lobar vs bronchopneumonia (morphology, organisms)
• Tuberculosis - primary vs secondary (Ghon complex, cavitation)
• COPD - emphysema (types: centriacinar, panacinar) vs chronic bronchitis (Blue bloater vs Pink puffer)
• Carcinoma lung - types (squamous, adenocarcinoma, small cell, large cell)
• Mesothelioma - asbestos association

GIT / Liver

• Peptic ulcer - H. pylori, pathogenesis
• Crohn's disease vs ulcerative colitis (differences)
• Carcinoma stomach - Lauren classification (intestinal vs diffuse)
• Carcinoma colon - APC gene, FAP
• Cirrhosis - causes, morphology, complications (portal hypertension, ascites, hepatic encephalopathy)
• Viral hepatitis - HBV markers (HBsAg, HBeAg, anti-HBc)
• Hepatocellular carcinoma

Kidney

• Nephrotic vs nephritic syndrome (differences)
• Minimal change disease
• Membranous nephropathy
• IgA nephropathy (Berger disease)
• Post-infectious glomerulonephritis
• Renal cell carcinoma (clear cell, VHL gene)
• Wilms tumor (nephroblastoma)
• Acute tubular necrosis
• Polycystic kidney disease

Female Reproductive / Breast

• Carcinoma cervix - HPV types 16, 18; CIN grading
• Carcinoma endometrium
• Carcinoma ovary - types (serous, mucinous, endometrioid)
• Fibrocystic change vs fibroadenoma vs carcinoma breast
• Carcinoma breast - types, BRCA1/2

Nervous System

• Edema brain (types: vasogenic, cytotoxic)
• Glioblastoma multiforme
• Meningitis - bacterial vs viral (CSF findings)

EXAM STRATEGY TIPS

1. Read the first 7 chapters of Robbins (Cell injury, Inflammation, Repair, Neoplasia, Immunity, Hemodynamics, Genetic diseases) - these form the bulk of General Pathology marks.
2. Draw diagrams wherever possible - flowcharts of apoptosis pathways, inflammation steps, metastasis cascade, and coagulation cascade are high-scoring.
3. Compare-contrast tables are gold: Necrosis vs Apoptosis, Benign vs Malignant, Nephrotic vs Nephritic, Crohn's vs UC, AML vs ALL, Hodgkin's vs Non-Hodgkin's.
4. Tumor markers - always learn as a table (CEA: colon; AFP: HCC, germ cell; PSA: prostate; CA-125: ovary; CA 19-9: pancreas; beta-hCG: choriocarcinoma).
5. Staining techniques for short notes: Congo red (amyloid), ZN stain (TB/AFB), PAS stain (fungi, glycogen), Sudan black (lipids), Prussian blue (iron/hemosiderin).
6. Previous year papers confirm that Cell Injury, Inflammation, Neoplasia, Anemias, and Glomerular diseases appear every year in almost every university.