• To develop, implement and promote the highest standards in teaching the pathology course. 
• To develop implement and promote clinical pathology diagnostic services to the general hospital, local community and regional hospitals, thereby assisting in the improvement of health care in the community.
• To develop, implement and promote health and safety guidelines for the laboratories
• To provide a medical curriculum within the department that produces physicians with  high standards of professional competence in an international setting that involves principles of identifying causes of diseases, making an appropriate diagnosis, their prevention and treatment approaches based on a solid foundation of basic sciences and supported by research based evidence, who will be ready for the postgraduate training and life as a physician and life long learner.

GOALS AND OBJECTIVES

The Pathology course aims at educating the student on the integrated basis for disease process.  At the end of the course, the student should be able to:

• demonstrate the ability to identify and explain the etiology, pathogenesis, gross and microscopic appearances, relevant laboratory investigations, complications and the usual outcome of common diseases. (listed in the curriculum) 
• correlate the important clinical features of the disease with the pathologic changes.  (This knowledge of Pathology should result in appropriate diagnostic approach, selection and interpretation of appropriate investigations and selection of the broad approaches to treatment.  The concept of images, locations, and chronology of evolution of lesions should help the student to correlate clinical observations in clinical practice).

The emphasis of the course is to provide a “learning experience” by active participation of the students.  It is not designed to simply deliver a “package” of information to the students.  The students are responsible to actively participate in the “learning experience” and learn from it rather than just memorization.

 

COMPETENCIES IN THE PATHOLOGY COURSE

The student should be able to demonstrate the following competencies through the pathology course

• Cognitive  - Knowledge  (see details below)              
• Non-cognitive  Professional Attitudes and Behavior  communication skills (see details below)      

Cognitive Competencies          

• Achieve excellent scientific knowledge in Pathology.
• Use the new vocabulary leant in pathology in the appropriate context.

• Procedures to gather data/information (selection of sources, targeted reading to find answers).
• Develop study techniques for self-learning to achieve the learning objectives for each lesson utilizing the lecture handouts, textbooks and other web based resources.
• Good description of the morphology of lesions.
• Analysis and interpretation of clinical data with links to basic sciences.
• Identification of etiology, pathogenesis, morphologic changes, structural basis for clinical symptoms and signs, relevant investigations and course of the illness of common/prototypic diseases discussed in the course.
• Solve clinical problems based on data provided and demonstrate scientific logic (scientific foundation of medicine).
• Draw concept maps to demonstrate understanding the inter-relationships among the pathologic processes.
• Internalize the selected images of disease processes and apply them to explain the clinical correlates.
• Demonstrate the practice of evidence based medicine.
• Demonstrate the ability to analyze new and previously “not-discussed” clinical situations using scientific approach. (critical thinking and independent research).

Non-cognitive Competencies

• Demonstrate regular attendance and active, constructive participation in all the mandated teaching-learning activities.
• Demonstrate respect to peers, faculty, staff and community in general.
• Adhere to rules of the course as detailed in the course syllabus and the student manual of St. George’s University.
• Demonstrate compassionate attitude.
• Demonstrate effective communication skills (express views clearly, express disagreements agreeably, allow others to contribute, ask questions to clarify others’ views, do not dominate discussions).
• Be accountable to fellow students, faculty and self for the responsibilities
• Share the tasks in a group activity, share the leadership tasks by rotations, care for the progress of the group as a whole
• Resolve conflicts amicably.
• Exhibit proper concern and care for the technical and human resources in the laboratory setting.
• Demonstrate honesty, integrity, trust and patient confidentiality.
• Demonstrate a professional attitude in all activities related to the course.
• Demonstrate cultural, ethnic and gender sensitivity in the daily activities.

 

SPECIAL COMPETENCY IN PATHOLOGY IN THE STUDY OF LABORATORY IMAGES IN PATHOLOGY

Independently find solutions to the following questions for each image and post them on the group website and present to the group in the lab.

• Why do I need to diagnose this slide as “X”?  List the features which are different from the normal appearances that makes one choose this diagnostic label.  Is there any other entity that resembles the appearance in some ways and needs to be distinguished from “X”.  (This approach will help the student to identify previously unseen pictures in pathology examination and USMLE)Consolidate this skill further by studying the appropriate pictures in the atlases.
  
• What is the etiopathogenesis of this lesion?
  
• What would the main clinical presentation of this patient be?  Will there be any associated lesions in other parts of the body?
  
• Are there any laboratory tests used in the diagnosis of this disease?  What are the relative contributions of these tests in the management of “X”?  Can you identify some other disease also where these tests can be positive?
  
• What is the course of this disease?  Are there any complications?
  (Students often tend to study too much clinical detail in this direction.  That tendency is strongly discouraged. If you are able to generate a one to two sentence response to each question, it would be sufficient.  There are groups who ignore the tutor’s suggestion to avoid such details.  Those groups may not do well in the exams).
  (For any of these etiology, pathogenesis, structural changes, clinical features, investigations, course) if you identify more than one feature, try to discuss which is more specific and for what stage of the disease.  Also find out if a similar feature could be linked to any other disease that you have studied so far.  A list of questions is attached to each image in the lab manual. 
  These are just guidelines and not comprehensive.  These add to the points for discussion (listed above 1 – 5).
  
• Develop a clinical vignette and a question that can be used to test the slide in the exam.
  
• Short list 3 – 4 most important features of this disease that can be tested in the exam.

 

TERMINAL OBJECTIVES FOR LECTURES ON INDIVIDUAL LESSONS/MODULES IN THE PATHOLOGY COURSE

• Lecture on Introduction To Pathology
   
  Explain the meaning of “Pathology”. (Scientific study of disease, abnormal          structure and function). Explain the concepts of various components – etiology (cause), pathogenesis (mechanisms of damage), morphology (structural alterations), cellular and molecular basis, functional implications (clinical features, investigations), progression and prognosis (complications and outcomes).
  
• Describe the roles played by pathologists in the clinical management of patients and medical research.
  
• Explain the importance of understanding pathology:
  
  • (Relevant to the patient) What are the causes of disease?  How does disease damage tissues?  How can this knowledge of structural damage explain the clinical signs and symptoms, help in selecting investigations, interpreting results of investigations, arriving at a clinical diagnosis, making a choice of treatment and monitoring the effect of treatment.
    
  • (Relevant to the family) genetic and environmental factors involved in the  causation of disease.
  • (Relevant to the community) understanding the cause of disease to take effective preventive measures.
• Outline what each division of pathology deals with  histopathology, cytology, autopsies,  immunopathology,  electron microscopy, molecular pathology, gene mapping, clinical chemistry, hematology.
• Classify diseases based on pathology, diseases broadly into inflammatory, ischemic, genetic and neoplastic (tumors).
• List some examples of agents causing disease under the categories‑physical, chemical, nutritional, infective, immunological.
• Distinguish the concept of general pathology as broad principles of disease irrespective of the organs involved (how and why of cell and tissue injury), from systemic pathology--as disease processes specifically involving individual organ systems.
• Identify the areas of interaction between clinical and pathology departments (clinical biochemistry, biopsy, cytology, autopsy etc)
• Utilize the information in the course syllabus to participate and do well in the course.

 

CELLULAR INJURY & NECROSIS
Define and use in proper context:

Agenesis	Hyaline (hyalin)
Anthracosis	Hyperplasia
Aplasia	Hypertrophy
Apoptosis	Hypoplasia
Atrophy	Hypoxia
Autolysis	Infarct
Autophagy	Ischemia
Bilirubin	Karyolysis
Cellular swelling (hydropic change)	Karyorrhexis
Dysplasia	Lipofuscin
Gangrene	Melanin
Heat-shock protein	Metaplasia
Hemosiderin	Necrosis
Hemosiderosis	Neoplasia
Heterophagy	Pyknosis
Homeostasis	Steatosis
Angiogenesis (neovascularization)	Organization
Keloid	Regeneration
Contact inhibition	Repair
Contracture	Scar
Dehiscence	Granulation tissue
Fibrosis (fibroplasia)

General Objectives:

• recognize "disease" as a deviation from the "normal or physiologic state" of cells, with special emphasis on causes, pathogenesis, morphologic changes and clinically significant functional consequences of such changes.
  
• illustrate the "landmarks" of cellular injury and death at light microscopic and ultrastructural levels, focussing on those clinically relevant changes indicative of irreversibility, specific disease entities and evidence of cellular adaptation.

 

Terminal Objectives:

• define the four aspects of a disease process.
  
• explain the mechanisms by which a cell achieves homeostasis.
  
• define cell injury and the sequential changes associated with it.
  
• give five examples of etiology of cell injury.
  
• using any example of cell injury, explain the sequence of events that take place when a cell is injured, including the target intracellular systems affected and the morphological changes culminating with cell death.
  
• using “ischemic injury” as an example, compare and contrast reversible versus irreversible cell injury, including mechanism, morphology and consequences.
  
• using an example, describe the mechanisms involved in chemical injury.
  
• using an example, describe the mechanisms involved in viral injury.
  
• list the morphological changes of cellular injury at ultrastructural level.
  
• define cell death, including the different morphological types and their significance.
  
• list and describe the different types of necrosis, including their appearance and common etiology.
  
• using an example, define and contrast normal and abnormal cellular accumulations.
  
• define and contrast the five most important cellular adaptation mechanisms using clinically relevant examples.

INFLAMMATION:

General Objectives:

• acquaint the student with a most important mechanism of defense without which the mammalian organism cannot survive.
  
• explain and illustrate with examples the various steps involved in the inflammatory response.
  
• discuss (using examples) those factors that initiate and modify the course of the inflammatory reaction.
  
• acquaint the student with the clinical manifestations of inflammation with the use of clinical scenarios when possible, making reference to their underlying pathogenetic mechanisms.

Terminal Objectives:

• using examples, explain five ways in which our bodies are physiologically protected from injury (defense mechanisms).
  
• define and contrast inflammation and infection.
  
• define and contrast exudation and transudation.
  
• list and explain the mechanism of production of the cardinal signs of inflammation.
  
• using an example, explain the series of steps that take place in the capillary bed during an acute inflammatory process.
  
• using an example, define normal and abnormal permeability at the microcirculation during inflammation.
  
• list and contrast the three common patterns of increased vascular permeability.
  
• describe the cellular events of inflammation.
  
• define chemotaxis and list three common chemotactic factors.
  
• using an example, describe the steps involved in phagocytosis (biochemical formulas are not required).
  
• list and explain the three possible mechanisms of release of leukocyte products during inflammation.
  
• define chemical mediation in inflammation. Explain the mechanisms of action and effects of: vasoactive amine, and plasma proteases (biochemical formulas are not required).
  
• define arachidonic acid metabolites. Give two examples.
  
• define cytokines. Give two examples including their effects.
  
• classify inflammation based on duration. Give examples for each type.
  
• define granuloma. Give three common etiologies.
  
• classify inflammatory exudates. Give examples.
  
• define: abscess, empyema and two other special forms of inflammation.
  
• define and contrast: bacteremia, septicemia, toxemia.
  
• describe the role of lymphatics in inflammation.
  
• list three common possible defects in leukocyte function that may affect the inflammatory response (use examples).
  
• list three systemic effects of inflammation.

 

REGENERATION & REPAIR

General & Terminal Objectives

• illustrate the mechanisms involved in the healing process and, at the end of this chapter, the student should be able to
  
• define and contrast regeneration and repair.
  
• classify cells (with examples) based on their regenerative activity.
  
• using a skin wound as an example, explain the various steps involved in the process of repair including cicatrization.
  
• classify skin wound healing. Give examples.
  
• list and discuss three factors that influence the rate of healing and how can we influence the outcome.
  
• name and explain your preferred theory to explain the stimulus to repair.
  
• illustrate the two main mechanisms required for regeneration & repair. Give some examples of factors involved in each.
  
• give three examples of factors in the host which may modify the inflammatory response and repair (local and systemic).

 

Pigmentation Objectives:

• Explain the distribution and clinical significance of exogenous pigments such as carbon in the body.
  
• Discuss the role of melanin in the body including: source and function . Give 3 examples of abnormalities of melanin pigmentation in the skin.
  
• Define jaundice. Explain why it occurs in obstructions of the bile duct. Give an example.
  
• Compare and contrast hemosiderosis and hemochromatosis.
  
• Discuss the pathogenesis of gout including epidemiology and predisposition.
  
• Classify gout.  List the pathology of acute and chronic gouty arthritis.

 

Amyloid Objectives

• Define amyloid and describe its staining properties.
  
• Compare and contrast AL amyloid and AA amyloid
  
• Using clinical examples, compare and contrast systemic and localized amyloidosis
  
• Explain the proposed pathogenesis of amyloid deposits in B-cell dyscrasias and reactive systemic amyloidosis and correlate it to the possible clinical manifestations.
  
• Using any organ as an example, describe the macroscopic and microscopic findings of amyloidosis and correlate it to the possible clinical implications.

PATHOLOGY OF INFECTIONS OBJECTIVES

• Explain the difference between infection and disease
• Describe the sequential responses of the host to microorganisms once they have entered the body (neutrophils, lymphocytes, macrophages, inflammatory exudates, antibodies, fever).
• Describe the routes through which organisms can spread within the body once they have set up a focus of infection and determine the clinical features of the same.
• Distinguish bacteremia from septicemia and elucidate the clinical features of septicemia.
• Explain the role played by exotoxins and endotoxins in producing tissue damage and shock
• Differentiate the usual tissue responses to different groups of organisms - acute inflammation, necrosis, lymphomononuclear cells, eosinophils, granulomas, mixed inflammation, fibrosis, necrosis, pseudomembrane
• Based on a given tissue response they should be able to suspect the likely group of organisms.
• Conceptualize the steps involved in making a clinical diagnosis of infectious disease.
• Some specific infections will be discussed in the lectures to illustrate classical pathological responses to the broad categories of organisms. FOR THE SPECIFIC ORGANISMS DISCUSSED –

Define to –

• Identify the diseases produced by the organism
• Explain the pathogenetic mechanisms of the organism (direct contact, toxins, enzymes, induction of cell mediated or humoral immune responses)
• Identify the type of host response to the organism and histological changes in the lesions.
• List the mode of infection, route of entry, primary site of infection, sequence of changes (if any), areas of spread and complications.
• Derive important clinical features of the diseases caused by the organism based on the knowledge of pathology.
• Select the important investigations for diagnosis.
• Recognize any special relevant data on epidemiology (age, sex, geography) for the organism and explain the same.

HEMODYNAMICS OBJECTIVES
Define and use in proper context:

Hemostasis	Melena
Coagulation	Hemarthrosis
Clot	Hematuria
Thrombosis	Hemothorax
Thrombus	Hemopericardium
Thrombocytopenia	Fibrinolysis
Embolism	Thrombolysis
Embolus	Factor V leiden
Lines of Zahn	D-dimer
Organization	Hypercoagulable state
Recanalization	Virchow's triad
Infarct      pale      red      bland      septic	Trousseau syndrome
Von willebrand factor	Tissue plasminogen activator (TPA)
Hemorrhage	Stasis
Occult bleeding	Shock      reversible      irreversible
Hemosiderin	Hyperemia
Petechia	Congestion
Ecchymoses	Congestive heart failure
Purpura	Edema
Hematoma	inflammatory
Hematemesis	noninflammatory
Hemoptysis	renal
Lymphedema	Anasarca
Effusion	Ascites
Exudate	Transudate

EDEMA

• Recapitulate the factors that govern the fluid exchange (at the arteriolar and venular ends of the capillaries) between vascular and extravascular space.
• Trace the pathway of fluid from the tissue space to the heart (lymphatics, thoracic duct, left subclavian vein, superior vena cava)
• Define edema as an abnormal accumulation of fluid in interstitial space and serous cavities (hydrothorax, hydropericardium, hydroperitoneum – ascites)
• Define anasarca as severe edema that affects the body in a generalized fashion.
• Distinguish localized edema from generalized edema and list the common causes for each.
• Explain the pathogenetic mechanism of edema based on capillary hydrostatic pressure and colloid osmotic pressure in capillaries and tissues.
• Distinguish the properties of exudates from those of transudate.
• Explain the mechanism of edema in venous blockage, congestive heart failure, lymphatic obstruction, renal disease, liver disease and protein malnutrition.
• Describe the morphology of edema clinically and microscopically.
• Distinguish pitting edema from non-pitting edema
• Explain the effects of edema in subcutaneous tissue, lungs, and brain.
• Derive the main lines of management of edema based on the knowledge of pathology.

HYPEREMIA AND HEMORRHAGE

• Distinguish hyperemia as an active process caused by arteriolar dilation from congestion as a passive phenomenon caused by impaired outflow from veins.
• Elucidate the causes of acute and chronic congestion of lungs, liver and describe the morphological changes.
• Define hemorrhage as extravasation of blood and due to rupture of blood vessels.
• Identify the common causes of hemorrhage (trauma, atherosclerosis, vasculitis, aneurysm, bleeding diathesis)
• Define the different varieties of hemorrhage viz. petechiae, purpura, ecchymosis, hematoma, hemothorax, hemopericardium, hemoperitoneum, hemarthrosis.
• Explain the chronological changes that take place in the extravasated blood in the tissues.
• Recognize that severe blood loss can lead to shock.

DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

• Define DIC as a serious and often fatal complication of many illnesses that involves widespread small thrombi in microcirculation and bleeding through out the body. Recognize that it can occur in acute, subacute and chronic forms. Recognize the need to diagnose it early and treat.
• Explain the main mechanism of diffuse endothelial injury that leads to DIC, with examples
• (Gram negative septicemia, immune mediated type II and III hypersensitivity, release of thromboplastic substances into circulation- amniotic fluid, snake bite, acute promyelocytic leukemia, extensive tissue necrosis, proteolytic enzymes and mucin released by carcinomas).
• Recognize that concurrent fibrinolysis proceeds hand in hand with widespread microthrombi.
• Explain the pathogenesis of shock based on decreased tissue perfusion.
• Explain the development of lactic acidosis and microinfarcts in DIC.
• Explain the pathogenesis of bleeding in DIC based on consumptive coagulopathy and fibrin degradation products (FDPs) acting as anticoagulants (inhibit thrombin, platelet aggregation and fibrin polymerization).
• Elucidate the clinical features of shock and bleeding in DIC.
• Explain the basis of investigations that can be performed to confirm the diagnosis of DIC (FDPs, D-dimers, coagulation tests)
• Based on the understanding of the pathogenesis of DIC, indicate broad lines of its management (heparin to prevent formation of thrombi, replacement of platelets and plasma)

SHOCK

• Define shock; recognize the importance of shock in clinical practice.
• Explain the common causes of cardiogenic, hypovolemic, septic, and distributive varieties of shock and highlight the pathogenesis of shock in each type.
• Identify theoretically the three stages of shock (non progressive, progressive and irreversible) and explain the pathophysiological changes and clinical features at each stage. Distinguish septic shock from hypovolemic shock based on clinical features. Define the lesions that lead to a fatal outcome.
• Describe the morphological changes produced by hypoxic injury in the following organs – brain, heart, kidney, lungs, adrenals, GIT, liver.

 

THROMBOSIS, EMBOLISM INFARCTION

• Recapitulate the normal process of coagulation, fibrinolysis and the factors involved.
• Recapitulate the role of endothelial cells in hemostasis.
• Define thrombosis, distinguish it from clotting.
• Recognize the normal and abnormal situations for thrombosis to occur.
• Enlist the important causes of endothelial cell injury, loss of laminar blood flow and hypercoagulability of blood which are the main factors that predispose to thrombosis.
• Explain the fate of thrombus 9dissolution, organization and recanalization, propagation, embolization)
• Distinguish a postmortem clot from thrombus based on gross and microscopic features.
• Differentiate the sites, predisposing factors and clinical effects of venous versus arterial thrombosis.
• Define and classify embolism (thrombo, fat, air, bone marrow, tumor, amniotic fluid, atherosclerotic, foreign body, infective) and derive the clinical scenarios.
• Enlist the common situations of arterial and pulmonary thromboemboli.
• Discuss the effects of minor, major and massive pulmonary thromboemboli.
• Explain the role played by cardiac, pulmonary status and collateral circulation in determining the outcome of emboli.
• Explain how paradoxical emboli develop.
• Define infarction, distinguish arterial and venous infarcts and list common sites.
• Identify the main causes of infarction in a given clinical situation (obstruction by thrombosis, embolism, hemorrhage into atherosclerotic plaque, torsion of blood vessels, hypo perfusion, vasculitis)
• Explain the difference between the pathogenesis of red and pale infarcts
• Analyze clinical vignettes of commonly occurring ischemic pathologies (as discussed in the lectures) due to thrombosis and embolism to identify mechanisms, pathogenesis, relevant investigations and predict usual outcomes (Pulmonary embolism, stroke, myocardial infarction, gangrene legs, intestinal infarction, pulmonary embolism.

NEOPLASIA OBJECTIVES

Define and use in proper context:

adenoma	desmoplasia	metastasis	sarcoma
anaplasia	DNA repair gene	microinvasion	scirrhous
angiogenesis	dysplasia	mixed tumor	serous
aplasia	endophytic	mucinous	stage
atrophy	exophytic	neoplasia	tumor
benign	grade	occult malignancy	tumor associated antigen
borderline malignancy	hamartoma	oncogene	tumor marker
cachexia	heterotopia	oncogenic	tumor specific antigen
cancer	hyperplasia	oncology	tumor suppressor gene
carcinoid	hypertrophy	papilloma
carcinogen	hypoplasia	paraneoplastic syndrome
carcinoma	in situ	parenchyma
carcinosarcoma	initiation	Philadelphia chromosome
choristoma	intraepithelial	pleomorphism
contact inhibition	invasion	point mutation
cystadenoma	leukoplakia	polyp
cystadenocarcinomas	low malignant potential	premaligant
differentiation	malignant	prognosis
dermoid	medullary	progression
desmoid	metaplasia	promotion
		protooncogene

• Discuss the following:
  • anaplasia
  • aplasia
  • atrophy
  • dysplasia
  • hypertrophy
  • hyperplasia
  • hypoplasia
  • metaplasia
  • neoplasia

  In terms of:

  • etiology
  • pathogenesis
  • morphology
  • functional sequelae
  • specific examples
• Outline the classification and nomenclature for benign and malignant neoplasms, using appropriate prefixes and suffixes and indicating specific exceptions to rules of nomenclature.
• Compare and contrast the following in terms of tissue of origin, gross and microscopic features, and mode of spread:
• normal vs. neoplastic tissue
• adenoma vs. carcinoma
• carcinoma vs. sarcoma
• List the general cytologic, biochemical, antigenic, metabolic, karyotypic, and molecular genetic changes found in neoplastic cells.
• List the most common sites of origin of:

• adenocarcinoma
• squamous cell carcinoma
• melanoma
• cystadenoma
• adenoma
• papilloma

• Compare and contrast grading vs. staging of neoplastic disease, in terms of:
• general principles
• clinical significance
• Cite local and general mechanisms which are believed to affect the rate of tumor growth.
• Discuss how tumor growth rates can be evaluated using mitotic rate and cell proliferation markers.
• List four major pathways by which neoplasms spread.
• Discuss metastasis of malignant neoplasms, in terms of:
• molecular genetics
• cellular adhesion
• mechanisms of invasion of extracellular matrix
• mechanisms of vascular dissemination and homing of tumor cells
• tissues and organs in which metastases are:
• common
• uncommon

and cite possible reasons for lack of metastases in some instances when cancer cells are spilled into the blood stream.

• Describe carcinogenesis, giving suitable examples,  in terms of:
• initiation and neoplastic progression
• sequence of gene mutations
• the following mechanism of carcinogenesis – self sufficiency of growth signals, insensitivity to growth inhibitory signals and evasion of apoptosis.
• The four steps in the normal cell cycle and examples of mutations affecting growth factors, receptor for growth factors, second messengers and nuclear transcription. Explain which among these is likely to be more potent.
• Balanced translocations, deletions and gene amplifications.
• Recognize the role of each of the following in the development of human cancer, citing general significance and at least one specific neoplasm associated with each:
  • physical agents
  • chemical agents
  • infectious agents
  • chronic inflammatory conditions
  • benign tumors
  • genetic diseases
  • genetic predispositions
  • hormones
  • immune response

• Match the following agents or conditions with neoplasms for which there has been a suggested relationship:

cyclophosphamide	hepatitis B and C viruses
circumcision	Epstein-Barr virus
tobacco	human papillomavirus (HPV)
smoked fish	human immunodeficiency virus (HIV)
aniline dyes	human T cell leukemia/lymphoma virus, type 1 (HTLV-1)
aflatoxin	ultraviolet radiation
asbestos	ionizing radiation
benzene	radon
2-naphthylamine	heredity
vinyl chloride	hormonal imbalance
Helicobacter pylori

• Discuss precancerous lesions (incipient malignancies), in terms of:
• definition
• etiology
• pathogenesis/growth kinetics
• common examples
• Describe the metaplasiaàdysplasiaàcarcinoma-in-situàinvasive carcinoma sequence.
• Discuss, compare, and contrast the following theories of origin of neoplasia:
  • multifactorial theory
  • genetic mutations
  • viral oncogene
  • epigenetic theory
  • immune-surveillance dysfunction
  • monoclonal origin
  • field origin
    

• Explain the genetic basis of the following tumors – retinoblastoma, chronic myeloid leukemia, Burkitt’s lymphoma, neuroblastoma, Wilm’s tumor, colon carcinoma
• List the DNA viruses which have been linked to tumor formation in man and animals.
• List the connections between viruses and tumors in terms of:
• epidemiology
• interactions of virus proteins with cell regulatory proteins
• modulation of the host immune system
• Contrast the mechanisms of neoplasm formation by DNA viruses with those by RNA viruses.
• Discuss the relationship between protooncogenes and oncogenes, as well as the relationship between cellular oncogenes and viral oncogenes.
• Compare and contrast protooncogenes and tumor suppressor genes, in terms of genotypic vs. phenotypic expression.
• Explain the concept of recessive cancer gene.
• Describe the following cancer-susceptibility syndromes:
  • ataxia-telangiectasia
  • Bloom syndrome
  • xeroderma pigmentosum
  • hereditary nonpolyposis colon cancer
  • Fanconi anemia
  • Li-Fraumeni syndrome
  • familial adenomatous polyposis coli
  • von Hippel-Lindau disease
    

            in terms of:

• genetic abnormality
• mechanisms of oncogenesis
• clinical features
• associated neoplasms

• Describe the following genes:
  • APC
  • DCC
  • p53
  • Rb
  • bcl-2
  • ras
  • myc
  • c-erb B2
  • BRCA
    

  in terms of:

  • chromosomal location
  • mechanisms of oncogenesis
  • associated neoplasms

• Discuss the following chromosomal translocations:
  • t(8;14)
  • t(9;22)

            in terms of:

• mechanisms of oncogenesis
• associated neoplasms
• Discuss dose dependency in chemical carcinogenesis.
• Explain the carcinogenic effect of irradiation.
• Cite evidence for estrogens as carcinogens.
• Describe the body's immune system and its role in the development of neoplasms, and explain the following concepts:
• anti-tumor immunity
• immunologic surveillance
• Discuss the different types of escape mechanisms utilized by neoplasms to evade the immunosurveillance system of an immunocompetent host.
• Discuss tumor specific antigens and tumor related antigens, in terms of:
• their presence on normal cells
• their importance in anti-tumor immunity
• Compare tumors transmitted by:
• dominant inheritance
• recessive inheritance

            on the basis of:

• examples
• incidence

• Compare and contrast:
  • acquired cancer-causing genetic mutations
  • germline cancer-causing genetic mutations
• explain the utility of  the following diagnostic procedures and laboratory tests used to diagnose, and monitor the progression of, neoplasms:
• Imaging
  • conventional radiography
  • computed tomography (CT)
  • magnetic resonance imaging (MRI)
  • ultrasound
  • nuclear medicine
  • positron emission tomography (PET)
• Histologic
  • needle biopsy
  • open biopsy
  • frozen section
  • immunohistochemistry
  • electron microscopy
• Cytologic
  • exfoliative cytology
  • fine needle aspiration (FNA) cytology
• Biochemical
  • tumor markers
• Molecular
• flow cytometry
• genetic analysis
• List the secretions or other fluids which are examined by cytologic means in the diagnosis of malignancy.
• List the organs in which cytology plays an important role in cancer case findings.
• Discuss the epidemiology of malignant neoplasms, in terms of

  • incidence

  • prevalence

  • geographic associations

  • environmental factors

  • age associations

  • genetic factors

  • carcinogens

  • changing incidence

  • preneoplastic disorders

• For both males and females, list in descending order:
• the five most common cancers
• the five most common causes of cancer death
• List the relative incidence of, and mortality due to, cancer for each sex and decade.

• Match each of the following public health measures with appropriate neoplasms in which the measure may be of some use:
  • cytologic examination
  • avoidance of ionizing radiation    
  • self-examination
  • avoidance of excessive sunlight
  • avoidance of tobacco
  • cancer genetic studies
• Cite at least three neoplasms that produce the same hormones as the organ from which the tumor arises.
• Cite at least three examples of paraneoplastic syndromes.
• Match each of the following tumor markers with the specific neoplasm(s) with which it is associated:
• human chorionic gonadotrophin (HCG)
• calcitonin
• catecholamines
• -fetoprotein (AFP)
• Contrast the effects of benign and malignant tumors on the host.
• List the common signs and symptoms of malignancy.
• List the common causes of death from cancer.

ENVIRONMENTAL PATHOLOGY

• Explain role of environment in disease production citing examples.
• Identify the deleterious effects of tobacco smoking and postulate the pathogenesis.
• Explain the additive effects of smoking and asbestos in lung cancer.
• Distinguish the common pneumoconioses based on pathogenesis and pathology (anthracosis, silicosis, asbestosis and berylliosis)
• Describe the pathogenesis and pathology related to alcohol abuse.
• Describe the tissue injury in substance abuse like cocaine, heroin and marijuana, hallucinogens and explain the clinical features. Recognize the pathologic lesions common to IV drug users.
• Recognize that therapeutic drugs can at times produce different pathologic processes and cite some examples.
• Recognize the settings for carbon monoxide poisoning and make a diagnosis with the characteristic clinical features
• Recognize the settings for cyanide poisoning and how it produces death.
• Recognize the pathogenetic mechanism and clinical features of lead toxicity in children and adults based on the pathologic lesions.
• Explain the lesions produced by exposure to ionizing radiation and recognize the clinical features.
• Distinguish the pathology induced by hyperthermia from that produced by infections.
• Identify the mechanisms of physiological alterations and pathology produced by hypothermia.

IMMUNOPATHOLOGY OBJECTIVES

• Recapitulate the normal development of hematopoiesis and steps involved in the maturation of different varieties of T cells, B cells, NK cells, mononuclear phagocytes, antigen presenting cells and dendritic cells (from Histology & Immunology Courses).
• Recapitulate the mechanisms of functions and interactions of these cells (from Immunology Course).
• Recapitulate the process of lymphocyte homing recirculation (Immunology course)
• Explain the concept of how MHC and clinical tissue typing is achieved (Immunology Course).
• Explain how the major histocompatibility complex (MHC) coordinates interactions among immune cells (Immunology Course).
• Explain how the common lab tests can identify abnormalities of immune system (Immunology Course)
• Differentiate the four varieties of hypersensitivity based on mechanisms, pathologic changes, clinical situations, lab data and outcomes.
• Identify the main mechanism(s) in a given clinical scenario of hypersensitivity.
• Distinguish the 3 main types of transplant rejection (hyper acute, acute and chronic) based on mechanism, morphologic changes, clinical features and outcomes using renal transplant as a standard example.
• Recognize that deficiencies of complement and defects in leukocyte functions including chemotaxis, phagocytosis and lysosomal activities also lead to immune deficiency and produce specific patterns of infections.
• Identify the infections that characterize AIDS and the tissue responses in such patients (the viral and immunological aspects of AIDS will be covered in the Microbiology course).
• Explain the mechanism and clinical features of Graft versus host reaction.
• Distinguish the common immunodeficiency states (listed) based on mechanisms, clinical features, lab data and outcomes (Bruton x linked agammaglobulinemia, selective IgA deficiency, common variable immunodeficiency, Di George Syndrome, Severe combined immunodeficiency, Wiskott Aldrich Syndrome).
• Explain the pathogenesis and morphological and clinical features of autoimmune diseases using SLE as a classical example.  Explain how the antibody patterns can distinguish between SLE, Rheumatoid arthritis, Sjogrens syndrome, Progressive systemic sclerosis and mixed connective disease.
• Explain the meaning of organ specific autoimmune disease citing examples of thyroid and stomach

RESPIRATORY SYSTEM

• Define and use in proper context:

acute interstitial pneumonia (AIP)	heart failure cell
adult respiratory distress syndrome (ARDS)	Hemoptysis
allergic bronchopulmonary aspergillosis (ABPA)	Horner syndrome
alveolar-capillary membrane	Hyaline membrane
Asteroid body	Hydrothorax
Asthma	Hypersensitivity pneumonitis (HP)
Atelectasis	Hypertrophic pulmonary
Barrel chest	osteoarthropathy
Bleb	Idiopathic interstitial pneumonia (IIP)
blue bloater	Idiopathic pulmonary fibrosis (IPF)
bronchial cyst	Honeycomb lung
Bronchiectasis	Non-small cell lung cancer (NSCLC)
bronchiolitis obliterans	Obstructive lung disease
bronchogenic carcinoma	Organizing pneumonia
bronchogenic cyst	Pancoast tumor
bronchopulmonary sequestration	Paraneoplastic syndrome
Bulla	Pink puffer
Caplan syndrome	Plexiform lesion
Charcot-Leyden crystal	Pneumothorax
chronic bronchitis	Pulmonary edema
chronic obstructive pulmonary disease (COPD)	Progressive massive fibrosis (PMF)
chylothorax	Pulmonary embolism
coin lesion	Pulmonary veno-occlusive disease (PVOD)
Consolidation	Rales
cor pulmonale	Reid index
cryptogenic fibrosing alveolitis (CFA)	Restrictive lung disease
cryptogenic organizing pneumonia (COP)	Rhonchi
diffuse alveolar damage (DAD)	Saddle embolus
diffuse parenchymal lung disease (DPLD)	Schaumann body
Emphysema	Severe acute respiratory syndrome  Ghon complex (SARS)
empyema	Small airways disease
extrinsic allergic alveolitis (EAA)	Status asthmaticus
Goodpasture syndrome	Tension pneumothorax
Hemothorax

• Describe the mechanisms by which the following pulmonary defense mechanisms accomplish their functions:
• nasal clearance
• laryngeal (including epiglottic) action
• tracheobronchial clearance
• alveolar clearance

• Explain the pathogenesis of each of the following manifestations of pulmonary disease:
  • pain
  • cough
  • dyspnea
  • sputum production
  • cyanosis
  • clubbing of fingers
  • hypertrophic pulmonary osteoarthropathy
  • secondary polycythemia
  • hemoptysis
  • cor pulmonale

• Discuss the following pulmonary congenital anomalies, in terms of morphology and clinical consequences:
  • agenesis
  • hypoplasia
  • congenital lobar overinflation ("emphysema")
  • congenital cyst
  • bronchopulmonary sequestration
• intralobar
• extralobar
  • Compare and contrast:
  • obstruction (resorption) atelectasis
  • compression atelectasis
  • contraction atelectasis
  • microatelectasis
  • patchy

  in regards to:

  • predisposing factors
  • etiology
  • pathogenesis
  • morphologic findings
  • clinical features

• Contrast obstructive and restrictive pulmonary disease, in terms of:
  • morphologic features
  • radiologic manifestations
  • pulmonary function test results
  • clinical manifestations
• Distinguish obstructive and restrictive lung diseases based on spirometry and list common examples of each.
• Compare and contrast:
  • emphysema
  • chronic bronchitis
  • bronchial asthma
  • bronchiectasis

  in terms of:

  • etiology
  • pathogenesis
  • morphologic features
  • radiologic features
  • clinical manifestations
  • complications and prognosis

• Compare and contrast
  • centriacinar (centrolobular) emphysema 
  • panacinar (panlobular) emphysema
  • paraseptal (distal acinar) emphysema
  • focal emphysema

    in terms of

    • incidence
    • age and sex distribution
    • etiology
    • pathogenesis
    • gross and microscopic morphology
    • physiologic changes
    • radiologic features
    • clinical presentation, course, and prognosis
      

• Discuss the Reid index, in terms of a normal index vs. an index indicative of chronic bronchitis
• Discuss respiratory bronchiolitis of smokers (small airways disease) in terms of:
  • pathogenesis
  • morphology
  • clinical presentation
• Discuss bronchiectasis, in terms of:
  • predisposing conditions including Kartagener’s syndrome
  • the types of organisms typically cultured from bronchi
  • sequelae
• Compare and contrast neonatal and adult respiratory distress syndrome in terms of:
  • predisposing factors/associated conditions
  • pathogenesis
  • morphology
  • complications
  • clinical course
• Compare and contrast the following forms of diffuse parenchymal lung disease (DPLD):
  • diffuse alveolar damage (DAD)
  • bronchilitis obliterans-organizing pneumonia (BOOP)
  • usual interstitial pneumonia (UIP)
  • desquamative interstitial pneumonia (DIP)
  • lymphoid interstitial pneumonia (LIP)
  • nonspecific interstitial pneumonia (NSIP)

  in terms of:

  • synonyms
  • associated diseases
  • etiopathogenesis
  • morphologic features
  • radiologic features
  • clinical manifestations
  • prognosi

• Discuss the following disorders:

• sarcoidosis
• Goodpasture syndrome
• idiopathic pulmonary hemosiderosis (IPH)
• hypersensitivity pneumonitis (HP)
• pulmonary alveolar proteinosis
  Wegener granulomatosis
  

in terms of:

• associated conditions
• etiopathogenesis
• morphologic features (pulmonary and extrapulmonary)
• radiologic features
• clinical manifestations
• prognosis

• Discuss pulmonary invovement in autoimmune ("collagen-vascular") diseases, noting the major morphologic manifestations in the lung of:
• systemic lupus erythematosus (SLE)
• rheumatoid arthritis (RA)
• progessive systemic sclerosis (PSS)
• Discuss the pulmonary features of cystic fibrosis (CF), in terms of:
• frequency of involvement of lung in CF
• pathogenesis
• morphology
• functional alterations
• clinical manifestations
• pulmonary complications
• obstructive
• infectious (including most common organisms involved)
• treatment
• prognosis
• Compare and contrast:
• bronchopneumonia
• lobar pneumonia
• primary atypical pneumonia
• aspiration pneumonia
• lung abscess
• pulmonary infiltrates in the immunocompromised host

  in terms of:

  • predisposing factors
  • etiologic organisms
    
  • pathogenesis
    
  • morphologic features
  • radiologic features
  • clinical manifestations
  • prognosis
    

• Describe the four classic stages of the inflammatory response in lobar pneumonia, in terms of:
  • temporal features
  • morphology
• Differentiate among tuberculosis, sarcoidosis, and granulomatous fungal disease on the basis of:
  • etiopathogenesis
  • morphologic features, including use of special stains
  • organs involved
  • radiologic features
  • clinical presentation
  • diagnostic tests
  • laboratory findings
  • prognosis
• Discuss pulmonary edema, embolism, and infarction in terms of:
  • predisposing factors and etiology
  • pathogenesis
  • morphologic features
  • radiologic features
  • clinical manifestations

• Compare and contrast pulmonary embolism caused by:
  • thrombus
  • fat
  • air
  • bone marrow
  • amniotic fluid
  • talc

  in terms of:

  • predisposing factors
  • incidence
  • morphology
  • pulmonary pathophysiology
  • complications
  • clinical course

• Compare and contrast primary and secondary pulmonary hypertension, in terms of:
  • predisposing factors/associated conditions
  • pathogenesis
  • age and sex distribution
  • clinical manifestations
  • size and type of vessels involved
  • morphologic features (including reversible vs. irreversible lesions)
  • hemodynamic consequences 
  • prognosis
• Compare and contrast the following thoracic tumors:

• squamous cell carcinoma of lung
• bronchogeneic adenocarcinoma
• bronchioloalveolar carcinoma
• small cell carcinoma of lung
• large cell carcinoma of lung
• bronchial carcinoid
• pulmonary hamartoma
• metastatic neoplasm to thorax
• pleural fibroma (solitary fibrous tumor) (not included in exam)
• malignant mesothelioma of pleura
• malignant lymphoma (not included in exam)

in terms of:

• epidemiology
• etiology
• pathogenesis
• morphologic features
• radiologic features
• clinical manifestations (pulmonary, extrapulmonary)
• staging
• treatment
• prognosi

• Compare central and peripheral neoplasms of the lung in terms of:
  • clinical presentation
  • radiographic presentation
  • histologic types
  • clinical course
  • prognosis
• List likely etiologies and expected effects on pulmonary function of:

• hydrothorax
  
• empyema
• hemothorax
• chylothorax
• pneumothorax
• tension pneumothorax
• pleural adhesion

• Discuss pleural fluid collections on the basis of fluid type and common associations
• List appropriate diagnostic procedures for patients clinically suspected of having pleural effusions
• Discuss:
  • pulmonary circulatory disease associated with congenital heart disease
  • persistent fetal ciruclation

  in terms of:

  • etiopathogenesis
  • size and type of vessels involved
  • morphologic features
  • pulmonary pathophysiology
  • prognosis

• Enumerate the different types of mediastinal masses based on location in:
  • superior mediastinum
  • anterior mediastinum
  • posterior mediastinum
  • middle mediastinum
• Compare and contrast:
  • thymoma
  • malignant thymoma
  • thymic carcinoma

  in terms of:

  • associated conditions and syndromes
  • clinical presentation and course

• Recapitulate the basic pathogenesis of pneumoconioses.
• Compare and contrast the following pneumoconioses:
  • coal workers' pneumoconioses
  • silicosis
  • asbestosis
  • berylliosis

  in terms of:

  • occupational exposure
  • pathogenesis
  • gross and microscopic morphology
  • complications
  • clinical course

• Discuss the following asbestos-related lung diseases:
  • fibrous pleural plaques
  • pleural effusion
  • asbestosis
  • bronchogenic carcinoma
  • malignant mesothelioma

  in terms of:

  • epidemiology
  • etiopathogenesis
  • morphology
  • clinical features
  • prognosis

• Discuss the following specific respiratory tract infections:
  
  • anthrax
  • Legionnaire's disease 
  • actinomycosis
  • nocardiosis
  • tuberculosis
  • atypical mycobacteriosis
  • mycoplasma pneumonia
  • psittacosis
  • histoplasmosis
  • coccidioidomycosis
  • blastomycosis
  • crytococossis
  • aspergillosis
  • mucormycosis
  • respiratory syncytial virus (RSV) infection
  • influenza pneumonia
  • adenovirus pneumonia
  • cytomegalic inclusion disease (CID)
  • severe acute respiratory syndrome (SARS)
  • Pneumocystis carinii pneumonia (PCP)
  • toxoplasmosis
  • strongyloidiasis

  in terms of:

  • characteristics of organism
    
  • predisposing factors
    
  • associated conditions
    
  • pathogenesis
  • morphology, including use of special stains
  • radiologic features
  • clinical features
  • prognosis

CARDIOVASCULAR SYSTEM OBJECTIVES

Define and use in proper context

Aneurysm	fibromuscular dysplasia
Angiitis	fibrous cap
Arteriolosclerosis	fibrous plaque
arteriosclerosis	fusiform aneurysm
arteriovenous fistula	hypertension
arteritis	leukocytoclastic vasculitis
atheroma	fibrous cap
atherosclerosis	fibrous plaque
false aneurysm
fusiform aneurysm	cardiac tamponade
endarteritis	cardiogenic shock
pseudoaneurysm	cardiomyopathy
vasculitis	chronic ischemic heart disease
anastomosis	conduction system of the heart
aneurysm	congenital heart disease
angina pectoris	congestive heart failure
arrhythmia	contraction band necrosis
Aschoff body	cardiac tamponade
cor bovinum	hypertension
cor pulmonale	hypertensive heart disease
coronary artery disease	hypertrophy of the myocardium
diastole	Libman-Sacks endocarditis
Dressler syndrome	Marantic endocarditis
ductus arteriosus	mitral valve prolapse
foramen ovale	myocardial infarct
heart failure	myocarditis
hemopericardium
pancarditis	systole
pericarditis	tetralogy of Fallot
Prinzmetal angina	transposition of great vessels
reperfusion injury	truncus arteriosus
rheumatic fever	unstable angina
rheumatic heart disease	valvular insufficiency
ring abscess	valvular regurgitatioin
stenosis	valvular stenosis
sudden cardiac death	systole
pancarditis

 

Atherosclerosis

• Recapitulate the normal anatomy and histology of the blood vessels and the heart.
• Define Arteriosclerosis and identify its various types.
• Define Atherosclerosis and explain the role of endothelial injury, various cellular elements and lipids in the formation of an atherosclerotic plaque
• Distinguish based on morphology an atherosclerotic plaque from a fatty streak.
• Distinguish based on morphology and prognosis a stable plaque from an unstable plaque; identify the factors that make a plaque unstable.
• Correlate the coronary artery pathology with the various types of acute coronary syndromes

 

Hypertension

 

• Recapitulate from the physiology course the renin-angiotensin axis.
• Distinguish benign from malignant hypertension based on clinical presentation and pathological features.
• Identify the common causes of secondary hypertension
• Derive the systemic effects of hypertension on the kidney, brain, heart, and retina

Aneurysm

• Define aneurysm and classify them based on morphology, location and age of the patient.
• Identify the clinical presentation and possible complications for each of these conditions

Vasculitis

• Distinguish the different vasculitides based on etiology, clinical presentation, morphology, complications and diagnostic investigations.
• Most of the vasculitides will be discussed in the lab with the images and all types may not be covered in the lectures

Congestive heart failure

• Recapitulate the physiology of cardiac output, Frank –Starling law, and the concepts of preload and afterload from your physiology course
• Distinguish left from right heart failure, systolic from diastolic heart failure, and forward from backward heart failure based on altered physiological findings
• Recognize the pathology in the organs such as the liver, lungs, and spleen secondary to congestive heart failure
• Identify the situations that can lead to cor pulmonale

Ischemic heart disease

• Identify the common and important risk factors for the development of ischemic heart disease
• Distinguish the various acute coronary syndromes based on the clinical features and the underlying coronary pathology
• Differentiate the types of ischemic diseases (angina pectoris, MI, chronic ischemic heart disease)
• Identify the factors associated with sudden cardiac death following an acute myocardial infarction
• Distinguish transmural from subendocardial myocardial infarction on the basis of etiology and the pathological changes noted in the heart and the coronary artery
• Predict the location of the infarct based on your knowledge of coronary vasculature
• Distinguish the pathological changes in the heart based on the knowledge of duration since the onset of symptoms and identify the important complications during the evolution of the infarct.
• Recognize the classical clinical presentation and the investigations used in the diagnosis of acute MI
• Recognize the term ‘silent MI’

Valvular heart disease

• Recognize the etiopathogenesis, clinical presentation, and investigations for acute rheumatic fever
• Distinguish on the basis of etiology, hemodynamic changes, pathological changes in the heart, clinical presentation, and investigations the following conditions; chronic rheumatic heart disease, calcific aortic stenosis, mitral valve prolapse, nonbacterial thrombotic endocarditis and Libman-Sacks endocarditis
• Distinguish acute from subacute infective endocarditis on the basis of causative organisms, host response, clinical presentation, patient profile, pathological changes, investigations and complications

Primary myocardial disease

• Distinguish on the basis of etiology, hemodynamic changes, pathological changes in the heart, clinical presentation and complications, the following conditions; myocarditis, dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy

Congenital heart disease

• Recapitulate the physiology of fetal circulation and the embryological development of the heart from the embryology course
• Distinguish on the basis of etiology, hemodynamic changes, pathological changes in the heart, clinical presentation and complications, Acyanotic and cyanotic congenital heart diseases

Cardiac neoplasms

• Identify the common location, morphological appearance and functional consequences of a cardiac myxoma
• Identify the common tumors which metastasize to heart

Pericardial disease

• Identify the etiopathogenesis, clinical presentation and morphological changes in relation to pericarditis and distinguish the causes of serous, serosanguineous, chylous and sanguineous pericardial effusions

ALIMENTARY TRACT OBJECTIVES

Define and use in proper context:

achalasia	intestinal metaplasia
acute gastritis	intrinsic factor
adhesion	intussusception
angiodysplasia	ischemic enteritis or colitis
appendicitis, acute	juvenile polyp
atresia	Krukenberg tumor
Barrett esophagus	linitis plastica
carcinoid syndrome	malabsorption
carcinoid tumor	Mallory-Weiss syndrome
chronic gastritis	Meckel diverticulum
chronic inflammatory bowel disease	megacolon
Crohn disease	melena
Curling ulcer	mucocele
Cushing ulcer	napkin ring lesion
diarrhea	necrotizing enterocolitis (NEC)
diverticulum	peptic ulcer
dysentery	pernicious anemia
dysphagia	Peutz-Jegher syndrome
dysplasia	Plummer-Vinson syndrome
enterocolitis	pseudomembranous colitis
enterotoxin	pseudomyxoma peritonei
erosion	pyloric stenosis
esophageal varices	reflux esophagitis
esophagitis	signet ring cell
gastritis, atrophic	sprue (celiac, tropical, nontropical)
gastritis, autoimmune	steatorrhea
gastritis, chronic idiopathic	stress ulcer
gastroesophageal reflux disease (GERD)	superficial gastritis
Helicobacter pylori	transmural inflammation
hematemesis	tubular adenoma
hematochezia	ulcer
hemorrhoids	ulcerative colitis
hernia	villous adenoma
Hirschsprung disease	Virchow node
hypergastrinemia	volvulus
hyperplastic polyp	Whipple disease
inflammatory polyp	Zollinger-Ellison syndrome

• Distinguish oral leukoplakia, erythroplasia and hairy leukoplakia based on morphology and clinical significance
• Describe the clinical presentation and morphology of congenital stenosis/ atresia of the esophagus and associated tracheal lesions
  
• Describe the following disorders of the esophagus:
• hiatal hernia
• achalasia
• Mallory-Weiss syndrome
• Reflux esophagitis (GERD

in terms of

• etiology
• pathogenesis
• clinical features
• complications
• morphologic features.
• Discuss etiology, pathogenesis, morphological features, preneoplastic potential of  Barret’s esophagus
• Describe esophageal varices, their pathogenesis and typical complications.
• Discuss the etiology, pathogenesis, gross appearance, histopathology, clinical course, and the route of metastasis of esophageal carcinoma.
• Discuss pyloric stenosis in terms of incidence, morphology, clinical presentation and course.
• Discuss the pathogenesis and the morphology of acute gastric ulcers.
• Contrast and compare duodenal and gastric peptic ulcers, and their typical complications.
• Discuss Gastrointestinal stromal tumors (GIST), in terms of histogenesis,            common sites and morphology.
• Describe typical gross and histological features of gastric carcinoma.
• Discuss the epidemiology and risk factors of gastric carcinoma.
• Correlate the pathologic findings and clinical symptoms of gastric carcinoma.
• Compare and contrast the following diseases that can lead to Malabsorption syndrome
  • Celiac sprue
  • Tropical sprue
  • Whipple disease
  • Chronic Pancreatitis

  in terms of

  • epidemiology
  • etiology
  • pathogenesis
  • morphology
  • clinical features.

• Describe the etiology, pathogenesis, and morphology of appendicitis, and list the  most common complications.
• Describe mucocele of the appendix and its relationship to pseudomyxoma peritonei.
• Discuss the following intestinal processes:
  • Hirschsprung disease
  • diverticulosis
  • diverticulitis

  in terms of

  • age predilection
  • etiology pathogenesis morphology
  • clinical features
  • complications.

• Compare and contrast:
  • necrotizing enterocolitis (NEC) ( Will be covered in pediatric pathology)
  • pseudomembranous colitis
  • ischemic colitis
  • amebic colitis

        in terms of

  • etiology
  • pathogenesis morphology
  • clinical features and course.

• Compare and contrast ulcerative colitis and Crohn disease, in terms of:
  • Epidemiology
  • pathogenesis
  • morphology
  • clinical features
  • complications
  • malignant potential.
• List the lesions that can produce small intestinal obstruction.
• Explain the differential diagnosis of ulcerative lesions of small and large intestines.
• Discuss the following types of colonic polyps:
  • hyperplastic
  • juvenile
  • hamartomatous
  • adenomas (tubular, villous, tubulovillous)

  in terms of 

  • incidence
  • pathogenesis
  • morphology
  • clinical features
  • malignant potential.

• Compare and contrast the following syndromes:
  • Peutz-Jegher syndrome
  • familial adenomatous polyposis (FAP)
  • Gardner syndrome
  • Hereditary nonpolyposis colorectal cancer (Lynch) syndrome (HNPCC)

  in terms of

  • genetics morphology
  • types
  • malignant potential of lesions produced
  • clinical features.

• Describe colorectal carcinoma, in terms of etiology pathogenesis, including genetic and molecular factors morphology, including grading and staging criteria clinical features and course.
• Contrast and compare the morphology and the clinical presentation of carcinoma of the right vs. left colon.
• Discuss carcinoid tumors of the GIT terms of pathogenesis, common levels of the GIT involved morphology clinical features (including extra-colonic manifestations) course and prognosis.
• Discuss gastrointestinal lymphoma, in terms of epidemiology etiology pathogenesis level of the alimentary tract most frequently affected morphologic features and clinical features.

LIVER AND BILIARY TRACT OBJECTIVES
Define in proper context:

alcoholic hepatitis	hyperbilirubinemia
alcoholic liver disease	icterus
ascites	hemosiderosis
bile	jaundice
bile stones	kernicterus ( Pediatric pathology)
biliary atresia (Pediatric pathology)	liver function test
bilirubin	macronodular cirrhosis
bridging fibrosis	Mallory body (hyaline
bridging necrosis	hyperbilirubinemia
Budd-Chiari syndrome	icterus
centrilobular necrosis	hemosiderosis
cholangitis	jaundice
cholecystitis	massive necrosis
alcoholic hepatitis	micronodular cirrhosis
alcoholic liver disease	nutmeg liver
ascites	portal hypertension
bile	primary biliary cirrhosis
bile stones	primary sclerosing cholangitis
biliary atresia (Pediatric pathology)	Reye syndrome
bilirubin	massive necrosis
cholelithiasis	micronodular cirrhosis
cholestasis	nutmeg liver
cholesterolosis	portal hypertension
cirrhosis	primary biliary cirrhosis
Councilman body	primary sclerosing cholangitis
fatty liver	Reye syndrome
Hemochromatosis	Rokitansky-Aschoff sinus
hepatic encephalopathy	secondary biliary cirrhosis
hepatitis	splenomegaly
	steatohepatitis
	steatosis
	submassive necrosis
	Wilson disease

 

• Discuss the significance of the following laboratory tests with reference to hepatic pathology:
  • alanine aminotransferase (ALT, SGPT)
  • aspartate aminotransferase (AST, SGOT)
  • alkaline phosphatase (ALP)
  • alpha-fetoprotein
  • ammonia
  • anti-mitochondrial antibody
  • anti-smooth muscle antibody
  • bilirubin: total, conjugated, unconjugated
  • ceruloplasmin
  • gamma-glutamyl transferase (GGT)
  • urobilinogen
• Distinguish how Bilirubin and Hemosiderin are formed. Distinguish biochemically pre-hepatic, hepatic and post- hepatic jaundice and give some common examples that can produce the same.
• Discuss and of cirrhosis, in terms of etiology   pathogenesis morphologic pattern (gross and microscopic) relationship to neoplasia.
• Discuss portal hypertension in terms of etiologic factors pathogenesis clinical features and etiology.
• Compare and contrast hepatitis cause by the following viruses: (From Microbiology course)
  • Hepatitis A virus (HAV)
  • Hepatitis B virus (HBV)
  • Hepatitis C virus (HCV)
  • Hepatitis D (delta) virus (HDV)
  • Hepatitis E virus (HEV)

  In terms of:

  • nomenclature of antigens and antibodies
  • epidemiology
  • modes of transmission
  • incubation period
  • laboratory findings
  • serologic findings at various stages in course of disease
  • morphologic findings (From Pathology)
  • clinical features and course, including propensity for chronicity
  • carrier state
  • complications (From Pathology)

• Discuss the pathogenesis, morphology, and clinical course of the following alcohol-induced liver disease:
  • fatty change (steatosis)
  • alcoholic hepatitis
  • Cirrhosis
• Compare and contrast:
  • alcoholic hepatitis
  • viral hepatitis
  • Autoimmune hepatitis

       In terms of

  • etiology
  • pathogenesis
  • morphology
  • clinical features and complications.

• Differentiate among the following disease processes, based on clinicopathologic data:
  • alcoholic cirrhosis                  
  • primary biliary cirrhosis          
  • secondary biliary cirrhosis
  • Primary sclerosing cholangitis is for self study and will not be included for exam.

 

• Discuss the following diseases
  • Hemochromatosis
  • Wilson’s disease
  • Alpha 1 anti trypsin deficiency

        In terms of

  • etiopathogenesis
  • morphology
  • clinical features and complications.

• Compare and contrast the following tumors:
  • hepatoblastoma
  • hepatocellular carcinoma
  • fibrolamellar variant
  • cholangiocarcinoma
  • metastatic carcinoma to liver

  in terms of

  • relative frequency
  • etiology
  • pathogenesis
  • relation to cirrhosis
  • morphology
  • methods of diagnosis in relation to alpha feto protein (AFP)
  • clinical findings.

• Describe cholelithiasis in terms of risk factors mechanisms of stone formation, composition of stones, morphology of stones, clinical features and complications.
• Compare and contrast
  Acute and chronic cholecystitis in terms of epidemiology, associated diseases, morphology, clinical findings and complications.
• Discuss carcinoma of the gallbladder in terms of epidemiology, relationship to cholelithiasis, morphology, clinical findings and course.

PANCREAS - OBJECTIVES                          
(Endocrine segment will be covered later under endocrine pathology)

• Student will be able to define and use in proper context:
  • Amylase                     
  • cystic fibrosis (CF)
  • gastrinoma
  • glucagonoma
  • insulinoma
  • lipase
  • mucoviscidosis
  • pancreatitis
  • pseudocyst
  • sweat chloride test
  • Whipple triad
  • Zollinger-Ellison syndrome
•  Discuss exocrine pancreatic insufficiency
  In terms of etiology, morphology clinical manifestations laboratory abnormalities
• Discuss cystic fibrosis (Pediatric pathology)
  In terms of genetics, primary defect, morphologic findings (in pancreas lung liver salivary glands male genital tract), laboratory manifestations, clinical findings and course.
• Compare and contrast acute and chronic pancreatitis in terms of etiologic/predisposing factors pathogenesis morphologic features laboratory manifestations clinical findings and course complications.
• Discuss differential diagnosis of epigastric and chest pain caused by lesions of GIT.
• Compare and contrast adenocarcinoma of the:
  • pancreatic head
  • pancreatic body/tail

  In terms of

  • incidence
  • risk factors
  • morphologic features
  • clinical presentation
  • complications
  • prognosis.

• Discuss islet cell tumors of the pancreas (Insulinomas, Gastrinomas)

  In terms of

  • incidence
  • morphology
  • benignity vs. malignancy
  • immunohistochemical characteristics
  • endocrine function
  • clinical features and course.
    

HEMATOPOIETIC SYSTEM OBJECTIVES
Define and use in proper context:

acute leukemia	leukocytosis
agnogenic myeloid metaplasia	leukoerythroblastosis
aleukemic leukemia	leukopenia
anemia	lymphoma
autosplenectomy	macrocytosis
basophilic stippling	mean cell hemoglobin (MCH)
Bence Jones protein	mean cell hemoglobin concentration (MCHC)
chronic leukemia	mean cell volume (MCV)
coagulation	microcytosis
complete blood count (CBC)	mucosa-associated lymphoid tissue (MALT)
direct antiglobulin (Coombs) test	myelodysplastic syndrome
dyserythropoiesis	myeloproliferative disorder
ecchymoses	nuclear-cytoplasmic asynchrony
erythropoiesis	pancytopenia
erythropoietin	petechiae
extramedullary hematopoiesis	Philadelphia chromosome
extravascular hemolysis	poikilocytosis
ferritin	polychromasia
factor VIII	proliferating pool
G6PD screen	red cell distribution width (RDW)
granulocytopenia	reticulocyte count
granulopoiesis	Schilling test
haptoglobin	sickle cell disease
hematocrit	sickle cell trait
hemoglobin electrophoresis	stem cell
hemostasis	thalassemia
hypochromia	thrombocytopenia
idiopathic thrombocytopenic purpura (ITP)	thrombocytosis
indirect antiglobulin (Coombs) test	thrombopoiesis
ineffective hematopoiesis	thrombopoietin
intravascular hemolysis	thrombotic thromocytopenic purpura (TTP)
intrinsic factor	total iron binding capacity (TIBC)
left shift	transferrin
leukemia	von Willebrand factor
leukemoid reaction

• Recapitulate the normal hematopoiesis ( from histology course)
• Define, state the significance of, and identify on a picture of the peripheral blood smear each of the following:

Erythrocyte	plasma cell
Reticulocyte	atypical lymphocyte
lymphocyte
Target cell	lymphoblast
Myeloblast
Schistocyte	Rouleaux
Ringed sideroblast	Döhle body
Basket (smudge) cell
Howell-Jolly body	Pappenheimer body
Heinz body	Polymorphonuclear leukocyte (pmn)
Neutrophil	Hairy cell
Band (stab) form	Basophil
Platelet	Eosinophil
Giant platelet	Monocyte

• Define, state the significance of, and identify on a bone marrow picture each of the following:
  

• normoblast
• megaloblast
• myeloblast
• promyelocyte
• myelocyte
• metamyelocyte
• band (stab) form
• neutrophil
• basophil
• eosinophil
• plasma cell
• lymphocyte
• megakaryocyte

• Explain the clinical features of anemia and distinguish the different types of anemia (listed in the handouts) based on etiopathogenesis, morphology, clinical features, investigations and outcomes. (anemia of blood loss, hemolytic anemias- intra and extravascular including hereditary spherocytosis,G6PD deficiency, hemoglobinopathies S, thalassemias, PNH, Immune hemolytic anemia warm and cold, Microangiopathic hemolytic anemia, anemias due to red cell parasites, megaloblastic anemia, Iron deficiency anemia, aplastic anemia, anemia of chronic disease and develop a diagnostic algorithm for a patient with anemia.

• Distinguish the common conditions that lead to leucopenia and leukocytosis of different white cells. Explain the clinical features produced by abnormalities of white cells.

• Compare and contrast intravascular vs. extravascular hemolysis, in terms of:
  • etiology
  • pathogenesis
  • laboratory diagnosis
  • clinical findings and course
• Explain the basis of classification (Note: not the detailed classification!) of acute myeloid leukemias and distinguish the common types based on morphology, clinical features. Identify the cytogenetics of AML-M3. Recognize the usual chemotherapeutic approach in the common types of AML.

• Distinguish the common myeloproliferative disorders- CML, polycythemia Vera, essential thrombocytosis and primary myelofibrosis based on etiology, morphology, clinical features, investigations and prognosis. Identify the cytogenetics of CML.

• Recognize myelodysplastic syndrome (MDS) based on clinical features, morphology, common chromosomal damage and explain how you evaluate for the development of AML in these patients.

• Identify the peripheral blood test results that indicate a bone marrow examination.
• Discuss multiple myeloma in terms of:
  • clinical presentation
  • etiology
  • clinicopathologic diagnosis
  • morphology and sites of lesions
  • clinical course
  • complications
  • prognosis
• Explain the common symptoms of lymphomas, the basis of classification (Note: not  the detailed classification), and distinguish the ones listed in the handouts based on important clinical features, morphologic features. Recognize the cytogenetics of follicular lymphoma and Burkitt’s lymphoma. Distinguish factors that determine the good and bad prognosis in acute lymphoblastic leukemia.

• Recapitulate the normal process of homeostasis, the role played by platelets and endothelial cells in the same.. (NOT INCLUDED IN EXAMS)

• Explain the basis of common coagulation disorders listed in the handouts and how laboratory testing can help distinguish them

• Select and interpret the results of hematological investigations in the common hematological diseases discussed in the lectures.

PEDIATRIC PATHOLOGY OBJECTIVES
Define and use in proper context

• Discuss the pathogenesis of deformations, and give examples of underlying factors which may lead to deformations via such pathogenetic mechanisms
• List the most common birth injuries (cranial injuries, fractures, peripheral nerve injuries, and liver rupture)
• Discuss intrauterine and perinatal infections in terms of:
  • Routes of spread
  • Common causative organisms
  • State the most common cause of death in children, as well as the most common non-traumatic cause of death in children:
  • under one year of age
  • between one and four years of age
  • between five and fourteen years of age
• List the common abnormalities in morphogenesis and discuss their  etiopathogenesis. (Malformation, Disruption, Deformation, Dysplasia)
• Define Prematurity and intrauterine growth retardation (IUGR) discuss common complications of Prematurity

• Hyaline membrane disease (respiratory distress syndrome of the newborn)
• Necrotizing enterocolitis
• Intraventricular and germinal matrix hemorrhage

• Describe the following disorders:
  • congenital rubella syndrome
  • bronchopulmonary dysplasia (BPD)
  • cystic fibrosis (CF, mucoviscidosis)
  • Dubin-Johnson syndrome
  • phenylketonuria
  • galactosemia
  • sudden infant death syndrome (SIDS)

  In terms of:

  • incidence and epidemiology
  • etiology and pathogenesis
  • morphology
  • clinical course
  • Discuss various causes of neonatal jaundice
  • Hemolytic disease of the newborn
  • Crigler-Najjar syndrome
  • Rotor syndrome
  • Biliary atresia
  • Idiopathic neonatal hepatitis

  In terms of

  • etiology and pathogenesis
  • morphology
  • clinical course

• Discuss the following pediatric neoplasms:
  • Leukemias
  • Neuroblastoma
  • Retinoblastoma
  • Wilms tumor (nephroblastoma)

  In terms of:

  • Frequency
  • age of onset
  • role of genetics and environment
  • morphology
  • clinical behavior
  • prognosis

 

ENDOCRINOLOGY PATHOLOGY OBJECTIVES
Diabetes Mellitus:

• Explain the role of insulin and other hormones in the regulation of plasma of blood glucose
  
• Explain the role of measurement of insulin and C peptide in clinical practice
  
• Adopt a classification of diabetes mellitus                                                   
  
• Distinguish type 1 from type 2 diabetes mellitus from clinical date
  
• Recognise the possible etiological factors of type 1 and type 2 diabetes
  
• Explain the contribution of genetic and environmental factors to the aetiology of diabetes
  
• Describe the main histological changes in the pancreas in type 1 and type 2 diabetes
  
• Explain the pathogenesis and pathophysiology of clinical symptoms and signs of diabetes
  
• Interpret results of the oral glucose tolerance test
  
• Explain the broad guidelines of management of diabetes
  
• Explain the role of HbA1c in the monitoring of diabetes
  
• Explain the causes and management of acute diabetic complications
  
• Explain the pathogenesis of symptoms in diabetic ketoacidosis and hyperosmolar nonketotic coma and the principles of management.
  
• Differentiate between the macroangiopathic and microangiopathic complications of diabetes
  
• Explain the pathogenesis and pathophysiology of diabetic nephropathy
  
• Explain the other long-term complications of diabetes including eye complications, diabetic neuropathy and diabetic foot disease.
  
• Explain the possible mechanisms of development of diabetic complications

THE PITUITARY GLAND AND HYPOTHALAMUS

• Recognise the anatomic relationship of the pituitary to the surrounding structures and its clinical significance.
  
• Explain the embryological and functional differences between the anterior and posterior pituitary
  
• Explain the concept of feedback inhibition in endocrinology and its clinical importance
  
• Describe the control and functions of pituitary hormones
  
• List the causes of hypopituitarism
  
• Describe the clinical features of hypopituitarism which result from hormone deficiency or mass effects of tumours
  
• Explain the methods of investigating a case suspected of hypopituitarism using blood measurements, dynamic tests, imaging techniques and immunostaining techniques
  
• Recognise hyperprolactinaemia as the commonest form of hyperpituitarism
  
• Explain the causes of hyperprolactinaemia
  
• Recognise the clinical features of hyperprolactinaemia
  
• Describe the diagnosis of hyperprolactinaemia
  
• Explain the main features of acromegaly
  
• Plan an investigation of a patient suspected of acromegaly
  
• Outline the main forms of treatment of acromegaly
  
• Recognise the two main types of diabetes insipidus: the central and nephrogenic diabetes insipidus.
  
• Make a diagnosis of diabetes insipidus by the interpretation of the water deprivation test

Thyroid gland

• Outline the main structural features of the thyroid gland
  
• Explain the main functions of the thyroid gland
  
• Explain the principle of negative feedback control of thyroid hormone secretion and its clinical importance
  
• Differentiate between hyperthyroidism and thyrotoxicosis
  
• Recognise the spectrum of clinical manifestations of thyrotoxicosis
  
• Recognise the manifestations of cretinism and the need for population screening
  
• List the causes and manifestations of hypothyroidism
  
• Identify the main morphological and histological changes in the thyroid gland in  hyper-and-hypo-thyroidism
  
• Define the role of laboratory tests and imaging techniques in diagnosing thyroid disorders
  -
• Describe the aetiology and pathogenesis of the different types of goitre
  
• Differentiate between the benign and malignant tumours of the thyroid gland
  
• Describe the role of the laboratory tests in the diagnosis of thyroid tumours and monitoring treatment

The Adrenal gland

• Describe the general structure of the adrenal gland and the hormones secreted by the different parts
  
• Appreciate the intercorrelations of the synthetic pathways of the different hormones of the adrenal cortex
  
• Recognise the role of protein binding in the interpretation of hormone levels
  
• Use the knowledge about biological effects of hormones to understand the manifestations of hormone deficiency or excess
  
• Describe the hypothalamic-pituitary-adrenal axis and its clinical importance
  
• Outline the control mechanisms of the adrenal steroids
  
• List the causes of adrenocortical insufficiency
  
• Describe the common symptoms and signs of adrenocortical insufficiency
  
• Explain the precipitating causes and clinical features of adrenal crisis
  
• Describe the laboratory investigation of adrenocortical insufficiency
  
• List the types of Cushing’s syndrome
  
• Describe the clinical features of Cushing’s syndrome and their metabolic basis
  
• nvestigate a case of Cushing’s syndrome, including the use of the high dose Dexamethasone suppression test in the differential diagnosis of Cushing’s syndrome
  
• List the causes of primary heraldosteronism
  
• Describe the clinical features of primary hyeraldosteronism and their physiological basis
  
• Explain the main differences in presentation of Cushing’s Syndrome and primary hyeraldosteronism
  
• Recognise the different presentations of C-21 hydroxylase deficiency
  
• Explain the effects of the other adreno-cortical enzyme deficiencies, including 11 b hydroxylae and 17 a hydroxylase deficiency
  
• Explain the main steps in the synthesis and degradation of catecholamines
• Explain the clinical features of phaeochromocytoma and their pathogenesis
  
• Describe the use of laboratory tests and imaging in the diagnosis of phaeochromocytoma
  
• Explain the importance of childhood neuroblastoma

METABOLISM OF CALCIUM AND PHOSPHATE

• Explain the hormonal control of calcium metabolism
  
• List the common causes of hypercalcaemia
  
• Recognise the clinical manifestations of hypercalcaemia
  
• Differentiate the three forms of hyperparathyroidism
  
• Distinguish the two main mechanisms of malignancy-induce hypercalcaemia
  
• Explain the main laboratory parameters used to investigate -hypercalcaemia
  
• Outline the principles of management of hypercalcaemia
  
• List the main causes of hypocalcaemia
  
• Recognise the clinical features of hypocalcaemia
  
• List the causes of hypoparathyroidism
  
• Explain the causes of hypophosphataemia
  
• Explain the clinical consequences of hypophostataemia including rhabdomyolysis
  
• List the main causes and effects of hyperphosphataemia
  
• Describe the causes and effects of hypomagnesaemia
  
• Describe the main causes and effects of hypermegnesaemia

RENAL PATHOLOGY OBJECTIVES

KIDNEY
Define and use in proper context:

anuria	nephrosclerosis
azotemia	nocturia
bacteriuria	oliguria
Bence-Jones protein	pyonephrosis
cast	proteinuria
dysuria	nephrolithiasis
glomerulonephritis	nephrosclerosis
hematuria	Pyelonephritis
hepatorenal syndrome	pyuria
hydronephrosis	uremia
Kimmelstiel-Wilson disease	urolitihiasis
nephrocalcin	Von Hippel   Lindau syndrome
nephrolithiasis	Wire loop lesion

• Define and use in the proper clinical context the following terms:
  • azotemia, uremia, anuria, oliguria, nocturia, dysuria, bacteriuria, pyuria, hematuria, proteinuria,nephritic syndrome, nephrotic syndrome, acute renal failure, chronic renal failure, global and segmental, diffuse and focal lesions on the glomeruli
• Distinguish the renal diseases( listed in the handouts) with reference to etiology, pathogenesis, morphology, symptoms, signs , usual investigations and outcomes.
• Interpret the results of the common investigations used in the evaluation of renal and urinary tract disease.
• Compare and contrast the; 1) relative frequency; 2) etiology and pathogenesis; 3) clinical presentation, course and prognosis; 4) laboratory findings; and 5) microscopic (light, immunofluorescent, electron microscopic) appearance for the following glomerular diseases:
  • minimal change disease
    
  • membranous glomerulonephritis
    
  • focal segmental glomerulonephritis
    
  • membranoproliferative  glomerulonephritis
    
  • diabetic glomerulosclerosis
    
  • amyloidosis
    
  • acute proliferative (poststreptococcal, postinfectious) glomerulonephritis
    
  • rapidly progressive glomerulonephritis (e.g. Goodpasture’s syndrome, Wegener’s granulomatosis
    
  • IgA nephropathy (Berger’s disease)
    
  • Alport’s syndrome
• Explain the concept of renal ablation glomerulopathy. Pick out the types of glomerulonephritis that lead to chronicity.
• Explain the 1) etiology and pathogenesis; 2) clinical features; 3) laboratory findings; and 4) microscopic (light, immunofluorescent, electron microscopic) appearance of the glomerular diseases associated with systemic lupus erythematosus (SLE). Explain the significance of detecting focal segmental proliferative lesions in the glomerulus.
• Compare and contrast the 1) relative frequency; 2) etiology and pathogenesis; 3) clinical presentation, course and prognosis; 4) laboratory findings; and 5) gross and microscopic appearance for the following renal tubular diseases:
  • acute pyelonephritis
  • chronic pyelonephritis
  •  acute drug-induced interstitial nephritis
  • drug-induced analgesic nephropathy
  • acute tubular necrosis (toxic and  ischemic)
• Compare and contrast the 1) pathogenesis; 2) gross and microscopic appearance; and 3) clinical presentation, course and prognosis of benign nephrosclerosis and malignant nephrosclerosis.
• Distinguish vascular diseases that involve the kidney with regard to 1: pathogenesis and 2) clinical presentation, course and prognosis.
• Distinguish the common cystic lesions in the kidney based on morphology, clinical features and genetic basis
•  Distinguish the common pathologies that cause obstruction to the urinary flow.
•  Distinguish the common renal tumors based on the age, pathology and genetic basis.

 

MALE GENITOURINARY TRACT OBJECTIVES
Urinary Bladder

• Define and use in proper context:
  • bacteriuria
  • cystitis                                    
  • dysuria
  • hematuria                               
  • pyuria
  • malacoplakia
  • urethral                       
• Compare and contrast the following inflammatory conditions:
  • infectious cystitis
  • interstitial cystitis
  • malacoplakia
  • with regard to:
    • etiology and pathogenesis
    • clinical course and complications
    • morphologic (gross and microscopic) appearance
• Explain the clinical features of bladder cancer.
• Distinguish morphologically the papillary and flat varieties on invasive and noninvasive carcinoma.
• Recognize that transitional carcinomas constitute approximately 90% and squamous cell carcinomas 7% of all bladder tumors.
• Identify etiological factors blamed for these malignancies.
• Recognize that the number of layers of cells help in distinguishing well differentiated carcinomas from normal transitional epithelium.
• Explain the concept of microscopic staging of bladder cancer.

PENIS, SCROTUM &TESTIS

• Define and use in proper context:
  

balanitis	paraphimosis
balanoposthitis	phimosis
choriocarcinoma	prepuce
chylocele	prostatitis
cryptorchidism	Schiller -Duval body
embryonal carcinoma	seminoma
epispadias	Sertoli-Leydig cell tumor
hematocele	smegma
hydrocele	spermatocytic seminoma
hypospadias	teratoma
orchitis	yolk sac tumor

• Distinguish Hypospadias from Epispadias and recognize urinary obstruction as an important complication.
• Distinguish the location of inflammation in balanitis and balanoposthitis and explain the role played by smegma in their genesis.
• Explain the basis of phimosis and paraphimosis and derive the important complications.
• Recapitulate from the microbiology course the sexually transmitted diseases and distinguish them on clinical, morphological and laboratory basis and recognize the important complications.
• Recognize candida as an important infection of penis and scrotum in diabetic males.
• Morphologically distinguish Bowen disease, Erythroplasia of Queyrat and Bowenoid Papulosis from squamous cell carcinoma of the penis. Identify the important etiological associations.
• Explain the mode of spread of penile carcinoma.
• Recognize the historical significance of the identification of the etiology for scrotal cancer.
• Distinguish hydrocele, hematocele, chylocele morphologically and etiologically.
• Explain the complications of cryptorchidism.
• Distinguish non-specific epididymo orchitis, mumps orchitis and granulomatous orchitis, based on morphology, etiology and complications.
  Identify the common clinical presentation of testicular neoplasms.
• Distinguish seminoma, embryonal carcinoma, yolk sac tumor, choriocarcinomas and teratomas based on morphology, cell of origin, peak age, course and tumor markers. Recognize that seminomas respond very well to chemotherapy and radiotherapy.
• Explain the routes of spread of testicular tumors and the basis of staging.

 

PROSTATE

• Distinguish acute and chronic prostatitis based on clinical features, etiology and morphology.
• Distinguish benign nodular hyperplasia and carcinoma of the prostate based on clinical features, zones of origin, etiology, morphology and therapeutic approach.
• Discuss the relationship of racial factors, Prostate specific antigen (PSA) and Prostatic intraepithelial neoplasia (PIN) to prostatic carcinoma.
• Explain the basis of grading, scoring and staging of prostate cancer.

OVARY PATHOLOGY OBJECTIVES

• Recapitulate the structure of normal ovary, identify surface epithelium, follicles, sex cord stroma and germ cells.
  
• Recapitulate the physiology of menarche and menopause.
  
• Recognize that clinical features of ovarian enlargement appear late because there is space for ovarian growth in the abdomen.
  
• Elucidate the hormonal effects and pressure effects of ovarian lesions.
  
• Differentiate follicular cysts, corpus luteum cysts chocolate cysts and polycystic ovarian disease based on based on  genesis, structure and clinical features.
  
• Differentiate the various tumors of the ovary based on cell of origin, structure and clinical features and explain their prognosis 
  
• Recognize that majority of ovarian tumors are benign and list the risk factors.
  
• Describe the modes of spread of malignant ovarian tumors and the usual sites of metastasis.
  
• Explain the basis and importance of "borderline malignancy" in surface epithelial tumors.
  
• Explain the meaning of pseudomyxoma peritonei and explain its relation to mucinous cystadenoma and mucocele of appendix.
• Differentiate the types of germ cell tumors ( teratoma, dysgerminoma, endodermal sinus tumor and chorio carcinoma) based on genesis, structure, associations with AFP,HCG and  behavior.
  
• Explain how hyperthyroidism and carcinoid syndromes can be generated by benign cystic teratoma.
  
• Differentiate the hormonal effects of functional ovarian tumors (granulosa cell tumor and Sertoli  Leydig cell tumor).
  
• Describe Meig's syndrome.
  
• Describe the gross and microscopic features and clinical setting of Krukenberg tumors.
  
• Explain the significance of clasifying ovarian tumors broadly into cystic and solid tumors and further typing based on histologic features.

BREAST PATHOLOGY OBJECTIVES

• Recapitulate the normal structure of breast (ducts, ductules, lobules, stroma, areola, nipple) and lymphatic drainage of breast. Explain the importance of recognizing myoepithelial cells
  
• Distinguish Fibrocystic disease (FCC), Inflammations, fibroadenoma, carcinoma based on clinical features, etiology, morphology and course of the disease.
  
• Explain the common clinical symptoms and signs of breast diseases. (lump, nipple discharge, inflammation )
  
• Explain the risk of cancer in FCC (Fibrocystic Changes).
  
• Recognize that nonneoplastic lesions of breast can mimic cancer clinically.  Differentiate breast abscess, duct ectasia, traumatic fat necrosis based on etiology, structural changes and morphology.
  
• Compare and contrast clinical, gross and microscopic features of fibroadenoma versus carcinoma.
  
• Explain the terms - Phylloides tumor, intraduct papilloma, peau'd orange, Paget's disease of nipple, Indian file pattern, gynecomastia, bluedome cyst.
  
• Differentiate lobular versus duct carcinomas.
              (clinical, gross, microscopic)
  
• Discuss the concept of In situ Carcinoma in breast (duct, lobular) and their clinical significance.
  
• Analyze the clinical features, risk factors, investigations, prognostic factors and therapeutic options for breast carcinoma.
  
• List the common sites of breast cancer and modes of spread. Explain how they are graded and staged.
  
• Explain the importance of self examination of breasts in early detection of cancer.
• Derive a list of lesions of breast which are associated  with:
  • Nipple discharge
    
  • Painless vague nodularity
    
  • Painful lumps/ nodules
    
  • Painless lumps/ nodules
    
  • Nodules with axillary lymph node enlargement
    
  • Pregnancy and lactation
    
  • Nipple or areola - cracking, fissuring, eczema
• Conceptualize the steps (advantages/ disadvantages) in arriving at a diagnosis in breast lesions -  (self examination, palpation, ultrasonography, mammography, cytology of nipple discharge, FNAC, needle biopsy, nipple aspiration, ductal lavage, core needle biopsy, lumpectomy, simple mastectomy + LN, receptors for estrogen and progesterone, flow cell cytometry for aneuploidy, gene study for oncogenes). Discuss the role of mammography in early detection of breast cancer.
  
• Recognize that breast carcinoma is the second most common carcinoma in females and approximately 1/10 will develop it.  However other nonmalignant lesions mimic it clinically.  Hence knowing the pathology of these lesions is important.
• Distinguish the two important lesions in male breast - gynecomastia and carcinoma.

 

FEMALE GENITAL SYSTEM
Define and use in proper context:     

Adenomyosis	hematosapinx
adenosis	HPV
arrhenoblastoma	HSV
atypical endometrial hyperplasia	hydrosalpinx
borderline ovarian tumor (BOT)	koilocytosis
Brenner tumor	kraurosis vulvae
Call-Exner body	Krukenberg tumor
carcinoma in situ (CIS)	hematosapinx
carcinosarcoma	Leukoplakia
cervical intraepithelial neoplasia (CIN)	low malignant potential (LMP)
chocolate cyst	luteal cyst
choriocarcinoma	malignant mixed Müllerian tumor (MMMT)
colposcopy	Meigs syndrome
condyloma acuminatum
condyloma latum	menorrhagia
cone biopsy	metrorrhagia
curettage	microinvasive carcinoma
cysadenocarcinoma	nabothian cyst
cystadenofibroma	Pap smear
cystadenoma	pelvic inflammatory disease (PID)
dysfunctional uterine bleeding (DUB)	pseudomyxoma peritonei
dysgerminoma	pyosalpinx
dysmenorrhea	sarcoma botryoides
dysplasia	Schiller-Duval body
embryonal carcinoma	Sertoli-Leydig cell tumor
endodermal sinus tumor	squamous intraepithelial lesion (SIL)
endometriosis	Stein-Leventhal syndrome
fibroma	teratoma
flat condyloma	thecoma
follicular cyst	vaginal intraepithelial neoplasia (VAIN)
gonadoblastoma	vulvar intraepithelial neoplasia (VIN)
granulosa cell tumor

 

BONES AND JOINTS OBJECTIVES

1. Define and use in proper context:

alkaline phosphatase	osteoblast
Brodie abscess	osteocalcin
callus	osteoclast
cancellous bone	osteocyte
chondrocyte	osteoid
Codman triangle	osteomalacia
cortical bone	osteopenia
diaphysis	pannus
eburnation	Pott disease
epiphysis	sequestrum
Heberden node	synovium
involucrum	tophus
lamellar bone	woven bone
metaphysis

• Discuss the following hereditary disorders, in terms of pathogenesis, morphology, and clinical presentation:
  • achondroplasia
  • osteopetrosis  
  • enchondromatosis
  • osteogenesis imperfecta
• Describe the morphologic sequence of normal bone growth, as well as of repair following fracture of a long bone.  Indicate the way(s) in which age, mobility, nutritional state, and infection influence the repair process.
• Discuss the following non‑neoplastic bone disorders, in terms of etiology, pathogenesis, morphology, and clinical findings and course:
  • osteoporosis
  • renal osteodystrophy
  • Paget disease
  • osteonecrosis
  • hyperparathyroidism
  • osteomyelitis
• Describe the following tumors (i.e., masses) of bones and joints:
  • multiple myeloma                  
  • osteoma         
  • osteoid osteoma         
  • osteoblastoma            
  • osteochondroma        
  • enchondroma 
  • osteosarcoma
  • chondrosarcoma        
  • giant cell tumor of bone         
  • Ewing sarcoma          
  • metastatic malignancy to bone

  in terms of:

  • biology (neoplastic vs. nonneoplastic, benign vs. malignant)
  • age distribution
  • etiology and pathogenesis
  • cell type and site of origin
  • morphologic and roentgenologic features
  • clinical findings and course    

• Compare osteoarthritis (degenerative joint disease) and rheumatoid arthritis, in terms of:
  • age and sex incidence           
  • etiology           
  • pathogenesis
  • laboratory findings
  • morphologic findings
  • clinical findings and course    
• Discuss the following disorders:
  • ankylosing spondylitis
  • Reiter syndrome        
  • psoriatic arthritis         
  • infectious arthritis
  • gout
  • calcium pyrophosphate crystal deposition disease

  in terms of:

  • age and sex incidence
  • etiology
  • pathogenesis
  • findings (laboratory, morphologic, clinical)
  • clinical course

CNS PATHOLOGY OBJECTIVES:

TRAUMA

• Distinguish epidural hematoma, subdural hematoma and subarachnoid hemorrhage based on etiology, pathogenesis, location and clinical features.
• Identify the cause and the clinical significance of lucid interval in epidural hematoma.
• Identify the evolution of a subdural hematoma.
• Identify the pathogenetic mechanisms of death in each of the above mentioned conditions.
• Define cerebral contusion.
• Identify the cause, pathogenetic mechanism and the clinical features of cerebral contusion.
• Define and differentiate coup and contrecoup lesions and identify its pathogenetic mechanisms.

CIRCULATORY DISORDERS

• Identify the structure and clinical significance of AV malformation.
• Recapitulate the locations, gross and histological structure and clinical features of berry aneurysms from cardiovascular pathology section.
• Identify different conditions that can coexist with berry aneurysms.
• Recapitulate the pathogenetic mechanism for the development of atherosclerotic aneurysms. Identify the predominant vessels of the CNS involved in this condition.
• Identify different causes, pathogenetic mechanisms and clinical features of intracerebral hemorrhage.
• Identify the pathogenetic mechanisms of Charcot-Bouchard aneurysms.
• Identify the causes and pathogenesis of global ischemia and localized infarction.
• Distinguish watershed infarcts from laminar necrosis based on location and pathogenesis.
• Identify the evolution of a brain infarct.

• Recapitulate the etiology of cerebral infarction in anterior and posterior circulations.

 

HYDROCEPHALUS

• Define hydrocephalus.
• Identify the etiology, pathogenetic mechanisms and clinical features of hydrocephalus.
• Distinigush communicating and noncommunicating hydrocephalus.

INFECTIOUS DISEASES

• Recapitulate the etiology, pathogenesis, gross appearance of the brain, histopathology and clinical features of meningitis from the infectious diseases module of general pathology.
• Identify the predominant area of the cerebrum predisposed to the development of cerebral abscess.
• Identify the role of astrocytes versus fibroblasts in cerebral abscess.
• Define and identify the pathogenetic mechanisms of daughter abscess.
• Identify the causes of death in cerebral abscess. Identify & distinguish various causes of viral encephalomyelitis based on location of lesions, histology, pathogenesis and clinical features. (Poliomyelitis, rabies, arboviral encephalitis, spongiform encephalitis, measles, herpes simplex encephalitis).

DEMYELINATING DISEASES

• Define multiple sclerosis. Identify the epidemiology, pathogenesis, pathology, clinical features and progression of this disease.
• Define Wernicke syndrome. Identify the cause, location of the lesions, pathogenesis, clinical features and the course of this condition.
• Differentiate Wernicke syndrome from Wernicke – Korsakoff syndrome based on histological changes of the lesions, clinical features and etiology.
  

DEGENERATIVE DISEASES

• Identify the etiology, pathogenesis, pathology and clinical features of Parkinson’s disease, Huntington’s disease, Amyotrophic lateral sclerosis and Alzheimer’s disease.

TUMORS

• Identify and differentiate the tumors of the CNS based on the location, age, histopathology and clinical presentation.

(Astrocytoma, meningioma, ependymoma, medulloblastoma, craniopharyngioma)

FORENSIC PATHOLOGY OBJECTIVES

Define and use in an appropriate forensic context:

Accelerative/decelerative force	Hepatitis
Agitated delirium	Herpes simplex
Air embolism	Hesitation marks
Alcoholic “hepatitis”	HIV
Alcoholic hyaline	HPV
Alopecia	Hypertrophic cardiomyopathy
Alternative light source	Incision
Amyloidosis	Intranuclear inclusions
Anion gap	Intrusion
Aortic dissection	Keratitis
Asphyxia	Laceration
Aspiration	Lichtenberg figures
Autoerotic asphyxia	Livor mortis
Basophilic stippling	Macronodular cirrhosis
Battle’s sign	Mallory Weiss Syndrome
Bone marrow embolism	Manner of death
Carbon monoxide	Metabolic acidosis
Carnal knowledge	Methanol
Cause of death	Micronodular cirrhosis
Chain of evidence	Mitochondrial DNA
Chlamydia	Myocarditis
“Codis”	Nasal septal perforation
Colposcopy	Nil disease
Commotio cordis	Ohm’s law
Consensual intercourse	Pericardial tamponade
Consent (legal)	Peripheral neuropathy
Contrecoup	Petechia (petechiae)
Contusion	Pneumocystis carinii
Coup	Prostate specific antigen (P-30)
Cunnilingus	Raccoon’s eyes
Delta V	Rape
Diffuse axonal injury	Rhabdomyolysis
Dilated cardiomyopathy	Rigor mortis
Dysrythmia	Serotonin syndrome
Endocarditis	Shaken/impact syndrome
Esophageal varices	Sodomy
Exsanguination	Sommer’s sector (Hippocamus)
Fellatio	Spontaneous abortion
Fetal alcohol syndrome	STD
Flail chest	Subcutaneous emphysema
Gonorrhea	Suction eccymosis
Hemothorax	Sympathomimetic
Hemotympanum	Tattooing/stippling
	Trace evidence
	Translational force
	Wernicke – Korsakoff Syndrome
	Wood light
	Wound ballistics

• Discuss the evolving roles of forensic pathology with regard to:
  • Clinical forensic examinations
  • Public health
  • Mass disaster teams
• Discuss with regard to Carbon monoxide poisoning:
  • Etiologies
  • Acute clinical presentation (% saturation + signs/symptoms)
  • Implications for therapy
  • Possible chronic pathological effects.
• Compare and contrast the symtomatology, pathologic effects and treatment of acute poisoning by ethanol, methanol and ethylene glycol.
  
• Discuss the potential variety of clinical presentations of acute cocaine toxicity (including signs, symptoms and complications) with regard to:
  • The central nervous system
  • The cardiovascular system
  • The respiratory system
  • Pregnancy
• Compare and contrast the mechanisms of action and the signs and symptoms of acute methamphetamine and acute heroin (narcotic) intoxication.
  
• Contrast the etiologic mechanisms and appearances of lacerations and incisions.
  
• Describe how affecting the Delta V (change in rate of movement) can improve transportation safety.
  
• Discuss a patient who presents to you in the emergency room with severe blunt chest trauma from an automobile collision. Considering your physical examination from the skin of the anterior chest all the way back to the spine:
  • List 4 potential serious injuries
  • How would you rule them in or out in your patient?
• List three clinical signs that would indicate to you that a patient had sustained a basal skull fracture.
  
• Asphyxia is suspected by the presence of facial congestation or cynanosis, as well as facial, palpebral or bulbar petechiae. List and be able to discuss three separate etiologic mechanisms.
  
• Compare and contrast the physical skin appearances of entrance and exit gunshot wounds.
  
• List three major determinants of high kinetic energy firearms wounds, i.e. what are the most important factors in wounding potential.
• Describe and discuss the contrasting appearances of:
  • Contact gunshot wounds
  • Close range gunshot wounds
  • Intermediate range gun shot wounds
  • Distant gunshot wounds
• Reach a reasonable diagnosis of a middle aged man who is brought by ambulance to your emergency room during a violent spring storm. Paramedics report he was found in a roadside ditch and suffered seizures en route to the hospital. You note tearing of his clothing, blood from the nose, mouth and ears and two small cutaneous burns. There are no apparent long bone or rib fractures. How would you approach his differential diagnosis form the stand point of:
  • Auto-pedestrian blunt force trauma
  • The questions of physical assault
  • Isolated traumatic head injury
  • Storm related injury
• List and discuss the respective roles and the five different principal professional components of a SART (Sexual Assault Response Team).
  
• Discuss the following components of the clinical sexual assault examination:
  • Patient elicited history (past medical, sexual and assault event)
  • Clothing exam
  • Skin exam
    • Trauma
    • Trace evidence
    • Alternative light source
  • Colposcopy
  • First specimens
  • Second specimens
  • Reference standard specimens obtained from the victim