The broad goal of the teaching of undergraduate student in Pathology is provide students with a comprehensive knowledge of the mechanisms and cause of disease, in order to enable him/her to achieve complete understanding of the natural history and clinical manifestations of disease, and to prepare him to be a teacher of Pathology.
At the end of the course, the student shall be able to:
(1) Describe the structure and ultrastructure of a sick cell, mechanisms of cell degeneration, cell death and repair and be able to correlate structure and functional alterations;
(2) Explain the pathophysiological processes which govern the maintenance of homeostatis, mechanisms of their disturbance and the morphological and clinical manifestations associated with it;
(3) Describe the mechanisms and patterns to tissue response to injury such that he/she can appreciate the pathophysiology of disease processes and their clinical manifestations;
(4) Correlate normal and altered morphology (Gross and Microscopic) of different organ systems in common diseases to the extent needed for understanding of disease processes and their clinical significance.
(b) SKILLS :
At the end of the course, the student shall be able to:
(1) Describe the rationale and principles of technical procedures of the diagnostic laboratory tests and interpretation of the results;
(2) Perform the simple bed – side tests on blood, urine and other biological fluid samples;
(3) Draw a rational scheme of investigations aimed at diagnosing and managing the cases of common disorders;
(c) INTEGRATION :
At the end of training he/she shall be able to integrate the causes of disease and relationship of different etiological factors (social, economic and environmental) that contribute to the natural history of disease most prevalent in India.
(d) CURRICULUM :
(A) General Pathology
01. Scientific study of disease
02. Some techniques used in study of disease
03. Aetiology – causes of disease
04. Heredity and disease
05. Animal cell, connective tissue, bacterial cell
06. Virus particle & Cellular metabolism
07. Retrogressive changes; degeneration
08. Necrosis and gangrene.
10. Hyperlipidaemia and lipidosis
11. Glycogen infiltration and glycogen storage diseases, mucopolysaccharides and mucopolysaccharide lipid storage diseases
12. Disorders of pigmentation
13. Pathological calcification and uratic infiltration
15. Phenomenon of repair
18. Autoimmunity ; Autoimmune diseases
20. Transplantation and Immunological tolerance
21. Host-parasite relationship
22. Disturbances of nutrition
23. Environmental disorders
24. Radiation injury
25. Circulatory disturbances
26. Haemorrhage, shock and reaction of body to injury
27. Disturbance of body fluid and electrolytes
28. Disturbance of growth of cells
29. General biology of tumours
30. Spread of malignant tumours
31. Aetiology and pathogenesis of cancer
32. Pathology of tumours
33. Diseases of infancy and childhood
(B) Systemic Pathology
01. Diseases of blood vessels
02. Diseases of heart
03. Diseases of red cells and bleeding disorders
04. Diseases of white cells, lymph nodes and spleen
05. Diseases of Respiratory system including COPD and Pneumoconioses
06. Diseases of the oral cavity, jaws and salivary glands
07. Diseases of the gastrointestinal tract including Barrett’s oesophagus as well as Carcinoma colon
08. Diseases of the liver and the biliary tract including Liver function tests, Jaundice with its laboratory diagnosis and Hepatocellular carcinoma
09. Diseases of the kidneys including Tumours like Wilms’ tumour and Renal Cell Carcinoma
10. Diseases of the lower urinary tract.
11. Diseases of the male genital tract
12. Diseases of the female genital tract
13. Diseases of the breast
14. Diseases of the endocrine system
15. Diseases of skin
16. Diseases of the musculoskeletal system
17. Diseases of the nervous system
(C) Clinical Pathology
01. Collection of blood
02. Haemoglobin estimation
03. Total and differential leucocyte count
04. Red cell count, packed cell volume and absolute indices, E.S.R.
05. Peripheral smear examination
08. Blood transfusion – pretransfusion tests
09. Examination of urine
10. Examination of C.S.F. and investigation of sterility in males.
11. Liver function tests and Laboratory diagnosis of jaundice
12. Renal function tests
Practicals and demonstrations in Pathology to cover the above subjects with special emphasis on common laboratory techniques.
COURSE CONTENT FOR DCP
- General pathology including immunopathology
- Systemic pathology
- Blood Banking including Transfusion medicine
- Laboratory organization including Quality control
- Basic microbiology & Clinical biochemistry
B Techniques and their applications
- Principles of sample collection for Hematology and Clinical Pathology,
- Histopathology and cytology specimens urine analysis, stool examination,
- pregnancy tests, microbiological and biochemical tests
- waste disposal and universal precautions
- 1. Fine needle aspiration cytology- staining & interpretation.
- 2. cytology of body fluids – staining and interpretation
- 1. Histopathologic techniques section cutting
- 2. Haematoxylin and Eosin stain and special stain which include PAS stain,Alcian blye stain reticulin stain Masson's Trichrome and perl's stain
- 3.priniciples of immunohistochemistry and immunofluorescence
2. Preparation of Leishman's stain and reagents for blood counts
3. Hands on experience in different methods of Haemoglobin estimation RBC,WBC,platelets and Reticulocyte counts, AEC, PCV, ESR and absolute indices and coagulation tests
- Preparation and interpretation of peripheral smear and Bone marrow
- Hemolytic workup including sickle cell preparation, Hb F& electrophoresis etc.
- Cytochemistry – peroxidase/sudan black B,PAS,LAP,NSE and perl's stsin
- Quality control and use of automated cell counters
- Cleaning of Glass ware
1.Bloodgrouping and typing
4.Donor screening and blood collection
5.Testing for STS, HIV, Hepatitis B&C
6.Rh antibody titration
7.Cold agglutinin titre
- Experience of interpretation and reporting of
- Gram’s stain
- Hanging drop
- KoH/Lactophenol preparation for fungi
- Sterilization techniques, culture methods, identification
- Hands on experience and interpretation of serological tests like Widal,VDRL,HIV ,HBV, RF, ASO.
Basic Biochemistry applied to biochemical investigation:-
pH-meter,flame photometer,Semi Autoanalyser and Autoanalyser Electrophoresis Carying out biochemical investigations like blood sugar, urea, creatinine, proteins, bilirubin,SGOT,SGPT,Alkaline phosphatase etc.
COURSE CONTENT FOR MD
The study of Pathology Anatomy includes all aspects of Pathology as encompassed in the branches of General and Systemic Pathology. Only the broad outlines are provided.
A) General Pathology:
Normal cell and tissue structure and function. The changes in cellular structure and function in disease. Causes of disease and its pathogenesis. Reaction of cells, tissues, organ systems and the body as a whole a to various sublethal and lethal injuries.
B) Systemic Pathology:
The study of normal structure and function of various organ systems and the
aetiopathogenesis , gross and microscopic alterations of structure of these organ
systems in disease & functional correlation with clinical features.
The study of Haematology includes all aspects of the diseases of the blood and
bone marrow. This would involve the study of the normal, and the causes of
diseases and the changes thereof.
3. Laboratory Medicine (Clinical Biochemistry/Clinical Pathology including
4. Transfusion Medicine (Blood- Banking).
5. In the following fields the student is expected to acquire a general acquaintance of
techniques and principles and to interpret data
- Electron microscopy
- Molecular Biology
- Maintenance of records
- Information retrieval, Computer, Internet in medicine.
It is difficult to give a precise outline of the Course Content for postgraduate training. A
postgraduate is supposed to acquired not only professional competence of a well –
trained specialist but also academic maturity, a capacity to reason and critically
scientific data as well as to keep himself abreast of the latest developments in the field of the pathology and related sciences. A brief outline of what is expected to be learnt during the MD Course is given under each head.
- The student should be able to demonstrate an understanding of the histogenetic and patho-physiologic processes associated with various lesions
- Should be able to identify problems in the laboratory and offer viable solutions.
- Given the clinical and operative data, the student should be able to identify, and systematically and accurately describe the chief gross anatomic
alterations in the surgically removed specimens and be able to correctly diagnose at least 80 percent of the lesions received on an average day from the surgical services of an average teaching hospital.
- A student should be able to demonstrate ability to perform a systematic gross
Examination of the tissues including the taking of appropriate tissue sections and in special cases as in intestinal mucosal biopsies, muscle biopsies and nerve biopsies, demonstrate the orientation of tissues in paraffin blocks.
- The student should be able to identify and systematically and accurately describe the chief histomorphological alterations in the tissue received in the surgical pathology service. He/She should also correctly interpret & correlate with the clinical data to diagnose at least 90% of the routine surgical material received on an average day. He/She should be able to diagnose at least 75% of the classical lesions being commonly encountered in the surgical pathology service without the aid of the clinical data.
- Be conversant the automatic tissue processing machine and the principles of its running .
- Process a tissue ,make a paraffin block and cut sections of good quality on a rotary microtome.
- Stain paraffin sections with at least the following:
(i) Haematoxylin and eosin
(ii) Stains for collagen, elastic fibers and reticulin
- Iron stain
- PAS stain
- Acid fast stains
- Any other stains needed for diagnosis.
- Demonstrate understanding of the principles of:
- Fixation of tissues
- Processing of tissues for section cutting
- Section cutting and maintenance of related equipment
- Differential (Special) stains and their utility
- Cut a frozen section using freezing microtome / cryostat, stain and interpret the slide in correlation with the clinical data provided, and correctly diagnose at least 75 per cent of the lesions within 15 minutes. Perform fat stain on frozen section.
- Demonstrate the understanding of the utility of various immunohistochemical
stains especially in the diagnosis of tumour subtypes.
- Should be aware of the technique of autopsy .
- Should have sufficient understanding of various disease processes so that a meaningful clinico-pathological correlation can be made.
- Demonstrate ability to perform a complete autopsy independently with some physical assistance , correctly following the prescribed instructions. Correctly identify all major lesions which have caused, or contributed to, the patient’s death on macroscopic examination alone on microscopy in at least 90% of the autopsies in an average teaching hospital.
- In places where non- medicolegal autopsies are not available each student /candidate should be made to dissect organs from atleast five medico-legal autopsies.
- Write correctly and systematically Provisional and Final Anatomic Diagnosis reports.
- Should possess the background necessary for the evaluation and reporting of Cytopathology specimens.
- Demonstrate familiarity with, the following keeping in mind the indication for the test.
- Choice of site from which smears may be taken (as in the case of vaginal smears)
- Type of samples.
- Method of obtaining various specimens (urine sample, gastric smear, colonic lavage etc.)
- Be conversant with the principles and preparation of solutions of stains.
- Independently prepare and stain good quality smears for cytopathologic examination.
- Be conversant with the techniques for concentration of specimens:i.e. various filters, centrifuge and cytocentrifuge.
- Independently be able to perform fine needle aspiration of palpable superficial lumps in patients; make good quality smears, and be able to decide on the type of staining in a given case.
- Given the relevant clinical data, he/she should be able to independently and correctly:
- Evaluate hormonal status in all cases as may be required.
- Diagnose the status of malignancy or otherwise in at least 75% of the cases received in a routine laboratory and categorize them into negative, inconclusive and positive.
- Demonstrate ability in the technique of screening and dotting the slides for suspicious cells.
- Indicate correctly the type of tumour , if present, in at
least 75% cases.
(v) Identify with reasonable accuracy the presence of
organisms, fungi and parasites in atleast 75% of cases.
- Should demonstrate the capability of utilising the principles of the practice of Haematology for the planning of tests, interpretation and diagnosis of diseases of the blood and bone marrow.
- Should be conversant with various equipments used in the Haematology laboratory.
- Should have knowledge of automation and quality assurance in Haematology.
- Correctly plan a strategy of investigating at least 90% of the cases referred for special investigations in the Hematology Clinic and give ample justification for each step in consideration of the relevant clinical data provided.
- Correctly and independently perform the following special tests, in
addition to doing the routine blood counts:
- Haemogram including Reticulocyte and Platelet counts.
- Bone marrow staining including stain for iron
- Blood smear staining
- Cytochemical characterization of leukemia with special stains like Peroxidase, Leukocyte Alkaline Phosphatase (LAP), PAS, Sudan Black, etc.
- Hemolytic anemia profile including HbF, Hb electrophoresis etc.
- Coagulation profile including PT,APTT.FDP.
- BM aspiration and BM biopsy
- Demonstrate familiarity with the principle and interpretation of results
and utility in diagnosis of the following:
(i) Platelet function tests including platelet aggregation and adhesion and PF3 release
(ii) Thrombophilia profile: Lupus anticoagulant (LAC),
Anticardiolipin Antibody (ACA), Activated Protein C Resistance (APCR) ,Protein C (Pr C), Protein S (Pr S) and Antithrombin III (AT III)
- Immunophenotyping of leukaemias
- Describe accurately the morphologic findings in the peripheral and bone marrow smears, identifying and quantitating the morphologic abnormalities in disease states and arriving at a correct diagnosis in at least 90% of the cases referred to the Haematology clinic, given the relevant clinical data.
- Possess knowledge of the normal range of values of the chemical content of body fluids, significance of the altered values and its interpretation.
- Possess knowledge of the principles of following specialized organ function tests and the relative utility and limitations of each and significance of the altered values.
- Renal function test
- Liver function test
- Gastric and Pancreatic function
- Endocrine function test
- Tests for malabsorption
- Know the principles, advantages and disadvantages scope and limitation of Automation in laboratory.
- Know the principles and methodology of quality control in laboratory.
- Plan a strategy of laboratory investigation of a given case, given the relevant clinical history and physical findings in a logical sequence, with a rational explanation of each step; Be able to correctly interpret the laboratory data of such studies, and discuss their significance with a view to arrive at a diagnosis.
- Demonstrate familiarity with and successfully perform
i) routine Urinalysis including Physical, Chemical and Microscopic,
examination of the sediment.
ii) macroscopic and microscopic examination of Faeces and identify the ova and cysts of common parasites.
iii) A complete examination; physical, chemical and cell content of Cerebrospinal Fluid (C.S.F). , Pleural and Peritoneal fluid.
iv) Semen analysis.
v) Examination of Peripheral Blood for the commonly occurring parasites.
- Independently and correctly perform at least the following Quantitative Estimations by Manual Techniques and/or Automated Techniques.
- Blood urea
- Blood sugar
- Serum Proteins total & fractional
- Serum Bilirubin total & fractional
- Serum amylase
- Demonstrate familiarity with the following Quantitative Estimations of blood/ serum by Automated Techniques.
Serum cholesterol ,Uric acid, Serum Transaminases (ALT and AST/SGOT and SGPT), etc.
- Prepare standard solutions and reagents relevant to the above tests, including the preparation of normal solution, molar solution and Buffers.
- Explain the principle of Instrumentation, use and application of the instruments commonly used in the labs eg..Photoelectric colorimeter, Spectrophotometer, pH meter, Centrifuge, Electrophoresis apparatus, ELISA Reader , flow cytometer
Transfusion Medicine (Blood Banking)
Students should possess knowledge of the following aspects of Transfusion
- Basic immunology
- ABO and Rh groups
- Clinical significance of other blood groups
- Transfusion therapy including the use of whole blood and RBC concentrates.
- Blood component therapy
- Rationale of pre-transfusion testing.
- Infections transmitted in blood.
- Adverse reactions to transfusion of blood and components
- Quality control in blood bank
Student should be able to correctly and independently perform the following
- Selection and bleeding of donors
- Preparation of blood components i.e. Cryoprecipitates, Platelet concentrate, Fresh Frozen Plasma, Single Donor Plasma, Red Blood Cell concentrates .
- ABO and Rh grouping.
- Demonstrate familiarity with Antenatal and Neonatal work
- Direct antiglobulin test
- Antibody screening and titre
- Selection of blood for exchange transfusion
- Demonstrate familiarity with principle and procedures involved in
- Resolving ABO grouping problems.
- Identification of RBC antibody
- Investigation of transfusion reaction.
- Testing of blood for presence of (a) HBV (Hepatitis B Virus Markers).
- HCV (Hepatitis C Virus Markers )
- HIV (Human Immunodeficiency Virus Testing)
Basic Science (in relation to Pathology)
(i) Demonstrate familiarity with the current concepts of structure and function of the immune system, its aberration and mechanisms thereof.
(ii) Demonstrate familiarity with the scope, principles, limitations and interpretations of the results of the following procedures employed in clinical and experimental studies relating to immunology.
- ELISA techniques
- HLA typing
(iii) Interpret simple immunological tests used in diagnosis of diseases and in research procedures.
- Immunofluorescence techniques especially on kidney and skin biopsies
- Anti-nuclear Factor (ANF)
- Anti- neutrophil cytoplasmic antibody (ANCA)
b) Electron Microscopy
- Demonstrate familiarity with Principles and techniques of electron microscopy and the working of an electron microscope (including Transmission and Scanning Electron microscope: TEM and SEM)
- Recognise the appearance of the normal subcellular organelles and their common abnormalities (when provided with appropriate photographs).
c) Enzyme Histochemistry
Should be familiar with the principles, use and interpretation of common enzyme histochemical procedure (Alkaline Phosphates, Acid Phosphates, Glucose-6-Phosphate Dehydrogenase , Chloroacetate Esterase.
Demonstrate familiarity with the principles and exact procedures of various immunohistochemical stains using both PAP ( Peroxidase- Antiperoxidase) and AP-AAP (Alk. Phosphatase-anti Alk. Phosphatase) ABC (Avidin-Biotin Conjugate) Systems; employing monoclonal and polyclonal antibodies. Be aware of the limitations of immuno his to chemistry.
Skills (desirable )
Be able to perform immunohistochemical staining using paraffin section with at least one of the commonly used antibodies (Cytokeratin or LCA) using PAP method.
e) Molecular Biology
Should understand the principles of Molecular biology especially related to the understanding of disease processed and its use in various diagnostic tests.
Should be conversant with the principle & steps and interpretations of a Polymerase Chain Reaction (PCR Western Blot, Southern Blot, Northern Blot and Hybridisation procedures.
Demonstrate familiarity with methods of Karyotyping and Fluorescent-in-situ Hybridisation (FISH)