Pathology for Medical Students
Overview Textbooks and References Ten-year series, OSCEs, Tests
  • Introduction
  • Syllabus
  • Timetable
  • Examination
  • Tips
  • Textbooks
  • Booklist
  • Senior's Notes

    Online references
  • Vermont Uni's CATS
        [Lecture Notes(topical), Cases(20), Quiz]
  • Utah University   [Pots and slides]
  • Histology-World   [Slides and Quizes]

    Links and Directories
  • NUS Pathology Dept  [Uninformative]
  • Past Year Questions
  • 2000 Pro
  • 2000 Re
    Online Quizes
  • Pittsburgh Uni - 250+ Case studies
        [By presentation(CPC style) or by diagnosis]
    For NUS Students Only:
  • NUS Mednet CPC & CTS
  • NUS Histo & Lab Data  [Click 'Quiz']

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    Category of subject: Para-clinical
    Duration of posting: Year 2(70% of content), Year 3(5%), Year 4(25%)
    Final examination: End of Year 4 (2nd professional MBBS)
      Pathology, contrary to popular belief, is not about dead bodies and murder mysteries. That subspeciality is known as Forensic Pathology, and together with Chemical Pathology, General Pathology, and Systemic Pathology, make up your Pathology curriculum.
      Pathology starts with General and Systemic patho lectures and tutorials in the preclinical years, building upon your knowledge of "normal" Anatomy and Physiology. However, it can be very confusing without the clinical experience of later years.
      Year 3 see a near-total neglect of Patho, apart from Combined-Pathoclinical-Conferences, which are case studies involving the clinicians, pathologists, and radiologists. Chem Path and Forensic Path are taught in Year 4.
      The final exam is taken only at the end of fourth year. Naturally much of the year 2 work will be forgotten, however, clinical work during year 3 and 4 will help you in your revision as well as lend focus to the important topics.
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    Official syllabus available?: Yes- Issued at start of course
    Four main sections:
    A. General (Basic) Pathology [20% of final exam]
    B. Systemic Pathology [50%]
    C. Forensic Pathology [15%]
    D. Chemical Pathology [15%]
    General and Systemic Patho subdivisions:
    1. Theory
    2. Gross specimens (Pots)
    3. Histopathology (Slides)

    General Patho Modules & [Weightage of Past Essays]:
    1. General Concepts of Diseases [0]
    2. Cardiovascular [5]
    3. Inflammatory and Repair Processes [4]
    4. Infections [1]
    5. Immunological Diseases [8]
    6. Abnormalities of Growth and Differentiation [0]
    7. Neoplasia [9]
    Systemic Patho Modules & [Weightage of Past Essays]:
    1. Cardiovascular [22]
    2. Respiratory [24]
    3. Gastrointestinal [32]
    4. Hepatobiliary [24]
    5. Pancreas (+ Diabetes)[11]
    6. Lymphohaemopoeitic system [17]
    7. Renal System [44]
    8. Male gential system [10]
    9. Breast [10]
    10. Female genital system [20]
    11. Paediatric Patho [0]
    12. Endocrine [22]
    13. Skin [1]
    14. Bones/Joints/Soft Tissue [13]
    15. Central Nervous System [24]
    Forensic Pathology [1 out of 6 Essay Qns]:
    1. Death certification, Coroner's Cases
    2. Medico-legal examination of the living & dead
    3. Sudden & unexpected death
    4. Offenses against the person (trauma)
    5. Asphyxial deaths, drowning.
    6. Traffic accidents
    7. Abortion, child abuse
    8. Sexual offenses (DNA, Rape)
    9. Dangerous drugs
    10. Toxicology.
    11. Misc (Lightning)
    Chemical Pathology [1 out of 6 Essay Qns]:
    1. Acid-base disorders
    2. Sodium disorders
    3. Potassium disorders [2]
    4. Renal function
    5. Liver function
    6. Diabetes Mellitus [1]
    7. Diagnostic Enzymology [2]
    8. Paraproteinaemias [1]
    9. Calcium disorders [1]
    10. Lipid disorders [1]
    11. Tumour markers [2]
    12. Dynamic Endocrine Testing
    13. Thyroid disorders [2]
    14. Adrenal disorders [1]
    15. Hypertension
    16. Metabolic bone disorders
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  • 3 year course (Year 2 to 4)
  • Patho Dept: "The bulk of undergraduate teaching in general and systemic pathology is completed in the 2nd year of the medical course. This is carried out by means of lectures, tutorials and practical classes. The department houses an excellent museum containing numerous common and uncommon histopathological specimens. In the 3rd and 4th years, teaching is continued in the form of combined-teaching sessions and clinico-pathological conferences. The students also return to the department for a 3-week posting in which the basic concepts of pathology and laboratory medicine are revised from a more clinical point of view. One of these 3 weeks is spent in a posting at the Institute of Science and Forensic Medicine, Singapore General Hospital, during which the students acquire experience in autospy pratice and legal aspects of Medicine. Formal lectures in forensic pathology and chemical pathology are also conducted in the 4th year. "
    Year 2Year 3Year 4
    % of syllabus70%5%25%
  • General Patho
  • Systemic Patho
  • Clinco-pathological
       (optional/do online )
  • Chem Path
  • Forensic Path
  • Clincal pathology
  • CPC
  • Time spent /
    Course Format
    Every week (35 weeks):
  • Lectures: 2 hours
  • Tutorial/Slides: 4 hours
  • - None scheduled-
    (Except 1/3 of class
    starting year 4
    with short postings)

    (But pick up a lot from
    clinical postings)
  • Forensic: 1 afternoon X 16 weeks
  • Chem Path: 1 afternoon X 10 weeks
  • CPC
    3 weeks short postings:
  • Forensic (SGH): 1 week
  • Chem & Clinical Patho: 2 weeks
  • Tests/Exams
  • Mid-year test (Essay+Prac)
  • End-of-year test(Essay+Prac)
  • - None -
  • Case writeup (During short posting)
  • Forensic writeup(may be scrapped)
  • 2nd Pro MBBS
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    Breakdown of marks
    - No official breakdown
    - Year 2 class tests: 20-30%
    - Year 4 CA (case writeups): 5-10%
    - Final exam: 50-70%
    Final exam
  • Timing: End of Year 4. (12-13 April 2000)
       - 12th April 2000 - Essay
       - 13th - Practical
       - 18th - Viva
       - 20th - Board of examiners
  • Papers:
       - 1 Essay Paper (Answer all 6 questions)(3 hours)
       - 1 practical (Pots, Pictures, Slides)(2 hours)
       - NO mcq paper
       - Viva only for pass/fail or distinction.
  • Weightage: No official breakdown
       - Essay paper: Out of 6 questions:
          1 general path, 3 systemic, 1 forensic, 1 chem path.
       - Practical: 2/3 pots, 1/3 slides.
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    Primary textbook (choose 1)
  • Basic Pathology (Kumar, Cotran, Robbins) -   Also called "Mamma Robbins" (ala Goldilocks and the 3 bears),
    this is easy to read with nice pictures (unlike Baby), yet not too intimidating (like Papa).
  • Senior's notes - Last coming in at 3 sets (1 general, 2 systemic), it closely follows the lecture content, but is prone
    to outdated information and typos.
    Reference text
  • Robbins Pathologic Basis of Disease (Cotran, Robbins, Kumar) -    "Papa Robbins" weighs in at 1400 pages(6th Ed)
    and is mainly useful for weightlifting exercise, as it is rather verbose. Some have finished reading it though!
  • Chemical Patho textbook (Evelyn Koay's) - I forget the exact name, but the book by one of the lecturers.
  • Chemical Patho textbook (Lippincott) - I also forget the name, but looks like the Lippincott biochem book.
  • Wheater's Basic histopathology (Burkitt) - Nice colourful histo pictures. (A bit too much though)
    Other must-have stuff
  • Forensic Patho lecture notes. (Don't bother getting a textbook)
  • Senior's note for Slides - A thin set detailing what you should see during your slide sessions.
  • Senior's histopath photos - Very rarely found these days, they're quite useful during year 4 revision. Alternatively,
    visit the patho lab towards the end, or pick one of the links to a histopath site above.
    Nice-to-have stuff
  • Pocket Companion to Robbins Pathologic Basis of Disease (Robbins, Cotran, Kumar) -    Deceptively small,
    this 800 page book is packed full with words and lists, making it a poor choice as your first or primary textbook.
    Revision guides & MCQs
  • BRS Pathology (Schneider) - No pictures, but great clear concise summaries (contrast with Robbins' longwindedness!)
  • High Yield Pathology (Damjanov)- A thin book new on the market, I haven't used it, and it probably isn't too great.
  • Robbins Review of Pathology (Klatt) - Clinical questions based on Robbins.
    Book review sites
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    Study tips
    Year 2
    1)Clinical experience
  • The patho tutors often don't teach, or assume you know, the clinical aspects of the diseases.
  • The obvious solution is to read a clinical textbook, but this is easier said than done.
  • A good compromise is to read literature aimed at laymen(which you are), or to read the first few
    paragraphs from a clinical text, and only for the major topics.
  • Just read to get a feel of what the condition is - don't try to memorize the facts or go into details.
    2)Build upon Physio, Histo and Biochem.
  • I regretted (vaguely) not building a good foundation in year 1, because as is said (ad infinitum),
    "If you don't know what is normal, how can you tell what is abnormal?"
  • There is no shame (and unfortunately no time) in going back to look at your year 1 stuff.
    3)Concentrate on the generalities and major topics.
  • It's very easy, and very unecessary, to go into the fine details in patho.
  • Focus firstly on the generalities - things such as inflammation, cancer.
    With knowledge of normal histology, and basic patho concepts, you can diagnose most patho slides!
  • Patho, unlike subjects such as Surgery, has no clear cut-off between "must know" and "nice to know".
    In patho, there's a very gentle gradation from undergrad to postgrad level, so it's easy to "overstudy".
    Be aware of this pitfall, and leave out minor topics (see your syllabus), and the fine print of major ones.
  • Summarize the main topics using a fixed structure (sieve):
    Intro, Definition, Egs, Epidemiology, Aetiology, Pathogenesis, Clinical Presentation,
    Morphology, Histology, Stage/Grade(for cancer), Complications/Natural History/Prognosis.
    During Clinical Years
    1)Forget Patho
  • No, not really. You shouldn't, although you will, in the excitement of clinical years.
  • You won't be able to set aside time specifically for patho, but at least try to read up
    the gross morphology/histopath aspects of clinical topics you come across.
  • It's really easy to skip doing CPCs now that they're computerized, especially if they difficult.
  • Even if you don't/can't do them, browse through the answers during MUD/Counterstrike breaks.
    or Counterstrike.
    Year 4
    1)Forensic & Chem Path lectures
  • Must go!
  • Most times the question comes straight from the lecture.
    2)Patho short posting
  • Forensic path is an eye-opener, if a bit long-drawn. Too bad Outram coffeeshop moved.:P
  • Chem path is a useful refresher, especially if your patho posting is towards the end.
  • Reverse CPC under SM Chong was real fun, especially now that you have clincial knowledge.
  • Don't be intimidated by how patho has become ancient history for you!
  • A LOT of patho is actually clinical knowledge you picked up from the ward, and what was
    totally confusing in year 2 suddenly becomes so easy to understand.
  • All you have to do is to revise your pathogenesis, morphology, and histopath. (Easier said than done ;)
  • Concentrate on General Path first, until the 10 signs of inflammation or invasion or whatever come out
    like verbal diarrhoea. Use this in system path: ie. myocarditis/pancreatitis/x-itis => inflammation diarrhoea.
  • Chem and forensic path together form 33% of the essay, so don't neglect them or spot questions!
  • Go for the big topics - there are no MCQs, and they don't set essays on nitty-gritties.

  • Exam tips
    No mcqs, so that's one big relief! Chuck all those small facts and details! :)
    Essay paper is 6 questions over 3 hours (ie. 30mins per question)
  • Breakdown is 1 general path, 3 systemic, 1 chem and 1 forensic.
  • Expect one or two "write short notes on" questions, usually on smaller topics.
  • Questions are moving towards Approach-orientated clinical problems, rather than
    pure recall/regurgitation (Eg. "Discuss the pathology of myocardial infarction")
  • Chem path questions: (1)clinical scenario and lab results or (2)Write about XYZ.
    The approach is roughly the same as the diagnosis in (1) is rarely a problem.
  • Forensic path is (in the good old days of Prof Chao) a matter of memorizing his
    notes and regurgitating it out, with whatever slant the question requires.
  • There has never been integration between general/chem/forensic, and rarely
    systemic path questions involving multiple systems.
    Practical paper(2 hours)(? 30 questions)
  • I forget the breakdown, but I think it's 10 slides and 20 pots/pictures.
  • The format is similar to your end-of-year 2 test, or the mock exam in year 4.
  • No negative marking, so write something (anything!) and move on when the bell rings.
  • Don't write an essay - just the keywords, and don't forget to name the side/organ.
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    Past Year Exams
    April 2000 Pro
    National University of Singapore
    Second Professional Part III for MBBS
    Class of 2001
    Breakdown of marks (in 2000)
    (1)Continual Assessment - 20%
      (1.1)Class Test
      (1.2)Forensic project
      (1.3)Short posting writeup
    (2)Essay paper - 60%
      (2.1)4 general/systemic
      (2.2)1 chemical patho
      (2.3)1 forensic patho
    (3)OSCE - 20%
    No MCQs.
    No clinical.
    [breakdown differs in different years]

    Essay Paper (12 April 2000)
    1. Describe the pathogenesis and pathological features of the diseases associated with Helicobacter pylori.
    2. Describe the pathogenesis of myocardial infarction and the subsequent complications that may arise.
    3. What is oedema? Describe the pathogenesis of oedema in: a)cardiac failure b)liver cirrhosis c)acute inflammation
    4. Write short notes on the following: a)primary pulmonary tuberculosis b)small cell carcinoma of the lung c)cor pulmonale
    5. A 58-year old man was reviewed at the medical outpatient clinic with a long history of renal impairment. Review the role of the clinical biochemistry laboratory in the management of this patient.
    6. Discuss how you would distinguish the differences in the appearance of homicidal, suicidal and defensive wounds. What are the features that can help you determine if the wound is self inflicted or otherwise.

    OSCE (13 April 2000)
    20 stations, 5 minutes each.
    15 pots/pictures of pots.
    5 slides.
    [breakdown may differ between years]

    [Slide]Liver congestion
    [Slide]Secondary carcinoma of lymph node (NPC Squamous cell)
    [Slide]Chronic gastric ulcer
    [Slide]Bronchial pneumonia
    [Slide]Basal cell carcinoma
    [Pot]Aortic aneurysm with background atherosclerosis
    [Pot]Ovarian teratoma (mature)
    [Pot]Liver cirrhosis
    [Pot]Pleomorphic adenoma of salivary gland
    [Pot]Thyroid cancer/adenoma
    [Pot]Prostatic hyperplasia + bladder enlargement + bilat hydroureter & hydronephrosis
    [Picture of Pot]Acute haemorrhagic pancreatitis
    [Picture of Pot]Pulmonary thromboembolism
    [Picture of Pot]Ductal carcinoma of breast with Paget's
    [Picture of Pot]Colon cancer with polyposis syndrome

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    2000 Supplementary/Re Exams
    National University of Singapore
    Second Professional Part III for MBBS
    Class of 2001
    Essay Paper (Reexam 2000)
    1. Give an accont of the pathogenesis, clinical manifestations and possible seequalae of infective endocarditis.
    2. Discuss the major mechanisms involved in immunologic tissue injury, and illustrate by describing the pathology of one disease.
    3. A 40-year-old woman presents with a thyroid nodule. Discuss the pathology of the common conditions with a view to correlating the clinical presentation, gross and microscopic appearances and approach to management.
    4. Write short notes on the following:
    (a) cervical intraepithelial neoplasia
    (b) secondary hyperparathyroidism
    (c) giant cell tumour of bone
    5. A 44-year old woman was referred to the outpatient department with a history of generalized pruritus and was noted to be jaundiced. Discuss the role of the clinical biochemistry laboratory in the diagnostics evaluation of this patient.
    6. What are the features that would lead you to suspect that a child has been abused. How would you proceed to examine and confirm your suspicion? What would you do when suspicion is confirmed?
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