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Must Know Exam Topics in Pathology for

MBBS Students

12-15 minutes

Pathology, Pharmacology and Physiology. Three pillars of

medicine. My seniors told me that, a good doctor is that
person who knows these three subjects well. Even though
my opinion differs a bit, it is a fact that these three non
clinical subjects are important as far as understanding
general medicine (the toughest clinical subject) is
concerned. This article is supposed to give a detailed
description of the important topics in pathology. For other
subjects, please read my article on My Second Year MBBS
Experience.

Yes. Pathology can be really difficult for the

undergraduates. Not because of the concepts, but because
of the amount of facts that a student has to mug up to
construct a good answer on the answer sheet. Examiners
are infamous for setting questions from that disease which
a doctor will never see in life. The diseases that a doctor
sees every day in his clinic have no place in the question
papers. Gene mutations and microscopic features make the
examiner happy, not the clinical features.  So after second
year the student will land up in second year syndrome
(diagnosing a small skin color change as some rare
malignant neoplasm).

Robbins, the standard textbook in pathology for

undergraduates consists of 10 general pathology and 19
systemic pathology chapters. It will take two days, if an
undergraduate wants to read all the 470 pages of general
pathology. But only 10 questions will be asked. The student

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would have studied 90% of the portion, but the questions

could still come from the rest 10%.So on the day before the
exam the student will be in dilemma to whether read
Robbins or to switch to some preparatory manual books.
Preparatory manuals have given everything in point wise.
So students feel easy to remember. But the greatest
disadvantage of that is that it is not false proof. So here I
enumerate those topics from which I used to get questions
for the exams in my college. These are all must know topics.
If you study these topics and relevant diagrams from
Robbins, good marks are assured.

GENERAL PATHOLOGY

Cell Injury

Hypertrophy, hyperplasia, atrophy and metaplasia can

come as short answer questions. The difference between
any two is also a must know question. So is apoptosis and
necrosis. Morphological types of necrosis and pathways of
apoptosis will make a five marks question. Apoptosis as
such is a long question. Difference between apoptosis and
necrosis and dystrophic and metastatic calcifications are
the favorite questions of examiners. Free radical in injury,
reperfusion injury and endogenous pigments (lipofuscin,
melanin, hemosiderin) are infrequent, but can be asked.

Acute and Chronic inflammation

Reading vascular and cellular events and mediators of

acute inflammation will keep you in safe zone. Outcomes of
acute inflammation can be expressed well  in answer sheet
using diagram given in the Robbins. Morphologic patterns
of acute inflammation and granulomatous inflammation can
also be asked. Don’t attend any viva voce or written exam
without understanding granuloma well (don’t ask me why.
My professor told so).

Regeneration and repair| Hemodynamic disorders

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Repair and regeneration was a special topic because

despite of the massive size, only 2 questions used to come
from that chapter. When granulation tissue is asked, make a
histological diagram also. Difference between healing by
primary and secondary intensions is very important.
Edema, Shock (septic), DIC and Embolism are long
questions. Must know topics from this chapter also include
“differentiate between” questions  which are white and red
infarct, arterial and venous thrombi, ante mortem and post
mortem clot.

Genetic Disorders| Disease of Immune system

Lysosomal storage disorders, Turners syndrome, Klienfilters

syndrome, Down syndrome and genomic imprinting are
important short notes. SLE, RA, Sjorgren syndrome,
tolerance and transplant rejection can come as short
notes.SLE used to consume my valuable working hours by
virtue of its massive size. All types of hypersensitivities are
important. The “differentiate between” question is Central
and peripheral tolerance.

Neoplasia

You should be well versed with all the terminologies like

polyp, choristoma, hamartoma etc. Laboratory diagnoses of
cancer and paraneoplastic syndromes were my professional
exam long question. Chemical mediators, oncoviruses,
tumor antigen and tumor markers are short notes. Invasion
and metastatic cascade can decide whether you can
proceed to next year or not. Differentiate between questions
include benign and malignant neoplasm & initiators and
promoters.p53 and RB are rare questions.

Infectious diseases| Nutritional diseases | Diseases of

Infancy

Don’t sit in the examination hall without reading Leprosy

and T.B . Differentiate between Tuberculoid and

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Lepromatous leprosy consumed my 3 marks in my

professional exam. Since you are an Indian, you are
expected to know tuberculosis well and it can be asked in
pathology, microbiology, medicine, pediatrics and
gynecology(practically anywhere)Vitamin A and D
deficiencies are important(Professors don’t like B and C).
Neuroblastoma, Cystic fibrosis and Wilms tumor can make
your life difficult.

Systemic Pathology

Blood Vessels

If I were the examiner, then I would surely put pathogenesis

of atherosclerosis and it’s morphology as a long answer
question. Promise yourself that you would leave no stones
unturned while reading atherosclerosis. Risk factors of
atherosclerosis should be in your fingertips. Debakey
classification of dissection and difference between
aneurysm and dissection can appear as short answers.

c-ANCA and p-ANCA related vasculitis usually comes as

MCQs. Giant cell arteritis, Takayasu arteritis and Kaposi
sarcoma are possible short answers. Hemangioma is a
question of practical exam.

Heart

Myocardial infarction is the most important question of

heart. Time of onset of key events, laboratory markers of
myocardial injury and morphological changes (gross, light
microscopic and electron microscopic) can spit venom at
you (if you know what I mean). Cardiomyopathy, its
different types and the differences between them make a
five mark question.

Diseases of WBCs and Lymph nodes

Learn causes for neutrophilia , neutropenia, eosinophilia,

eosinopenia, basophilia, basopenia etc. because it is one of

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the most common viva question. The important neoplasms

for undergraduates are AML, CML, ALL, ALL, Burkitt
lymphoma, Hodgkin’s lymphoma and Multiple Myeloma.
Don’t dig too deep into its mutations. Understand and
practice its morphology diagrams. BCR-ABL fusion gene
diagram is very important so is WHO classification of AML.
Differences between myeloblast & lymphoblast  and
Hodgkin’s and Non-Hodgkin’s lymphoma are the chief short
questions. Learn everything possible about Hodgkin’s
lymphoma with special emphasis on Reed-Sternberg cells.

Bed Blood Cell and Bleeding Disorders

Definition, classification and types of anemia are the most

significant question of this chapter. Iron deficiency anemia
assumes special importance because it is very much
prevalent in India. Learn in detail Sickle cell anemia,
Thalassemia, Megaloblastic anemia, Folate trap, Paroxysmal
Nocturnal Hemoglobinuria, Hemophilia and Disseminated
Intravascular Coagulation are the possible questions from
this chapter. Bleeding disorders are a store house of MCQs.
A good idea about investigations pertaining to anemias is
good to have. 

The Lung

ARDS is a good to know topic. Definition, classification and

differences between different types of emphysema are a
long answer question. Asthma and its diagrams can make
your life not lesser than worse. Sarcoidosis, pneumonia
(etiology and morphological types i.e. bronchopneumonia
and lobar pneumonia), pneumoconiosis and carcinoma of
lung are of paramount importance. Sometimes crazy
examiners do ask the difference between tuberculosis &
sarcoidosis and obstructive & restrictive lung diseases. 

The Gastrointestinal Tract

Barret Esophagus is an example of metaplasia as well as a

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possible short answer from this chapter. The pathogenesis,

morphology and diagram of gastric injury and ulcer
formation can come as a long answer question. Cushing
and Curling ulcers will confuse you as far as MCQs are
concerned. H. pylori gastritis itself and its difference
between autoimmune gastritis are not infrequent questions.
For me, Hypertrophic Gastropathies appeared as rat traps
with baits because these pathologies will confuse a lot in
MCQs.  Gastric Adenocarcinoma as such is not asked as a
theory question but the morphology of the same is
frequently asked especially Linitis plastica. Celiac disease is
an ‘easy to score’ question. Classification of polyps and
Inflammatory Bowel Diseases (both Crohn’s disease and
Ulcerative Colitis) were the two most commonly
encountered questions from this chapter.

Liver and Biliary Tract

Pathogenesis of Cirrhosis and portal hypertension comes

under ‘must know’ list of topics. Among the viral hepatitis,
Hep B & C are more important for an under graduate
student. The sequence of serological markers in both
infections itself is a short answer question. A characteristic
feature of Hep E infection is the high mortality rate among
pregnant women. Morphologic features of acute and
chronic hepatitis caused me head ache many times. Alcohol
is a commonly abused substance in India so is questions on
alcoholic liver disease and its morphology. I never studied
Wilson disease because I got a good idea about the
pathogenesis from one of the episode of the House MD
series. NAFLD, Hemochromatosis and alpha-1-antitrypsin
deficiency are not infrequent but learn these topics only
after you complete hepatitis and cirrhosis.

The Kidney

I was asked to write about the mechanisms of Glomerular

injury in my pre-final exams. I never expected question, but
MBBS is all about surprises. There is a nice table given in

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Robbins. Difference between nephritic and nephrotic

syndromes is a cliché question. I think the examiner’s
bowel habits will get deranged if he/she doesn’t ask that
question. Learn these tow topics thoroughly so that you can
answer even at the mid night. Causes of nephrotic
syndrome have been described in a table in Robbins which
is good to know. In this era on non-communicable disease,
don’t go to exam hall without reading diabetic nephropathy.
Learn some differentiating features of Ischemic type acute
kidney injury from toxic type. Autosomal dominant
polycystic kidney disease and autosomal recessive
polycystic kidney disease are two important short notes.
Find out the differences between these two entities.
Urolithiasis is an important topic for practical exam. Renal
cell carcinoma and Wilm’s tumour are the must know
neoplasms in this chapter.

Male Genital System

Most of the questions asked from this chapter are related to

the neoplasms. So give special attention to classification of
testicular tumors, seminoma and differentiating features of
seminomatous tumors from non-seminomatous tumors.
Seminoma is important viva question because Yuvraj singh
suffered from the same (extragonadal seminoma located in
mediastinum). Benign prostatic hyperplasia is a very
common condition in older males and a very common
question as far as pathology is concerned. Learn the
pathogenesis of BPH as well as prostate cancer.

Female Genital Tract

Cervical cancer is a lethal but preventable cancer. Likewise

a question on cervical cancer will be lethal if you don’t know
the answer because most of time if not all, it will be a long
answer question. Learn all the risk factors, HPV types,
staging, pathogenesis, screening and vaccination. Don’t
leave any pages unturned. Endometriosis, endometrial
hyperplasia, leiomyoma and adenomyosis are short answer

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questions. Read the table given in Robbins to understand

the differences between type I and type II endometrial
carcinoma. Classification of ovarian tumors is an important
short note.  Read thoroughly hydatidiform mole as well.

If you are a medical student and you feel yourself worthless,

the spare some time to read this article(written by my
classmate Ranaprathap ) - An Open Letter to the Stressed
Medico - an Introspection in the Context of the Recent
Suicide of a Medical Student

My other articles are :

My Second Year MBBS Experience

My First Year MBBS Experience

Feel free to contact me by email :  doc.sarathrs@gmail.com

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