Whom am I addressing
basically this is for 4th year GMC students … i will be specific about teachers favourite test and viva questions … but any medical student can benefit from general guidelines about the subject …
Why me
As being topper of class and obtaining 3rd position in KMU in 4th year … i think its my responsibility and duty to share my knowledge and study techniques and tips … so that my junior students should get more benefit in less time and i believe in sharing … knowledge spreads by sharing and sharing is caring …
i stood 1st in community medicine… obtaining highest marks in theory as well as viva in our class …
Dedication:
These guidelines are dedicated to my father Dr. Hussain Babar. Everything that i do and everything that i have belongs to him and every height that i reach in my life … all the credit goes to him … and he has been the best teacher, the best friend and the best father … i wish everyone is blessed with a father like him … if you have benefited even a tiny bit from my suggestions … as a token of gratitude please pray for my father’s health and happiness …
The love between father and son is always hidden … they never express it but is always there… no one can be more sincere to you than your father … take care of your father … you are in this world because of them …
Requests:
I request Farhat ullah Bettani and all my classfellows specially fawad, qaiser, shoaib and imran to include their inputs into these guidelines…
WHICH BOOKS TO STUDY :
these study tips are not an alternative to your course books… so study them …
1) Excel ( for most of topics, but it has many mistakes, if you do not understand any topic go to park and illyas )
2) Park’s textbook of Prevention and Social Medicine ( Must for epidemiology )
3) Illyas’s Public health and community medicine ( Must for Biostatistics and HMIS )
4) Zahid Jan compiled papers ( these are chapter wise and gives you very good idea about important questions) and also new pattern papers
I have uploaded Zahid Jan papers on net for important questions of both pathology and community medicine … Zahid jan papers can be downloaded by clicking on Zahid Jan compiled papers present in the downloads section.
Basically it does not depend upon the book … but it depends upon the reader how he studies the book …
Whenever you have difficulty in choosing a book … Always read same topic from both the books and then choose the book according to that topic …
Always try to use a single book .. you will be less confused … more focussed … more quick to learn …
Most of them are notes of community dept. two lectures …
But most imp things are 1. Research Proposal.doc 2. Field Journal.doc
these are my research project and field journal … you will have plenty of help in making yours research project and field journal … by looking at them as samples …
if you still have difficulty in your research project… you can ask here or for a detailed answer email me at khalidshakeelbabar@gmail.com … please be patient for replies …
HOW TO STUDY COMMUNITY MEDICINE:
Community Medicine is a general subject …. sometimes when you study community medicine … everything looks the same to you … every topic looks the same … and you get confused how to differentiate between the topics … and you are asked about definitions and almost every word has a definition … so you are like how am i gonna remember all that definitions … and what is the importance of this subject … its not even applied to our community … so why am i reading this … the subject seem to be useless to you … and you stop studying it …
Community is a general subject, so if you are a talkative person … its the most easiest subject for you … you can talk all day long … and its you community medicine subject … most of us have general concept about community and health … in community medicine it is just arranged stepwise and in sequence ,,, so this subject you know already … you just have to arrange it in your mind to write it … its so simple … some of our friends did not study for the tests but used to get pass because of their general concept ( but this does not apply to all :p ) … and by reading community text books you can develop if you think you are missing general knowledge and common sense … its not applied to our community so that’s why its more important to read bcoz you can apply it in future … one more aspect of community of immense importance is research … you cannot run away from it … you have to do it in your life ,.. try to learn it here … it will be easy for you in future … and you have to pass the subject if you want to become a doc and everyone has passed through this phase and you can also do it … don’t lose faith …
Every topic is so much interlinked that if you have general concept you can write about any topic …
Epidemiology and Biostat are most imp chapters … 60 percent viva is from them and atleast 2 – 3 questions in exam come from these chapters ..
Epidemiology:
Start Community from Epidemiology … it is the most important topic … first read it from notes of epidemiology ( uploaded as well ) for concept … then read it from park … you will remember it for a long time …
Read Incidence , prevalence and then read just one study design one day … there are five studies designs … you can finish them easily in 5 days … cover other aspects of epidemiology like steps of epidemic investigation … definition of epidemic, endemic and pandemic along with examples … do surveillance and sampling … and at the end if you have time cover uses of epidemiology … it covers your basic epidemiology …
Viva questions for epidemiology ?
1. name epidemiological study designs ?
experimental, descriptive, case control, cohort, comparative cross sectional. ( just name them , dont classify them. Common MISTAKE)
2. what epidemiological study design is followed in your research project and why have you chosen it?
most of students or almost all of them follow descriptive study design, if you have followed any other please mention that … reason of chosing descriptive study design is that it is easier, does not have any special requirements , can be completed easily in due coarse of time
3 . differentiate between retrospective cohort study and case control study?
in cohort study we go from cause to disease … and first of all there is selection of exposed and unexposed subject.
while in case control study we go from disease to cause … and first of all there is selection of cases (diseased) and non diseased (controls) and they are asked about exposure of risk factor …
in retrospective cohort (disease has already occurred) … we go into history … and select EXPOSED and UNEXPOSED subjects from RECORDS and then follow them farwards in history up to appearance of DISEASE. so, here also we go from cause to disease and first select exposed and nonexposed… but in here disease has already occurred and we go through records …
4. what is nested case control study?
from an ongoing cohort study cases are taken and are followed as case control study , it is called nested case control study
5. what are the steps of cohort (or any other study can be chosen) study ? please refer to notes or text book
6. what are the disadvantages and advantages of cohort (or any other study can be chosen) study? please refer to notes or text book … Most often students forget the main disadvantage of cross sectional study, which is loss of temporal association.
7. what is the best study design? experimental study design
8. what is bias ? its types? what do you think about berkesonian bias ? park page69 20th edition.
9. what is the single most important disadvantage of cohort study ? Ethical Problems
10. what is the most important or ongoing cohort study ? The Framingham Heart Study
11. what is the difference between exposure and risk factor?
Risk Factor is a thing which increases the chances of getting a disease. While exposure does not itself causes disease when exposure and favorable environment combine they form risk factor and it causes disease.
12. what is the difference between cause and risk factor? Risk Factor has three types … it can be causative (eg smoking for lung cancer) or contributory (eg physical inactivity for Coronary Heart Disease ) or predictive ( illiteracy for perinatal mortality)
13. what is ecological study ? It is Analytical Study which has POPULATION as UNIT of study (others have INDIVIDUALS as UNIT of study)
14. what is matching? Park p68 2othedition
15. Differences between cohort and case control ? Park p75 2othedition
16. what is surveillance? its types ? what is sentinel surveillance? please see Surveillance lecture from downloads section
17. name the steps of epidemic investigation ? Park p118 20th edition
18. which two study designs are used in epidemic investigation? Descriptive (at step 5 & 6) and Case Control (at step 6 & 7) study design
19. What is incidence study design? ( by which study design we can find out incidence) Cohort Study Design
20. What is prevalence study design ? ( by which study design we can find out prevalence ) Cross sectional Study Design
21. Define sampling ? its types ? give an example of random sampling used in our social setup ? for definition and types refer to notes … eg is that of lottery system.
22. Types of Blinding ? Park p79 20th edition or see notes
23. difference between incidence and prevalence? mainly incidence is of new cases while prevalence is of existing cases (new plus old ) for more differences see notes
REMEMBER for generation of hypothesis we do Descriptive Study, while for testing hypothesis we do Analytical Studies ( cohort or case control or comparative cross sectional study), and for proving hypothesis we do experimental study.
COMMENTS and QUESTIONS are welcomed: But be patient for the ANSWERS . if there were NO COMMENTS and QUESTIONS the post will stop here… it wont continue… everyone needs a little bit of encouragement AND if you find any MISTAKES please let me know … i will be really glad … updated on 21/7/ 2011
Whom am I addressing?
basically this is for 4th year GMC students … i will be specific about teachers favourite test and viva questions … but any medical student can benefit from general guidelines about the subject …
Why me?
As being topper of class and obtaining 3rd position in KMU in 4th year … i think its my responsibility and duty to share my knowledge and study techniques and tips … so that my junior students should get more benefit in less time and i believe in sharing … knowledge spreads by sharing and sharing is caring …
i stood 2nd in pathology … Farhat was 1st in pathology both theory and viva … and i stood 1st in community both theory and viva … i would also like to take his advice into this post …
Dedication:
These guidelines are dedicated to my three friends in 4th year sami, nafees and jamshed. I dedicate them these guidelines because they discuss everything with me except Study. Nowadays they take ping pong classes from me but whenever i ask about studies they are very good at changing the subject. Best Wishes to them and all the 4th year.
Requests:
I request Farhat ullah Bettani and all my classfellows specially fawad, qaiser, shoaib and imran to include their inputs into these guidelines…
WHICH BOOKS TO STUDY :
these study tips are not an alternative to your course books… so study them …
1) Robbins ( Long / medium)
2) Dr. Shahzad Iqbal Volume 1 and 2 (for certain topics that are not in robbins and given in our exams such as investigations of diseases )
3) Zahid Jan compiled papers ( these are chapter wise and gives you very good idea about important questions) and also new pattern papers
NEW UPDATE: I have uploaded Zahid Jan papers on net for important questions of both pathology and community medicine on request of Harem at comment No. 4 … Zahid jan papers can be downloaded by clicking on Zahid Jan compiled papers present above or here.
UPDATED ON 27-06-2011
Basically it does not depend upon the book … but it depends upon the reader how he studies the book …
Some students try to use harsh mohan … i have not read it … liked robbins too much … Whenever you have difficulty in choosing a book … Always read same topic from both the books and then choose the book according to that topic …
Always try to use a single book .. you will be less confused … more focussed … more quick to learn …
Special pathology is like a sea … if you do not focus on topics, you will wander and be confused and at the end you will miss the important topics … and important topics are not few … there is a long list of topics and they repeat … so cover them first to be on safe side then study anything else … … your year will end but special pathology is so long it will not end …
you should do some chapters completely … like RBC, WBC, heart, Liver, Female Reproductive Tract, others are selective … buy Papers by Zahid jan … and consult from it for specific topics in lungs, male genital tract, breast, kidney etc … i will try to cover them in detail one by one…
Once you know the important questions … try to prepare them for annual exam … giving it a read is not enough… you must be clear about the headings … divide each question into headings in your mind like definition, causes, pathogenesis, classification, clinical features (less imp in patho) , morphology (most imp) macroscopic and microscopic, Diagnosis, Staging and grading in case of few tumors (not all tumors, but if for any tumor apply generalized staging and grading)
First Generalize the things , then make them specific… let me give you examples … most tumors are grey white in colour … remember only those who have specific colours … write grey white for the others … there are some general investigations which are done for all the tumors make a list of it then remember specific tumor markers and specific investigations for specific tumors… if you know the general features of benign and malignant tumors you can apply them to all the specific benign and malignant tumors … All the GIT lesions can be of three types Excavated (ulcer) , Exophytic (protruded) , or Flat … remember it generally for morphology of GIT tumors and lesions … it modifies in certain specific conditions … remember the specific conditions and it will be quite easy for you … but you may not always have the easy way sometimes you have to cram classifications and morphology … as we have done it you can also do it … so be confident
General Guidelines for Staging: REMEMBER STAGING is based on MACROSCOPIC FEATURES (GROSS FEATURES visible with naked eye)
Stage 1: it will always be limited to site of origin…
Stage 2: Spreads to adjacent areas but not upto anatomical boundary like lateral pelvic wall or diaphragm
Stage 3: Spreads upto anatomical boundary and may cross it.
Stage 4: Distant Metastasis
General Guidelines for Grading: REMEMBER GRADING is based on MICROSCOPIC FEATURES (visible with microscope)
Grade 1: Well Differenciated
Grade 2: Moderately Differenciated
Grade 3: Poorly Differenciated
UPDATED ON 23/06/2011
CHAPTERS:
RBC:
V.imp Level 1 Most Important both paper and viva point of view …
NORMAL ADULT REFERENCE RANGES;
Remember normal Adult reference ranges, DON’T forget to REMEMBER the UNITS.
Tip: Remember normal ranges of kumar, it will help you both in medicine and pathology.
MCV (mean corpuscular volume) = 80 – 96 fL
Anemia with less than 80 MCV is Microcytic Anemia.
Anemia with more than 96 MCV is Macrocytic Anemia.
Anemia with 80 – 96 MCV is Normocytic Anemia.
Remember Normal values and ranges of Hb, RBC, WBC, ESR, Retic Count and platelets. Normal range of Platelets is 150,000 – 400,000 / micro Litre. But Generally thrombocytopenia is considered when the level falls below 100,000 / micro Litre.( NOT BELOW 150). (viva Q)
In All HYPOCHROMIC Anemias MCH ( Mean corpuscular Hemoglobin) level is decreased.
In All HYPOCHROMIC Anemias MCHC ( Mean Corpuscular Hemoglobin Concentration) level is decreased except HEREDITARY SPHEROCYTOSIS (HS) and SICKLE CELL ANEMIA (SCA), in these diseases MCHC is raised. (Viva question).
Chrome stands for colour and colour of RBC is due to Hemoglobin, so it stands for the amount of hemoglobin. HYPERCHROMIC (more Hb) HYPOCHROMIC (less Hb) NORMOCHROMIC (normal Hb). All types of Anemias can occur.
I m discussing now HYPOCHROMIC ANEMIAS.
MCH is MASS of Hb per given red cell. It’s mass, hence its unit is pico gram.
MCHC is CONCENTRATION of Hb per VOLUME of packed cells. Its mass per Volume hence its unit is gm/dl. It’s a ratio between mass and volume.
i have made a video in order to explain the difference between MCH and MCHC … and the link is given below …
In All HYPOCHROMIC Anemias, MASS or content of Hb is DECREASED and volume is less decreased, except in Hereditary Spherocytosis and Sickle Cell Anemia, in which both MASS and VOLUME are decreased. Comparatively VOLUME is more decreased. So in HS and SCA, MCHC is INCREASED (because it is inversely proportional to volume). Volume is decreased due to dehydration of RBCs.
ESR depends upon level of fibrinogen and immunoglobulin. They are present in plasma and depend on level of plasma. Hence in Anemia less RBCs more plasma more fibrinogen and Immunoglobulin so more or increased ESR. In polycythemia more RBCs less plasma less ESR
RDW ( Red Cell Distribution Width ) is raised in Iron deficiency anemia but constant in thalassemia. Thalassemia all RBCs are of same size. In Iron deficiency Anemia RBCs are of different sizes (Anisocytosis). So in Iron deficiency Anemia, RDW is increased.
ANEMIA;
Definition of Anemia; Remember Dr. Ameen Jan’s Definition. Its Asked in Viva. Anemia is present when there is decreased level of Hb below the reference level for age and sex of individual. (Also it is in Kumar)
Classification of anemia very imp.
Remember both the classifications … According to Cause (blood loss, inc. destruction, dec. production) According to Morphology (Microcytic, Macrocytic, Normocytic)
Hemolysis is of three types …
1) Intra Vascular hemolysis ( inside the blood vessels can be due to trauma or toxins etc. )
2) Extra Vascular hemolysis ( At Spleen and Liver due to phagocytosis by Macrophages over there because of tight spaces and less deformability of RBCs ) RBC size 8 mm while splenic spaces are 3 mm wide … due to remarkable variabilitiy in shape … RBCs can pass through it … but when RBC lose membrane they lose this variability and they repture … so they are phagocytosed by macrophages over there. Liver macrophages are called Kupffer Cells…
3) Ineffective Erythropoises ( hemolysis of precursor red cells at bone marrow )
Remember JAUNDICE is HYPERBILIRUNINEMIA not hemoglobinemia.
RBCs only contain enzymes and no organelles like Mitochondria… and they get energy by anaerobic respiration (does not require oxygen) … one of the enzymes of RBCs, required for anaerobic respiration is lactate dehydrogenase … whenever there is hemolysis … repturing of rbcs its contents like lactate dehydrogenase will be released … in all types of hemolysis … hence raised lactate dehydrogenase is a marker of hemolysis but it is non-specific … is also present in many cells …
why does RBC get energy by anaerobic respiration ? this is nature’s perfect design … if RBC were able to get energy by aerobic respiration they would have utilized the oxygen they were carrying … so RBC carries oxygen but cannot utilize it hence it is a good carrier …
Vit B12 deficiency can be due to many causes like
1) Decreased Intake (inadequate diet, vegetarian {Vit B12 has animal sources only}]
2) Impaired Absorption
( a. Intrinsic Factor deficiency – problem lies at stomach… pernicious anemia (autoimmune gastritis), Gastrectomy (removal of stomach)
b. ileitis (problem at ileum )
c. bacterial overgrowth (small intestine)
d. malabsorption states (small intestine) etc )
3) increased demand
pregnancy, hyperthyroidism, chronic infection, cancer etc
Vitamin B12 deficiency has many causes, one of its cause is pernicious anemia. When autoimmune gastritis causes vitamin b12 deficiency, it is called pernicious anemia. it is common in western world so it is stressed in western books. in our setup dietary deficiency is more common.
REMEMBER the absorption sites…
Iron at Duodenum
Folic Acid at Jejunum
Vitamin B12 at Ileum
so whenever their is Malabsorption state (eg. celiac disease, spru ) in small intestine, there will be three types of Anemias…
Iron Deficiency Anemia ( Microcytic Hypochromic )
Folic Acid Deficiency Anemia (Macrocytic)
Vitamin B12 Deficiency Anemia (Macrocytic)
and Blood Film will have Dimorphic Picture (Two types of RBCs)
1) Microcytic
2) Macrocytic
TO BE CONTINUED … LAST UPDATED ON 27-06-2011
WBC:
It is one of most important chapters… I tried to read it a little differently which made it easier to understand … I will tell you how did I read it …
First of all you should have some core knowledge … you should know and understand some basic terms. Hematopoietic system has two cellular components …
Myeloid Series (it includes RBCs, platelets, Granulocytes and Monocytes) (simply All Blood Cells except Lymphocytes)
Lymphoid Series (it includes T and B Lymphocytes i.e. Agranulocytes )
We have differentiated them like that because they arise from different progenitor cells. Myeloid Series Cells arise from Common Myeloid Progenitor while Lymphoid Series Cells arise from Common Lymphoid Progenitor, you don’t believe me see for yourself :p open robbins and see the differentiation of blood cells (p591). Look at the picture. Identify the position of Stem Cell (it is a pluripotent cell), Multipotent Progenitor Cells , and MYELOBLAST ( a unipotent progenitor… note that it differentiates into neutrophil … I personally think its name should have been neutrophiloblast but it is not… it is named differently to confuse you basically it is a neutrophiloblast )
Remember a Pluripotent Stem Cell can differentiate into cell of ANY germ layer. Here Haematopoitic Stem Cell is a pluripotent Stem Cell, it can differentiate into both Myeloid and Lymphoid Series Cells. A defect in Pluripotent stem cell can affect both myeloid and lymphoid series.
Remember a Multipotent Stem cell can differentiate into a number of CLOSELY RELATED CELLS. Here Myeloid and Lymphoid progenitor cells are multipotent cells. A defect in Myeloid progenitor cell can only affect Myeloid Series Cells only. A defect in Lymphoid progenitor cell can affect T and B lymphocytes only. It will affect either one of the series not both the series.
MYELOID NEOPLASM:
After reading first few pages from long robbins, which has the above basic concept go to Myeloid Neoplasms (P620 LR 8th edition). (don’t read disorders of wbc now). Why? Because the above basic concept is used in Myeloid Neoplasms. They will become easier if you read them now.
Interestingly Myeloid Neoplasms can overlap one another … making it confusing … but if you try to remember the DIAGNOSTIC FEATURES you will always be able to label them correctly.
The pathogenesis of All Myeloid neoplasms is summarized in the first few paragraphs. Basically there is a transformation (defect) in one cell of bone marrow. The effect of that transformation depends upon two things.
Position of Transformed cell ( whether it is higher (pluripotent) or lower (Multipotent or unipotent) in the chain of blood cells formation)
Effect on differentiation of transformed cell ( whether it is inhibited or stimulated or stopped or defective ie which type of cells the transformed progenitor cell is going to form)
Now, you can appreciate the importance of position of Transformed (or defected) cell, if you have initial concept of Pluripotent and Multipotent stem cells. The above two point pathogenesis can be applied on any Myeloid neoplasms with little differences.
Myeloid Neoplasms can be of three types
Acute Myeloid Leukemias (AML)
Myelodysplastic Syndrome (MDS)
Myeloproliferative Disorders ( it includes Chronic Myeloid Leukemia(CML), polycythemia vera (PV), essential thrombocytosis(ET), primary myelofibrosis (PMF) )
Almost All are Multipotent stem cell disorders except Chronic Myeloid leukemia (CML), which is a Pluripotent Stem cell Disorder.
So All Myeloid Neoplasms can differentiate into one another, while CML being pluripotent not only differentiates into myeloid neoplasms but also into Lymphoid neoplasms.
Now lets make myeloid neoplasms simple.
AML is a MULTIPOTENT stem cell disorder (position of transformed cell) in which there is maturation ARREST (arrest means stoppage) ( it is effect on differentiation of transformed cell), which leads to accumulation of immature cells in the bone marrow ( its very logical that when differentiation(division) will stop, the progenitors cells (the dividing immature cells) will accumulate ).
Hence the diagnosis is simple as well, if you find at least 20% MYELOID BLASTS ( the dividing immature progenitor cells)(they can be any blast cells like myeloblast (blast cell of neutrophil), monoblast ( blast cell of monocyte) or any other myeloid series blast cell) in the BONE MARROW, label it as AML.
MDS is a MULTIPOTENT stem cell disorder (position of transformed cell) in which there is maturation DEFECT ( defective maturation means dysplastic differentiation ) ( it is effect on differentiation of transformed cell), which leads to dysplastic (abnormal) myeloid lineages in bone marrow.
Hence if you find bone marrow dysplasia of myeloid series cells, label it as MDS. As it is multipotent stem cell disorder, it can also transform to any myeloid neoplasm such as AML. If in MDS, the Myeloid blast cells equals to 20% or more it will be transformed to AML.
In all Myeloproliferative disorders, there is NO defective differentiation but the differentiation is STIMULATED (INCREASED), so normal mature blood cells are formed in increased amounts.
Myeloproliferative disorders have certain common features and same pathogenesis.
Pathogenesis is such as an enzyme (tyrosine kinase) gets mutated and activated. This mutated active enzyme causes proliferation and survival of bone marrow progenitor cells without need of growth factors. So increased number of mature blood cells are formed independent of growth factors.
CML is a pluripotent stem cell disorder characterized by Philadelphia chromosome (diagnostic feature). CML being pluripotent not only transforms into myeloid neoplasms (eg AML) but also into Lymphoid neoplasms (eg ALL).
In PV there is panmyelosis ( increased in production of all the myeloid cells but it is the increase in RBCs that causes all the clinical symptoms. Like all the Myeloprofilerative disorders the increase in RBC is independent of growth factor ( in this case which is erythropoietin). So in PV, there is increase in RBC level with LOW erythropoietin (diagnostic features). ( remember in Secondary Polycythemia erythropoietin level is high)
ET is characterized by thrombopoietin independent thrombocytosis.
PMF is characterized by obliterative marrow fibrosis (most imp), dysplastic megakaryocytes, leukoerythroblastosis and teardrop shaped red cells.
Study upto here. Now go to heading neoplastic proliferation of White blood cells and read lymphoid neoplasms as well.
Important Lymphoid neoplasms are Hodgkin Lymphoma, Burkitt’s Lymphoma and Multiple Myeloma. Read all of them but remember these three.
Before reading them you should have a clear concept of difference between Lymphoma and Leukemia. (V imp VIVA question)
There are three main differences.
Lymphoma is neoplastic proliferation of LYMPHOID series cells in lymph node
While Leukemia is neoplastic proliferation of HSC in bonemarrow (ie both lymphoid and myeloid series)
Lymphoma present as discrete LYMPHOID MASSES
While Leukemia does not.
Lymphoma mainly arise in LYMPHOID TISSUE such as lymph node but it can arise in any organ
While Leukemia arise in BONE MARROW or BLOOD only.
Now Classification of leukemia:
Leukemia
a) Acute Leukemia
i) AML
ii) ALL
b) Chronic Leukemia
i) Chronic Myeloproliferative Disorders
ii) Chronic Lymphoproliferative Disorders
Chronic Myeloproliferative disorders are CML, PV, PMF, ET.
Remember LEUKEMIA contains BOTH MYELOID and LYMPHOID neoplasms.
Now about WHO Classification of Lymphoid Neoplasms:
Try to remember it in the end of chapter… if you have given a read to chapter you will atleast remember the names of most of neoplasms… it has five subclasses… if you look closely basically they are three in no.
1- Precursor and peripheral B cell neoplasms
2- Precursor and peripheral T cell neoplasms
3- Hodgkin’s Lymphoma
All the precursor neoplasms have one subtype that is ALL.
Myeloid Neoplasms can be classified as;
1. AML
2. MDS
3. Myeloproliferative disorders ( CML, PV, PMF, ET )
Other Important viva questions are the following:
Difference between hodgkin and non hodgkin’s lymphomas,
Enumerate all Hodgkin’s lymphomas
What is RS cell and what are its types.
Diagnostic Findings of the above mentioned leukemias and lymphomas.
All the above questions are answered in my notes and they can be downloaded from downloads section or here.
At the end give a read to spleen and disorders of white cells like leukopenia and leukocytosis … sometimes asked in viva … ( i was asked in my stage viva about causes of neutropenia …)
Remember Splenomegally is just enlargement of spleen while Hypersplenism is enlargement of spleen along with pancytopenia.
Remember when the immature cells in bone marrow do not come to peripheral blood, it is called aleukemic leukemia or subleukemic leukemia. And when they come to peripheral blood, it is called leukoerythroblastic leukemia.
Dont forget to download the notes of WBC from downloads section or here .
KIDNEY:
if you do it properly … it is the most easiest chapter of pathology … if not , it will become your headache … lets make it simple …
You must have some core knowledge before starting this chapter …
Kidney diseases can be divided into 4 types depending upon anatomic components of kidney …(in other words it is classification of kidney diseases)
1. Glomerular diseases
2. Tubular diseases
3. Interstitial diseases
4. Blood Vessels diseases
Now we move towards clinical manifestations of renal diseases… its most imp part of this chapter … if you can grab this concept, this whole chapter will become easy to you …
you should know the difference between azotemia and uremia … (imp for viva)
Remember
1) Azotemia is BIOCHEMICAL ABNORMALITY only, characterized by elevation of Blood Urea Nitrogen and Creatinine levels.
2) In Azotemia, failure of renal excretory function occurs only.
3) In Azotemia, there are no secondary involvements.
Azotemia can be due to pre-renal, renal and post-renal causes.
Remember
1) Uremia is BIOCHEMICAL ABNORMALITY plus it has CLINICAL SIGN and SYMPTOMS. ( in other words when azotemic patients develop sign n symptoms, he is called uremic)
2) In Uremia, failure of renal excretory function occurs along with ENDOCRINE and METABOLIC Abnormalities.
3) In Uremia, there are secondary involvements of GIT, peripheral nerves and Heart.
Remember NePhROtic Syndrome is characterized by
1. PROteinuria > 3.5gm/day (NePhROtic has PRO in it) (it will lead to)
2. HYPOalbuminemia (this will decrease oncotic pressure and it will lead to)
3. severe Edema
4. Hyperlipidema (this will lead to)
5. Lipiduria
so all the examples of nephrotic syndrome will have the above features…
Remember Nephritic Syndrome is characterized by
1. Hematuria
2. Proteinuria (but proteinuria is more pronounced in nePhROtic syndrome)
3. Hypertension
APGN (Acute Proliferative Glomerulonephritis) and RPGN (Rapidly Progressive Glomerulonephritis) are the examples of Nephritic syndrome, almost all other glomerular diseases are examples of Nephrotic syndrome …
Now you can write about clinical features of glomerular diseases on the basis of nephritic and nephrotic syndrome…
Acute Renal Failure is characterized by oliguria/anuria plus azotemia.
Chronic Renal Failure is characterized by prolonged sign and symptoms of uremia.
Remember the classification of Glomerular Diseases, its important.
You should know about the histological alterations which will help you in remembering the morphology…
4 basic histological alterations are;
1. Hypercellularity (due to 1. cellular proliferation, 2. leukocyte infiltration, 3. Crescent Formation … basically it is the morphology of APGN … remember it from the word Proliferative in APGN)
2. BM Thickening
3. Hyalinosis
4. Sclerosis
Remember Diffuse means all Glomeruli involvement while Focal means only proportion of glomeruli are involved.
Remember Global means involvement of entire single glomerulus while Segmental means part of each glomerulus is involved.
In APGN, there is Diffuse and Global Hypercellularity …
Above is the core knowledge … now you can start remembering the diseases ..
You should remember the Glomerular diseases under the following headings like light microscopic picture, electron microscopic picture and Immunoflourescence…
Charts of Glomerular diseases made by Bilal bhai our senior and topper can be downloaded from the following address … i have added some info into it… Flow Chart of mechanism of Glomerular Diseases made by me can be downloaded along with it …
Charts for Glomerular Diseases
Other imp questions of this chapter are; Acute Tubular Necrosis, Pyelonephritis (Acute and Chronic), Urinary Tract Obstruction, Urolithiasis, and Tumors of Kidney… for details of imp questions see papers …
LAST UPDATED ON 07-11-2011
COMMENTS and QUESTIONS are welcomed: But be patient for the ANSWERS . if there were NO COMMENTS and QUESTIONS the post will stop here… it wont continue… everyone needs a little bit of encouragement
AND if you find any MISTAKES please let me know … i will be really glad …
A woman was waiting at an airport one night
With several long hours before her flight.
She hunted for a book in the airport shop
Bought a bag of cookies and found a place to drop.
She was engrossed in her book but happened to see
That the man beside her as bold as could be
Grabbed a cookie or two from the bag between
Which she tried to ignore to avoid a scene.
She munched cookies and watched the clock
As the gutsy cookie thief diminished her stock.
She was getting more irritated as the minutes ticked by
Thinking if I wasn’t so nice I’d blacken his eye.
With each cookie she took, he took one too.
When only one was left she wondered what he’d do.
With a smile on his face and a nervous laugh
He took the last cookie and broke it in half.
He offered her half as he ate the other.
She snatched it from him and thought, “Oh brother!
This guy has some nerve and he’s also rude.
Why he didn’t even show any gratitude.”
She had never known when she had been so galled
And sighed with relief when her flight was called.
She gathered her belongings and headed to the gate
Refusing to look back at that thieving ingrate.
She boarded the plane and sank in her seat.
Then sought her book which was almost complete.
As she reached in her baggage she gasped with surprise.
There was her bag of cookies in front of her eyes.
If mine are here, she moaned with despair
Then the others were his and he tried to share.
Too late to apologize she realized with grief
That she was the rude one, the ingrate, the thief.
A son and his father were walking on the mountains.
Suddenly, the son falls, hurts himself and screams:
“AAAhhhhhhhhhhh!!!”
To his surprise, he hears the voice repeating,
somewhere in the mountain: “AAAhhhhhhhhhhh!!!”
Curious, he yells: “Who are you?”
He receives the answer: “Who are you?”
Angered at the response, he screams: “Coward!”
He receives the answer: “Coward!”
He looks to his father and asks: “What’s going on?”
The father smiles and says: “My son, pay attention.”
And then he screams to the mountain: “I admire you!”
The voice answers: “I admire you!”
Again the man screams: “You are a champion!”
The voice answers: “You are a champion!”
The boy is surprised, but does not understand.
Then the father explains: “People call this ECHO,
but really this is LIFE.
It gives you back everything you say or do.
Our life is simply a reflection of our actions.
If you want more love in the world, create more love in your heart.
If you want more competence in your team, improve your competence.
This relationship applies to everything, in all aspects of life;
Life will give you back everything you have given to it.
YOUR LIFE IS NOT A COINCIDENCE. IT’S A REFLECTION OF YOU!
I read this story about last words of Alexander. I learned some lessons from it. I would like to share it with you…
Alexander, after conquering many kingdoms, was returning home. On the way, he fell ill and it took him to his death bed. With death staring him in his face, Alexander realized how his conquests, his great army, his sharp sword and all his wealth were of no consequence.
He now longed to reach home to see his mother’s face and bid her his last adieu. But, he had to accept the fact that his sinking health would not permit Him to reach his distant homeland. So, the mighty conqueror lay prostrate and pale, helplessly waiting to breathe his last.
He called his generals and said, “I will depart from this world soon, I have three wishes, please carry them out without fail.”
With tears flowing down their cheeks, the generals agreed to abide by their king’s last wishes.
“My first desire is that”, said Alexander,
“My physicians alone must” carry my coffin.”
After a pause, he continued, “Secondly, I desire that when my coffin is being carried to the grave, the path leading to the graveyard be strewn with gold, silver and precious stones which I have collected in my treasury”.
The king felt exhausted after saying this. He took a minute’s rest and continued. “My third and last wish is that both my hands be kept dangling out of my coffin”.
The people who had gathered there wondered at the king’s strange wishes. But no one dared bring the question to their lips.. Alexander’s favorite general kissed his hand and pressed them to his heart. “O king, we assure you that your wishes will all be fulfilled. But tell us why do you make such strange wishes?”
At this Alexander took a deep breath and said: “I would like the world to know of the three lessons I have just learned.
Lessons to learn from last 3 wishes of King Alexander…
I want my physicians to carry my coffin because people should realize that no doctor can really cure any body. They are powerless and cannot save a person from the clutches of death. So let not people take life for granted.
The second wish of strewing gold, silver and other riches on the way to the graveyard is to tell People that not even a fraction of gold will come with me. I spent all my life earning riches but cannot take anything with me. Let people realize that it is a sheer waste of time to chase wealth.
And about my third wish of having my hands dangling out of the coffin, I wish people to know that I came empty handed into this world and empty handed I go out of this world”.
With these words, the king closed his eyes. Soon he let death conquer him and breathed his last. . . . LESSON TO LEARN
Remember, your good health is in your own hands,
look after it.
Wealth is only meaningful if you can enjoy while
you are still alive and kicking.
What you do for yourself dies with you but what you
The most important people in a person’s life are his parents and siblings. These are the relationships chosen by Allah. So, we should respect them accordingly. The second most important people in a person’s life are his friends. These are the relationships chosen by us for ourselves. But we can get wrong. Sometimes we make wrong choices and we realize that later on. It is important to have good friends. But it is more important to not to loose good friends. So keep your good friends close to you and hold them tight. When we let people get close to us, then we have expectations from them and if they do not act according to our expectations then we get hurt. So, when you let people too close to you, then you are giving them chance to hurt you and make you cry. But a real friend won’t let you cry. “Don’t cry because those who made you cry don’t deserve your tears and those who deserve them won’t let you cry.”
So, it is important to choose your friend carefully. I won’t say don’t let people come close to you. Don’t alienate from people. Love, live and share with people. But before letting them close, judge and understand them. Don’t Test them judge them. Judge how they introduce you to other people? How much they care about you? How much they respect you? How they say your name? Try to understand their feelings, emotions and aspirations. If you find that they will help, encourage and stand by you. Then trust them and let them into your lives and make a life long relationship. Celebrate little moments, like birthdays, results and weekends. Find happiness in each moment. Live each moment. Make good memories that you will remember for life and will tell your grandsons.
Don’t loose your friends. Keep them close to your heart, when you feel you are loosing contact with your friends, then throw a party and have a get together. Make sure you are a part of their lives. Always listen to your friends and stand by them. When you hear some bad thing about your friend, don’t believe it blindly, go to your friend and listen to their part of story. A good friend will always listen to you and trust you.
These are my thoughts and they may be wrong. If you think they are wrong please let me know. Comments are welcomed. May you have many friends in your life and may they glitter your life like stars in the sky…
May Allah flood your life with happiness, your heart with love, your soul with spirit and your mind with wisdom on this occasion, wishing u a very Happy Eid Mubarak!
I read this story on the net … and i felt like sharing… so i am sharing it with all of you…
My mother used to ask me what is the most important part of the body.
Through the years I would take a guess at what I thought was the correct answer. When I was young, I thought sound was very important to us as humans,
so I said: My ears mummy
she said: No, many people are deaf, but you keep thinking about it and I will ask you again soon.
Several years passed before she asked me again. Since making my first attempt, I had thought about the correct answer.
So this time I told her: Mummy, Sight is very important to everybody, so it must be our eyes.
She looked at me and told me: You are learning fast, but the answer is not correct because there are many people who are blind.
Stumped again, I continue my quest for knowledge and over the years, mother asked me a couple more times and always her answer was:
No, but you are getting smarter every year, my child.
Then last year my grandpa died. Everybody was hurt. Everybody was crying. Even my father cried. I remember that especially because it was only the second time I saw him cry.
My mom looked at me when it was our turn to say our final good-bye to
grandpa.
She asked me: Do you know the most important part of body yet, my dear?
I was shocked when she asked me this now. I always thought this was a game between her and me.
She saw the confusion on my face and told me:
This question is very important. It shows that you have really lived in your life. For every body part that you gave me in the past, I have told you were wrong and I have given you an example why. But today is the day you need to learn this important lesson.
She looked down at me as only a mother can. I saw her eyes well up with tears.
she said:
My dear ,the most important body part is your shoulder
I asked :
Is it because it holds up my head ?
she replied:
No, it is because it can hold the head of a friend or a loved one when they cry. Every body needs a shoulder in life, my dear. I only hope that you have enough love and friends that you will always have a shoulder to cry on when you need it.
Then and there I knew the most important body part was not a selfish one.
It is sympathetic to the pain of others.
People will forget what you said, people will forget what you did. But people will never forget how you made them feel.
Blessed be the sacred land,
Happy be the bounteous realm,
Symbol of high resolve, Land of Pakistan.
Blessed be thou citadel of faith.
The Order of this Sacred Land
Is the might of the brotherhood of the people.
May the nation, the country, and the State
Shine in glory everlasting.
Blessed be the goal of our ambition.
This flag of the Crescent and the Star
Leads the way to progress and perfection,
Interpreter of our past, glory of our present,
Inspiration of our future,
Symbol of Almighty’s protection.
its fun when we are kids… we make mistakes and no one cares… and we learn from mistakes … but when we grow up… everyone becomes so critical about our mistakes… then we try to not to make any mistake rather than learning from our mistakes… this is a negative approach…
the best way to learn is to learn from your own mistakes…
so dont be afraid of making mistakes because you will learn from your mistakes. Secondly, dont repeat your mistakes. This is important. Make mistakes but accept them and try not to make them again. That’s how you will learn.
Acceptance of one’s mistakes is important. I have seen many people who do not try to see their own mistakes when they fail. If you wont accept your mistakes, you wont count them as your mistakes and you wont correct them.
So, i wish that you always make new mistakes, and learn from your each mistake made. Also make sure to write comments because it makes me correct my mistakes…
I read this story on the net … and i felt like sharing… so i am sharing it with all of you…
Blessed be the sacred land,
its fun when we are kids… we make mistakes and no one cares… and we learn from mistakes … but when we grow up… everyone becomes so critical about our mistakes… then we try to not to make any mistake rather than learning from our mistakes… this is a negative approach…
