On the Cambridge Medical Course, pathology is an absolute beast of a subject with a massive syllabus, comprising the following topics:
* HISTOPATHOLOGY – According to the local definition, this subject which spans pretty much all of medicine except huge detail on treatment, focusing on disease pathogenesis and microscopic/macroscopic morphology.
* CHEMICAL BIOLOGY – a subject that mainly focuses on investigations, but also diseases characterised by a particular measurable imbalance in the body.
* MEDICAL MICROBIOLOGY – focuses on microorganisms causing disease, the infectious diseases themselves and their investigation and treatment.
* CLINICAL IMMUNOLOGY – spans diseases relating to autoimmune processes or states of immunodeficiency.
* HAEMATOLOGY – covers diseases of the blood and bone marrow such as polycythaemias and cytopenias, malignant diseases, clotting disorders, transfusion medicine and investigations relating to blood and bone marrow.
* MEDICAL GENETICS – focuses on genetic disorders and their investigation.
This page contains general information on how to tackle the pathology course, for actual course content and further information please see the separate pages for sub-topics listed above.
How to go about path and fit in your rotations
CLICK TO EXPAND
In my opinion the solution is to start as early as you can, and to match your pathology revision with the specialties you are rotating through, in order to make the revision as relevant as possible. Here is how I tried to match things:
* Histopathology - paediatric (and maternal) pathology, reticulo-endothelial system
* Chemical pathology - (pregnancy,) foetus and neonate, inborn errors of metabolism
* Medical genetics
OBSTETRICS AND GYNAECOLOGY
* Histopathology - female genital pathology, (paediatric and) maternal pathology
* Chemical pathology - pregnancy(, foetus and neonate)
* Histopathology - musculo-skeletal pathology, nervous system
* Clinical immunology
* Histopathology - male urogenital tract, breast and tumours during ONCOLOGY, heart, blood vessels and pulmonary pathology for CARDIOPULMONARY MEDICINE (=the Papworth placement)
* Chemical pathology - tumour markers for ONCOLOGY, acid-base balance and serum proteins / clinical enzymology for CARDIOPULMONARY MEDICINE
* Medical microbiology - INFECTIOUS DISEASE PLACEMENT
* This is quite an ambitious plan for the MAD placement, so either try to get started ahead of time or be prepared to continue working on these topics afterwards.
WHAT IS LEFT OVER
Trying to arrange things like this, you are left with the following:
* Histopathology - GI tract, liver, biliary tree and pancreas, endocrine pathology
* Chemical pathology - electrolytes, renal, liver, lipids and GI, endocrinology, toxicology and emergencies and intensive care.
Of course, you can just work through each topic one by one - here's an estimate of how long it may take you:
* Histopathology - takes by far the most amount of time, so start early. I'd say unless you are some kind of genius, plan a few weeks to get through everything.
* Chemical pathology - either work through alongside your histopathology or do in one go. I did the latter and it took me about two weeks to get through it.
* Medical microbiology - Can be a LOT of work if you want to make your own notes from scratch. It did that and it took about two weeks.
* Haematology - Easily fitted into a low-intensity placement such as paeds, but may/will need revisiting as some diseases can be quite complicated (e.g. the lymphomas).
* Clinical immunology - Takes only a few days and there is some overlap with the histopatholgy syllabus.
* Medical genetics - Took me a day or two, so easy to tick off.
Which books to use
* Histopathology - As a starting point and scaffold for each disease named in the syllabus, I highly recommend the Oxford Handbook of Clinical Pathology. If you're the type of person not wanting to make notes, this book can be a substitute. For more detail, I worked mainly with Robbins Basic Pathology, switching to Robbins and Coltran's Pathologic Basis of Disease for the important topics. They are quite wordy textbooks, but I got used to working with them. I also used Xiu Pathology Crash Course but liked and needed it less and less as the year went on. Useful as always is the Oxford Handbook of Clinical Medicine and Kumar and Clark, either as the full or the essentials version.
To fill time during commutes, runs or the gym and still learn some path, make sure to get your hands on Goljan's Pathology lectures in audio format. They are excellent, better than any podcast you find on the medportal. E-mail me if you have trouble getting your hands on them.
* Chemical Pathology - Initially, I found it hard to find the right book for this topic. I started with the Illustrated Colour Text in Clinical Biochemistry, but that was not detailed enough to tick off every point in the syllabus. I then used Marshall Clinical Chemistry and Beckett Lecture Notes in Clinical Biochemistry to expand my knowledge. Even though the overall information is pretty similar in both books, I sometimes found one chapter better in one than the other, so perhaps it's worth getting both out of the library. Towards the end of the year, I bought the Oxford Handbook of Clinical and Laboratory Diagnosis, a book that I wished I had bought earlier in the year, because it is less wordy and neatly lists loads of investigations and links it to their clinical application. It also has a section listing investigations for particular presenting symptoms.
* Medical Microbiology - MM was by far the hardest topic for which to find the right book. My advice is to start with the podcasts on Medportal and then expand with the following: Medical Microbiology at a Glance or your pre-clinical pathology notes if you still have them, followed by Lecture Notes in Medical Microbiology and Infection. You should also absolutely include the BNF, even if you don't use any of the books I just mentioned. Make sure you work through the introduction of chapter 5 for the antibiotics part of MM. The Oxford Handbook of Clinical Medicine is of course also in the mix, especially regarding infectious diseases. Finally, use Dr Carmichael's handout from the various symposia and the infectious diseases placement - they are very useful.
* Clinical Immunology - For this topic, I had purchased Lecture Notes in Immunology, but found that I did not use it very much. Instead, I used the same books as listed under Histopathology.
* Haematology - I started with Haematology at a Glance, which I still recommend, but unfortunately it is not detailed enough. Therefore I've supplemented with Robbins Basic Pathology, sometimes even Robbin and Coltran Pathologic Basis of Disease (e.g. for lymphoma). For brief but good overviews, I used
Oxford Handbook of Clinical Pathology. Finally, don't forget the
Oxford Handbook of Clinical Medicine.
* Medical Genetics - This is the only topic where you don't really need a book, just stick to the lectures and revisit some pre-clinical lectures on genetics and biochemistry.
* Revision - For MCQ's, try Robbins and Coltran Review of Pathology. For the practical exam, try Robbins and Coltran Atlas of Pathology in order to become familiar with gross pathological specimen. I think I worked through this entire book and even enjoyed it! There are also useful flashcards with histopathology and cases, again by Robbins or more case-based by Lange. For Clinical Biochemistry revision, I used Murphy Case Studies in Clinical Biochemistry, a book that I enjoyed reading and can only recommend, even though it was perhaps (unfortunately!) less relevant to the actual practical exam.
* By the way, in case you download my pathology notes on the pages of the various sub-topics, I have cited the books and resources I used for each particular chapter, so that will give you a much more detailed idea of any references that may be of use.
How to use the resources on medportal
The podcasts are organised by placement or by pathology sub-topic (e.g. haematology or medical microbiology). Definitely work through the medical microbiology podcasts, I think they are a good starting point for what's asked for in the syllabus. For the rest of the many podcasts available, it is really hard to recommend with certainty whether to use them or not. Having worked through them all in an enormous effort, I don't feel like it was of much benefit, but then again who knows what would have happened had I not. Therefore I'd say use them for rough guidance, but don't base your notes on them, it's much more useful to spend the majority of your time working with a good book while going through the syllabus. Read more on which podcasts are useful on the various specialty pages.
Furthermore, an incomplete set of pathology related lectures from R&I weeks will be uploaded to the medportal at unforeseeable times. They either pop up under the R&I subsites or the pathology sites, and locating them can be a challenge. Take a look at the R&I week section for more information on which lectures are particularly useful.
Finally, there is a list of ~50 case studies showing macroscopic pathology accompanied by questions. Definitely work with these in preparation for the practical exam.
How to prepare for the exam
For the MCQ exam, it's good to have gone through plenty of cases, making a diagnosis based on a short case summary. Furthermore, you obviously need to know the defining pathological features of the diseases in the syllabus. Know the buzz-words for the various diseases, mostly to do with histology, e.g. Auer rods, Charcot-Leyden crystals, Tamm-Horsfall protein and so on. Never stop paying attention when an odd syndrome comes up, for example von-Hippel-Lindau disease. Know which antibiotic to use for infections with particular organisms.
Revisit your 2nd year pre-clinical pathology notes, for example regarding what type of vaccine is used for which particular infectious disease. The syllabus states that pathology is more than just being able to list the causes of particular symptoms/diseases but obviously that's one important aspect of what you need to be able to do.
For the practical exam, know how to interpret a full blood count as almost every case starts with one. Be able to recognise features of disease on gross pathological specimen. Know which investigations are necessary in which case and why, and how they are carried out. Know which pattern of results indicates which disease and be able to make a detailed differential diagnosis. Be able to add more detail to your answer than what you initially think is the main point of the question, so you can get as many points as possible.
Also, I'd still take a look at the past few year's essay questions as writing the essays was a very good exercise. For your notes, stick to the format of definition, epidemiology, aetiology and risk factors, pathogenesis, macroscopic and microscopic features, clinical features, investigations, treatment (not in great detail, that's for the final year!) and prognosis. For cancer, staging and routes of spread area also useful to include.
I'll update this section as soon as I have more detailed info, in the meantime feel free to e-mail with any questions.