- tumour nomenclature and classification;
- benign and malignant behaviour;
- molecular mechanisms of carcinogenesis;
- oncogenes and tumour-suppressor genes;
- invasion and metastasis;
- grading and staging;
- paraneoplastic syndromes;
- biopsy and cytological diagnosis;
- screening and tumour markers.
A particularly important distinction is:
- Grade reflects differentiation and biological aggressiveness.
- Stage reflects the anatomical extent of disease.
### 1.6 Clinicopathological correlation
Students integrate:
> Symptoms and signs + laboratory findings + imaging + morphology + relevant molecular findings → diagnosis, prognosis and complications
The student should be able to recognise a clinical syndrome, explain its pathological basis, predict the expected findings and anticipate its progression.
### 1.7 Practical and professional competence
Pathology also develops competence in:
- specimen collection and preservation;
- appropriate laboratory request and documentation;
- blood-smear preparation;
- urine examination;
- gross-specimen examination;
- microscopy;
- interpretation of pathology reports;
- recognition of critical results;
- appropriate investigation selection;
- confidentiality;
- professional handling of patient material.
### What Pathology should ultimately enable
An MBBS student should develop the ability to:
> Explain the mechanism of disease, recognise its structural and functional expression, interpret relevant investigations, formulate a differential diagnosis, and anticipate complications and prognosis.
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## 2. Microbiology: Establishing Infectious Causes and Preventing Infection
### Central purpose
Microbiology explains infectious agents, host-microbe interactions, laboratory diagnosis, antimicrobial resistance, infection prevention and public-health measures.
Microbiology helps the student answer four questions:
1. Could an infectious agent explain the illness?
2. Which agent is most likely?
3. What specimen and test can establish the cause?
4. How should resistance, transmission and prevention be addressed?
### 2.1 Infectious agents and disease
Students study medically important:
- bacteria;
- viruses;
- fungi;
- protozoa;
- helminths;
- prions;
- other clinically relevant infectious agents.
A clinically useful framework is:
> Agent → reservoir and transmission → virulence factors and pathogenesis → clinical syndrome → specimen → diagnosis → treatment implications → prevention
This prevents organism-based learning from becoming an unrelated collection of names and facts.
### 2.2 Host-microbe interaction
Students learn to distinguish:
- contamination;
- colonisation;
- carriage;
- infection;
- invasive disease;
- toxin-mediated disease;
- opportunistic infection.
The mechanisms studied include:
- adhesion;
- invasion;
- toxin production;
- capsule formation;
- intracellular survival;
- biofilm formation;
- immune evasion;
- effects of normal microbiota;
- host immune responses;
- immune-mediated complications.
The essential question is not simply whether an organism is present. The student must determine whether its presence represents clinically significant disease.
### 2.3 Specimen selection and collection
Microbiological diagnosis begins before the specimen reaches the laboratory.
Students learn to select, collect and transport:
- blood;
- urine;
- respiratory specimens;
- cerebrospinal fluid;
- stool;
- wound aspirates;
- tissue;
- genital specimens;
- skin, hair and nail samples;
- specimens for serology;
- specimens for molecular testing.
Diagnostic quality depends on:
- specimen type;
- timing;
- volume;
- collection technique;
- contamination control;
- transport conditions;
- prior antimicrobial treatment;
- acceptance and rejection criteria.
An accurate test performed on an inappropriate specimen can still produce a misleading conclusion.
### 2.4 Laboratory diagnosis
Students learn the principles and interpretation of: