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Sunday, July 24, 2011

Pathology - 4th Term - **updated again** example question added

This article pre-cedes this article:
For Pathology in 4th Term, you EXPLICITLY need 2 resources: your notes + the LARGE "daddy" Robbins Basis of Disease (the one with the purple cover). 

Let me clarify why people prefer Baby Robbins: Basic Pathology in the next two paragraphs. If you need a book in your hand when you study, get Robbins Basic Pathology (baby robbins). Trust me, you don't want to carry around this big guy, its huge. That' mainly why people prefer small robbins. BUT, if you prefer PDF textbooks, it's a no brainer. Even if you don't, it would make more sense to get Daddy Robbins for the GOOD reasons explained later.

Big Daddy Robbins is what the pathology department uses. Go meet with Dr. B. There's stacks of this book sitting in his office. Even if you study with Baby Robbins, many people prefer the Big Robbins for your slides. Get a digital copy, and use Control + F to quickly scan the text for topics, to do your slides Quickly, otherwise you'll spend too much time. Its +1400 pages so this is really the only way to do it. Little "baby" Robbins is good as a readable text but will occasionall tends to miss out on extra important details for fully understanding concepts. Things in itallics in Big Robbins will be used for exams,  I notice they pop up here and there verbatim, moreso on the 1st midterm exam than the others. In addition, many pictures in Big Daddy show up in your lab module slides, as well as exams. All the details you need are in there. Thirdly, graphs and tables in Big Robbins are useful and pertinent to the lecture material, some of which are in little Robbins but not all of them. 

How to get a digital copy: Goto www.filestube.com and search for Robbins Basis of Disease or ask around for digital copies. For those of you with mac's, you may need to download a .CHW file viewing software. Just do a google search for ".chw mac viewer" and download the free software. There's also an ipad app, CHW+ lite, its free, but you cant quickly search the whole book for keywords like on a computer.

Read the notes in and out. Make your own questions and associations, making sure to re-itterate medical terms in common terms. Cue-words are oftentimes blatantly not used so that you can recognize what is being referred to using descriptive language. Be aware of how to verbally describe everything, especially histology. Instead of "psammoma bodies", which clues you into 4 specific cancers... you could be given "concentric eosinophillic calcifications". Hence, you need to know what things look like (so look at pictures!!)

**update - I would highly recommended the Sukumbi Slides if you can get a hold of them. They help you along with the correct type of thought process you need in this class.

THIS IS ALL YOU NEED. I swear. I know you'll get sucked into using outside stuff so, that's why I included the rest... if you want to not hear it atleast read this article for specific strategy suggestions:
OK, so for those that insist on using outside sources:

1st) above all else, like I mentioned in an earlier post, BE FAMILIAR with everything. Keep it simple, you have a LOT of information to learn. The last thing you want to do is waste your time stumbling through 12 resources looking for something or doing hours of questions that will inevitably not help you on the exam. Check out ALL these resources early, know what they contain and if they will be helpful to you, and then build your priorities. When you're in a battle, you want to know exactly where to reach for your gun, get it? Don't get lost in space, remember Robbins Textbook is #2 and lecture notes are #1.

Okay, so for the list of other sources you can use with concrete information. I reccommend Utah's WebPath, the visual tutorials to learn the material, and the examination (picture quiz + MCQ) sections for questions, along with the 2010 Kaplan Videos. First Aid is always a good idea to keep taking notes in as well, and is a good summary to make sure you aren't missing something. Don't go out of your way much more than this. DJ3 I REALLY LIKE. It does a great job organizing some of the information and is a nice review sometimes if you have time, You should look at this website atleast once because the way the information is on this site is how it should be in your notes, but isn't. Emedicine is a fantastic and reliable source as well, divided into logical presentation, causes, associations/prognosis, treatment, etc. Pathconsult is great for those verbal descriptions from gross to microscopic appearances, as well as Differential Diagnosis. Goljan is great for commonly confusing concepts and neat associations you may have missed. He brings in a lot of physiology and biochemistry as well as microbiology, which is great especially as you take Microbiology simultaneously with Pathology and it all starts to blurr together. Anyway, check out these guys.

KEEP IN MIND: some resources will be helpful LATER in the class (after MT1), so don't look at these in the beginning, deem them useless, and never go back to them again. You're shooting yourself in the foot. The class changes dramatically after MT1, and you need to re-evaluate which resources you want to be using during that time. (example question below is in NO way indicative of exam 1 from what I can recall)... correct me if im wrong.

The reason why I recommend Kaplan Videos, First Aid, and WebPath, is because they stay moderately useful during the entire course. First aid contains a lot of useful info for microbiology, and Goljan does a good job integrating the two like I said, so these will be helpful during the 1st and 2nd parts of path course. The last 3rd of the Path course, you will be done with Micro, and Goljan becomes less helpful. Researching things into detail is better (robbins primarily), but you can get extra insight with pathConsult, histological pictures with SurgPath4U and Webpathology.
  • First Aid 2011 - your holy Bible
  • Kaplan Videos + Qbank***
  • Goljan's Audio Lectures
  • Utah WebPath ***includes lots of great MCQ
  • Webpathology
  • SurgPath4U
  • PathCONSULT  is no longer available for free - only through paid subscription
  • eMedicine
  • D3J - this is actually quite good organized material, but you have to reference the notes so you don't learn extra stuff that wasn't presented in class. 

*****ADDITION****** MY EXAMPLE QUESTION using the renal section at end of the course:
This is not to scare you, and please read the other article about strategies for this Class!! 
I just wanted to try to explain why the questions you choose to do and the material you learn from are more important than doing questions that emulate the real exam (which is incredibly difficult to find).  

1)      A 10-year-old girl is brought to the physician because of increasing lethargy and passing dark-coloured urine for the past week. She had a sore throat two weeks prior to this. On physical examination she is afebrile with blood pressure 140/90 mm Hg. Laboratory studies show her serum creatinine is 2.8 mg/dL and urea nitrogen 24 mg/dL. Urinalysis shows 2+ blood, 1+ protein, no glucose, and no ketones. Microscopic urinalysis shows dysmorphic RBC's. A renal biopsy is performed and on microscopic examination shows glomerular hypercellularity, with PMNs present. Electron microscopy shows subepithelial electron dense "humps". Which of the following laboratory test findings is most likely to be present in this girl?
A)     Elevated serum glucose
B)      Antibody to double stranded DNA
C)      Antiglomerular basement membrane antibody
D)     Positive C3 nephrogenic factor
E)      Elevated antistreptolysin O titer

*** You have to know quite a lot of information to be able to... listen... NOT answer this question wrong. However, you only need to know 2 words in order to answer this question correctly. Once you have done the notes through and through, and thoroughly reviewed each disease with First Aid and Kaplan, understood what things look like, why they are measured, and what they are associated with, and enough "EASY" questions such as , Webpath, Qbanks, robbins rapid review, and other... you will have accumulated this knowledge in order to AVOID WRONG ANSWERS and dissect a Path Exam question like this (as well as Pathophys questions in 5th term, and USMLE Questions on your big day).
**What do I mean? 
**You have to understand WHY each piece of information is being given, whether or not you should give it weight towards being something sensitive (applicable to many disesases), or something specific (to a limited few diseases). The specific pieces of information are what you want, because all the other information therefore doesn't matter, and you can quickly narrow down your differential diagnosis (which is sometimes asked for with a "most likely" question). Who cares how old, what gender, or what symptoms this patient is having in this question, because you know they recently had an infection (1) and have "subepithelial" deposits (2). You'll learn that's enough to answer it. E is the answer: associated with post-streptococcal glomerulonephritis. Why? because sub-epithelial humps occur commonly in 2  or 3 conditions. Now you're pretty much at a 50/50, and just need to know some basic facts about 2 diseases instead of pulling your hair out at the limitless possibilities.
**BUT, im not saying the age, gender, or symptoms, etc are not importnat!! They may, and WILL be the SPECIFIC  information required to answer other questions!!  They will be. When are certain peices of information Specific and when are they not??! You must know when to pay attention to what, and this will come with practice and time. 
So knowing this, when you study, you can ask yourself, oh.. hmm.. what OTHER diseases have this risk factor, what OTHER diseases have this lab value, or this histology, or this symptom? Now, you are building the knowledge you need to take 100 words and turn it into a very short list of possibilities. And you will find out, this process is INCREDIBLY time consuming, hence the horror stories of 4th term. Its a lot of work guys+gals. At some point you knew this was going to happen. 
******Please take a read through the other Pathology Suggestions Article, you'll find it Helpful, and I don't want people thinking the early parts of this course are way like this. 

For additional Questions, This next resource is VERY good, although it helps you learn the material, it does not prepare you for the long vinettes on the 2nd and 3rd Pathology Midterms.

Robbins Review of Pathology - ***QUESTION BOOK*** the red one  ----->
Rapid Review Pathology - great review book                           
Robbins Atlas - Really good with visuals and short captions - didn't have time to look long at this but when i glanced at it, looked to be quite in tune with the class.


  1. Thank you, thank you, thank you!

  2. How do the questions on Robbins Review of Pathology compare to the exam questions?