Applied pathology, which PM&DC defines to include microbiology, haematology and immunology, is about 6% of NRE Step I, roughly 12 of 200 items. The legible row in PM&DC's table shows 11; we scale the basic-science rows to 60 items. It is the broadest of the basic domains: general pathology, immunology, genetics, bacteriology, virology, parasitology, mycology, haematology and systemic pathology. Microbiology questions are written around Pakistani pathogens: Salmonella including XDR typhoid, Mycobacterium tuberculosis, hepatitis viruses, dengue, CCHF, malaria and Leishmania.
Weight and expected item count
About 12 items, or 12 minutes of paper time, across a very wide range of topics. That breadth means you cannot cover everything with equal depth; you choose the themes that recur across the clinical domains. Pathology is also the domain where gaps hurt twice, because the same facts appear in medicine, surgery and paediatrics questions.
What is tested
| Block | Topics |
|---|---|
| General pathology | Cell injury, necrosis and apoptosis; acute and chronic inflammation and repair; neoplasia (carcinogenesis, grading, tumour markers); haemodynamic disorders (thrombosis, embolism, infarction, shock); genetic disorders and cytogenetics |
| Immunology | Hypersensitivity, autoimmunity and immunodeficiency |
| Microbiology | Gram-positive and gram-negative pathogens, Salmonella (including XDR typhoid) and Vibrio; mycobacteria and TB pathology; virology (hepatitis viruses, HIV, dengue, CCHF, rabies, polio); parasitology (malaria, leishmaniasis, amoebiasis, helminths); mycology and opportunistic infections |
| Haematology | Anaemias (iron deficiency, thalassaemia, megaloblastic, haemolytic); leukaemias, lymphomas, myeloma; coagulation disorders and blood banking |
| Systemic pathology | Cardiovascular and respiratory; GIT and hepatobiliary (hepatitis B and C, cirrhosis, HCC); renal and urinary tract; endocrine, breast and female genital tract; CNS, bone and soft tissue |
| Chemical pathology | Clinical laboratory interpretation |
Local guideline points
- XDR Salmonella Typhi (H58): resistant to chloramphenicol, ampicillin, co-trimoxazole, fluoroquinolones and third-generation cephalosporins; first described in Hyderabad, Sindh in 2016.
- Hepatitis C and B: serology interpretation, natural history, cirrhosis and hepatocellular carcinoma. Hepatitis C viraemic prevalence is estimated at about 4.3% in Pakistan.
- Vector-borne and zoonotic infections: P. vivax is the commonest malaria species, dengue is transmitted by Aedes aegypti, CCHF by Hyalomma ticks, and cutaneous leishmaniasis is a recognised local skin condition.
- Thalassaemia: a significant burden in Pakistan; interpret a blood film and haemoglobin electrophoresis pattern.
- Polio: wild poliovirus type 1 remains endemic in Pakistan; understand the virology behind AFP surveillance.
The programme and treatment side of these is in local guidelines.
Three typical traps
- Memorising organisms without the disease picture. Stems describe a patient and a laboratory result, not an organism name. Link each organism to its typical presentation, specimen, stain or culture finding and complication.
- Misreading serology. Hepatitis B patterns (acute, chronic, immune after vaccination, immune after infection) depend on the combination of markers. Learn the combinations as a table and test yourself on new ones.
- Confusing similar anaemias and blood films. Iron deficiency, thalassaemia trait, anaemia of chronic disease and sideroblastic anaemia share microcytosis. The discriminating features are ferritin, iron studies, red cell distribution width and electrophoresis. Work from the discriminating test, not the shared feature.
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How to revise it
| Session | Do this |
|---|---|
| 1 | General pathology: cell injury, inflammation, neoplasia basics, thrombosis and shock; 20 questions |
| 2 | Haematology: anaemia algorithm, haemolysis, thalassaemia, leukaemias, coagulation tests, transfusion |
| 3 | Bacteriology: a one-page grid for Gram-positive, Gram-negative, acid-fast, with Salmonella and Vibrio |
| 4 | Virology and parasitology: hepatitis, HIV, dengue, CCHF, rabies, polio; malaria, leishmaniasis, amoebiasis, helminths |
| 5 | Immunology and genetics: hypersensitivity types, autoimmune disease, immunodeficiency, chromosomal disorders |
| 6 | Systemic pathology by organ; clinical laboratory values; mixed block of 40 |
The best use of time is questions that mix microbiology with its clinical picture. See the study plan; pathology normally sits in weeks 4 to 5 of a 16-week schedule.
Core facts to state without notes
- Necrosis types: coagulative (most infarcts), liquefactive (brain and abscesses), caseous (tuberculosis), fat necrosis (pancreatitis) and fibrinoid (vasculitis, malignant hypertension).
- Hypersensitivity: type I immediate IgE, type II antibody against cells, type III immune complex, type IV T-cell mediated; match each to an example you can state.
- Hepatitis B serology: HBsAg means current infection; anti-HBs alone means vaccination; anti-HBc IgM suggests acute infection; HBeAg suggests high infectivity.
- Iron deficiency versus thalassaemia trait: both are microcytic; ferritin is low in iron deficiency and normal or high in trait, with a raised HbA2 on electrophoresis in beta-thalassaemia trait.
- Malaria: P. falciparum can cause cerebral malaria and severe disease; P. vivax relapses because of liver hypnozoites, which is why primaquine is added.
- Typhoid diagnosis: blood culture is the best test in the first week; the Widal test has well-known limits and is interpreted with caution.
- Classic morphology: Reed-Sternberg cells in Hodgkin lymphoma, starry-sky pattern in Burkitt lymphoma, Leishman-Donovan bodies in leishmaniasis, caseating granulomas with Langhans giant cells in TB.
Reading a pathology stem
Pathology stems often give a specimen finding, a blood film or a culture result with a short history. Work in this order: identify the process (injury, inflammation, neoplasia, infection, immune), identify the organ, then match the microscopic or laboratory finding to the named entity. Where the stem gives several findings, the most specific one decides the answer. For infections, ask which organism fits the specimen, the stain result and the clinical pattern together; any one alone can mislead.
| Can you say, in one sentence each... | Mark |
|---|---|
| How you interpret a hepatitis B serology panel | red, amber or green |
| How you separate the causes of microcytic anaemia | red, amber or green |
| The histological hallmark of TB, Hodgkin lymphoma and leishmaniasis | red, amber or green |
| Which hypersensitivity type underlies each of five named diseases | red, amber or green |
Links to other domains
Pathology interlocks with medicine (infections, haematology), pharmacology (antimicrobials) and community medicine (epidemiology, outbreaks). Write each cross-domain fact once on a card and revisit it.
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Frequently asked questions
How many pathology questions are in NRE Step I?
PM&DC's table shows 11 for applied pathology in its legible rows; we scale the basic-science rows to 60 items for about 12. Treat 11 to 12 as the range.
Does applied pathology include microbiology?
Yes. PM&DC's domain is Applied Pathology including microbiology, haematology and immunology, plus genetics and chemical pathology.
Which organisms matter most for the NRE?
Salmonella (including XDR typhoid), Mycobacterium tuberculosis, hepatitis B and C viruses, dengue and CCHF viruses, Plasmodium species, Leishmania and common Gram-positive and Gram-negative pathogens.
Are tumour markers and cytogenetics tested?
The syllabus lists neoplasia including tumour markers and genetic disorders and cytogenetics under general pathology.
How should I revise pathology?
Use clinical vignettes, build a grid of organisms with disease, specimen and complication, and learn serology and anaemia patterns as tables. Six focused sessions plus repeated mixed blocks is a workable plan.