Considerations and Tips

In General:
• Cases are from small animals (approximately 30%), large animals (approximately 30%), and other species (approximately 40%). —including avian species, laboratory animals, exotic species, and fish. Invertebrates are not included in the exam. Get confident in recognizing and describing the main diseases of these species.
• Cases from the necropsy room may be used and will be indicated during the exam. As a result, some post-mortem changes may be present; however, these are limited and do not obscure the key features of the lesions. You are expected to distinguish between post-mortem changes and true pathological lesions.
• For tumors, the number of mitoses in “high power field” is not accepted anymore. Before the exam, calculate the area of your microscope field at 400X and during the exam indicate the number of mitoses in this area (ex:0.237mm², or 0.16mm²). Your field area at 400X is enough for exam purposes; there is no need to count specifically in 2.37mm².
• Train for speed and endurance to describe 20 slides in one session.
• Be precise, concise and use appropriate terminology 
• In your description avoid redundancies and buzz words: “numerous” is faster to write and will give you as many points as “large number of…”

Know your anatomy/histology:
• Tissue identification can give important clues about the disease you are looking at. Train yourself to identify different tissues of different species.
 • Study recognizing endocrine organs, central nervous system and genital organs (i.e. mammary versus salivary gland, brainstem versus neurohypophysis, pancreas versus adenohyposhysis etc.). Nevertheless, not all the organs that you are not able to recognize are from the genital system.
• Be as specific as possible (i.e. gallbladder or urinary bladder, not only bladder) and be aware of specific histology differences among organs (ex: submucosa is not present in skin)
• Be specific in the anatomy also within the description, while locating the lesions (i.e. within the renal medulla or affecting the renal cortex, in which layer of the mucosa) 

Know specific variations of different species:
• Granulomas and inflammatory cells of reptiles, fish and certain rodents are different than those of mammals.

Look at all the tissue/whole slide:
• Check the slide without the microscope (subgross examination)
• In the tissue around a neoplasm, there may be important changes that are more relevant for the animal’s health than the actual tumor (i.e. Leishmaniasis in a skin with hemangioma).
• A slide may contain two organs, which are anatomically attached to each other such as pituitary and rete mirabilis.
• Make sure that there is a logical connection between your description, the morphological diagnosis and eventually the etiology.
 
Always include quantitative modifiers:
• Use the basic rule: what, where and how many. As an example for inflammatory cells: many lymphocytes, fewer plasma cells, some neutrophils (Use the order of decreasing quantity)
• Make sure that you are familiar with board-style descriptions. Practice this with your supervisor
 
Read the question carefully:
• Is the question: name the disease, the etiology or the etiologic diagnosis?
• Always answer the one most likely.
 
Trust on what you see in the slide and on what you know:
• Inventing things will lead to loss of points.
• Check a finding to the size and stain when interpreting things (i.e. Mycobacteria are not seen in H&E stains, describe the size of urates).
• Do not fixate on a disease and make your description fitting this imagined disease (i.e. mycobacteriosis and porcine multisystem wasting syndrome exist without multinucleated giant cells).
• There are other disease-processes than tumors and inflammation.
• For some specific cells (ex: multinucleated giant cells, epithelioid macrophages, syncytial cells, etc.) it may be necessary to describe them, for example: 80-100µm in size cell, with peripherally arranged nuclei (multinucleated giant cells, Langhans type).
• Cell sizes are given in description of tumors and cytology preparations.
  
Cytology:
• The cytology is the only exception where the organ and the sampling method (i.e. smear from an exudate, fine needle aspiration, impression from an organ) are given. This is important to figure out a list of differential hypotheses (disease processes) already before looking at the slide. By reading the organ and the sampling method, you should already know what you expect to see in the slide.
• Remember to evaluate the acellular component of the slide (background, granules, crystals, etc.), the cellularity of the sample (good, or scarce) and the blood contamination (no, minimal, moderate or severe).
• You have to recognize the cells, quantify them (in percentage or using modifiers like the majority, the minority etc), describe their arrangement (in clusters, around vessels, in bundles, etc) and classify them (normal, hyperplastic, neoplastic, inflammatory). In case of tumoral cells, their description follows the same rules as for tumors in histology. Normal cells do not need to be cytologically described (no need to describe for example that a normal lymphocyte is a small round cell with a high N/C ratio, scant eosinophilic cytoplasm, etc.). Experience is fundamental to distinguish different cell types. In cytology, almost all cells are individualized and roundish and you cannot rely on architecture as you do when you read histology. However, when clustered, you can often gain more information, i.e. epithelial or mesenchymal.
• The final judgment and the morphological diagnosis must be consistent with your previous description

Electron microscopy:
• Provide a detailed and systematic description of all visible structures, including both normal and altered features, using appropriate ultrastructural terminology (e.g., electron-dense, electron-lucent).
• Know how to recognize cell type/tissue.
• Have an idea about relative sizes of structures and organisms (e.g., mitochondria ~1 µm, bacteria ~1–2 µm, viruses ~20–300 nm) to avoid misinterpretation.
 

Species distribution for the 60 images:
•    20 large animals + 20 small animals + 20 other species 
Organ: be as specific as possible

Commonly asked questions include the following:
•    Morphologic diagnosis: name the lesion in specific pathologic anatomic terms, including all modifiers (severe acute multifocal ulcerative esophagitis, severe visceral urate deposition). Do not forget bilateral symmetrical etc., if appropriate
•    Etiology or cause: name the cause as specific as possible: Leptospira canicola, lead poisoning, genetic defect.
•    Name the disease: give the commonly used appellation of the shown case (visceral gout, canine distemper)
•    Etiologic diagnosis: name the organ and the most likely disease process/cause (viral pneumonia, mycobacterial enteritis, uremic gastritis)
•    Differential diagnosis: give one diagnosis for another lesion or disease that would resemble the first diagnosis (lymphadenitis – malignant lymphoma).
•    Pathogenesis: list or describe briefly the series of pathogenetic events that resulted in the lesion or disease shown (glomerular amyloidosis > proteinuria > hypoalbunemia > decreased plasma colloid pressure > generalized edema)

Additional question maybe asked such as:
What breed is mainly affected? Name another species affected by the disease? What other organ is commonly affected?
More than one morphological diagnosis might be asked even if caused by one disease process

Useful link (this link is intended to help you in preparing yourself for the section, but they are not part of the reading list).
•    Noah's arkive - https://davisthompsonfoundation.org/noahs-arkive/

Review and practice on images in pathology books and journals from reading list.
 

• Follow the sequence of events in important molecular pathways and understand which molecules are involved at each step.

Expect to meet a variety of topics as the sections in Veterinary Pathology will test knowledge reflecting different fields of pathology, including various species, organ systems and etiologies, as well as mechanisms and pathologic processes. Both your knowledge on “classical” diseases and recent developments will be tested. Even though diseases relevant to pathologists in Europe are particularly relevant, also expect to get questions related to important “classical” or emerging diseases occurring in other world regions.

Subsection Large and Small Animal
In the exam, pathology of domestic dogs and cats are included in the small animal section, and in the large animal section pathology of cattle, horses and other domestic equines, sheep, goat and swine is included. 

Subsection Laboratory animal 
Definition of “Well established or well described” animal models of human disease
By “WELL-ESTABLISHED”, the Examination Committee understands animal models that are commonly used by the scientific community based on the capacity to obtain/reproduce this model and on its detailed pathologic characterization. Classical examples include: transgenic RasH2 mice, bleomycin-induced pulmonary fibrosis in rodents, cisplatin or gentamicin-induced renal injury, collagen-induced arthritis in rats, or SIV in non-human primates.
By “WELL-DESCRIBED”, the Examination Committee understands animal models with good macro/microscopic characterization, regardless of it being reported for the first time or it being commonly used by the research community.
Please note that knowledge on the relevance of animal models because it is subjective and debatable, will not be tested.

Questions on “Well established or well described” animal models of human disease
The questions will mainly focus on the morphologic macro/microscopic characterization of the model and pathogenesis, as generally for the examination. 
The questions will not focus on:

• How to technically create an animal model. This applies to the paper selection as well: only papers including gross and/or microscopic descriptions of the models are in the scope.
• In vitro research models of human diseases
• “Satellite Symposium Issues” of Toxicologic Pathology 
• Animal models of diseases exclusively affecting domestic animals
• Animals models presented in the book “Nonhuman Primates in Biomedical Research” are NOT included as source of questions since, to date, the 2nd and last edition of this book is dated 2012. 

KO and KI mice are often employed to study the role of a gene, although they might not necessarily represent an animal model of human disease per se. These papers are of lower priority but might be considered if they include good pathology descriptions. 

Induced animal models are not included in the Gross Pathology and Histopathology parts of the examination.

Questions on background lesions and infectious diseases of lab animal species
In toxicologic pathology, it is crucial to know the background lesions of lab animal species as well as to have a profound knowledge of relevant infectious diseases. Study the relevant sources carefully for this section. 
 

• Read the questions carefully – are you requested to summarize some results or to interpret the meaning of the results?
• Be concise in your description and analysis, but for data analysis do not describe every point of the questioned graph. Give an overview as would be described in results section in article
• When asked to describe and interpret for example survival curves, do not interpret other data you may be presented with.
• Briefly means succinct and do not waste time filling the space offered by Examsoft. NOTE: space/words for answering questions in Examsoft can be restricted. 
• Clearly distinguish between describing results (3 % decrease of survival rate) and interpretation (compound X administration does not alter survival rate after a 28-day study)

Useful links (these links are intended to help you in preparing yourself 
for the section, but they are not part of the reading list).
Veterinary Pathology, Volume 53, Issue 5 September 2016 Special Focus: 

• Veterinary Forensic Pathology - https://journals.sagepub.com/toc/vetb/53/5
• WOAH manual online, Chapter  2.1.2 Biotechnology advances in the diagnosis of infectious diseases - https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-manual-online-access/