I didn't get a patch option for 10.5.6, but in the past, the "patch" versions of upgrades didn't contain full copies of files -- they presumably contain pieces of any updated files, which the installer somehow manages to merge with the existing file to generate a fully updated copy. Since they don't contain all of the whole files, the "patch" updates can be considerably smaller than the regular "delta" update which does.
A "combo" update is something else entirely -- whereas both the "patch" and "delta" updates usually released by Apple are "incremental" updates (eg. in Leopard, only bumping up the version by one 10.5.x version), a "combo" update of eg. Leopard can be used to upgrade from any previous version of 10.5. Since they contain full copies of any file updated to date, a "combo" update will naturally be the largest of the three.
Since I haven't been able to examine a recent "patch" update, I can't say whether or not this is still true, but one consequence of the "patch" mechanism in earlier patches was that temporary files were created where the contents of the update are first expanded, prior to patching of the existing file. This intermediate step wasn't accounted for correctly while updating the permissions repair database, resulting in spurious messages about "SUID" files being modified. Furthermore, this flaw could be exploited by an unprivileged "standard" user to create a situation that could result in them being granted "root" privileges.
Again, I can't confirm that this problem still exists, but if it hasn't been fixed, then it would be advisable to avoid "patch" updates if you are in charge of administering a computer shared by users that aren't fully trusted, such as in a school situation.