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GUIA-GUIDE SPC2006/02

GUIA

GUIDE

GENERAL PATHOLOGY COURSE

INTRODUCTION

PROFESSOR

OFFICE HOURS

SYLLABUS, LECTURES (POWER POINTS)

LEARNING OBJECTIVES

TEXTBOOKS

EVALUATION AND GRADING PROCESS

INTERNATIONAL PROGRAM REGULATIONS

PATHOLOGY

GENERAL PATHOLOGY 2006/02

INTRODUCTION: Pathology is one of the most important courses in medicine. It has two different levels; the first level is GENERAL PATHOLOGY. It is dedicated to learn the mechanisms of disease (molecular, immune, genetic, microbiologic, etc.) and is offered in second semester. General pathology lasts 60 hours and represents 30% of the final grade of the PATHOLOGY COURSE.

The second level, SYSTEMIC PATHOLOGY is offered in the third and fourth semesters. In this course you will apply the previously learned concepts in specific diseases of the human being. It has 120 hours and represents 70% of the grade of the PATHOLOGY COURSE.

PROFESSOR: The professor of the General Pathology course is R. Hugo Martínez Lozano, M.D. and pathologist. I will help you in understanding Pathology and assist you in specific needs. Do not wait until the last days of the course to solve your class problems.

OFFICE HOURS: The office of the Department is located in the International Program Building, ICB campus. You will be always welcomed, by appointment with Miss Daniela in the secretarial pool.

SYLLABUS, LECTURES P.P.: A pathology syllabus is attached to this pages.The syllabus follows the order of presentation of each subject matter and serve as a guide to the content of lectures. It is recommended to use the syllabus as a source of information BEFORE coming to lectures so that you come aware of the general principles to be discussed. It is also recommended to take your own class notes in order to complement and to update the information in the syllabus or lecture’s p.p.

You will have access to my LECTURES (POWER POINT) by the means that will select the president of your group.

Because the diversity of your background and the different levels of preparation that you have in basic sciences, we recommend you to review the other related basic sciences (cellular biology, histology, etc.) in order to have a better understanding of each subject.

LEARNING OBJECTIVES: Are included at the beginning of each lecture, so it will be easer for you to follow them.

RECOMMENDED TEXTBOOK: Dr. Damjanov says “The book is the course...” and we strongly agree with him. Our main textbook is:

1. Robbins & Cotran’s PATHOLOGIC BASIS OF DISEASE, 7th edition, 2005

As an alternative reference you have:

2. Rubin’s PATHOLOGY, 4th edition, 2004

Review books are exactly that... something to review (for instance, few weeks before the USMLE) AND DO NOT REPLACE THE TEXTBOOKS.

3.- We also recommend, in order to review morphological images, an atlas such as: Milikowski & Berman’s COLOR ATLAS OF BASIC HISTOPATHOLOGY, 1st. ed., 1997.

4.- Other: As a clinical reference for your use throughout the course, I also recommend you, the systemic pathology chapters of our textbook and Harrison’s INTERNAL MEDICINE. 16th. Ed.

EVALUATION AND GRADING PROCESS: In General Pathology, there will be two exams with 60 questions each; a midterm and a final. Their “value” is 15 points each (of the pathology course´s grade). Thus, the total value of this course is 30 points or 30% of Pathology course’s grade.

Example:

Midterm exam: 48 right answers (of 60): 80% or 12 points.+Final exam: 42 right answers (of 60): 70% or 10.5 points

General pathology score: 22.5 points... this score, plus the potential extrapoints of the PROMED permit this student to “pass” the course. In order to pass General Pathology, you MUST have a minimal grade of 60% (or 18 points). Otherwise, EVEN IF YOU PASS Systemic Pathology, this obtained grade will not be added to the global grade.

In relationship with mid-term and final exams:

1.- All questions are of the multiple choice or matching type.

2.- Most questions are related with the “problem-based evaluation” format (clinical vignettes, laboratory problems, research situations, etc.) -similar to those used by the USMLE exams-.

3.- A number of such questions are related with a correspondant image (gross, microscopical, ultrastructural, etc.)

4.- IN THE GENERAL PATHOLOGY COURSE YOU WILL NOT SEE “RECYCLED” EXAMS. Every exam will evaluate the correspondant course. I do not recommed you to use old exams as a “reference”.

PROMED (CONTINUOUS EVALUATION OR QIUZZES). Before some (random) lectures 4-5 questions will be shown on the screen. You will have 4-5 minutes to write your asnwers down in a paper that you must return to the teacher in order to be evaluated. The correct answer will then be given and discussed. TAKE NOTICE OF YOUR GRADES TO AVOID SURPRISES AT THE END OF THE COURSE. In case of an absence you will earn no points.

INTERNATIONAL PROGRAM REGULATIONS:

1. Each student will select a chair to sit during the lectures. Attendance will be given only if the student is seated in that particular chair.

2. To prevent interruptions and disturbing your classmates it is strongly recommended to avoid leaving the room once the lecture has begun.

3. If the student misses lecture for reasons as:I. SicknessII. Sickness or death of a relativeIII. Administrative affairs in UAG or Immigration offices

He/she must communicate it in advance and bring proof of it to the Absences/Attendances Committee in the International Group Office with Dr. De Anda within the first 72 hours after the event.

4. A student cannot present the final exam if he/she has more than 15% of absences.

5. According with the new regulations of the school of medicine, it is prohibited any activated cell phone during lectures or exams.

GENERAL PATHOLOGY SYLLABUS

#: TOPICS & REFERENCES:

1 Welcome Introduction to pathology Cellular responses to stress Cellular adaptations of growth & differentiation Cell injury & death. Part I

- Introduction- Causes- Mechanisms

Ref: pp. 4-18 & lecture’s information

2 Cell injury & death. Part II - Reversible & irreversible - Apoptosis - Intracellular accumulations Ref: pp. 19-32, 34-40 & lecture’s information

3 Inflammation (Acute & chronic) General features Historical highlights Acute inflammation

- Stimuli- Vascular changes- Cell events

End of acute inflammation Ref: pp. 48-62 & lecture’s information

4 Inflammation (Acute & chronic) Chemical mediators

- General features- Origin- Types

Outcomes of acute inflammation Ref: pp. 63-76 & lecture’s information

5 Chronic inflammation - Causes - Morphology (cells) - Granulomatous Systemic effects of inflammation Consequences of defective or excessive inflammation Ref: pp. 78-85 & lecture’s information

6 Tissue renewal & repair: regeneration, healing & fibrosis Definitions Control of normal cell proliferation & tissue growth Mechanisms of tissue regeneration Repair by healing, scar formation & fibrosis Cutaneous wound healing Fibrosis & overview. Ref: pp. 88-103, 107-116 & lecture’s information

7 Hemodynamic disorders I General features Edema Hyperemia & congestion Hemorrhage Ref: pp. 119-124 & lecture’s information

8 Hemodynamic disorders II Thrombosis D.I.C. Embolism Infarction Shock Ref: pp. 130-142 & lecutre’s information

9 Genetic disorders I General features Mutation Mendelian disorders

- Transmission patterns- Biochemical & molecular basis- Disorders asociated with defects in: - Structural proteins - Receptor proteinsRef: pp. 145-158 & lecture’s information

10 Genetic disorders II Disorders associated with defects in

- Enzymes- Regulators of cell growth

Multifactorial disorders Ref: pp. 158-170 & lecture’s information

11 Genetic disorders III Cytogenetic disorders

- Types of ch. Rearrangements- Disorders involving:

- Autosomes - Sex chromosomes- Single disorders with nonclassic inheritance - Triplet-repeat mutations - Mitochondrial genes mutations - Genomic imprintsRef: pp. 173-187 & lecture’s information

12 Diseases of immunity I General features of the immune system

- Innate & adaptive- Cells & tissues- Mechanisms (HLA)Disorders of the immune system:- Hypersensitivity reactions: I, II, III, IV.Ref: pp- 194-217 & lecture’s information

13 Disorders of immunity II Autoimmune diseases

- Immune tolerance- Mechanisms of autoimmunity- SLE- RA- SS- SclerodermaRef: pp. 223-239 & lecture’s information

14 Disorders of immunity IIIImmunologic deficiency syndromes- Primary- Secondary - AIDSRef: pp. 240-258 & lecture’s information

15 Workshop (review) 16 Mid-term exam: Topics 1-15

17 Neoplasia I General features Definitions, nomenclature Biology of tumor growth (characteristics of benign & malignant nature) Epidemiology

Ref: pp. 270-287 & lecture’s information

18 Neoplasia II Molecular basis of cancer

- Normal cell cycle- 7 fundamental changes that determine malignant phenotype (& discussion

of six of them)Ref: pp. 288-309 & lecture’s information

19 Neoplasia III Invasion & metastasis

Molecular basis of multi-step carcinogenesisCarcinogenic agents & their mechanisms- Chemical- Radiation- Microbial - Viral - H.p.Ref: pp. 309-328 & lecuture’s information

20 Neoplasia IV Clinico-pathologic consequences:

- Tumoral effects - Local & hormonal - Cachexia - Paraneoplastic syndromes- Grading & staging- Diagnosis of cancer - Cytology - Conventional histopathology: - Biopsy - Surgical specimens - Special techniques: - Immunohistochemistry - Flow cytometry - “Tumor markers”Ref: pp. 332-339 & lecture’s information

21 Infectious diseases I General features History Categories of infectious agents Trasmission & dissemination of microbes Mechanisms of injury:

- Viral- Bacterial- Effects of host immunityImmune evasion Infection in immunosuppressed hosts

Special techniques for dx. Ref: pp. 344-361 & lecutre’s information

22 Infectious diseases II Viral infections

- Transient- Latent- Productive- TransformingBacterial infections- Gram (+)- Gram (-)Mycobacteria- TB- Atypical- LeprosyRef: pp. 363-387

23 Infectious diseases IIISpirochetes- Syphilis- Lyme dis.Anaerobic bacteria- ClostridaObligate intracellular bacteria- Chlamydia- Rickettsia

Fungal infections- Yeasts- MoldsParasitic infections - Protozoa- Metazoa (Infestations)Ref: pp. 388-411 & lecture’s information

24 Infectious diseases IV Emerging & re-emerging infectious diseases

- General features- Old diseases- New diseases- Infections with increased frecuency- Re-emerging diseases- Major concerns- Some notes on bioterrorismRef: pp. 345-346, review of the chapter & a lot of lecture’s information

25 Selected topics on environmental pathology Mechanisms of toxicity Addictions:

- Tobbacco- Alcohol- Sedative-hypnotics- Stimulants- OpioidsLead poisoningUV radiationRef: pp. 417-426, 432-433, 441-442 & lecture’s information

26 Nutritional pathology Nutritional deficiencies

- Protein-energy malnutrition- Anorexia nervosa & bulimia- Vitamin def. - “ADEK” - Thiamine - Riboflavine - Niacin - Vit C - Folate- Mineral def.

- Zinc - Selenium Ref: pp. 447-461 & lecture’s information

27 Diseases of the Infancy & childhood I General features Congenital anomalies Birth wight & gestational age Birth injuries Perinatal infections Neonatal RDS Necrotizing enterocolitis GM-intraventricular hemorrhage Fetal hydrops Ref: pp. 470-486 & lecture’s information

28 Diseases of Infancy & childhood II Some inborn errors of metabolism

- PKU- Galactosemia- CFSIDSBenign neoplasias- Hemangiomas- TeratomasMalignant neoplasias- Incidence & types- The neuroblastic tumors- Wilms tumorRef: pp. 487-506 & lecture’s information

29 Workshop (review)

30 Final exam (topics 17-29)

IMPORTANT: IN EVERY TOPIC, PAY SPECIAL ATTENTION TO THE MEDICAL (CLINICAL) SIGNIFICANCE, WITH PARTICULAR EMPHASIS IN THE DISEASES DISCUSSED IN EVERY LECTURE.