Pathology Guide 2nd Sem.

130963 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. Sickness II. Sickness or death of a relative III. 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

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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 proteins Ref: 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 imprints Ref: 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 - Scleroderma Ref: pp. 223-239 & lecture’s information

14

Disorders of immunity III Immunologic deficiency syndromes - Primary - Secondary - AIDS Ref: 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 carcinogenesis Carcinogenic 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 immunity Immune 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 - Transforming Bacterial infections - Gram (+) - Gram (-) Mycobacteria - TB - Atypical - Leprosy Ref: pp. 363-387 23

Infectious diseases III Spirochetes - Syphilis - Lyme dis. Anaerobic bacteria - Clostrida Obligate intracellular bacteria - Chlamydia - Rickettsia Fungal infections - Yeasts - Molds Parasitic 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 bioterrorism Ref: 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 - Opioids Lead poisoning UV radiation Ref: 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 - CF SIDS Benign neoplasias - Hemangiomas - Teratomas Malignant neoplasias - Incidence & types - The neuroblastic tumors - Wilms tumor Ref: 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.