Saint James School of Medicine

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1 1 Saint James School of Medicine COURSE: GENERAL PATHOLOGY CLASS: MDIII SEMESTER: Spring (Jan-Apr, 2013) COORDINATOR: Associate Professor Dr. Reza Farhour COURSE DESCRIPTION: Pathology is the study of structural and functional abnormalities that are expressed as diseases of organs and systems. Traditionally, the discipline is divided into general pathology and systemic pathology; the former focuses on the fundamental cellular and tissue responses to pathologic stimuli, while the latter examines the particular responses of specialized organs. Knowledge & understanding of pathology is essential for all doctors as this subject forms the bridge preclinical sciences & clinical subjects and it involves the investigation of the causes (etiology) of disease as well as the underlying mechanisms (pathogenesis) that result in the presenting signs and symptoms of the patient. In MED III & IV the pathological basis of all diseases is thought which will help student in rational treatment of patients.

2 COURSE OBJECTIVES: 2 By the end of the course, the medical student will be able to: a. Knowledge (theory) 1. Understand the concepts of cell injury & changes produced thereby in different tissues & organs & the body s capacity for healing 2. Understand the normal homeostatic mechanisms, the derangement of these mechanisms & the effects on human systems. 3. Understand the etiopathogenesis, the pathological effects & clinic-pathological correlation of common infectious & non-infectious diseases. 4. Understand the concept of neoplasia with reference to etiology, gross & microscopic features, diagnosis & prognosis in different tissues & organs of the body. 5. Have knowledge of common immunological disorders & their resultant effect on the human body. b. Skill (Practical in pathology) 1. be conversant with the organization & functioning of the laboratories & should be aware of the safety precautions to be taken in the laboratories. 2. be aware of the common methods of collection of samples for hematological & biochemical investigations & anticoagulants to be used. They should be conversant with the methods of collection of the body fluids for cytological examinations. 3. have knowledge of sample collection & methods of processing of samples & common histological techniques including H & E staining. 4. have knowledge of application & significance of frozen section. 5. identify as spotters the common histopathological, hematological & cytological slides & specimens & charts & their interpretations. c. Behavior (attitude) 1. utilize the services of a clinical laboratory in the diagnosis and management of a clinical case. 2. understand a laboratory report and explain it to the patient. 3. be aware of lab safety, biomedical waste disposal, handling of specimen in taking care of the self and patients and other personnel. 4. understand ethical practices 5. utilize blood bank services its ethical aspects, pros and cons of transfusion.

3 3 SUMMARY OF COURSE CONTENTS: NO CHAPTER 1 CELL INJURY AND CELL DEATH, CELLULAR ADAPTATIONS 2 INFLAMMATION 3 TISSUE RENEWAL, REPAIR and REGENERATION 4 HEMODYNAMICS, SHOCK 5 GENETIC DISORDERS 6 IMMUNOPATHOLOGY 7 NEOPLASIA 8 INFECTIOUS DISEASES 9 ENVIROMENTAL AND NUTRITIONAL DISEASES 10 DISEASES OF INFANCY AND CHILDHOOD 11 HEMATOPOIETIC AND LYMPHOID DETAILS OF COURSE CONTENTS: 1. CELL INJURY AND CELL DEATH a. Definitions b. Causes of cell injury c. Mechanisms of cell injury d. Necrosis e. Apoptosis f. Sub cellular alterations in cell injury g. Intracellular accumulations h. Pathologic calcification i. Hyaline change j. Cellular aging k. Adaptations l. Atrophy m. Hypertrophy n. Hyperplasia o. Metaplasia 2. INFLAMMATION a. Definitions

4 b. Types of inflammation c. Acute inflammation d. Chronic inflammation 4 3. REGENERATION a. Control of normal Cell Proliferation and Tissue Growth b. Stem Cells c. Cell Cycle d. Mechanisms of Cell Growth e. Mechanims of Tissue regeneration f. ECM g. Healing by Repair, Scar formation and Fibrosis 4. HEMODYNAMICS a. Edema b. Hyperemia, congestion, hemorrhage c. Hemostasis d. Thrombosis e. Embolism f. Infarction g. Shock 5. GENETIC DISORDERS a. Definitions b. Mutations c. Mendelian disorders d. Multifactorial inheritance e. Chromosomal abnormalities 6. DISEASES OF IMMUNITY a. Defense mechanisms b. Types of immunity c. Cells of immunity d. Cytokines and functions e. HLA f. Hypersensitivity g. Transplant rejections h. Autoimmune disorders i. Immunodeficiency j. amyloidosis 7. NEOPLASIA a. Definitions b. Components of tumors c. Naming of tumors d. Classification of tumors e. Characteristics of benign and malignant tumors f. Metastasis g. Cancer epidemiology

5 h. Carcinogenesis i. Cancer etiology j. Clinical aspects of neoplasia 5 8. INFECTIOUS DISEASES a. general principles of microbal pathogenesis b. New and Emerging Infectious Diseases c. Immune Evasion by Microbes d. Viral Infections e. Bacterial Infections 9. ENVIRONMENTAL DISORDERS and NUTRITIONAL DISORDERS a. Protein Energy Malnutrition b. Vitamin deficiencies c. Obesity d. Physical injuries e. Radiation injuries f. Personal exposures g. Chemical injuries 10. DISEASES OF INFANCY AND CHILDHOOD a. Causes of death in infancy and childhood b. Birth weight and gestational age c. IUGR d. Congenital anomalies e. Respiratory Distress Syndrome f. Erythroblastosis fetalis g. Inborn errors of metabolism h. Cystic fibrosis i. Sudden Infant Death Syndrome j. Tumors 11. HEMATOPOIETIC AND LYMPHOID a. Development & Maintenance of Hematopoietic Tissues b. Disorders of White Cells i. Leukopenia ii. Reactive (Inflammatory) proliferations of white cells iii. Neoplastic proliferation of white cells c. Spleen i. Splenomegaly ii. Neoplasms iii. Congenital anomalies iv. Rupture d. Thymus i. Developmental disorders ii. Thymic hyperplasia iii. Thymomas

6 e. Anemias f. Polycytemia g. Bleeding disorders, Hemorrhagic diathesis 6 TEACHING LEARNING METHODS: The teaching learning activities during the pathology course will be carried out through 1. Lectures 2. Practicals 3. Tutorials 4. Case based team work 5. Integrated teaching 6. Self directed learning ASSESSMENT: The assessment format consists of 5 main sections: 1. Attendance: Students must attend all lectures on a regular basis. Minimum of 80% attendance for every month is mandatory. Any student falling short of 80% attendance will not be allowed to take the exam. 2. Assignment 3. Practical 4. Quiz 5. Exam Marks distribution of all assessment: ASSESSMENT WEIGHTEGE % Assignment 10 Practical 5 Quiz 5 Exam 80 TOTAL 100

7 GRADING: 7 Grades will be based on the total assessment mark Final grade will be an aggregate of all the four exams & courseworks The grading scale is as follows: SCORE GRADE < 70% FAIL (F) 70-79% C 80-89% B % A EXAMINATION SCHEDULE: a) PATTERN: TYPE OF QUESTIONS MULTIPLE CHOICE (MCQs & BAQs) NO OF QUESTIONS 50 DURATION 1 HOUR b) CHAPTERS: EXAM I 1,2,3 EXAM II 4,5,9 EXAM III 7, 10 EXAM IV 6,8, 11 c) EXAM DATES; EXAM I May 25th & 28th 2012 EXAM II June 22nd & 25th 2012 EXAM III July 20th & 23rd 2012 EXAM IV 20th Aug & 22nd Aug 2012

8 RECOMMENDED TEXT 8 BOOKS: 1. Kumar V.,Abbas A.K.,Fausto N, Aster,J.C (ed) 2010,Robbins and Cotran pathologic basis of disease. 8 ed. Elsevier, Philadelphia. 2. Rubin R.,Strayer (ed), 2008,Rubin s Pathology ed.lippincott Williams, Baltimore. 3. Mohan H., 2010, Text book of pathology, 6ed.Jaypee publications, New Delhi. 4. Stephen J. McPhee, Gary D. Hammer, (ed) 2010, Pathophysiology of Disease: An Introduction to Clinical Medicine, Sixth Edition, McGraw-Hill 5. Arthur S.Schneider, Philip A.Szanto, 2002, Board Review Series Pathology, 4th ed., Lippincott Williams 6. Edward F.Goljan, Rapid Review Pathology, second ed., Mosby 7. Bruce A. Fenderson, Review Of Pathology Illustrated Q&A, 2 nd Ed, Lippincott Williams Online Sources: 1. (take password from Dr. Hammoudi) 2. (For MCQs, Slides, case Study) 3. (For Virtual Slides)

9 9 LECTURE SCHEDULE: Spring 2013 Wk Day DATE CHAPTER TOPIC Professor 1 Tuesday Registration & Orientation Wednesday INTRODUCTION TO PATHOLOGY Thursday ADAPTATIONS OF CELLULAR GROWTH AND DIFFERENTIATION DEFINITIONS, ETIOLOGY, PATHOGENESIS HYPERTROPHY, HYPERPLASIA, ATROPHY, METAPLASIA Friday CELL INJURY AND CELL DEATH MECHANISMS OF CELL INJURY AND CELL DEATH Monday CELL INJURY AND CELL DEATH MORPHOLOGICAL ALTERATIONS IN CELL INJURY AND NECROSIS 2 Tuesday CELL INJURY AND CELL DEATH APOPTOSIS, AUTOPHAGY, INTRACELLULAR ACCUMULATIONS, PATHOLOGIC CALCIFICATIONS, AGING Wednesday INFLAMMATION QUIZ 1 B 1, ACUTE INFLAMMATION, MEDIATORS OF INFLAMMATION, Thursday INFLAMMATION OUTCOMES OF ACUTE INFLAMMATION Friday INFLAMMATION CHRONIC INFLAMMATION, CELLS MEDIATORS, OUTCOMES Monday INFLAMMATION IC EFFECTS OF INFLAMMATION AND CONSEQUENCES OF EXCESSIVE INFLAMMATION 3 Tuesday TISSUE RENEWAL, REGENERATION AND REPAIR Wednesday TISSUE RENEWAL, REGENERATION AND REPAIR STEM CELLS, CELL CYCLE, MECHANISMS OF TISSUE REGENERATION QUIZ 2 B 1, ECM, HEALING BY REPAIR, ANGIOGENESIS Thursday

10 10 Friday EXAM I CHAPTER 1,2 & 3 Monday Or EXAM I CHAPTER 1,2 & 3 4 Tuesday HEMODYNAMIC DISORDERS EDEMA, Hyperemia, Hemorrhage Wednesday HEMODYNAMIC DISORDERS HEMOSTASIS AND THROMBOSIS,EMBOLISM Thursday HEMODYNAMIC DISORDERS HEMOSTASIS AND THROMBOSIS,EMBOLISM Friday HEMODYNAMIC DISORDERS INFARCTION, SHOCK Monday NUTRITIONAL DISORDERS QUIZ 1 B 2, VITAMIN DEFICIENCES A, D, C, B1, THIAMINE 5 Tuesday NUTRITIONAL DISORDERS DIETARY INSUFFICIENCY, Wednesday NUTRITIONAL DISORDERS OBESITY Thursday NUTRITIONAL DISORDERS INJURY BY THERAPEUTIC DRUGS AND DRUG ABUSE, PHYSICAL INJURIES Friday NUTRITIONAL DISORDERS AIR POLLUTION, METALS Monday GENETIC DISORDERS QUIZ 2 B 2, IONIZING RADIATION, TOBACCO, ALCOHOL 6 Tuesday GENETIC DISORDERS IONIZING RADIATION, TOBACCO, ALCOHOL Wednesday GENETIC DISORDERS DEFINITIONS, MUTATIONS, MENDELIAN DISORDERS Thursday GENETIC DISORDERS MULTIGENIC, CHROMOSOMAL DISORDERS Friday GENETIC DISORDERS SINGLE-GENE DISORDERS WITH NONCLASSIC INHERITANCE Monday GENETIC DISORDERS MOLECULAR DIAGNOSIS OF GENETIC DISEASES 7 Tuesday REVISION CHAPTERS 4,5 & 9 Wednesday REVISION CHAPTERS 4,5 & 9

11 11 Thursday Friday EXAM II Chapters 4, 5 & 9 Monday Or EXAM II Chapters 4, 5 & 9 8 Tuesday NEOPLASIA NOMENCLATURE, CHARACTERISTICS OF BENIGN AND MALIGNANT NEOPLASMS, METASTASES Wednesday NEOPLASIA EPIDEMIOLOGY OF CANCER Thursday NEOPLASIA MOLECULAR BASIS OF CANCER, ONCOGENES Friday NEOPLASIA MECHANISMS OF INVASION AND METASTASES Monday PUBLIC HOLIDAY 9 Tuesday NEOPLASIA MULTISTEP CARCINOGENESIS, CANCEROGENIC AGENTS Wednesday NEOPLASIA GENOMIC INSTABILITY Thursday NEOPLASIA HOST DEFENCE AGAINST TUMORS Friday NEOPLASIA CLINICAL ASPECTS OF NEOPLASIA Monday NEOPLASIA Quiz 1 B 3,REVIEW 10 Tuesday DISEASES OF INFANCY & CHILDHOOD Wednesday DISEASES OF INFANCY & CHILDHOOD Thursday DISEASES OF INFANCY & CHILDHOOD Friday DISEASES OF INFANCY & CHILDHOOD Monday DISEASES OF INFANCY & CHILDHOOD 11 Tuesday DISEASES OF INFANCY & CHILDHOOD CONGENITAL ABNORMALITIES DISORDERS OF PREMATURITY PERINATAL INFECTIONS FETAL HYDROPS INBORN ERRORS OF METABOLISM I SIDS and Tumors Wednesday REVISION Quiz 2 B 3,

12 12 Chapter 7 & 10 Thursday Friday EXAM III Chapters 7 & 10 Monday Or EXAM III Chapters 7 & Tuesday IMMUNOPATHOLGY DEFENCE MECHANISMS, TYPES OF IMMUNITY, ANTIGEN,ANTIBODY Wednesday IMMUNOPATHOLGY DUALITY OF IMMUNE, Ag+Ab BINDING Thursday IMMUNOPATHOLGY HYPERSENSITIVITY- I & II, III, IV Friday Public Holiday Monday Public Holiday 13 Tuesday IMMUNOPATHOLGY TRANSPLANT REJECTIONS, AUTOIMMUNE DISEASES SLE, SJOGREN SYNDROME, IC SCLEROSIS, INFLAMMATORY MYOPATHIES, Wednesday IMMUNOPATHOLGY PRIMARY IMMUNODEFICIENCY, AQUIRED IMMUNODEFICIENCY (AIDS), AMYLOIDOSIS Thursday HEMATOPOIETIC AND LYMPHOID Quiz 1 B 4, Development & Maintenance of Hematopoietic Tissues, Disorders of White Cells Friday HEMATOPOIETIC AND LYMPHOID Monday HEMATOPOIETIC AND LYMPHOID 14 Tuesday HEMATOPOIETIC AND LYMPHOID Wednesday HEMATOPOIETIC AND LYMPHOID Disorders of White Cells Spleen, Thymus Anemia, Polycytemia Bleeding disorders, Hemorrhagic diathesis Thursday HEMATOPOIETIC AND LYMPHOID Friday HEMATOPOIETIC AND LYMPHOID Bleeding disorders, Hemorrhagic diathesis Quiz 2 B 4,

13 13 Review Monday INFECTIOUS DISEASES CATEGORIES OF INFECTIOUS AGENTS, DIAGNOSTIC TECHNIQUES 15 Tuesday INFECTIOUS DISEASES MECHANISMS OF CELL INJURY INDUCED BY INFECTIOUS AGENTS AND HOST RESPONSE, ACUTE AND CHRONIC VIRAL INFECTIONS Wednesday INFECTIOUS DISEASES BACTERIAL INFECTIONS INDUCED BY GRAM POSITIVE AND NEGATIVE MICROORGANISMS Thursday INFECTIOUS DISEASES INFECTIONS INDUCED BY OTHER BACTERIA, FUNGAL, Friday INFECTIOUS DISEASES PARASITIC INFECTIONS, Monday REVISION Quiz 3 B 4, Chapter 6 & 8, 11 Tuesday Wednesday Exam IV Chapters 6 & 8, 11 Friday Or Exam IV Chapters 6 & 8, 11