ivms understanding the basic medical sciences foundation of clinical medicine
DESCRIPTION
IVMS is the ultimate medical student Web 2.0 companion. This SDL-Face to Face hybrid courseware is a digitally tagged and content enhanced replication of the United States Medical Licensing Examination's Cognitive Learning Objectives (Steps 1, 2 or 3). Including authoritative reusable learning object (RLO) integration and scholarly Web Interactive PowerPoint-driven multimedia shows/ PDFs. Comprehensive hypermedia BMS learning outcomes and detailed, content enriched learning objectives.TRANSCRIPT
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“IVMS and integration of basic and clinical sciences”
Towards Understanding the
Basic Medical Sciences Foundation of Clinical Medicine
Prepared and presented by Marc Imhotep Cray, M.D.
Medical Teacher http://www.imhotepvirtualmedsch.com/
Basic Pathology
Medical Diagnosis
CORRELATION
TO
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“IVMS and integration of basic and clinical sciences”
The integration of basic and clinical sciences in undergraduate medical science
2
IVMS teaching philosophy is based on the integration of basic and
clinical sciences.
This means that the learning of basic science is placed in the context
of clinical medicine.
Such an approach is seen to be more meaningful and relevant to
students.
Curriculum integration usually involves both horizontal and vertical
integration and is the pattern that is becoming widespread throughout
the world.”
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“IVMS and integration of basic and clinical sciences”
11 benefits of integrated learning in undergraduate medical education
3
1. Improved motivation and satisfaction 2. Professional socialization 3. Enhanced self reflection and self appraisal 4. Reinforced and deep learning 5. Prepares for life‐long learning 6. Improved understanding of biological principles, mechanisms & basic concepts 7. Heightened relevance of learning 8. Facilitates curriculum review 9. Promotes co‐operation between staff members from different disciplines 10. Enhances clinician reflections on the scientific basis of practice 11. Enhances basic scientists reflections on clinical applications and research From: Integration of basic and clinical sciences ‐ AMEE 2008 http://www.amee.org/documents/IntroductionMedical Education BradleyMattick.pdf
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“IVMS and integration of basic and clinical sciences”
“What is Horizontal and Vertical Integration”
4
Horizontal: bring together the disciplines, topics,
subjects of basic medial science or clinical medicine
Vertical: bringing together basic medial science and
clinical medicine
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“IVMS and integration of basic and clinical sciences”
PATHOLOGY • PATH
– pertaining to a morbid process (disease)
• (from “pathos” = travail or sorrow (Greek)
• OLOGY
– the scientific study of …
5
“Let’s exemplify vertical integration by briefly looking at how one relates
Basic Pathology to Medical Diagnosis
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“IVMS and integration of basic and clinical sciences”
DISEASE
ETIOLOGY
PATHOGENESIS
PATHO- MORPHOLOGY
COURSE PROGNOSIS
COMPLICATIONS
6
PATHOLOGY: SCIENTIFIC STUDY OF…
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“IVMS and integration of basic and clinical sciences”
MENINGITIS
N. meningitidis
SEPTICAEMIA
ACUTE INFLAMMATION
MENINGES
SPREAD VIA CSF DEATH
(IF UNTREATED) VENTRICULITIS ENDARTERITIS
HYDROCEPHALUS
E
P
PM
P
NH C
7
Ex: SCIENTIFIC STUDY OF DISEASE
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“IVMS and integration of basic and clinical sciences”
PATHOLOGY OBJECTIVES
1 To introduce a NEW VOCABULARY of terms, definitions, and disease processes.
2 To introduce the BASIC RESPONSES of the human organism to injury.
• Correlation with clinical picture.
8
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“IVMS and integration of basic and clinical sciences”
SIGNS and SYMPTOMS
STRUCTURAL & FUNCTIONAL ALTERATIONS
PATHOLOGY OBJECTIVE (2)
9
CORRELATION
induced by disease
form
the basis by which attending
are produced
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“IVMS and integration of basic and clinical sciences”
& clinician
& pathologist
PHYSIOLOGY & FUNCTION
ORGAN STRUCTURE
SIGNS AND SYMPTOMS
PATHOMORPHOLOGY
DETECTED BY CLINICIAN
DETECTED BY PATHOLOGIST
ALTERS
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“IVMS and integration of basic and clinical sciences”
LEVELS OF STUDY OF PATHOLOGY
• MOLECULAR
• CHEMICAL
• ULTRASTUCTURAL
• CELLULAR
• TISSUE
• ORGAN
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PATHOMORPHOLOGY
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“IVMS and integration of basic and clinical sciences”
PATHOMORPHOLOGY
• PATHO.. - the disease
• MORPH .. - the shape (structure)
• OLOGY .. - the study of
i.e. how a disease process alters the “shape” (structure) of cells, tissues and organs …… or ……
the “DAMAGE” caused by the disease process.
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“IVMS and integration of basic and clinical sciences”
“ORGANOMEGALY”
13
AS A PRECEPT THERE IS BUT ONE CAUSE OF ORGANOMEGALY
AN ALTERATION OF MORPHOLOGY
“CHANGE IN SHAPE & / 0R SIZE”
SOMETHING MUST BE ADDED TO THE ORGAN
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“IVMS and integration of basic and clinical sciences”
WHAT MAY BE ADDED?
• NORMAL CELLS
• FLUID
• BLOOD
• INFLAMMATORY
• NEOPLASTIC CELLS
• GAS
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HYPERPLASIA or HYPERTROPHY
EDEMA
CONGESTION
TUMOR
EMPHYSEMA
EXUDATE
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“IVMS and integration of basic and clinical sciences”
HISTOPATHOLOGY /
PATHOMORPHOLOGY
OVERVIEW
Companion learning tools to the following general
pathology section:
IVMS General Pathology Lecture Notes.pdf
Images
IVMS-Gross Pathology, Histopathology, Microbiology and
Radiography High Yield Image Plates
WebPath
http://www-medlib.med.utah.edu/WebPath/webpath.html
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“IVMS and integration of basic and clinical sciences”
CELLULAR DEGENERATION
AND INFILTRATION THEY ARE RELATED TO CHANGES WHICH MAY BE
REVERSIBLE
THE AGENTS WHICH CAUSE CELULAR
DEGENERATION AND OR INFILTRATION , WHEN
OCCURING OVER LONGER PERIODS OF TIME WILL
ULTIMATELY LEAD TO THE DEATH OF THE CELL
WITH MORPHOLOGIC CHANGES
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“IVMS and integration of basic and clinical sciences”
CELL INJURY THUS REFLECTS
TWO LEVELS OF SEVERITY
1. ONE COMPATIBLE WITH RECOVERY
2. THE SECOND IRREVERSIBLE
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“IVMS and integration of basic and clinical sciences”
COMPATIBLE WITH RECOVERY
CLASSAFICATION
CELL DEGENERATION AND INFILTRATION CAN BE DIVIDED INTO SEVERAL MORPHOLOGIC PATTERNS DEPENDING ON THE METABILITE(S) THAT ACCUMULATE IN THE CELL
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“IVMS and integration of basic and clinical sciences”
CLOUDY SWELLING
THIS IS CHARACTERIZED MORPHOLOGICALLY BY A SLIGHT SWELLING OF THE CELLWITH GRANULARITY AND CLOUDINESS OF THE CYTOPLASM
THIS IS SEEN MOST OFTEN IN RENAL TUBULAR CELLS, HEPATIC CELLS AND CARDIAC MUSCLE.
ORGANS WITH THIS AFFECT ARE SLIGHTLY LARGER , FIRM AND PALE
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“IVMS and integration of basic and clinical sciences”
CLOUDY SWELLING(2)
THIS CAN BE CAUSED BY MANY FACTORS INFECTIONS
FEBRILE ILLNESS
EXCESSIVE COLD OR HEAT
ANOXIA
MALNUTRITION
PHYSICAL INJURY
VASCULAR DISTURBANCES
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“IVMS and integration of basic and clinical sciences”
HYDROPIC OR VACUOLOR
DEGENERATION THIS IS A MORE PRONOUNCED FORM OF
INTRACELLULAR EDEMA, AND ALTHOUGH IT IS
REVERSIBLE , IT RREFLECTS A MORE SERIOUS INJURY
TO THE CELL
IT IS CAUSED BY THE SAME AFFECTS THAT
PROUDUCE CLOUDY SWELLING
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“IVMS and integration of basic and clinical sciences”
HYDROPIC OR VACUOLOR
DEGENERATION(2)
THIS DEGENERATION IS OF PARTICULAR PROMINENCE IN THE KIDNEYS , OFTEN RESULTING FROM HYPOKALEMIA
AND IN LIVER CELLS WHICH ARE EXPOSED TO POISONS OR TOXINS (SUCH AS CARBON TETRACHLORIDE AN CHLOROFORM)
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“IVMS and integration of basic and clinical sciences”
HYDROPIC OR VACUOLOR
DEGENERATION(3)
ON MICROSCOPIC EXAMINATION THIS APPEARS AS
SMALL , CLEAR VACOULES DISPERSED
THROUGHOUT THE CYTOPLASM
IN SEVERE CASES THE VACOULES COALESCE AND
FORM LARGE CLEAR SPACES WHICH MAY DISPLACE
THE NUCLEUS
PROGRESSION IS TOWARD FRANK NECROSIS
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“IVMS and integration of basic and clinical sciences”
FATTY DEPOSITION (FATTY METAMORPHOSIS)
THIS CHANGE IS DUE TO AN ABNORMAL
ACCUMULATION OF FAT WITHIN PARENCHYMAL
CELLS
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“IVMS and integration of basic and clinical sciences”
FATTY DEPOSITION (FATTY METAMORPHOSIS)(2)
THE PRESENCE OF FAT REPRESENTS AN ABSOLUTE INCREASE IN INTRACELLULAR FAT AND REPRESENTS SEVERE CELL INJURY
THE SIZE OF THE FAT VACOULE IS NOT DEPENDENT ON THE PATHOLOGIC MECHANISM
THERE ARE MULTIPLE CAUSES WHICH LEAD TO THIS DEGENERATION
FATTY CHANGE IS OFTEN PRECEDED BY CLOUDY SWELLING
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“IVMS and integration of basic and clinical sciences”
GLYCOGEN DEGENERATION (INFILTRATION)
GLYCOGEN IS MORMALLY ABUNDANT IN LIVER AND MUSCLE CELLS
IN SOME CONDITIONS ABNORMAL ACCUMULATIONS OCCUR PRODUCING VISIBLE GLYCOGEN VACOULES WITHIN THE CYTOPLASM OR NUCLEI
GLYCOGEN INFILTRATION IS FOUND IN DIABETES MELLITUS
GLYCOGEN STORAGE DISEASES
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“IVMS and integration of basic and clinical sciences”
HYALINE DEGENERATION
IN THIS , THERE IS A REGRESSIVE CHANGE IN
THE CELLS IN THAT THE CYTOPLASM NOW
HAS A GLASSY EOSINOPHILIC APPEARANCE
THIS DEGENERATION IMPLIES THAT THE
INJURY TO THE CELL CYTOPLASM HAS
CAUSED DENATURATION AND COAGULATION
OF THE CYTOPLASM
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“IVMS and integration of basic and clinical sciences”
MUCOID DEGENERATION
THIS DESCRIPTION REFERS TO THE EXTRACELLULAR ACCUMULATION OF MUCOPOLYSACCHARIDE AND GROUND SUBSATNCE WITHIN CONNECTIVE TISSUE
THIS CHANGE IS SEEN IN COLLAGEN DISEASES. THERE IS NO INTRA- CELLULAR DEFECT
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“IVMS and integration of basic and clinical sciences”
CELL DEATH AND NECROSIS
• NECROSIS REFERS TO THE MORPHOLOGIC CHANGES
THAT FOLLOW CELL DEATH AND PERMIT VISIBLE
RECOGNITION THAT THE CELL HAS DIED
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“IVMS and integration of basic and clinical sciences”
IRREVERSIBLE
NECROSIS
MOST OF THE CHANGES THAT INDICATE CELLULAR
DEATH ARE MORE PROMINENT IN THE NUCLEUS THAN
IN THE CYTOPLASM
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“IVMS and integration of basic and clinical sciences”
COAGULATION NECROSIS
THIS TYPE OF NECROSIS IS CHARACTERISED BY THE CELL BECOMING AN ACIDOPHILIC MASS, USUALLY WITH THE LOSS OF THE NUCLEUS, BUT WITH REMNANTS OF ENOUGH BASIC SHAPE TO PERMIT RECOGNITIONOF THE CELL BOUNDARIES
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“IVMS and integration of basic and clinical sciences”
LIQUEFACTION NECROSIS
IN THIS CASE THERE IS A RAPID AND TOTAL ENZYMATIC DISSOLUTION OF THE CELLS
THERE IS COMPLETE DESTRUCTION OF THE CELL WALL
THIS TYPE OF NECROSIS IS SEEN OFTEN IN THE BRAIN
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“IVMS and integration of basic and clinical sciences”
ENZYMATIC NECROSIS
THIS PRESENTS WITH ACUTE DESTRUCTION OF THE PANCREAS
THIS FROM THE RELEASE OF THE PANCREATIC ENZYMES OUTSIDE OF THEIR NORMAL CONFINES
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“IVMS and integration of basic and clinical sciences”
CASEOUS NECROSIS
THIS SEEN WITH TUBERCULOSIS INFECTIONS
THE CELLS ARE CHANGED TO A GRANULAR,
EOSINOPHILIC MASS OF AMORPHOUS FAT AND
PROTEIN GROSSLY LOOKING LIKE SOFT FRIABLE
CHEESE
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“IVMS and integration of basic and clinical sciences”
GANGRENOUS NECROSIS
THIS IS RELATED TO ISCHEMIA AND A SUPERIMPOSED BACTERIAL INFECTION
THE INITIAL EVENT MAY HAVE BEEN A BACTERIAL INFECTION WHICH COMPROMISED THE VASCULARITY ALLOWING SAPROPHYTIC ORGANISS TO THRIVE -THEREBY FURTHER INCREASING THE ISCHEMIC CHANGE
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“IVMS and integration of basic and clinical sciences”
FIBRINOID NECROSIS
THIS IS SEEN PRINCIPALLY WITH DISEASES OF HYPERSENSITIVITY ORIGIN
THERE IS THE APPEARANCE OF FIBRIN DEPOSITS IN THE CONNECTIVE TISSUE AND IN THE WALLS OF THE BLOOD VESSELS
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“IVMS and integration of basic and clinical sciences”
CAUSES OF CELL INJURY
AND DEATH
1) ANOXIA
2) PHYSICAL AGENTS
3) CHEMICAL AGENTS
4) BIOLOGIC AGENTS
5) IMMUNE MCAHANISMSDERRANGEMENTS
6) GENETIC DEFECTS
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“IVMS and integration of basic and clinical sciences”
DIFFERENTIAL DIAGNOSIS
38
INFLAMMATORY
VASCULAR
NEOPLASTIC
DRUGS
INFECTION
CONGENITAL
AUTOIMMUNE
TRAUMATIC
ENDOCRINE / METABOLIC “VINDICATE”
IS THE PROCESS.. - SUDDEN ONSET
- CARDINAL SIGNS/SYMPTOMS
- MASS
- HISTORY
- CARDINAL SIGNS/SYMPTOMS
- FROM BIRTH
- SYSTEMIC
- HISTORY
- Sn/Sx