General objectives:

1)      To give the student a working knowledge of the vocabulary used in pathology.
2)      To instill an understanding of the basic mechanisms that produce disease.
3)      To provide the student with the ability to correlate signs and symptoms of disease with underlying cell, tissue and organ pathology.
 
 
Organization of the course:
 
The course consists of 15 two-hour lectures.  The first five of these deal with topics in general pathology, i.e., basic reactions of cells and tissues to abnormal stimuli that underlie all diseases.  The remainder of the course covers specific responses of specialized organ systems to disease-causing stimuli, with emphasis on diseases that the student is most likely to encounter in clinical practice.
 
 
Specific objectives:
 
A.  Cellular aspects of disease
 
1.       Define disease, symptom, sign, etiology, and pathogenesis.
2.       Compare characteristics of epithelial and mesenchymal cells.
3.       Review the structure and function of the normal cell, with emphasis on:
          a.       The mitochondrion and Krebs cycle.
          b.      The plasma membrane and mechanisms by which substances cross it.
4.       List typical causes of cell injury.
5.       Define ischemia, hypoxia, and anoxia.
6.       Define the following adaptive responses of cells to stress and know common examples of each:
          a.       Atrophy
          b.      Hypertrophy
          c.       Hyperplasia
          d.      Metaplasia
7.       Understand the relationship between swelling of cells and failure of the sodium pump.
8.      Understand the mechanism of lipid accumulation in cells such as hepatocytes.
9.      Define necrosis and list the cellular changes with which it is associated.
10.  Define apoptosis and understand its purpose.

B.  Immunology
 
1.      Compare and contrast innate and acquired immunity.
2.      Know the purpose of the complement system.
3.      Define antigen and know properties of antigens.
4.      Define hapten and epitope.
5.      Understand the different purposes of humoral and cell-mediated immunity.
6.      Know the structure of IgG, and know the major characteristics of other subgroups of Ig molecules.
7.      Understand the functions of T helper cells, T cytotoxic cells, and B cells AND how each of these is activated.
8.      List the key differences between primary and secondary immune responses and understand the basis for vaccination.
9.      Describe the mechanisms that produce each of the four types of hypersensitivities and list common examples of each.
 
C.  Inflammation
 
1.      Define acute and chronic inflammation.
2.      Know the roles of the following cells in inflammation:  endothelial cells, neutrophils, mast cells, fibroblasts, monocytes, basophils, and platelets.
3.      List the four cardinal signs of inflammation and explain their physiological basis.
4.      Know how prostaglandins are produced and the mechanism by which aspirin prevents their formation.
5.      Define edema and know the difference between a transudate and an exudate.
6.      Define chemotaxis and list common substances that are chemoattractants.
7.      Understand why the disease Leukocyte Adhesion Deficiency leads to recurrent bacterial infection.
8.      Describe how neutrophils ingest bacteria and list means by which they kill these bacteria.
9.      List the key reactions of oxygen-dependent killing by neutrophils.
10.  List mechanisms by which toxic substances leak from neutrophils and know the importance of proteinase inhibitors in limiting damage from these substances.
11.  Describe the pathogenesis of poststreptococcal glomerulonephritis and emphysema.
12.  Describe how interleukin-1 produced at a site of inflammation produces systemic symptoms.
13.  List the symptoms of the acute phase response.
14.  Explain the basis for diagnostic tests for the acute phase response, including increased ESR, rise in SAA and CRP, and leukocytosis due to neutrophilia.
15.  List the benefits of the inflammatory response.
           
D.  Infectious diseases
 
1.       Review the general structure of viruses.
2.       Compare and contrast RNA and DNA viruses.
3.       Know the six general characteristics of sexually transmitted diseases.
4.       With respect to HIV:
          a.       Describe the structure of the virus and its genome.
          b.      Describe the life cycle of the virus.
          c.       Understand the mechanism of AZT and protease inhibitors.
          d.      Correlate the cells that are infected by HIV with the consequences of infection.
          e.       Know the definition of AIDS and the system used to categorize patients.
          f.        Describe the typical course of infection with HIV, including population at risk, symptoms, and serology.
          g.       Define "opportunistic infection" and identify common causative organisms.
5.       With respect to Chlamydia:
          a.       Describe the life cycle of the organism.
          b.      Identify diseases caused by different serotypes of the organism.
          c.       For each disease, list mode of transmission, population at risk, symptoms, and treatment.
          d.      Understand the concept of non-gonococcal urethritis.
6.       With respect to gonorrhea:
          a.       Identify the causative organism.
          b.      Describe symptoms, course of disease, treatment.
7.       With respect to syphilis:
          a.       Identify the causative organism.
          b.      Describe the stages of the disease with regard to typical symptoms.
          c.       Know common diagnostic tests and treatments.
 
E.  Neoplasia
 
1.       Identify the most common cancers in the US and list those that are increasing or decreasing in incidence.
2.       Define neoplasm, tumor, cancer, carcinoma, sarcoma, dysplasia, anaplasia, and carcinoma in situ.
3.       Understand nomenclature for tumors from various organs.
4.       Compare and contrast benign and malignant neoplasms.
5.       Know the difference between grade and stage of a tumor.  List the characteristics of the TNM classification of staging.
6.       Describe the concept of clonal origin of tumors.
7.       Identify mechanisms by which tumors arise:
          a.       Chromosomal translocations
          b.      Oncogenes and anti-oncogenes
          c.       Autonomous growth of cells
8.       Understand the concept of oncofetal or tumor antigens, e.g., CEA, PSA, a-fetoprotein.
9.       List methods for studying epidemiology of cancer and identify their shortcomings.
10.   List common classes of carcinogens.
 
F.  Cardiovascular system
 
1.       Review normal structure and function of heart and great vessels.
2.       Review development of heart and understand crucial role of proper septation.
3.       Identify common congenital abnormalities of heart and classify with respect to whether they cause cyanosis in newborns.
4.       With respect to ischemic heart disease and atherosclerosis:
          a.       List risk factors.
          b.      Describe pathogenesis of an atherosclerotic plaque on the cellular level.
          c.       Define angina.
          d.      List common consequences/complications of a myocardial infarction.
          e.       List blood tests for diagnosis of MI.
5.       With respect to valvular disease:
          a.       Define insufficiency, regurgitation, and stenosis.
          b.      List populations at risk.
          c.       Describe pathogenesis of rheumatic heart disease.
          d.      Define endocarditis and understand its link to valvular disease.
6.       Identify causes of cardiomyopathy and population at risk.
7.       Define aneurysm and list common causes.
8.       Define pericardial effusion and pericardial tamponade.
 
G.  Respiratory system
 
1.       Review structure and function of lung, respiratory tree, and cells of the lung.
2.       Define ventilation, perfusion, and diffusion.
3.       With respect to bronchopneumonia, lobar pneumonia, interstitial pneumonia, and lung abscess:
          a.       Identify the population at risk.
          b.      Describe the area of the lung that is affected.
          c.       Identify the most common mode of transmission.
          d.      Identify the most common causative organisms.
4.       List common respiratory infections in the immunocompromised patient.
5.       Describe the typical course of infection with TB with respect to symptoms and histopathology.
6.       Describe the pathogenesis of respiratory distress syndrome and identify common causes.
7.       Compare and contrast emphysema and chronic bronchitis with respect to risk factors, symptoms, and effects on histology of the lung.
8.       Define restrictive lung disease and list common causes.
9.       Know the typical responses of the lung to acute injury.
10.   Describe possible consequences of embolus to the lung depending on site of trapping.
11.   Define cor pulmonale.
12.   List different types of lung tumors and identify common symptoms.
13.   Define pneumothorax.
 
H.  Blood and lymphoid tissue
 
1.      Define serum, plasma, leukocytosis, leukopenia, polycythemia, anemia, thrombocytosis, thrombocytopenia, and reticulocyte.
2.      Understand the basis for typing and cross-matching of blood.
3.      Know what common blood tests measure: hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, bleeding time, clotting time, PT, PTT, clot retraction, clot lysis.
4.      With respect to anemia:
          a.       List the major types and their causes.
          b.      Classify them with respect to appearance of red cells.
5.      Understand the roles of vessel constriction, platelets, coagulation factors, and Vitamin K in coagulation.
6.      Compare symptoms due to thrombocytopenia and deficiency of clotting factors.
7.      List common anticoagulants and their mode of action.
8.      Compare leukemias and lymphomas.  Know the most common types of each, the populations that are most frequently affected, the usual prognoses, and known causes.
9.      Describe staging system for lymphomas.
10.  Describe the pathogenesis and treatment of Rh disease of the newborn.
 
I.  Endocrine system
 
1.      Define endocrine gland, hormone.
2.      Review structure of endocrine glands and list hormones that they produce or store.
3.      Understand the concept of feedback inhibition in controlling production of hormones.
4.      With respect to the anterior pituitary, thyroid, and adrenal cortex:
          a.       Identify diseases associated with hypofunction; list causes and symptoms.
          b.      Identify diseases associated with hyperfunction; list causes and symptoms.
5.      Review structure and function of the endocrine pancreas, including role in glucose metabolism.
6.      Compare and contrast type I, type II, and gestational diabetes with respect to:
          a.       Age of onset
          b.      Risk factors
          c.       Symptoms
7.      List the chronic complications of diabetes and discuss their pathogenesis.
 
J.  Bones and joints
 
1.      Review the structure and functions of normal bones and joints and understand the differences between cortical and flat bones.
2.      Identify the major cell types in bone and their functions.
3.      Know the major congenital and hereditary diseases of bone.
4.      With respect to metabolic diseases of bone (osteoporosis, osteomalacia, rickets, and Paget’s disease):
          a.       Identify the underlying cause.
          b.      Identify risk factors.
          c.       List symptoms and treatments.
5.      Know common causes of avascular necrosis.
6.      Know common causative organisms and populations at risk for osteomyelitis.
7.      Identify the major types of fractures, and know the sequence by which fractured bones heal.
8.      Know the most common primary and metastatic tumors of bone.
9.      Compare and contrast osteoarthritis and rheumatoid arthritis with respect to:
          a.       Etiology and risk factors
          b.      Histological changes
          c.       Symptoms
10.  Know the major features of systemic sclerosis, systemic lupus erythematosus, dermatomyositis, Duchenne’s muscular dystrophy, selective muscle atrophy, polymyositis, and myasthenia gravis.
 
K.  Urinary and male genital tracts
 
1.      Review structure and functions of the kidney.
2.      List the six major symptoms of glomerular/tubular disease and explain their pathogenesis.
3.      Compare and contrast nephritic and nephrotic kidney disease.  List common examples of each.
4.      Describe causes and consequences of acute and chronic renal failure.
5.      Define interstitial nephritis; list common causes and consequences.
6.      Describe typical course of a urinary tract infection if left untreated.  List common causes and symptoms.
7.      Identify congenital and hereditary diseases of the GU system, including adult polycystic kidneydisease.  List consequences of the latter.
8.      Distinguish between benign and malignant hypertension; list consequences of each.
9.      List common tumors of the kidney and bladder and identify the populations at risk.
10.  Describe symptoms of benign prostatic hyperplasia and prostatic cancer.  Discuss means for diagnosis.
11.  Define varicocele, hydrocele, cryptorchidism, and torsion of testis.
12.  Identify the different mechanisms by which a transplanted kidney may be rejected.
 
L.  Gastrointestinal system
 
1.      Review normal structure and function of the GI tract, excluding the oral cavity.
2.      Define tracheal-esophageal fistula and list its symptoms.
3.      Describe causes and symptoms of esophagitis.
4.      List risk factors for esophageal cancer.
5.      List causes and symptoms of acute and chronic gastritis.
6.      Define gastric ulcer.  Compare and contrast acute (stress) ulcers with peptic ulcers, with regard to cause, histological appearance, symptoms, complications, and treatment.
7.      Discuss the role of Helicobacter in formation/perpetuation of ulcers.
8.      List risk factors and symptoms of gastric carcinoma.
9.      Compare and contrast Crohn's disease with ulcerative colitis, with respect to:
          a.       Clinical course.
          b.      Population at risk.
          c.       Symptoms.
          d.      Histological appearance, area of intestine affected.
          e.       Consequences.
          f.        Association with development of cancer.
10.  Describe pathogenesis and symptoms of appendicitis.
11.  Define diverticulosis and diverticulitis.  List symptoms of the latter.
12.  List the three types of colonic polyps and identify their association with increased risk for development of cancer.
13.  Identify risk factors for colon cancer, sites affected, means for diagnosis, and symptoms.  Discuss the Dukes' system for staging.
 
M.  Female genital tract and breast
 
1.      Review structure and function of female genital tract and breast.
2.      Describe course of disease and symptoms due to infection with HPV, herpes simplex type II, Candida, and Trichomonas.
3.      Understand the factors that maintain the health of the vagina.
4.      With regard to cervical intraepithelial neoplasia and cervical cancer:
          a.       Discuss the role of HPV.
          b.      Identify the populations at risk.
          c.       Describe the histological changes and symptoms.    
          d.      Discuss diagnosis (Pap smear) and treatment.
5.      Define abnormal uterine bleeding and dysfunctional uterine bleeding.  Know the common causes.
6.      Define endometrial hyperplasia.  List causes, symptoms, treatments.
7.      List risk factors for endometrial cancer.
8.      Define leiomyoma.  List causes, locations, treatments.
9.      Define endometriosis.  Identify population at risk.  List symptoms and treatments.
10.  Define fibroadenoma of the breast.  Identify population at risk and symptoms.
11.  Compare and contrast nonproliferative and proliferative fibrocystic disease. 
12.  With respect to breast cancer:
             a.       Identify the two major categories.
             b.      Identify risk factors.
             c.       Describe symptoms and consequences.
 
N.  Nervous system
 
1.      Review structure of the brain.
2.      Discuss histopathology and symptoms of degenerative diseases of the brain, including Parkinson's disease and Alzheimer's disease.
3.      Discuss the pathological changes and clinical course of multiple sclerosis.
4.      Define stroke.  Identify the two major categories and the major causes and consequences of each.
5.      Define herniation of the brain.  List common causes and consequences.
6.      Define parenchymal, subarachnoid, and subdural hemorrhages hemorrhages.  List populations at risk and typical symptoms.
7.      Describe the possible consequences to the brain of hypertension.
8.      Identify common types of tumors affecting the nervous system, their characteristics, and the cells from which they arise.
9.      With respect to meningitis and brain abscesses:
          a.       Identify sources of infection.
          b.      List possible consequences.
          c.       List symptoms.
          d.      Compare and contrast viral and bacterial meningitis.
10.  Identify common causes of encephalitis.  List symptoms.
11.  Know the locations, common causes, and typical consequences of subdural and epidural hematomas.
12.  List common congenital abnormalities of the central nervous system.