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PATHOPHYSIOLOGY+OBJECTIVES

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					PATHOPHYSIOLOGY


GENERAL OBJECTIVES:
                                rd
- The students of the 2nd year(3 . Semester) of Medicine in the International Program of
Medicine at the U.A.G. (Autonomous University of Guadalajara), at the end of the
Pathophysiology course, should be able to:

- Aply the basic principles of Anatomy, Physiology and Pathology to the Pathophysiological
principles in the next group of human diseases;


 Pathophysiology Units:


 1.- Fever
 2.- Atherosclerosis
 3.- Ischemic heart disease
 4.- Cardiac arrhytmias
 5.- Arterial Hypertension
 6.- Heart failure
 7.- Chronic Obstructive Pulmonary Disease (C.O.P.D.)
 8.- Restrictive Ventilatory Disorders
 9.- Acute pulmonary edema
 10.- Acute respiratory failure
 11.- Glomerulonephritis
 12.- Nephrotic syndrome
 13.- Acute renal failure
 14.- Chronic renal failure
 15.- Acid-Base disturbances
 16.- Esophageal diseases
 17.- Peptic ulcer disease
 18.- Hepatic encephalopathy
 19.- Portal hypertension
 20.- Diarrhea
 21.- General principles of endocrinology disorders
 22.-Pituitary gland diseases
 23.- Adrenal dysfunction
 24.- Thyroid dysfunction
 25.- Obesity
 26.- Diabetic Ketoacidotic state
 27.- Diabetic Non-ketoacidotic state
 28.- Diabetic neuropathy
 29.- Hypoglycemia
 30.- Pain
 31.- Hyperuricemia and Gout
 32.- General effects of cancer
 33.- Paraneoplastic syndromes
 34.- Septic shock
 35.- Acquired Immuno-Defficiency Syndrome (A.I.D.S.)
 36.- Parkinson and Alzheimer diseases
 37.- Diabetic Neuropathy
 38.-Diabetic Retinopathy
 39.-Seizures
 40.- Asthma
 41.- Intracranial pressure abnormalities.
1.- FEVER

SPECIFIC OBJECTIVES:

The student of the Pathophysiology course, at the end of the unit of Fever, should be able to
explain the mechanism of control of human body temperature and it's alterations.

 * To identify the "normal" ranges of human body
    temperature.

 *To identify the physiological variants of the normal
   human body temperature.

 *To identify the extra-corporeal factors that affects
   the body temperature.

 *To describe the human body mechanism to produce heat.

 *To describe the human body mechanims to loss heat.

 *To explain the interrelation betwen mechanism to
   produce and loss heat in the maintenance of normal
   human body temperature.

 *To explain the " Set Point " concept.

 *To localize the Thermoregulator center.

 *To describe the functions of the Thermoregulator
   center in regulation of temperature.

 *To identify the definiton of Fever

 *To identify the definiton of Hyperthermia

 *To describe the differences betwen Fever and
   Hyperthermia.

 *To identify the concept of "Endogenous Pyrogen" and
   it's origen.

 *To identify the stimulus to production and release of
   Endogenous Pyrogen.

 *To identify the role of Endogenous Pyrogen to produce
   fever.

 *To identify the protective role of Fever in
   pathologic states.

 *To identify the harmful role of Fever in pathologic
   states.
2.-ATHEROSCLEROSIS

SPECIFIC OBJECTIVES:

- At the end of the unit of Atherosclerosis, students should be able to identify the frecuency,
relevance, predisposing factors, mechanisms of development, clinical picture and complications
of atherosclerosis.

* To explain how heritage, male sex, aging, high fat and
   sodium diet intake, arterial hypertension, diabetes
   mellitus, cigarette smoking and air pollution
   predisposes to atherosclerosis development.

* To describe the proposed steps of atherosclerotic
        lesion development.

 * To identify the elements of atherosclerotic plaques

 * To explain the pathophysiological mechanisms of
    endothelial vascular damage, that promotes
    atherosclerosis development.

 * To describe the complications of atherosclerotic
    plaques. (Oclusion, thrombosis, disloging and
    peripheral embolism, aneurysm formation)

 * To describe the different clinical pictures of
    atherosclerosis in regard to localization.

* To elaborate a therapeutic plan in order to reduce
        development and complications of atherosclerosis.


3.-ISCHEMIC HEART DISEASE

SPECIFIC OBJECTIVES:

- At the end of the unit, students should be able to identify the frecuency, relevance, risk factors,
mechanisms of development, clinical picture and complications of Ischemic heart disease.

 To identify the risk factors (Atherosclerosis, high
   blood pressure, Diabetes Mellitus, cigarette smoking
   so-on.)

 To mention the relevance of I.H.D.

 To identify and explain the diferent clinical
   presentations of I.H.D.

 To explain the mechanism that regulate coronary blood
   flow, and identify the diferences in regional
   myocardial blood flow.

 To explain the concept of "Pressure gradient" and
   "Hydraulically significant artery lesion", and the
   importance of these in development of myocardial
   ischemia.
To explain the general mechanism to produce tisular
   ischemia.

 To identify the factors that determine myocardial
   oxygen supply and consumption.

 To explain the relations between the previous factors
   in development of myocardial ischemia.

 To describe the effects of myocardial ischemia.

 To identify the complications of myocardial ischemia.

 To identify the prognostic factors in patients with
   acute myocardial infarction.

 To mention the different modalities of Reperfusi{on
       treatment in Acute Myocardial Infarction.

 To explain the complication of Reperfusion Teraphy

 To mention the proposed mechanisms if Reperfusion
       injury
 To mention the proposed treatments to prevent
       reperfusion inujury.


 4.- CARDIAC ARRHYTMIAS

SPECIFIC OBJECTIVES:

- At the end of the unit, students should be able to identify the causes and mechanism of
arrhytmia production, the local and systemic effects of arrhytmias and complications.


To explain the electrical properties of myocardial
   fibers.

To explain the concepts of, "Action potential",
   "Resting membrane potential", "Threshold level",
   "Absolute refractory period", "Relative refractory
   period", "Automaticity", "Functional syncytium", "The
   All or Nothing principle", "Fast and slow response
   fibers".

To identify the diferent phases of the "Action
   potential".

To identify the role of sodium, potassium, calcium
        chlorine in the action potential development.

To explain the concept of Pacemaker, and the factors
   that regulate this.

To mention the two mechanism to produce arrhytmias.
   ( Enhanced automaticity and Re-entry mechanism ).

To explain the mechanism of "Enhanced automaticity"
   and mention the factors that could cause this, for the
   genesis of arrhytmias.

To explain the mechanism of " Re-entry " and the
   factors that could cause this.To mention the
   requirements of "Re-entry" in the genesis of this type
   of arrhytmias.

To mention the diferent types of arrhytmias, acording
   to the site of origin.

To mention the various clinical presentation of
   arrhytmias.
To explain the circulatory effects of cardiac
   arrhytmias.

To mention the complications of cardiac arrhytmias.


5.-ARTERIAL HYPERTENSION

SPECIFIC OBJECTIVES:

- At the end of the unit, students should be able to identify, to explain the concepts of arterial
blood pressure, the factors that determine it, the abnormal mechanism to increase levels and
the systemic effects of high blood pressure with it's complications.


To explain the concepts of; Stroke volume, Pre-load,
   After-load, Cardiac output, peripheral resistances,
   total peripheral resistances, the inter-relationship
   between them to produce certain level of arterial
   blood pressure A.B.P. (Systolic, diastolic and mean
   A.B.P.)

To explain the role of the Autonomic Nervous System
   (A.N.S.), Heart, kidney, arteriolar vessels,sodium,
   calcium and hormones in the control of arterial blood
   pressure.

To identify and explain the factors that modify the
   "Normal" arterial blood pressure.

To identify the prevalence and relevance of High blood
   pressure.

To identify and explain the importance of the
   classification of Hypertension as: Benign and
   Malignant.

To identify the several etiologies of Hypertension

To explain the pathophysiology mechanism to produce
   Hypertension in the "Secondary Types of Hypertension"

     + To explain the renal mechanism to produce
      Hypertension.

     + To explain the mechanism of Adrenal disorders to
      produce Hypertension
+ To explain the mechanism of Pheochromocytoma to
     produce Hypertension

     + To explain the mechanism of aortic coartaction to
      produce Hypertension.


     + To explain the " Pathophysiology Theories " of
      Primary Hypertension.

To identify and explain the systemic effects of
   Hypertension.

To identify the complications of Hypertension.

To elaborate a therapeutic plan to control
       hypertension.


6.-HEART FAILURE

SPECIFIC OBJECTIVES:

- At the end of the unit, students should be able to identify, explain the several types of
circulatory failure, the differences between cardiac failure and other types of circulatory
failure,the several etiologies of heart failure,
the mechanism to produce it, and the compensatory and perpetuating mechanism in heart
failure.

 To identify the factors that determine and affect
    Cardiac output.
 To explain the concept of "Heart failure" and
    "Circulatory Failure"

 To mention the different mechanism to produce Heart
    failure and circulatory failure.

 To explain the myocardial effects of increased
    Pre-load or After-load.

 To explain the myocardial "Compensatory mechanism"
    to increases in pre-load or after-load

 To identify the differences between "Concentric" and
    "Excentric" myocardial hypertrophy.

 To explain the mechanism of myocardial "Concentric
    and Excentric" hypertrophy

 To mention and explain the late cardiac indexes and
    hemodinamic findings of Heart failure.

 To mention the mitochondrial and sarcoplasmic
    reticulum alterations in failing hearts.

 To mention and explain the role of the aggravating
    and perpetuating factors of Heart failure.
       + Kidney
       + Sympathetic over-activity
       + Renin-Angiotensin-Aldosterone System
       + Prostaglandins
       + Bradikinin/Kallidin
       + Atriopeptin I and II
       + P.G.Y.
       + Growth, Thyroid and Cortisol Hormones
       + Others

7.- CHRONIC OBSTRUCTIVE PULMONARY DISEASE (C.O.P.D)

SPECIFIC OBJECTIVES:

- At the end of the unit, students should be able to identify and explain the concept of "airways
obstruction" , the different types of C.O.P.D., the several etiologies, the clinical picture, the
mechanism to produce this, the compensatory responses to C.O.P.D. and the laboratory
findings.

 To mention the normal airways physiology

 To mention and explain the physiology respiratory
   terms of:

   + T.L.C. = TOTAL LUNG CAPACITY
   + V.C. = VITAL CAPACITY
   + T.V. = TIDAL VOLUME
   + R.V. = RESIDUAL VOLUME
   + F.R.C. = FUNCTIONAL RESIDUAL CAPACITY
   + D.S. = DEATH SPACE
   + F.E.V.1 = FORCED EXPIRATORY VOLUME 1 sec
   + F.V.C. = FORCED EXPIRATORY VITAL CAPACITY
   + FEV1/FVC = RATIO OF FEV1 / FVC
   + PaO2 = ARTERIAL PARTIAL PRESSURE OF OXYGEN
   + PaCO2 = ARTERIAL PARTIAL PRESSURE OF CO2
   + pH     = NEGATIVE LOF [ H+ ]
   + HCO3 = PLASMA HCO3 CONCENTRATION
   + DL.CO2 = DIFFUSION CAPACITY OF CARBON MONOXYDE
   + AIRWAY RESISTANCE
   + ALVEOLAR-CAPILLARY MEMBRANE
   + GAS EXCHANGE
   + COMPLIANCE
   + HYPOXEMIA
   + HYPO AND HYPERCAPNIA

 To explain the concept of "airway obstruction" and of
   C.O.P.D. (Chronic Obstructive Pulmonary Disease)

 To mention and explain the several causes of airway
   obstruction

 To mention and explain the laboratory findings of
   patients with C.O.P.D.

 To explain the mechanism of clinical findings in
   patients with C.O.P.D.

 To explain the compensatory mechanism in C.O.P.D.
 To mention and explain the concept of "Small airways
   obstructive disease"
To mention the several etiologies of "Small airways
   disease"

 To mention the relevance of early detection and
   treatment of "Small airways obstructive disease"

 To mention at least two Pulmonary test for detection
   of "Small airways disease"

 To mention the definition of Chronic Bronchitis and
   it's causes

 To mention the definition of Pulmonary emphysema and
   it's causes

 To mention the definition of Bronchiectasis and it's
   causes

 To mention and explain the complications of C.O.P.D.

 To elaborate a therapeutic plan to reduce development
        and COPD complications.


8.- RESTRICTIVE VENTILATORY DISORDERS (R.V.D.)

SPECIFIC OBJECTIVES:

- At the end of the Unit, students should be able to mention and explain the concept of
Restrictive ventilatory disorders, the different types, the several etiologies, the mechanisms and
the clinical and laboratory features.

To mention and explain the "Restrictive Ventilatory"
   concept

To mention the several etiologies of R.V.D.

To explain the differences between "Pulmonary" and
   "Extra-Pulmonary" disorders, that affect pulmonary
   distensibility

To explain the mechanisms of Pulmonary disorders to
   decrease pulmonary distensibility

To explain the mechanisms of Extra-Pulmonary disorders
   to decrease pulmonary distention
To mention the clinical picture of R.V.D.

To explain the mechanisms to produce the clinical
   picture in R.V.D.

To explain the compensatory mechanisms in R.V.D.
   patients

To mention and explain the laboratory findings of
   R.V.D. patients.
9.-ACUTE PULMONARY EDEMA             (A.P.E.)

SPECIFIC OBJECTIVES:

- At the end of the Unit, students should be able to mention and explain the pulmonary
hemodinamics, water content, the concept of Pulmonary edema, the etiologies, mechanisms,
clinical and laboratory features and compensatory mechanisms of pulmonary edema

To mention the factors of Starling equation (Plasma
       oncotic and hydrostatic pressures and interstitial
       oncotic and hydrostatic pressures, and membrane
       permeability).

To explain the Starling equation in regard to water
   balance in any tissue.

To explain the concept of Fluid Filtration Rate

To mention and explain the factors determining fluid
   balance in the lungs.
 + Intravascular forces: - Hydrostatic pressure
                   - Oncotic pressure
 + Extravascular forces: - Fluid interstitial pressure
                  - Oncotic interstitial pressure
 + Alveolar/capillary - To small molecules
   membrane permeability - To proteins
 + Lymphatic drainage - Flow rate
                  - Pressures

To mention the several etiologies of acute pulmonary
   edema (Cardiogenic and Non-Cardiogenic)

To explain the pathophysiology secuence of
   "Cardiogenic" pulmonary edema formation


To explain the pathophysiology of High altitude
   pulmonary edema

To explain the pathophysiology of Re-expansion
   pulmonary edema

To explain the pathophysiology of Neurogenic pulmonary
   edema

To explain the pathophysiology of Drugs induced
   pulmonary edema

To explain the pathophysiology of Neonatal Respiratory
   Distress Syndrome

To explain the mechanism of pulmonary edema secondary
   to Hypoproteinemia

To explain the mechanism of pulmonary edema secondary
   to decreased lymphatic drainage

To explain the pulmonary compensatory mechanisms in
   pulmonary edema

To explain the clinical findings and complications of
   acute pulmonary edema


10.- ACUTE RESPIRATORY FAILURE

SPECIFIC OBJECTIVES:

- At the end of the unit of Respiratory failure, students should be able to identify, mention and
explain the concept of Respiratory failure in terms of clinical findings and laboratory values, the
several etiologies and the pathophy-
siologic mechanisms to produce it, the compensatory responses in patients with acute or
chronic respiratory failure, the clinical picture and mention the general treatment.

 To mention and explain the concept of Respiratory
   failure in regard to clinical picture and to
   laboratory features.

 To mention and explain the mechanisms to decrease PaO2

   - Hypoventilation

   - Limitation of diffusion

   - Ventilation/Perfusion mismatching (V/Q)

   - Right-to-Left shunting of blood

   - Low FiO2 breathing

 To explain the mechanism that produce the differences
   in responses to treatment between:

   - Hypoventilation
   - V/Q mismatching
   - Right-to-Left shunt

 To mention the several etiologies and explain the
   mechanisms through they produce respiratory failure:


   - Extrapulmonary causes:

     + Low FiO2 inspired

        - Mechanical
     + Failure of breathing mechanisms:
        - Neurological

   - Pulmonary causes:

     + Airways obstruction

     + Diffuse pulmonary infection

     + Bronchial-aspiration

     + Inhalation of toxins and irritants
     + Narcotic overdose pulmonary edema

     + Immunologic responses to host antigen

     + " Shock lung"

     + Associated with systemic diseases

     + Post-cardiopulmonary bypass surgery

To mention and explain the clinical picture of
   patients with acute respiratory failure

 To explain the compensatory mechanisms and the effects
   of them in acute respiratory failure

To mention and explain the clinical picture of
   patients with chronic respiratory failure


 To explain the compensatory mechanisms and the effects
   of them in chronic respiratory failure

 To mention the general measures of treatment of
   patients with acute and chronic respiratory failure


 11.- GLOMERULONEPHRITIS

SPECIFIC OBJECTIVES:

  - At the end of the unit, students should be able to mention and explain the definition of "
Glomerulonephritis " (G.M.N.) and " Glomerulopathies ", the Glomerulopathic syndromes, the
several etiologies and pathophysiologic mechanisms to produce G.N., the effects of glomerular
damage in G.N., the compensatory responses to those effects. To mention the pathological
spectrum and explain the laboratory findings.

 To mention and explain the concept of Glomerulonephri-
   tis and Glomerulopathies and it's gross differences

 To mention and explain the Glomerulopathic Syndromes

   - Acute Glomerulonephritis (Nephritic Syndrome)

   - Rapidly progressive Glomerulonephritis

   - Chronic Glomerulonephritis

   - Nephrotic Syndrome

   - Asymptomatic urinary abnormalities

 To mention the several group of etiologies of G.N.

   - Infectious diseases


   - Multisystem diseases
   - Primary Glomerular diseases

   - Miscellaneous

To mention and explain the mechanisms to produce
   G.N.

   - Circulating Antigen-Antibody complex deposition

   - Anti-Glomerular basement membrane antibodies

   - In-situ Antigen-Antibody complex formation

   - Activation of Alternate Complement pathway

   - Others non-immunologic mechanisms
To mention the pathologic types of G.N. and the
   "Most" common Glomerulopathic Syndromes associated
    with each one

To mention and explain the effects of glomerular
   damage

To explain the compensatory mechanisms and effects of
   them in G.N.

To mention the laboratory findings of patients with
   G.N.

To mention and explain the clinical picture and
   complications of G.N.


12.- NEPHROTIC SYNDROME

SPECIFIC OBJECTIVES:

 - At the end of the unit, students should be able to mention and explain the definition of
Nephrotic Syndrome (N.S.), the several etiologies and the "Most common" patologic type of
Glomerulonephritis associated with it, the mechanism that produce severe proteinuria. To
mention and explain the effects and the compensatory mechanisms to the severe proteinuria of
Nephrotic Syndrome and the laboratory findings and complications of N.S.

 To explain the "Normal" protein kinetics at the kidney

   - Protein Glomerular filtration rate

   - Protein Filtration Fraction

   - Protein tubular metabolism and reabsorption

   - Barrier mechanisms

      + Functional barrier

      + Anatomical barrier

 To mention and explain the definition of Nephrotic
   Syndrome
 To mention the etiologies of N.S. and glomerular
   damage

 To mention and explain the mechanism of proteinuria

   - Selective proteinuria

   - Non-Selective proteinuria

 To mention and explain the effects of severe
   proteinuria on:

   - Hypo-albuminemia
   - Osmolarity regulation
   - Antidiuretic Hormone
   - Sodium and Water balance
   - Intravascular volume balance
   - Cardiovascular system
   - Edema
   - Gastrointestinal level
   - Immune System
   - Lipoproteins
   - Coagulation System

 To explain the compensatory mechanisms of:

   - Kidney
   - Renin-Angiotensin-Aldosterone System
   - Antidiuretic Hormone (A.D.H.)
   - Atrial Natriuretic Hormone
   - Liver
   - Immune System

   to the severe proteinuria and hypoproteinemia in N.S.

 To mention and explain the clinical picture and
   complications of Nephrotic Syndrome

 To mention and explain the laboratory findings on N.S.


13.- ACUTE RENAL FAILURE

SPECIFIC OBJECTIVES:

   -At the end of the unit, students should be able to identify and explain the concept of Acute
Renal Failure (A.R.F), the several types, the etiologies, the pathophysiological mechanisms to
produce it. The clinical picture and the compensatory responses in A.R.F. and the laboratory
findings.

PRE-REQUISITES: Students had to review the Anatomy of the kidney, with emphasis on
arterial and venous irrigation, the urine drainage system, the normal Physiology with regard to
the mechanism that maintain a "normal" renal perfusion, Glomerular Filtration Rate (G.F.R.), the
processes of filtration, secretion, reabsorption, dilution and concentrating mechanisms, the role
of kidney in acid-base balance, the endocrinology system of the kidney (Renin-Angiotensin-
Aldosterone system, Erythropoietin Hormone, Prostaglandins, Thromboxanes) and the
metabolism or excretion of other substances as Hormones, wastage products and so-on.

 To definy the concept of Acute Renal Failure
 To mention the concept of Oliguria and Anuria

 To mention the several types of A.R.F.
     + Pre-Renal Azotemia or Failure
     + Intra-Renal Failure


          + Post-Renal Failure

 To explain the concept and the pathophysiology of
   Acute Renal Failure and explain the responses to:

    - Decreased Renal Perfusion
    - Diminished G.F.R.
    - Renin-Angiotensin System
    - Constriction of Afferent artery
    - Vasodilation of Efferent artery
    - Filtration, secretion and reabsorption mechanisms
    - Diluting and concentrating mechanisms
    - Retention of wastage substances
    - Excretion of important buffer substances
    - Altered acid-base balance
    - Electrolyte disturbances

 To explain the concept of Pre-Renal Azotemia and
   Pre-Renal Failure with it's differences between them.

 To mention the several etiologies of Pre-Renal
   Azotemia and Pre-Renal Failure.

 To explain the concept and the pathophysiology of
   Parenchymal Renal failure (Intra-renal failure)

 To mention the several etiologies of Intra-Renal
   Failure

 To explain the concept and the pathophysiology of
       post-Renal Failure

 To mention the several etiologies of Post-Renal
   Failure

 To explain the compensatory mechanisms in patients
   with Acute Renal Failure and the effects of them.

 To mention and explain the effects on organs or
   systems involved in patients with Acute Renal Failure,


14.- CHRONIC RENAL FAILURE

SPECIFIC OBJECTIVES:

   -At the end of the unit, students should be able to identify and explain the concept of Chronic
Renal Failure (C.R.F), the several types, the etiologies, the pathophysiological mechanisms to
produce it. The clinical picture and the compensatory responses in C.R.F. and the laboratory
findings.

To definy the concept of Chronic Renal Failure
To mention the main differences of acute Vs. chronic
        renal failure

To mention the different etiologies and the incidence
        of C.R.F.

To explain the mechanisms by which hypertension
         induces progressive injury and C.R.F.

To explain the mechanisms by which Diabetes Mellitus
               induces progressive injury and C.R.F.

To explain the mechanisms by which hypertension and
        Diabetes Mellitus association induces progressive
        injury and C.R.F.

To explain the clinical, laboratory, radiologic
         manifestation of C.R.F.

To mention and explain the general measures of
        treatment.

To mention and explain the specific measures of
        treatment related to:

                - Sodium, water balance
                - Potassium balance
                - Protein intake
                - Anemia
                - Gastrointestinal abnormalities
                - Hypertension control
                - Neuromuscular abnormalities
                - Endocrine disturbances
                - Dermatologic abnormalities
                - Skeletal and muscle abnormalities
                - so-on.

 To mention and explain the different types for dyalitic procedures.


 To mention the indications of emergency dyalitic
              programs.

 To mention the indications of elective dyalitic
              programs.

 To mention and explain the mechanisms of dyalitic complications.


15.-ACID BASE DISTURBANCES

SPECIFIC OBJECTIVES:

  -At the end of the unit, students should be able to identify and explain the concept of Acid-
base balance, the several types of acid-base disturbances, the etiologies, the
pathophysiological mechanisms to produce it. The clinical picture and the compensatory
responses in acid-base disturbances and interpretate the laboratory findings.

To mention the normal values of arterial blood gas parameters.
 To mention and explain how the pH is buffered and regulated under normal levels.

To mention the components of Henderson Haselbach equation

To mention the sources of fixed acid and non-fixed acid

To mention and explain the mechanins by which the Lungs regulates non-fixed acid excretion.

To mention and explain the mechanins by which the Kideny regulates fixed acid excretion.

To mention the extracellular fluid and intracellular fluid buffer system.

To mention the different types of simple acid-base disorders.

To mention the different types of mixed acid-base disorders.

To mention and explain the concept of anion gap.

 To mention and explain the etiologies of metabolic and respiratory acidosis,,metabolic and
respiratory alkalosis.

To explain the mechanisms to compensate the acid-base disturbances.


To mention and explain the mixed acid-base disorders

To mention and explain the treatment of metabolic acidosis

To mention and explain the treatment of metabolic alkalosis

To mention and explain the treatment of respiratory acidosis

To mention and explain the treatment of respiratory alkalosis

To mention and explain the main clinical manifestations and complications of acid-base
disturbances.

16.- ESOPHAGEAL DISEASES

SPECIFIC OBJECTIVES:

  -At the end of the unit, students should be able to identify and explain the most common
esophageal diseases, the several types, the etiologies, the pathophysiological mechanisms to
produce it. The clinical picture and their complications, the different lab., X rays, endoscopic and
other diagnostic procedures.

To mention and describe the anatomy, physiology of swallow mechanism

To mention and describe the abnormalities of swallow mechanism and propsed treatments.

To mention and describe the anatomy, physiology of the esophagus

To mention the neurohumoral control of Lower Esophageal Sphincter.

To mention and explain the main symptoms of esophageal disorders, such as dysphagia,
odynophagia, pyrosis, atipical chest pain, regurgitation, G.E.Reflux.

To mention and explain the different etiologies of mechanical and motility abnormalities
dysphagia.
To mention and explain the complications of gastro-esophageal reflux.

 To elaborate a terapheutic plan of G.E.R., life style and food habits,medical treatment and
indications for surgical treatment.



17.- PEPTIC ULCER DISEASE

SPECIFIC OBJECTIVES:

   -At the end of the unit, students should be able to identify and explain the peptic ulcer
disease, the several types, the etiologies, the pathophysiological mechanisms to produce it. The
clinical picture and their complications, the different lab., X rays, endoscopic and other
diagnostic procedures.

01.- To mention and describe the anatomy, physiology of gastric secretion and motility
functions.

02.- To mention and describe the abnormalities of gastric hydrochloric acid secretion
         To mention and describe the abnormalities of gastric mucosal barrier function and it´s
role related to gastric peptic ulcer development

03.- To mention and explain the etiologies and differences between gastric and Duodenal ulcer

04.-To mention the role of Helicobacter Pylori in the development of peptic ulcer disease.

05.- To mention the treatment of Helicobacter Pylori.

06.- To mention the role of Non-steroidal anti-inflammatory drugs in the development of peptic
ulcer disease.

06.- To mention and explain the different complications of peptic ulcer disease.

07.-To mention and explain the treatment, medical ald surgical modalities of the complications
of peptic ulcer

08.- To elaborate a terapheutic plan related to life style and food habits,medical treatment and
indications for surgical treatment.

09.- To mention the hypergastrinemia states related to peptic ulcer development.


18.-HEPATIC ENCEPHALOPATHY

SPECIFIC OBJECTIVES:

  -At the end of the unit, students should be able to identify and explain the liver anatomy,
physiology about chemical detoxification and synthetic functions. To mention and explain the
several types, etiologies,and the pathophysiological mechanisms to produce Hepatic
encephalopathy. The clinical picture and their complications, the different lab., X rays,
endoscopic and other diagnostic and terapheutic procedures.


 To mention and explain the anatomy, liver irrigation, functional unit, biochemical reactions and
synthetic      functions of the liver.

To mention and explain the etiologies of liver cirrhosis.

To mention and explain the etiologies of portal vein shunts, non related to liver cirrhosis.
To mention de causes of liver cirrhosis decompensation to induce hepatic coma.

To mention and explain the substances related in development of liver encephalopathy.

To mention and explain therapeutic plans to prevent decompensations in a liver cirrhotic
patient.

To mention and explain therapeutic plans to treat decompensations in a liver cirrhotic patient
with  hepatic coma..


19.-PORTAL HYPERTENSION

SPECIFIC OBJECTIVES:

  -At the end of the unit, students should be able to identify and explain the liver anatomy,
physiology about chemical detoxification and synthetic functions. To mention and explain the
several types, etiologies,and the pathophysiological mechanisms to produce Portal vein
hypertension The clinical picture and their complications, the different lab., X rays, endoscopic
and other diagnostic and terapheutic procedures.


 To mention and explain the anatomy, liver irrigation, functional unit, biochemical reactions and
synthetic functions of the liver.

To mention and explain the etiologies of liver   cirrhosis.

To mention and explain the etiologies of portal vein shunts, non related to liver cirrhosis.

To mention de causes of esophageal varices bleeding

To mention and explain therapeutic plans to prevent decompensations in a liver cirrhotic
patient.

To mention and explain therapeutic plans to treat decompensations in a liver cirrhotic patient
with esophageal variceal bleeding.



20.-DIARRHEA

SPECIFIC OBJECTIVES:

  - At the end of the Unit, students will be able to mention and explain the concepts of diarrhea,
malabsorption,
the several types and etiologies and their pathophysiological mechanism of them, the
compensatory responses, the clinical picture, laboratory findings and complications of them.

PRE-REQUISITES: Students have to review the anatomy, histology and the different absorptive
and secretory capacities and selectivity of the several gastro-intestinal tract portions, the
different compositions of the G.I. tract secretions and their amounts.

To mention and explain the differences between diarrhea
  and malabsorption.

To mention the following mechanisms to produce diarrhea
  + Osmotic diarrhea
  + Secretory diarrhea
  + Abnormalities of permeability
   + Motility disturbances
   + Altered Ionic transport
   + Lymphatic obstruction
   + Decreased absorption surface area

To explain the mechanism of Osmotic diarrhea, it's
  causes and the characteristics.

To explain the mechanism of Secretory diarrhea, it's
  causes and the characteristics


To explain the mechanism of diarrhea secondary to
  abnormalities of the membrane permeability, it's
  causes and the characteristics

To explain the mechanisms and causes of diarrhea
  secondary to motility disturbances (Increased and
  Decreased) and it's characteristics

To explain the mechanism of diarrhea secondary to
  altered ionic transport, it's causes and the
  characteristics

To explain the mechanism of diarrhea secondary to
  lymphatic obstruction, it's causes and the
  characteristics
To explain the mechanisms of diarrhea secondary to
  decrease in absorption surface area

To mention and explain the clinical picture of
  diarrhea, independently of the mechanism responsible



21.-GENERAL PRINCIPLES OF ENDOCRINOLOGY DISORDERS

SPECIFIC OBJECTIVES:

- At the end of the unit, students will be able to mention and explain the basic concepts of
endocrinology, the mechanisms of action of the hormones, the several types as hyperfunctional
and hypofunctional states of the pituitary gland.


PRE-REQUISITES: Students have to review the Anatomy and Physiology of Pituitary gland, the
mechanism to control the secretion rate, the physiological variants of this and the physiological
effects of the pituitary hormones.

To mention and explain the followings concepts or
  definitions and their differences:

   + Hormone ( Peptidic, Steroid and Amine)
   + Neurotransmitters
   + Receptor ( Membrane, Intracytoplasmic, Nuclear)


   + "Target Organ"
   + "Source organ"
   + Second messenger
   + Calcium/calmodulin complex
   + Basal Metabolism
   + Protein synthesis (Anabolism)
   + Protein breakdown (Catabolism)
   + Hypothalamus - Pituitary - Peripheral gland axis
   + Secretion control mechanisms:
     - "Feed-Back" regulation
     - Circadian rhythm
     - C.N.S. control
     - "Down-regulation"
     - "Up-regulation"

To mention and explain the concepts of "Hyperfunction"
  and "Hypofunction" endocrine disorders, related with
  Primary, secondary, tertiary, ectopic, peripheral and
  exogenous origin

To mention and explain the Pan-Hypopituitarism

To mention and explain the clinical findings of
  Hypersecretion of Growth Hormone

To mention and explain the laboratory findings of
  Hypersecretion of Prolactin

To mention and explain the clinical findings of
  Hypersecretion of Vasopressin

To mention and explain the laboratory findings of
  Hypersecretion of FSH nad LH.

22.-PITUITARY GLAND DISEASES

- At the end of the unit, students will be able to mention and explain the basic concepts of
pituitary gland, the mechanisms of action of the pituitary hormones, the several types and
etiologies of adrenal disorders and it's effects

PRE-REQUISITES: Students have to review the Anatomy and Physiology of the pituitary gland,
the mechanism to control the secretion rate, the physiological variants of this and the
physiological effects of the pituitary hormones.

Hipothalamic and anterior pituitary insufficiency
Developmental and genetic causes of hypopituitarism
Acquired hypopituitarism,Presentation and diagnosis,Laboratory investigation,Treatment
Pituitary tumors and Treatment
Prolactin Synthesis,Secretion,Action
Hyperprolactinemia Presentation and diagnosis,Treatment
Prolactinoma Etiology and prevalence,Presentation and diagnosis,Treatment
Growth hormone, Synthesis, Secretion,Action,Insulin like growth factors
Disorders of growth and development, Skeletal maturation and somatic growth
GH deficiency in children, Nutritional short stature, Psychosocial short stature
Presentation and diagnosis,Laboratory investigation,Treatment, Adrenocorticotropin hormone
Synthesis, Secretion ,Action, ACTH deficiency, Presentation and diagnosis, Laboratory
diagnosis,Treatment.
Cushing`s Disease ,Etiology and prevalence, Presentation and diagnosis, Laboratory
investigation, Treatment, Gonadotropins: FSH and LH Action,Gonadotropin deficiency
Presentation and diagnosis,Laboratory investigation, Treatment, Pituitary adenomas
Presentation and diagnosis, Laboratory investigation, Treatment.
Thyroid stimulating hormone, Synthesis and secretion,Action, TSH deficiency, TSH secreting
adenomas ,Treatment.
Diabetes Insipidus, Vasopresin, Action, Secretion, Synthesis,Secretion, Metabolism, Thirst
Oxytocin,Deficiencies of vasopressin secretion and action, Diabetes Insipidus clinical
characteristics, Etiology, Pathophysiology, Differential diagnosis,Treatment, Excess vasopressin
secretion and action, Hyponatremia clinical characteristics, Etiology, Pathophysiology,
Differential diagnosis, Treatment.

23.-ADRENAL DISORDERS

SPECIFIC OBJECTIVES:

- At the end of the unit, students will be able to mention and explain the basic concepts of
endocrinology, the mechanisms of action of the hormones, the several types and etiologies of
adrenal disorders and it's effects

PRE-REQUISITES: Students have to review the Anatomy and Physiology of Adrenal glands,
the mechanism to control the secretion rate, the physiological variants of this and the
physiological effects of the adrenal hormones.


To mention and explain the followings concepts or
  definitions and their differences:

   + Hormone ( Peptidic, Steroid and Amine)
   + Neurotransmitters
   + Receptor ( Membrane, Intracytoplasmic, Nuclear)
   + "Target Organ"
   + "Source organ"
   + Second messenger
   + Calcium/calmodulin complex
   + Basal Metabolism
   + Protein synthesis (Anabolism)
   + Protein breakdown (Catabolism)
   + Hypothalamus - Pituitary - Peripheral gland axis
   + Secretion control mechanisms:
      - "Feed-Back" regulation
      - Circadian rhythm
      - C.N.S. control
      - "Down-regulation"
      - "Up-regulation"


To mention and explain the concepts of "Hyperfunction"
  and "Hypofunction" endocrine disorders, related with
  Primary, secondary, tertiary, ectopic, peripheral and
  exogenous origin

To mention and explain the Adrenal Hyperfunction and
  Hypofunction related to the previous types of endocrine
  disorders.

To mention and explain the clinical findings of
  Hypercortisolism in the several types of it

To mention and explain the laboratory findings of
   Hypercortisolism in the several types of it

To mention and explain the clinical findings of
  Hypocortisolism in the several types of it

To mention and explain the laboratory findings of
  Hypocortisolism in the several types of it
24.-THYROID DISFUNCTION

SPECIFIC OBJECTIVES:

- At the end of the Unit, students will be able to mention and explain the basic concepts of
thyroid physiology and the types and etiologies of thyroid disorders and the clinical and
laboratory effects of these disorders.



PRE-REQUISITES: Students have to review the anatomy and physiology of thyroid gland, the
mechanisms to control the secretion rate, the iodide physiology (uptake, organification, storage,
thyroid hormone synthesis and release), the several types of thyroid hormones and their
physiological effects.

To mention and explain the several etiologies of
  thyroid hyperfunction, according to the classification
  of Primary, secondary, tertiary, ectopic and exogenous.

To mention and explain the clinical findings of
  the different types of Hyperthyroidism.

To mention and explain the laboratory findings of the
  several types of Hyperthyroidism and the differences
  between them.
To mention and explain the several etiologies of
  Hypothyroidism, according to the classiffication of
  Primary, secondary, tertiary and iatrogenic.

To mention and explain the clinical findings of the
  several types of Hypothyroidism

To mention and explain the laboratory findings of the
  several types of Hypothyroidism and the differences
  between them

25.- OBESITY

SPECIFIC OBJECTIVES:

-At the end of the unit, students will be able to mention and explain the basic concepts of
Obesity, the definition, the relevance of it, the several theories of it's production and the
systemic effects and the complications of excess body fat.



PRE-REQUISITES: Students have to review the " Normal " physiology and byochemistry of
food ingestion, absorption, storage and the metabolism of the nutrients. Review the concepts of
" Centers of regulations of food ingestion " at the hypothalamus (Hunger and Appetite centers)

To mention and explain the relevance of "Obesity" as a
  health problem in U.S.A.

To mention the "most common" problems associated and
  secondary to obesity

To mention and explain the concept of "Obesity"
To mention the different etiologies of increase in
  weight

To mention and explain the concepts of "Hunger",
  "Satiety" and "Appetite"

To mention and explain the location, and role of the
  "Hunger" (Lateral Hypothalamic area) center in the
  regulation of searching for food

To mention the factors that affect the "Hunger" center
  with stimulation and inhibition of it.

    + Plasma Glucose levels
    + Plasma Aminoacid levels
    + Plasma lipid levels
    + C.N.S. Cortex (Limbic system)
    + Head receptors
    + Gastric filling/emptying receptors
    + Somatic sensory signals
    + Polypetide factors (Interleukin 1, Adipsin,
                     Cachectin)
    + C.C.K
    + Leptin
         + so-on


 26.- DIABETIC KETOACIDOTIC STATE

SPECIFIC OBJECTIVES:

- At the end of the Unit, students will be able to mention and explain the basic concepts of
pancreatic endocrine physiology and the types and etiologies of Diabetes Mellitus and the
acute metabolic complications.

PRE-REQUISITES: Students have to review the anatomy and physiology of the endocrine
pancreas, the mechanisms to control the secretion rate of insulin, glucagon, and their
physiological effects.

To mention and explain the synthesis, regulation and     mechanism of action of insulin.

To mention and explain the synthesis, regulation and     mechanism of action of glucagon.

To mention and explain the several etiologies of
  Diabetes Mellitus according to the classification
  of Primary, secondary.

To mention the acute metabolic complications of Type I Diabetes Mellitus

To mention and explain the clinical findings of the
  acute diabetic ketoacidotic state, regarding to:

        - Causative factors
        - Role of lack of insulin
        - Role of glucagon and the counter-regulatory hormones.
        - Role of ketone bodies production in the clinical picture
        - Role of dehydration and osmotic diuresis
        - Complications of dehydration, hypovolemia, metabolic acidosis, hypokalemia so-on in
        the clinical picture.
To mention and explain the general measures in the treatment of D.K.A. focused on:

        - Insulin administration
        - Volume repletion
        - Potassium supplementation
        - Bicarbonate indications


To mention the main complications related to the treatment.

27.-DIABETIC NON-KETOACIDOTIC STATE

SPECIFIC OBJECTIVES:

- At the end of the Unit, students will be able to mention and explain the basic concepts of
pancreatic endocrine physiology and the types and etiologies of Diabetes Mellitus and the
acute metabolic complications.

PRE-REQUISITES: Students have to review the anatomy and physiology of the endocrine
pancreas, the mechanisms to control the secretion rate of inuslin, glucagon, and their
physiological effects.

To mention and explain the synthesis, regulation and mechanism of action of insulin.

To mention and explain the synthesis, regulation and mechanism of action of glucagon.

To mention and explain the several etiologies of
  Diabetes Mellitus according to the classification
  of Primary, secondary.

To mention the acute metabolic complications of Type II Diabetes Mellitus

To mention and explain the clinical findings of the
  Diabetic Hyperosmolar Non-ketoacidotic state, regarding to:

          - Causative factors
          - Role of insulin defficiency
          - Role of glucagon and the counter-regulatory hormones.
          - Role of ketone bodies production in the clinical picture
          - Role of dehydration and osmotic diuresis
         - Complications of dehydration, hypovolemia, metabolic acidosis, hypokalemia so-on in
the clinical picture.

To mention and explain the general measures in the treatment of D.H.N.K.A. focused on:

        - Insulin administration
        - Volume repletion
        - Potassium supplementation
        - Bicarbonate indications

To mention the main complications related to the treatment.


28.-DIABETIC NEUROPATHY

SPECIFIC OBJECTIVES:
- At the end of the Unit, students will be able to mention and explain the basic concepts of
pancreatic endocrine physiology and the types and etiologies of Diabetes Mellitus and the long
term complications.

PRE-REQUISITES: Students have to review the anatomy and physiology of the endocrine
pancreas, the mechanisms to control the secretion rate of insulin, glucagon, and their
physiological effects.

To mention and explain the synthesis, regulation and     mechanism of action of insulin.

To mention and explain the metabolic pathway of glucose

To mention and explain the several etiologies of
  Diabetes Mellitus according to the classification
  of Primary, secondary.

To mention the long term metabolic complications of Type I and type II Diabetes Mellitus

To mention and explain the clinical findings of the
  Diabetic Neuropathy.

To mention and explain the proposed mechanisms to develop diabetic neuropathy with regard
to:

        - Polyol pathway
        - Protein glycosilation
        - The aldose reductase enzyme

To mention and explain the general measures in the prevention and treatment

        - Insulin administration
        - Aldose reductase inhibitors
        - Myo-inositol supplementation.
        - Anti-neuritic drugs.

29.-HYPOGLYCEMIA

SPECIFIC OBJECTIVES:
- At the end of the Unit, students will be able to mention and explain the basic concepts of
pancreatic endocrine physiology and the counter-regulatory hormones

PRE-REQUISITES: Students have to review the anatomy and physiology of the endocrine
pancreas, the mechanisms to control the secretion rate of insulin, glucagon,the role of
catecholamines, cortisol, growth hormone, somatostatin related to glucose metabolism.

To mention and explain the synthesis, regulation and     mechanism of action of insulin.

To mention and explain the synthesis, regulation and mechanism of action of
glucagon,catecholamines,      cortisol, growth hormone, somatostatin .

To mention and explain the several etiologies of
  hypoglycemia according to the classification
  of fasting and postpandrial.

To mention and explain the clinical findings of the
  acute severe hypoglcyemia

To mention and explain the general measures in the       treatment of hypoglycemia
30.- PAIN

SPECIFIC OBJECTIVES:

- At the end of the Unit, students will be able to mention and explain the basic concepts of pain
and analgesia system.

PRE-REQUISITES: Students have to review the anatomy and physiology of the pain receptors,
pain fibers, ascending spinal tracts, C.N.S. relays and brain cortex physiology.

To mention and explain the relevance of pain as a health problem

To mention and explain the physiology and substances
      that activates nociceptors.

To mention and explain the Pain fibers

To mention and explain the several theories of spinal    analgesia, related to "Wide Dynamic
Range" neurons, endogenous opioids role.

To mention the ascending tracts to transmit peripheral pain to the Brain cortex.

To mention and explain the role of the C.N.S. nucleus in the supra-spinal analgesia system.

 To mention and explain the proposed mechanisms to       explain individual different responses to
sam apinful    stimuli.

To mention the proposed theories to explain chronic painful syndromes.

To mention and explain different treatments fo pain relief.

31.- HYPERURICEMIA AND GOUT

SPECIFIC OBJECTIVES:

- At the end of the Unit, students should be able to mention and explain the Purine metabolism
pathway, it's abnormalities, and the effects of the increase in Uric acid production as the most
common disorder of this metabolic pathway.


To mention and explain the sources, daily production,
   daily excretion, routes of excretion of Purines.

To mention the importance of Purines in the Genetic
   code information, energy production and metabolism

To mention and explain the concepts of Solute, Solvent,
   Solution, Saturation, crystallization.

To mention the "Normal" levels of Uric acid in plasma
   of adults.

To mention the "Normal" variants in the level of uric
   acid with regard to:

    - Sex
    - Age
    - Social status
    - Intelligence Quotient ( I.Q.)
To mention the "Saturation" point of the Uric acid in
   human plasma.

To mention the frequency of Hyperuricemia (Gout) in the
   General population.

To mention and explain the diferent Gout Stages:

    - Asymptomatic
    - Acute Gouty Arthritis
    - Intercritical Gout
    - Chronic Tophaceous Gout
    - Nephrolitiasis
    - Interstitial Nephritis

To mention and explain the relevance and frequency in
  the understanding of the "Asymptomatic" hyperuricemic
  patients, to avoid or preclude the Drug treatment.

To mention and explain the classification and
   mechanisms of Hyperuricemia production.

   - Over-production

   - Under-excretion

   - Combination of both

To mention and explain the proposed theories in the
   development of the "Acute Gouty Arthritis"
To mention and explain the posible role of the
   Precipitating factors in the development of "Acute
   Gouty Arthritis"

To mention and explain the proposed theories of the
  "Self-Limitation" of the " Acute Gouty Arthritis"
   attacks

To mention and explain the mechanisms of action of:

   - Allopurinol
   - Probenecid
   - Colchicine
   - Glucocrticoids



 their complications and the role of them in the treatment
  of patients with symptomatic Gout.


32.- GENERAL EFFECTS OF CANCER

SPECIFIC OBJECTIVES:

- At the end of the Unit, the students should be able to mention and explain the differences
between Normal cells and pathological cells, the factors and the mechanisms to modify the
Normal cells and the effects of those "Modified" cells.

To mention and explain the relevance of cancer as a health problem
To mention and explain the normal cell cycle, the concepts of cellular diferentiation, dysplasia,
      anaplasia and cancer

To mention and explain the local effects of cancer

To mention and explain the remote effects of cancer cells.

To mention the five most common cancers in U.S.A.

To mention the most common carcinogens

To mention the different theories of cancer development.




33.-PARANEOPLASTIC SYNDROMES

SPECIFIC OBJECTIVES:

- At the end of the Unit, the students should be able to mention and explain the differences
between Normal cells and pathological cells, the factors and the mechanisms to modify the
Normal cells and the effects of those "Modified" cells.

To mention and explain the relevance of cancer as a health problem




To mention and explain the normal cell cycle, the concepts of cellular diferentiation, dysplasia,
      anaplasia and cancer

To mention and explain the remote effects of cancer cells.

 To mention the most common cancers involved in the development of paraneoplastic
syndromes.

 To mention the proposed mechanisms by which cancer cells induces paraneoplastic
syndromes.


34.- SEPTIC SHOCK

SPECIFIC OBJECTIVES:

- At the end of the Unit, the students should be able to mention and explain the concepts of
infection, bacteremia, sepsis, septicemia, septic shock, systemic inflammatory response
syndrome.

To mention and explain the relevance of sepsis as a health problem

To mention and explain the relevance of septic shock,related to epidemiology, etiology,
mortality and economic impact.

To mention and explain the microbial signals involved in the activation of Host response.

To mention the proposed mechanisms by which during septic shock the following systems
became activated, and their consequences.
        - Coagulation system
        - Complement system
        - Neutrophils
        - Monocytes/Macrophages
        - Platelets.
        - Vascular endothelium
        - Cytokines
        - Arachidonic acid metabolites.
        - others..

To mention and explain the clinical manifestations



To mention and explain the major complications

To mention and explain Multiple Organ Failure

To mention and explain the main laboratory findings

To elaborate and explain an approach to diagnose the syndrome.

To mention and explain the general measures of treatment

To mention and explain the specific measures of treatment



35.- ACQUIRED IMMUNO-DEFFICIENCY SYNDROME (AIDS)

SPECIFIC OBJECTIVES:

- At the end of the Unit, the students should be able to mention and explain the etiology,
epidemiology, relevance, mechanisms of transmission, mechanisms to induce
immunodefficiency, complications, treatment and immunizations related to H.I.V.infection.

To mention the epidemiology around the world, and states of higher index of HIV infected
population in USA.

 To mention the Etiology of AIDS with their properties such as morphology, genome, life cycle,
so-on.

To mention and explain the HIV transmission and measures to reduce the risk of this.

To mention the life cycle of HIV in humans

To mention and explain the role of HIV to induce cellular and humoral immune dysfunction.

To mention the Laboratory test for detection and monitoring exposed and infected HIV persons.

To mention the clinical manifestation of HIV infected patients.

To mention the proposed actual treatment of HIV infected patients.

To mention the prognosis

To mention the actual role of vaccines to prevent HIV    infection.


36.- PARKINSON´S DISEASE AND ALZHEIMER´S DISEASES
SPECIFIC OBJECTIVES:

- At the end of the Unit, the students should be able to mention and explain the epidemiology,
socio-economic impact, proposed etiologies, proposed pathophysiology, clinical picture and
proposed treatment.

To mention the epidemiology of Parkinson´s disease & Alzheimer´s Disease.

To mention and explain the clinical manifestations of   Parkinson´s disease & Alzheimer´s
Disease.

To mention and explain the proposed etiologies of Parkinson´s disease & Alzheimer´s Disease.

To mention the pathologic features of Parkinson´s disease & Alzheimer´s Disease.

To mention the differential diagnosis of dementia

To mention the clinical manifestations of Parkinson´s disease & Alzheimer´s Disease.

To mention the proposed treatments of Parkinson´s disease & Alzheimer´s Disease.

37.- DIABETIC NEUROPATHY

SPECIFIC OBJECTIVES:

- At the end of the Unit, students will be able to mention and explain the basic concepts of
pancreatic endocrine physiology and the types and etiologies of Diabetes Mellitus and the long
term complications.

PRE-REQUISITES: Students have to review the anatomy and physiology of the endocrine
pancreas, the mechanisms to control the secretion rate of insulin, glucagon, and their
physiological effects.

To mention and explain the synthesis, regulation and    mechanism of action of insulin.

To mention and explain the metabolic pathway of glucose

To mention and explain the several etiologies of
  Diabetes Mellitus according to the classification
  of Primary, secondary.

To mention the long term metabolic complications of Type I and type II Diabetes Mellitus

To mention and explain the clinical findings of the
  Diabetic Neuropathy.

 To mention and explain the proposed mechanisms to      develop diabetic neuropathy with regard
to:

        - Polyol pathway
        - Protein glycosilation
        - The aldose reductase enzyme
        - Growth factors role.

 To mention and explain the general measures in the prevention and treatment of it´s
complications.

        - Insulin administration
        - Aldose reductase inhibitors
        - Myo-inositol supplementation.
        - Anti-neuritic drugs.

38.-DIABETIC RETINOPATHY

SPECIFIC OBJECTIVES:

- At the end of the Unit, students will be able to mention and explain the basic concepts of
pancreatic endocrine physiology and the types and etiologies of Diabetes Mellitus and the long
term complications.

PRE-REQUISITES: Students have to review the anatomy and physiology of the endocrine
pancreas, the mechanisms to control the secretion rate of insulin, glucagon, and their
physiological effects.

01.- To mention and explain the synthesis, regulation and mechanism of action of insulin.

02.- To mention and explain the metabolic pathway of glucose

03.- To mention and explain the several etiologies of
   Diabetes Mellitus according to the classification
   of Primary, secondary.

04.- To mention the long term metabolic complications of Type I and type II Diabetes Mellitus

05.- To mention and explain the clinical findings of theDiabetic Retinopathy.

06.- To mention and explain the proposed mechanisms to develop diabetic Retinopathy with
regard to:

        - Polyol pathway
        - Protein glycosilation
        - The aldose reductase enzyme
        - Growth factors role.

07.- To mention and explain the general measures in the prevention and treatment of it´s
complications.

         -Education of the patient
         -Diet
        - Insulin administration
        - Laser Photocoagulation therapy

39.- SEIZURES AND EPILEPSY

SPECIFIC OBJECTIVES:
- At the end of the Unit, students will be able to mention and explain the basic concepts of a
seizure, of epilepsy, the classification of seizures, the causes of seizures, the approach, the
differential diagnosis and treatment.


To mention and explain the basic concepts of a seizure, and of epilepsy

 To mention and explain the classification of seizures and epilepsy as Partial and generalized
seizures.

To mention and explain the causes of seizures

To mention and explain the evaluation of a patient with a seizure and the differential diagnosis
To mention and explain the actual treatment of partial and generalized epilepsy.


40.- ASTHMA

SPECIFIC OBJECTIVES:

- At the end of the Unit, the students should be able to mention and explain the basic concepts
of Asthma, related to etiology, prevalence, clinical manifestations, complications and treatment.

To explain the concept of "airway obstruction" and the main differences between asthma and
C.O.P.D. (Chronic      Obstructive Pulmonary Disease)

To mention the prevalence of asthma

To mention and explain the several causes of asthma

To mention and explain the pathogenesis of asthma.

To mention and explain the clinical manifestations of asthma.

To mention and explain the complications of asthma.

To mention and explain the diferential diagnosis of asthma.

To elaborate a therapeutic plan for prevention of acute attacks and control of them.



41.-INTRACRANIAL PRESSURE ABNORMALITIES

                    SPECIFIC OBJECTIVES:

- At the end of the Unit, the students should be able to mention and explain the basic concepts,
related to etiology, prevalence, clinical manifestations, complications and treatment.

To mention the prevalence and etiology

To mention and explain the several causes

To mention and explain the pathogenesis.

To mention and explain the clinical manifestations

To mention and explain the complications

To mention and explain the diferential diagnosis

 To elaborate a therapeutic plan for prevention, surgical management and medical treatment
them.

				
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