Towards Understanding the
Basic Medical Sciences
Foundation of Clinical Medicine
Prepared and presented by Marc Imhotep Cr...
The integration of basic and clinical sciences
in undergraduate medical science
IVMS teaching philosophy is based on the i...
11 benefits of integrated learning in
undergraduate medical education
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Improved motivat...
“What is
Horizontal and Vertical Integration”
Horizontal: bring together the disciplines, topics,
subjects of basic medial...
“Let’s exemplify vertical integration by briefly looking at how one relates

Basic Pathology to Medical Diagnosis

PATHOLO...
PATHOLOGY: SCIENTIFIC STUDY OF…
PATHOGENESIS
PATHOMORPHOLOGY

ETIOLOGY

DISEASE
PROGNOSIS

COURSE
COMPLICATIONS

“IVMS and...
Ex: SCIENTIFIC STUDY OF DISEASE
P

SEPTICAEMIA

E
N. meningitidis

MENINGITIS

PM
ACUTE
INFLAMMATION
MENINGES

P
DEATH
(IF...
PATHOLOGY OBJECTIVES
1 To introduce a NEW VOCABULARY of terms,
definitions, and disease processes.
2 To introduce the BASI...
PATHOLOGY OBJECTIVE (2)
STRUCTURAL & FUNCTIONAL ALTERATIONS
induced by disease
CORRELATION
form
the basis by which attendi...
SIGNS AND SYMPTOMS
DETECTED BY CLINICIAN

& pathologist

PHYSIOLOGY & FUNCTION

ALTERS
ORGAN STRUCTURE
DETECTED BY PATHOLO...
LEVELS OF STUDY OF PATHOLOGY
•
•
•
•
•
•

MOLECULAR
CHEMICAL
ULTRASTUCTURAL
CELLULAR
TISSUE
PATHOMORPHOLOGY
ORGAN

“IVMS a...
PATHOMORPHOLOGY
• PATHO.. - the disease
• MORPH .. - the shape (structure)
• OLOGY .. - the study of
i.e. how a disease pr...
“ORGANOMEGALY”
AN ALTERATION OF MORPHOLOGY
“CHANGE IN SHAPE & / 0R SIZE”
AS A PRECEPT THERE IS BUT ONE
CAUSE OF ORGANOMEGA...
WHAT MAY BE ADDED?
•
•
•
•
•
•

NORMAL CELLS HYPERPLASIA or HYPERTROPHY
FLUID EDEMA
BLOOD CONGESTION
INFLAMMATORY EXUDATE
...
HISTOPATHOLOGY /
PATHOMORPHOLOGY
OVERVIEW
Companion learning tools to the following general
pathology section:
IVMS Genera...
CELLULAR DEGENERATION
AND INFILTRATION
 THEY ARE RELATED TO CHANGES WHICH MAY BE
REVERSIBLE
 THE AGENTS WHICH CAUSE CELU...
CELL INJURY THUS REFLECTS
TWO LEVELS OF SEVERITY
1. ONE COMPATIBLE WITH RECOVERY
2. THE SECOND IRREVERSIBLE

“IVMS and int...
COMPATIBLE WITH RECOVERY
CLASSAFICATION
 CELL DEGENERATION AND INFILTRATION CAN BE
DIVIDED INTO SEVERAL MORPHOLOGIC PATTE...
CLOUDY SWELLING
 THIS IS CHARACTERIZED MORPHOLOGICALLY BY
A SLIGHT SWELLING OF THE CELLWITH
GRANULARITY AND CLOUDINESS OF...
CLOUDY SWELLING(2)
THIS CAN BE CAUSED BY MANY FACTORS
 INFECTIONS
 FEBRILE ILLNESS
 EXCESSIVE COLD OR HEAT
 ANOXIA
 M...
HYDROPIC OR VACUOLOR
DEGENERATION
 THIS IS A MORE PRONOUNCED FORM OF
INTRACELLULAR EDEMA, AND ALTHOUGH IT IS
REVERSIBLE ,...
HYDROPIC OR VACUOLOR
DEGENERATION(2)
 THIS DEGENERATION IS OF PARTICULAR PROMINENCE
IN THE KIDNEYS , OFTEN RESULTING FROM...
HYDROPIC OR VACUOLOR
DEGENERATION(3)
 ON MICROSCOPIC EXAMINATION THIS APPEARS AS
SMALL , CLEAR VACOULES DISPERSED
THROUGH...
FATTY DEPOSITION
(FATTY METAMORPHOSIS)
 THIS CHANGE IS DUE TO AN ABNORMAL
ACCUMULATION OF FAT WITHIN PARENCHYMAL
CELLS

“...
FATTY DEPOSITION
(FATTY METAMORPHOSIS)(2)
 THE PRESENCE OF FAT REPRESENTS AN
ABSOLUTE INCREASE IN INTRACELLULAR FAT
AND R...
GLYCOGEN DEGENERATION
(INFILTRATION)
 GLYCOGEN IS MORMALLY ABUNDANT IN LIVER AND
MUSCLE CELLS
 IN SOME CONDITIONS ABNORM...
HYALINE DEGENERATION
 IN THIS , THERE IS A REGRESSIVE CHANGE IN
THE CELLS IN THAT THE CYTOPLASM NOW
HAS A GLASSY EOSINOPH...
MUCOID DEGENERATION
 THIS DESCRIPTION REFERS TO THE
EXTRACELLULAR ACCUMULATION OF
MUCOPOLYSACCHARIDE AND GROUND SUBSATNCE...
CELL DEATH AND NECROSIS
• NECROSIS REFERS TO THE MORPHOLOGIC CHANGES
THAT FOLLOW CELL DEATH AND PERMIT VISIBLE
RECOGNITION...
IRREVERSIBLE
NECROSIS
 MOST OF THE CHANGES THAT INDICATE CELLULAR
DEATH ARE MORE PROMINENT IN THE NUCLEUS THAN
IN THE CYT...
COAGULATION NECROSIS
 THIS TYPE OF NECROSIS IS CHARACTERISED BY
THE CELL BECOMING AN ACIDOPHILIC MASS,
USUALLY WITH THE L...
LIQUEFACTION NECROSIS
 IN THIS CASE THERE IS A RAPID AND TOTAL
ENZYMATIC DISSOLUTION OF THE CELLS
 THERE IS COMPLETE DES...
ENZYMATIC NECROSIS
 THIS PRESENTS WITH ACUTE DESTRUCTION OF
THE PANCREAS
 THIS FROM THE RELEASE OF THE PANCREATIC
ENZYME...
CASEOUS NECROSIS
 THIS SEEN WITH TUBERCULOSIS INFECTIONS
 THE CELLS ARE CHANGED TO A GRANULAR,
EOSINOPHILIC MASS OF AMOR...
GANGRENOUS NECROSIS
 THIS IS RELATED TO ISCHEMIA AND A
SUPERIMPOSED BACTERIAL INFECTION
 THE INITIAL EVENT MAY HAVE BEEN...
FIBRINOID NECROSIS
 THIS IS SEEN PRINCIPALLY WITH DISEASES OF
HYPERSENSITIVITY ORIGIN
 THERE IS THE APPEARANCE OF FIBRIN...
CAUSES OF CELL INJURY
AND DEATH
1) ANOXIA
2) PHYSICAL AGENTS
3) CHEMICAL AGENTS
4) BIOLOGIC AGENTS
5) IMMUNE
MCAHANISMSDER...
DIFFERENTIAL DIAGNOSIS
IS THE PROCESS..
VASCULAR - SUDDEN ONSET
INFLAMMATORY- CARDINAL SIGNS/SYMPTOMS
NEOPLASTIC - MASS
DR...
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IVMS Understanding the Basic Medical Sciences Foundation of Clinical Medicine

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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.

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IVMS Understanding the Basic Medical Sciences Foundation of Clinical Medicine

  1. 1. 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 CORRELATION TO Medical Diagnosis “IVMS and integration of basic and clinical sciences”
  2. 2. The integration of basic and clinical sciences in undergraduate medical science 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.” “IVMS and integration of basic and clinical sciences” 2
  3. 3. 11 benefits of integrated learning in undergraduate medical education 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Improved motivation and satisfaction Professional socialization Enhanced self reflection and self appraisal Reinforced and deep learning Prepares for life‐long learning Improved understanding of biological principles, mechanisms & basic concepts Heightened relevance of learning Facilitates curriculum review Promotes co‐operation between staff members from different disciplines Enhances clinician reflections on the scientific basis of practice 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 “IVMS and integration of basic and clinical sciences” 3
  4. 4. “What is Horizontal and Vertical Integration” Horizontal: bring together the disciplines, topics, subjects of basic medial science or clinical medicine Vertical: bringing together basic medial science and clinical medicine “IVMS and integration of basic and clinical sciences” 4
  5. 5. “Let’s exemplify vertical integration by briefly looking at how one relates Basic Pathology to Medical Diagnosis PATHOLOGY • PATH – pertaining to a morbid process (disease) • (from “pathos” = travail or sorrow (Greek) • OLOGY – the scientific study of … “IVMS and integration of basic and clinical sciences” 5
  6. 6. PATHOLOGY: SCIENTIFIC STUDY OF… PATHOGENESIS PATHOMORPHOLOGY ETIOLOGY DISEASE PROGNOSIS COURSE COMPLICATIONS “IVMS and integration of basic and clinical sciences” 6
  7. 7. Ex: SCIENTIFIC STUDY OF DISEASE P SEPTICAEMIA E N. meningitidis MENINGITIS PM ACUTE INFLAMMATION MENINGES P DEATH (IF UNTREATED) “IVMS and integration of basic and clinical sciences” C NH VENTRICULITIS ENDARTERITIS HYDROCEPHALUS SPREAD VIA CSF 7
  8. 8. 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. “IVMS and integration of basic and clinical sciences” 8
  9. 9. PATHOLOGY OBJECTIVE (2) STRUCTURAL & FUNCTIONAL ALTERATIONS induced by disease CORRELATION form the basis by which attending SIGNS and SYMPTOMS are produced “IVMS and integration of basic and clinical sciences” 9
  10. 10. SIGNS AND SYMPTOMS DETECTED BY CLINICIAN & pathologist PHYSIOLOGY & FUNCTION ALTERS ORGAN STRUCTURE DETECTED BY PATHOLOGIST & clinician PATHOMORPHOLOGY “IVMS and integration of basic and clinical sciences” 10
  11. 11. LEVELS OF STUDY OF PATHOLOGY • • • • • • MOLECULAR CHEMICAL ULTRASTUCTURAL CELLULAR TISSUE PATHOMORPHOLOGY ORGAN “IVMS and integration of basic and clinical sciences” 11
  12. 12. 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. “IVMS and integration of basic and clinical sciences” 12
  13. 13. “ORGANOMEGALY” AN ALTERATION OF MORPHOLOGY “CHANGE IN SHAPE & / 0R SIZE” AS A PRECEPT THERE IS BUT ONE CAUSE OF ORGANOMEGALY SOMETHING MUST BE ADDED TO THE ORGAN “IVMS and integration of basic and clinical sciences” 13
  14. 14. WHAT MAY BE ADDED? • • • • • • NORMAL CELLS HYPERPLASIA or HYPERTROPHY FLUID EDEMA BLOOD CONGESTION INFLAMMATORY EXUDATE NEOPLASTIC CELLS TUMOR GAS EMPHYSEMA “IVMS and integration of basic and clinical sciences” 14
  15. 15. 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 “IVMS and integration of basic and clinical sciences”
  16. 16. 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 “IVMS and integration of basic and clinical sciences”
  17. 17. CELL INJURY THUS REFLECTS TWO LEVELS OF SEVERITY 1. ONE COMPATIBLE WITH RECOVERY 2. THE SECOND IRREVERSIBLE “IVMS and integration of basic and clinical sciences”
  18. 18. 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 “IVMS and integration of basic and clinical sciences”
  19. 19. 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 “IVMS and integration of basic and clinical sciences”
  20. 20. CLOUDY SWELLING(2) THIS CAN BE CAUSED BY MANY FACTORS  INFECTIONS  FEBRILE ILLNESS  EXCESSIVE COLD OR HEAT  ANOXIA  MALNUTRITION  PHYSICAL INJURY  VASCULAR DISTURBANCES “IVMS and integration of basic and clinical sciences”
  21. 21. 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 “IVMS and integration of basic and clinical sciences”
  22. 22. 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) “IVMS and integration of basic and clinical sciences”
  23. 23. 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 “IVMS and integration of basic and clinical sciences”
  24. 24. FATTY DEPOSITION (FATTY METAMORPHOSIS)  THIS CHANGE IS DUE TO AN ABNORMAL ACCUMULATION OF FAT WITHIN PARENCHYMAL CELLS “IVMS and integration of basic and clinical sciences”
  25. 25. 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 “IVMS and integration of basic and clinical sciences”
  26. 26. 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 “IVMS and integration of basic and clinical sciences”
  27. 27. 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 “IVMS and integration of basic and clinical sciences”
  28. 28. 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 “IVMS and integration of basic and clinical sciences”
  29. 29. CELL DEATH AND NECROSIS • NECROSIS REFERS TO THE MORPHOLOGIC CHANGES THAT FOLLOW CELL DEATH AND PERMIT VISIBLE RECOGNITION THAT THE CELL HAS DIED “IVMS and integration of basic and clinical sciences”
  30. 30. IRREVERSIBLE NECROSIS  MOST OF THE CHANGES THAT INDICATE CELLULAR DEATH ARE MORE PROMINENT IN THE NUCLEUS THAN IN THE CYTOPLASM “IVMS and integration of basic and clinical sciences”
  31. 31. 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 “IVMS and integration of basic and clinical sciences”
  32. 32. 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 “IVMS and integration of basic and clinical sciences”
  33. 33. ENZYMATIC NECROSIS  THIS PRESENTS WITH ACUTE DESTRUCTION OF THE PANCREAS  THIS FROM THE RELEASE OF THE PANCREATIC ENZYMES OUTSIDE OF THEIR NORMAL CONFINES “IVMS and integration of basic and clinical sciences”
  34. 34. 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 “IVMS and integration of basic and clinical sciences”
  35. 35. 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 “IVMS and integration of basic and clinical sciences”
  36. 36. 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 “IVMS and integration of basic and clinical sciences”
  37. 37. CAUSES OF CELL INJURY AND DEATH 1) ANOXIA 2) PHYSICAL AGENTS 3) CHEMICAL AGENTS 4) BIOLOGIC AGENTS 5) IMMUNE MCAHANISMSDERRANGEMENTS 6) GENETIC DEFECTS “IVMS and integration of basic and clinical sciences”
  38. 38. DIFFERENTIAL DIAGNOSIS IS THE PROCESS.. VASCULAR - SUDDEN ONSET INFLAMMATORY- CARDINAL SIGNS/SYMPTOMS NEOPLASTIC - MASS DRUGS - HISTORY INFECTION- CARDINAL SIGNS/SYMPTOMS CONGENITAL- FROM BIRTH AUTOIMMUNE - SYSTEMIC TRAUMATIC - HISTORY “VINDICATE” ENDOCRINE / METABOLIC- Sn/Sx “IVMS and integration of basic and clinical sciences” 38

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