Course Name:
Musculoskeletal and Integument (MSI)
Class Hours:
Class Directors:
Office:
Telephone:
E-mail:
Monday-Friday, 8:00-12:00
Molly Hill, Ph.D.
BMSB 1053
405-271-2133, x46611
Molly-Hill@ouhsc.edu
Allan Wiechmann, Ph.D.
BMSB 553
405-271-2377
Allan-Wiechmann@ouhsc.edu
I.
Course description: This course is designed to teach undergraduate medical students
about the normal and abnormal structure, function and development of the musculoskeletal and
integument (MSI) systems. Major topics will include the pathophysiology of infectious,
inflammatory, non-neoplastic and neoplastic diseases as well as genetic disorders in the bone,
muscle, skin and connective tissues.
II.
Learning objectives: (Bolded items reflect competencies)
A.
Patient Care
1.
Students will demonstrate the essentials of formulating a problem list and
differential diagnosis.
Formulate a problem list and generate differential diagnoses from case studies of
patients with diseases affecting the musculoskeletal and integument systems.
2.
Students will demonstrate the ability to interpret results of commonly used
diagnostic studies and to reason deductively in solving clinical problems.
Implement a medical plan from case studies for the care and treatment of patients
with diseases of MSI based on results of diagnostic studies, clinical presentation
and pathologic manifestations.
3.
Students will demonstrate the ability to communicate effectively, both orally
and in writing.
Explain orally and in writing, the rationales for the differential diagnoses and
medical plans derived from case studies of patients presenting with diseases of
MSI.
4.
Students will demonstrate awareness of health promotion and disease
prevention.
Describe the epidemiology and methods and effectiveness of preventive measures
for the most common diseases of the MSI.
B.
Medical Knowledge
1.
Students will demonstrate knowledge of the normal structure and function of
the organs, tissues and cellular components of the musculoskeletal and
integument systems.
2.
3.
a.
Describe the basic segmental organization of the human body, including
the arrangement of the peripheral nervous system and the dermatomal,
Blaschkonian, and Langer's organization of the body surface.
b.
Explain the development of the integument, skeleton, muscles, and
innervation in the trunk and limbs.
c.
Identify the primary functions of the skin, skeleton, and muscle.
Students will demonstrate knowledge of the molecular, biochemical and
cellular mechanisms that is important in maintaining the body’s homeostasis.
a.
Relate the structural features of the cells and tissues of the MSI to their
individual function as well as to other cells and tissues in these organs.
b.
Relate mineral ion homeostasis to its roles in skeletal development and
function.
c.
Describe the physiology of muscle function.
Students will demonstrate knowledge of the various causes and pathogenesis
of maladies, emphasizing the common and important clinical, laboratory,
radiologic and pathologic manifestations.
a.
List the most common inflammatory (autoimmune, rheumatic, collagen)
diseases affecting the MSI.
i.
Differentiate the major clinical and pathologic features of
inflammatory diseases involving muscle, bone, joint, skin and soft
tissues.
ii.
b.
Formulate a plan to identify the disease using the pathologic
manifestations of the disease as well as laboratory and/or
radiologic tests.
List the most prevalent bacterial, viral, fungal and parasitic diseases
affecting the MSI.
i.
Differentiate the major clinical and pathologic features of
infectious diseases involving muscle, bone, joint, skin and soft
tissues.
ii.
c.
List the non-neoplastic and neoplastic diseases affecting these systems
(bone, skin, soft tissues, adipose and fibrous tissues, and skeletal and
smooth muscle).
i.
Differentiate the major clinical and pathologic features of major
benign and malignant diseases involving muscle, bone, joint, skin
and soft tissues.
ii.
d.
C.
Formulate a plan to identify the disease based on pathologic
manifestations as well as laboratory and/or radiologic tests.
List the genetic disorders affecting the MSI.
i.
Differentiate the major clinical and pathologic features of genetic
diseases involving muscle, bone, joint, skin and soft tissues.
ii.
4.
Formulate a plan to identify the disease and the causative organism
based on pathologic manifestations as well as laboratory and/or
radiologic tests.
Formulate a plan to identify specific genetic diseases based on the
pathologic manifestations as well as laboratory and/or radiologic
tests.
Students will demonstrate knowledge of the pathology and pathophysiology
of the various diseases and conditions seen in the MSI.
a.
Identify the major immunologic mechanisms involved in the pathogenesis
of inflammatory diseases and the resulting pathology.
b.
Identify the major virulence factors of microbes and relate how they
enable the microbe to evade protective host responses and result in tissue
damage.
c.
Describe the process whereby abnormal growths alter normal structure
and function in the MSI.
d.
Identify vulnerabilities of trunk and limb development to environmental
and genetic influences and how these result in disease processes.
Experience-based learning and improvement
Students will demonstrate the ability to retrieve, effectively evaluate and use
medical literature to provide evidence based practice.
1.
Utilize the primary medical literature to determine effective treatment
regimens for diseases involving the MSI.
2.
D.
E.
Compare and contrast treatments of MSI diseases based on evidencebased medicine versus non-traditional therapies.
Interpersonal and communication skills
Students will demonstrate the ability to work effectively with others as a member of
a health care team or other professional group.
1.
Work together to formulate a problem list and generate differential
diagnoses from case studies of patients with diseases affecting MSI.
2.
Work together to implement a medical plan based on results of diagnostic
studies, clinical presentation and pathologic manifestations from case
studies of patients with diseases affecting MSI.
Professionalism
1.
Students will demonstrate honesty and integrity in all interactions with
colleagues and a commitment to support competent and ethical practice in
one’s self and colleagues.
Practice honesty and integrity in assigned tasks in all classroom and clinical
situations.
2.
Students will demonstrate an understanding of, and respect for, the roles of
other health care professionals, and of the need to collaborate with others in
caring for individual patients and in promoting the health of defined
populations.
Respect and appreciate the roles of all health care professionals by identifying the
role that each member of the health care team plays in the care and treatment of
patients with diseases affecting the MSI.
3.
Students will demonstrate the capacity to recognize and not exceed the
limitations in one’s knowledge and clinical skills, and demonstrate a
commitment to continuously improve and grow.
Commit to continuous improvement of skills and knowledge necessary to care for
patients with diseases affecting the MSI.
III.
Conduct of the course
Each week includes 6-8 hours of lecture with lots of homework assignments and self-study.
Each week concludes with a discussion of case studies that they would receive on Monday.
Week 1: “She ain’t nothing but skin and bones”
Monday
Tuesday
`Wednesday
1
Intro to MSI
System:
Distribute case
studies
2
Segmental
9:00-10:00
and
dermatomal
organization
of human
body
10:00-11:00 3Self-study:
Review of
anatomy of
MSI
11:00-12:00 Self-study:
Review of
anatomy of
MSI
1-9: Assigned readings
8:00-9:00
4
Self-study:
Function of
skin, muscle,
and bone
Self-study:
Function of
skin, muscle,
and bone
9:00-10:00
Inflammatory
and immunemediated
diseases I
2
IIMD II
Self-study:
Self-study
Histology of
cells/tissues of
MSI
Self-study:
Self-study
Histology of
cells/tissues of
MSI
Self-study:
Clinical
presentation
11:00-12:00 Self-study:
Clinical
presentation
1-8: Assigned readings
10:00-11:00
3
Self-study:
Laboratory
tests
Self-study:
Laboratory
tests
4
Self-study:
Treatment
Self-study:
Treatment
Friday
8
Case studies:
TBL
Hormone
and nutritionrelated
diseases
7
Hormonal and 9Hormone
nutritional
and nutritioneffects on
related
bone
diseases
5
Week 2: “The heartbreak of psoriasis!”
Monday
Tuesday
8:00-9:00
6Limb
development
Thursday
Case studies:
TBL
Self-study:
case studies
Case studies:
TBL
Self-study:
case studies
Case studies:
TBL
`Wednesday
Thursday
Friday
5
IIMD III
7
Self-study:
Case studies:
TBL
6
8
Self-study:
Case studies:
TBL
Self-study:
Case studies
Case studies:
TBL
Self-study:
Case studies
Case studies:
TBL
IIMD IV
Self-study:
Clinical
presentation.
Self-study:
Clinical
presentation
Week 3: “Then Satan went out from the presence of the Lord and smote Job with sore boils
from the sole of his foot to the crown of his head”
Monday
Tuesday
`Wednesday
Thursday
Friday
1
MSI
infections I
(Bacterial)
9:00-10:00 2MSI
infections II
(Viral)
Self study:
10:00Clinical
11:00
presentation
Self study:
11:00Clinical
12:00
presentation
1-7: Assigned readings
8:00-9:00
3
Self-study:
Laboratory
tests
Self-study:
Laboratory
tests
4
Self-study:
Treatment
5
6
MSI infections III
Self-study:
(Mycology/Parasitic) Laboratory
tests
7
MSI infections IV
Self-study:
(Mycology/Parasitic) Treatment
Self-study:
Treatment
Self study: Clinical
presentation
Self study: Clinical
presentation
Self-study:
Case studies
in ID
Self-study:
Case studies
in ID
Case
studies:
TBL
Case
studies:
TBL
Case
studies:
TBL
Case
studies:
TBL
Week 4: “One of every three cancers diagnosed in the United States this year will be skin
cancer”
Monday
Tuesday
`Wednesday
Thursday
Friday
1
Benign and
Malignant
Diseases of
MSI I
2
Benign and
9:00-10:00
Malignant
Diseases of
MSI II
10:00-11:00 Self-study:
Clinical
presentation
11:00-12:00 Self-study:
Clinical
presentation
1-6: Assigned readings
8:00-9:00
3
Self-study:
Laboratory
tests
Self-study:
Laboratory
tests
4
Self-study:
Treatment
Self-study:
Treatment
Week 5: “Brittle bones and thick skin”
Monday
Tuesday
8:00-9:00
9:00-10:00
1
Genetic
Diseases of
MSI
2
Genetic
Diseases of
3
Self-study:
Laboratory
tests
Self-study:
Laboratory
5
Benign and
Malignant
Diseases of
MSI III
6
Benign and
Malignant
Diseases of
MSI IV
Self-study:
Clinical
presentation
Self-study:
Clinical
presentation
Self-study:
Laboratory
tests
Case studies:
TBL
Self-study:
Treatment
Case studies:
TBL
Self-study:
Case studies
Case studies:
TBL
Self-study:
Case studies
Case studies:
TBL
`Wednesday
Thursday
Friday
5
Self-study:
Laboratory
tests
Self-study:
Treatment
Case studies:
TBL
Genetic
Diseases of
MSI
6
Genetic
Diseases of
Case studies:
TBL
MSI
10:00-11:00 Self-study:
Clinical
presentation
11:00-12:00 Self-study:
Clinical
presentation
1-6: Assigned readings
Week 6: Assessment
Monday
tests
4
Self-study:
Treatment
Self-study:
Treatment
Tuesday
MSI
Self-study:
Clinical
presentation
Self-study:
Clinical
presentation
`Wednesday
8:00-9:00
9:00-10:00
10:00-11:00
11:00-12:00
IV.
Method of Evaluation and Grading:
1.
Patient Care
Multiple choice exam
Self, group and instructor assessments in TBLs
2.
Medical Knowledge
Multiple choice exam
3.
Experience-based learning and improvement
Multiple choice exam
4.
Interpersonal and communication skills
Self, group and instructor assessments in TBLs
5.
Professionalism
Self, group and instructor assessments in TBLs
Course Materials:
TBD
Course Outline: Topics
Week 1: “She ain’t nothing but skin and bones
I.
Intro to MSI System (Lecture)
-Organization of the course
-Case studies
Self-study:
Case studies
Case studies:
TBL
Self-study:
Case studies
Case studies:
TBL
Thursday
Friday
II.
Segmental and dermatomal organization of human body (Lecture)
-Normal cutaneous growth and differentiation
III.
Review of anatomy of MSI (self-study)
-Identification of all bones and joints within the articulated human skeleton
-Major muscle groups that move the large and medium sized non-axial joints and their
root innervation
-Regional areas of long bones
-Basic macroanatomy of the skin, adnexae, nails and external mucosae, including
variations with location
-Basic anatomy of hair and sweat structures and of the integumentary vasculature and
nervous supplies
IV.
Function of skin, muscle, and bone (self-study)
-Function and purpose of osteoprogenitor cells, osteoblasts, osteocytes, and osteoclasts
-Cortical bone and cancellous bone
-Endochondral and intramembranous ossification
-Lamellar and woven bone
-Neural control of muscle physiology
-Five major physiologic functions of the skin
-Function of epidermis, dermis, and subcutaneous layers with their structure
V.
Histology of cells/tissues of MSI (self-study)
-Bone histology
-Basic microanatomy of the skin, adnexae, nails and external mucosae, including
variations with location
-Basic histologic structure of the skin and name it component parts
VI.
Limb development (Lecture)
Bone growth and development
Bone homeostasis
VII.
Hormonal and nutritional effects on bone (Lecture)
-Hormonal control of calcium homeostasis
-Skeleton as calcium reserve
VIII.
Hormone and nutrition-related diseases (Lecture x 2)
-Pathogenesis and pathology
-Rickets and osteomalacia
-Osteoporosis
IX.
Case studies (TBL)
Week 2: “The heartbreak of psoriasis
Inflammatory and immune-mediated diseases
Rheumatoid arthritis
Drug eruptions
Crystal-induced arthritis
Erythema nodosum
Seronegative
Granuloma anulare
spondyloarthropathies
SLE
Keratosis pilaris
Sjogren’s syndrome
Lichen planus
Scleroderma/systemic
Psoriasis
sclerosis
Antiphospholipid syndrome
Pityriasis rosea
Dermatomyositis/polymyositis Urticaria
Arteritis/vasculitis syndromes Angioedema
Fibromyalgia
xerosis/ichthyosis vulgaris
Inflammatory myopathies
Burn, sun and cold
exposures
Gout/pseudogout
Alopecia
Follicular diseases
I.
Inflammatory and immune-mediated diseases I and II (Lecture x 2)
-Pathogenesis, pathology, and immune mechanisms of disease
II.
Clinical presentation of inflammatory and immune-mediated diseases (self-study)
-Signs and symptoms
III.
Laboratory tests and diagnosis of inflammatory and immune-mediated diseases (selfstudy)
-CBC, ESR, CRP, autoimmune screen (rheumatoid factor, ANA), serum biochemistry
and synovial fluid analysis
-Radiographic features of osteoarthritis, rheumatoid arthritis, and fracture
IV.
Treatment of inflammatory and immune-mediated diseases (self-study)
-Major indications, side effects, drug interactions and contraindications of drugs used in
the management of locomotor disease
-Analgesics, non-steroidal anti-inflammatory drugs, corticosteroids, allopurinol, slow
acting and cytotoxic drugs
V.
Inflammatory and immune-mediated diseases III-IV (Lecture x 2)
-Pathogenesis, pathology, and immune mechanisms of disease
VI.
Clinical presentation of inflammatory and immune-mediated diseases (self-study)
-Signs and symptoms
VII.
Epidemiology and prognosis of inflammatory and immune-mediated diseases (self-study)
-age, sex, genetic, constitutional, environmental, occupational
-expected outcomes
VIII.
Case studies (TBL)
Week 3: “Then Satan went out from the presence of the Lord and smote Job with sore boils from
the sole of his foot to the crown of his head”
Bacterial, viral, fungal and parasitic diseases
Skin and soft tissue infections
Bacterial
Viral
Fungal
cellulitis
necrotizing fasciitis
erysipelas
impetigo
toxic shock
syndrome
syphilis
folliculitis
furunculitis
burns
(Psuedomonas)
leprosy
erythema
infectiosum
hand/foot/mouth
disease
herpes simplex
herpes zoster
molluscum
contagiosum
roseola
rubella
rubeola
varicella
Warts (HPV)
verrucae plantaris
verrucae planae
condyloma
acuminatum
RMSF
Scalded skin
syndrome
myonecrosis
osteomyelitis
septic arthritis
Infestations/Parasitic
Candidiasis
scabies
pityriasis
versicolor
tinea capitis
tinia corporis
tinea cruris
pediculosis
flea bites
bed bug bites
Spider bites (brown
recluse, black widow)
tinea manus
tinea pedis
tinea kerion
lumpy jaw
sporotrichosis
chromomycosis
mycetoma
Musculoskeletal infections
myalgias
pleurodynia
acute
rhabdomyolysis
trichinosis
cysticercosis
Lyme disease
prosthetic infections
I.
Bacterial and viral infections (Lecture x 2)
-Pathogenesis, pathology, and microbiology (etiology, transmission, prevention)
II.
Clinical presentation (self-study)
-Signs and symptoms
III.
Laboratory tests and diagnosis of bacterial and viral infections (self-study)
-Culture of tissues, blood and other body fluids
-Histopathology
-Serologic tests
IV.
Treatment of bacterial and viral infections (self-study)
-Concepts of resistance
-Mechanisms of action
-Strategies for utilizing antimicrobials
V.
Fungal and parasitic infections (Lecture x 2)
-Pathogenesis, pathology, and microbiology (etiology, transmission, prevention)
VI.
Clinical presentation (self-study)
-Signs and symptoms
VII.
Laboratory tests and diagnosis to identify fungal and parasitic diseases (Self-study)
-Culture of tissues, blood and other body fluids
-Histopathology
-Serologic tests
VIII.
Treatment of fungal and parasitic infections
-Concepts of resistance
-Mechanisms of action
-Strategies for utilizing antimicrobials
IX.
Case studies
Week 4: “One of every three cancers diagnosed in the United States this year will be skin
cancer”
Non-neoplastic and neoplastic diseases
Musculoskeletal
Neoplastic
osteoma
osteoid osteoma
osteoblastoma
osteosarcoma
chondrosarcoma
fibrosarcoma
Ewing Sarcoma/PNET
giant cell tumor
bone metastases
Skin and soft tissue
melanoma
basal cell carcinoma
squamous cell carcinoma
keratoacanthoma
dermatofibroma
hemangioma
neurofibroma
Non-neoplastic
achondroplasia
osteogenesis imperfecta
osteopetrosis
polyostotic fibrous dysplasia
Padget disease of bone
I.
Benign and malignant diseases (Lecture x 2)
-Pathogenesis and pathology
II.
Clinical presentation (Self-study)
-Signs and symptoms
III.
Laboratory tests and diagnosis (Self-study)
IV.
Treatment of benign and malignant diseases (Self-study)
V.
Benign and malignant diseases (Lecture x 2)
-Pathogenesis and pathology
VI.
Clinical presentation (Self-study)
-Signs and symptoms
VII.
Laboratory tests and diagnosis (Self-study)
VIII.
Treatment of benign and malignant diseases (Self-study)
IX.
Case studies
seborrheic keratosis
Week 5: “Brittle bones and thick skin”
Genetic/metabolic disorders
Musculoskeletal
Muscular dystrophies
Metabolic diseases of muscle
Motor neuron diseases
Dwarfism
Ehlers-Danlos sydrome
Marfan syndrome
Osteogenesis imperfecta
Achondrogenesis
Skin and soft tissue
Epidermoysis bullosa
Ehlers-Danlos sydrome
Dupuytren’s disease
Limited scleroderma
Raynaud’s disease
Mixed CT disease
Stickler sydnrome
PXE
I.
Genetic diseases (Lecture x 2)
II.
Clinical presentation (Self-study)
-Signs and symptoms
III.
Laboratory tests and diagnosis of genetic diseases (Self-study)
IV.
Treatment of genetic diseases (Self-study)
V.
Genetic diseases (Lecture x 2)
VI.
Clinical presentation (Self-study)
-Signs and symptoms
VII.
Laboratory tests and diagnosis of genetic diseases (Self-study)
VIII.
Treatment of genetic diseases (Self-study)
IX.
Case studies