New York Institute of Technology
Department of Physician Assistant Studies
Course:
Credits:
Instructor:
Phone:
Office Hours:
Office:
PHAS 304 - Clinical Pathophysiology
3
Frank A. Acevedo, PA-C, M.S.
516-686-3881
Wednesday 8:30 - 9:30 AM, 3 - 5 PM
Room 365, NYCOM II
Course description:
This introductory course provides students with the foundation for evaluating disease
states from a pathophysiological perspective. An understanding of physiology, basic
cellular, tissue, and organ architecture is developed and used to explain how internal and
external stimuli as well as genetic and environmental factors affect organ systems to
indicate the presence of disease. Topics such as cellular inflammation, types of immune
responses, edema, coagulation pathways, normal and abnormal cell division, pulmonary
gas exchange, cardiac function, hormonal regulation and microcirculatory changes are
examined.
Prerequisite: Permission of PA Program Chair
Objectives:
Students will:
1. Describe normal cell structure and organ architecture.
2. Describe how external stimuli affect cells and organs.
3. Describe features of acute/chronic cellular inflammation.
4. Categorize various types of immune responses to corresponding body system.
5. Explain factors that enhance and/or suppress the immune system.
6. List and describe Starling’s forces.
7. Apply Starling’s Forces to development of edema at the micro and macro circulatory
levels.
8. Draw/describe coagulation pathway.
9. Identify normal blood vessel layers.
10. Describe factors that affect blood vessels.
11. Describe normal cell division.
12. Discuss factors that lead to neoplasia (abnormal cell division).
13. Explain patient signs and symptoms using physiological principles.
14. List and match hormonal secretions with their organ of origin and target organ.
15. Identify disease states that may be caused by faulty hormonal regulation.
16. Explain the effect of cardiac dysfunction with regard to the following: cardiac
impulse and the generation of the cardiac cycle, microcirculatory fluid dynamics, and
renal abnormalities.
17. Contrast and explain the various factors that affect gas exchange at the alveolar level.
Required Text:
1. Guyton, A.C., Hall, J.E. 1999. 10th Edition. Textbook of Medical Physiology.
Saunders.
2. Kotran, R.S.; Kumar, V.; Robbins, S.L. 1998. 6th Edition. Pathologic Basis of
Disease. W.B. Saunders Co.
Professional Journals:
Journal of Clinical Pathology
Journal of Morphology
Journal of Physiology
Journal of Applied Physiology
Use of Technology:
All students must have access to a computer and an Internet Provider. Use of the NYIT
computer facilities will meet this requirement for those without their own computers.
Useful Websites:
http://path.upmc.edu/cases.html
 On Line Pathology Case Database
http://worldmall.com/erf/sources.htm
 Pathology WWW.links
http://medstat.med.utah.edu/WebPath/webpath.html
 The Internet Pathology Laboratory for Medical
Education
http://path.upmc.edu/casemonth/ap-casemonth.html
 Anatomic Pathology Case of the Month
http://edcenter.med.cornell.edu/CUMC_PathNotes/PathNot
es.html
 Cornell Path Notes
http://vh.radiology.uiowa.edu
 Anatomy & Physiology Tutorials
http://gwinfo.maricopa.edu/class/bio201/index.html
 Anatomy & Physiology Lectures
http://www.kumc.edu/AMA-MSS/study/study.htm
 Medical Study Guide
Required Equipment:
None
Special Dress Requirements:
None
Evaluation Methodology:
Students will be evaluated by non-cumulative, multiple-choice examinations that are
based on lectures, handouts, and any assigned readings.
Course Requirements:
1. Class Attendance & Participation - Students must be present for all lectures. Two
absences will result in a grade reduction by one full grade. Students who miss more
than three classes may be asked to withdraw from the class. All are expected to be
prepared before class and be able to answer directed questions.
2. A midterm examination.
3. A final examination.
Evaluation Criteria:
1. Class Attendance/Participation
2. Quizzes
3. Midterm Examination
4. Final Examination
Percent of Grade:
5%
5%
45%
45%
Lecture
No.
1
Date/Time
Topic
Reading
Assignments
Pgs. 1-35
3
Introduction to Cells & Structure
 Normal cell structure
 Cellular response to stress
 Causes of cell injury & death
 Arrangement of tissues & organs
2
3
Inflammation & Repair
 The inflammatory response
 Inflammatory classification
 The reparative process
Pgs. 51-92
3
3
Blood Vessels/Immunology
 Immunology
 Atherosclerosis
 Aneurysms
 Vascular tumors
 Thrombosis
Pgs. 467-516
4
2
Fluid Mechanics, Circulation &
Coagulation
 Embolic phenomenon
 Thrombotic diseases
 Hemorrhagic diseases
 Edema, congestion, effusion,
ascites
Pgs. 93-122
5
2
Neoplasia
Pgs. 241-304
 Pathogenesis
 Classification of neoplastic diseases
 Metastatic & synchronous lesions
6
3
Pulmonary Physiology
 Mechanics of ventilation
 The respiratory unit
 Oxygen exchange
 Oxygen transport
 Lung volumes/capacities
Guyton:
Pgs. 477-522
Lecturer
3
Pulmonary Physiology
 Cellular respiration
 Control of respiration
 Arterial blood gasses
 Mixed venous oxygenation
 COPD, asthma, pneumonia
2
Midterm Examination
8
3
Cardiac Physiology
 Cardiac cycle
 Vector analysis
 Cardiac output
Guyton:
Pgs. 107-140
9
3
Cardiac Physiology
 Systemic vascular resistance
 Oxygen consumption
 Starling's forces
 Fluid dynamics, edema formation
Guyton:
Pgs. 141-157, 239293, 297-312
10
3
Renal Physiology
 Urine formation
 Waste product excretion
 Hormonal regulation
 Rennin, angiotensin, aldosterone
Guyton:
Pgs. 315-347
11
3
Renal Physiology
 Antidiuretic hormone
 JG apparatus
 Diuretic activity
 Fluid & electrolytes
Guyton:
Pgs. 349-420
12
3
Endocrine Physiology
 Hormone secretion/regulation
 Pituitary hormones
 Hypothalamic control
 Thyroid secretions
 Parathyroid hormones
 Mineralocorticoids, glucocorticoids
 Adreno-pituitary axis
Guyton:
Pgs. 985-1000
7
Guyton:
Pgs. 525-554
13
3
GI Physiology
 Peristalsis
 Intestinal obstruction
 Gastrin, CCK, secretin
 Bile production
Guyton:
Pgs. 793-831
14
3
GI Physiology
 Hepatic function
 Colon function
 Pancreatic secretions
Guyton:
Pgs. 833-851
15
2
Final Examination
Clinical Pathophysiology
Instructional Objectives
Upon completion of this course, the student will be able to:
I.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
PULMONARY PHYSIOLOGY
Define alveolar ventilation.
Identify the structures involved in the control of respiration.
Draw a typical respiratory unit and label all components.
List the factors that affect the rate of gas diffusion across the respiratory
membrane.
Define the Haldane effect.
Define the Bohr effect.
Draw the oxyhemoglobin dissociation curve and list the factors which influence
it.
Describe the mechanical process of ventilation and list all muscles involved
during passive respiration.
List the factors that influence oxygen and carbon dioxide diffusion and transport.
Define the role of surfactant.
List the factors that favorably affect the natural instability of the alveoli.
List the three components that make up the "Work of Breathing".
Describe at least three factors that can affect oxygen transport to the tissues.
Define spirometry.
Draw a diagram depicting normal respiratory excursions and label all volumes
and capacities.
Provide at least two examples of ventilation perfusion abnormalities.
Compare and contrast asthma and ARDS.
Draw the ultrastructure of the respiratory membrane.
Describe the role of chemoreceptors and osmoreceptors in the regulation of
respiration.
List three factors that cause alveolar hypoventilation.
Define hypoxia.
Describe the effect of chronic hypercapnia on the normal regulation of breathing.
List the components that determine mixed venous oxygenation (SVO2).
Define normal pleural pressures and describe the mechanism
behind the development of "tension pneumothorax".
Interpret arterial blood cases for:
a.
respiratory and metabolic acidosis
b.
respiratory and metabolic alkalosis
c.
compensation
List the components of the Henderson-Hesselbach equation.
Describe the basic physiologic changes present in:
a.
pneumonia
e.
restrictive lung disease
b.
asthma
f.
pneumothorax/tension
c.
COPD
pneumothorax
d.
ARDS
II.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
III.
1.
CARDIAC PHYSIOLOGY
Trace a cardiac impulse from its point of origin in the atrium to its end point in
the ventricles.
Draw an action potential for cardiac muscle and label all the phases.
Describe the physiologic anatomy of cardiac muscle.
Describe the role of the "plateau" phase of the action potential in cardiac muscle.
Define syncytium.
Explain the effect of heart rate on the duration of contraction.
Define systole and diastole.
Describe during which part of the cardiac cycle the coronary arteries receive their
blood supply.
Draw a normal EKG tracing, label the waves and correlate the electrical activity
with the events of the cardiac cycle.
Correlate heart sounds with the events of the cardiac cycle.
Define the Frank-Starling law of the heart.
Define the terms preload and afterload and explain how each affects cardiac
output.
Describe the effects of the parasympathetic and sympathetic nervous systems on
heart rate.
Describe the effect of potassium on the contraction of cardiac muscle.
Explain the determinants of cardiac output and contrast cardiac output with stroke
volume.
Define cardiac failure and list three potential causes.
Describe the effect of hydrostatic versus pressure on the veins of the lower
extremity.
Describe the role of a Swan-Ganz catheter in determining left ventricular
function.
Identify and define the various shock states and list the cardiac output, capillary
wedge and systemic vascular resistance for each state.
Describe the hemodynamics involved in the production of a bruit.
Explain the Starling equilibrium for fluid exchange at the capillary level.
Explain the mechanism involved in the development of pitting and non-pitting
edema.
Define the terms:
a.
isotonic
b.
hypertonic
c.
hypotonic
Describe the determinants of oxygen consumption at the tissue level.
Define systemic vascular resistance and list two factors that can increase or
decrease this value.
Identify the most common cardiac arrhythmias and describe the physiologic
reason for their development.
RENAL PHYSIOLOGY
Draw a schematic representation of the nephron.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Identify and describe the role of the glomerulus.
Duplicate the formula utilized for calculating osmolality and utilize it to solve
osmolality problems where all the variables are provided.
List the body fluid compartments and provide relative values for each
compartment in the traditional 70 kilogram patient.
Describe the specific role of each of the following structures:
a.
arcuate artery
h.
proximal tubule
b.
arcuate vein
i.
loop of Henle
c.
afferent artery
j.
distal tubule
d.
efferent artery
k.
collecting duct
e.
peritubular capillaries
l.
renal pelvis
f.
vasa recta
j.
juxtaglomerular apparatus
g.
Bowman's capsule
Describe the mechanism/s involved in the formation of the plasma filtrate at the
level of the nephron.
Define the counter current multiplier and explain its role in the formation of
concentrated urine.
List the four solute concentrating mechanisms found within the renal medulla.
Describe the role of antidiuretic hormone (ADH) in the regulation of urinary
output.
List the determinants of molecular selectivity at the level of the glomerular
membrane.
List two examples of afferent feedback and efferent feedback that help regulate
the juxtaglomerular complex.
Identify the various steps involved in the formation and processing of the urinary
filtrate.
Match various parts of the nephron with the major substance that is either
reabsorbed or secreted at that region.
List the layers of the glomerular membrane.
When provided with a schematic representation of a nephron, label each section
with respect to the sites of action of various diuretic agents.
Define glomerular filtration rate.
Describe the role of dopaminergic receptors at the renal level.
Describe the role of aldosterone, renin and angiotensin at the renal level.
List the amount of blood that flows through the kidneys in a per minute fashion
and also as a percentage of cardiac output.
Match the capillary beds surrounding the nephron with the appropriate hydrostatic
pressures.
List at least three factors that adversely affect the glomerular filtration rate.
List at least two factors that favorably affect the glomerular filtration rate.
Define the renal tubular threshold maximum with regards to glucose.
Describe the mechanism utilized in measuring glomerular filtration rate.
Define the terms, sensible and insensible with regards to fluid loss.
IV.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
ENDOCRINE PHYSIOLOGY
Describe the functional and anatomic relationship between the hypothalamus and
the pituitary gland.
List the principle activity for each of the hormones secreted by the anterior
pituitary gland.
Identify the region from which the posterior pituitary receives its stimulation to
release hormones.
Match a list of hormones with their corresponding portion of the pituitary gland.
When provided with a list of potential hormone substrates be able to identify
which choice cannot be utilized to form hormones.
Explain the relationship between the pituitary gland and the adrenal glands.
List the possible sites where hormone receptors may be found.
List three mechanisms of hormonal action.
Describe the embryological origin of both the anterior and posterior pituitary
glands.
Define the term hormone in its classical description.
Describe the effects of positive and negative feedback on hormone secretion.
List the "releasing hormones" and explain the role of the hypothalamus in their
elaboration.
Explain the effect of growth hormone on nutritional substrates.
Describe the effects of panhypopituitarism.
Describe the role of iodine in the production of thyroid hormones.
List all of the steps involved in the synthesis and secretion of thyroid hormones.
Explain the conversion of thyroxine to triiodothyronine in the periphery.
Describe the metabolic effects of thyroid hormones.
Describe the metabolism and transport of thyroid hormones in the bloodstream.
Describe the mechanics of thyroid gland dysfunction.
Describe the physiologic effects of insulin, the regulation of insulin and the
mechanism of insulin action.
Explain the physiologic effects of glucagon and the process of glycogenolysis,
gluconeogenesis and ketosis.
List the three commonly produced acids during diabetic ketosis.
Explain the pathophysiology of Diabetes Mellitus for both insulin dependent and
non-insulin dependent types.
Describe the physiologic causes of diabetic symptoms.
Describe the physiology behind the development of ketosis.
Explain the importance of phosphate replacement during diabetic ketoacidosis.
List the anti-inflammatory effects of glucocorticoids.
List the hormones produced in the adrenal medulla and cortex.
Explain the regulation of aldosterone secretion.
Describe the physiologic effects of glucocorticoids and mineralocorticoids.
Explain the role of stress in the production of cortico- steroids.
Describe the role of parathyroid hormone secretion, vitamin D and calcitonin in
the regulation of calcium metabolism.
V.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
IMMUNOLOGY AND COAGULATION
Define immunity and list the components of the immune system.
Explain the differences between passive immunity and active immunity.
Identify five features unique to the immune system with regards to its interaction
with foreign substances.
List the two major functions of lymphoid tissue.
Explain the role of antibodies and sensitized lymphocytes.
Describe the characteristics of a hapten that make it antigenic.
Identify both primary and secondary components of lymphoid tissue.
Explain the role of the thymus in the immune process.
Describe the mechanism for preprocessing lymphocytes.
State the role of T and B lymphocytes in the immune process.
Describe the function of both the variable and constant portions of antibodies.
Identify the various immunoglobulins produced in the body and match them with
regards to function, site of production and role.
Describe the two ways in which antibodies work in neutralizing foreign
substances.
Reproduce the complement cascade and label the classical and alternate
pathways.
Given a reproduction of the complement cascade, be able to identify and label the
activated factors and their specific functions.
Describe in detail the steps involved in the activation of the alternate pathways.
Construct a diagram illustrating the role of T cells within the immune system and
relate their relationship to B cells.
List at least two conditions that adversely affect T cell function.
List at least four effector mediators in immune/allergic reactions.
Describe Type I - Type IV allergic reactions and explain what immunoglobulins
are involved at each phase.
Discuss the role of the reticuloendothelial system.
Describe the process of hemostasis.
Draw a diagram of the coagulation cascade.
Explain the role of vascular constriction in hemostasis.
Outline the role of the platelet plug in the initial control of bleeding.
Define procoagulants and anticoagulants.
Draw a diagram that illustrates the lytic pathway.
Explain the mechanism of action for Heparin and Coumadin.
Describe the extrinsic and intrinsic coagulation cascades.
Explain what tests would be ordered to follow a patient on anticoagulation
therapy.
List the various sites of RBC production and the time frame during which they are
actively produced at each site.
Explain the role of erythropoietin in RBC production.
List two major functions of red blood cells.
Describe the method for normal iron metabolism and storage.
List all of the substances normally contained within a red blood cell.
Describe the key elements of RBC production.
37.
38.
39.
VI.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
List the nutritional deficiencies that impair RBC maturation and result in
megaloblastic anemia.
Describe the forms in which absorbed iron is stored.
Define polycythemia and list at least two potential causes.
GI PHYSIOLOGY
List all of the anatomical structures that constitute the GI tract. Include all
accessory organs/glands.
Describe in which part of the GI tract iron absorption occurs.
List the phases of gastric stimulation.
Describe the reasons why certain hormones are secreted in an inactive form by the
pancreas. List those hormones secreted in their inactive form.
Given two columns, one of cells and the other containing their gastric secretions,
be able to match each secreted substance with their cell.
List the nervous pathways important to GI tract function and discuss each
pathways specific role.
Describe the enterohepatic circulation and discuss its role in the preservation of
bile salts.
Discuss the function and origin of each of the following substances:
a.
intrinsic factor
i.
enterokinase
b.
bicarbonate
j.
pepsinogen
c.
bile
k.
histamine
d.
hydrochloric acid
l.
carboxypeptidases
e.
mucous
m.
amylases
f.
CCK
n.
lipases
g.
gastric
o.
trypsin
h.
secretin
p.
chymotripsinogen
Describe the importance of micelle formation in fat digestion.
Discuss the physiology of various gastrointestinal disorders to include:
a.
peptic ulcer disease
e.
vomiting
b.
gastritis
f.
gastrointestinal
c.
"short gut" syndrome
obstruction
d.
diarrhea
A.
1.
2.
3.
4.
5.
B.
1.
2.
3.
4.
C.
1.
2.
3.
4.
CELLS AND CELL STRUCTURE, INJURY, TISSUES AND ORGANS
Identify and explain the parts of normal cell structure.
List the germ cell layers and the cells derived from them.
Regarding reversible cell injury:
a.
define hydropic degeneration
b.
discuss the ultrastructural changes that occur
within:
i.
endoplasmic reticulum
ii.
mitochondria
iii.
plasma membrane
iv.
nucleolus
Regarding morphologic reactions to persistent stress, define and explain:
a.
atrophy
d.
metaplasia
b.
hypertrophy
e.
dysplasia
c.
hyperplasia
f.
intracellular storage
Regarding irreversible cell injury, define:
a.
coagulative necrosis
d.
caseous necrosis
b.
liquefactive necrosis
e.
fibrinoid necrosis
c.
fat necrosis
f.
gangrenous necrosis
INFLAMMATION AND REPAIR
Describe the clinical features of acute and chronic inflammation.
Define:
a.
edema
b.
resolution
c.
organization
d.
transudate
e.
exudate
f.
suppurative inflammation
g.
serous inflammation
h.
membranous inflammation
i.
granulomatous inflammation
j.
chemotaxis
k.
phagocytosis
l.
granulocyte
m.
lymphangitis
Define and describe the components of the inflammatory response.
List the systemic manifestations of inflammation.
THE IMMUNE SYSTEM
List the major cell types involved in the immune response.
Discuss the morphologic and functional differences of the following:
a.
T-lymphocyte
c.
natural killer cells
b.
B-lymphocyte
d.
macrophages
List and describe the four types of hypersensitivity reactions.
Discuss the difference between cellular and humoral immunity.
5.
Define:
a.
antigen
d.
synovitis
b.
antibody
e.
autoimmunity
c.
serositis
6.
Describe the similarities and differences between an allergic reaction and an
anaphylactic reaction.
7.
Regarding Acquired Immunodeficiency Syndrome, discuss its course and
prognosis:
a.
define AIDS
b.
discuss its epidemiology
c.
list the transmission modes of HIV
d.
describe its pathogenesis
e.
describe the pathology and clinical features
8.
Regarding Systemic Lupus Erythematosus:
a.
define SLE
b.
describe its pathogenesis and pathology
c.
list its clinical features
d.
discuss its course and prognosis
9.
Regarding Rheumatoid Arthritis:
a.
define Rheumatoid Arthritis
b.
describe its pathogenesis and pathology
c.
list its clinical features
d.
list the drugs involved in suppressing the
inflammatory process
10.
Discuss the role in the immune system of the:
a.
thymus gland
b.
lymph nodes
a.
spleen
11. Discuss the different considerations in transplant immunology to include:
a.
rejection
b.
matching
c.
graft vs host
d.
immunosuppression
D.
1.
2.
3.
4.
5.
FLUID MECHANICS, CIRCULATION, AND COAGULATION
Explain the differences between congestion, hemorrhage and infarct.
List the different types of emboli and the origin of each one.
Describe the pathogenesis, morphology and clinical features of congestive heart
failure.
Explain the pathogenesis and morphology of pulmonary edema.
Regarding shock:
a.
define this condition
b.
discuss the pathogenesis
c.
list the pathological effects on various organs
6.
E.
1.
2.
3.
4.
5.
6.
F.
1.
2.
3.
4.
5.
6.
7.
8.
Define the following:
a.
edema
b.
congestion
c.
hemorrhage
d.
embolus
e.
infarct
f.
petechiae
g.
h.
i.
j.
k.
l.
thrombus
effusion
ascites
transudate
exudate
hematoma
BLOOD VESSELS
Describe the intrinsic and extrinsic pathways for coagulation.
Regarding atherosclerosis:
a.
define this condition
b.
discuss its pathogenesis and morphology
c.
describe its characteristic lesion and its
progression
d.
list its risk factors and complications
Define and describe the pathogenesis, pathology and clinical presentation of:
a.
arteriosclerosis
e.
Wegener's Granulomatosis
b.
Raynaud's Phenomenon
f.
Buerger's Disease
c.
polyarteritis nodosa
(thrombo-angitis
d.
temporal arteritis
obliterans)
List the different types of aneurysms and describe their pathology and clinical
features.
Regarding varicose veins:
a.
list the risk factors, pathology and clinical features
b.
define deep vein thrombosis
Define and discuss the pathology and clinical features of:
a.
lymphangitis
c.
angiosarcoma
b.
hemangioma
d.
lymphangiosarcoma
NEOPLASIA
List the criteria for malignant tumors.
Explain the process of metastasis.
Discuss how tumors are classified.
Explain how to stage and grade tumors.
Define doubling time.
List examples of chemical, physical and viral carcinogens.
List the systemic effects tumors have on the host.
Explain the predisposing factors of developing a tumor.
9.
10.
Define the following:
a.
hyperplasia
h.
b.
hypoplasia
i.
c.
hypertrophy
j.
d.
atrophy
k.
e.
metaplasia
l.
f.
carcinogen
m.
g.
dysplasia
n.
Define the terms synchronous and metachronous.
carcinoma
sarcoma
metastasis
invasion
transformation
oncogene
anaplasia