New York Institute of Technology
Department of Physician Assistant Studies
Course:
Course Coordinator:
Credits:
Instructor:
Phone:
Office Hours:
Office:
PHAS 310 - Introduction to Clinical Medicine I
Frank Acevedo, PA-C
9
NYCOM Faculty
516-686-3820
Wednesday 8:30 - 9:30 AM, 3 - 5 PM
NYCOM II, 365
Course description:
This multi-component course explores the intricacies of human disease through a
systems approach for: Dermatology, Infectious Disease, Pulmonary Medicine,
Cardiology, Gastroenterology, Hematology/Oncology, Allergy/Immunology, and
Nephrology. The student will learn about the etiologies, pathophysiolgy, clinical
manifestations, appropriate diagnostic tests and management of common disease
entities.
Prerequisite: Permission of PA Program Chair
Objectives:
Students will:
1. Delineate clinical problems and develop appropriate management plans.
2. Recognize the need for specialty referral to other health care providers or agencies
as appropriate.
3. Formulate a differential diagnosis based upon signs and symptoms, appropriate
diagnostic tests, and physical examination findings.
4. Apply critical thinking skills to medical decision-making.
Required Text:
1. Harrison's Principles of Internal Medicine. 16th Edition. McGraw-Hill
2. Handouts
Professional Journals:
Archives of Internal Medicine
New England Journal of Medicine
Journal of the American Medical Association
Journal of Infectious Diseases
Cardiology
Journal of the American Academy of Dermatology
Journal of Respiratory Diseases
Clinics in Hematology
Cancer
Diseases of the Chest
Digestive Diseases and Sciences
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://mchip00.nyu.edu/student-org/erclub/ekghome.html
 Interpreting EKG's
http://www.helix.com/
 Glaxo Educational Center
http://arborcom.com/frame/clin_dis2.htm
 Nutrition Resources on the Internet
http://hopkinsid.com/education/id_caserounds/caserounds9.html#top
 Case Rounds in Infectious Disease
http://hopkins-aids.edu/
 AIDS Case Presentations
http://www.medsch.wisc.edu/chslib/hw/pulmonar/pulmho
me.htm
 University of Wisconsin-Madison Pulmonary
Medicine Site
http://cardiology.medscape.com/Home/Topics/cardiology/
cardiology.html
 Medscape Cardiology Homepage
http://cpmcnet.columbia.edu/dept/gi/elsewhere.html
 Gastroenterology Resources
http://info.med.yale.edu/intmed/nephrol/RenalRsc.html
 Yale Nephrology
http://www.vh.org/
 Virtual Hospital Site/ Cross Reference to All Internal
Medicine
Required Equipment:
None
Special Dress Requirements:
None
Evaluation Methodology:
Students will be evaluated by multiple-choice examinations that are based on lectures,
handouts, and assigned readings.
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2
Evaluation Criteria for Each Module:
1. Midterm
2. Quizzes
3. Final
Percent of Grade:
45%
10%
45%
The final grade for the entire course will be a cumulative grade derived by a weighted
value. This weighted value is determined by assigning a percentage relative to the
number of hours in a given module as a function of the total hours for the entire course.
Clinical Medicine I is a total of 234 hrs.
Pulmonary
29 hours
Infectious Diseases 20 hours
Cardiology
34 hours
Nephrology
30 hours
Hematology/Oncology26 hours
Allergy/
Immunology
34 hours
Dermatology
18 hours
Gastroenterology
43 hours
Course Requirements:
1. Midterm examination in each module.
2. Multiple-Choice Quizzes based on assigned readings.
3. Final examination in each module.
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3
Pulmonary
Lecture
No.
Date/Time
Topic
Lecturer
1
2
Approach to the Pulmonary Patient
Marcus, M.D.
2
2
Pulmonary Infections I
Marcus, M.D.
3
2
Pulmonary Function Testing
Schecter, M.D.
4
2
Tuberculosis
Marcus, M.D.
5
2
Pulmonary Infections II
Marcus, M.D.
6
2
Pulmonary Infections III
Marcus, M.D.
7
2
Asthma
Marcus, M.D.
8
2
Pulmonary Emboli
Marcus, M.D.
1
Midterm Examination
9
2
Pulmonary Circulation
Marcus, M.D.
10
2
Pulmonary Neoplasms
Sorett, M.D.
11
2
Mediastinum, Surgical Approaches to
Pulmonary Disease
Lackner, M.D.
12
2
COPD
Schecter, M.D.
13
2
Pleural Disease
Marcus, M.D.
14
2
Respiratory Failure
Sorett, M.D.
15
2
Interstitial Disease
Schecter, M.D.
16
2
Medical Imaging of the Thorax
Acevedo, PA-C
1
Final Examination
Reading Assignments: See Schedule
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4
Cardiology
Lecture
No.
1
Date/Time
Topic
Lecturer
1
Approach to the CV Patient I
Sacher, D.O.
2
1
Hypertension
Sacher, D.O.
3
2
EKG I
Sacher, D.O.
4
2
EKG II
Sacher, D.O.
5
2
ASHD I
Sacher, D.O.
6
2
ASHD II
Sacher, D.O.
7
2
ASHD III
Sacher, D.O.
8
2
Myocardial Infarction
Sacher, D.O.
1
Midterm Examination
9
1
Congestive Heart Failure, Shock,
Hemodynamics
Sacher, D.O.
10
2
Cardiac Surgery
Davidson, M.D.
11
2
Valvular Heart Disease I
Sacher, D.O.
12
2
Valvular Heart Disease II
Sacher, D.O.
13
1
Procedures in CV Medicine
Sacher, D.O.
14
2
Myocarditis, Pericardial Disease,
Rheumatic Heart Disease Adult
Congenital Heart Disease
Sacher, D.O.
15
2
Peripheral Vascular Disease
Sacher, D.O.
1
Final Examination
Reading Assignments: Dubin's EKG, See Schedule
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5
Nephrology
Lecture
No.
1
Date/Time
Topic
Lecturer
2
Disorders of Water Metabolism I
Falk, D.O.
2
2
Falk, D.O.
3
4
5
6
1
2
2
1
1
2
2
2
2
2
1
Disorders of Water Metabolism II,
Disorders of Potassium
Renal Pharmacology
Acid-Base Disturbances
Acute Renal Failure
Nutrition in Renal Disease
Midterm Examination
Chronic Renal Failure
Glomerulonephritis
Medical Imaging of the Renal System
Nephrotic Syndrome
Dialysis
Final Examination
7
8
9
10
11
Reading Assignments:
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Marcus, M.D.
Falk, D.O.
Falk, D.O.
Ahmed, D.O.
Falk, D.O.
Falk, D.O.
Falk, D.O.
Acevedo, PA-C
Falk, D.O.
Falk, D.O.
See Schedule
6
Hematology
Lecture
No.
1
2
3
4
5
6
7
8
9
10
Date/Time
2
2
2
2
2
1
2
2
2
2
2
1
Topic
Red Blood Cells Part I
Hemostasis and Thrombosis Part I
White Blood Cells Part I
Red Blood Cells Part II
Pediatric Hematology
MIDTERM
Plasma Cell Disorders
Biology of Stem Cells and Bone Marrow
Transplantation
Transfusion Medicine
Hemostasis and Thrombosis Part II
White Blood Cells Part II
FINAL
Reading Assignments:
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Lecturer
Villani, MD
Allen, MD
Koltiz, MD
Villani, MD
Schaeffer, MD
Allen, MD
Bayer, MD
Carleton, MD
Allen, MD
Bayer, MD
Harrison's, Handouts
7
Lecture
No.
1
Date/Time
Gastroenterology
Topic
Lecturer
2
Introduction/Esophageal Disorders
DeBeer, D.O.
2
2
Biliary Tract Disorders
Feinman, M.D.
3
4
5
2
2
2
DeBeer, D.O.
Feinman, M.D.
Hutak, PhD
6
7
8
9
10
2
2
2
2
2
Peptic Ulcer?GI Bleeding
Infectious & Parasitic Diarrhea
Drugs Used in the Treatment of GI
Disease
Intro to Nutrition
Gastric Tumors, Diverticulosis
Liver Case Presentations
Malabsorption
Functional Bowel Disorders, IBD
11
1
2
12
13
14
15
16
2
2
2
2
1
17
18
19
20
21
2
2
2
2
2
1
MIDTERM
Cirrhosis, Vascular Diseases of the GI
Tract
Colorectal Surgery
Gastric Acidity Compounds
Acute & Chronic Pancreatitis
Colorectal Neoplasia
Medical Imaging of the Abdomen &
Pelvis
Laxitives, Catharthics, Antidiarrheals
Emetic & Antiemetic Compounds
Review
GI Nutrition
Neoplasms of the Large Bowel &
Diseases of Anus & Rectum
Final Examination
Ahmed, D.O.
Pasternak, D.O.
Feinman, M.D.
Goldblum, M.D.
DeBeer, D.O.
Pasternak, D.O.
Falivena, D.O.
Hutak, PhD
Goldblum, M.D.
DeBeer, D.O.
Chaudhry, D.O.
Hutak, PhD
Hutak, PhD
DeBeer, D.O.
Ahmed, D.O.
DeBeer, M.D.
Reading Assignments: See Schedule
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8
Infectious Disease
Lecture
No.
Date/Time
Topic
Lecturer
1
2
Introduction to Infectious Diseases
Barese, PA-C
2
2
Ambulatory Infectious Diseases
Barese, PA-C
3
2
Soft Tissue Surgical Infections
Barese, PA-C
4
2
STDs
Barese, PA-C
5
2
Specimen Collection Techniques
Barese, PA-C
1
Midterm Examination
6
14
HIV/AIDS (Separate Examination)
Eckert-Williams, M.D.
7
2
CNS Infections
Barese, PA-C
8
2
GI Infections
Barese, PA-C
9
2
Barese, PA-C
10
2
Infections in Immunocompromised
Hosts
TB & Other Mycobacterial Infections
1
Final Examination
Barese, PA-C
Reading Assignments: See Schedule
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9
Clinical Nutrition
Lecture
No.
1
Date/Time
Topic
Lecturer
2
Coronary Heart Disease, Hypertension
Smoking
Capozzi, D.O.
2
2
Obesity & Eating Disorders I
Capozzi, D.O.
3
2
Obesity & Eating Disorders II
Capozzi, D.O.
4
2
Surgical Nutrition
Acevedo, PA-C
5
2
Macronutrients & Metabolism
Capozzi, D.O.
1
Final Examination
Reading Assignments: Handouts/PowerPoint Presentations
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10
Pulmonary Medicine – PHAS 310
Instructional Objectives
Upon completion of this course, the student will be able to:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Identify a patient with a disorder of the respiratory system by obtaining a
detailed history and physical examination.
Describe the anatomy and physiology of the respiratory tract to include:
a.
gas exchange
b.
oxygen transport
List pathologic states that cause disturbances in each.
Describe the oxyhemoglobin dissociation curve and the major factors
influencing the curve.
Discuss the role of surfactant in pulmonary physiology.
Describe conditions where abnormalities are seen.
Discuss the measurements of lung volumes commonly used to differentiate
between respiratory problems of restrictive or obstructive patterns
Interpret results of an arterial blood gas with regards to gas exchange and acidbased balance.
Discuss the various techniques utilized for pulmonary imaging, the application
and interpretation of each, to include:
a.
CT scan
b.
MRI
c.
Nuclear medicine imaging
d.
Ultrasound
e.
Interventional radioogy
Discus the indications and complications of invasive and non-invasive
procedures used to make a differential diagnosis in the patient with respiratory
disease to include:
Describe the criteria used to determine an acceptable sputum gram stain.
Discuss various methods that can be used to obtain an acceptable sample.
Describe pulmonary function testing, its indications and interpretation.
Define the pathophysiology of asthma. List various stimuli that cause increased
airway responsivenes. Discuss its signs and symptoms, assessment, laboratory
findings, therapy, prognosis and clinical course.
Contrast the two major types of COPD by definition.
Describe the pathology, signs, symptoms and lab findings.
Discuss the principles of acute and chronic management of COPD to include
preservation of remaining lung function and use of corticosteroids.
Discuss the etiology, mode of transmission, clinical manifestations, diagnosis
and treatment of tuberculosis.
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11
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
Discuss the pathophysiology and common features of interstitial lung diseases.
Describe the clinical presentation, laboratory tests, diagnostic approach and
staging of disease activity to include
a.
occcupational/environmental causes
b.
sarcoidosis
c.
collagen vascular diseases
d.
drug induced
e.
idiopathic
Discuss pneumonias and differentiate their clinical course and laboratory
findings. Describe the clinical course, prognosis and treatment of each to
include:
a.
bacterial
b.
fungal
c.
viral
d.
parasitic
Describe the pathogenesis, classification, clinical presentation, diagnosis and
treatment of lung abscesses.
Differentiate between the laboratory values of a transudate and exudate.
List common conditions associated with pleural effusions.
Discuss the indications, procedure, and complications of performing a
thoracocentesis.
Discuss the management of emergency situations when hemoptysis occurs.
Define ARDS and list conditions that can lead to it.
Describe the classification of primary lung neoplasms.
Describe the diagnostic work-up and staging of lung cancer. List populations at
high risk for the development of lung cancer.
Discuss the indication for mechanical ventilation and the various mechanical
ventilation options available to the clinician.
Discuss the general care of patients receiving mechanical ventilation.
Define barotrauma.
Discuss how patients are weaned from mechanical ventilation. List the weaning
criteria.
List risk factors for the development of pulmonary embolism and discuss
recognition, differential diagnosis, work-up and treatment.
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12
Cardiology – PHAS 310
Instructional Objectives
Upon completion of this course, the student will be able to:
1.
Describe the normal anatomy and physiology of the heart and circulatory
system.
2.
Explain normal heart sounds and correlate the events associated with the waves
of the jugular and carotid pulses with the phases of the cardiac cycle.
3.
Describe the pathophysiology of congestive heart failure. List the causes, clinical
findings, EKG abnormalities, diagnostic workup and medical management.
Differentiate between acute and chronic CHF.
4.
Differentiate between left and right-sided failure and how pulmonary capillary
wedge pressure and central venous pressure are used to evaluate myocardial
function.
5.
Explain the complications of untreated heart failure and its effect on renal and
pulmonary function with regard to:
a.
BUN
b.
fluid and electrolyte balance
c.
acid base balance
6.
Define systemic hypertension. Describe the etiology, contributing factors and
complications of the disease as it affects various organ systems to include:
a.
cardiovascular
b.
neurological
c.
renal
Describe the initial evaluation and step-wise approach to initiating treatment.
7.
Define arteriosclerosis and list disorders associated with early arteriosclerosis.
Describe etiologic factors in the development of the disease to include:
a.
hypercholesterolemia
b.
hypertriglyceridemia
Discuss complications, prevention and treatment of the disease.
8.
Describe the etiology, risk factors, clinical features and treatment associated with
pulmonary hypertension and cor pulmonale.
9.
Describe the Goodwin classification of myocardial disease (dilated, restrictive
and hypertrophic cardiomyopathies) to include their pathophysiology, etiologies,
diagnostic workup and treatment.
10.
Describe the etiology, laboratory studies, clinical features, course, prognosis and
treatment of valvular lesions of the heart to include:
a.
mitral stenosis/regurgitation
b.
aortic stenosis/regurgitation
c.
mitral valve prolapse
Discuss complications of prosthetic valve replacement.
11.
Define rheumatic fever and identify its etiology.
List the Jones criteria and explain each clinical feature. Discuss the course,
prognosis, treatment and prevention of the disease.
12.
List the clinical classification, etiologies, cardinal manifestations and treatment
of pericarditis.
13.
Define endocarditis. List the most common etiology, clinical manifestation,
differential diagnosis and indication for emergency therapy and prophylaxis.
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13
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
For the following non-invasive cardiac examination methods that include
roentgenography, echocardiography, radionucleotide tests, discuss the
indications and techniques for:
a.
stress tests
f.
Holter monitors
b.
MUGA scans
g.
cardiac cath
c.
thallium scans
i.
tansesophageal echo
d.
dipyridamole thallium scans
j.
CT scans
e.
MRIs
List the indications and diagnostic value for Holter monitoring and signal
averaged EKG.
Describe cardiac catheterization and list the indications, contraindications,
diagnostic, therapeutic applications and complications of the procedure.
List the classifications of shock based on etiology (i.e. cardiogenic, extracardiac
obstructive, oligemic, and distributive shock). Discuss the hemodynamic
profiles, clinical manifestations and specific management of each.
List commonly used vasopressor agents used to treat shock.
Discuss cardiovascular and hemodynamic changes in pregnancy, complications
of maternal cardiac disease with pregnancy and their management.
Describe the risk factors and etiology of coronary heart disease and myocardial
infarction.
Describe the clinical manifestations, differential diagnosis, laboratory findings,
prognosis and management of coronary heart disease and myocardial infarction.
Identify the major complications that may follow a myocardial infarction as well
as the treatment and prognosis for each.
List the indications, patient selection criteria, risk and efficacy of angioplasty
and bypass surgery. Discuss cardiac rehabilitation and its role post-operatively
and post-myocardial infarction.
Describe the risks of surgery in the cardiac patient. Describe the preoperative
investigations and optimization of the cardiac patient.
Describe the indications and selection of a candidate for cardiac transplant. List
early and late course complications of the procedure.
Explain the electrical activity of the heart as recorded on an EKG tracing.
Define the normal wave forms, duration and interval for each component of the
tracing.
Explain the vector concept and electrical axis of the normal EKG and
significance of abnormalities of the axis.
Measure atrial and ventricular rates, axis deviation, rhythm, rate, ischemic
changes.
Identify rate, rhythm and conduction disturbances of the ventricle and atria to
include:
a.
asystole
b.
atrial premature contractions (APCs)
c.
ventricular premature contractions (VPCs)
d.
heart blocks
e.
flutters
f.
fibrillations
g.
bundle branch blocks
h.
hemiblocks
i.
Wolf Parkinson White
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14
29.
30.
31.
32.
33.
34.
Identify EKG manifestations of ventricular hypertrophy (left and right). List
most common causes of each. Evaluate a 12 lead EKG for abnormalities
Identify EKG findings associated with myocardial ischemia and infarction.
Locate the infarct. Distinguish between an acute and old MI.
Identify the EKG findings seen in digitalis toxicity and electrolyte disturbances.
Discuss treatment of these arrhythmias or disturbances.
Identify changes on an EKG associated with atrial enlargement. Explain Ppulmonale and P-mitrale.
Describe the classification, etiology, clinical manifestations and treatment of the
diseases of the aorta to include:
a.
aneurysms
b.
aortic dissection
c.
aortic occlusions
d.
Aortitis
Appropriately evaluate and manage patients with myocarditis.
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15
Nephrology – PHAS 310
Instructional Objectives
Upon completion of this course, the student will be able to:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Describe the anatomy and physiology of the renal system and the formation of
urine.
Construct a differential diagnosis for a patient with major symptoms relating to
the urinary system to include:
a.
dysuria
b.
incontinence
c.
polyuria
d.
nocturia
e.
hematuria
f.
oliguria
List the indications for the use of the following diagnostic modalities used to
evaluate renal function and interpret their results:
a.
urinalysis
b.
biochemical tests
c.
creatinine clearance
d.
urinary electrolytes
e.
urine C&S
List the rationale for the indications and interpretations of the following:
a.
IVP
b.
ultrasonography
c.
renal scan
d.
CT/MRI
Describe the acid base regulation within the kidney to include primary and
secondary disturbances and its compensatory mechanisms.
Describe the concept of anion gap and list the differential diagnosis of increased
anion gap and normal anion gap in metabolic acidosis.
Describe the regulation of sodium balance within the nephron. List the signs and
symptoms, etiologies, and treatment of disturbed sodium balance.
List common diuretics used, their site of activity, mechanism of action and
complication of usage.
Describe the regulation of potassium within the kidney.
List the signs and symptoms, causes and treatment of hyper and hypokalemic
states.
Compare the three types of renal tubular acidosis (type I, type II and type IV) and
their treatment.
List the most common causes of acute glomerulonephritis to include:
a.
Infectious:
i.
poststreptococcal
ii.
non-streptococcal
b.
Multisystem Diseases
i.
systemic lupus erythematosus
ii.
Henoch-Schonlein purpura
iii.
Goodpasture Syndrome
c.
Primary glomerular disease
i.
Berger's Disease
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16
d.
12.
13.
14.
15.
16.
17.
18.
19.
Miscellaneous
i.
Guillain-Barre Syndrome
ii.
DPT vaccine
iii.
idiopathic
Describe clinical courses, diagnosis and treatment for the above entities.
Define the four characteristics of nephrotic syndrome and explain its
pathophysiology. Identify the major etiologies and plan a course of action for the
specific diagnosis, dietary and medical intervention to include:
a.
minimal change disease
b.
focal and segmental sclerosis
c.
membranous glomerulonephritis
Identify the principal causes of tubulointerstitial disease of the kidney to include:
a.
Toxins
i.
lead nephropathy
ii.
antibiotics
iii.
radiographic toxins
b.
Immune Disorders
i.
hypersensitivity nephropathy
ii.
Sjogrens Syndrome
iii.
Amyloidosis
iv.
AIDS
c.
Vascular disorders
i.
sickle cell
ii.
acute tubular necrosis
d.
Hereditary renal disorder
i.
polycystic kidney disease
ii.
hereditary nephritis
e.
Infectious injury
i.
acute pyelonephritis
ii.
chronic pyelonephritis
f.
Miscellaneous disorders
i.
chronic urinary tract obstruction
ii.
vesicoureteral reflux
Describe the pathophysiology, diagnosis, prognosis and treatments for the above.
Describe the clinical presentation, diagnosis, prognosis and treatment of acute
interstitial nephritis.
List the most common infectious agents and drugs associated with the
development of acute interstitial nephritis.
Classify the following types of renal stones and describe the pathophysiologic
conditions that predispose to their formation:
a.
calcium
b.
uric acid
c.
cystic
d.
struvite
Discuss the clinical manifestations, diagnostic evaluation and treatment options
for nephrolithiasis.
Define the presenting manifestations of acute renal failure.
Discuss the major causes and give examples of:
a.
pre-renal azotemia (due to decreased perfusion)
b.
renal azotemia (renal parenchymal disorder)
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17
20.
21.
22.
23.
24.
25.
26.
27.
28.
c.
post renal azotemia (obstruction of urine flow)
d.
acute tubular necrosis
Discuss the purpose of the fluid challenge test.
Plan a course of treatment to include proper fluid and electrolyte balance for a
patient with acute renal failure.
Explain the pathophysiology of renal insufficiency and progression to chronic
renal failure.
List the clinical manifestations of uremia as they affect:
a.
fluid and electrolyte disturbance
b.
endocrine/metabolic disturbances
c.
neuromuscular disturbances
d.
cardiovascular and pulmonary disturbances
e.
dermatologic disturbances
f.
gastrointestinal disturbances
g.
hematologic and immunologic disturbances
Explain the importance of conservative measures of treatment for renal
insufficiency and counsel the patient and family for the possibilities of eventual
renal failure.
Explain the indications for and types of dialysis to include:
a.
hemodialysis
b.
peritoneal dialysis
c.
arterial-venous hemofiltration
List the indications for renal transplantation. Discuss:
a.
donor selection
b.
tissue typing
c.
clinical immunogenics
For renal transplantation, explain the procurement process, pretransplant
evaluation, reasons for transplantation and therapy for immunosuppression.
Discuss the clinical course and management of the recipient to include
complications of infections and rejection.
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18
Gastroenterology – PHAS 310
Instructional Objectives
Upon completion of this course the student will be able to:
1.
Trace the course of the digestive tract from the mouth to the anus, naming each
division and structure and briefly describing the anatomy and function for each
structure.
2.
Describe the tissue layers of the digestive tract.
3.
Discuss the functions of the pancreas and liver in the digestive process. Trace the
anatomical routes of pancreatic and hepatic biliary flow into the digestive tract.
4.
Explain the role of the liver in the metabolism of bilirubin.
5.
Trace the anatomy of the biliary tract. Explain the mechanism of bile formation
and bile release.
6.
Explain the mechanism of swallowing, peristalsis and the function of the lower
esophageal sphincter.
7.
Explain the functions for the following enzymes and hormones:
a.
pepsin
f.
lactase
b.
lipase
g.
secretin
c.
proteolytic enzymes
h.
enterokinase
d.
amylase
i.
cholecystokinin
e.
gastrin
8.
Regarding absorption:
a.
describe the mechanism of absorption from the bowel
b.
list the types and sites of absorption
c.
explain the process of digestion and absorption of:
i.
proteins
ii.
fats
iii.
carbohydrates
iv.
fat-soluble vitamins
v.
water and sodium
vi.
iron
vii.
water soluble vitamins
9.
Explain the cephalic, gastric and intestinal vagal stimulation of digestive
function.
10.
Describe the pathophysiology, clinical features, diagnosis and treatment of these
esophageal disorders:
a.
achalasia
d.
Mallory-Weiss tears
b.
reflux esophagitis
e.
Zenker's diverticulum
c.
hiatal hernia
f.
webs and rings
11.
Regarding squamous cell carcinoma of the esophagus
a.
list the predisposing factors
b.
list the clinical features
c.
explain the diagnosis and management
12.
Explain the gastric physiology related to peptic ulcer formation.
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13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Regarding duodenal and gastric ulcers:
a.
discuss the etiology and risk factors
b.
list the clinical features
c.
describe the diagnostic modalities
Regarding peptic ulcer disease, describe the principles of these medical
interventions used in treatment:
a.
antacid therapy
b.
dietary restrictions
c.
anticholinergic agents
d.
H2 (histamine) receptor antagonists
i.
Cimetidine (Tagamet)
ii.
Ranitidine (Zantac)
e.
Carafate
List the complications and describe the surgical procedures for duodenal and
gastric ulcers.
Briefly describe these conditions that may develop after peptic ulcer surgery:
a.
recurrent ulceration
b.
afferent loop syndromes
c.
bile reflux gastritis
d.
dumping syndrome
e.
malabsorption
Describe the pathogenesis, clinical features, diagnosis and management of
Zollinger-Ellison Syndrome.
Regarding gastric carcinoma, describe the epidemiology, risk factors,
morphology, diagnosis and management.
Discuss the differences between erosive, nonerosive and corrosive gastritis.
Explain these following tests used in the diagnosis of malabsorption:
a.
stool fat
b.
xylose absorption
c.
x-ray studies
d.
biopsy
e.
Schilling test
f.
blood tests
Describe the etiology and presentations of fat malabsorption, lactose intolerance,
celiac sprue, and regional enteritis.
List the differences between Crohn's disease and ulcerative colitis with regards to:
a.
epidemiology
b.
pathogenesis
c.
morphology
d.
clinical features
e.
diagnostic techniques
f.
differential diagnosis
g.
complications
h.
management
i.
prognosis
Describe diverticulosis and how it leads to diverticulitis. Explain the differential
diagnosis and management for both.
Discuss irritable bowel syndrome, its clinical features and management.
Explain mesenteric ischemia and ischemic colitis as vascular disorders of the
intestine.
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26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
List and describe the types of benign tumors of the small and large intestine
including adenomas, leiomyomas and polyps.
Regarding colorectal carcinoma:
a.
list the etiology and risk factors
b.
describe the morphology and staging with regards to Duke's classification
c.
list the clinical features
d.
discuss the diagnosis and management
e.
explain the complications
Describe the following screening and diagnostic tests for colorectal cancer:
a.
gastric washings and cytologic studies
b.
endoscopy
c.
diagnostic radiology
d.
stool analysis for occult blood (guiaic study)
e.
proctosigmoidoscopy
f.
colonoscopy
g.
carcinoembroyonic antigen level (CEA)
Discuss the clinical signs and symptoms of the following anorectal disorders:
a.
hemorrhoids
b.
infections
c.
dermatologic diseases
d.
anatomic lesions
Regarding the evaluation of gastrointestinal bleeding, describe the similarities
and differences between acute and chronic GI bleeding and how their
management differs.
Regarding the evaluation of diarrhea, identify the various causes of:
a.
acute diarrhea
i.
viruses
ii.
bacteria
iii.
protozoa
iv.
anxiety, stress
b.
chronic diarrhea
i.
protozoa
ii.
inflammation
iii.
drugs
iv.
tumors
v.
malaborsption syndromes
vi.
post-surgical states
Regarding the evaluation of constipation, identify the various causes, to include:
a.
metabolic disturbances
b.
endocrine factors
c.
habitual use of laxative
d.
mechanical obstruction
e.
lesions
f.
drugs
Regarding the evaluation of jaundice, discuss the clinical signs associated with:
a.
unconjugated hyperbilirubinemias
b.
conjugated hyperbiliribuinemias
Discuss the differential diagnosis of jaundice and the use of liver function tests.
When comparing hepatitis A, hepatitis B, and hepatitis C:
a.
discuss their etiology and epidemiology
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36.
37.
38.
39.
40.
41.
b.
describe their pathogenesis and morphology
c.
list their clinical and laboratory features
d.
discuss their complications and prognosis
e.
list the differential diagnosis
f.
describe the management of each
Compare chronic persistent, chronic lobular, and chronic active hepatitis with
regards to:
a.
onset
b.
recurrence
c.
prognosis
d.
liver histology
Regarding cirrhosis:
a.
list the various types
b.
describe the pathogenesis and morphology
c.
list the clinical features
d.
describe the diagnosis and management
Regarding major sequelae of cirrhosis, describe the clinical features, diagnosis
and management of:
a.
portal hypertension
b.
variceal bleeding
c.
splenomegaly
d.
ascites
e.
peritonitis
g.
hepatic encephalopathy
List the common drugs associated with hepatic toxicity and describe how they
cause the toxicity.
Describe the epidemiology, etiology, clinical features, diagnosis, course and
management of hepatocellular carcinoma.
Regarding cholelithiasis and cholecystitis:
a.
discuss the pathogenesis of cholesterol and pigment gallstones
b.
describe the diagnosis
c.
discuss the clinical features
d.
describe the medical and surgical management
e.
list the complications
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42.
43.
44.
45.
46.
47.
Describe the complications of choledocholithiasis, to include:
a.
cholangitis
b.
obstructive jaundice
c.
pancreatitis
d.
cirrhosis
Regarding acute pancreatitis:
a.
describe the pathogenesis and etiology
b.
list the clinical features
c.
describe the diagnosis and management
d.
explain the complications
e.
describe the development of phlegmon, abscess and
pseudocyst
Explain the etiology, pathophysiology, clinical features, complications, diagnosis
and management of chronic pancreatitis.
List the elements of Ranson's criteria as it applies to acute pancreatitis and
explain its utilization in the prognosis.
Describe the clinical features, diagnostic procedures, laboratory findings, course
and management of pancreatic cancer.
Briefly explain the role these diagnostic modalities play in the gastrointestinal
system:
a.
endoscopy
b.
endoscopic retrograde cholangiopancreatography (ERCP)
c.
esophagogastroduodenoscopy (EGD)
d.
colonoscopy
e.
barium studies
f.
sigmoidoscopy
g.
cholecystography
h.
cholangiography
i.
ultrasound
j.
CT scan, MRI
k.
radionuclide bleeding scan
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Infectious Disease – PHAS 310
Instructional Objectives
Upon completion of this course, the student will be able to:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Describe the interplay between host and microorganism that lead to infection
and resolution to include:
a.
host immune factors
b.
host response to infection
c.
diagnosis and treatment of infectious disease
Explain the indications and techniques of specimen collection for examination
and the importance of specimen identification to include:
a.
blood
b.
sputum
c.
urine
d.
wound
e.
spinal fluid
Describe the indications and technique used to obtain:
a.
gram stains
b.
India ink stains
c.
acid fast stains
Identify and treat common ambulatory infectious diseases to include:
a.
pharyngitis
d.
soft tissue infections
b.
conjunctivitis
e.
otitis media
c.
URIs
f.
community acquired
pneumonia
Discuss community acquired pneumonias, contrast their:
a.
etiologic agent/risk factors
b.
clinical presentation/course
c.
laboratory manifestations
d.
treatment
Differentiate UTIs, cystitis, prostatitis with regard to:
a.
diagnostic criteria
b.
significance of bacteriuria
c.
responsible pathogens
d.
significance of recurrent UTIs
e.
treatment and management
Define nosocomial infections, list the most common causative pathogens, host
factors and modes of nosocomial infection transmission.
List the most common hospital acquired infections, their prevention, mode of
transmission, etiologic agents and treatment to include:
a.
UTIs
b.
wound infections
c.
bacteremia
d.
pneumonia
Discuss the risk of transmission of HIV and Hepatitis B, not only to patients, but
also hospital personnel. Discuss the significance of "universal precautions".
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10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Describe the clinical presentation, diagnostic evaluation, treatment management
of common enteric infections to include:
a.
Salmonella
b.
Shigella
c.
Campylobacter
d.
"traveler's diarrhea" (enterotoxigenic E. coli)
e.
C. difficile
Describe the clinical presentation, diagnostic evaluation, treatment of common
protozoan enteric infections to include:
a.
Giardia
b.
Cryptosporidiosis
c.
Trichinosis
d.
Schistosomiasis
e.
Amebiasis
f.
Toxoplasmosis
Describe the clinical presentation, diagnostic evaluation and treatment of
common helminthic infections to include:
a.
enterobiasis
b.
toxocariasis
c.
hookworms
d.
tapeworms
Discuss the fluid and electrolyte replacement requirements with regards to
profuse or prolonged diarrheal states.
Identify common superficial skin infections, name the causative microbial agent,
clinical course and treatment for:
a.
impetigo
b.
erysipelas
c.
cellulitis
Identify the presentation and treatment of anaerobic skin and soft tissue
infections in include:
a.
crepitant cellulitis
b.
gangrene
c.
necrotizing fascitis
d.
skin abscesses
Describe the clinical presentation, differential diagnosis, laboratory findings and
complications of bacterial meningitis.
List the three most common bacterial agents responsible for meningitis, their
epidemiology, clinical settings and treatment for each.
Differentiate between various viral disease of the CNS and their etiologies to
include:
a.
aseptic meningitis
b.
encephalitis (primary and post infectious)
c.
Creutzfeldt-Jakob Disease
d.
subacute sclerosing panencephalitis
List CNS conditions associated with AIDS to include:
a.
viral agents (CMV, HSV, AML)
b.
Cryptococcal meningitis
c.
Toxoplasmosis
d.
AIDS dementia
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20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
Discuss the clinical manifestation, laboratory workup and treatment for each of
the above.
Discuss the pathogenesis, etiology, clinical
manifestations, treatment and prognosis of brain abscesses.
Define endocarditis and list the three classifications. Discuss the clinical
manifestations, laboratory features, diagnosis and treatment of each.
Discuss surgical management and the role of antimicrobial prophylaxis in
endocarditis.
List the types of exanthems caused by:
a.
viruses
c.
bacteria
Describe the assessment and manifestation of each.
Differentiate between infectious causes of vesicles/bullae and their treatment to
include:
a.
varicella
b.
herpes I & II
c.
staph infections
Discuss the etiology, clinical presentation, laboratory findings and treatment of
toxic shock syndrome.
Discuss Lyme Disease. Identify and describe the causative organism,
epidemiology, clinical manifestations (in three stages), treatment, prognosis and
prevention.
Define Rocky Mountain Spotted Fever. Discuss its etiology, clinical
manifestations, differential diagnosis, complications, treatment and prevention.
Describe osteomyelitis and its pathogenesis. List the hallmark of acute vs.
chronic osteomyelitis. Discuss its clinical manifestations, diagnosis and
treatment.
Differentiate between syphilis, genital herpes, chancroid, Donovanosis, and
LGV. Identify the etiologic agent, clinical manifestation, diagnosis, clinical
course and treatment of each.
List the most common etiologic agent, clinical manifestation, diagnosis and
treatment for the following disorders:
a.
urethritis (gonococcal & non-gonococcal)
b.
epididymitis
c.
cystitis
g.
proctitis
d.
cervicitis
h.
acute arthritis
e.
vulvovaginitis
i.
genital warts
f.
PID
j.
scabies
Define AIDS, list the etiologic agent and risk factors. Describe its
pathophysiology and immunopathogenesis.
List commonly encountered opportunistic infections and their treatment
associated with AIDS.
Discuss the diagnosis, treatment, prevention and prognosis of AIDS.
Discuss tuberculosis. List the possible modes of
transmission, pathogenesis,
clinical manifestation and diagnosis.
List drugs used to treat TB and the major side effects of each.
Discuss extrapulmonary manifestations of TB.
Discuss multidrug resistant tuberculosis and alternative treatments used.
Define Leprosy and identify the etiologic agent. Discuss the clinicopathologic
classification, clinical manifestations, diagnosis and treatment.
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40.
Discuss mycobacterium avium-intracellulare with regard to clinical
manifestation, diagnosis and treatment.
41.
List pathogens commonly associated with immunocompromised patients to
include:
a.
the asplenic patient
b.
secondary to chemotherapy
c.
secondary to organ transplant
d.
secondary to corticosteroid therapy
e.
the cancer patient
f.
the elderly
g.
pregnancy
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Clinical Nutrition – PHAS 310
Instructional Objectives
Upon completion of this course, the student will be able to :
NUTRITIONAL ASSESSMENT:
1.
Define basal metabolic rate.
2.
Discuss the major factors that determine the total energy requirement of an
individual.
3.
Describe how to calculate caloric requirements in a typical diet.
4.
State the energy requirements for a normal adult male and female, and the
recommended percentage of calories derived from carbohydrates, lipids, and
proteins in an ideal diet.
5.
Briefly define nutrition and discuss the role of a dietician in nutritional
counseling.
6.
Discuss the resources that can be utilized to define the recommended dietary
allowances, to include, vitamins, minerals, protein, fat, carbohydrates, and trace
elements.
CARDIOVASCULAR NUTRITION:
1.
Explain the role of dietary control and dietary changes in reducing the risk of
heart disease.
2.
Describe the role of sodium content in hypertension.
3.
Explain how fat modified diets play a role in the control of hyperlipidemia.
4.
List foods that should be avoided when modifying dietary fat content.
ENDOCRINE NUTRITION:
1.
List dietary recommendations for diabetic patients.
2.
Discuss dietary changes and caloric restrictions in the diet of an obese
individual.
3.
Explain the criteria for successful weight reduction and methods of weight
control besides food limitation.
GASTROINTESTINAL NUTRITION:
1.
Explain the dietary principles utilized in the treatment of peptic ulcer disease.
2.
List foods that must be avoided by individuals with lactose intolerance.
3.
Define the gluten-free diet used in celiac sprue.
4.
Explain the dietary principles in the treatment of pancreatitis.
5.
Describe the concept of a residue restricted diet in the treatment of disorders of
the large intestine.
6.
Explain fatty food intolerance in biliary tract disease.
7.
Describe the dietary principles utilized in the treatment of hepatic disease.
RENAL NUTRITION:
1.
Discuss the need for protein restriction in renal disease.
2.
Explain the sodium depletion syndrome in renal disease.
3.
Explain the need for fluid restriction in patients with renal disease.
4.
Explain the role of hypo-magnesemia in the development of renal disease.
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PEDIATRIC/ADOLESCENT NUTRITION:
1.
Explain the dietary benefits of breast-feeding.
2.
Describe options for treating lactose intolerance in the pediatric population.
3.
Describe the dietary changes and needs that occur in the pediatric and adolescent
population.
4.
Discuss the recognition and treatment of bulimia, and anorexia nervosa.
NUTRITION IN PREGNANCY:
1.
Discuss the recommended dietary allowances for females during pregnancy.
2.
Discuss the importance of providing an adequate caloric allowance during
pregnancy.
3.
List the foods that must be included in the diet of a pregnant female.
4.
Explain the need for vitamin supplementation during pregnancy.
5.
Explain foods that should be increased, and substances, foods that should be
avoided during active breast-feeding.
SURGICAL NUTRITION:
1.
Explain the progression of dietary needs in a post-operative patient from clear
liquids to a regular diet.
2.
Describe the metabolic responses to surgery with regards to, catabolic phase,
anabolic phase, and fat gain phase.
3.
With regards to enteral feedings describe the feedings available, administration
of feedings, and the complications and hazards of each.
4.
Explain the benefit of enteral feedings.
5.
Discuss the general guidelines utilized in determining the need for total
parenteral feedings.
6.
Discuss caloric calculations in total parenteral feedings.
7.
Discuss the need for trace elements.
SPECIAL CASES IN NUTRITION:
1.
Describe nutritional problems that arise in patients with cancer.
2.
Describe the changes that occur with aging with regards to nutritional
requirements.
3.
Explain the special dietary requirements that are necessary in patients with burns
and fractures.
4.
Calculate the basal energy expenditure utilizing the Harris Benedict Formula.
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