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• Explain the response of the heart in terms of heart rate and stroke volume to exercise and to inactivity. Explain how oxygen saturation is maintained during exercise: oxygen intake, diffusion and transport.Explain how carbon dioxide excretion is achieved. Explain how inactivity modifies the bodys ability to use O2 efficiently.
• Upon completion of this case, students should understand how disruption of the alveolar capillary membrane affects gas transfer in the lung.
• Explain the development of the normal heart. Explain the transition from a fetal to a neonatal circulation. Describe the most common congenital heart defects and explain why some produce cyanosis while others do not. Explain the potential long-term consequences of uncorrected left to right shunts. Explain Eisenmenger physiology. Describe the treatment options for the various congenital heart defects.
• To understand the regulation of Cardiac Output. To understand the mechanism, pathophysiology, and classification of congestive heart failure. To explain how anemia causes CHF. To understand oxygen supply and demand at the tissue level. To understand the causes of macrocytic anemias.
• Upon completion of this case, students should understand how the structure of hemoglobin impacts on its role in oxygen transport. They should also understand the genetics of thalassemia.
• Upon completion of this case, students will understand the assessment and management of congenital problems in children.
• Describe normal angular growth in children. Describe normal rotational growth in children. Describe the normal femoral version, tibial torsion, and femoral-tibial axis upon cessation of growth. Describe the causes for abnormal angular and rotational growth and their management. Describe metatarsus adductus and its treatment.
• Upon completion of this case, students will have gained insight into the role of mechanical dysfunction as a cause of pain in a young adult.
• Upon completion of this case, students will appreciate that joint pain can arise from a number of different etiologies, and explore osteonecrosis as one of these etiologies.
• Upon completion of this case, students will have an understanding of metabolic bone disease using Paget's disease of bone as an example.
• Upon completion of this case, students will understand the normal control of eye movements.
• Upon completion of this case, students will understand the role of cerebellum in the control of movement.
• Upon completion of this case, students will understand the control of facial movements.
• Upon completion of this case, students will have an understanding of peripheral nerve function and its role in perception with emphasis on polyneuropathy.
• Upon completion of this case, students will understand the anatomy and physiology of the sensory pathways of the spinal cord.
• Upon completion of this case, students will understand the anatomy and physiology of the eye and optic nerves.
• Upon completion of this case, students will understand the anatomy and physiology of the visual system in the brain.
• Upon completion of this case, students should understand the supra-spinal organization of the sensory system.
• Upon completion of this case, students will understand infection of the nervous system.
• Upon completion of this case, students will understand CSF flow and hydrocephalus.
• Upon completion of this case, students will become familiar with basic concepts of seizures and epilepsy.
• Upon completion of this case, students will have an understanding of cerebral metabolism and blood flow.
• Upon completion of this case, students will improve their understanding of the social context, prevalence, risk factors, mechanisms, and consequences of drug use.
• After completing the tutorial the student will expand on the material learned in the previous problem to be able to discuss the differences in renal manifestations of intrinsic causes of acute kidney injury in the context of autoimmune disease.
• Upon completion of this case, students should recognize the normal flora of the gastrointertinal tract, and understand that it may invade the genitourinary tract and cause infection.
• Radiation-induced carcinogenesis Increasing survivorship of cancer patients and recognition of long term toxicities of treatment
• Upon completion of this case, students will gain an understanding of the role of viruses in the development of cancer and the potential for immunomodulation in the treatment of cancer.
• Upon completion of this case, students will understand the role of inheritance, environment and infectious agents in the development of cancer, using gastric cancer as a model.
• Upon completion of this case, students will develop an understanding of the metastatic cascade and why some cancers metastasize to some sites preferentially.
• Upon completion of this case, students will gain an understanding of the importance that patients place upon alternative and complementary medicine in cancer treatment and some of the issues that arise in appraising this information.
• Upon completion of this case, the student will have a basic approach to the diagnosis of a new mass lesion, including imaging modalities and diagnostic procedures, as well as an understanding of the multi-disciplinary approach to cancer care and the role of Clinical Practice Guidelines in determining therapy.
• Upon completion of this case, students will understand the cortical organization of executive function and behaviour.
• Upon completion of this case, students will understand the pathophysiology of altered consciousness.
• Upon completion of this problem, students should be able to explain the physiological responses of the body (heart, lungs and blood) to increased demand for oxygen during exercise.
• Upon completion of this case, students should understand the concept of qualitative platelet defect.
• Upon completion of this case, students will have an understanding of metabolic disorders that result in musculoskeletal problems using acute gout as a prototype.
• Upon completion of this case, students will have gained an understanding of the problem of metabolism resulting in multiple joint problems using tophaceous gout as a prototype..
• Upon completion of this case, the student will have gained an understanding of infections in bone and joints and will be able to compare and contrast pediatric and adult disease.
• Describe normal vaginal and colonic flora, and understand the Gram-stain features and culture plate features of these organisms. Understand the role of genitourinary tract anatomy and physiology in the prevention/development of urinary tract infections. Understand the epidemiology of body temperature and the physiology of the febrile response. Understand the role of the innate immune system in preventing and combating infectious diseases.
• Viral Carcinogenesis. Changing manifestations of HIV-related complications. Role of immunomodulation as treatment for cancer.
• Differentiation of hereditary versus familial cancers Role of lifestyle in pathogenesis of cancer. Role of infectious agents in pathogenesis of cancer. Cancer prevention. Prevalence of cancer in North America.
• Tropism. Metastatic cascade. Angiogenesis.
• Application of critical appraisal skills to assessing literature on complementary medicine and development of methodology to assess. Role of oxidative damage in the genesis of cancer. Cancer prevention.
• Describe normal patterns of neonatal limb development. Describe neonatal physical examination. Understand the difference between congenital and developmental problems in limb deformities.
• Understand that there is a lack of clarity on the delineation of the physiology of patellofemoral syndrome. Understand the non-pharmacologic, pharmacologic and surgical options available for the management of patellofemoral syndrome. Understand the relationship of the patella on the femoral condyles and particularly how maltracking of the patella plays a significant role in this syndrome.
• Understand bone physiology and pathophysiology. Recognize the identifying features of osteonecrosis. Appreciate that the usual presentation of osteoarthritis can be complicated/confounded by other conditions (such as spontaneous osteonecrosis, especially in older adults). Know how to investigate a patient with suspected osteonecrosis. Know how the condition is managed and be able to counsel the patient accordingly..
• Discuss the causes of bone pain. Learn a basic approach to the patient with Paget's disease. Interpret the significance of physical findings. Discuss the rational approach to investigations: x-ray, bone scan, CT scan, MRI for back pain, and blood tests.
• Understanding of metabolism of uric acid pathways. Understand external factors that affect uric acid. Understand treatment of subacute gout. Understanding concept of overproduction vs. underexcretion and renal handling of uric acid. Understanding how medications affect uric acid.
• Understand uric acid pathways and factors that affect them. Understand treatments for tophaceous gout, their benefits and limitations and associated risks and how they work pharmacologically. Understand the differential diagnosis of polyarticular arthritis and the ordering of appropriate investigations
• Compare and contrast pediatric and adult disease in terms of bone structure, growth and disease presentation. Bone structure and blood supply. Compare and contrast acute versus chronic bone infection. Mechanisms of bone and joint infection. Approach to hip pain in a child.
• Understand the anatomy of the individual extra-ocular muscles. Understand which cranial nerves are involved in the control of eye movements, and specifically which muscles are innervated by which nerves. Understand the role of key structures in the production of conjugate coordinated eye movements (1) Frontal cortical gaze centers (2) Para-pontine reticular formation (PPRF) (3) Medial longitudinal fasciculus. Examination of eye movement.
• Explain the role of the cerebellum in the control of movement. Understand the basic organization of the cerebellar connections in the brain and spinal cord. Understand how alcohol affects the cerebellum in particular and the nervous system in general. Understand the examination of coordination and gait.
• Understand the anatomy of seventh cranial nerve and the muscles innervated by it. Understand the anatomic difference between a facial palsy caused by an upper motor neuron lesion and one caused by a lower motor neuron lesion. Describe the clinical differentiation between a facial palsy caused by an upper motor neuron lesion and one caused by a lower motor neuron lesion. Understand the other (non-motor) functions of the seventh cranial nerve. Examination of the facial nerve.
• Anatomy and physiology of peripheral nerves. The mono-synaptic reflex arc. Effects of metabolic derangements on nerve function (i.e. diabetes) Examination of sensation and reflexes.
• Organization of the two major sensory systems of the spinal cord. Concept of peripheral versus central loss of sensation. Concept of upper versus lower motor neuron dysfunction. Dysfunction of the nervous system secondary to nutritional deficiency, B12 in particular. Examination of sensation and reflexes.
• Anatomy and physiology of the eye; cones, rods, eye ball, optic nerve. Concept of visual acuity and visual fields. Anatomy and physiology of optic nerve and optic chiasm. Optic neuritis and demyelination. Examination of the papillary reflex and visual fields.
• Anatomy of the visual pathways. Physiology of vision. Cerebral infarction. Examination of visual fields.
• Cortical organization of sensation. Parietal lobe function. CNS neoplasia.
• Basic anatomy and physiology of consciousness. The mechanism of decreased level of consciousness. Types and causes of intracranial hemorrhage. Intracranial pain senstive structures. Examination of the unconscious patient.
• Executive function of the frontal lobe. Brain organization of behaviour. Trauma of the central nervous system. Examination of mental status.
• Concept of blood brain barrier. Cerebral spinal fluid (CSF). Central Nervous System (CNS) infections.
• Anatomy and physiology of cerebral spinal fluid flow (CSF). Concept of raised intra-cranial pressure. Neoplasia in the nervous system.
• Definition of seizure. Classification of seizures and concept of epilepsy. Embryology of the nervous system (neural tube defect).
• Cerebral metabolism and blood flow; review the vascular supply of the brain (arteries and veins). Pathophysiology and mechanisms of cerebral ischemia. Stroke syndromes.
• Students should also have an understanding of: the social context for drug use; risk factors that increase the likelihood of drug use leading to adverse consequences; the prevalence and pattern of drug use and adverse consequences in both general and clinical populations; the physical, behavioural, and social components of drug abuse and drug dependence; the physical and behavioural mechanisms of drug action, tolerance, and withdrawal; a prevalent type of family presentation involving drug use in a primary care setting.
• Understand how particles can enter the respiratory tract and how the lung can partially, but incompletely, protect itself against penetration by potentially toxic particles. Develop an awareness of the concept of occupational lung disease. Understand the differing capacities of oxygen and carbon dioxide across the alveolar capillary membrane and how that determines the arterial blood gas anomalies in an interstitial lung process (as distinct from COPD). Understand the mechanisms behind chronic inflammation and how this leads to tissue damage / fibrosis. Understand how interstitial lung disease affects the mechanics of breathing. (What sort of breathing pattern would be expected? What anomalies on pulmonary function tests would be expected?)
• Describe the development of hemoglobins during embryonal, fetal periods and during infancy. Discuss the transition of various types of hemoglobins to adult hemoglobins. Describe various hemoglobinopathies and different types of thalassemia (alpha- and beta-thalassemia). Explain the role of hemoglobin in gas exchange and discuss the cardiac compensation for anemia. Discuss the pathophysiology of generalized anasarca with special reference to hydrops fetalis.
• Understand the physiology of platelet functions. Understand the congenital and acquired defects of platelet function (Note: the pathophysiology of the platelet anitgen system and its clinical significance will be discussed in MF4).
• Understand the structure and function of the kidney. Appreciate the mechanisms of microvascular damage and the effect on renal function. Be aware of the manifestations of autoimmune diseases in the kidney.
• Explain the hyperandrogenic, hyperinsulinemic state present with polycystic ovarian (PCO) syndrome. Explain why June has oligoamenorrhea. What conditions are on your differential? What would be an appropriate set of investigations to address this woman's problems?
• What is the mechanism for snoring? What are the physiologic effects of sleep apnea?
• How would you counsel June regarding her cardiac risk? How would you further investigate and manage her blood sugar?
• Pediatrics Approach to the Patient
• Upon completion of this case, the student will have become familiar with septic arthritis and osteomyelitis, and understand differences between pediatric and adult disease.
• Understand bone structure and blood supply. Understand mechanisms of bone and joint infection. Understand the significance of an acute monoarthritis and proper emergent management. Overview of septic arthritis including common organisms, and treatment. Compare and contrast acute versus chronic bone infection. Compare and contrast pediatric and adult disease in terms of bone structure, growth and disease presentation.
• After completing this case, students will have explored mechanisms for the development of hypoxemia.
• Understand oxygenation and mechanisms of hypoxemia. Develop an understanding of the concepts of sensitivity and specificity of lab tests. Develop an understanding of the concept of "pre-test probability." Understand the role of various tests used to work up pulmonary embolism.
• Upon completion of this case, students will have a better understanding of pain, inflammatory and autonomic pathways in the central nervous system.
• Physiology of cortical spreading depression. Anatomy and physiology of brainstem pain pathways. Diagnostic criteria and differential diagnosis for migraine. Red flags for headache to support imaging.
• Upon completion of this case, students should be able to describe the immunological factors that must be taken into account when considering recipient and donor selection for renal transplantation as a treatment option for patients with end-stage renal disease (ESRD).
• Understand the basic concepts of how the immune system identifies self and non-self with a focus on the Major Histocompatibility Complex (MHC). Understanding the concept of finding an "HLA match"and the impact this has on successful transplantation and graft survival. Learn more about transplantation as one of the options for treatment of ESRD including transplantation.
• Introduction to Otolaryngology and Head and Neck Surgery (ENT)
• Introduction to the basic clinical exam, relevant anatomy and common clinical scenarios in Otolaryngology and Head and Neck Surgery.
• Describe the major immune cell types found in blood and tissue.
• Explain how the immune system promotes homeostasis, rather than just responds to infection with host defense.
• Consider the balance between physiologically beneficial immune responses versus immunopathology, fibrosis and malignancy.
• Explain indicators and physiological implications of acute inflammation.
• Identify two clinically/therapeutically relevant inflammatory cytokines.
• Discuss diagnostic and therapeutic applications of immunology in medicine.
• Interpret common laboratory values suggestive of ongoing inflammation (eg. CBC, ESR, CRP, ferritin).
• Differentiate between the roles and indications for radiation, radiosurgery and surgery in the management of solid tumours.
• Describe the challenges and limitations of using biological therapies including identifying the appropriate patient population, cost and access.
• Discuss some of the ethical dilemmas presented to the medical team when a patient does not meet the exact eligibility criteria for guideline-approved therapy.
• Explain the response of the respiratory system to exercise and high altitude (ventilation, lung mechanics, pulmonary blood flow, ventilation-perfusion relationship, diffusion and oxygen/carbon dioxide transportation).
• Explain how these physiological responses are modified by training (endurance exercise training).
• Summarize the oxygen and carbon dioxide dissociation curves.