Integration Foundation

• Upon completion of this problem, students will be able to explain how skin forms an integral component of the immune system and the consequences of breaches in this barrier. They will be able to describe the composition of normal host flora, the classification of bacteria and explain how these bacteria can lead to infections, such as those at surgical sites, especially when facilitated by the presence of prosthetic material.
• Upon completion of this problem, students should be able to describe cancer-directed and non-cancer-directed treatments in the management of metastatic cancer. Students should be able to explain the need for urgent treatment in some instances of incurable cancer.
• Upon completion of this problem, the student should be able to describe how tobacco and radiation exposure can result in carcinogenesis. Students should be able to describe the value of identifying occupational exposures to carcinogens at the individual, workplace, and community levels.
• Upon completion of this problem, the student should be able to define the terms “primary, secondary, and tertiary prevention” as they relate to cancer. Students should be able to describe the characteristics of an effective population screening program and the mechanisms by which screening can reduce the burden of cancer.
• Upon completion of this problem, students should be able to describe the pathogenesis and progression of HIV infection and the role the virus plays in causing long-term immunosuppression. Students will be able to describe how long-term immunosuppression can result in opportunistic infections.
• Upon completion of this problem, students should be able to describe how long-term immunosuppression can result in opportunistic infection and increase the risk of developing malignancy.
• Upon completion of this problem, students should be able to discuss the role of adjuvant chemotherapy and surveillance in at risk patients after surgery. Students will describe the metastatic cascade and explain why some cancers metastasize preferentially to certain sites.
• At the completion of this problem, students should be able to define sepsis and describe the pathophysiology of septic shock. They should be able to identify the diagnostic work up and management of someone with sepsis and articulate the process of antimicrobial selection in such cases.
• Explain how the body regulates temperature and the physiology of the febrile response.
• Describe the anatomy and histology of skin and the role of skin integrity in preventing infections and relate this to the pathogenesis of surgical site infections.
• Explain how bacteria are classified based on their shape and gram stain features.
• Describe normal host flora and how this varies between sites such as the skin and GI/GU tract.
• Explain why coagulase-negative staphylococci rarely cause human disease, but commonly cause disease in the presence of prosthetic devices.
• Discuss the importance of infection control in preventing the acquisition and spread of nosocomial infections.
• Review the components and function of the innate, humoral, and cellular immune systems.
• Define and describe the pathophysiology of septic shock.
• Distinguish the clinical presentation of septic shock and be able to differentiate this from other forms of shock.
• Identify the potential common underlying infections and the laboratory/microbiologic work up of someone presenting with community-acquired sepsis.
• Apply the principles of antimicrobial selection for patients with undifferentiated septic shock.
• Describe the microbiology of severe community acquired pneumonia and the appropriate antibiotics for empiric treatment.
• Discuss the process and importance of appropriate narrowing of antimicrobials when likely causative organisms are identified
• Describe the societal cost of tobacco use as it relates to cancer.
• List sources of radiation exposure that can result in an increased risk of cancer.
• List some long-term side effects of cancer treatments, including the development of secondary cancers.
• Describe several potential sources of occupational exposure to carcinogens and the importance of identifying such occupational carcinogens in a patient with cancer.
• Describe cancer/tumour terminology as it pertains to malignant potential and tissue of origin.
• Describe at least one current international system for cancer staging and explain the rationale for “staging” individual cancers.
• Describe the role for radiation in the treatment of solid tumours, and differentiate between the roles and indications for radiosurgery and conventional beam radiation.
• Describe the role of clinical genetic testing in familial cancer syndromes.
• Describe hereditary/familial cancers.
• Identify the main ethical issues that arise in cancer genetics testing.
• Describe the role of screening in the management of high risk individuals.
• Construct and analyze a pedigree to assess which individuals should be offered extended cancer screening, and genetic counseling/testing.
• Describe the mechanism of action of bisphosphonates in the treatment of cancer related bone lesions.
• Describe the rationale for endocrine therapy in hormone sensitive cancers.
• Identify broad classes of cancer-directed treatment that can be used in the setting of incurable cancer.
• Identify general modalities of non-cancer-directed treatment that can be used in the setting of incurable cancer.
• List oncologic emergencies in the setting of advanced cancer and palliative care.
• Explain the rationale for instituting urgent cancer treatment in the setting of incurable cancer.
• Describe the principles of pain and symptom management in cancer.
• Develop a diagnostic approach to the finding of a new nodule on chest x-ray.
• Differentiate the terms localized cancer, regional spread and distant spread and consider the imaging modalities which play a role in staging cancer.
• Describe the role of surgical management of tumours and the role and advantages of targeted therapies.
• Discuss the value of having a multi-disciplinary and allied health team approach in the comprehensive care of patients with cancer.
• Explain the psychosocial impact of inherited disease.
• List the criteria for an effective screening program and describe the rationale for each criterion.
• List the most common cancers in Canada and worldwide, and the major risk factors for these cancers.
• Explain what is meant by tropism.
• Describe angiogenesis and how medications may influence this as part of cancer treatment.
• Discuss the concepts in managing metastatic disease.
• Discuss the national and global epidemiology of HIV.
• Describe the natural history and progression of HIV infection, differentiate between HIV infection and AIDS.
• Discuss the principles of antiviral pharmacotherapy including the mechanism of action of drugs used to manage HIV.
• Describe the opportunistic infections that typically only occur in the immunocompromised host.
• Review the function of T cells and understand how HIV infection leads to CD4 cell depletion and immunosuppression.
• Describe how long-term immunosuppression leads to decreased surveillance of abnormal and potentially cancerous cells.
• Describe how T cell depletion caused by HIV infection can result in unchecked B cell proliferation thereby increasing the risk of transformation to malignant cells.
• Explain how viruses can cause cancer and how this risk is increased by immunosuppression.
• Discuss that lymphoma is a malignancy of lymphatic tissue which can involve either B (mostly commonly) or T cells.
• Describe the spectrum of herpes viruses, their associated diseases, and explain how herpes viruses establish latency with specificity in certain tissues and the role immunosuppression plays in their re-activation.
• Identify psychosocial factors that influence adherence to HIV therapy.
• Upon completion of this problem, students will be able to integrate the various branches of the immune system and be able to identify when to initiate an immunodeficiency work-up.
• Identify when a clinician should consider an underlying immunodeficiency.
• Describe the initial work-up of a patient suspected to have an underlying immunodeficiency.
• Identify the consequences of deficiencies in different arms of the immune system with a focus on B-cell deficiency.
• Review the normal process of wound healing.
• Explain the role of biofilm formation in the infection of prosthetic devices.
• Describe the pathophysiology and inflammatory pathways resulting from exposure to an infectious agent.
• Describe the role of the spleen in host defence and explain why individuals who are asplenic/hyposplenic are at particular risk for certain infections.
• Discuss common barriers to treatment and social adjustment for refugees after arrival to Canada.
• Describe the presentation of defects in different branches of the immune system.
• Describe the natural history of immune deficiency in children and adults.
• Explain how social determinants of health can influence the presentation of illness in individuals with underlying disease.
• Describe the organ systems susceptible to infection in different immune deficiencies and how these complications can be identified and prevented.
• Explain the difference between primary and secondary immunodeficiency in terms of etiology and presentation.
• Review the anatomy and histology of normal lymphoid tissue.
• Describe the current cancer screening programs in Ontario.
• Describe how different cancer treatment modalities (surgery, radiation, adjuvant chemotherapy and chemotherapy) can be used synergistically to reduce disease burden.
• Describe how tumors are determined to be appropriate for endocrine therapy, chemotherapy or other targeted therapies.
• Identify goals of care when discussing treatment options in both curative and noncurative cancer.