Curriculum Renewal Objective archive

• Upon completion of this problem, students will be able to describe the pathophysiology of multiple myeloma and its clinical features. Students will be able to describe the importance of apoptosis in the normal tissue and in tumorigenesis, and the limitations of conventional cytoreductive cancer therapies in tumours with defective apoptosis. Students should be able to describe the impact of genetic testing on cancer staging and therapy. Students will be able to describe a palliative approach to care.
• Upon completion of this case, students will be able to broadly describe the pathophysiology, clinical manifestations and general approach to management of the hematological malignancies in children. Students should be able to describe the role of genetic testing in the management of children with ALL.
• Describe the clinical features and diagnostic approach to multiple myeloma.
• Define the term “clonality”.
• Understand a paraprotein and testing for identification (serum protein electrophoresis vs serum immunofixation vs serum free light chains).
• Describe the general process for approving and accessing new cancer treatments for patients in the Canadian health care system.
• Describe the therapeutic principles involved in the treatment of acute lymphoblastic leukemia.
• Describe the acute toxicities of treatment, including tumour lysis syndrome, leukostasis, and disseminated intravascular coagulopathy.
• Describe the long-term effects of treatment, including secondary malignancies.
• Identify the key general principles in managing childhood hematologic malignancies.
• Express how androgens may influence brain differentiation and discuss the concept of brain sex and its potential implications in behavioral development.
• Explain the sequence and timing of normal female and male pubertal development.
• Explain how the principles of treatment differ between central and non-central causes (of precocious puberty).
• Outline the hormonal changes during menopause.
• Recognize that in normal human fertility, conception is not always readily achieved, even when no obvious medical problem exists.
• Describe how the physiological changes in pregnancy are protective against blood loss.
• Identify the principles of management of post-partum hemorrhage and review the management of hemorrhagic shock.
• Discuss barriers and contraindications to breastfeeding.
• Recognize the role of the gastrointestinal immune system in the maintenance of health and in the pathophysiology of gastrointestinal disease (e.g., celiac).
• Compare and contrast the etiologies of acute and chronic pancreatitis.
• Describe the embryology, blood supply, and histology of the small intestine, comparing the ileum with the jejunum.
• List the primary sites of absorption of each macronutrient.
• Describe the role of genetic testing in staging and treatment of ALL.
• Develop an approach to the diagnostic work up of myeloma (bone marrow aspirate, skeletal survey).
• Review staging and prognosis of multiple myeloma and the use of FISH cytogenetics to risk stratify patients.
• Describe a normal karyotype, and a chromosome rearrangement.
• Describe the impact of chromosome abnormalities on the selection of therapy for multiple myeloma.
• Describe the role of gene expression profiling in treatment of multiple myeloma.
• Conceptualize multiple myeloma as it relates to its premalignant states smoldering myeloma and monoclonal gammopathy of undetermined significance (MGUS).