Download Spring 2010 - University of Southern California

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University of Southern California
Division of Biokinesiology and Physical Therapy
Entry-Level D.P.T. Program
Spring 2010
Course Description: This course will provide students with an understanding of the basic
cellular and molecular processes that underlie many of the diagnoses they encounter as physical
therapists. Initially there is an overview of the general concepts of pathology followed by
modules in: clinical genetics, inflammation/immunology, oncology and infectious disease.
Course Number and Title: PT 516: Principles of Disease
Prerequisites/Co-requisites: None
Course Director:
Jack Turman, Jr., Ph.D., P.T.
Associate Professor
Division of Biokinesiology and Physical Therapy, School of Dentistry
Depts. of Cell and Neurobiology, and Pediatrics, Keck School of Medicine
Office: Center for Health Professions G-10G
Office hours: Fridays, 11:30-12:30
Office Phone: x22947
email: [email protected]
Teaching Assistant:
Charalambos “Bobby” Charalambos
[email protected]
Office Hours: Monday, 12-1 PM, Office: G30A
Guest Lecturers:
Kathy Burke, Ph.D.
Research Associate
Center for Premature Infant Health and Development
Keck School of Medicine
Maria Villacres, Ph.D.
Dept. of Pediatrics
USC Keck School of Medicine
Credits: 2
Course Schedule: M 10:00-11:30 AM, F 1:00-2:30 PM
Room: Center for Health Professions G-15
Examination Schedule:
Midterm Examination: Monday, February 26 1:00-3:00 PM, Room G-15
Final Examination (Cumulative): Monday, May 10 1-4 PM, Room G-15
GRADING SCALE: Below is the most stringent grading scale possible, final grades in this
course are based on a curved scale. The mean total number of points is equal to a B- grade.
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Passing grades:
93 -100
90 – 92
87 – 89
83 – 86
80 – 82
77 – 79
73 – 76
A
AB+
B
BC+
C
Non-passing grades:
70 - 72
67 – 69
63 – 66
60 – 62
< 60
CD+
D
DF
Point Distribution:
Midterm: 125 points
Final (Cumulative): 250 points
Component of Semester 2 Project: Management for Patients with Surgical Needs: 25 points
Total Course Points: 400 points
Course Objectives
 Define the four aspects of the disease process that guide the study of pathology.
 Define and discuss hypertrophy, atrophy, hyperplasia, metaplasia, reversible cell injury,
irreversible cell injury, and cell death.
 Briefly discuss the 7 classic causes of cell injury.
 Discuss mechanisms of cell injury: include ATP depletion, mitochondrial damage, loss of
calcium homeostasis, free radical production.
 Discuss the injury process following a hypoxic-ischemic injury.
 Differentiate necrosis and apoptosis and discuss the mechanisms, which may bring about
these two cellular events.
 Discuss the structural and biochemical changes are associated with cellular aging.
 Discuss the relationship between cellular senescence and telomere shortening
 Discuss two processes associated with the repair of tissues.
 Differentiate cell types according to their proliferative capacity.
 Differentiate autocrine, paracrine, and endocrine signaling.
 Discuss the variables that impact cell number in adult tissue.
 Briefly discuss the components of extracellular matrix and the role of the matrix in cell
development and in pathological conditions discussed throughout the course.
 Discuss how pathologists use signaling molecules, receptors, signal transduction proteins,
and transcription factors to learn more about disease processes.
 Differentiate the benefits of embryonic versus the adult forms of stem cells.
 Differentiate the different types of primary errors of morphogenesis.
 Discuss the different variables that determine one’s response to a teratogen exposure.
 Discuss the risk factors for, epidemiology associated with, and possible outcomes associated
with preterm delivery.
 Discuss the factors associated with epigenetics.
 Define hereditary, familial, and congenital as they relate to the genetic basis of disease.
 Define genome mutations, chromosome mutations, and gene mutations, and identify diseases
that have these mutations as a part of their etiology.
 Differentiate pleiotropism and genetic heterogeneity.
 Define point mutation and differentiate a point mutation in a coding vs. noncoding sequence.
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Differentiate between a DNA deletion and insertion.
Discuss three characteristics of autosomal dominant disorders.
Discuss five characteristics of autosomal recessive disorders.
Discuss the basic genetics of X-linked disorders.
Define the four pathological mechanisms associated with Mendelian disorders.
Discuss the normal karyotype and understand the nomenclature used to describe normal and
pathological karyotypes.
Discuss the different chromosomal anomalies that result in cytogenetic disorders.
Discuss the genetics of Down syndrome and the phenotypical abnormalities associated with
this syndrome.
Explain the general characteristics associated with cytogenetic disorders involving the sex
chromosomes.
Define three different categories of disorders that result from single gene disorders.
Define Fragile X syndrome and its characteristics.
Discuss how Prader-Willi syndrome is a type of genomic imprinting disorder.
Define inflammation and discuss the positive and negative outcomes of the inflammatory
process.
Discuss the cellular, chemical, and tissue components involved in the inflammatory response.
Differentiate the acute versus chronic inflammatory response.
Discuss and identify the different histological and morphological patterns in acute and
chronic inflammation.
Discuss blood panel changes associated with inflammation.
Discuss the cause and different types of responses of fever.
Discuss the processes associated with wound healing.
Differentiate healing by first intention versus second intention.
Discuss the local and systemic factors that influence wound healing.
Discuss the complications that can accompany wound healing.
Define neoplasia, neoplasm, tumor, cancer.
Differentiate proto-oncogene vs. oncogene.
Discuss the morphology of adenomas, papillomas, cystadenomas, polyps
Discuss four criteria used to characterize benign and malignant tumors.
Discuss morphological changes associated with anaplasia.
Discuss three key points of the kinetics of tumor cell growth.
Discuss the process of dissemination in metastatic tumors and the basic steps of metastases.
Discuss a mechanism by which a viral infection may cause tumor growth.
Differentiate between innate immunity, specific immunity, and passively required immunity.
Briefly define: granulocytes, neutrophils, eosinophils, tissue mast cells, monocytes,
macrophages, platelets, lymphocytes, T-cells, and B-cells.
Differentiate between CD4+ and CD8+ T-cells.
Discuss the major characteristics of the immunogloblins, major histocompatibility complex,
cytokines, and the T-cell receptor.
Discuss the processes associated with: type I, III, and IV hypersensitivity disorders.
Discuss the mechanisms involved in transplant rejection.
Explain the immunopathophysiological process that results in acute graft vs. host disease.
Define and explain the concept of immunologic tolerance.
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Discuss clonal deletion, clonal anergy, peripheral suppression by T cells, molecular mimicry.
Discuss the mechanisms of autoimmune diseases.
Discuss the pathology and etiology of systemic lupus erythematosus.
List Koch’s postulates which link specific microorganisms to specific diseases.
List the recent molecular biology revisions of Koch’s postulates that link traits of organisms
to particular disease processes.
Specify the host barrier mechanisms provided by the respiratory system, gastrointestinal
system, urogenital system, and skin.
Explain the mechanism for entry, dissemination, and release of microbes from the body.
Describe the mechanisms by which viruses and bacteria cause disease.
Discuss the pathogenesis associated with the following respiratory infections: influenza
viruses, haemophilus influenza infection, tuberculosis.
Discuss the pathogenesis associated with staphylococcal and streptococcal infections.
Discuss the pathogenesis associated with the following common infections of childhood:
mumps, measles, Epstein-Barr virus, polio, chickenpox, whooping cough, diptheria.
Discuss five general mechanisms by which viruses kill host cells.
Describe the morphology and make-up of a typical virus.
Discuss four mechanisms by which viruses “live off” of host cells.
Define viral tropism and the steps related to the initiation of a viral infection.
Discuss and differentiate between the lytic and lysogenic cycle and replication of
retroviruses.
Discuss the role of a retrovirus in HIV infection and in cancer research.
Discuss the epidemiology, etiology, pathogenesis, natural history, and clinical features of
HIV/AIDS.
Explain the general mechanisms for opportunistic infections, and discuss the pathogenesis of
opportunistic infections associated with AIDS.
Differentiate the process of acute inflammation, surgical wound repair following an
orthopedic surgical procedure, in a patient without a postsurgical infection versus a patient
with a postsurgical infection.
Course Texts:
Required: Kumar, Abbas, Fausto (2005) Pathologic Basis of Disease, 8th Edition, Elsevier
Saunders, Philadelphia.
Course Policies and Procedures: TURN OFF YOUR CELL PHONES. Attendance is required
in this course. Attendance is important, as I will cover information in lectures that are not
included in your lecture note package. I do not like students using laptops during lectures in
this course. I expect that you will be paying attention to the figures that I am discussing and
taking notes appropriately.
Description Of Teaching Methods And Learning Experiences:
Bring the textbook with you to each lecture, as the figures from the text are the focus of
most lectures. Pathology is a visual science. You need to have the figures to study while the
lecture is in progress. Make sure to register with the textbook website as described on the inside
front cover of the textbook. This will give you access to all the text figures, case studies and
supplementary figures. As the course progresses, Dr. Turman will inform you of any required
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material located in the case studies or supplementary figures. Class time will be devoted to
lecturing on the reading material from the textbook, handouts, and current research pertaining to
the topic of discussion. All reading assignments come from the texts or handouts provided by the
lecturers. Attempt to read textbook material prior to coming to class to have a general
understanding of vocabulary terms. Other than the first day of class, you are expected to have a
general familiarity with the textbook reading material before coming to class. The examinations
will cover information from lecture and from the assigned reading. There will be material from
the reading material, not covered in lecture, included on the examinations. Guest lecturer(s)
compose his/her own questions and associated key. Examinations consist of multiple-choice
questions, true-false questions, fill-in the blanks, matching, and slide identification questions. If
you fail to achieve a grade of “C” or better, then you must test out of the course during the next
semester. The make-up examination will be in an essay format. If you have questions regarding
material presented during lecture or in the readings please attend office hours. I will not answer
questions via email as the nature of this course requires the use of many schematics and
photomicrographs and I cannot reproduce these via emails.
Special Accomodations: Disability Services and Programs (DSP) is dedicated to maintaining an
environment that ensures all students with documented disabilities at USC equal access to its
educational programs, activities and facilities. The accommodations are designed to level the
playing field for students with disabilities, while maintaining the integrity and standards of USC's
academic programs. Accommodations are determined on a case-by-case basis. Students who require
special accommodations are encouraged to contact Jill Hopkins Student Affairs Coordinator CHP155 early in the semester to discuss individual needs. Students will be referred to DSP
([email protected], www.usc.edu/student-affairs/asn/DSP) to arrange appropriate support services
and strategies. For this course, a letter from DSP must be presented to the Course Director with
discussion of individual special accommodations at during the SECOND WEEK of the semester.
Statement Of Academic Integrity: We expect all students to be honest and forthright in their
academic studies. Students are expected to avoid:
 plagiarism (the use of the words or ideas of others that are not appropriately cited),
 unauthorized collaboration (using the work of another student or collaborating on
assignments that are to be completed independently),
 cheating in an examination (using unauthorized materials during exams),
 fabrication of data (falsifying the results of ones data).
All work submitted in this course must be your own and produced exclusively for this course.
For the consequences of academic dishonesty, refer to the SCampus. Violations will be taken
seriously and may result in an "F" for the course, suspension, and or expulsion. If you are in
doubt regarding the requirements, please consult with Dr. Turman before you complete any
requirement of the course.
Course Outline of Topics and Readings:
January 11 - Cellular Adaptations, Cell Injury, & Cell Death
Reading: Kumar et al. pgs. 1-32, 39-41, 994-996
January 15 – Cellular Adaptations, Cell Injury, & Cell Death
Reading: Kumar et al. pgs. 1-32, 39-41, 994-996
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January 18 – Holiday
January 22 - Cellular Adaptations, Cell Injury, & Cell Death, Inflammation
Reading: Kumar et al. pgs. 1-32, 39-41, 994-996, 43-75
January 25 – Inflammation
Reading: Kumar et al. 43-75
January 29 – Inflammation
Reading: Kumar et al. pgs. 43-75
February 1 – Tissue Renewal, Regeneration and Repair
Reading: Kumar et al. pgs. 79-92
February 5 – Tissue Renewal, Regeneration and Repair
Reading: Kumar et al. pgs. 79-92, 102-109 (Independent Reading)
February 8 - Developmental and Genetic Diseases
Reading: Kumar et al. pgs. 136-142, 158-164, 167-173, 447-456
February 12 - Developmental and Genetic Diseases
Reading: Kumar et al. pgs. 136-142, 158-164, 167-173, 447-456
February 15 – Holiday
February 19 – No Class, CSM Meeting
February 22 – Developmental and Genetic Diseases
Reading: Kumar et al. pgs. 136-142, 158-164, 167-173, 447-456, 471-473 (Independent
Reading)
February 26 - Midterm
March 1-12 - Clinical; March 15-19 – Spring Break
March 22 – Biology of Cancer (Dr. Burke)
Reading: Kumar et al. pgs. 259-280, 298-302, 320-323
March 26 - Biology of Cancer (Dr. Burke)
Reading: Kumar et al. pgs. 259-280, 298-302, 320-323
March 29 – Introduction and Overview of the Immune System
Reading: Kumar et al. Pgs. 183-197
April 2 - Introduction and Overview of the Immune System
Reading: Kumar et al. Pgs. 183-197
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April 5 – Hypersensitivity Reactions
Reading: Kumar et al. pgs. 197-201, 204-208
April 9 - Hypersensitivity Reactions/Transplant rejection
Reading: Kumar et al. pgs. 197-201, 204-208, 226-230
April 12 – Autoimmune Disease
Reading: Kumar et al. pgs. 208-221
April 16 - Autoimmune Disease
Reading: Kumar et al. pgs. 208-221
April 19 – Principles of Infectious Diseases – Pathology associated with Tuberculosis
Reading: Kumar et al. pgs. 332-335, 338-348, 357-359, 366-372
April 23 - Principles of Infectious Diseases – Pathology associated with Tuberculosis
Reading: Kumar et al. pgs. 332-335, 338-348, 357-359, 366-372
April 26 – Introduction to Virology and the Biology of AIDS
Reading: Kumar et al. pgs. 235-249
Dr. Villacres
April 30 - Introduction to Virology and the Biology of AIDS
Reading: Kumar et al. pgs. 235-249
Dr. Villacres
May 3– Study Day
May 10 – Cumulative Final Examination 1-4 pm
PT 516 Component of Semester 2 Project: Management of Patient with Surgical Needs
Group Assignment: Write a 2-page paper addressing the acute tissue response following a
surgical procedure.
Paper Format:
Length: 2 pages (not including references)
Font: 12 point Times New Roman
Spacing: Double
Paper Guidelines: The paper will have 2 components:
1). Address the acute inflammatory response that would be expected following the surgical
procedure and address the different possible outcomes associated with an acute inflammatory
process.
2). Discuss the wound healing process that will occur following the surgical procedure, and local
and systemic factors that will influence wound healing.
Grading: Total points = 25
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10 points for acute inflammation content
10 points for wound healing content
5 points for paper clarity, organization and grammar.