Download Infections Week

Principles of Pathological Sciences - Learning Objectives
Obesity
STORYLINE 1: POCT
 Describe five risk factors for type 2 diabetes
 State and apply the BMI equation and use an appropriate chart to evaluate BMI
 Define “POCT” and give three examples. Evaluate pros and cons compared to lab testing
using an example
 Describe how dipstick urinalysis is carried out from sample collection to result
 List five substances which can be detected by dipstick urinalysis and a pathological condition
which they may indicate
 Describe the chemical reaction which causes a colour change on the dipstick when glucose is
present in the urine (5 pts)
STORYLINE 2 – Diagnosing diabetes
 Describe what HbA1c is, what its detection is used for, why it is a good test for Type 2
diabetes
 State which laboratory carries out HbA1c testing
 Describe how HbA1c is measured from a blood sample (i.e. describe boronate affinity HPLC)
 Evaluate the pros and cons of HbA1c and the fasting blood glucose. Judge which you think to
be more appropriate as a first-line diagnostic for type 2 diabetes.
STORYLINE 3 – Lipid profile
 Define atherosclerosis; name 5 risk factors; name three pathologies caused by
atherosclerosis and explain the mechanism by which the pathology arises
 State which laboratory carries out lipid profiles
 List four substances measured as part of a standard lipid profile
 Describe the principle of a “colourimetric assay” (i.e. reaction which causes a colour
change; estimation of concentration using absorption of light). Explain how this method
enables high levels of automation and efficiency in the clinical biochemistry lab.
 Describe the colourimetric assay protocol used to measure cholesterol (5 points)
STORYLINE 4 – Chest pains intro
 Explain how and why ECG and cardiac-specific troponin measurement are the two key tests
in diagnosing a myocardial infarction
 Name five different causes of chest pains
 Define the term “lead” in the context of a 12-lead ECG
 Draw and label a normal ECG wave, including P wave, QRS complex and T wave
 Define the terms STEMI and NSTEMI and draw an example ECG wave for each
 Describe and explain the pathophysiology caused by STEMI, NSTEMI, and unstable angina
 Name three pathology tests done on a patient with severe chest pains and explain what
each test is assessing
STORYLINE 5 – Chest pains biochemistry
 Name the two cardiac-specific troponin subunits and describe what their function is within
the troponin protein complex
 Explain what cardiac specific troponin detected in the blood indicates and why
 State which pathology lab in the hospital carries out cTNT subunit testing
 Name the assay used to measure cTNT (Chemiluminescent Magnetic ImmunoAssay, [CMIA])
 Describe how CMIA measures cTNT levels
 Explain how immunoassays (e.g. for cTNT measurement) can be automated
 Explain how many substances can be measured from the blood using CMIA – be able to
name three (e.g. Troponin T, Troponin I, HIV antigen; any other listed on the Assay Menu
slide). Explain how the same CMIA protocol with different antibody reagents allows one
machine to measure many different substances in a patient sample.
STORYLINE 6 – Chest pains imaging
 Name and describe three imaging methods which can be used to view the heart
 Echocardiogram: describe how this uses ultrasound to image the heart; know what
ultrasound is; define the terms hyperechoic, hypoechoic, acoustic shadowing, attenuation
and be able to label these on an image.
 Know that cCTA uses x-rays, and is used for low to intermediate CAD patients. Discuss pros
and cons of this technique
 ICA: describe this test, understand that an intervention can be employed if necessary – PCI,
describe procedure (5 pts)
 Define restenosis and explain why this is a problem for the patient, and explain what can be
implemented to reduce the likelihood of restenosis (e.g. drug-eluted stent; scope for
showing off extra study and evaluating research)
Cancer
STORYLINE 1: Screening
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Name the three NHS national screening programmes and explain their general goal (to
identify asymptomatic individuals at an early and treatable stage of disease)
State who is eligible for the bowel cancer screening programme and discuss why
(demonstrate knowledge of bowel cancer epidemiology)
Describe the bowel cancer test kit contents, explain how to do the test and where it is
analysed.
Describe the guaic faecal occult blood test (gFOBT) and know that it is the lab test used in
the Bowel Cancer Screening Programme (2pts); describe the practical steps carried out in
the lab; describe and explain how the chemical reaction detects blood, and identify that it is
an example of a colourimetric test.
State the three types of gFOBT result (Normal, Abnormal, Unclear) and how many windows
indicate each. Explain what is done when an abnormal or unclear result occurs.
Analyse and evaluate gFOBT test results in the context of sensitivity and specificity measures
STORYLINE 2: Endoscopic methods
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State what body region the 12 types of endoscopy listed refer to
Define which areas a colonoscopy examines, and who normally conducts the procedure.
Briefly describe the procedure and the three types of drugs generally required (sedative,
analgesic, smooth muscle relaxant); describe patient prep (diet and laxative) and explain
why this is required
Define polypectomy and explain when, how and why it is conducted
Describe how most colorectal cancers arise in the region between the sigmoid colon and
rectum (~55%). Draw a diagram of the colon and label this region.
Describe the approximate results of a colonoscopy (5 in 10 normal, 4 in 10 polyps, 1 in 10
cancer)
Describe what happens to polyps and biopsy samples excised from suspect areas – they are
sent to Cellular Pathology (the actual lab is confusingly called Histopathology) for processing
prior to examination by a specialist cellular pathologist
STORYLINE 3: Cellular pathology
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Describe tissue fixation and explain why it is done; define what formalin is composed of
Describe the process of preparing an H&E stained slide from a biopsy sample (based on the 9
steps in the quiz question at the end of the storyline)
Describe the manual H&E staining protocol
Describe the basic properties of haematoxylin and eosin (colour and charge) and explain
what structures each one predominantly stains and why, and that hydrophobic substances
do not stain well.
Define the term “grade” in the context of histology
Compare and contrast the differences between non-cancerous and cancerous colon tissue
STORYLINE 4: Staging investigations
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Define radiology, and the difference between radiographers and radiologists
Define staging in the context of cancer
Compare and evaluate the pros and cons of MRI vs PET scanning for cancer staging
Describe using three examples how EM radiation is utilised in imaging (radio waves, x-rays,
gamma rays)
Define the two basic forms of x-ray radiation
Describe the five x-ray densities, using the terms transmission, absorption, scattering and
attenuation
Explain how ultrasound can be used for imaging
Describe the TNM model of staging for colon cancer and explain what imaging can be used
in the process
Explain the role of the multidisciplinary team (MDT) and give three examples of pathology
test results which they might discuss for a newly diagnosed colon cancer patient
STORYLINE 5: Blood tests I
 Describe the procedure of venepuncture
 Describe what additives are in purple-top, gold-top, and green-top vacutainers, explain their
purpose and an example pathology test each blood sample is used for
 Distinguish between whole blood, plasma, and serum and describe how they are produced
 Full blood count: describe what vacutainer is used and why
 Describe how white blood cells, red blood cells and Hb concentration are measured in a full
blood count
 Define macro- and microcytosis regarding red blood cell morphology, and give an example of
a cause for each
 Define the concept of a “reference range” in pathology test results
 Describe what a blood film is, and what stain is commonly used (May-Grunwald-Giemsa)
 Describe the process of cell fixation and explain why it is necessary in the production of
histological sections
STORYLINE 6: Blood tests II
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Describe the six proteins commonly measured in a liver function test (“liver panel”) and
explain how these are automatic measured
Describe four substances measured in a urea and electrolytes (U&E) panel, and how they are
automatically measured in the lab
State which lab carries out LFTs and U&Es
STORYLINE 7: Tumour Markers
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List four tumour markers. For each, give an example of a cancer the tumour marker can be
used to monitor
Discuss the limitations of CEA as a diagnostic tool for colon cancer (refer to sensitivity and
specificity)
Explain how CEA is measured (CMIA – same as troponin)
Infections Week
STORYLINE 1: Urinary tract infections
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Jenny
Something along the lines of “discuss the pros and cons of dipstick urinalysis and other
methods of UTI diagnostics”
STORYLINE 2: HIV POCT
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Compare and contrast rapid POCT with laboratory-based immunoassay in the diagnosis of
HIV
Explain the difference between third and fourth generation HIV tests
Define the term “window period” in the context of infectious diseases
Explain how HIV POCT test works (immunochromatographic lateral flow assay) – draw a
diagram
STORYLINE 3: HIV lab testing
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State which vacutainers can be used to collect blood for HIV lab testing by immunoassay
CMIA – can use same questions as for TNT and CEA measurement
Explain the three types of results (negative, strong reactive/positive, weak reactive/positive)
and what the next step is in each case
Explain what the immunocomb assay is used for
STORYLINE 4: HIV monitoring
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Storyline to be produced by Sanjay Bhagani, to cover HIV viral load and CD4 counts; need to
review to develop learning objectives
Alireza to add in scene about PCR
STORYLINE 5: TB and other comorbidities
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Written by Rob Shorten, need to review to develop learning objectives
STORYLINE 6: Hospital and community acquired infections
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Written by Rob Shorten, need to review to develop learning objectives
Trauma Week
STORYLINE 1: Emergency
 Lecturer TBC
 Content to cover major trauma centre, pre-hospital care and what’s done on arrival
STORYLINE 2: Blood transfusion
 Lecturer TBC (asked Mallika Sekhar, contact from Keith Gomez)
 To recap on blood groups
STORYLINE 3: Trauma – anatomy
 Gautam
STORYLINE 4: Imaging traumatic injuries
 Niall Power
STORYLINE 5: Coroner’s Court
 Peter Straker