PHAR 1203 Integrated Basic Health Sciences Semester I September to December 2010 (10 weeks) Contents Introduction .................................................................................................................................... 2 Course Development Committee and Resource Personnel ........................................................... 3 Course Assessment ......................................................................................................................... 4 Course Objectives ........................................................................................................................... 5 Cell and Cell Biology ...................................................................................................................... 10 Problem 1 ‐ Calming the Nerve ................................................................................................. 10 Problem 2 ‐ Defective Haemoglobin ......................................................................................... 11
Cardiovascular System .................................................................................................................. 12 Problem 3 – Low Flow … ........................................................................................................... 12 Problem 4 ‐ …Leading to No Flow ............................................................................................. 13
Respiratory System ....................................................................................................................... 14 Problem 5 – Got a Smoke, Anyone? ......................................................................................... 14 Problem 6 ‐ Short Breath in a Tall Man .................................................................................... 15
Renal System ................................................................................................................................. 16 Problem 7 – Stressed Out ......................................................................................................... 16 Problem 8 ‐ A Case of Sore Throat and Back ............................................................................ 17
Textbooks ...................................................................................................................................... 18 Multimedia Resources .................................................................................................................. 19 Websites ....................................................................................................................................... 21
Introduction The study of Basic Health Sciences, including Anatomy, Physiology, Biochemistry and Community Health, is important for building a strong foundation of knowledge of natural drugs and their actions within the body and also further understanding of pathophysiology of diseases involving various organ systems in the body. These basic medical sciences are taught in an integrated approach, covering various topics such as cell and cell biology, tissues, and organ systems and areas like central and peripheral nervous system, digestion and metabolism, cardiovascular and renal, respiration, endocrines and reproduction and muscles, bones and joints. The course also includes community health aspects involving public health, primary care and epidemiology of diseases related to various organ systems.
Course Development Committee and Resource Personnel Name Tel. Ext. Ms. Camille Mitchell Anatomy 5005 Dr. Junette Mohan Physiology 4755 Dr. Brian Cockburn Biochemistry Mr. Roy David Dalrymple Community Health Dr. VV Gouripur Pharmacology 5001
Course Assessment Format Marks PBL Evaluation 5 marks MCQ 15 marks Course Assessment Mark of first term (Total) (Total)‐ 20 marks (20%)
Course Objectives 1. CELL AND CELL BIOLOGY ANATOMY OBJECTIVES
1. Describe planes of reference used to locate structures within the body. 2. Define with examples directional terms for human body. 3. List regions of the body. 4. Identify the various organs in the body. 5. Describe the types, composition/components and functions of various body
membranes. 6. Describe the structure of the eukaryotic cell and describe the structures and functions of
organelles in general. 7. Describe the composition and structures of cell membrane. Relate its structure to the
functions it performs. 8. List the stages of mitosis and discuss the events of each stage. 9. Discuss the significance of mitosis. 10. List the four principal tissue types. Briefly describe the functions of each type. 11. Describe types, composition/components distribution, functions and modifications of
epithelia. 12. Define gland. Compare and contrast various types of glands in the body. 13. List the basic types of connective tissues. Describe the structure, functions and locations
of each. 14. Describe the structure, location and functions of the four types of muscular tissue. 15. Describe the basic characteristics, components and functions of nervous tissue. 16. Distinguish between neurons neuroglia in terms of structure, function and location. 17. Describe the capacitation of spermatozoa. Describe the site and the process involved in
fertilization up to morula stage. 18. Describe embryogenesis, foetogenesis including organogenesis. 19. Describe blood cells, their morphological features and properties. 20. Describe the lymphatic system. Explain its structure functional significance and describe
the lymphatic pathway in brief. 21. Describe the microscopic structure of the skin and its appendages.
PHYSIOLOGY OBJECTIVES 1. Describe functional organization of the body and membrane transport systems of
human body. 2. Describe the electrical properties of resting cells. 3. Describe the transmission of electrical signals along nerve and muscles.
BIOCHEMISTRY OBJECTIVES
1. Define carbohydrates and classify with examples for each class.
2. briefly discuss isomerism with examples on a. stereoisomerism b. anomerism
3. Discuss mutarotation. 4. Briefly discuss the structure of starch and glycogen. 5. Explain the mucopolysachchrides with examples. 6. Understand the functions of carbohydrates. 7. What are lipids?
PUBLIC CARE AND PRIMARY HEALTH OBJECTIVES 1. What is epidemiology? 2. Describe in brief biological, environmental and social determinants of health.
2. CIRCULATORY SYSTEM
ANATOMY OBJECTIVES
1. Describe the components of circulatory system. i) CVS ii) Lymphatic system
2. List different types of formed elements of blood and describe their appearances. 3. Describe the gross anatomy of the heart. 4. Describe the structure and functions of three layers of heart wall. 5. Describe the chambers and valves of heart. 6. Describe flow of blood through the heart. Distinguish between pulmonary and systemic
circulations. 7. Describe conducting system of the heart. Explain its structure and location. Trace the
path of impulse conduction. 8. Describe the structure and functions of vascular tree. 9. In the form of flow chart, list arterial branches of ascending aorta and aortic arch. 10. Describe the arterial pathways that supply upper extremity. 11. Describe the major arteries serving thorax, abdomen, upper and lower extremity. 12. Describe the venous drainage of thorax, lower extremities and abdominal legion. 13. Describe fetal circulation to and from the placenta. 14. Describe the general location, histological structure and functions of lymph nodes and
lymphoid organs. 15. Briefly describe the development of the heart. Demonstration of heart and major blood vessels in the wet specimen
PHYSIOLOGY OBJECTIVES 1. Distinguish the three types of cardiac muscle cells and their functions. 2. Describe the generation of action potentials in the normal heart and the ionic basis for
myogenic rythmicity (automaticity). 3. Sketch the action potentials of pacemaker, Purkinje and contractile cardiac cell,
describing the phases and the ionic bases for these.
4. Discuss the sequence and time course of conduction of the cardiac action potential through the normal heart.
5. Explain the origin of the ECG. 6. Sketch the normal ECG and know the events which give rise to its various components. 7. Briefly describe the differences between ECG recordings obtained using different lead
arrangements (chest, limb or augmented limb). 8. Describe the behavior of the heart as a muscle, including the excitation‐contraction
coupling and its ability to contract isometrically or isotonically. 9. Discuss after load and preload in terms of heart function (i.e. in terms of arterial
pressure and end‐diastolic volume). 10. Define the relationship between cardiac output, stroke volume and heart rate. 11. Discuss the factors which affect heart rate and the ionic basis for a change in heart rate. 12. State the determinants of stroke volume. 13. Give an account of the factors (intrinsic and extrinsic) which can alter the cardiac
output. 14. Explain the relationship between cardiac output, total peripheral resistance and blood
pressure. 15. List the determinants of resistance in a blood vessel. 16. Define arterial pressure and describe methods for its measurement. 17. Give an overview of the mechanisms involved in the control of arterial pressure (long
and short terms). 18. Give an account of the neural reflex loops for short term control of blood pressure
(including the cardiovascular control centres). 19. Classify the various groups of baroreceptors and be aware of their relative importance
in short term blood pressure control. 20. Explain how the characteristics of the baroreceptors. Underline their role as short term
controllers of blood pressure. 21. Discuss the various other inputs to the pressure control system (e.g. chemoreceptors,
higher centres, nociceptors), and know their relative importance. 22. Discuss the role of the hypothalamus in blood pressure control. 23. Discuss the role of the kidney in blood pressure control. 24. Describe Erytheopyosis. 25. Describe the role of nutrients and growth factors and other substances for
erythropiosis. 26. Describe physiology of coagulation cascade fibrinolysis and thrombus formation. 27. Describe types of hemoglobin and abnormalities of hemoglobin production. 28. Describe the functions of hemoglobin. 29. Describe the physiological significance of blood groups (A, B, O and Rh groups). 30. Describe the blood transfusion reactions.
BIOCHEMISTRY OBJECTIVES 1. Classify lipoproteins and give the basis for their classification. 2. Briefly discuss the composition and function of each lipoprotein. 3. What is atherosclerosis and know its etiology.
PUBLIC CARE AND PRIMARY HEALTH OBJECTIVES
1. Describe the epidemiology of coronary heart disease and atherosclerosis, control and prevention.
2. Describe an effective Primary Health Care approach to the prevention of major cardiovascular diseases.
3. Discuss the broad goals of public health strategies, policies and plans including: i) Improve the National pattern of physical activity. ii) Reduced numbers of obese in the population iii) Reduced levels of blood lipids iv) Increased hypertension detection, control and prevention v) Reduced cigarette smoking
3. RESPIRATION
ANATOMY OBJECTIVES
1. Identify the organs of respiratory system. 2. List the types of epithelial tissue that characterize each region of the respiratory tract. 3. Identify the boundaries of nasal cavity and discuss the relationship of para nasal sinuses
to the respiratory system. 4. Describe the structure of respiratory division of lungs and explain how its structure aids
in gas exchange. 5. Compare the right and left lungs. 6. Describe the mediastinum, its subdivision and contents. 7. Describe the organization of the pleural membrane. Demonstration of the organs of the respiration system in the wet specimen
PHYSIOLOGY OBJECTIVES
1. Explain the difference between breathing, ventilation and respiration. 2. List various lung volumes and capacities. 3. Describe how pulmonary function tests help in the diagnosis of lung disorders. 4. Draw a diagram of spirogram indicating the lung volume and capacities. 5. Describe the physiological significance of residual volume and RV/TLC ratio. 6. Discuss airway resistance, lung compliance, surface tension in terms of factors affecting
them and their effect on work of breathing. 7. Outline major immune defenses in upper and lower respiratory tract. 8. Explain in outline the chemical control of breathing. 9. Describe the neural pathways involved in breathing using diagram to illustrate various
respiratory centres, feedback loops. 10. Describe abnormal patterns of breathing. 11. Describe location of peripheral and central structures involved in control of breathing
and outline their roles.
BIOCHEMISTRY OBJECTIVES
1. Discuss the factors which influence oxygen binding by hemoglobin and explain how exchange of gases is regulated.
2. Describe the organizational structure of electron transport chain. 3. Discuss relevance of oxidative phosphorylation to life of cells. 4. Discuss significance of disruption of oxidative phosphorylation by inhibitors, uncouplers
and physical methods. PUBLIC CARE AND PRIMARY HEALTH OBJECTIVES
1. Outline the health issues involved in asthma and its prevention. 2. Discuss the effects of active and passive smoke and issues involved in smoking in the
home and work environment. 3. Describe the public health concerns with respect to environmental pollutants.
4. RENAL/ URINARY SYSTEM
ANATOMY OBJECTIVES
1. List the components of the renal system. 2. Describe briefly the gross anatomy of kidneys. 3. Describe briefly the gross anatomy of ureter and the lower urinary tract. 4. Discuss the histology of kidney with special reference to the nephron and distinguish the
different regions the renal tubule. 5. Describe the blood supply of the kidneys.
Demonstration of the organs of the renal system in the wet specimen PHYSIOLOGY OBJECTIVES
1. Describe the major fluid compartments of the body and percentage of body fluids in each compartment.
2. Discuss the factors which regulate body water. 3. Explain the mechanism of urine formation and urine concentration. 4. Describe the transport processes in the kidney which are involved in the maintenance of
water and electrolyte balance. 5. Describe the role of kidney in regulation of acid base balance. 6. Define a diuretic drug and list diuretic drugs. 7. Describe role of kidney in blood pressure control.
BIOCHEMISTRY OBJECTIVES
1. Describe the biochemical basis of kidney stone formation and the dietary factors which influence this process.
2. Describe the processes by which blood levels of urea, ammonia, HCO3 and H ion are regulated by kidneys.
Cell and Cell Biology
Problem 1 Calming the Nerve A novel compound was being tested for its effect on a nerve preparation. Intracellular recordings showed expected changes in membrane potentials following changes in the ionic composition of the extracellular fluid. After application of the novel compound the nerve no longer generated an action potential when stimulated.
Problem 2 Defective Haemoglobin At a consultation, the physician of ten year old Jennifer told her parents that one of the proteins in the daughter’s blood cells was defective. He said that sophisticated techniques had demonstrated that the defect involved only one of the hundreds of amino acid building blocks found in a particular protein called haemoglobin. Unfortunately, he said, this single substitution does have a profound effect on the performance of red blood cells.
Cardiovascular System
Problem 3 – Low Flow … Mr. M is a 57 year old public servant who smokes 40 cigarettes per day and prefers a diet of fried foods and lots of meat. He has a history of ischemic heart disease and has complained recently of indigestion, with brief episodes of epigastric pain. At a recent doctor’s visit, on the basis of an abnormal ECG pattern, the doctor advised that he suspected advanced atheroma of the left coronary artery and that he might have to have an angioplasty but first referred him for coronary angiogram. Unfortunately, before the angiogram could be done, Mr. M suffered severe chest pain and was rushed to the hospital where an ECG was immediately attached and blood was taken for determination of serum enzymes and other cardiac markers.
Problem 4 …Leading to No Flow Since his heart attack last year, Mr. M has had to keep regular doctors visits. He has now become breathless on exertion. His lipid profile shows that he has hypercholesterolemia. He has now become breathless on exertion. Mr. M presents to your pharmacy adjacent to his physicians office to obtain a refill of his prescription of diuretic (furosemide). His doctor requested lipid profile test revealed the following results:
Cholesterol 297 mg/dl 170 ‐ 200 Triglycerides 141 mg/dl 40 ‐ 160 Direct HDLC 47 mg/dl 40 ‐ 60
VLDL 28 mg/dl 20 ‐ 40 LDL 222 mg/dl 60 ‐130
Respiratory System
Problem 5 – Got a Smoke, Anyone? Forty‐ year old Shirley, presented to her doctor with dyspnea on exertion. Her breathing was through pursed lips and she had a cough productive of thick sputum. She had been smoking heavily since age 18 years. Physical examination showed an over‐expanded chest, reduced diaphragm movement and increased use of the accessory muscles of respiration. Her investigations showed increased total lung capacity and residual volume. Her airway resistance (Raw) was above the normal of 2.4 cm H20/L/sec and her PaO2 was decreased. A chest X‐ray confirmed the hyperinflation of the lungs and a lowered diaphragm. Based on these results, the doctor advised her to have her alpha 1 – antitrypsin level measured and an annual pulmonary function test to include measurement of compliance, airway resistance and work of breathing.
Problem 6 Short Breath in a Tall Man Dwight Y, a 25 year‐old, 180 cm tall, hospital worker, experienced dyspnea, wheezing, tightness of the chest and coughing while playing football yesterday evening. He visited his doctor who learnt that Dwight had started to experience chest tightness about 2 weeks ago when his cousins visited him from England. The doctor also learnt that his cousins smoked heavily, but that Dwight did not smoke. On examination, the doctor confirmed the presence of prolonged expiratory wheezing, and found cyanotic nail beds, tachypnea, chest hyperexpansion and scattered coarse crackles. In the doctor’s office, he was asked to perform a single forced expiration using a spirometer which he repeated after he was given an inhaled bronchodilator and to exhale into a peak flow meter. The doctor also requested a blood test and chest X‐ray. While getting these tests done, Dwight wondered what treatment the doctor would recommend and whether the doctor might tell him that he could not continue playing football. The results of the tests done in the doctor’s office and in the laboratory were as follows: Baseline Spirometry & Peak Flow Metre
Results
Laboratory Results
Forced Vital Capacity
4.5 L Hb (g/dl) 16.5
Forced Expiratory Volume in 1 second
2.2 L PaO2 (mm Hg) 60
Peak Expiratory Flow Rate
200 L/min PaCO2 (mm Hg) 50
Spirometry Results after Bronchodilation O2 saturation (%) 90 Forced Vital Capacity
4.7 L
Forced Expiratory Volume in 1 second
2.8 L
Renal System
Problem 7 – Stressed Out Michael is a CEO of one of the major hospitals in Trinidad. He has had uncontrolled hypertension for the past 10 years, and has recently noticed puffiness around his face and ankles, shortness of breath and fatigue. His blood pressure was 190/115. His doctor requested tests which revealed the following results: BUN : 50 mmol/L Na + : 141 mmol/LCreatinine : 450 µmol/L K+ : 4.8 mmol/LHb : 8.5 g/dL Ca 2+ :1.8 mmol/L There was proteinuria on urinalysis.
Problem 8 A Case of Sore Throat and Back Seven year old Carlos was kept home from school because he complained of a sore throat and had a slight fever. About 3 weeks later, his mother noticed that his face, abdomen and legs were swollen and was not interested in playing with his friends. She took Carlos to the paediatrician who took a throat swab for culturing, and a blood sample and a urine sample, for laboratory analyses. The analysis of the blood sample revealed: BUN: 12.0 mmol/L Uric acid: 0.60 mmol/L Creatinine: 150 µmol/L HCO3‐ : 19 mmol/L Creatinine Clearance: 50ml/min The urine sample was dark and cloudy and scant in volume. The pediatrician prescribed antibiotics and advised that Carlos should be kept at home until recovery.
Textbooks Anatomy
• Moore, K. L. & Dalley, A. F. Clinically Oriented Anatomy (Latest edition). Philadelphia: Lippincott, Williams & Wilkins.
Physiology
• Marieb, E. N. (2003). Human Anatomy and Physiology, (6th edition). Benjamin‐Cummings.
• Martini, F. H. (2005). Fundamentals of Anatomy & Physiology (7th edition). Benjamin‐Cummings.
Biochemistry
• Murray, R. K., Granner, D. K., Mayes, P. A., & Rodwell, V. W. Harper’s Biochemistry. (Latest edition). Prentice Hall International.
Community Health
• Torrence, M. E. (1997). Mosby's Biomedical Science Series: Understanding Epidemiology. Mosby
Multimedia Resources Available at the Medical Sciences Library CD/DVD ROMS
• Acland’s Atlas of Human Anatomy • The Heart, Mediastinum and Great Vessels • Interactive Physiology ‐ Cardiovascular System (A.D.A.M) • The International Pharmacopoeia • McMinn’s Interactive Clinical Anatomy Head & Neck • Multiple Organ Failure • Respiratory System • Welch Allyn’s Interactive CD‐ROM Eye, Ear, Nose & Throat
AUDIOCASSETTES
• Ascultatory Pneumonia in Other Diseases (15 min) • Ascultatory Pneumonia in Various Diseases & Review (35 min) • Cardiac Auscultation: … Heart Sound Simulator (2 hrs) • Cardiac Auscultation the 2nd and 1st Heart Sounds (1 hr) • Chest Sounds (15 min) • Congenital Heart Sounds (15 min) • Diseases of the Respiratory System (30 min) • Heart Sounds, Chest Sounds & Breathing Sounds (1 hr) • Heart Sounds & Murmurs: a Practical Guide (1 hr) • Johns Hopkins Physician’s Lipid Education Program: Disorders (2 hrs) • Lung Sounds (21 min) • Screening strategies for Lipid Disorders (2 hrs) • Rapid Interpretation of Heart Sounds and Murmurs (1 hr) • Understanding Lung Sounds (1 hr)
SLIDE TAPES
• Apnea (14 min) • Asphyxia (12 min) • Chest X‐Ray: Pleura, Diaphragm, Lung (23 min) • Chest Injuries – Intensive Care (25 min) • Chest Radiography of Neonate (21 min) • Early Treatment of Acute Myocardial Infraction (26 min) • Radiographic Anatomy: Heart Diseases (35min) • Respiratory System: History Taking (37 min) • Respiratory System: Physical Examination (35 min) • Respiratory Distress (11 min) • Wheezing in Young Children (26 min)
VIDEOTAPES
• Airway Obstruction in Infants and Children (27 min) • Asthma: the Continuing Challenge (18 min) • Bedside Emergencies 1 : Hypoglycemia: Diabetes (1 hr 46 min) • Branched Examination of the Thorax (4 min) • COPD –Differential Diagnosis (22 min) • Diagnostic Tests : Heart: External Test ( 23min) • Diagnostic Tests : Heart: Internal Test (22 min) • Diagnostic Testing II: Diseases of the Urinary System (17 min) • Diagnostic Testing II: Urinary System: Endoscopy and Radiology (18 min) • Endoscopic Examination of the Upper Airway (22 min) • Family Practice Review : Common Vascular Problems (2 hrs) • Family Practice Review: New Approaches to Congestive Heart Failure (2 hrs) • Family Practice Review of Arrhythmias ‐ Super Ventricular Arrhythmias (2 hrs) • Family Practice Review of Super Ventricular Arrhythmias & Ventricular (2 hrs) • Family Practice: a Review of Urology; Vasectomy Hypertension (2 hrs) • Gastroduodenal Artery to Renal Artery Bypass (13 min) • Gross Anatomy: Larynx. (11 min) • Management of the Upper & Lower Airway (16 min) • Neck & Anterior Triangle (24 min) • Nephritis (45 min) • Pneumonia & a Review of Pulmonary Intestinal Lung Disease (1 hr. 57 min) • Pneumonia & Respiratory Failure (1hr. 58 min) • Pharynx and Nasal Cavity (16 min.) • Questions & Answers About AIDS (38 Min) • Respiratory System (22 min) • Respiratory Tract Infection (1 hr) • Respiratory System (30 min) • The Right Puff (8 min) • Root of the Neck & the Thorax (23 min) • A Review of Adult Cardiology Preoperative Evaluation With Cardiology (2 hrs ea) • A Review of Smoking Cessation (1hr. 49 min) • Stroke Progress (49 min) • Tuberculosis – Prevention & Practices for Health Care Workers (20 min) • Specificity of Receptors in Vitro Method Using Rabbit Jejunum (50 min) • Video Atlas of Two‐dimensional Flow Color Flow Echocardiography (1 hr 30 min)
Websites John Rylands University Library of Manchester http://rylibweb.man.ac.uk/pharmacy/databases.html Resources for Pharmacy http://www.lib.uconn.edu/~sgiovenale/pharpracdb.htm Pharmacy Library http://info.lib.uh.edu/pharmacy/articles/databases.html?SubjectID=27 Hardin MD: Respiratory system and lung diseases http://www.lib.uiowa.edu/hardin/md/resp.html Introductory Anatomy: Respiratory System http://www.lib.uiowa.edu/hardin/md/resp.html Lung Diseases http://healthlibrary.stanford.edu/resources/internet/bodysystems/resp_lung.html Martindale’s: Cardiology and Pulmonary Centre http://www.martindalecenter.com/MedicalCardio.html Oxygen Delivery System http://sln.fi.edu//biosci/systems/respiration.html Physiology of the Respiratory System http://www.acbrown.com/lung Respiratory System http://omni.ac.uk/browse/mesh/D012137.html Respiratory Care Areas of Interest on the Web http://www.rcsw.org/ts_med.htm#RESPIRATORY Respiratory Therapy: Subject Guide http://www.usi.edu/library/Documents/NursingandHealth/Resp%20Therapy.pdf Smoking and Respiratory Disease http://www.ash.org.uk/html/factsheets/html/fact05.html The Virtual Anaesthesia Textbook