Professional Education «northern state medical university»




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MINISTRY OF HEALTHCARE OF THE RUSSIAN FEDERATION

State Government-Funded Educational Institution of Higher Professional Education

«NORTHERN STATE MEDICAL UNIVERSITY»

of Ministry of Healthcare of the Russian Federation







«APPROVED»

Dean of the International Faculty of General Practitioner

A. V. Kudryavtsev, PhD
_____________________________
«____»_____________________20 г.



SYLLABUS OF DISCIPLINE (MODULE)

Discipline___ pathophysiology, clinical pathophysiology

Field of training 31.05.01 «General medicine»

Year of training 3,4 term 5,6,

Form of the interim attestation (pass/fail test, exam) exam

Department _ pathological physiology

Course workload 288 (hours)/ 8 (credits)





Reviewed at the department meeting

Minutes № 13

«19» май 2016

Head of the department

__________________________


Author and compiler:

Solovieva Natalia Vladislavovna Staff department, doctor of medicine science, docent

Last name, first name, patronymic name, academic degree, academic title, position

Arkhangelsk, 2016

Purpose and objectives of the course
The purpose is - the formation of students' ability to deal effectively with professional medical tasks based on pathophysiological analysis of data on pathological processes, states, reactions and diseases with the knowledge of the general laws and mechanisms of their origin, development and completion, as well as to formulate principles (algorithms, strategies) and methods of detection, treatment and prevention.
Objectives

to familiarize students with the basic concepts and modern concepts of general nosology;

to examine the etiology, pathogenesis, principles of detection, treatment and prevention of the most socially significant diseases and pathological processes;

train pathophysiological ability to conduct analysis of data on pathological syndromes, pathological processes, forms of pathology and selected diseases;

create methodological and methodical basis of clinical thinking and rational action doctor.
2. Location of the course within the educational program (EP)

The program is developed following the requirements of Federal State Education Standard (FSES) for higher education in the field of 31.05.01«General medicine».
Discipline "Pathophysiology, clinical pathophysiology" refers to the cycle of mathematics, natural sciences, specialty "Medicine" higher professional medical education, taught in the fifth, sixth, seventh semester.

Basic knowledge necessary for studying the discipline form:

- in the cycle of humanitarian, social and economic disciplines (philosophy, bioethics, jurisprudence, history of medicine, Latin);

- in a series of mathematical, natural sciences: physics, mathematics; medical informatics; chemistry; biology; biochemistry; Anatomy; topographical anatomy and operative surgery; histology, embryology, cytology; normal physiology; microbiology; immunology;

- in a series of professional disciplines: health; life safety, disaster medicine.

It is prior to study disciplines: public health and health care, health economics; epidemiology; medical rehabilitation; Dermatology; psychiatry, medical psychology; otolaryngology; ophthalmology, forensic science; obstetrics and gynecology; pediatrics; faculty therapy, occupational diseases; Hospital therapy, endocrinology; infectious diseases; phthisiology; polyclinic therapy; anesthesiology, intensive care, intensive therapy; Faculty surgery, urology; Hospital surgery, pediatric surgery; oncology, radiation therapy; traumatology, orthopedics, propaedeutics internal medicine, X-ray diagnostics; general surgery, X-ray diagnostics; dentistry; neurology, medical genetics, neurosurgery.

3. List of planned learning outcomes of the discipline (module) in connection to the planned outcomes at completion of the educational program


Codes of developed competences

Competences




Know

Be able to (can)

Master (be a master in)




Professional competences

GPC-9


etiology, pathogenesis, principles of detection, treatment and prevention of the most socially significant diseases and pathological

processes

conduct pathophysiologic analysis of clinical and laboratory, experimental and other data and formulate their opinion on the basis of the most likely causes and mechanisms of development of pathological processes (diseases), the principles and methods of detection, treatment and prevention

skills pathophysiological analysis of clinical syndromes substantiate pathogenetic methods (principles) the diagnosis, treatment, rehabilitation and prevention of diseases



4. Volume of the course and types of academic work:
Total workload of the course is 8 credits.


Type of the academic work

Total hours


Term

5 6

In-class learning (total)

166

84

82

Including:

54

28

26

Lectures (L)

112

56

56

Practicals (P)

86

42

44

Seminars (S)

36




36

Laboratory-based practicals (LBP)

288







Clinical practicals (CP)

166

84

82

Self-studies (total)

54

28

26

Examination

112

56

56

Total course workload (hours)

86

42

44


5. Course content:
5.1. Content of the course sections


No

Name of the course section

Content of the section

1

2

3



NOSOLOGY

The notion of "nosology", parts nosology. The notions of "pathologic process", pathologic state", "pathologic reactions", "typical pathologic processes", "remission", “recurrence","complication". Disease, definition. Principles used in classification of diseases.

Stages of disease.Etiology, definition. The nature and characteristics of pathogenic factors. Factors of diseases: environmental, genetic, social. The relation between causes and conditions in the development of diseases. The notions of "pathogenesis", "vicious circles".



DISORDERS OF THE REGIONAL CIRCULATION AND MICROCIRCULATION


Arterial hyperemia: definition, causes, types (physiologic and pathologic), mechanisms (neurogenous, neuromyoparalytic and humoral) and consequences. Reactive hyperemia. Manifestations of arterial hyperemia and its mechanisms.

Venous hyperemia: definition, causes and consequences. Manifestations of venous hyperemia and their mechanisms.

Ischemia: definition, causes and consequences. Manifestations of ischemia and their mechanisms, factors that influence on the consequences of ischemia.

Stasis: types and causes.

Sludge syndrome: types, causes, and mechanisms.

3.

INFLAMMATION


Definition and significance of inflammation. Causes of inflammation. Primary and secondary alteration in the focus of acute inflammation: causes, mechanisms of development, manifestation. Physico-chemical changes in the focus of inflammation. Exudation. Definitions of an exudate and transudate. Sequence and mechanisms of vascular changes in acute inflammation.Inflammatory mediators that influence on these processes. Phagocytosis: stages. Local and systemic signs of inflammation. Nature and effects of inflammatory mediators: vasoactive amines, complement, kinin, and clotting systems, arachidonic acid metabolites, platelet-derived factor, cytokines and chemokines, nitric oxide, lysosomal constituents. General features of acute and chronic inflammation.

4.

DISORDERS OF THERMOREGULATION. FEVER.



Definition of fever. Differences between fever and hyperthermia. Types of pyrogens. The biological significance of fever. Pathogenesis of fever. Features of thermoregulation at different stages of fever. Types of fever: - based on the extent of temperature rise;- based on the circadian temperature fluctuations. Exertional hyperthermia: causes, mechanisms. Definition of hypoxia and its classification.

5.

REACTIVITY


Reactivity of the body and its role in the development of disease. Forms and types of reactivity.

6.

DISORDERS OF THE HOST DEFENCE SYSTEM

Typical forms of disordered immunologic reactivity. Principles of classification of immunodeficiency states. Primary immunodeficiencies: classification and clinical manifestations. Forms of primary immunodeficiency (causes, mechanisms, clinical manifestations): a) B system-dependent; T system-dependent; combined. Secondary (acquired) immunodeficiency states. AIDS

7.

ALLERGY

The notion of the "allergy". Types of allergens. Exogenous and endogenous allergens. Stages of allergy.a) Immunologic stage.b) Pathochemical stage.c) Pathophysiological stage. Anaphylactic (I) type of allergy. The nature of allergen and antibody. Mediators of the anaphylactic reaction. Type II hypersensitivity. The nature of allergen and antibody. Mechanisms and clinical examples of type II allergies. Type III hypersensitivity. The nature of allergen and antibody.Mechanisms and clinical examples of type III allergies. Systemic and local immune complex disease. Type IV hypersensitivity. The nature of allergen and antibody.

8.

DISORDERS OF CARBOHYDRATE METABOLISM. DIABETES MELLITUS.


Hypoglycemia: сauses and mechanisms. Hypoglycemic coma. Hyperglycemia: causes and mechanisms. Diabetes mellitus: characteristic features, classification, pathogenesis of type I and type II forms. Metabolic disorders (carohydrate, protein, lipid) in diabetes mellitus. Complications of diabetes mellitus (chronic and acute). Ketoacidotic coma.

9.

DISORDERS OF LIPID METABOLISM. ATHEROSCLEROSIS.



The main classes of lipoproteins and their functions. Atherogenic and antiatherogenic lipoproteins. Mechanisms of hyperlipidemia. Obesity: definition, diagnostic approaches, pathological significance. Types and pathogenesis of obesity. Atherosclerosis: description and pathological features. Risk factors of atherosclerosis. Stages of atherogenesis:- initiation;- formation and evolution of atheroma;- complications.

10.

WATER DYSBALANCE. EDEMA.


Hypohydration: causes, types, mechanisms of development, manifestations, consequences, and pronciples of treatment. Overhydration: causes, types, mechanisms of development, manifestations, consequences, and pronciples of treatment. Edema: definition, types, the main factors of development, principles of treatment. Edema during cradiac failure: etiology, pathogenesis, and manifestations. Renal edema: etiology, pathogenesis, manifestations, and consequences.

11.

DISORDERS OF THE TISSUE GROWTH. NEOPLASMS.


Definition of neoplasms. Principles of classification of neoplasms.

Forms of neoplastic cell abnormality.

Characteristic features of benign and malignant tumors.

Genetic hypothesis of cancer; classes of genes that incur mutations during neoplastic transformation of a cell.

The concept of oncogenes.

Mechanisms of transformation of protooncogene to oncogene. Role of antioncogenes in carcinogenesis.

Role of genes that regulate DNA repair in carcinogenesis.

Chemical carcinogenesis: types of carcinogens; initiation and promotion.

Radiation carcinogenesis.

Viral carcinogenesis.

The concept of tumor progression.

Antineoplastic mechanisms. Principles of prevention and treatment of neoplastic diseases.

12.

EMERGENCY STATES


Shock: characteristics, types, etiology, pathogenesis, manifestations, principles of treatment. Coma: characteristics, types, etiology, general pathogenesis, manifestations, principles of treatment.

13.

PATHOPHYSIOLOGY OF THE NERVOUS SYSTEM. DISORDERS OF LOCOMOTION AND SENSATION


General etiology, pathogenesis, and typical forms of pathology of the nervous system. Disorders of locomotion: manifestations of the upper (central) and lower (peripheral) motor neuron damage. Disorders of the extrapyramidal system: muscle dystonia and dyskinesia. Hypokinetic and hyperkinetic movement disorders: types, etiology and pathogenesis.

Disorders of sensation: general etiology and classification. Positive and negative abnormal sensory phenomena. Hypo- and hypersthesia, dysesthesia: types and mechanisms of disorders. Levels of sensation disorders.Localization of sensory abnormalities.Types and mechanisms of ataxia. Pain. Denervation syndrome.

14.

PATHOPHYSIOLOGY OF ENDOCRINE SYSTEM
PATHOPHYSIOLOGY OF THE PITUITARY AND ADRENALS GLANDS


General etiology and pathogenesis of endocrine disorders. Typical forms of functional pathology of adenopituitary.

Hypopituitarism: types, causes, mechanisms of development and manifestations. Hyperpituitarism: types, causes, mechanisms of development and manifestations. Acromegaly and gigantism. Typical forms of disorders of neurohypophysis. Diabetes insipidus.Typical forms of adrenals’ dysfunstion. Hypercortisolism: types, pathogenesis and manifestations. Cushing’s disease and syndrome, hyperaldosteronism. Hypocortisolism: types, pathogenesis and manifestations. Acute adrenal failure and Addison’s disease, hypoaldosteronism, syndromes of adrenal androgen excess. Disorders of adrenal’s medulla. Manifestations and consequences of phyochromocytoma.

15.

PATHOPHYSIOLOGY OF THYROID GLAND


Synthesis and control of secretion of thyroid hormones. Physiological effects of thyroid hormones.

Hypothyroidism: types, causes, mechanisms of development and clinical manifestations. Common hypothyroid states: myxedema, cretinism, endemic goiter. Hyperthyroidism: types, causes, mechanisms of development and clinical manifestations. Pathogenesis and manifestations of Grave’s disease, Hashimoto’s thyroiditis.

16.

PATHOLOGY OF THE RED BLOOD CELLS SYSTEM. ANEMIA.



Definition of anemia and its classification. Anemias of blood loss: types, causes, hematological signs. Hemolytic anemias: types, common causes, manifestations, hematological signs. Hereditary spherocytosis: pathogenesis, manifestations, hematological signs. Sickle cell disease: pathogenesis, manifestations, hematological signs. Thalassemia syndromes: types, pathogenesis, manifestations, hematological signs.B12 (Megaloblastic) anemia: causes, pathogenesis, manifestations, hematological signs. Iron deficiency anemia: causes, pathogenesis, manifestations, hematological signs. Aplastic anemia: causes and pathogenesis, hematological signs. Erythrocytosis: causes and mechanisms

17.

PATHOLOGY OF THE WHITE BLOOD CELL SYSTEM. LEUKOCYTOSIS, LEUKOPENIA.



Leukopenia: definition and causes. General mechanisms of leukopenia. Patterns of shift to the right. Leukocytosis: causes and mechanisms. Types of leukocytosis; patterns of shift to the left. Leukemoid reactions: typical features, causes, mechanisms of development, physiologic significance.

18.

MALIGNANCIES OF HEMATOPOIETIC CELLS. LEUKEMIA

Typical features, types, etiology, and general pathogenesis of hematopietic cell tumors. Leukemia: general characteristics, causes, classification and mechanisms of development. Characteristics of the leukemic reaction of the peripheral blood; types of leukemic reaction. Lymphoid tumors: pathological basis, clinical manifestations, and peripheral blood picture in acute lymphoblastic leukemia and chronic lymphocytic leukemia. Myeloid tumors: classification, pathological basis, clinical manifestations, and peripheral blood picture in acute myeloblastic leukemia and chronic myelogenous leukemia. Phenomenon of tumor progression in hematopoietic cell tumors.

19.

PATHOPHYSIOLOGY OF HEMOSTASIS


The system of hemostasis: components and their function. Typical forms of pathology of the hemostatic system. Thrombotic syndrome: its main causes, mechanisms of development, manifestations and consequences. Hemorrhagic syndrome: causes, mechanisms of development, manifestations and consequences.Causes and mechanisms of thrombocytopenia and thrombocytopathia. Abnormalities in clotting factors. Hemophylias. The syndrome of disseminated intravascular coagulation: stages, mechanisms of development, manifestations and consequences.

20.

Disorders of cardio-vascular system
CORONARY INSUFFICIENCY. MYOCARDIAL INFARCTION

Definition of coronary insufficiency. The main cuases of coronary insufficiency. Adaptive mechanisms developing during acute and chronic coronary insufficiency.

The syndromes of coronary insufficiency: angina pectoris, myocardial infarction, chronic ischemic heart disease, sudden coronary death.

21.

HEART FAILURE


Definition, general causes and classification of heart failure. Myocardial and nonmyocardial cardiac insufficiency. Adaptive reactions during acute and chronic heart failure: Frank-Starling mechanism, myocardial hypertrophy, redistribution of cardiac output, salt and water retention, activation of the sympathetic system. Pathogenesis of the myocardium decompensation during hypertrophy. Hemodynamic abnormalities in heart failure. Clinical features of heart failure: the syndromes of cardiac edema and cachexia.

22.

DISORDERS OF SYSTEMIC BLOOD PRESSURE. ARTERIAL HYPERTENSION


Definition and principles of classification of arterial hypertension. Renal arterial hypertension: pathogenesis of renovascular, renoprival, renal parenchymal hypertension. Pathogenesis of endocrinogenic arterial hypertension. Essential hypertension: etiology and pathogenesis.

23.

PATHOPHYSIOLOGY OF RESPIRATORY SYSTEM



Alveolar hyper- and hypoventilation: causes, mechanisms of development, consequences, and typical changes in breathing volumes. Disorders of the neurogenic control of breathing. Pathological forms of breathing. Types and consequences of perfusion disorders: pulmonary arterial hyper- and hypotension.

Types and mechanisms of ventilation-perfusion mismatch. Abnormal diffusive capacity of the alveolar-capillary barrier.

24.

HYPOXIA



Definition of hypoxia and its classification. Exogenous hypoxia: causes, types and typical changes. Respiratory hypoxia: causes, types and typical changes in the given type of hypoxia. Anemic hypoxia: causes, types and typical changes. Circulatory hypoxia: causes, types and typical changes. Histotoxic and substrate types of hypoxia: causes, types and typical changes. Adaptive reactions in acute hypoxia. Mechanisms of long-term adaptation to hypoxia.

25.

PATHOPHYSIOLOGY OF DIGESTION


Typical forms of functional pathology of the digestive tract: general etiology. Disorders of appetite, taste, and initial treatment of food in the oral cavity. Disorders of swallowing: dysphagia, achalasia, diffuse esophageal spasm. Disorders of digestion in the stomach: disturbance of secretory and motor function. Disorders of digestion in the intestine: disturbance of secretion, motor function, and absorption. The syndrome of malabsorption: etiopathogenesis, manifestations and consequences. Typical disorders of cavity digestion: causes, manifestations.

Typical disorders of parietal digestion: causes, manifestations. Pathogenesis of peptic ulcer of the stomach and duodenum

26.

PATHOPHYSIOLOGY OF THE LIVER. JAUNDICE.


General causes of liver dysfunction. The syndrome of hepatic insufficiency. Causes, types and pathogenesis of hepatic coma. The syndrome of hepatic insufficiency. Typical disorders of carbohydrate, aminoacid, protein, and lipid metabolism in hepatic insufficiency; failure of detoxification function. Hemolytic jaundice: causes, mechanisms, clinical and laboratory manifestations. Obstructive jaundice: types, causes, mechanisms, clinical and laboratory manifestations, consequences. Hepatocellular jaundice: causes, mechanisms, stages, clinical and laboratory manifestations.

27.

PATHOPHYSIOLOGY OF KIDNEYS


General causes and mechanisms of kidneys dysfunction. Disorders of filtration, tubular reabsorption and excretion. Syndromes of acute renal insufficiency: typical features, causes and manifestations.. Syndromes of chronic renal insufficiency: typical features, causes and manifestations. Uremic coma. Nephrotic and nefritic syndromes: typical features, causes and manifestations. Pyelonephritis: characteristic features, causes and pathogenesis. Nephrolitiasis: causes, mechanisms of development, consequences.
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