The University of the West Indies

Faculty of Medical Sciences, Mona

MB BS
Medical Undergraduate Programme

Student Course & Study Guide

Year 1, Semester 1

Student Course & Study Guide

Introduction
This booklet has been produced by the Faculty to assist you in preparation for your new courses. It contains specific information about each course, including a syllabus of core content, learning resources and, most importantly, a list of objectives that each student is expected to achieve by the end of each course. You should use these to guide your self study and to prepare yourself for course assessments and examinations. We also encourage you to read the general MB BS Student Handbook which contains important information about the programme and some useful study hints. In case of loss, the text of this booklet is available for download to registered students. Information on how to do this can be obtained from the Faculty administration.

General information about your courses

The MB BS Programme is comprised of a series of required core courses. Most of these courses contribute to your GPA and must be completed satisfactorily for the award of your degree. This booklet includes information on the core courses in Semester 1. In addition, some are categorized as pass/fail courses. These include the University Foundation Courses, student selected modules and electives in the Stage 2 programme. These courses must also be completed satisfactorily but the grades do not contribute to your GPA.

Student Assessment in Stage 1

Except where otherwise indicated, all core courses will be examined following completion of the taught components. This will usually take the form of a written examination including multiple choice and/or short answer questions. In addition, some courses include practical work, project assignments and/or a practical examination. Unless otherwise stated, the grade obtained for each of the core courses will contribute to your GPA. The Faculty requires that you achieve a minimum grade of C for all core courses and that your grade point average is maintained at 2.0 or above.

Page 1

Student Course & Study Guide

The standards and pass mark for all examinations will be determined in each case by the examiners who will employ standard setting exercises where necessary. Further details on standard setting and the assessment process can be found in the MB BS Student Handbook. The regulations governing examinations in the Faculty are also subject to the general University regulations covering examinations which are published by the Examinations Section of the Registry.

Page 2

Fundamentals of Disease and Treatment

DT11A

Fundamentals of Disease & Treatment

About this course

Fundamentals of Disease & Treatment is one of the first courses in the programme and is an important introduction to the integrated approach that is used in the delivery of the courses in Stage 1. It provides an early introduction to basic disease processes such as infection, inflammation, genetic disorders, tumor pathology and disorders of growth. This is important in assisting you later on in the course to appreciate how these affect the different organ systems. In addition, it provides an introduction to the chemical structures and families of drugs that are used in the treatment of patients and how they work to modulate disease processes.

Aim of the Course

The main aim of this course is to provide a background for the better understanding of the system-based courses that follow it. The multidisciplinary approach used and much of the content is basic to your understanding of disease states and how drugs work.

Useful Revision
In preparation for this course, you may find it helpful to search the internet for articles on basic pathology, pathogenic micro-organisms and pharmacology to familiarize yourself with some of the new terminology.

Page 1

Fundamentals of Disease & Treatment

Core Content
This is a list of topic areas which form the core of the course. It is provided to help you to focus on your objectives and assist you to achieve the expected learning outcomes. Introduction to microbial pathogens Microbial genetics Antimicrobial chemotherapy Normal human body flora Sterilization & disinfection Cell pathology Inflammation Disorders of cellular growth Wound healing Neoplasia Cytogenetics Immune response Humoral and cellular immunity Hypersensitivity Immunology of infectious diseases Autoimmunity Tumor Immunology Transplantation Immunodeficiency & AIDS Clinical Enzymology Plasma Proteins Complement system Cells of inflammation & immunity Antineoplastic drugs and their clinical applications Antimicrobial & Antiparasitic chemotherapy Autacoids Immunosuppressants Pharmacodynamics Pharmacokinetics Toxicology Drug development Drug Interactions Histology of lymphoid tissue

Page 2

Fundamentals of Disease & Treatment

Student Learning Objectives

On completion of this course, you should be able to: Discuss the characteristics of the major groups of microorganisms bacteria, viruses, fungi and parasites. Describe the basic aspects of microbial and antimicrobial genetics Describe the mechanisms and effects of cell injury Describe the changes that occur as a result of increased demand and external stimulation Discuss the mechanisms of regeneration and healing Discuss the causes and characteristics of acute and chronic inflammation Discuss the biology and effects of tumor growth Describe the classification and nomenclature of neoplasms List the differences between benign and malignant neoplasms Describe the spread of cancer Discuss the genetic basis of disease Discuss the role of the laboratory in the identification of infectious agents and in selecting appropriate anti-microbial treatment Describe the mechanisms involved in immunity Discuss the steps involved in humoral and cellular immunity Discuss the mechanisms of hypersensitivity reactions Discuss the proposed mechanisms of immunological tolerance and the ways in which it can be bypassed resulting in the development of autoimmune diseases Describe the clinical and pathological features of common autoimmune diseases Classify tumor antigens and discuss the mechanisms of immune surveillance and development of tumours Discuss the common primary immunodeficiency states Discuss the nature of the Human Immunodeficiency Virus (HIV), modes of transmission, pathogenesis and clinical features of HIV infection and AIDS Discuss the mechanisms involved in graft rejection

Page 3

Fundamentals of Disease & Treatment

Discuss the principles of measurement of enzymes and isoenzymes Describe the distribution of enzymes of clinical importance in body tissues Describe the mechanisms of increase in enzymes in body fluids Discuss abnormal enzyme patterns in common or important diseases Describe the principles of separation and the nomenclature of the major plasma proteins. Discuss the main properties and clinical importance of the following proteins: albumin, ! 1 antitrypsin, ! fetoprotein, ceruloplasmin, !-2-macroglobulin, haptoglobin, transferin, fibrinogen, Bence-Jones protein. Discuss the basic structure and functions of the immunoglobulins Discuss the causes of hypo and hyper-globulinaemia List the causes of monoclonal and polyclonal gammopathies Discus the concept of acute phase proteins and carrier proteins Describe the common serum protein electrophoretic patterns Discuss the functions of the complement system Describe the different pathways of the complement cascade Describe the functions of the breakdown products of the complement system Describe the clinical significance of measuring major complement components Describe the sources and features of the cells participating in the different types of immune response Discuss the features of cells of the immune system that contribute to the effectiveness of immune responses Discuss the role of cytokines in amplification of the immune response Describe the properties of malignant cells which render them susceptible to the effects of chemotherapy Describe the cell cycle & the action of various drugs in different phases of the cycle

Page 4

Fundamentals of Disease & Treatment

Discuss the influence of the benefits and toxicities of various drugs on the selection of combination as opposed to singleagent chemotherapy Discuss the timing of chemotherapy in relation to stage of disease and timing of surgical procedures Describe end-points used to objectively assess response to chemotherapy. Describe the genesis of cancer in order to exploit possibility of targeted therapy Describe the various routes of administration of drugs, their absorption, distribution, metabolism, excretion, clearance, volume distribution, half-life, bioavailability, multiple dosing kinetics, steady state, non-linear kinetics and the design and optimization of dosage regimens Discuss the concept of receptors with respect to structureactivity relationships Describe the features of agonists and antagonists Describe the log dose-response curve Discuss the theories of drug action, tolerance and tachyphylaxsis Describe the side effects and toxic effects of drugs, the therapeutic index as well as the mechanisms of drug toxicity Describe the stages involved in drug development Discuss the pharmacodynamic and pharmacokinetic modes of drug-interactions Describe the pharmacology of the following drug types:o Antineoplastic drugs o Antimicrobial chemotherapeutic drugs o Antiparasitic chemotherapeutic drugs o Autocoids o Immunosuppressants

Page 5

Fundamentals of Disease & Treatment

Teaching/Learning Methods
This course is delivered in a series of didactic lectures supported by practical demonstrations using an interdisciplinary approach. The teaching staff comprises members primarily from Pharmacology, Pathology & Microbiology. The lectures are intended to guide and direct your study and to stimulate your interest in the topics. A look at lecture titles ahead of time will provide a guide to preparatory reading. Lecture attendance is important but must be supplemented by your own reading. You are encouraged to use your lecture notes and the learning objectives provided above to guide your progress. Regular small group discussion is an excellent way of reviewing and reinforcing your knowledge to achieve retention and you should develop this approach to learning at an early stage.

Assessment
On completion of the course, you will be assessed formally by means of a written (Multiple Choice Question type) examination paper and a practical component. Your assigned grade will contribute to your overall GPA. The standard and pass mark for the examination will be determined by the examiners. Details of the assessment process will be provided by the Course Coordinator.

Useful Resources
There is no specific textbook for this course. However, you may find it useful to browse the worldwide web for topics listed under course content or to read relevant chapters on basic pathology in books such as General Pathology by Walter & Israel.

Page 6

The Locomotor System

SF11A

The Locomotor System

About this course

This is the first in a series of systems-based courses providing a comprehensive and integrated approach to the learning of the structure and function of the human body. This course is taught in Semester 1 of the first year and is comprised of both lectures and practical work in the Anatomy Laboratory. The course provides a basis for the understanding of joint and muscle function. Through the use of illustrative cases and inclusion of relevant pathophysiology, it also provides a foundation for your later appreciation of the features, diagnosis and management of common clinical conditions that affect muscles, bones and joints.

Aim of the Course

The aim of this early course is to provide you with a thorough knowledge base of the functional anatomy of the upper and lower limbs and of the spinal column as these relate to each other in health and disease. It also introduces you to the terminology used in describing the relationships and functions of the human body.

Useful Revision
Prior to the course, you are expected to have only a basic understanding of how muscles work to produce movement across joints and a general concept of the structure of bones and joints. A brief reading of the relevant sections in any standard anatomy textbook may be helpful to you at this stage. For this, and later study, the learning objectives provided will prove useful in defining areas that need to be covered.

Page 1

The Locomotor System

Core Content
This list of key points forms the core of the course. It is provided to help you to focus on the objectives of the course, so that you are able to achieve the expected learning outcomes. structure and functions of the musculoskeletal system as these relate to locomotion gross and microscopic structure of bone, muscle and connective tissue functional anatomy of the muscles, bones, joints and ligaments of the upper and lower limbs including the arches of the foot functional anatomy of the bones, joints and ligaments of the spinal column and the muscles which surround and support it functional anatomy of the joints of the limbs and spine and their applied relevance to clinical practice origin, course and distribution of the clinically important nerves of the upper limb with special reference to the brachial plexus and the posterior triangle of the neck origin, course and distribution of clinically important blood vessels of the upper limb with special reference to the relationships of: o the subclavian and axillary arteries o the brachial plexus o the veins occurring in relation to the roof of the cubital fossa. dermatomes and myotomes clinical importance of arterial anastomoses around the scapula, the elbow and in the hand origin, course and distribution of the clinically important nerves of the lower limb with special reference to surface markings and bony landmarks origin, course and distribution of the main arteries of the lower limb with special reference to o the effects of acute and chronic arterial obstruction o the importance of anastomoses around the hip and knee

Page 2

The Locomotor System

venous drainage of the lower limb with reference to the effects of varicose veins, venous hypertension and proximal venous obstruction lymphatic drainage of the upper and lower limbs and the causes of lymphoedema pathological principles underpinning common diseases of the musculoskeletal system including inflammation and wound and fracture healing clinically important regions including: o the axilla and its contents, the cubital fossa and the carpal tunnel o the femoral sheath and triangle, the popliteal fossa, the adductor canal and the fascial compartments cross-sectional anatomy and the radiological techniques used for imaging the limbs and spinal column important peripheral nerve lesions and their clinical features

Student Learning Objectives

On completion of this course, you should be able to: accurately identify each of the bones of the upper and lower limbs and point out their important features given the anatomical specimens, describe the projections and articular facets of the vertebral bodies and the joints of the spinal column given the anatomical specimens, specifically identify the atlas and the axis and the characteristic features which distinguish cervical, thoracic and lumbar vertebrae describe and classify the functional anatomy of the important joints and ligaments of the limbs and spine and indicate the types of cartilage found in each describe the mechanics of the shoulder, elbow, wrist, hip, knee and ankle joints and the special features that help to maintain their stability describe the fascial spaces of the hand and their clinical relevance describe the joints and movements of the hand and fingers in relation to the insertions and actions of the muscles and tendons which affect it

Page 3

The Locomotor System

describe the arches of the foot name and describe the locations and relationships of the clinically important bursae occurring in the upper and lower limbs explain the importance of synovial fluid and synovial membranes in the body describe the pectoral region including the general structure and lymphatic drainage of the breast and the boundaries of the axilla using diagrams and/or prosected specimens, identify the muscles of the limbs and illustrate the action of each on the joints which they affect using diagrams and/or prosected specimens, identify the muscles which support and act upon the spinal column indicate the nerve supply of the muscles of the upper and lower limbs and the effect of their denervation on movement and action across joints describe the origin and important relationships of the brachial plexus describe the origin, course, clinically important relationships and distribution of the axillary, radial, median and ulnar nerves in the upper limb describe the origin, course, relationships & distribution of the sciatic, femoral, common peroneal, deep & superficial peroneal, and sural nerves in the lower limb using common examples, describe and explain the effects of disease and injury on the major nerves of the upper limb using common examples, describe and explain the effects of disease and injury on the major nerves of the lower limb describe the origin, course, important relationships of the axillary, brachial, radial and ulnar arteries in the upper limb describe the origin, course, branches and relationships of the femoral, and popliteal, arteries and the distribution of their important branches in the leg and foot list the clinical features of acute and chronic ischaemia affecting a limb

Page 4

The Locomotor System

describe the venous drainage of the lower limb including the deep and superficial venous systems and the role of valves and perforating veins using diagrams and/or prosected specimens, identify the course and terminations of the long and short saphenous venous systems and the common sites of perforating branches define and discuss the causes and effects of varicose veins, perforator incompetence, venous hypertension and deep venous obstruction describe the lymphatic drainage of the upper and lower limbs describe the clinical features of chronic lymphatic obstruction and list important causes briefly describe the radiological techniques available for imaging the anatomy of the limbs and spine describe the processes of wound and fracture healing list and briefly describe common neoplastic and degenerative diseases that affect the musculoskeletal system list and briefly describe, with illustrative examples, some common injuries of the bones, joints and soft tissues of the limbs

Teaching/Learning Methods
This course is delivered by a combination of laboratory work and formal lectures from both clinical and basic medical sciences teaching staff. A significant proportion of your time will be spent working in the anatomy laboratory and you will be required to obtain and wear a laboratory coat at these times. Tutorials will be conducted using prosected specimens. Your participation and performance is important and is considered essential if you are to gain maximum benefit. Not all of the objectives will be covered in lectures or formal teaching and students are encouraged to use the learning objectives provided to guide their own self-study. A look at lecture titles prior to attending lectures will give you a picture of the area to be discussed and provide a guide to preparatory reading. Regular small group discussion is an excellent way of reviewing and reinforcing your knowledge of normal anatomy and physiology and students are encouraged to use this approach to learning not only in formal activities but throughout their programme of study.

Page 5

The Locomotor System

Assessment
Your participation and performance in small group laboratory work is considered important in the evaluation of your overall performance. Intermittent short practical (spotter) tests may also be held on material covered in the laboratory. On completion of the course, you will be assessed formally by means of a written (Multiple Choice Question type) examination paper and a practical laboratory component. Your assigned grade will contribute to your overall GPA. The standard and pass mark for the course examination will be determined by the examiners. Details of the assessment process will be provided by the course coordinator. The regulations governing this examination and all others conducted in the Faculty are determined by the general regulations covering all University examinations.

Useful Resources
Books
Lasts Anatomy Regional and Applied. (current edition) C.S. Sinnatamby (Churchill Livingstone). Cunninghams Textbook of Anatomy (current Edition) (Oxford Press) Robbins Pathologic Basis of Disease (6th Ed.) R. Cotran, V. Kumar and T. Collins (W.B. Saunders and CO.) Human Anatomy (current edition) Marieb & Mallatt Benjamin Cummings (Addison Wesley Longman, Inc.) ADAM (CDROM interactive human anatomy software available to students in the Hopwood Centre above the Medical Library)

Websites Links to useful websites can be found at:

http://www.med.umich.edu/lrc/Hypermuscle/Hyper.html http://www.ptcentral.com/muscles/ http://www.vesalius.com/

Page 6

The Locomotor System

Glossary of terms
Abduction - movement away from the central axis of the body/limbs. Acetabulum - the cuplike cavity on the lateral aspect of the hip girdle that receives the head of the femur Adduction - movement towards the central axis of the body/limbs. Anastamosis - the union or joining of blood vessels (also used to describe surgical joining of tubular structures Anterior - the front of an organism, organ or body part; same as ventral Aponeurosis - a broad flattened tendon. Appendicular - referring to the bones of the limbs and limb girdles that are attached to the axial skeleton Axial - referring to the bones of the skull, vertebral column and bony thorax that form the central axis of the body Bursa - a fibrous sac containing fluid that occurs between bones and tendons where it acts to decrease friction during movement Caudal - literally towards the tail; in humans, towards the inferior portion of the trunk Condyle - rounded projection at the end of a bone that articulates with another bone Circumduction - a movement in which the limb describes a cone. It is not a primary movement, but in fact, a sequence of flexion, abduction, extension and adduction. Diaphysis - the elongated shaft of a long bone Distal - away from the attached end of a structure, especially a limb Dorsal - posterior; pertaining to or towards the back; opposite to ventral

Page 7

The Locomotor System

Epicondyle - an elevation placed above the articular surface of a condyle. Epiphysis - that part of a bone formed from a secondary center of ossification, commonly found at the ends of long bones on the margins of flat bones, and at tubercles and processes during the period of growth, epiphyses are separated from the main portion of bone by cartilage. Facet - smooth, somewhat flat surface on a bone for articulation. Fascia - membranous structure of collagen fibres arranged in two directions intersecting each other. It may be pulled maximally until the fibres are perpendicular to each other. Foramen - hole in the bone. Fossa - depression on a bony surface. Fovea - small depression on a bony surface. Gomphosis - joint in which a peg shaped process is inserted in a socket, connected to each other by fibrous tissue. Hamulus - a hooklike process. Incisura - a notch Inferior below; toward the feet; same as caudal Insertion the movable point at which the force of a muscle is applied. Ligament - a band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. Lumbar - region of the back between the thorax and the pelvis Motor Unit - the motor neuron together with the muscle fibres that it innervates. It varies in size greatly. For extraocular muscles it is 510 muscle fibres per motor nerve while for gastrocnemius it is 1600 -1900 muscle fibres per motor nerve. Origin - the more fixed attachment of a muscle.

Page 8

The Locomotor System

Posterior - towards the back; same as dorsal Profundus - deep; farther from the body surface. Prone - refers to the body lying horizontally with the face downward; opposite of supine Proximal - towards the attached end of a limb or near the origin of a structure Ramus - a broad process projecting from the main body. Sagittal plane - the vertical plane dividing the body into left and right portions Sherringtons law - The principle of reciprocal innervation of muscles. The contraction of a group of prime movers is under normal circumstances always accompanied by a corresponding degree of the appropriate antagonists. Sulcus - a groove or furrow on the bone. Superior - closer to the head; above Supine - refers to the body lying horizontally with the face upward; opposite of prone Suture - a fibrous joint found only in the skull, in which articular surfaces of the bones are connected by a thin layer of fibrous tissue (the sutural ligament). Symphysis - a secondary cartilaginous joint, in which the articular surfaces of the bone are covered by hyaline cartilage and are connected to each other by fibrocartilage. This joint is of a permanent nature and some movement is permitted (e.g. pubic symphysis). Synarthrosis - an immovable joint Synchondrosis - a primary cartilaginous joint where the interposing tissue is hyaline cartilage and no movement is permitted. Syndesmosis - fibrous joint where the bones are connected by an interosseous ligament, at which practically no movement can take place. (eg. tibiofibular syndesmosis).

Page 9

The Locomotor System

Synovial - referring to the lubricating and nourishing fluid or the membrane which produces it; this fluid is found in freely mobile joints with articular cartilages and within the coverings of some tendons Tendon - cord like structure composed of numerous parallel fascicles of collagen fibres, by which a muscle is attached. Trochanter - large blunt process on a bone; best known on the upper aspect of the femur Tubercle - small rounded process on a bone Tuberosity - large or broad process on a bone; larger than a tubercle

Page 10

Meiosis to Man
Introduction to Embryology & Histology

DD11A

Meiosis to Man An introduction to Embryology & Histology

About this course

This course deals with the development and differentiation of cells, tissues and organs. It covers a general view of human development and the structure of tissues and is completed early in the first semester. It is designed as a basis for the more detailed study of the development, structure and functioning of the body systems and provides a basis for an understanding of congenital abnormalities. The teaching staff is primarily drawn from the Section of Anatomy with input from the Department of Pathology.

Aims of the Course

The primary aim of this course is to provide you with an understanding of the processes by which a single fertilized ovum develops into specialized tissues and organs to eventually form a complex multicellular organism. It provides a rational basis for your later understanding of the relationships and positions of normal adult structures and of the abnormalities which may result from disorders of development.

Useful Revision
Before beginning this course, you should be familiar with the processes of mitosis & meiosis and should have acquired a basic knowledge of cell structure and the biology and chemistry of cells. It may help you to browse through the glossary and to review the basic principles of cell division and genetics.

Core Content
The course covers the following areas: Gametogenesis Formation of the embryonic disc and the chorionic sac Formation of germ layers and the early differentiation of tissues The organo-genetic period The foetal period Development of the placenta and foetal membranes Development of the body cavities

Page 1

Meiosis to Man An introduction to Embryology & Histology

Development of the mesenteries and diaphragm Pharyngeal operators Birth defects Basic tissue types Classification, structure and function o Various types of epithelia and glands o Connective tissue cells and fibres o Bone & cartilage o Muscle o Nerve

Student Learning Objectives

On completion of this course, you should be able to: Describe the process of spermatogenesis Explain the term non disjunction Describe the process of ovulation Describe the process of fertilization Describe cleavage of the zygote and implantation of the blastocyst Describe proliferation and differentiation of the trophoblast Describe the development of the amniotic cavity, bilaminar embryonic disc, yolk sac and the connecting stalk Describe the formation and growth of the primitive streak Define primitive knot, primitive groove and primitive pit Describe development of the notochord and neural tube Describe the development of the cardiovascular system and list the sites of blood formation Describe the allantois, oropharyngeal membrane and cloacal membrane Describe the general body form resulting from folding of the embryo and the effect of this process on the septum transversum, heart, foregut, midgut, allantois and yolk sac. List the significant differences between development during the embryonic and foetal periods. Describe the differences in the vulnerability of embryos and foetuses to teratogenic agents

Page 2

Meiosis to Man An introduction to Embryology & Histology

List the possible effects of environmental agents and other factors on foetal growth and development. Describe the processes of intrauterine growth retardation, amniocentesis, foetuscopy, foetal blood sampling and ultrasonography. List six common congenital anomalies and the embryonic basis for them Describe the genetic factors responsible for foetal development List the main tissue types Describe the preparation of histological slides (specimen collection, staining) Recognize and label histological specimens of the following tissues: o Epithelial tissue o Connective tissue o Muscle (smooth, striated & cardiac) o Nervous tissue

Teaching/Learning Methods
These will include lectures, tutorials and practical laboratory sessions. You will be required to become familiar with a number of tissue types and will be provided with a set of histological slides to assist you to recognize and describe important tissues and their cell types. Not all of the objectives will necessarily be covered in lectures and you are encouraged to use the learning objectives provided to guide your self-study. Small group discussion is an excellent way of reviewing and reinforcing your knowledge and students are encouraged to form their own groups and to use this approach throughout their programme of study.

Page 3

Meiosis to Man An introduction to Embryology & Histology

Assessment
On completion of this course, students will be assessed by a written (Multiple Choice Question type) examination paper and a practical. The final grade for this course will contribute to your GPA. The standards and pass mark for the examination is determined by the examiners. Details of the assessment process will be provided by the course coordinator. The regulations governing this examination are determined by the general regulations covering all University examinations and as laid out in the specific Faculty regulations.

Useful Resources
The Developing Human, Clinically Oriented Embryology, Moore and Persaud, Saunders Co. Study Guide and Review Manual of Human Embryology. Moore and Persaud, Saunders Co. Notes on General Embryology, T.L. The, Section of Anatomy, Mona.

Websites (optional)

Links to useful websites can be found at:

http://www.med.uc.edu/embryology/ http://www.ucalgary.ca/UofC/eduweb/virtualembryo/ http://www.med.unc.edu/embryoimages/ http://www.obultrasound.net/

Glossary of terms
Abortion - premature expulsion of a conceptus from the uterus or expulsion of an embryo or foetus before it is viable/capable of living outside the uterus. Blastocyst - (Gr. blastos, germ + kystis, bladder). A morula with a fluid filled cavity. Cleavage - A series of mitotic cell divisions of the zygote that result in the formation of early embryonic cells, the blastomeres.

Page 4

Meiosis to Man An introduction to Embryology & Histology

Conceptus - (L. concepito, derivates of a zygote). Refers to the embryo and the associated membranes with the placenta. Embryo - (Gr. embryon). Developing human being during its early stages of development. Embryonic Period - This period extends from fertilization to the end of the 8th week of pregnancy by which time the beginnings of all major structures are present. Fertilization - The union of an oocyte and a sperm. Foetus - The developing human after the embryonic period (from 9 weeks after fertilization to birth). Gastrula - (Gr. gaster, stomach). A trilaminar (ectoderm, mesoderm and endoderm) embryonic disc that differentiates into the tissues and organs of the embryo. Implantation - The process during which the blastocyst attaches to the endometrium (lining of the uterus). Morula - (L. morus, mulberry). A mass of blastomeres on the 3rd to 4th day after fertilization just as the developing human enters the uterus. Neurula - (Gr. neuron, nerve). The embryo in the 4th week with the formation of the neural tube, the primordium of the central nervous system (Brain and Spinal Cord). Oocyte - (L. ovum, egg). The female germ cell produced in the ovaries. Primordium - (L. primus, first + ordior, to begin). Refers to the first indication for the earliest stage of development of an organ or structure. Sperm - (Gr. sperma, seed). The male germ cell produced in the testes. Zygote (Gr. zygotos, yoked). The beginning of a new human being resulting from the union of an oocyte and a sperm.

Page 5

Introduction to Molecular Medicine

DD13A

Introduction to Molecular Medicine

About this course

This course covers medical aspects of genetics including population genetics. Molecular techniques used in diagnosis and treatment are presented and ethical implications surrounding the application of molecular biology to medicine are also introduced. The teaching staff is primarily drawn from the Section of Biochemistry with input from the Tropical Medicine Research Institute and the Department of Pathology and Microbiology.

Aims of the Course

The aim of this course is to introduce you to the principles of Molecular Biology, and to show how they are used to understand and treat human disease. It builds on the fundamentals of the structure and basic functions of nucleic acids and proteins and serves as an important foundation for your understanding of advances in genetics and developments in modern medical research.

Useful Revision
Students beginning this course should have a basic knowledge of cell structure and the biology and chemistry of cells. It will be useful to browse through the glossary and to review some of the basic principles of genetics and nucleic acid structure from your early science studies.

Core Content
The following general areas are covered 1. DNA, RNA structure, chromosomes, genes, genetic code, gene expression, mutations, genome diversity, laboratory manipulation of nucleic acids How genes are inherited, population genetics Molecular techniques, emphasizing those used in diagnosis and treatment Molecular medicine in practice recombinant proteins, gene therapy, pharmacogenomics, the Human Genome Project (HGP). Ethical considerations and implications in the application of molecular biology to medicine.

2. 3. 4.

5.

Page 1

Introduction to Molecular Medicine

More specifically, the course focuses on the following principles: DNA as genetic material, double helix, genetic code, central dogma Genome diversity bacterial, viral and retroviral genomes, plasmids, extrachromosomal DNA DNA replication , transcription Translation/protein synthesis splicing in haemoglobin and immunoglobulin synthesis, post translational modifications Antibiotic action on bacterial replication and protein synthesis Population genetics: inheritance, linkage Mutations: focus on haemoglobinopathies Inborn errors of metabolism DNA and RNA isolation Chromosome karyotyping, in situ hybridization Recombinant DNA technology hybridization, Polymerase Chain Reaction (PCR), trangenesis Production of recombinant proteins, monoclonal antibodies The Human Genome Project (HGP) applications, ethical issues Gene therapy, pharmacogenomics

Page 2

Introduction to Molecular Medicine

Student Learning Objectives

On completion of this course, you should be able to: describe how DNA was shown to be the genetic material describe how DNA replicates itself and how mutations may arise explain how the information carried in DNA is translated into synthesis of proteins explain antibiotic action at the level of replication and protein synthesis state the central dogma of molecular biology explain how some viruses do not conform to this dogma explain how some retroviruses may cause disease describe how mutations may lead to disease e.g. sickle cell, cystic fibrosis, thalassemias compare and contrast the genomes of prokaryotes and humans and discuss the diversity in relation to disease and treatment describe methods for isolation and purification of DNA, hybridization describe the techniques of PCR, Restriction Fragment Length Polymorphism (RFLP), sequencing, DNA fingerprinting, transgenesis and in situ hybridization relate these techniques to their uses in the diagnosis of genetic and infectious diseases and in forensic medicine describe the use of molecular biology techniques in the production of recombinant proteins and antibodies provide an overview of the Human Genome Project (HGP) describe the fundamentals of somatic gene therapy discuss the ethical issues associated with these techniques, the HGP, gene therapy and pharmacogenomics

Page 3

Introduction to Molecular Medicine

Teaching/Learning Methods
These may include lectures, tutorials, practical laboratory sessions, visits to laboratories on and off-site and computer based sessions. In addition to the those listed below, there are also many informative websites which can be accessed. Not all of the objectives will necessarily be covered in the lectures and students are encouraged to use the learning objectives provide in this guide and the clinical problems they will see to guide their self-study. Regular small group discussion is an excellent way of reviewing and reinforcing your knowledge and students are encouraged to use this approach to learning not only in formal activities but throughout their programme of study.

Assessment
On completion of this course, students will be assessed by a written (Multiple Choice Question type) examination paper and a practical component. However, attendance at the practical sessions is mandatory and a student must obtain a satisfactory grade on the written report. Failure to do so may result in the student being debarred from writing the examination. The standards and pass mark for the examination is determined by the examiners. Details of the assessment process will be provided by the course coordinator. The regulations governing this examination are determined by the general regulations covering all University examinations and as laid out in the specific Faculty regulations.

Useful Resources
Textbook of Biochemistry with Clinical Correlations, (current edition) Editor T. M. Devlin Human Genetics: Concepts and Applications, Ricki Lewis, ISBN: 007246268x. Molecular Biotechnology, Principles and Applications of Recombinant DNA. Bernard R. Glick and Jack J. Pasternak ISBN: 1-55581-224-4

Page 4

Introduction to Molecular Medicine

Useful Websites

Links to useful websites can be found at:

http://www.ncbi.nlm.nih.gov/About/primer/genetics.html http://en.wikipedia.org/wiki/Genetic_fingerprinting http://www.genome.gov/10001772

Glossary of terms
Allele - One of the different forms of a gene that can exist at a single locus on a chromosome Autosomes - All the chromosomes except the sex chromosomes; found in somatic cells cDNA - A singlestranded DNA complementary to an RNA from which it was synthesized using reverse transcriptase Clone - A large number of cells or molecules derived from a single ancestral cell or molecule Denaturation - Conversion from the double-stranded to the single-stranded state, most often accomplished by heat Diploid set of chromosomes - Contains two copies of each autosome and two sex chromosomes DNA (deoxyribonucleic acid) - A double chain of linked nucleotides (having deoxyribose as their sugars); the fundamental unit of which genes are composed Eukaryotic cell - A cell containing a nucleus Exons - DNA sequences that are transcribed into protein structures Gene therapy - Introduction of a fully functional and expressible gene into a target cell, aimed at correcting a specific disease permanently Gene - Fundamental physical and functional unit of heredity; a segment of DNA that makes transcription possible Genetic code - The correspondence between triplets in DNA (or RNA) and amino acids in protein

Page 5

Introduction to Molecular Medicine

Genome - The complement of genetic information unique to each species of organism Haploid set of chromosomes - One copy of each autosome and one sex chromosome; characteristic of germ cells Heterozygote - An individual with different alleles of a particular gene, e.g. HbAS (sickle cell trait) Histone - A type of basic protein that forms a unit around which DNA is tightly coiled in the nucleosomes of eukaryotic chromosomes Homozygote - An individual with identical alleles for a particular gene, e.g. HbAA (normal), HbSS (sickle cell disease) Hybridization - Variety of related techniques based on observation that two singlestranded nucleic acids of complementary base sequences will form a double-stranded hybrid. Hyperchromicity - The increase in optical density that occurs when DNA is denatured Introns (intervening sequences) - DNA that is transcribed but not translated into protein. Karyotype - The entire chromosomal complement of cell or species (as visualized during mitosis) Linkage - The association of genes on the same chromosome Linkage disequilibrium - A situation in which some combinations of genetic markers occur more or less frequently in the population than would be expected from their distance apart Locus Chromosomal - location of a gene or other piece of DNA Marker allele - Any allele of interest in an experiment Marker DNA - Fragment of known size used to calibrate an electrophoretic mRNA (messenger RNA) - An RNA molecule transcribed from the DNA of a gene, and from which a protein is translated by the action of ribosomes Missense - A single base change mutation that alters an amino acid in the gene product

Page 6

Introduction to Molecular Medicine

Mutation - A process that produces a gene or chromosome set different from that of the wild type or the result of such a process Nucleases - Enzymes that can degrade nucleic acids by breaking the phosphodiester bonds Nucleotide - A molecule composed of a base, a sugar and a phosphate group; the basic building block of nucleic acids Oncogene - A gene that has sustained some genetic damage and, therefore, produces a protein capable of cellular transformation Polymorphism - A variation in DNA sequence within a population Prokaryotic cell - A cell with no nuclear membrane, hence, no separate nucleus Proto -oncogene A gene whose protein product normally controls the cell cycle but has the capacity to induce cellular transformation given it sustains some genetic insult. Restriction enzyme - A bacterial endonuclease that recognizes specific base sequences in DNA and breaks the DNA chain at those points Ribosomes - Complex of protein and ribosomal RNA (rRNA) that catalyzes the translation of mRNA into an amino acid sequence RNA (ribonucleic acid) - A single stranded nucleic acid (may fold back on itself to form double-stranded regions), having ribose as sugar and uracil rather than thymine as one of its bases Splicing - The removal of introns and joining of exons in RNA; introns are spliced out and exons are spliced together tRNA - A class of small RNA; molecules that take specific amino acids to the ribosome during translation such that amino acids are inserted to form a polypeptide chain Wild type - The genotype or phenotype found in nature or in a standard laboratory stock

Page 7

Cell Biology
DD120

Cell Biology

About this course

The Cell Biology course spans semesters 1 and 2 and addresses the following areas: cell types, biomolecules & biomembranes, metabolism & bioenergetics. It provides an introduction to medically relevant cell types, embracing their biological properties, intracellular and surface features and how they generate energy for their cellular needs and also includes an introduction to major biomolecules, enzyme inhibition and bioenergetics.

Aims of the Course

This course explores the components and functions of cells, organelles and biomembranes and allows students to understand the factors which affect their functions. It aims to provide students with a framework which will allow them to appreciate the mechanisms of intracellular and extracellular control at the metabolic level. It also explains the ways in which the body derives its requirements for energy and growth.

Useful Revision
Students beginning this course should have a fundamental knowledge of cell structure and the biology and chemistry of cells including how they reproduce and the factors that affect chemical reactions. Before you begin, it would be useful to review some of this material as it was covered during your earlier education in the sciences.

Core Content
The ultrastructure of the components of eukaryotic cells, their organelles and surfaces Biomembranes and their functional properties Hydrogen-bonds and the influence of pH on cellular metabolism and bio-membranefunction The different biomolecules found in cells, with an emphasis on their structure nd their interaction with the aqueous environment

Page 1

Cell Biology
Mechanisms of intracellular metabolic control and of metabolic control from extracellular signals The methods by which humans derive their energy requirements, whether aerobically or anaerobically

Student Learning Objectives

On completion of this course, you should be able to: Describe the ultrastructure and functions of the major organelles and surface features of eukaryotic cells Describe the generalised structures and properties of commonly occurring monosaccharides, disaccharides, polysaccharides and amino acids as well as the physiologically active peptides, proteins, active steroids and lipids. Describe the structures and physical properties of common membranes and their molecule transport systems. List common monosaccharides and their important derivatives which are produced in the body Classify monosaccharides by ring structure and reducing properties and explain the term isomerism Explain the significance of glycosuria and the accumulation of polysaccharides or sugar alcohols in tissues. Describe the chemical structure and characteristic reactions of amino acids including hydrophilic and hydrophobic side chains and the properties of the peptide bond. Explain the possible clinical significance of amino-aciduria. Describe the four levels of structure of proteins and how this relates to their role as catalysts, structural elements and signals and in transportation, motility and recognition. Describe and discuss important proteins found in the body, including ribonuclease, plasma proteins, haemoglobin, myoglobin, collagen, keratin and insulin. Discuss the relationship of structure to function indicated by effects of minor and major (denaturation) changes Explain the defects in proteins which result in haemophilia, haemoglobinopathy and defects of collagen synthesis Outline the structure and properties of saturated and unsaturated fatty acids and the nutritional requirements for lipids

Page 2

Cell Biology
Describe prostagandins and outline their contraceptive value Describe the role played by triglycerides in energy storage and obesity Outline the structure of phospholipids with special reference to the hydrophobic and hydrophilic portions of the molecule Explain the fluid mosaic model and the role of phospholipids in membrane structure and lipid transport List the important lipid storage diseases Describe the structural role of glycolipids with particular reference to steroids, cholesterol and its derivatives Explain the variation of bioactivity of hormonal steroids with small changes in molecular structure Outline the physiological role of bile salts Outline the principles of formation of gall stones and the causes of steatorrhoea Describe the major effects of hormone deficiency and the effects of anabolic steroids. List the importance of cell organelles and the significance of compartmentation in eukaryotic cells. Describe the localization of enzymes and pathways in nuclei, mitochondria, lysosomes, Golgi, peroxisomes and ribosomes. Describe what is meant by lysosomal storage diseases and give an example. * draw standard enzymology Michaelis-Menten and Lineweaver-Burk plots, showing the effects of standard competitive and non-competitive inhibitions. Illustrate the molecular mechanisms operating in typical allosteric modulation and covalent modification of enzyme activity in the control of intracellular metabolism. Illustrate the common features of general metabolic pathways. Explain the mechanisms by which anaerobic eukaryotic and prokaryotic cells in humans generate ATP. Explain the chemiosmotic mechanism whereby the oxygen is used by mitochondria to generate ATP. Explain the importance and regulation of blood glucose. Illustrate the reactions of the glycolytic pathway, its energy yield and the products of aerobic and anaerobic metabolism. Explain the role of glycolysis in the red blood cell.

Page 3

Cell Biology
Explain the features and importance of hypoglycaemic coma and the effects of storing blood products. Describe the utilization of lactose and galactose and the place of fructose as a glucose alternative. Illustrate the pentose phosphate pathway in different tissues. Explain the hormonal regulation of glycogen storage and the effects of exercise on mobilization of glycogen stores. Explain gluconeogenesis, and the regulation of blood glucose. Describe the types and causes of diabetes mellitus. Explain the TCA Cycle as the final oxidative pathway for acetyl CoA and its role in energy production and amino acid biosynthesis. Explain the causes and effects of lactic acidosis. Explain oxidative phosphorylation and the action of inhibitors of the respiratory chain. Explain the energy yield and enzyme reactions of ?-oxidation in relation to obesity. Describe the interrelationships of fat and carbohydrate metabolism and the mechanism of ketosis and starvation. Describe de novo synthesis of fatty acids, chain elongation and desaturation. Describe the fate of specific amino acids including alanine, phenylalanine, tyrosine, tryptophan and methionine. Explain the causes of porphyria. Classify and describe the catalytic properties of enzymes and the effects of pH and temperature on their activity. Describe the methods available for the investigation of enzyme activity including isolation and assay. List and discuss important enzyme deficiency states. Describe the effect of the proportions of enzyme and substrate on reac-tion velocity using the Michaelis-Menten equation and the oxidase- urease value. Describe the role of reversible and irreversible inhibitors Explain the mechanisms of enzyme action and the role of co-factors in binding and catalytic sites. Explain the terms, induced fit and allosterism. Describe with examples, the use of enzymes as drug targets, AMO inhibitors and anticholinesterases.

Page 4

Cell Biology

Teaching/Learning Methods
The course utilises didactic lectures, practical demonstrations and practical laboratory work in addition to instructional videotapes, computer software and small group tutorials. The teaching staff includes mainly members from the Biochemistry Section. Not all of the objectives will necessarily be covered in the lectures and students are encouraged to use the learning objectives provided in this guide and the clinical problems they will see to guide their self-study. Regular small group discussion is an excellent way of reviewing and reinforcing your knowledge and students are encouraged to use this approach to learning not only in formal activities but throughout their programme of study.

Assessment
On completion of this course, students will be assessed by a written (Multiple Choice Question type) examination paper and a practical component. Attendance at the practical sessions is mandatory and a student must obtain a satisfactory grade on the written report. Failure to do so may result in the student being debarred from writing the examination. The standards and pass mark for the examination will be determined by the examiners. Further details on the assessment process can be found in the student handbook. The regulations governing this examination are determined by the general regulations covering all University examinations and as laid out in the specific Faculty regulations.

Useful Resources
Textbook of Biochemistry with clinical correlations, Thomas Devlin, Wiley.Brock Molecular Cell Biology, Lodish et al., Scientific American Books. Biochemistry Lippincotts Illustrated Review. D.C. Champe & R.A. Harvey Biochemistry by Diagrams, E. Y. St. A. Morrison

Page 5

Cell Biology
Clinical Chemistry in Diagnosis and Treatment, Zilva and Pannal, Lloyd-Luke

Websites:
Please note that the Medical Library has developed a useful resource site for web-based information which can be accessed at: http://www.mona.uwi.edu/library/subject_portal.html http://commtechlab.msu.edu/sites/dlc-me/zoo/ http://www-mcb.ucdavis.edu/courses/bis102/ http://www.cdc.gov/ http://www.nbsc.com/index2.htm http://www.sbu.ac.uk/water/index.html http://www.adam.com http://expasy.hcuge.ch/sprot/enzyme.html http://www.bmb.leeds.ac.uk/illingworth/metabol/index.htm http://www.bmb.leeds.ac.uk/illingworth/oxphos/index.htm http://www.bmb.leeds.ac.uk/illingworth/muscle/index.htm http://www.clunet.edu/BioDev/omm/exhibits.htm#displays http://gened.emc.maricopa.edu/bio/bio181/BIOBK/BioBookT OC.html http://www.cellbio.com/ http://www.bio.cmu.edu/Courses/BiochemMols/BCMolecules .html http://info.bio.cmu.edu/Courses/BiochemMols/BiochemistryLi nks.html http://esg-www.mit.edu:8001/esgbio/7001main.html http://www.sciam.com/

Videotapes and CD-ROMS:

Please check with the Medical Library and the H.D. Hopwood Centre (top floor Medical Library) or in the BMS Cluster Room for appropriate current listings.

Page 6

Cell Biology

Glossary of terms
Adenosine Triphosphate (ATP) - the common currency of energy exchange in all living systems. Aerobic metabolism - the metabolism of cells that use oxygen as electron acceptor to generate energy Anabolism - the conversion of small molecules into larger ones Anaerobic metabolism - the metabolism of cells that do not use oxygen for energy production Carbohydrates (or sugars) - water soluble compounds that play roles in both energetics and cell and organ structure. Catabolism - the conversion of large, complex molecules into smaller, simpler metabolites Chemical reaction - a process by which one or more compounds are converted or changed into one or more different compounds Enzyme - a protein catalyst Isomers - compounds containing the same atoms in different arrangements Lipids - water insoluble organic substances extracted from cells and tissues. Metabolic pathway - the specific sequence of the chemical reactions making up the metabolism of a living organism Proteins - polymers made up of amino acid residues.

Page 7

Introduction to Medical Practice

Unit 1 MP100

Introduction to Medical Practice Unit 1

About this course

The practice of medicine is grounded in a philosophy of life and healthy living and has evolved through many different eras which span the religio-magic to recent advances in technology. These have influenced diagnostic and treatment modalities both of which have contributed to improved quality of care and quality of life. While the early years of training in medical school continue to emphasize the principles of basic sciences underpinning the practice of medicine, it is important to remember that it is the patient who provides the focus for all aspects of the application of this knowledge. Future physicians must be aware of the rich tradition of the profession as a basis for understanding why the practice of medicine continues to hold a special place in society. As they enter the profession, they must also consider what is required to ensure that this place of honour is maintained, and indeed, be strengthened. This multi-faceted introductory course will focus on historical perspectives of the profession, ethical behaviour, standards of care, personal and professional development issues, communication skills and all aspects of the doctor-patient relationship.

Aims of the Course

The course seeks to provide motivation for understanding the basic medical sciences and aims to inculcate at an early stage the attitudes and behaviours appropriate to the practice of medicine. It spans the first two years and is divided organizationally into two units which are designed to provide you with the foundation skills necessary for your clinical and hospital-based clerkships Unit 1 (Year 1) The first year concentrates on personal & professional development, an important theme running through the curriculum. Specifically, it includes communication skills and professional conduct, including deportment and patient confidentiality along with a parallel basic course in pre-hospital management of common emergencies Unit 2 (Year 2) The second year of the course concentrates on basic clinical skills of history taking and clinical examination. Details of this component will be provided at the beginning of year 2.

Page 1

Introduction to Medical Practice Unit 1

Core Content
The following key points will serve to focus and enable you to achieve the expected learning outcomes. History and scope of medicine Public health and clinical care Ethics of medicine; standards of care and the law Patients expectations of their doctors The team approach to the practice of medicine Communication, patient education and counseling Introduction to conducting a medical interview Assessment and pre-hospital management of common medical emergencies

Student Learning Objectives

On completion of this course, you should be able to: Relate the practice of medicine to ethics, standards of care and the law Describe the various ethical and legal responsibilities of the physician Explain the principles which underpin the physicians Code of Ethics Recognize concepts related to personal and professional development and communication skills Describe the desirable attributes of the physician from a patients perspective Describe how the doctor-patient relationship is established and nurtured List and discuss issues related to the doctor-patient relationship in interactions with patients, family and colleagues Describe the team approach to the practice of medicine Describe the role and function(s) of each member of the health team in providing holistic patient care Recognize the value of interpersonal skills as they relate to the dynamics of team work Identify the skills required to successfully achieve effective communication for patient education and counseling Recognize the universality of a structured format for interviewing and its adaptability to different clinical situations Articulate the physicians frame of reference for decision making in patient care

Page 2

Introduction to Medical Practice Unit 1

Apply data gathering skills to problem formulation and patient education Describe the range of vital signs involved in patient care Provide assisted ventilation for patients with common emergencies Describe the types and characteristics of external injuries and wounds Describe the types of bone and joint injuries Safely extricate an injured person from the drivers seat following a motor vehicle accident Describe the indications for cardio-pulmonary resuscitation

Teaching/Learning Methods
A variety of methods are employed in the delivery of the content including didactic lectures and small group teaching, including handson activities. Videotapes are used to introduce the learning of dynamic skills. Group assignments and presentations at seminars are used to hone communication skills and to encourage students to work as members of a team. These are reinforced in seminars, by role-play and through opportunities to observe how medicine is practiced. Teachers will be drawn from an appropriate range of health professionals from within the University and selected non-university agencies.

Assessment
Unit 1 is a Pass/Fail course. Satisfactory completion (a pass) requires both of the following: A minimum attendance of 80% of all interactive/practical sessions A passing grade in a written (MCQ type) examination at the end of Year 1 Failure will not necessarily mean an automatic debarment from pursuing Unit 2 (Year 2). However, failing students will be required to undergo a repeat assessment prior to starting Unit 2. Students will normally have 3 attempts at passing Unit 1. Failure at the third attempt may require withdrawal from the MBBS programme.

Page 3

Introduction to Medical Practice Unit 1

Useful Resources
Recommended reading Hutchinsons Clinical Methods 21st Edition by Michael Swash. McLeods Clinical Examination. 10th Edition Edited by John F. Munro and Ian W. Campbell. Coulehan, John and Block, Marian (2006) The Medical Interview: Mastering Skills for Clinical Practice, 5th ed. 909 pp. Soft cover. Available through F. A. Davis Co. U.S.$39.95. Emergency Care and Transportation of the Sick and Injured (Eighth Edition) The AAOS Orange Book. Brady Pre hospital Emergency Care (Sixth Edition) Minstorich, Hafen and Karren. Brady Emergency Care (Ninth Edition) OKeefe, Limmer et al.

Page 4