The document discusses the integration of basic and clinical sciences in undergraduate medical education. It provides examples of how integrating basic pathology concepts helps students understand medical diagnosis. Specifically, it explains how pathological processes and their structural and functional alterations form the basis for clinical signs and symptoms. Through several examples, it demonstrates how pathological findings correlate with clinical presentations of diseases like meningitis and organomegaly. The overall approach aims to make basic science learning more meaningful and relevant to medical students by placing it in a clinical context.

1. Towards Understanding the
Basic Medical Sciences
Foundation of Clinical Medicine
Prepared and presented by Marc Imhotep Cray, M.D.
Medical Teacher
http://www.imhotepvirtualmedsch.com/
Basic Pathology
CORRELATION
TO
Medical Diagnosis
“IVMS and integration of basic and clinical sciences”

2. The integration of basic and clinical sciences
in undergraduate medical science
IVMS teaching philosophy is based on the integration of basic and
clinical sciences.
 This means that the learning of basic science is placed in the context
of clinical medicine.
 Such an approach is seen to be more meaningful and relevant to
students.
 Curriculum integration usually involves both horizontal and vertical
integration and is the pattern that is becoming widespread throughout
the world.”
“IVMS and integration of basic and clinical sciences”
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3. 11 benefits of integrated learning in
undergraduate medical education
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Improved motivation and satisfaction
Professional socialization
Enhanced self reflection and self appraisal
Reinforced and deep learning
Prepares for life‐long learning
Improved understanding of biological principles, mechanisms & basic concepts
Heightened relevance of learning
Facilitates curriculum review
Promotes co‐operation between staff members from different disciplines
Enhances clinician reflections on the scientific basis of practice
Enhances basic scientists reflections on clinical applications and research
From: Integration of basic and clinical sciences ‐ AMEE 2008
http://www.amee.org/documents/IntroductionMedical Education BradleyMattick.pdf
“IVMS and integration of basic and clinical sciences”
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4. “What is
Horizontal and Vertical Integration”
Horizontal: bring together the disciplines, topics,
subjects of basic medial science or clinical medicine
Vertical: bringing together basic medial science and
clinical medicine
“IVMS and integration of basic and clinical sciences”
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5. “Let’s exemplify vertical integration by briefly looking at how one relates
Basic Pathology to Medical Diagnosis
PATHOLOGY
• PATH
– pertaining to a morbid process (disease)
• (from “pathos” = travail or sorrow (Greek)
• OLOGY
– the scientific study of …
“IVMS and integration of basic and clinical sciences”
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6. PATHOLOGY: SCIENTIFIC STUDY OF…
PATHOGENESIS
PATHOMORPHOLOGY
ETIOLOGY
DISEASE
PROGNOSIS
COURSE
COMPLICATIONS
“IVMS and integration of basic and clinical sciences”
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7. Ex: SCIENTIFIC STUDY OF DISEASE
P
SEPTICAEMIA
E
N. meningitidis
MENINGITIS
PM
ACUTE
INFLAMMATION
MENINGES
P
DEATH
(IF UNTREATED)
“IVMS and integration of basic and clinical sciences”
C
NH
VENTRICULITIS
ENDARTERITIS
HYDROCEPHALUS
SPREAD VIA CSF
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8. PATHOLOGY OBJECTIVES
1 To introduce a NEW VOCABULARY of terms,
definitions, and disease processes.
2 To introduce the BASIC RESPONSES of the
human organism to injury.
• Correlation with clinical picture.
“IVMS and integration of basic and clinical sciences”
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9. PATHOLOGY OBJECTIVE (2)
STRUCTURAL & FUNCTIONAL ALTERATIONS
induced by disease
CORRELATION
form
the basis by which attending
SIGNS and SYMPTOMS
are produced
“IVMS and integration of basic and clinical sciences”
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10. SIGNS AND SYMPTOMS
DETECTED BY CLINICIAN
& pathologist
PHYSIOLOGY & FUNCTION
ALTERS
ORGAN STRUCTURE
DETECTED BY PATHOLOGIST
& clinician
PATHOMORPHOLOGY
“IVMS and integration of basic and clinical sciences”
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11. LEVELS OF STUDY OF PATHOLOGY
•
•
•
•
•
•
MOLECULAR
CHEMICAL
ULTRASTUCTURAL
CELLULAR
TISSUE
PATHOMORPHOLOGY
ORGAN
“IVMS and integration of basic and clinical sciences”
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12. PATHOMORPHOLOGY
• PATHO.. - the disease
• MORPH .. - the shape (structure)
• OLOGY .. - the study of
i.e. how a disease process alters the “shape”
(structure) of cells, tissues and organs …… or
……
the “DAMAGE” caused by the disease process.
“IVMS and integration of basic and clinical sciences”
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13. “ORGANOMEGALY”
AN ALTERATION OF MORPHOLOGY
“CHANGE IN SHAPE & / 0R SIZE”
AS A PRECEPT THERE IS BUT ONE
CAUSE OF ORGANOMEGALY
SOMETHING MUST BE ADDED TO THE ORGAN
“IVMS and integration of basic and clinical sciences”
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14. WHAT MAY BE ADDED?
•
•
•
•
•
•
NORMAL CELLS HYPERPLASIA or HYPERTROPHY
FLUID EDEMA
BLOOD CONGESTION
INFLAMMATORY EXUDATE
NEOPLASTIC CELLS TUMOR
GAS EMPHYSEMA
“IVMS and integration of basic and clinical sciences”
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15. HISTOPATHOLOGY /
PATHOMORPHOLOGY
OVERVIEW
Companion learning tools to the following general
pathology section:
IVMS General Pathology Lecture Notes.pdf
Images
IVMS-Gross Pathology, Histopathology, Microbiology and
Radiography High Yield Image Plates
WebPath
http://www-medlib.med.utah.edu/WebPath/webpath.html
“IVMS and integration of basic and clinical sciences”

16. CELLULAR DEGENERATION
AND INFILTRATION
 THEY ARE RELATED TO CHANGES WHICH MAY BE
REVERSIBLE
 THE AGENTS WHICH CAUSE CELULAR
DEGENERATION AND OR INFILTRATION , WHEN
OCCURING OVER LONGER PERIODS OF TIME WILL
ULTIMATELY LEAD TO THE DEATH OF THE CELL
WITH MORPHOLOGIC CHANGES
“IVMS and integration of basic and clinical sciences”

17. CELL INJURY THUS REFLECTS
TWO LEVELS OF SEVERITY
1. ONE COMPATIBLE WITH RECOVERY
2. THE SECOND IRREVERSIBLE
“IVMS and integration of basic and clinical sciences”

18. COMPATIBLE WITH RECOVERY
CLASSAFICATION
 CELL DEGENERATION AND INFILTRATION CAN BE
DIVIDED INTO SEVERAL MORPHOLOGIC PATTERNS
DEPENDING ON THE METABILITE(S) THAT
ACCUMULATE IN THE CELL
“IVMS and integration of basic and clinical sciences”

19. CLOUDY SWELLING
 THIS IS CHARACTERIZED MORPHOLOGICALLY BY
A SLIGHT SWELLING OF THE CELLWITH
GRANULARITY AND CLOUDINESS OF THE
CYTOPLASM
 THIS IS SEEN MOST OFTEN IN RENAL TUBULAR
CELLS, HEPATIC CELLS AND CARDIAC MUSCLE.
 ORGANS WITH THIS AFFECT ARE SLIGHTLY
LARGER , FIRM AND PALE
“IVMS and integration of basic and clinical sciences”

20. CLOUDY SWELLING(2)
THIS CAN BE CAUSED BY MANY FACTORS
 INFECTIONS
 FEBRILE ILLNESS
 EXCESSIVE COLD OR HEAT
 ANOXIA
 MALNUTRITION
 PHYSICAL INJURY
 VASCULAR DISTURBANCES
“IVMS and integration of basic and clinical sciences”

21. HYDROPIC OR VACUOLOR
DEGENERATION
 THIS IS A MORE PRONOUNCED FORM OF
INTRACELLULAR EDEMA, AND ALTHOUGH IT IS
REVERSIBLE , IT RREFLECTS A MORE SERIOUS INJURY
TO THE CELL
 IT IS CAUSED BY THE SAME AFFECTS THAT
PROUDUCE CLOUDY SWELLING
“IVMS and integration of basic and clinical sciences”

22. HYDROPIC OR VACUOLOR
DEGENERATION(2)
 THIS DEGENERATION IS OF PARTICULAR PROMINENCE
IN THE KIDNEYS , OFTEN RESULTING FROM
HYPOKALEMIA
 AND IN LIVER CELLS WHICH ARE EXPOSED TO
POISONS OR TOXINS (SUCH AS CARBON
TETRACHLORIDE AN CHLOROFORM)
“IVMS and integration of basic and clinical sciences”

23. HYDROPIC OR VACUOLOR
DEGENERATION(3)
 ON MICROSCOPIC EXAMINATION THIS APPEARS AS
SMALL , CLEAR VACOULES DISPERSED
THROUGHOUT THE CYTOPLASM
 IN SEVERE CASES THE VACOULES COALESCE AND
FORM LARGE CLEAR SPACES WHICH MAY DISPLACE
THE NUCLEUS
 PROGRESSION IS TOWARD FRANK NECROSIS
“IVMS and integration of basic and clinical sciences”

24. FATTY DEPOSITION
(FATTY METAMORPHOSIS)
 THIS CHANGE IS DUE TO AN ABNORMAL
ACCUMULATION OF FAT WITHIN PARENCHYMAL
CELLS
“IVMS and integration of basic and clinical sciences”

25. FATTY DEPOSITION
(FATTY METAMORPHOSIS)(2)
 THE PRESENCE OF FAT REPRESENTS AN
ABSOLUTE INCREASE IN INTRACELLULAR FAT
AND REPRESENTS SEVERE CELL INJURY
 THE SIZE OF THE FAT VACOULE IS NOT
DEPENDENT ON THE PATHOLOGIC MECHANISM
 THERE ARE MULTIPLE CAUSES WHICH LEAD TO
THIS DEGENERATION
 FATTY CHANGE IS OFTEN PRECEDED BY CLOUDY
SWELLING
“IVMS and integration of basic and clinical sciences”

26. GLYCOGEN DEGENERATION
(INFILTRATION)
 GLYCOGEN IS MORMALLY ABUNDANT IN LIVER AND
MUSCLE CELLS
 IN SOME CONDITIONS ABNORMAL
ACCUMULATIONS OCCUR PRODUCING VISIBLE
GLYCOGEN VACOULES WITHIN THE CYTOPLASM
OR NUCLEI
 GLYCOGEN INFILTRATION IS FOUND IN
 DIABETES MELLITUS
 GLYCOGEN STORAGE DISEASES
“IVMS and integration of basic and clinical sciences”

27. HYALINE DEGENERATION
 IN THIS , THERE IS A REGRESSIVE CHANGE IN
THE CELLS IN THAT THE CYTOPLASM NOW
HAS A GLASSY EOSINOPHILIC APPEARANCE
 THIS DEGENERATION IMPLIES THAT THE
INJURY TO THE CELL CYTOPLASM HAS
CAUSED DENATURATION AND COAGULATION
OF THE CYTOPLASM
“IVMS and integration of basic and clinical sciences”

28. MUCOID DEGENERATION
 THIS DESCRIPTION REFERS TO THE
EXTRACELLULAR ACCUMULATION OF
MUCOPOLYSACCHARIDE AND GROUND SUBSATNCE
WITHIN CONNECTIVE TISSUE
 THIS CHANGE IS SEEN IN COLLAGEN DISEASES.
THERE IS NO INTRA- CELLULAR DEFECT
“IVMS and integration of basic and clinical sciences”

29. CELL DEATH AND NECROSIS
• NECROSIS REFERS TO THE MORPHOLOGIC CHANGES
THAT FOLLOW CELL DEATH AND PERMIT VISIBLE
RECOGNITION THAT THE CELL HAS DIED
“IVMS and integration of basic and clinical sciences”

30. IRREVERSIBLE
NECROSIS
 MOST OF THE CHANGES THAT INDICATE CELLULAR
DEATH ARE MORE PROMINENT IN THE NUCLEUS THAN
IN THE CYTOPLASM
“IVMS and integration of basic and clinical sciences”

31. COAGULATION NECROSIS
 THIS TYPE OF NECROSIS IS CHARACTERISED BY
THE CELL BECOMING AN ACIDOPHILIC MASS,
USUALLY WITH THE LOSS OF THE NUCLEUS,
BUT WITH REMNANTS OF ENOUGH BASIC
SHAPE TO PERMIT RECOGNITIONOF THE CELL
BOUNDARIES
“IVMS and integration of basic and clinical sciences”

32. LIQUEFACTION NECROSIS
 IN THIS CASE THERE IS A RAPID AND TOTAL
ENZYMATIC DISSOLUTION OF THE CELLS
 THERE IS COMPLETE DESTRUCTION OF THE CELL
WALL
 THIS TYPE OF NECROSIS IS SEEN OFTEN IN THE
BRAIN
“IVMS and integration of basic and clinical sciences”

33. ENZYMATIC NECROSIS
 THIS PRESENTS WITH ACUTE DESTRUCTION OF
THE PANCREAS
 THIS FROM THE RELEASE OF THE PANCREATIC
ENZYMES OUTSIDE OF THEIR NORMAL CONFINES
“IVMS and integration of basic and clinical sciences”

34. CASEOUS NECROSIS
 THIS SEEN WITH TUBERCULOSIS INFECTIONS
 THE CELLS ARE CHANGED TO A GRANULAR,
EOSINOPHILIC MASS OF AMORPHOUS FAT AND
PROTEIN GROSSLY LOOKING LIKE SOFT FRIABLE
CHEESE
“IVMS and integration of basic and clinical sciences”

35. GANGRENOUS NECROSIS
 THIS IS RELATED TO ISCHEMIA AND A
SUPERIMPOSED BACTERIAL INFECTION
 THE INITIAL EVENT MAY HAVE BEEN A BACTERIAL
INFECTION WHICH COMPROMISED THE
VASCULARITY ALLOWING SAPROPHYTIC
ORGANISS TO THRIVE -THEREBY FURTHER
INCREASING THE ISCHEMIC CHANGE
“IVMS and integration of basic and clinical sciences”

36. FIBRINOID NECROSIS
 THIS IS SEEN PRINCIPALLY WITH DISEASES OF
HYPERSENSITIVITY ORIGIN
 THERE IS THE APPEARANCE OF FIBRIN DEPOSITS
IN THE CONNECTIVE TISSUE AND IN THE WALLS OF
THE BLOOD VESSELS
“IVMS and integration of basic and clinical sciences”

37. CAUSES OF CELL INJURY
AND DEATH
1) ANOXIA
2) PHYSICAL AGENTS
3) CHEMICAL AGENTS
4) BIOLOGIC AGENTS
5) IMMUNE
MCAHANISMSDERRANGEMENTS
6) GENETIC DEFECTS
“IVMS and integration of basic and clinical sciences”

38. DIFFERENTIAL DIAGNOSIS
IS THE PROCESS..
VASCULAR - SUDDEN ONSET
INFLAMMATORY- CARDINAL SIGNS/SYMPTOMS
NEOPLASTIC - MASS
DRUGS - HISTORY
INFECTION- CARDINAL SIGNS/SYMPTOMS
CONGENITAL- FROM BIRTH
AUTOIMMUNE - SYSTEMIC
TRAUMATIC - HISTORY
“VINDICATE” ENDOCRINE / METABOLIC- Sn/Sx
“IVMS and integration of basic and clinical sciences”
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