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Jde o povinný studijní předmět, který patří mezi základní teoretické předměty profilujícího základu. Jeho absolvováním student získá znalosti a dovednosti v oblasti patofyziologie, které jsou nezbytným předpokladem pro další úspěšné studium ve vyšších ročnících. V rámci předmětu student například následující znalosti, dovednosti a kompetence:
- je schopen objasnit funkce a regulační mechanismy lidského organizmu, orgánů a jejich částí ve zdraví, se zřetelem k pochopení základů dysfunkcí v nemoci. Seznámení se základními rysy patologických procesů a jejich možný vznik z fyziologického základu.
- popsat struktury lidského těla a především mechanismy, které se podílí na řízení jeho funkcí, od úrovně molekulární až po orgánovou. Uplatnit poznatky základních vědních lékařských oborů ve své klinické rozvaze a v indikaci vhodných zákroků a vyšetření. Last update: Procházka Zdeněk (24.05.2023)
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Vysvětlení funkce lidského organismu za patologických stavů. Zvládnutí základů klinického myšlení tak, aby byl student připraven osvojit si v klinických předmětech účelné diagnostické i terapeutické postupy. Last update: Maxová Hana, doc. MUDr., Ph.D. (13.09.2023)
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In order to successfully complete the course, it is necessary to take an oral exam (3 questions + 1 practical task). In order to register for the exam, a completed credit from the winter and summer semesters is required. To get credit for the winter and summer semesters, you need: • fulfillment of continuous tests • active participation in seminars • not have more than 2 absences from seminars during one semester (absence will also be considered serious ignorance or passivity during the seminar) Exceptions are handled by the head of the institute. Last update: Maxová Hana, doc. MUDr., Ph.D. (13.09.2023)
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Moodle kurz: https://dl1.cuni.cz/course/view.php?id=6503
HAMMER, Gary D.; MCPHEE, Stephen J.; EDUCATION, McGraw-Hill (ed.). Pathophysiology of disease: an introduction to clinical medicine. New York: McGraw-Hill Education Medical, 2014.
https://accessmedicine.mhmedical.com/book.aspx?bookid=2468
SILBERNAGL, S.; LANG, F. Color Atlas of Pathophysiology, Thieme. 2016.
HALL, John E. Guyton and Hall textbook of medical physiology. 13th edition. Philadelphia, PA: Elsevier, [2016]. ISBN 978-1-4557-7005-2.
Ganong’s Review of Medical Physiology: https://accessmedicine.mhmedical.com/Book.aspx?bookid=2525
MCCANCE, K. L.; HUETHER, S. E. Pathophysiology: The Biologic Basis for Disease in Adults and Children. 2019; St. Louis, MO: Elsevier, 2019.
COSTANZO, Linda. Physiology Cases and Problems. Lippincott Williams & Wilkins, 2012.
NEČAS, Emanuel. Obecná patologická fyziologie. Karolinum, 2021, 1 online zdroj (312 stran). ISBN 978-80-246-4669-5.
NEČAS, Emanuel. Patologická fyziologie orgánových systémů. Karolinum, 2009.
NEČAS, Emanuel. Patologická fyziologie orgánových systémů. 2. vyd. V Praze: Univerzita Karlova v Praze, nakladatelství Karolinum, 2009, 2 svazky (379 stran, strana 381-760) . ISBN 978-80-246-1710-7.
Last update: Maxová Hana, doc. MUDr., Ph.D. (18.09.2023)
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EXAM QUESTIONS FROM PATHOPHYSIOLOGY AND TOPICS FOR PATHOPHYSIOLOGY PRACTICAL EXAM modified, valid from 2023/2024
EXAM QUESTIONS FROM PATHOPHYSIOLOGY GENERAL Health, illness, death Disorders of temperature control Edema, ascites Concrements, colic Icterus Acidosis Alkalosis Hyperhydration Dehydration Disorders of K+ and Cl- metabolism, relation to AB balance Disorders of Ca, P metabolism Classification of hypoxias, consequences Ischemia, ischemia-reperfusion injury, oxidative stress Chemical and toxic injury of organism Inflammation, SIRS, sepsis AB balance testing
BLOOD Anemic syndrome Anemias caused by erythrocytes loss Anemias caused by impaired hematopoesis Hyperviscosity Disorders of hemostasis DIC Hematologic testing
CIRCULATION Pathophysiology of arteries, atherosclerosis Pathophysiology of capillaries and veins, vein thrombosis Primary arterial hypertension Secondary hypertension Hypovolemic shocks, compensatory mechanisms Distributive shocks Acute heart failure Chronic heart failure Disorders of coronary circulation, clinical forms of ischemic heart disease Acute myocardial infarction Hemodynamics of valvular defects Hemodynamics of congenital heart defects Disturbances of impulse conduction in the heart and cardias arrhythmias, including ECG findings Testing of cardiovascular system Characteristics of pathological ECG recordings
KIDNEY Disturbances of renal blood flow Disorders of glomerular filtration Disorders of tubular transport Nephrotic and nephritic syndrome Acute renal failure Chronic renal failure Disorders of urinary tract Dialysis: principles and effect Testing of renal function
RESPIRATION Changed compliance of lung and respiratory system Changed airway resistance Pneumothorax Defense lung reflexes Control of breathing in respiratory diseases Disturbances of alveolar ventilation, respiratory insufficiency Hypobaria, hyperbaria Artificial ventilation, oxygenotherapy Inequalities of ventilation-perfusion ratio Diffusion impairment, lung edema Pulmonary embolism Pulmonary hypertension Bronchial asthma Obstructive pulmonary diseases, especially COPD Restrictive pulmonary diseases Lung function tests
ENDOCRINOLOGY Disturbances of hormonal regulations Disorders of adenohypophysis Cushing’s syndrome Addison’s disease, disorders of mineralocorticoids Disorders of adrenal medulla, stress Hyperfunction of thyroid gland Hypofunction of thyroid gland Disorders of sex hormones in ontogenesis Diabetes mellitus, classification and acute complications Chronic complications of diabetes mellitus Examination of endocrine glands
GIT, METABOLISM Obesity Metabolic syndrome, gout Primary hyponutrition Malabsorption syndrome Consequences of vitamin deficiency, hypervitaminosis Disorders of oesophagus and stomach Vomiting, diarrhea Constipation, ileus Pancreatitis Liver failure Portal hypertension and ascites Examination of function of liver and pancreas
NERVOUS SYSTEM Disorders of somatosensoric sensation Pain Visual disorders Hearing disorders Disorders of the vestibular system, olfaction and taste Disorders of neuromuscular junction and muscles Lower motor neuron disorders (flacid paralysis) Upper motor neuron disorders (spastic paralysis) Spinal shock Disorders of basal ganglia Cerebellar disorders Disorders of cerebral blood flow Intracranial hypertension and hypotension Brain edema, disorders of brain blood barrier Epilepsy and epileptic seizures Sleep disorders and disorders of consciousness Syndrome of dementia Schizofrenia, mood disorders Examination method in neurology
TOPICS FOR PATHOPHYSIOLOGY PRACTICAL EXAM 1. Description of ECG (physiological x basic pathological findings)
2. Description of hemodynamic changes (heart failure, valve disease, systemic hypertension, hypotension)
3. Interpretation of lung function testing (physiological x pathological findings)
4. Physical principles in the pathophysiology of breathing (compliance, elasticity, static and dynamic work of breathing, hypobaria, hyperbaria)
5. Principles of dialysis
6. Description of EMG – conduction velocity, H-reflex
7. Interpretation of oGTT (physiologic curve x diabetes mellitus, malabsorption, hyperthyroidism)
8. Interpretation of laboratory findings – reasoning (reference values x patient values) Last update: Maxová Hana, doc. MUDr., Ph.D. (13.09.2023)
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SYLABUS OF PATHOLOGICAL PHYSIOLOGY modified, valid from 2023/2024
GENERAL Health, illness, death – definition, symptom/syndrome/disease, stages of a disease, extrinsic and intrinsic causes of diseases, clinical and biological death, signs of brain death Disorders of temperature control – fever, hyperthermia and its consequences, hypothermia and reaction of the body Edema, ascites – Starling forces, generalized (heart failure, hypoproteinemia) versus localized (inflammatory, venostatic, lymphostatic), pathogenesis of ascites Concrements, colic - concrement formation (types, saturation of fluid, AB balance), characteristics of different types of colic and their propagation, other consequences of concrements Icterus – causes (prehepatal, hepatal, posthepatal), diagnostics, complication Acidosis – metabolic, respiratory, causes, compensation, consequences (influence on ICF) Alkalosis - metabolic, respiratory, causes, compensation, consequences (influence on ICF) Hyperhydration – iso/hyper/hypo-osmolar, causes, consequences (lung and brain edema) Dehydration – iso/hyper/hypo-osmolar, causes, consequences (blood viscosity, hypovolemic shock) Disorders of K+ and Cl- metabolism, relation to AB balance – causes, ICF/ECF, resting membrane potential, arrhythmias, sceletal muscles Disorders of Ca, P metabolism - parathyroid glands, relation between Ca and P, parathormon, vitamin D, calcitonin, causes and consequences (tetany, calcifiation) Classification of hypoxias, consequences - pathophysiological mechanisms of hypoxic, ischemic, anemic, histotoxic hypoxia, clinical signs, compensatory mechanisms, HIF Ischemia, ischemia-reperfusion injury, oxidative stress – role in pathogenesis opf disese, consequences on cellular level, ROS, NOS, antioxidants Chemical and toxic injury of organism – CO, cyanide, nitrates, organophosphates, botulism, alcohol, methanol, paracetamol, amanitin, faloidin, salicylates, digitalis, atropine Inflammation, SIRS, sepsis - primary and secondary trauma, general mechanisms of cellular damage, factors affecting the susceptibility of specific cells/tissues/organisms to various forms of damage, mechanisms of acute inflammation, chronic inflammation, SIRS/sepsis - definition, pathophysiological mechanisms, clinical signs AB balance testing – pH, respiratory (CO2) and metabolic component (BE, HCO3-), AG, Cl-corr, principals of blood sampling and measurement
BLOOD Anemic syndrome – symptoms (paleness, fatigue, dyspnea), compensatory mechanisms Anemias caused by erytrocytes loss - chronic posthemorrhagic (causes – GIT, urogenital system), hemolytic (causes), lack of iron, chronic disease anemia (hypersplenism, renal insufficiency, liver, tumors) Anemias caused by impaired hematopoesis – bone marrow disorders, erythropoetin, Fe, B12 Hyperviscosity – causes (polyglobulia, CML, paraprotein), symptoms (CNS, heart, cyanosis, thrombosis/bleeding) Disorders of hemostasis – conditions related to hypercoagulation or bleeding diathesis, innate and acquired disorders DIC – causes, pathogenesis and consequences Hematologic testing - complete blood count, morphologic classification of anemia, percentages of the types of WBCs, erythrocyte sedimentation rate, tests of hemostasis (Quick, aPTT)
CIRCULATION Pathophysiology of arteries, atherosclerosis – narrowing and obstruction, aneurysms, atherosclerosis (pathogenesis, symptoms) Pathophysiology of capillaries and veins, vein thrombosis – edemas, specific features of venous flow, thrombosis (deep venous thrombosis, thrombophlebitis), chronic venous insufficiency, varices, embolism Primary arterial hypertension – mechanisms of BP regulation, BP values, decreased compliance of large arteries, causes (CO, kidneys, sympathetic , endothelium), consequences, principals of therapy Secondary hypertension – renal (parenchyma, renovascular), endocrine (types), hypertension during pregnancy Hypovolemic shocks, compensatory mechanisms – types, stages of shocks, compensatory mechanisms and circulation failure causes, organ consequences, principles of therapy Distributive shocks – septic, anaphylactic, neurogenic, causes of vasodilation (NO), principles of therapy Acute heart failure – factor influencing CO, left/right side failure, causes, cardiogenic shock, central venous pressure, symptoms, diagnostics (EF, CVP), principles of therapy Chronic heart failure – classification of heart failure, causes, compensatory mechanisms (Frank-Starling´s law), molecular mechanisms, principles of therapy Disorders of coronary circulation, clinical forms of ischemic heart disease – determinants of myocardial oxygen supply, coronary bed flow, causes, acute coronary syndrome and chronic forms of IHD Acute coronary syndrome – causes, consequences of coronary flow arrest, symptoms, principles of diagnostics (ECG, laboratory findings) and therapy, life threatening complications of MI Hemodynamics of valvular defects – causes of valvular defects, volume and pressure overload, consequences (heart failure, pulmonary hypertension) Hemodynamics of congenital heart defects – without shunt (coarctation), with shunt (septal defects, PDA, Fallot´s tetralogy), factors influencing hemodynamics Disturbances of impulse conduction in the heart and cardias arrhythmias, including ECG findings – causes (disturbances of AP conduction - blocks, ectopic AP generation, reentry), consequences, principles of therapy Testing of cardiovascular system – BP, ECG, echocardiography, Holter monitoring, myocardial perfusion scintigraphy, ergometry (ischemia, anaerobic treshold) Characteristics of pathological ECG recordings - myocardial hypertrophy, ischemic changes, ions imbalance - K+ and Ca2+
RENAL DISEASES Disturbances of renal blood flow – causes of decreased and increased renal blood flow, consequences, autoregulation and its changes Disorders of glomerular filtration – quantitative and qualitative Disorders of tubular transport – innate and acquired, symptoms and consequences(ability to concentrate, ions imbalace, AB balance) Nephrotic and nephritic syndrome – pathogenetic mechanisms and symptoms, consequences, principles of therapy Acute renal failure – causes (prerenal, renal, postrenal), phases (oliguric, polyuric), consequences (disturbances of ECF, ions, AB balance, uremia) Chronic renal failure - causes, consequences, compensatory mechanisms, chronic cardiorenal and renocardial syndrome, hepatorenal syndrome Disorders of urinary tract – incontinence, urine retention, vesicoureteral reflux, urolithiasis Dialysis: principles and effect – hemodialysis and peritoneal dialysis, principles, indications, advantages and disadvantages Testing of renal function – urinalysis (casts, protein, hematuria, glucose), GFR and eGFR, fractional excretion, ability to concentrate, urodynamic tests
RESPIRATION Changed compliance of lung and respiratory system - causes, consequences – components of lung compliance (elasticity, surface tension), static and dynamic measurement, work of breathing, atelectasis Changed airway resistance – factors affected airway resistance, extrathoracic and intrathoracic (air trapping, equal pressure point), consequences of increased airway resistance (work of breathing, V/Q) Pneumothorax – causes, classification, consequences (tension type), mechanism of reabsorption, therapy Defense lung reflexes – sneezing, protective apnoea, cough (causes, complications) Control of breathing in respiratory diseases - ventilatory response to hypoxia and hypercapnia – central and peripheral receptors, isoventilatory response, changed respiratory regulation in chronic hypercapnia, pathologic respiratory patterns (Cheyne-Stokes´, Biot´s, Kussmaul´s) Disturbances of alveolar ventilation, respiratory insufficiency – hypo- and hyperventilation, causes, consequences - respiratory insufficiency (partial/global, latentn/manifest), AB dysbalance, tetany, dyspnea Hypobaria, hyperbaria – adaptation to life in high mountains, high altitude sickness, pulmonary and brain edema, chronic high altitude sickness, nitrogen narcosis, decompression sickness Artificial ventilation, oxygenotherapy – volume or pressure controlled, assist-control mode, PEEP, high frequency oscillatory ventilation, ways of oxygen administration, hyperbaric, side effects Inequalities of ventilation-perfusion ratio – physiologic non-uniformity, hypoxic pulmonary vasoconstriction, causes of unequal ventilation and perfusion, consequences (venous admicture, alveolar death space) Diffusion impairment, lung edema – diffusion path prolongation, decrease of diffusion area, transfer factor, interstitial and alveolar lung edema, its causes and consequences Pulmonary embolism – causes, consequences according degree of embolism (acute, chronic), diagnostics, principles of therapy Pulmonary hypertension – causes of increased pulmonary resistance, types (precapillary, postcapillary, hyperkinetic), impact on vascular morphology, principles of therapy Bronchial asthma – changed mechanics of breathing, paroxysmal obstruction (air trapping, equal pressure point), causes (bronchial hyperreactivity), eosinophilic inflammation, consequences (hypoxemia, cor pulmonale, status asthmaticus), principles of therapy Obstructive pulmonary diseases, especially COPD – changed mechanics of breathing, pathogenesis of emphysema and bronchitis, clinical forms (pink puffers, blue bloaters), principles of therapy Restrictive pulmonary diseases – pulmonary fibrosis, pneumonia, RDS, ARDS – causes and consequences of restriction (mechanics of breathing, pulmonary hypertension), pathophysiology of ARDS a RDS Lung function tests - spirometry, bronchoconstriction and bronchodilation tests, blood gases, transfer factor, expired nitric oxide
ENDOCRINOLOGY Disturbances of hormonal regulations – hypothalamic-pituitary axis (primary, secondary and tertiary disorders), feedback loop, causes of hypo- and hyperfunction Disorders of adenohypophysis – regulatory hormones, growth hormone, prolactin, panhypopituitarism Cushing’s syndrome – causes (ACTH dependent, independent, iatrogenic), consequences of increased glucocorticoid levels (obesity, muscle atrophy, diabetes, hypertension, immunosuppression, striae, osteoporosis, CNS) Addison’s disease, disorders of mineralocorticoids – causes and consequences of increased mineralocorticoid levels, hypocorticalism, Addisonian crisis Disorders of adrenal medulla, stress – causes and consequences of increased catecholamines levels (vasoconstriction, organ perfusion), stress reaction, pheochromocytoma Hyperfunction of thyroid gland – causes and consequences of increased thyroid hormone levels, Graves-Basedow´s disease, thyreotoxic crisis Hypofunction of thyroid gland – causes (acquired, congenital) and consequences of decreased thyroid hormone levels, Hashimoto’s thyroiditis, myxedematous coma Disorders of sex hormones in ontogenesis – sex determination and development (types – chromosomal, gonadal, genital, hormonal), (pseudo)hermaphroditisim, (pseudo)pubertas praecox Diabetes mellitus, classification and acute complications – types, prediabetes, insulin deficiency x resistance, symptoms of DM, coma hypoglycemic, ketoacidotic and hyperosmolar (principles of therapy) Chronic complications of diabetes mellitus – macrovascular, microvascular – nephropathy, retinopathy, neuropathy, diabetic foot syndrome, principles of therapy of DM Examination of endocrine glands – adrenal glands (24 hour measurement, dexamethasone suppression test, ACTH production), thyroid gland (TSH/T3/T4, antibodies), DM – glycemia, oGTT, C-peptide, glycated hemoglobin
GIT, METABOLISM Obesity – primary and secondary, types of obesity and adipose tissue (endocrine function), consequences and risks of obesity Metabolic syndrome, gout – diagnostic criteria and other disorders in metabolic syndrome, insulin resistance, hyperuricemia – causes and clinical manifestations Primary hyponutrition – kwashiorkor, marasmus, simple and stress starvation, cachexia, disorders of food intake (anorexia, bulimia), consequences of malnutrition Malabsorption syndrome – primary (coeliac disease, selective malabsorption) and secondary, consequences of malabsorption Consequences of vitamin deficiency, hypervitaminosis – vitamin A (retina, keratinization), D (Ca/P metabolism), E, K (blood clotting), B1 (beri-beri), folic acid and B12 (anemia, CNS), C (scurvy) Disorders of oesophagus and stomach – motility disorders, GERD, early and late dumping syndrome, pathogenesis of ulcers, functional consequences of gastritis Vomiting, diarrhea – causes (pathogenesis), consequences (changes in hydration, ions, AB balance), complications Constipation, ileus – causes (pathogenesis), consequences (changes in hydration), types of ileus and life threatening complications Pancreatitis – acute and chronic, pathogenesis, diagnostics, consequences and complications (shock, DIC, ARDS), principles of therapy Liver failure – acute and chronic, causes, diagnostics and consequences (encephalopathy, coagulopathy, hepatorenal and hepatopulmonary syndrome) Portal hypertension and ascites – pathogenesis, portocaval shunts, splenomegaly, hypoalbuminemia, hyperaldosteronism, complications Examination of function of liver and pancreas – liver tests, albumin, INR, ammonia, amylase, lipase
NERVOUS SYSTEM Disorders of somatosensoric sensation– dissociation of sensation, spinal syndromes - anterolateral and medial lemniscal system Pain – nociception mechanisms, peripheral and central sensitization, pain classification, principles of pain therapy Visual disorders – diseases of the optical apparatus of the eyes (abnormalities of refraction, glaucoma and cataract), diseases of the retina (retinitis pigmentosa, diabetic retinopathy, night and colour blindness), pathophysiology of the visual pathway and visual information processing, overview of visual examination Hearing disorders – conductive and sensorineural hearing loss, overview of hearing tests Disorders of the vestibular system, olfaction and taste - vertigo, kinetosis, Meniere's disease, vestibular nystagmus, loss/reduction of olfactory and gustatory perception, olfactory and gustatory pseudohallucinations Disorders of neuromuscular junction and muscles – motor unit, toxins, myastenia, Lambert-Eaton, muscular dystrophies, myotony, endocrine myopathies Lower motor neuron disorders (flacid paralysis) – causes (radiculopathies, neuropathies), paresis/plegia, atrophy, hyporeflexia, fasciculations and fibrilations Upper motor neuron disorders (spastic paralysis) – causes (corticospinal tract lesions, motoric cortex, decortication and decerebration), paresis/plegia, spasticity, abnormal reflexes (Babinski) Spinal shock – pseudoflacid plegia, phases of development, organ consequences (urinary bladder), neurogenic shock, autonomic dysreflexia Disorders of basal ganglia – pathways (direct and indirect) and mediators of BG, hypokinetic-hypertonic syndrome (parkinsonism), hyperkinetic-hypotonic syndrome (chorea, athetosis, hemibalism) Cerebellar disorders – paleocerebellar (ataxia, titubation) and neocerebellar syndrome (dyssynergia, dysmetria, adiadochokinesis) Disorders of cerebral blood flow – flow regulation, global disorders and strokes, ischemic (TIA, RIND) and hemorrhagic strokes, hypoxic-ischemic encephalopathy), excitotoxicity, penumbra, consequences (motor functions, aphasia etc.), principles of therapy Intracranial hypertension and hypotension – Monro-Kellie doctrine, causes, symptoms (trias), consequences (herniations), princples of therapy Brain edema, disorders of brain blood barrier– types (vasogenic, cytotoxic, osmotic, interstitial), brain blood barrier - permeability, ontogenetic development (newborns) Epilepsy and epileptic seizures – causes (neurotransmitters, paroxysmal depolarization shift), focal (with elementar or complete symptomatology), generalized (with motoric or without motoric symptoms), status epilepticus Sleep disorders and disorders of consciousness – disorders of REM and nonREM phases (insomnia, narcolepsy, somnambulism, sleep paralysis, pavor nocturnus, sleep apnea), causes of disorders of consciousness (ARAS), quantitative and qualitative disorders (GCS) Syndrome of dementia - cognitive functions, degenerative, vascular, Alzheimer´s disease, frontotemporal dementia, Lewyho bodies dementia Schizofrenia, mood disorders – neurotransmitters, positive (hallucinations, delusions) and negative signs, unipolar and bipolar disorder, anxiety Examination method in neurology – EMG, EEG, polysomnography, monosynaptic reflex
Last update: Maxová Hana, doc. MUDr., Ph.D. (13.09.2023)
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