modified contents of systematic pathology

8/12/2019 Modified Contents of Systematic Pathology

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Specific objectivesDiseases of the vascular system:

This chapter aims at providing the students with the ability to:

1-define atherosclerosis, medial calcific sclerosis and arteriosclerosis

2- List the risk factors for atherosclerosis, and explain the role major risk factors in the pathogenesis

of the disease.

3- Describe the morphologic details of the classic and the complicated lesions of atherosclerosis4- Explain the theories of atherogenesis and the role of endothelial cells, macrophages, smooth

muscle cells, and lipoproteine and the possible role of thrombosis

5- Correlate the clinical course with the lesions and complications of atherosclerosis

6- Define hypertension and explain the difference between benign and malignant hypertension

7- Explain the role of the blood volume and peripheral resistance, and the role of the rennin-

angiotensin-aldosterone system in the regulation of blood pressure.

8- Describe the morphologic features of arteriolosclerosis.

9- List the important types of vascultitis ( polyarteritis nodosa, hypersensitivity angiitis, wegner

granulomatosis, temporal arteritis, Takayasu arteritis, Kawasaki disease, and thrombo-angiitis

obliterans).

10- Explain the difference between Raynauds disease and Raynauds phenomenon

11- List the common types of aneurysms, and explain the differences between them (atherosclerotic,

dissecting, syphilitic, mycotic, and the congenital types)

12- Define varicose veins, list examples and describe their possible complications

13- List the causes of lymphangiitis and lymphedema, and explain their complications.

14- list the types of vascular tumors and tumor-like lesions, and describe their biologic and

morphologic characteristics (hemangiomas, glomangioma, hemangioendothelioma,

hemangiopericytoma, hemangiosarcoma, Kaposis sarcoma, lymphangiomas, and

lymphangiosarcomas)

Diseases of the heart:


1- list the mechanisms of cardiac dysfunction and cardiac adaptation

2- Explain the dynamics of the left sided and right sided heart failure, causes, and effects.

3- Explain the pathogenesis of ischemic heart diseases, and the role of fixed coronary obstruction,

coronary thrombosis, vasoconstriction and increased oxygen demands

4- Define four syndromes of ischemic heart diseases ( Angina pectoris, myocardial infarction, chronicischemic heart diseases and sudden cardiac death)

5- Explain the differences between stable, Prenzemetals, and unstable angina

6- Explain the pathogenesis of myocardial infarction, and describe the functional and morphologic

changes of myocardium following occlusion of the coronary artery.

7- Compare between transmural and subendocardial myocardial infarctions

8- Explain the clinical course and complications of myocardial infarction.

9- Explain the diagnostic tools and therapeutics intervention for acute myocardial infarction.

10- Define chronic ischemic heart diseases and describe the morphologic changes and clinical course

11- Define sudden cardiac death, and list the most probable causes

12- Describe the structural and functional changes in the heart in hypertension

13- Define Cor-pulmonale and explain its causes and effects.

14- List the causes of mitral and aortic valve lesions and describe their effects

15- Describe calcific aortic valve disease in normal and in congenitally bicuspid valves16- Describe the morphologic features and clinical effects of mitral valve prolapse.

17- Explain the pathogenesis of rheumatic fever, and describe the cardiac lesions in acute and

chronic phases of the disease

18- Compare between acute and subacute infective endocarditis, regarding etiology, morphological

changes and complications

19- Describe the characteristic features of non-bacterial thrombotic (Marantic) and Limbman-Sacks

endocarditis.

20- Describe the cardiac changes in Carcinoid syndrome

21- Compare the three types of cardiomyopathies ( Dilated, hypertrophic, and restrictive)


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22- List the major causes of myocarditis, and describe the structural changes and effects.

23- List the types of pericardial effusion, and the types of acute and chronic pericarditis

24- List the primary tumors of the heart, and describe the morphology and clinical course of atrial

myxomas.

25- Classify congenital heart diseases, and describe the anatomic and hemodynamic changes in:

atrial septal defect, ventricular septal defect, patent ductus arteriosus, Fallots tetralohgy,

transposition of great arteries, truncus arteriosus, tricuspid atresia, total anomalous pulmonary

venous connections, coarctation of aorta, pulmonary stenosis, and aortic stenosis.

Diseases of the lung:


1- Differentiate between pulmonary vascular disease, obstructive airway disease, and

restrictive pulmonary disease

2- Identify the mechanism of pulmonaryhemodynamic edema of left-sided heart failure, and

pulmonary edema of microvascular injury in adult respiratory distress syndrome

3- Explain the wide range of effects of pulmonary embolism, from no symptoms altogether, to

immediate death, or hemorrhagic infarct of the lung, or pulmonary hemorrhage, or pulmonary

hypertension and cor-pulmonale

4- Enumerate the causes of pulmonary hypertension, and describe its effects.

5- Explain the mechanism of absorptive and compressive atelectasis (collapse).6- Define emphysema, enumerate its types, and explain the protease-antiprotease theory. Describe

the morphologic changes and functional abnormalities in emphysema

7- Define chronic bronchitis and explain the morphologic changes and clinical course

8- Define bronchial asthma, and explain the pathogenesis of the extrinsic allergic and the non-

reaginic types of asthma. Describe the morphology of the lungs, the functional changes and the

clinical course

9- Define bronchiectasis and explain its pathogenesis. Describe the morphologic and functional

changes, the clinical course and complications.

10- Differentiate between lobar pneumonia, bronchopneumonia and interstitial pneumonia, in terms

of the causative agents, the morphologic changes, the clinical course and complications.

11- Describe the pathogenesis of lung abscess, its morphology, effects and complications.

12- Differentiate between primary and secondary pulmonary tuberculosis, regarding the

pathogenesis, morphologic characteristics, patterns of progression and prognosis.13- List the causes of diffuse interstitial pulmonary fibrosis, and explain the morphologic and

functional changes of the lungs in idiopathic pulmonary fibrosis.

14- Explain the risk factors for lung cancer. Describe the morphologic and biologic differences

between squamous cell carcinoma, small cell undifferentiated (oat cell) carcinoma, adenocarcinoma,

large cell undifferentiated carcinoma, bronchioloalveolar carcinoma, and carcinoid tumors. Explain

the clinical course, modes of presentation and commonly associated paraneoplastic syndromes

15- List types of pleural effusion, their common causes and clinical effects.

16- Define pneumothorax, and explain the causes and clinical effects

17- Describe the epidemiology, morphology and clinical course of pleural mesothelioma.

Diseases of the Head and Neck:


1- List the inflammatory and neoplastic condtions of the external ears.2- Differentiate between acute suppurative and acute serous otitis media, and explain how can

chronic otitis media cause hearing impairment, osteomyelitis of the mastoid air cells, and rarely

brain abscess

3- Explain the relationship between otitis media and cholesteatoma.

4- Explain how can lesions of the inner ear; such as otosclerosis, Menieres disease, labyrinthitis and

acoustic neuroma encroach on the vestibular and choclear functions, and result in hearing

impairment and vertigo.


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Diseases of the Liver, Biliary System & Exocrine pancreas:

Students should be able to perform the following:

1- List the mechanisms of jaundice and provide examples of congenital and acquired forms .

2- Describe the circulatory disturbances of the liver associated with hepatic vein obstruction, portal

vein obstruction, and hepatic artery occlusion.

3- Describe the morphologic and topographic variations of hepatocyte necrosis.

4- Compare between the types of viral hepatitis (hepatitis A,B,C,D,E, and G), with references to:

epidemiology, pathogenesis, and clinical syndromes. Describe the morphologic characteristics of the

liver in the healthy carrier state, acute hepatitis, fulminating hepatitis, severe chronic (active0

hepatitis and mild chronic (persistent) hepatitis.

5- Identify cholangitis, pericholangitis, and primary sclerosing cholangitis.

6- Describe the morphology and clinical course of liver abscesses.

7-Define cirrhosis, and explain the pathogenesis and clinical course of alcoholic liver disease, post-

necrotic cirrhosis, alpha-I-antitrypsin deficiency, Wilsons disease, cardiac cirrhosis and and the rare

congenital types of cirrhosis.

8- Describe benign and malignant tumors of the liver, with reference to predisposing factors,

morphologic features and clinical course. The list should include: hepatocellular adenoma, bile duct

adenoma, hepatocellular carcinoma, cholangiocarcinoma, hebatoblastoma.

9- Explain the pathogenesis of gallstones, their morphology, clinical course and complications.

10- Describe acute and chronic cholecystitis, morphologic changes and clinical course.

11- Describe tumors of gall bladder and bile ducts (The ampulla of Vater).12- Explain the pathogenesis of acute and chronic pancreatitis, and describe the morphologic

features and clinical course.

13- Enumerate tumors of the pancreas, and give an account of pancreatic carcinoma.

Diseases of the Endocrine Pancreas:

Students should be able to:

1- Define diabetes mellitus, describe the characteristics of different types. Explain the pathogenesis,

the morphologic changes, and the metabolic abnormalities that determine the clinical course and

complications.

2- Give a brief account of islet cell tumors, with special reference to insulinomas, glucagonomas, and

gastrinomas.

3- List the pathogical finding in Zollinge-Ellison syndrome, and in the multiple endocrine neoplasia

(MEN) syndromes

Diseases of the urinary system;

Students must be able to:

1- Explain the pathological changes in chronic renal failure; the water and electrolyte disturbances,

abnormalities in calcium and phosphates metabolism, the cardiopulmonary, hematopoietic,

gastrointestinal, skeletal, dermatologic and neurologic changes.

2- Define the major clinical syndromes associated with renal diseases: nephritic and nephritic

syndromes, proteinuria, hematuria, pyuria and bacteruria.

3- Enumerate the most common congenital anomalies of the kidneys, and list the important types of

cystic renal disease.

4- Explain the pathogenesis of glomerulonephritis (GN), and descrie the morphologic and clinical

changes that characterize the following glomerular diseases: acute poststreptococcal GN, rapidly

progressive GN, membranous GN, minimal change disease, focal segmental glomerulosclerosis,membrano-proliferative GN(type I&II), focal proliferativwe GN, IgA-nephropathy (Bergers

disease), and chronic GN. Students must be able to differentiate between these disease, regarding

their etiology, pathogenesis, microscope, immunofluoresence and electron-microscopy.

5- Describethe glomerular lesions in association with systemic diseases, such as diabetes mellitus,

SLE, amyloidosis, henoch-schonlein purpura, and bacterial endocarditis.

6- List the pathogenesis, clinical presentation and structural changes in acute tubular necrosis.


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7- Give a brief account of the different types of interstitial nephritis (IN), with special reference to

acute and chronic bacterial pyelonephritis, drug-induced and analgesic abuse IN, hypercalceic IN,

and hyperuricemic IN.

8- List the important renal vascular diseases, and explain the renal changes in hypertensive disease,

renal artery stenosis and thromboembolism.

9- List the causes of obstructive uropathy and describe the morphologic changes and the clinical

course. Explain the pathogenesis and morphologic features of renal calculi: the oxalate, uric acid and

urate, and the triple phosphates.

10- Enumerate the tumors of the kidneys, and describe the gross and microscopic characteristics of:

renal cell adenoma, renal cell carcinoma, Wilms tumor, transitional cell carcinoma of the renal

pelvis and urinary tract.

11- Describe the changes in urinary bladder in acute and chronic cystitis, and the inter-relation

between cystitis, stones, and tumors.

Diseases of the Male Reproductive System:


1- Define the important congenital abnormalities: hypospadias, epispadias, phimosis, paraphimosis

and cryptochidism.

2- List the inflammatory conditions of the male genital organs.

3- Explain the features of the premalignant lesions; Bowens disease, Bowenoid papulosis, and

erthroplasia of Queyrat.4- Describe the characteristic features of condyloma acuminatum, giant condyloma (Verrucous

carcinoma), and squamous cell carcinoma.

5- Describe the different types of orchitis and epididymitis, and explain the changes seen in

autoimmune granulomatous orchitis.

6- Describe the morphologic changes and the clinical course of torsion of the testis.

7- Explain the relationship of cryptochidism to infertility and development of seminoma.

8- Classify testicular tumors, and identify the characteristic features (including tumor markers) of

seminoma, embryonal carcinoma, teratoma, yolk-sac tumor, choriocarcinoma, Leydig-Sertoli cell

tumors, testicular lymphoma, and adenomatoid tumor of the epididymis.

9- Define hydrocele, hematocele, chylocele, spermatocele and varicocele.

10- Describe the clinical presentation, morphologic and diagnostic features of acute and chronic

prostatitis.

11- Describe the morphologic features and the clinical course of nodular hyperplasia of prostate.12- Describe the epidemiology, morphologic features and clinical course of carcinoma of the prostate.

Diseases of the Female Reproductive System:


1-Explain the causes and the pathologic changes in pelvic inflammatory disease.

2-Differentiate between lichen sclerosus et atrophicus and hyperplastic dystrophy.

3- Describe the morphologic characteristic and biological behavior of tumors of the vulva, including:

condyloma accuminatum, papillary hyradenoma, extramammary Pagets disease, squamous cell

carcinoma, and malignant melanoma.

4- Differentiate between the following tumors of the vagina: squamous cell carcinoma,

adenocarcinoma, and embryonal rhabdomyosarcoma.

5- Describe the morphologic changes in acute and chronic cervicitis, endocervical microglandular

hyperplasia, and endocervical polyps.6- Describe carcinoma of the uterine cervix; its pathogenesis, morphologic features and clinical

course.

7- Describe the cyclic endometrial changes, and the features of aovulatory cycles, inadequate luteal

phase and discordance between the glandular and stromal patterns.

8- Define senile cystic endometrial atrophy and cystic endometrial hyperplasia.

9- Explain the relationship between adenomatous hyperplasia of the endometrium, and endometrial

carcinoma.


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10- Describe the morphologic features and the clinical course of leiomyomas of the uterus, and

differentiate between leiomyomas and leiomyosarcomas.

11-Describe the morphologic features & clinical course of endometrial stromal sarcoma.

12- Describe the morphologic features of acute and chronic salpingitis.

13- List the common types of non-neoplastic cysts of the ovaries.

14- Classify ovarian neoplasms into: surface epithelial tumors, germ cell tumors, and sex cord-

stromal tumors, and list the specific members of each group.

15- Describe the morphologic characteristic and biological behavior of serous tumors, mucinous

tumors, Brenners tumor, and endometroid carcinoma.

16- Describe the morphologic features and biological behavior of dysgerminoma, ovarian teratoma,

yolk-sac tumor and choriocarcinoma.

17- Describe the characteristic features of granulose cell tumor, theca cell tumor, setoli cell tumor,

Leydig cell tumor, ovarian fibroma and hilus cell tumor (androblastomas).

18- Describe the etiology, morphologic features and clinical course of ectopic pregnancy

19- Describe the morphologic features and clinical course of toxemia of pregnancy

20- differentiate between complete and partial mole, invasive mole, and gestional choriocarcinoma

Diseases of the Breast:

Students are expected to do the following:

1- List the important congenital abnormalities of the breast and nipples.

2- Describe the changes in acute mastitis and breast abscess.3- Describe the morphologic changes of mammary duct ectasia and fat necrosis.

4- List the morphologic changes and clinical course of fibrocystic change of the breast.

5- Describe the morphologic features and biological behavior of the following tumors of the breast:

fibroadenoma, cystosarcoma phyyoides,and intraductal papilloma.

6- List the risk factors for breast carcinoma, and characteristic features of the following entities:

intraductal carcinoma, lobular carcinoma in-situ, invasive duct carcinoma, invasive lobular

carcinoma, medullary carcinoma, colloid carcinoma, papillary carcinoma, and Pagets disease of the

breast. Describe the important prognostic factors for breast carcinoma.

7- Define gynecomastia and describe the characteristic of carcinoma of the male breast.

Diseases of the Endocrine System:


1- Explain the hypothalamic-pituitary-target endocrine gland relationship.2- List the causes of hyperpituitarism, and describe the manifestations of the common pituitary

hyperfunction syndromes; including the amenorrhea-galactorrhea syndrome, gigantism, acromegaly,

and Cushings disease.

3- List the causes of hypopituitarism, and describe the manifestations of pituitary dwarfism &

hypogonadism, the Sheehans syndrome and the empty sella syndrome.

4- Describe the manifestations of diabetes insipidus, and the syndrome of inappropriate ADH

secretion by nonendocrine tumors.

5- Describe the manifestations of hyper-and of hypo-hypothyroidism.

6- List the types of thyroiditis, and describe the pathogenesis, morphologic changes and clinical

course of Hashimotos thyroiditis.

7- Define goiter, and differentiate between diffuse and nodular goiter, and between simple and toxic

goiter.

8- Describe the pathogenesis, morphologic changes and clinical course of graves disease.9- List the important types of thyroid adenoma and carcinoma, and describe their morphologic and

biological characteristics. The list of adenomas should include; fetal, hurthle cell, micro-and macro-

follicular. The list of carcinomas should include; papillary, follicular, medullary, and

undifferentiated carcinoma.

10- List the causes and effects of hyper-parathyroidism, and define primary, secondary and tertiary

hyper-parathyroidism.

11- List the causes and effects of hypo-parathyroidism, and define the syndromes of pseudo-

hypoparathyroidism and pseudo-pseudo-hypoparathyroidism.


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12- List the causes of adrenal cortical hypo-and hyperfunction.

13- Explain the effects of acute and chronic adrenal hypo-function. Describe the Waterhouse-

Friderichsen syndrome and Addisons disease as prototypes.

14- Explain the etiology and clinical course of the syndromes of adrenocortcal hyperfunction. The list

should include; Cushings syndrome, Conns syndrome, and congenital adrenal hyperplasia.

15- Describe the morphologic characteristic and biological behavior of pheochromocytomas and

neuroblastomas of the adrenal medulla.

Diseases of the Skeletal System:


1- List the common hereditary bone dystrophies and explain the pathogenesis, the morphologic

features and the clinical course of the following conditions: osteogenesis imperfecta, osteopetrosis,

achondroplasia, hereditary exostosis, fibrous dysplasia & fibrous cortical defect.

2- List the common aquired bone dystrophies, and explain the pathogenesis, the morphologic

characteristics, and the clinical course of the following: osteoporosis, rickets and osteomalacia,

osteitis fibrosa cystica, renal osteodystrophy, and pagets disease of bones.

3- Describe the steps of healing of bone fractures, and factors that influence healing.

4- Describe the steps of development of acute and chronc suppurative osteomyelitis, and the bone

lesions in tuberculosis and in syphilis.

5- Classify bone tumors, and describe the type of patient, the common location and the radiologic

pictures of osteoma, osteoid osteoma, osteoblastoma, osteosarcoma, chondroma, chondromyxoidfibroma, chondroblastoma, chondrosarcoma, Ewings tumor, and giant cell tumor of bone.

6- Explain the pathogenesis of osteoarthritis, and describe the morphologic changes in the affected

joints, and the clinical course of the disease.

7- Compare and contrast between osteoarthritis and rheumatoid arthritis; regarding the type of

patient, the associated manifestations, the joints involved, the nature of the pathological process and

the clinical course.

8- Describe the characteristic changes in the affected joints in suppurative arthritis, tuberculous

arthritis, Lime disease, gout and pseudogout.

9- Define: bursitis, ganglion, Bakers cyst, pigmented villonodular synovitis (nodular tenosynovitis,

giant cell tumor of tendon sheath).

10- Describe the morphologic and biologic features of the following soft tissue tumors: benign and

malignant fibrous histiocytoma, lipomas and liposarcomas, rhabdomyoma and rhabdomyosarcoma,

leiomyoma and leiomyosarcoma, fibroma and fibrosarcoma, tumor-like fibrous proliferation(fibromatosis) and synovial sarcoma.

Diseases of the Central Nervous System:


1-Explain the mechanism and clinical course of increased intracranial pressure, types of brain edema

and the causes and clinical course of hydrocephalus.

2- Compare acute suppurative meningitis, acute lymphocytic meningitis, and chronic meningitis,

regarding etiologic agents, morphologic changes and clinical course.

3- Describe the clinical presentation of encephalitis, and explain the differences between the group of

bacterial or fungal encephalitis, and the groups of acute and of slow viral encephalitis. Show the

morphologic differences between: herpes simplex, poliomyelitis, rabies, cytomegalovirus, HIV-1

encephalitis, subacute sclerosing panencephalopathies, progressive mutifocal leukoencephalopathy,

and subacute spongiform encephalopathies (prion disease).4- Describe the morphologic and functional characteristics of hypoxic brain injury, occlusive

cerebro-vascular diseases (Brain infarcts), and spontaneous hemorrhage (Intraparenchymal and or

subarachnoid).

5- Describe the brain lesions in hypertension, and define: lacunae, subcortical leukoencephalopathy,

and hypertensive encephalopathy.

6- Describe the mechanism, the morphologic changes, and clinical course of the different types of

traumatic brain injury including: epidural hematoma, subdural hematoma, concussion, contusion,

lacerations, intraparenchymal and subarachnoid hemorrhage, and diffuse axonal injury.


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7- Describe the differential morphologic and biological characteristics of the following brain tumors:

astrocytomas (various biologic grades: plocystic astrocytoma, anaplastic astrocytoma, and

glioblastoma mutiforme), oligodendroglioma, ependymoma, medulloblastoma, meningioma,

craniopharyngioma, pinealoma, dermoid cyst colloid cyst, schwannomas, neurofibromas,

lymphomas, and metastases.

8- Describe the clinical and morphologic features of demyelinating diseases, with special reference to

multiple sclerosis, perivenous encephalomyelitis, and leukodystrophies.

9- Describe the general features of the group of degenerative diseases of the nervous system, and

describe the characteristic morphologic and functional changes in the following representative

examples: Alzheimers disease parkinsons disease

Diseases of peripheral nervous System:


1- Explain the mechanism of degeneration and regeneration of peripheral nerves.

3- Explain how does the reaction of striated muscle to injury entails atrophy, degeneration, necrosis

and regeneration.

4- Describe the pathogenesis of myasthenia gravis, and its clinical course.

5- List the congenital and metabolic myopathies , and describe the Duchenne and Bekers types.

Diseases of the Skin:

Students should be able to:1- Define acute inflammatory dermatoses including: urticaria, acute eczematous dermatitis, and

erythema multiform. Describe its morphologic features.

2- List chronic inflammatory dermatoses: psoriasis and lichen planus and describe its morphologic

features.

3- List the blistering (bullous) diseases: pemphigus, bullous pemphigoid, and dermatitis

herpetitiformis. Explain its pathogenesis and describe its morphologic features.

4- List benign and premalignant epithelial lesions including: seborrheic keratosis, keratoacanthoma,

verruca (warts), and actinic keratosis. Describe its morphologic features.

5- List malignant epidermal tumors: suamous cell carcinoma and basal cell carcinoma. Explain its

pathogenesis and define its morphologic and biological characteristics.

6- Define tumors and tumor-like lesions of melanocytes: nevocellular nevus (pigmented nevus, mole),

dysplastic nevus, and explain the pathogenesis of malignant melanoma and describeits morphologic

and biological characteristics.

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