Handout - 1 - Intro Clin Med Lecture I Introduction (1).pdf

MMI 3013/HON 3253/MMI 6613 Intro to Clinical Medicine Lecture 1 Introduction to Clinical Medicine and Pathology (and a little history) Thomas G. Forsthuber, M.D. Dr. Med. Professor of Immunology Office: BSE 3.250B Office hours: Monday, 4:30 – 5:...

MMI 3013/HON 3253/MMI 6613 Intro to Clinical Medicine Lecture 1 Introduction to Clinical Medicine and Pathology (and a little history) Thomas G. Forsthuber, M.D. Dr. Med. Professor of Immunology Office: BSE 3.250B Office hours: Monday, 4:30 – 5:30 PM per Zoom or in-person E-mail: [email protected] How the class works: This course will be more fun if you participate This course is an introductory course to human diseases and underlying disease concepts Ask if you have questions First, we will discuss basic medical/pathological principles. Then we will discuss specific diseases During each lecture we will present a “case of the day” Illness does not look pretty. Be prepared for some graphic images. We will do Kahoots for review and fun This is the nature of medicine. You have been warned. There will be 4 multiple choice exams. Best 3 out of 4 count for The syllabus for the class explains the most important questions grade. Attendance at in-person lectures is required. Grading scheme and other information is in the syllabus Follow University Health and Safety guidelines (e.g. Covid, Flu) Recording of class content including live lectures is not Handouts will be posted on Canvas (before class if possible) allowed except under conditions outlined in syllabus. Exams are based on handouts. Please don’t take pictures. We will use parscore forms for exams Distribution of lecture content, including live lectures, is Grades will be posted ASAP after the exam strictly prohibited. No extra credit or make-up exams Second course will be offered during Spring semester with additional medical concepts in a group-based case presentation format (BIO 4473, Advanced Clinical Medicine). Pre-req is the present course. Handouts for the lectures will be posted before (if possible) each class Suggested Books for additional reading: Kumar, Abbas, Aster: Robbins Basic Pathology (Elsevier-Sounders, 10th edition or higher, ISBN 9780323353175; suggested) (~$91.99) Kumar, Abbas, Fausto, Aster: Pathologic Basis of disease (Elsevier- Sounders, 8th edition or higher, ISBN 978-1-4160-3121-5) MedScape for further readings: https://www.medscape.com/for-you StatPearls: https://www.ncbi.nlm.nih.gov/books/NBK430685/ Fun facts: The beginnings of “medicine” Today we will: Chinese traditional medicine over 5000 years old The Sumerians (Mesopotamia/today Syria/Iraq) and Egyptians knew about disease states and Briefly talk about the history of medicine had healers and specialists (3000 BC) Introduce some important and useful general medical Diseases were caused by bad spirits, worms, principles intestinal decay, punishment from the gods Today Introduce common clinical lab and diagnostic tests Greece is generally considered the cradle of modern Western medicine Greek medicine moved away from “supernatural” to natural causes, observation and logical thinking Greek Medicine revolved around the four “humors”: blood, phlegm, yellow bile, black bile. Not “science” but a step to form theories Greeks did not test their theories (no human anatomical studies or autopsies).  Imhotep Edwin Smith Papyrus © Jeff Dahl - Fragment from the Edwin-Smith Papyrus Two noteworthy ancient doctors Imhotep – “the one who comes in peace” (probably 2650 BC): pyramid builder and physician to the pharaoh Professional title: “Shepherd of the anus” Hippocrates (460-377 BC) founded a school of physicians whose writing have been preserved. He is credited with the Hippocratic Oath. He was instrumental in developing the four-humor theory. Earliest known writing on medicine Purchased in 1862 by Edwin Smith, American Egyptologist, from Mustafa Agha Imhotep speculated to be original author Includes information on trauma surgery, anatomy, diagnosis and treatment of 48 medical conditions including heart failure! Imhotep rejected “magic” in favor of science for healing Romans advanced Greek medicine Hippocrates (460 BC) Celsus (Aulus Celsus, roman writer/physician: 30 BC – 38 AD) identified the cardinal signs of inflammation. – He translated the work cancer from “crab” like growth described by the Greeks (Hippocrates). – He wrote “De Medicina”, a book on surgery, diet, pharmacy, etc. which still exists. Galen (Claudius Galenus, 129-201 AD, Greek physician. Considered one of the greatest physicians of all times. He worked as a physician to the Roman gladiators. His writings guided medicine for 1,500 years into the Middle Ages. Worked for roman emperor Claudius Aurelius and his son. Was the first to describe that: Arteries are filled with blood instead of “pneuma” (air). Urine is produced by kidneys Hippocratic Oath Spinal cord and spinal nerves control muscle function Hippocratic school taught careful observation, careful The heart is the origin of blood vessels, brain origin of nerves reporting of symptoms, use of observation for Sensory nerves are different from motor nerves prognostication Since he couldn’t do autopsies on humans so he got some facts Instrumental in developing the theory of the four humors wrong (he studied monkeys).  Edward Jenner (1749-1823) Medicine transforms into a science: Introduced first systematic vaccination Medicine did not advance beyond the teachings of Galen until the He discovered that cowpox could protect against smallpox Renaissance (13th – 14th century) – no substantial advancements) Leonardo da Vinci (1452-1519) learned from human dissection about the functions of muscles, bones, and tendons. William Harvey (1578-1657) Discovered that the blood is moved through the body by the heart (famous book ‘De Motu Cordis et Sanguinis’) Rudolf Virchow (1821-1905) introduced the concept of cellular pathology – diseases arise from alterations within cells and tissues using microscopic observation Ignaz Semmelweis (1818-1865) Robert Koch (1843-1910) Founder of modern bacteriology Established that sanitary conditions in surgery and the healthcare setting saves countless lives He compared childbed fever in maternity wards staffed by midwife vs doctors and medical students He became known as the “savior of mothers” Discovered causes of tuberculosis, cholera, anthrax  Louis Pasteur (1822-1895) The first “cellular pathologist”: Rudolf Virchow Ilustrierte Zeitung Berlin, 1902 Virchow is frequently called the “Father of modern Pathology” Credited with first recognizing leukemia Virchow’s node: enlarged left supra-clavicular lymph node as early sign of gastric cancer Discovered principles of vaccination, fermentation, and pasteurization Discovered pulmonary thromboembolism (he coined the term embolism) Discovered first vaccines for rabies and anthrax Founded cellular pathology and encouraged his students to think “cellular” and use microscopes “The only source for a living cell is another living cell” Sir Joseph Lister (1827-1912) Sigmund Freud (1856-1939) Father of psychoanalysis Father of antiseptic surgery Used phenol to sterilize instruments, wounds, dressings  George Papanicolaou (1883-1962) Sir Alexander Fleming (1881-1955) He discovered that vaginal smear could detect uterine cancer (1943) Discovery of penicillin and research on lysozyme He was a pioneer in early cancer detection He noticed in 1928 that mold (Penicillium notatum) inhibited the growth of Staphylococcus aureus on a culture plate Basic Principles of Human Disease The four pillars to understanding disease: Human diseases in the broadest sense are undesired deviations from the Disease etiology: the cause(s) of a disease. norm (the “generally accepted standard”) – Infection, injury, genetic defects, – Example: Streptococcus pneumonia infection of the lungs Diseases are usually detected if they cause signs or symptoms Pathogenesis: the disease process – Signs: Fever, high blood pressure, bleeding = can be seen by doctor, – Example: Streptococcus infection of the lung leads to lung detected by clinical tests (for example X-ray) damage, inflammation, fluid accumulation – Symptoms: pain, drowsiness, vertigo = reported by the patient, cannot Lesion = Morphologic changes/ultrastructural : structural changes in the affected tissues be measured. – Example: Bacterial pneumonia leads to lobar consolidation, inflammatory infiltrates, lung edema Some diseases are predetermined: example - genetic defects Functional changes = impaired function of an organ system = Some diseases are acquired: example - infection, trauma, degenerative clinical manifestation – Example: Lobar bronchopneumonia, fever, pain, malaise, possibly death! Some diseases can be seen by eye: example - jaundice Pathogenesis Functional Some diseases may be visible only with medical tests, imaging: example – Etiology Lesion changes pigment or inclusions visible in cells by microscope, urine protein.  How to recognize diseases (pathologic The diagnosis begins with observation alterations): A) The right arm is affected Reported by the patient (e.g. pain, nausea) B) The left arm is affected Gross examination: The alteration (lesion) is visible by naked eye (physical examination, autopsy) Histologic examination: Alterations are visible by microscope Laboratory examination: e.g. blood tests, urine sample, DNA test Specialized examinations: X-ray, ultrasound, endoscopy, magnetic resonance imaging, The scientific foundation for the cardinal signs of inflammation: The “old” physicians recognized “disease”: The four phases of acute inflammation: Celsus (30 BC – 38 AD) I. 0 – 4 hours: preformed factors: The four cardinal signs of acute inflammation: Antibodies, complement, serum Calor (heat) factors, vasoactive factors, Dolor (pain) CS: RUBOR, CALOR, Rubor (redness) II. 4 - 48 hours: influx of Tumor (swelling) neutrophils CS: RUBOR, CALOR, DOLOR, Galen (129-201 AD) TUMOR Fifth sign: functio laesa = Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 14 August 2006 10:46 PM) III. 24-96 hours: influx of Impaired function macrophages CS: RUBOR, CALOR, DOLOR, TUMOR, FUNCTIO LAESA WebPath IV. > 96 hours: adaptive immunity: T lymphocytes are activated and migrate to inflammatory site CS: DOLOR, TUMOR, FUNCTIO LAESA