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Clinical Pathology II - #24160


 

 
Linda J. Bowers, DC, Karen Ganzhorn
4.25
75.0
3.5
1.5

Students will interpret routine clinical chemistry studies as well as total laboratory interpretation using urinalysis, hematological, and chemistry findings. Case studies will be used to illustrate important concepts of laboratory diagnosis.
Please select from the list on the right.

The Institution-wide learning goals define the common ground that unites the programs within the university. They are purposefully broad so that the various colleges and schools can continue to develop their unique identities through varying ways in which the goals are met.

  1. Effective Communication
    Graduates will demonstrate effective verbal, non-verbal, and written communication skills in a wide variety of contexts, including collaborative activities.
  2. Self Directed and Lifelong Learning
    Graduates will be aware of the limits of one’s personal knowledge and experience and have an intellectual interest in scholarly and creative endeavors. Graduates will actively set appropriate learning goals, pursue them, and apply the knowledge gained.
  3. Ethical Reasoning
    Graduates will demonstrate a willingness to recognize the values of others while maintaining one’s own integrity, and act ethically and professionally in all endeavors.
  4. Individuals, Communities and Cultures
    Graduates will demonstrate awareness and sensitivity to the cultural and health practices of individuals and communities. Graduates will be able to identify appropriate health related resources.
  5. Service to the Community
    Graduates will understand and value the benefits of service to the community.
  6. Influence of Mind, Body and Spirit on Health
    Graduates will recognize the inter-relationship of the mind, body and spirit and the influence of extrinsic factors on an individual’s health.
  7. Critical Thought and Knowledge Acquisition
    Graduates will acquire, appraise and apply scientific information. Graduates will contextually organize and synthesize relevant information to address an issue or problem.
  8. Competence in one's Discipline
    Graduates will demonstrate competence of appropriate depth and scope for one's discipline.

Course Objectives
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  1. Describe tests that comprise a basic clinical chemistry panel, determine clinical situations that require these tests to be ordered, describe patient preparation for these tests, interpret test results, list common test interferences, and evaluate the need for follow-up testing.
  2. Evaluate the need for special chemistry tests, describe patient preparation and common test interferences, and interpret test results.
  3. Correctly diagnose a patient's problem given the history and laboratory results.
  4. Describe the etiology, incidence, signs and symptoms, laboratory findings, treatment rationale, and prognosis for the following conditions:
  1. Diabetes mellitus, impaired glucose intolerance, hypoglycemia
  2. Hyperlipoproteinemias, steatorrhea and malabsorption 
  3. Hepatitis, cirrhosis, liver cancer, cholestasis, fatty liver, primary biliary cirrhosis
  4. Hyperthyroidism, hypothyroidism, thyroiditis, thyroid cancer
  5. Hyperparathyroidism and hypoparathyroidism
  6. Selected NMS conditions: Paget's disease of bone, multiple myeloma, bone cancer, osteomyelitis, fat embolism, various arthritides, Lyme disease, Reiter's syndrome, osteoporosis, osteomalacia

    Topics covered:
  1. Carbohydrate disorders
  2. Protein disorders
  3. Lipid disorders
  4. Enzymes and disease
  5. Liver function tests
  6. Thyroid function tests
  7. Calcium and phosphorus metabolism and disease
  8. Kidney function tests
  9. Musculoskeletal disorders
Materials
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A. Required Text(s):
  1. Course lecture/lab notes (available in bookstore)

B. Recommended Text(s):
  1. Merck Manual
  2. Clincal Laboratory Medicine, Ravel
  3. The ABC's of Interpretive Laboratory Data, Bakerman

C. Required Materials for Lab:

Lab coat
Lab manual
Assignments
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  1. Read all handout materials and course notes
  2. In-class worksheets
Attendance
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It is vital to your success in this class that you attend lecture and lab. Therefore, if you miss 10% of lecture or lab you will be dismissed from class. Laboratory attendance is mandatory; absences from lab must be pre-arranged with and sanctioned by the instructor.  Unsanctioned laboratory absence will result in dismissal from the course.
Grading Criteria
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  1. It is your responsibility to see me regarding your performance in this class. Scores will be posted to eNorthwestern as soon as the homework/quizzes/exams are graded.
  2. My previous tests, quizzes, and worksheets are not sanctioned for student use. If you use a non-sanctioned test, quiz, or worksheet, you will be found guilty of cheating and, at a minimum, will receive a score of zero for that test, quiz or worksheet and the behavioral standards committee will be notified. If you are found guilty of inappropriate test-taking in any manner, you will receive a zero on that homework/quiz/exam and the behavioral standards committee will be notified.
  3. You must notify me as soon as possible if you are going to miss a quiz, test, or lab either by e-mail (lbowers@nwhealth.edu) or phone (952.885-5431).
  4. Make-up exams are given at my discretion. You need to fill out a make-up examination request form. Proof regarding the absence will be needed. (For example, wedding invitation, boarding pass, note from physician, funeral notice). Note: make-up examinations may be different from the original examination. Examinations cannot be taken early.
  5. Lecture quizzes (6 quizzes @ ~20-26 points each)
    Make-up quizzes will be given at the discretion of the instructor. Make-up quizzes will be worth a maximum of 50% of the original quiz. Exceptions will be made at the discretion of the instructor. You may not "drop" a quiz.
  6. In-class and homework assignments (~10 points)
  7. Midterm written lecture examination (100 points).
    The midterm examination may be reviewed by setting up a meeting with the instructor no later than 3 weeks after the midterm examination
  8. Final written lecture examination (100 points, not comprehensive).
  9. Grading: To pass this course you must demonstrate minimal competency by scoring 70% or better on written examinations and receive a passing score for the laboratory portion. Successful completion of the laboratory portion is necessary in order to receive a passing grade for the course.
  10. If you fail the course, you must re-take the entire course, i.e., both laboratory and lecture portions.
  11. Grievances involving my judgement in assigning a grade based on academic performance may be resolved only through an informal manner and not through any grievance procedure.

    Criteria for passing the laboratory portion:
    1. Worksheets: need a passing score on all worksheets
    2. Venipuncture: need 5 successful blood draws, one of which is a syringe draw, one is a butterfly draw
    3. Attendance:  mandatory for all 10 labs, attendance is taken at the beginning of the session; if you are not there at the beginning, you will be counted as absent.

Guaranteed grades are as follows:

A = 90 - 100 %
B = 80 - 89%
C = 72 - 79%
D = 70 - 71%
F = 69% or less
Course Competencies
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-

COGNITIVE DOMAIN


Students will be able to describe chemistry tests and when they should be ordered in a clinical setting:

Blood glucose HDLc, LDLc
Serum protein Bilirubin
Serum cholesterol Serum bile acids
Serum triglyceride Antimitochondrial antibodies
Alkaline phosphatase Antismooth muscle antibodies
Acid phosphatase Alpha fetoprotein test
Gamma glutamyl transpeptidase Thyroxine - free, total
Lactate dehydrogenase T3 uptake test
Creatine phosphokinase TSH - sTSH, usTSH
Aspartate transaminase (AST) TRF assay
Alanine transaminase Serum calcium and phosphorus
(ALT) BUN
Amylase Creatinine
Lipase Uric acid

Describe what tests comprise a basic clinical chemistry panel, what clinical situations require these tests to be ordered, how to interpret test results and what follow-up testing is needed:

Chemistry panel Cardiac function/health tests
Liver function tests  
Thyroid function tests Calcium/phosphorus metabolism
Kidney function tests Carbohydrate metabolism tests

Describe the etiology, incidence, signs and symptoms, laboratory findings, treatment rationale, and prognosis for the following conditions:

Diabetes mellitus, type I and II Thyroid cancer
Impaired glucose tolerance Hyperparathyroidism
Hypoglycemia Hypoparathyroidism
Hyperlipoproteinemia (types II and IV) Paget's disease of bone
  Bone cancer
Hepatitis: A, B, chronic active, alcoholic, chronic aggressive Arthritis (osteoarthritis, rheumatoid, septic, ankylosing spondylitis, gouty, psoriatic, pseudogout)
Cirrhosis Osteomyelitis
Liver carcinoma, primary and metastatic Fat embolism
Cholestasis - acute and chronic Multiple myeloma
Primary biliary cirrhosis Lyme disease
Hyperthyroidism Reiter's syndrome
Hypothyroidism Osteoporosis
Fatty liver Osteomalacia
Thyroiditis  


Given a case history and laboratory results, students will diagnose the following conditions:

Multiple myeloma Muscular dystrophy
Paget's disease of bone Malabsorption due to celiac sprue
Bronchogenic carcinoma with mets to bone Acute pancreatitis, alcoholic liver disease
Obstructive jaundice due to cancer of the head of the pancreas Viral infection, physiologic increase in calcium and phosphorus
Myxedema Acute blastic crisis of CML
Hodgkin's disease Bronchogenic carcinoma
Colorectal cancer with mets to the liver Myocardial infarction, HLP IIa
Vitamin B 12 deficiency Sickle cell crisis, respiratory infection
Secondary gout Cirrhosis
Hyperthyroidism Gilbert's syndrome
Psoriatic arthropathy Ulcer, iron deficiency anemia
Rickets, ear infection Infectious mononucleosis
Acromegaly Viral hepatitis B
Iron deficiency anemia Myasthenia gravis
Healing bone fractures, coma Ulcerative colitis


Conditions:
Clinical Condition Etiol. & Epidem Patho-physiology Nat.History & course Exam & Dx RX/ Mgmt
IDDM
3
2
2
1,2,3,5,7
3,5,6
NIDDM
3
2
2
1,2,3,5,7
3,4,5,6,8
Gestational dm
2
2
2
1,2,3,5,7
  
IGT
2
1
2
1,2,3,5
3,4,5
Hypoglycemia
3
1
2
1,2,3,5
3,5
HLP II and IV
2
2
3
1,2,3,5,7
3,5,6,8
Gluten-induced ent
2
2
2
1,2,3,5,7
3,5
Tropical sprue
2
2
2
1,2,3,5,7
3,6
Lactose intolerance
2
2
2
1,2,3,5,7
3
Cholestasis
2
3
2
1,2,3,5
3,5,6
Hepatitis A, B, CAH
2
3
2
1,2,3,5,7
5,6
Alcoholic liver disease
2
2
2
1,2,3,5
3,5
Fatty liver
2
2
2
1,2,3,5
5,6
Cirrhosis
2
2
2
1,2,3,5
3,5
PBC
1
2
2
1,2,3,5,7
6
Carcinoma (1,2)
2
2
2
1,2,3,5,7
6
Cretinism
2
2
2
1,2,3,5
6
Myxedema
3
2
2
1,2,3,5
3,6
Hyperthyroidism
3
2
2
1,2,3,5
6
Euthyroid goiter
2
2
2
1,2,3,5
3,6
Thyroiditis
3
2
2
1,2,3,5,7
6
Thyroid neoplasm
3
2
2
1,2,3,5,6,7
6
Hyperparathyroidism
2
2
2
1,2,3,5
6
Paget's disease
2
2
2
1,2,3,5,6
1,2,5,6
Multiple myeloma
2
2
2
1,2,3,5,6,7
3,4,6
Mets to bone
2
2
2
1,2,3,5,6
6
Osteosarcoma
2
2
2
1,2,3,5,6
6
Fat embolism
2
2
2
1,2,3,5
6
Osteomyelitis
2
2
2
1,2,3,5,6
6
Osteoarthritis
2
2
2
1,2,3,5,6
1,2,3,4,5,6
Rheumatoid arthritis
2
2
2
1,2,3,5,6
1,2,3,4,5,6,8
Juvenile RA
1
1
1
1,2,3,5
6
Felty's syndrome
1
1
1
1,2,3,5
6
Psoriatic arthritis
2
2
2
1,2,3,5,6,7
1,2,3,5,6
Gouty arthritis
2
2
2
1,2,3,5,6,7
1,3,4,5,6
Chondrocalcinosis
2
2
2
1,2,3,5,6,7
1,4,5,6
Septic arthritis
2
2
2
1,2,3,5,6
6
Ankylosing spondy
2
2
2
1,2,3,5,6,7
1,2,4,5,6
Lyme disease
2
2
2
1,2,3,5,7
6
Reiter's syndrome
2
2
2
1,2,3,5,6,7
1,5
Osteoporosis
2
2
2
1,2,3,5,6
1,3,4,5,6
Osteomalacia
2
2
2
1,2,3,5,6
3,6
Rickets
2
2
2
1,2,3,5,6
3,6
Muscular dystrophy
1
1
1
1,2,3,5
6
Acromegaly
1
1
1
1,2,3,5
6
Hypoparathyroidism
1
1
1
1,2,3,5
6


Elaboration of Coding Definitions Regarding Conditions/Topics

The following codes refer to the depth of coverage for Etiology and Epidemiology; Pathophysiology, and; Natural History and Course:

0 No coverage or content
1 Introduction, without test items
2 Moderate class discussion and/or handout material, with test items
3 Extensive discussion and/or handout material, with test items

For Exam and Diagnosis, the following numbers indicate which aspects of exam and diagnosis of each condition are taught in this course:

1 Presenting SX: Presenting symptoms related to condition are discussed.
2 History findings: Relevant personal and family history are discussed.
3 Exam findings: General physical exam findings are discussed.
4 Chiro. findings: Posture, subluxation, muscle tone and length, trigger pts.
5 Lab findings: Blood, urine, CSF
6 Imaging findings: Normal, CT, CAT, MRI
7 Special test findings: eg sweat test for cystic fibrosis, spirometry for asthma.

For Treatment/Management, the following numbers indicate which aspects of treatment and management of each condition are taught in this course:

1 Chiropractic: Adjustments, soft tissue techniques
2 PT: Physical therapy modalities of all types
3 Nutrition/Suppl: Diet and supplement recommendations
4 Exercise: Stretching, strengthening, aerobic exercise recommendations
5 Lifestyle Mgmt: Stress reduction, smoking cessation, allergen avoidance...
6 Medical: Drugs, antibiotics, surgical procedures, radiotherapy...
7 Other: Acupressure/puncture, massage, homeopathic or herbal Rx..
8 Guidelines: If published, do you refer to them regarding this condition?



PSYCHOMOTOR DOMAIN


Students will be able to obtain specimens for laboratory analysis including the following procedures:
  1. Correctly fill out a test request form.
  2. Process whole and clotted blood specimens and urine samples for routine urinalysis or culture for either analysis or mailing.
  3. Perform 3 successful multidraw venipunctures, one syringe draw and one butterfly draw safely, correctly, with minimum discomfort to the patient..
  4. Make acceptable peripheral blood smears.
  5. Perform a throat swab competently and safely, process the specimen and interpret the results.
  6. Adhere to OSHA regulations as they relate to laboratory office procedures during laboratory sessions.


Students will perform routine laboratory tests including:


a. Glucose c. Routine urinalysis
b. Hemoglobin, hematocrit d. Erythrocyte sedimentation rate


AFFECTIVE DOMAIN


Students will demonstrate integrity, sensitivity, respect, courtesy, compassion and professionalism at all aspects of this course.
Weekly Calendar of Learning Objectives
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Week Dates Topics/Learning objectives
Week 1 -- Lec: Carbohydrates: chemistry, metabolism, regulation of blood glucose, diabetes mellitus (IDDM, NIDDM, gestational, secondary, IGT), screening tests (questionnaire, urine glucose, FBG, 2hr-postprandial BG), diagnostic tests (OGTT, HbA1c), fasting hypoglycemia, postprandial hypoglycemia, case histories.
Lab 1: Three blood glucose measurements (one - self, two - unknowns) Case histories (3): carbohydrate. Ordering laboratory tests.
Week 2 -- Lec: Proteins: chemistry, functions, electrophoresis, albumin, alpha 1 globulins, alpha 2 globulins, beta globulins, gamma globulins (IgG, IgM, IgE, IgA, IgD), typical electrophoretic patterns
Lab 2: Urinalyses (1) - unknown, Venipuncture: multidraw, processing Case history: protein.
Week 3 -- Lec: Lipids: functions, chylomicrons, VLDL, LDL, HDL, metabolism, cholesterol, triglycerides, ketosis, steatorrhea, malabsorption, gluten-induced enteropathy, tropical sprue, lactose intolerance, qualitative fecal fat, chyluria
Lab 3: Urinalysis (1), Case history (3): cholesterol.
Week 4 -- Lec: Lipids: functions, chylomicrons, VLDL, LDL, HDL, metabolism, cholesterol, triglycerides, ketosis, steatorrhea, malabsorption, gluten-induced enteropathy, tropical sprue, lactose intolerance, qualitative fecal fat, chyluria
Lab 4: Multidraw venipuncture, Case history (2): cholesterol.
Week 5 -- Lec: Enzymes: alkaline phosphatase (ALP), acid phosphatase (ACP), gamma glutamyltransferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), amylase, lipase, lactate dehydrogenase (LDH), creatine phosphokinase (CPK), enzymes and disease (myocardial infarction, hepatitis, cholestasis, pancreatitis, prostate cancer, malignancy, hematopoietic disease, muscle disease), case histories.
Lab 5: enzymes.
Week 6 -- Lec: Liver: functions, liver function tests: bilirubin, ammonia, lipids, enzymes, proteins, serum bile acids, antimitochondrial antibodies, anti smooth muscle antibodies, alpha fetoprotein test, prehepatic jaundice, posthepatic jaundice, hepatic jaundice, cholestasis, hepatitis A, hepatitis B, chronic hepatitis, alcoholic liver disease, fatty liver, cirrhosis, primary biliary cirrhosis, carcinoma, case histories.
No lab, midterms:
Week 7 -- Lec: Liver function tests continue, midterm
Lab 6: Venipuncture: multidraw,Throat swab, Sputum cytology. Case history(3): sputum culture and sensitivities, respiratory conditions.
Week 8 -- Lec: Thyroid: physiology, thyroid function tests (PBI, T4, free thyroxine assay, T3 uptake test, free thyroxine index, T3, TSH, TRF), cretinism, myxedema, hyperthyroidism, goiter, thyroiditis, neoplasm, case histories.
Lab 7: Urinalysis, LFT's
Week 9 -- Lec: Calcium: calcium metabolism, plasma regulation of calcium, hypercalcemia, hyperparathyroidism, hypocalcemia, hypoparathyroidism, case histories.
Lab 8: Venipuncture: Butterfly draw, processing. Case history(4): thyroid.
Week 10 -- Lec: Kidney: BUN, creatinine, BUN:creatinine, uric acid, case histories.
Lab 9: Urinalyses (3): unknowns Case history (3): calcium. kidney
Week 11 -- Lec: Neuromusculoskeletal conditions: Paget's disease of bone, multiple myeloma, metastatic carcinoma to bone, osteogenic sarcoma, fat embolism syndrome, osteomyelitis.
Lab 10: Venipuncture: syringe draw, processing Case studies (2): kidney. Ordering laboratory tests, processing lab specimens, mailing.
Week 12 -- Lec: Neuromusculoskeletal conditions: osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, Felty's syndrome, psoriatic arthritis, gouty arthritis, chondrocalcinosis, septic arthritis, ankylosing spondylitis, lyme disease, Reiter's syndrome, osteoporosis, osteomalacia, rickets, muscular dystrophy, acromegaly.
Week 13 -- Case Histories
Week 14 --
 FINAL EXAMS AS SCHEDULED
Week 15 --
 FINAL EXAMS AS SCHEDULED
Please Note
This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
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Last updated:8/3/2006
 

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