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Pathophysiology and Therapeutics 3 (PT 3)

(Systems: Renal, Reproduction, Endocrine)

Fall, 2018

Learning Objectives and Readings/Other Learning Resources*

*For readings available as eBooks, links are included. Links also are included for many
book chapters and several websites. If you are on campus, clicking on the eBook or book
chapter links should open the eBooks or book chapters. If you are off campus, you may
have to first log into the FAU library proxy link (https://login.ezproxy.fau.edu/login) and
then click the specific book link or book chapter link. If you have any trouble accessing
the books or chapters, please contact the medical librarians Amanda Chiplock
(achiplock@health.fau.edu) and Tiffany Follin (tfollin@health.fau.edu)

PT3 Learning Objectives 2018 1


Course Objectives

A. Knowledge for Practice (Medical Knowledge)

Renal
 Describe the gross and microscopic anatomy of the kidney and collecting system to nephrogenesis
and the genetics of kidney diseases.
 Explain the pathophysiology of renal glomerular, vascular and interstitial diseases.
 Describe the role of the kidneys in the regulation of fluid, electrolyte and acid-base balance and
the pathophysiology of the associated disorders.
 Describe the endocrine function of the kidneys and the effect of systemic hormones on renal
function.
 Describe the pharmacology of diuretic drugs and drug pharmacokinetics to management of renal
disease.
 Explain the role of renal function tests, including urinalysis and renal imaging, into evaluation and
management of renal disease.
 Describe the clinical consequences of reductions in glomerular filtration rate and the
manifestations and management of end-stage renal disease.
 Apply knowledge of the pathophysiology of diseases of the ureters, bladder and urethra to the
management of obstructive uropathy, renal tumors and cysts, and urologic complications of the
genitourinary tract.

Reproduction
 Understand basic concepts and vocabulary in epidemiology, pathology and modern clinical
management strategies for problems related to the male and female reproductive disorders.
 Explain the normal structure and function of the male and female reproductive organs.
 Distinguish the etiology, pathogenesis, and pathophysiology that occurs in the male and female
reproductive organs and their clinical consequences.
 Understand basic principles of pharmacological therapy for disorders of the reproductive systems.

Endocrine
 Have a basic understanding of the structure and mechanisms of action of the classical hormones,
as well as the principles of control and regulation of hormone synthesis and release.
 Understand basic concepts and vocabulary in epidemiology, pathology and modern clinical
management strategies for problems related to endocrine disorders.
 Explain the normal structure and function of the endocrine organs.
 Distinguish the etiology, pathogenesis, and pathophysiology that occurs in the endocrine organs
and their clinical consequences.
 Understand basic principles of pharmacological therapy for disorders of the endocrine.
 Recognize abnormal findings that are expected on the physical and laboratory examinations of
patients with various endocrine disorders.

PT3 Learning Objectives 2018 2


B. Practice Based Learning and Improvement:
 Identify strengths, deficiencies, and limits in one’s knowledge and expertise.
 Set learning and improvement goals, and learn independently
 Identify and perform learning activities that address one’s gaps in knowledge, skills, or
attitudes.
 Integrate newly-acquired knowledge into previously established frameworks.
 Demonstrate critical thinking and clinical reasoning skills.
 Locate, appraise, and assimilate evidence from scientific studies related to health problems.
 Use information technology to optimize learning.
 Incorporate feedback into daily practice.
 Provide meaningful and constructive feedback to others.
 Display initiative in pursuing the study of medicine

C. Interpersonal and Communication Skills


 Present and explain medical information to peers in a logical and organized fashion.
 Communicate and work effectively with the other members of a small group.
 Demonstrate leadership skills.
 Demonstrate sensitivity, honesty, and compassion to others.
 Demonstrate flexibility and show respect for the ideas of others across a broad range of
backgrounds and perspectives.
 Demonstrate insight and understanding about emotions and human responses to emotions
that allow one to develop and manage interpersonal interactions

D. Professionalism
 Demonstrate compassion, integrity and respect for others, including faculty, staff and other
students
 Demonstrate accountability to others, including faculty, staff and other students
 Demonstrate sensitivity and responsiveness to a diverse population
 Demonstrate a commitment to ethical principles pertaining to the study and practice of
medicine
 Fulfill all responsibilities related to educational activities in a timely manner, with a
commitment to excellence and full engagement

PT3 Learning Objectives 2018 3


Renal, Reproduction and Endocrine (PT 3) Course Objectives and
Reading References Fall 2018

TEXTBOOKS

Title Author(s) Publisher


Greenspan’s Basic and Clinical Endocrinology - 10th Edition
Available in ebook form on Access Medicine at: Gardner, Shoback McGraw Hill
http://accessmedicine.mhmedical.com/book.aspx?bookID=380
Harrison's Principles of Internal Medicine: Volumes 1 and 2 – 18th
Kasper, Fauci,
or 19th Edition
Hauser, Longo, McGraw-Hill
Available in ebook form on Access Medicine at
http://accessmedicine.mhmedical.com/book.aspx?bookID=1130 Jameson, Loscalzo
Lippincott
Renal Pathophysiology: The Essentials 4th Edition Rennke, Denker Williams
&
Wilkins
Robbins and Cotran: Pathologic Basis of Disease - 10th edition
Kumar, Abbas and
Available in ebook form on Clinical Key at Elsevier
Aster
https://www.clinicalkey.com/#!/browse/book/3-s2.0- C20110055734
Renal Physiology – 5th edition
Available in ebook form on Clinical Key at
Koeppen and Stanton Elsevier
https://www.clinicalkey.com/#!/browse/book/3-s2.0-
C20100685373
Endocrine and Reproductive Physiology- 4th edition
Available in ebook form on Clinical Key at White and Porterfield Elsevier
https://www.clinicalkey.com/#!/browse/book/3-s2.0- C20100690353

Acid-Base, Fluids, and Electrolytes made ridiculously simple- 2 nd MedMaster


Preston, RA
edition Inc., Miami
Vander’s Renal Physiology, 8th edition
D. Eaton/J. Pooler McGraw-Hill
https://accessmedicine.mhmedical.com/book.aspx?bookID=505
Basic and Clinical Pharmacology 13th Edition, McGraw-Hill, 2015.
Katzung B McGraw-Hill
http://accessmedicine.mhmedical.com/book.aspx?bookid=1193
Corey Foster
The Washington Manual of Medical Therapeutics LWW
Neville Mistry

References (listed in Glomerular Handout):

http://www.pathophys.org/ckd/
A website explaining chronic kidney disease

http://www.unckidneycenter.org/kidneyhealthlibrary/glomerulardisease.html
This is a good web site with easy to understand descriptions of glomerular disease.

http://www.kidneypathology.com/English_version/Tutorial_index.html
Good explanation of renal diseases

http://pathology.osu.edu/residents/StudyGuides/EM/ElectronMicroscopy.htm
Limited electron microscopy pictures of renal diseases
PT3 Learning Objectives 2018 4
http://library.med.utah.edu/WebPath/RENAHTML/RENALIDX.html
Pictures of renal disease - this site is geared more towards pathology residents.
http://www.uncnephropathology.org/jennette/tutorial.htm
Tutorial in renal disease

http://librepathology.org/wiki/index.php/Medical_kidney_diseases

WEEK 1: Renal Physiology, Kidney injury and Renal Radiology

Monday, October 22: 8:00 AM -8:50 AM


Introduction and Review of Renal Histology: Perumareddi and Trelka
Learning Objectives:
1. Review the anatomy and the histology of the kidney with attention to function

Monday, October 22: 10:00 AM -10:50 AM


Hemodynamics and Glomerular Filtration: Schmidt-Kastner
Learning Objectives:
1. Review the basic organization of the nephron, including the glomeruli, tubuli, loop of Henle, and
collecting ducts.
2. Recognize the specific arrangement of the vascular system in different segments of the nephron.
3. Explain the definition of glomerular filtration rate (GFR), renal plasma flow (RPF), and renal blood
flow (RBF).
4. Understand that the glomerular filtrate is an ultrafiltrate of plasma and explain why albumin is not
normally filtered at the glomerulus; know that the glomerular filtration rate (GFR) equals the
product of the ultrafiltration coefficient and the net filtration pressure.
5. Understand the importance of autoregulation of renal blood flow and recognize the role of
intrarenal regulation by macula densa cells.

Monday, October 22: 11:00 AM -11:50 AM


Renal Clearance: Schmidt-Kastner
Learning Objectives:
1. Understand the definition of renal clearance, including the units in which it is expressed.
2. Understand that the clearance of para-amino-hippuric acid (PAH) relates to renal plasma flow.
3. Understand how inulin is used to estimate glomerular filtration rate (GFR).
4. Calculate the glomerular filtration rate (GFR) from the clearance of creatinine, and know that
elevated plasma [creatinine] often indicates a subnormal GFR.

Tuesday, October 23: 8:00 AM -8:50 AM


Tubular Transport and body Fluid Compartments: Schmidt-Kastner
Learning Objectives:
1. Define reabsorption, secretion and excretion in renal tubules; explain simple diffusion, facilitated
diffusion, primary active transport, secondary active transport, endocytosis and paracellular
transport; and provide examples for specific solutes and tubular location.
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2. Understand that filtered glucose and amino acids are reabsorbed in the proximal tubule by a Na -
linked mechanism, and that strong organic acids and bases are secreted into the proximal tubule.
3. Explain what percentage of the body weight is water; how water is usually distributed among the
intracellular, interstitial and plasma compartments; and how these volumes are normally
maintained.
4. Understand the major solutes of the intracellular, interstitial and plasma compartments, and how
these different solute compositions are maintained.
5. Define osmolarity and tonicity; know that all body fluid compartments have the same osmolarity
and are electroneutral, and that most body solutes are electrolytes.
6. Understand how addition or subtraction of water and/or NaCl affects intracellular, extracellular
and plasma volumes, osmolarity and the concentration of plasma proteins.

Tuesday, October 23: 9:00 AM -9:50 AM


Renal Processes for Sodium, Chloride and water: Schmidt-Kastner
Learning Objectives:
1. Understand that the kidney's most important task is maintenance of the extracellular fluid volume
and of the circulating arterial plasma volume which requires regulating excretion of Na+, Cl- and
water.
2. Understand reabsorption of Na+, Cl- and water in the proximal tubule, including facilitated
diffusion via co-transporters and Na+-H+ antiport, and extrusion of across the basolateral membrane
by Na+,K+-ATPase.
3. Explain the role of reabsorption of Na+, Cl- and water in the loop of Henle, including the tubular
location and average magnitude of reabsorption, the Na+,K+,2Cl-cotransporter; know that there is a
standing osmotic gradient in the medullary interstitium and that the loop of Henle is called a
countercurrent multiplier.
4. Understand that the distal nephron can vary water and NaCl reabsorption independently.
5. Explain how water reabsorption in the distal nephron is influenced by antidiuretic hormone (ADH;
vasopressin); why the distal nephron is called the cortical diluting segment; and illustrate the renal
sites of action of ADH including role of aquaporins.
6. Understand that the release of ADH from the posterior pituitary is influenced by changes in plasma
osmolarity, blood pressure, alcohol, stress, nausea, and angiotensin II.
7. Explore the complexity of urea movements along the tubules.

Wednesday, October 24: 10:00 AM-10:50 AM


Sodium and Water Balance: Scott
Learning Objectives:
1. Define the meaning of extracellular fluid volume (ECFV) including the plasma volume and
interstitial volume as well as how the total body sodium (TBNa) is the total amount of sodium in
the body and that it is determined by the sodium intake and elimination
2. Describe how TBNa determines the size of the extracellular fluid volume (ECFV) and that
conversely the TBNa can be approximated from sodium in the ECFV.
3. Explain how disorders of ECFV overload [congestive heart failure, cirrhosis] are caused by
abnormal sodium balance.

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4. Compare the treatment of volume overload (sodium restriction and diuretics to eliminate sodium)
with the treatment of volume depletion (administration 0.9% normal saline).
5. Explain how ECFV size is determined by Na balance and is assessed clinically whereas the serum
sodium concentration is determined by water balance and tells us only about water balance.

Wednesday, October 24: 11:00 AM-11:50 AM


Disorders of Water Balance, Hyponatremia, and Hypernatremia: Scott
Learning Objectives:
1. Explain the clinical mechanisms that protect the body against the toxicity of hypo- and
hypernatremia, including the intracellular potassium levels and intracellular concentration of myo-
inositol.
2. Describe the clinical side effects and presentation of each type of sodium disorder including the
diseases and drugs that result in sodium disorders.
3. Explain the entity called Osmotic Demyelinating Syndrome, including its presentation, the risk
factors and its prevention.
4. Define Central and Nephrogenic Diabetes Insipidus including:
a. the urinary response to the administration of ADH for each
b. learn the different causes of each disorder
c. describe the treatment of each syndrome
5. Explain the treatment goals for hypo- and hypernatremia including:
a. differences between treating acute vs. chronic
b. how quickly the sodium level can be normalized

Thursday, October 25: 10:00 AM-10:50 AM


Renal Contributions to Acid-Base Balance: Schmidt-Kastner
Learning Objectives:
1. Explain how the kidneys contribute to the acid-base balance by conserving filtered HCO3- and by
regenerating the HCO3- that was lost when fixed acids were buffered in the tissues.
2. Explain that most filtered HCO3- is reabsorbed in the proximal tubule, via a pathway involving: H+
secretion via a luminal Na+/H+ antiporter, carbonic anhydrase, HCO3- reabsorption via a
basolateral Na+/3HCO3- cotransporter, and a small transtubular pH gradient (pathway 1).
3. Describe how the kidney uses two pathways to excrete H+ and regenerate lost HCO3-: titration of
filtered bases like HPO42- (=pathway 2) and metabolism of glutamine resulting in NH4+ excretion
(=pathway 3).
4. Understand that intercalated cells in the distal nephron secrete H+ via a lumenal H+-ATPase whose
activity is stimulated by aldosterone.
5. Review the function of the Renin-Angiotensin system.

Thursday, October 25: 11:00 AM -11:50 AM


Whole Body Acid-Base: Schmidt-Kastner
Learning Objectives:
1. Define the normal pH, [H+], pCO2, and [HCO3-] of arterial plasma.

PT3 Learning Objectives 2018 7


2. Understand how carbonic acid is generated during metabolism, the role of carbonic anhydrase,
and the magnitude of daily carbonic acid production. Understand that carbonic acid is buffered in the
tissues, and excreted in the lungs.
3. Understand the Henderson-Hasselbalch equation, and that pH balance requires maintenance of
the ratio [HCO3-]/pCO2.
4. Classify the four simple acid-base disorders: respiratory acidosis, respiratory alkalosis, metabolic
acidosis, and metabolic alkalosis.
5. Explain the buffering systems and compensatory mechanisms used to defend the body against
these acid-base disorders.

Friday, October 26: 8:00 AM -8:50 AM


Kidney Imaging: LeBlang
Learning Objectives:
1. List the differential diagnosis of hematuria, highlighting the most common causes.
2. Summarize the imaging work up of hematuria.
3. Describe the imaging appearances of the most common causes of hematuria.
4. Describe the clinical presentation and imaging appearance of RCC (Renal cell carcinoma).

Friday, October 26: 9:00 AM-9:50 AM


Regulation of K+ Balance and K+ Sparing Diuretics: Scott
Learning Objectives:
1. Recognize the normal range of extracellular (= plasma) [K ] and explain why hypo- and
hyperkalemia is dangerous.
2. Describe the mechanisms that maintain K homeostasis and the factors that Influence these
mechanisms.
3. Explain how the principal cells and intercalated cells of the distal nephron differentially contribute
to regulating K excretion.
4. Explain why patients taking thiazide and loop-acting diuretics tend to lose K , and the steps that
can be taken to minimize this K loss.
5. Recognize the major K -sparing diuretics and explain their mechanisms of action.

WEEK 2: Water and Electrolyte balance; acid-base balance, kidney, bladder and prostate
pathology

Monday, October 29: 10:00 AM - 11:50 AM


Assessing the Patient with Acute Kidney Injury, Part 1 and Part 2: Richards
Learning Objectives:
1. Describe acute kidney injury as well as the clinical and laboratory findings of acute kidney injury
and chronic kidney disease.
2. Describe the difference between pre-renal, intrinsic acute renal injury and post renal acute kidney
injury.
3. Explain the etiologies as well as the clinical and laboratory findings in pre-renal and intrinsic acute
kidney injury.

PT3 Learning Objectives 2018 8


4. Summarize the pathogenesis of acute kidney injury with attention to the physiology of renal
autoregulation.
5. Define the treatment options for patients with acute kidney injury as well as the complications and
outcomes of acute kidney injury.
6. Explain the mathematical calculation of GFR/creatinine clearance as well as the Fractional
excretion of sodium (FENa) and the factors that influence the interpretation of renal function.

Tuesday, October 30: 8:00 AM-8:50 AM


Approach to Acid Base Problems 1: Richards
Learning Objectives:
1. Describe how the body defends against (H ) loads: buffering, respiratory compensation and renal
H+ secretion.
2. Describe the mechanism of endogenous acid production and renal acid excretion.
3. Explain the clinical tools used to evaluate acid-base status: (a) blood gases; (b) range of respiratory
compensation; (c) serum anion gap (AG) = [Na-(HCO3 Cl)].
4. List the pH, PCO2 and HCO3 in the four simple acid-base disorders. Describe mixed or complex
acid-base disorders.
5. Describe the pathophysiology of metabolic acidosis: (a) acid overproduction; (b) loss of
bicarbonate; (c) low NH4 excretion.

Tuesday, October 30: 9:00 AM-9:50 AM


Approach to Acid Base Problems 2: Richards
Learning Objectives:
1. Describe how the body defends against (H ) loads: buffering, respiratory compensation and renal
H+ secretion.
2. Describe the mechanism of endogenous acid production and renal acid excretion.
3. Explain the clinical tools used to evaluate acid-base status: (a) blood gases; (b) range of respiratory
compensation; (c) serum anion gap (AG) = [Na-(HCO3 Cl)].
4. List the pH, PCO2 and HCO3 in the four simple acid-base disorders. Describe mixed or complex
acid-base disorders.
5. Describe the pathophysiology of metabolic acidosis: (a) acid overproduction; (b) loss of
bicarbonate; (c) low NH4 excretion.

Wednesday, October 31: 10:00 AM -10:50 AM


Approach to Acid Base Problems 3: Richards
Learning Objectives:
1. Describe the approach to hyperchloremic acidosis and high anion gap acidosis.
2. Explain the generation and maintenance of metabolic alkalosis. Generation: exogenous
bicarbonate loads; (b) loss of acid in gastric juice or in the urine.
3. Describe the approach to low urine Chloride (saline sensitive alkalosis) and high urine Chloride
(saline resistant alkalosis).

Wednesday, October 31: 11:00- 11:50 AM


Approach to Acid Base Problems 4: Richards
PT3 Learning Objectives 2018 9
Learning Objectives:
1. Explain the clinical laboratory tests to define simple and mixed acid base disorders.

Thursday, November 01: 10:00 AM- 10:50 AM


Kidney, Bladder and Prostate Pathology, Part 1: Levitt
Learning Objectives:
1. Summarize the congenital abnormalities of the kidney including developmental abnormalities,
cystic diseases, Alport Syndrome & Thin Basement Membrane Lesion.

Thursday, November 01: 11:00 AM- 11:50 AM


Kidney, Bladder and Prostate Pathology, Part 2: Levitt
Learning Objectives:
1. Describe and classify important adult and pediatric tumors of kidney, including clinical staging
and treatment options.

Friday, November 2: 8:00 AM-8:50 AM


Kidney, Bladder and Prostate Pathology, Part 3: Levitt
Learning Objectives:
1. Summarize the congenital lesions of the ureters and the bladder and prostate.
2. Describe and classify the tumors of the ureters and bladder including the clinical staging and
treatment options for the bladder tumors.
3. Describe and classify the inflammatory and metaplastic lesions of the ureter and bladder.
4. Summarize the inflammatory, hyperplastic and neoplastic diseases of the prostate.
5. Describe the Gleason grading system for prostate cancer.

Friday, November 2: 9:00 AM -9:50 AM


Pharmacology and Renal Disease: Bailin
Learning Objectives:
1. Understand how drugs are eliminated by the kidneys.
2. Understand how kidney disease affects the pharmacokinetic process.
3. Recognize how renal disease affects the pharmacokinetics of certain drugs (i.e morphine,
phenytoin, and insulin).
4. Understand how CKD effects loading and maintenance dosing of drugs

WEEK 3: Kidney, bladder and prostate pathology; Renal diseases – glomerular, interstitial
and tubular

Monday, November 5: 10:00 AM -10:50 AM


Pathology of Tubular and Interstitial Renal Disease: Levitt
Learning Objectives:
1. Describe the pathogenesis and morphologic characteristics associated with acute and chronic
pyelonephritis.
2. Explain interstitial nephritis and at least two forms of drug induced nephritis.
3. Summarize the pathogenesis and morphology of acute tubular necrosis.

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4. Describe the difference between benign and “malignant” nephrosclerosis.

Monday, November 5: 11:00 AM-11:50 AM


Interstitial Nephritis: Arrascue
Learning Objectives:
1. Describe the structure and function of the renal interstitium and differentiate between acute and
chronic interstitial diseases.
2. Explain the pathogenesis of acute interstitial nephritis and describe the histopathology and clinical
findings including the urinalysis and the urine chemistry findings.
3. Summarize the common causes of chronic interstitial nephritis, such as analgesic abuse, chronic
pyelonephritis, chronic use of calcineurin inhibitors for prevention of transplant rejection and
Lithium.
4. Describe the clinical differences between interstitial diseases and glomerular diseases especially as
it relates to the urinalysis findings and the urine chemistry.

Tuesday, November 6: 8:00 AM -8:50 AM


Primary Glomerulonephritis: Richards
Learning Objectives:
1. Differentiate the major clinical and pathologic features of the nephrotic and nephritic syndromes.
2. Discuss the epidemiology, pathogenesis, clinical presentation, and treatment of the primary
glomerular diseases:
a. Minimal change disease
b. Focal segmental glomerulosclerosis c. Membranous glomerulonephritis
c. IgA nephropathy
3. Distinguish the pathologic findings found in each of the primary glomerular diseases.
4. Name the primary glomerulonephropathies that present most commonly with the nephritic
syndrome.
5. Name the primary glomerulonephropathies that present most commonly with the nephrotic
syndrome.

Tuesday, November 6: 9:00AM – 9:50 AM


Secondary Glomerulonephritis: Richards
Learning Objectives:
1. Describe the epidemiology, pathogenesis, clinical presentation, and treatment of the secondary
glomerular diseases:
a. Diabetes mellitus
b. HIV
c. Hepatitis C
d. Post-infectious glomerulonephritis
e. Systemic lupus erythematosis
f. Membranoproliferative glomerulonephritis
g. Anti-glomerular basement membrane disease
h. ANCA-positive: Wegener’s Granulomatosis, Churg-Strauss, Microscopic polyangiitis

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2. Describe the most important immunopathological mechanisms of glomerular immunological injury
3. List the secondary causes of membranous nephropathy
4. Describe the major pathologic differences between membranous nephropathy and
membranoproliferative glomerulonephritis.

Wednesday, November 7: 10:00 AM-10:50 AM


Hematuria and Proteinuria: Lazar
Learning Objectives:
1. Review the classification and pathophysiology of hematuria / proteinuria.
2. Discuss the current tests available for measurement of proteinuria.
3. Emphasize the particular importance for microalbuminuria monitoring.

Wednesday, November 7: 11:00 AM -11:50 AM


Renal Stones: Lazar
Learning Objectives:
1. Describe the different types of stone diseases and their incidences.
2. Understand the pathogenesis of stone formation.
a.calcium oxalate
b.struvite
c.cystine
3. Describe the common causes of calcium oxalate renal stones.
a.promoters of stone disease
b.inhibitors of stone disease
4. Be familiar with the medical evaluation and treatment of patients with stone disease.
a.tests used for evaluation of stone disease
b.treatment options available for:
a. calcium oxalate
b. cystine
c. struvite

Thursday, November 8: 10:00 AM- 10:50 AM


Chronic Kidney Disease: Lazar
Learning Objectives:
1. Describe the intact nephron hypothesis.
2. Understand the tubular adaptations to nephron loss as it relates to sodium, potassium, water, and
acid-base homeostasis.
3. Understand the trade-off hypothesis and how this affects the management of patients with CRF.
4. Obtain an understanding of the pathogenesis and the clinical impact of the anemia of kidney
disease.
5. Appreciate the pathogenesis and clinical expression of different types of renal osteodystrophy.

Thursday, November 8: 11:00 AM-11:50AM


Thiazide and Loop Acting Diuretics: Lazar
Learning Objectives:
PT3 Learning Objectives 2018 12
1. Recognize the sites and mechanism of action of the thiazide and loop acting diuretics.
2. Describe the differences and similarities between the thiazide and loop-acting diuretics.
3. Identify the effects and clinical use of the thiazide and loop-acting diuretics.
4. Explain the major renal and non-renal complications (side effects) of thiazide and loop acting
diuretic therapy.

Friday, November 9: 8:00 AM -8:50 AM


UTI and Pyelonephritis: Richards
Learning Objectives:
1. Discuss the epidemiology and risk factors for bacterial urinary tract infections.
2. Explain the mechanism by which bacteria reach the bladder and kidney (hematogenous vs.
ascending infection).
3. Describe the clinical manifestations and complications of bacterial urinary tract infections.
4. List the differences between bladder (cystitis) and kidney (pyelonephritis) infection.
5. List the diagnostic tests used to confirm cystitis and/or pyelonephritis

Friday, November 9: 9:00 AM -9:50 AM


Benign Prostatic Hyperplasia and Voiding Disturbances/prostate cancer: Taub
Learning Objectives:
1. Describe the natural history of benign prostatic hyperplasia (BPH) and which parts of the prostate
are affected by hyperplasia and which by carcinoma.
2. Summarize the clinical findings and treatment of BPH including the enzyme blockers and the alpha
blockers.
3. Describe the different types of voiding dysfunction
4. Summarize the clinical findings and treatment for voiding dysfunction
5. Describe the epidemiology of prostate cancer
6. Explain the use of the serum prostatic specific antigen (PSA) test in screening and diagnosis of
prostate cancer
7. Summarize how a diagnosis of prostate cancer is established
8. Describe the clinical stages of prostate adenocarcinoma
9. Describe the treatment of prostate cancer

WEEK 4: Renal Dialysis and Simulation center, prostate disease and pathology laboratory

Wednesday, November 14: 11:00 AM -11:50 AM


Renal Transplantation: Foster
Learning Objectives:
1. Understand the indications and contraindications to renal transplantation.
2. Discuss the process of recipient and donor selection.
3. Identify key concepts used in donor and recipient surgeries.
4. Introduce medications used for immunosuppression.
5. Review the process of graft rejection.
6. Highlight important primary care issues in the renal transplant population.

PT3 Learning Objectives 2018 13


WEEK 5: Renal Exam, male Repro and Thanksgiving

Tuesday, November 20: 8:00 AM -8:50 AM


Male Anatomy and Physiology: Trelka
Learning Objectives:
1. Describe the anatomy and histology of the male reproductive system.
2. Be able to identify the cells responsible for testosterone secretion and those responsible for
spermatogenesis
3. Illustrate hypothalamic/pituitary control of testicular function
4. Describe the biosynthesis, transport and receptor of action for testosterone
5. Describe the function of testosterone in utero, during puberty and during adulthood
a.Use this knowledge to describe clinical manifestations of hypogonadism in utero, puberty and
adulthood/senescence
6. Explain the role of FSH, LH, Sertoli cells and Leydig cells on spermatogenesis and name 3 causes of
infertility

Tuesday, November 20: 9:00 AM -9:50 AM


Pathology of male GU System: Levitt
Learning Objectives:
1. Describe the epidemiology of common neoplastic diseases affecting the urethra, penis and testis
including risk factors and prognosis.
2. List the different types of germ cell and non-germ cell tumors of the testis.
3. Describe the benign and malignant neoplasm of the penis.
4. Name the common vascular and inflammatory lesions of the testis and related structures.
5. Summarize the clinical staging and treatment options for testicular neoplasms.

WEEK 6: Pregnancy and Reproductive System/Disorders

Monday, November 26: 10:00 AM- 10:50 AM


Anatomy of Female Reproductive System: Trelka
Learning Objectives:
1. Describe the gross anatomical relationships of the organs of the female reproductive system.
2. Describe the histology of the ovary and follicles, the uterine tube and vagina
3. Describe the histology of the uterus during menstrual cycle changes and correlate with the
hormonal changes.
4. Explain the role of the hypothalamo-hypophyseal axis in regulating the menstrual cycle.

Monday, November 26: 11:00 AM- 11:50 AM


Female Lower Genital Tract Pathology: Trelka
Learning Objectives:
1. Describe the skin diseases of the vulva including infections, leukoplakia, vulvar intraepithelial
neoplasia (VIN) and carcinoma.
2. Explain the role of human papillomaviruses and neoplasms of the vulva and cervix including
the epidemiology and pathogenesis.
PT3 Learning Objectives 2018 14
3. Describe cervical intraepithelial neoplasia (CIN), its detection by PAP smear and its association
with the transformation zone
4. List the malignancies that can arise in the vagina including sarcoma botryoides (pediatric
tumor).

Wednesday, November 28: 10:00 AM -10:50 AM


Pathology of the Uterus, Fallopian tubes and ovaries: Trelka
Learning Objectives:
1. Describe ovarian cysts including the ovarian malignancies which may be cystic
2. Compare the female germ cell tumors to the male ones.
3. List the different types of endometrial lesions, including polyps, hyperplasia and carcinoma.
4. Describe the myometrial tumors including leiomyoma and leiomyosarcoma.

Wednesday, November 28: 11:00 AM 11:50 AM


Evaluation of Upper Tract Disorders: Smith
Learning Objectives:
1. List common causes of acute abdominal pain related to the female reproductive tract, and their
underlying mechanisms
2. Explain how the history, physical exam, laboratory tests and imaging studies are used to establish
a diagnosis
3. List common treatment approaches for these conditions

Thursday, November 29: 8:00 AM -8:50 AM


Abnormal Uterine Bleeding: Hecht (VIDEO)
Learning Objectives:
1. Review menstrual cycle and explain the various parts
2. Describe the variations of abnormal uterine bleeding
3. List the differential diagnosis of abnormal uterine bleeding
4. Describe the treatment for abnormal uterine bleeding

Thursday, November 29: 9:00-9:50 AM


Physiology of a normal pregnancy: Smith
Learning Objectives:
1. List the most important physiologic changes in pregnancy
2. Identify the potential risks of these changes
3. Explain how these changes increase the likelihood of maternal and fetal/neonatal survival

Thursday, November 29: 10:00-10:50 AM


Maternal disorders of Pregnancy (Diabetes, preeclampsia, placenta): Zann
Learning Objectives:
1. Describe the physiology, recognition, & management of:
a. Spontaneous Abortion
b. Ectopic pregnancy
c. Preeclampsia and Eclampsia
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d. Gestational Diabetes Mellitus

Friday, November 30: 8:00-8:50 AM


Infertility and assisted reproduction: Peress
Learning Objectives:
1. Define infertility and discuss the scope of the problem as it relates to a couple’s fertility potential
2. Review the diagnostic evaluation of male factor infertility including semen analysis and tests of
sperm function
3. Review the diagnostic evaluation of female factor infertility including ovulatory dysfunction and
anatomical disorders
4. Outline various therapies for male and female infertility including Assisted Reproductive
Technologies (ARTS)

Friday, November 30: 9:00 AM -9:50 AM


Breast Pathology: Trelka
Learning Objectives:
1. Describe the anatomy and histology of the breast.
2. Explain benign breast disease including mastitis, fat necrosis and fibrocystic changes.
3. List the types of carcinoma in situ and invasive carcinoma.
4. Explain the risk factors for breast carcinoma.
5. Describe the staging for breast carcinomas - T (tumor size) N (lymph node metastases) M (distant
metastases) system.
6. Describe the benign tumors of the breast.

WEEK 7: Reproductive disorders, endocrinology (pituitary and adrenal) and metabolic


bone disease

Monday, December 03: 10:00 AM -10:50 AM


Anatomy of the Endocrine System: Trelka
Learning Objectives:
1. Summarize the components of the hypothalamo-hypophyseal system and how it develops.
2. Identify and discuss the function of the various trophic cell types found in the adenohypophysis.
3. Review the function of these cells.
4. List the cell types and explain the way in which they synthesize and store their hormones in the
thryoid, parathyroid, adrenal, pancreas and pineal endocrine glands.
5. Give a brief review of the function of each organ.
6. Review the physiology of the various hormones produced by these endocrine glands.

Monday, December 03: 11:00 AM -11:50 AM


Physiology of the Endocrine System: Trelka
Learning Objectives:
1. Understand hormonal function, production and effects
2. Review location and anatomy of endocrine glands
3. Present clinical correlates of dysfunction
PT3 Learning Objectives 2018 16
4. Review receptor locations and function
5. Expand background understanding to further study clinical endocrine diseases

Tuesday, December 04: 8:00 AM -8:50 AM


Pathology of the Pituitary and adrenal glands: Levitt (VIDEO)
Learning Objectives:
1. Describe the types of pituitary adenomas (functional and non-functional) and define a
craniopharyngioma.
2. Explain the physiologic changes in hypopituitarism as well as the causes.
3. Describe the diseases of the adrenal cortex and medulla, including neoplasms, inflammatory and
infectious conditions.

Wednesday, December 05: 10:00AM-11:50 AM


Adrenal Hyperfunction and Hypofunction: Frager
Learning Objectives:
1. Describe the 3 classes of hormones secreted by the adrenal cortex and their major actions
2. Explain the physiologic regulation of cortisol and aldosterone secretion by the adrenal cortex
3. Describe Cushing’s syndrome and how to differentiate it from Cushing’s disease including the
physical findings, the laboratory findings and the treatment.
4. Describe the expected effects of cortisol deficiency and of aldosterone deficiency
5. Explain the differences in the response of the pituitary-adrenal axis to cortisol deficiency on the
basis of adrenal disease and cortisol deficiency on the basis of inadequate pituitary ACTH secretion
6. Describe the treatment of primary and secondary adrenal insufficiency

Thursday,December 06: 9:00AM – 9:50AM


Hyperpituitarism: Levenson
Learning Objectives:
1. Recognize the clinical signs and symptoms of hypersecretion of each of the anterior pituitary
hormones
2. List steps in the biochemical evaluation of hypersecretion of anterior pituitary hormones
3. Describe the different forms of medical and surgical therapy of patients with hyperpituitarism
4. List the causes of hyperpituitarism

Thursday,December 06: 10:00AM – 10:50AM


Hypopituitarism: Levenson
Learning Objectives:
1. Recognize the clinical signs and symptoms of the lack/deficiencies of each of the anterior pituitary
hormones
2. Describe the signs and symptoms caused by the local effects of large space-occupying pituitary
masses
3. Explain the different forms of hormone replacement therapy of patients with hypopituitarism
4. List the causes of pan-/hypopituitarism

PT3 Learning Objectives 2018 17


Friday, December 07: 8:00AM – 8:50AM
Calcium Metabolism: Schmidt-Kastner
Learning Objectives:
1. Review the three types of bone cells: osteoblasts, osteoclasts, and osteocytes
2. Describe the regulation of formation of mature osteoblasts and osteoclasts, including an
involvement of major systemic and local hormones
3. Discuss the main biologic functions of calcium and phosphate, and compare their distribution
among different fluid compartments
4. Discuss the Calcium-sensing receptor (CaR) and recognize clinical entities that result from receptor
dysfunction.
5. Discuss the Calcium-sensing receptor (CaR) and recognize clinical entities that result from receptor
dysfunction.
a. Describe the biosynthesis, regulation of secretion and mechanisms of action of Parathyroid
Hormone (PTH)
6. Discuss the biosynthesis of vitamin D, the regulation of its activation and its target tissues;
a. describe the physiologic actions of vitamin D derivatives
7. Review renal functions in the control of calcium and phosphate metabolism

Friday, December 07: 9:00AM – 9:50AM


Metabolic Bone Disease: Levenson
Learning Objectives:
1. Review the causes of rickets and osteomalacia, including vitamin deficiency.Interpret laboratory
data, become familiar with X-ray findings and clinical management.
2. Review the risk factors and secondary causes of osteoporosis. Understand the complications,
diagnostic criteria, and treatment alternatives.
3. Understand the epidemiology, presentation, diagnosis, and treatment of Paget’s disease.
4. Interpret the biochemical, radiological and densitometry findings in the work-up of calcium and
bone/mineral disorders.

WEEK 8: Endocrinology- Thyroid Disease and Diabetes Mellitus

Monday, December 10: 10:00 AM -10:50 AM


Laboratory Evaluation of the Endocrine System and Pathology of Men: Rodriguez
Learning Objectives:
1. Learn how to analyze tropic/target hormone pairs
2. Review importance of feedback inhibition
3. Understand protein bound hormones
4. Review dynamic testing including stimulation and suppression testing
5. Recognize circadian rhythms of hormone secretion

Monday, December 10: 11:00AM -11:50 AM


Pathology of the Thyroid and Parathyroid: Trelka
Learning Objectives:
1. Review development, gross anatomy and histology of the thyroid and parathyroid glands.
PT3 Learning Objectives 2018 18
2. Review common causes and anatomic/physiologic manifestations of hyper- and hypothyroidism.
3. Review inflammation, hyperplasia and neoplasia of the thyroid gland.
4. Review common causes and anatomic/physiologic manifestations of of hyper- and
hypoparathyroidism.
5. Review hyperplasia and neoplasia of the parathyroid gland.

Tuesday, December 11: 8:00 AM -8:50 AM


Hypothyroidism: Rodriguez
Learning Objectives:
1. State the different causes of hypothyroidism
2. Understand the laboratory work-up for hypothyroidism
3. Understand the consequences of iodine deficiency in utero
4. Recognize effects of untreated hypothyroidism in children
5. Recall the signs and symptoms of hypothyroidism in adults
6. Understand how to treat hypothyroidism

Tuesday, December 11: 9:00 AM -9:50 AM


Hyperthyroidism: Rodriguez
Learning Objectives:
1. State the different causes of hypothyroidism
2. Understand the laboratory work-up for hypothyroidism
3. Understand the consequences of iodine deficiency in utero
4. Recognize effects of untreated hypothyroidism in children
5. Recall the signs and symptoms of hypothyroidism in adults
6. Understand how to treat hypothyroidism
Wednesday, December 12: 10:00 AM -10:50 AM
Nodular Thyroid Disease: Rodriguez
Learning Objectives:
1. Understand the mechanisms by which goiters develop.
2. Understand the malignant potential of non-functioning (“cold”) nodules.
3. Familiarize yourself with the use of diagnostic fine-needle aspiration for thyroid nodules.
4. Understand the different types of thyroid cancer.
5. Describe the treatment modalities for thyroid cancer.

Wednesday, December 12: 11:00 AM -11:50 AM


Repro and Endocrine Imaging: LeBlang
Learning Objectives:
1. Contrast various imaging modalities the normal and diseased state of the major endocrine organs
2. Present the radiological work up of patients with pituitary, thyroid, parathyroid and adrenal gland
disorders
3. Describe normal pelvic anatomy on imaging studies
(a) Hysterosalpingogram (HSG)
(b)US
(c) CT
PT3 Learning Objectives 2018 19
(d) MRI
4. Describe pathologic conditions of the:
(a) Ovaries
(b) Pelvic tissues/tubes
(c)Uterus

Thursday, December 13: 9:00 AM -9:50 AM


Diabetes Classification: Freedman
Learning Objectives:
1. Recognize that diabetes is a pandemic and describe the recommendations for screening
2. Explain the etiologic classification of diabetes and the major differences in the pathophysiology of
type 1 vs. type 2 diabetes
3. Describe the importance of glucose control (current best evidence)
4. Explain the epidemiology of type 1 diabetes
5. Describe the typical clinical presentations of both type 1 and type 2 diabetes.
6. Describe the pathogenesis of type 2 diabetes, highlighting the roles of impaired insulin secretion.

Thursday, December 13:10:00 AM -10:50 AM


Treatment of Diabetes: Freedman
Learning Objectives:
1. Review the treatment goals and rationale in patients with diabetes
2. Compare the pharmacologic approach in type 1 versus type 2 diabetes
3. Identify the glycemic burden – fasting vs. post-prandial hyperglycemia
4. Explain how to advance therapy in type 2 diabetes, targeting fasting versus post-prandial
hyperglycemia, oral agents, insulin replacement therapy
5. Explain how to initiate physiologic insulin replacement in type 1 diabetes, replacing basal, prandial
and corrective insulin needs

Thursday, December 13: 11:00 AM 11:50 AM


Diabetic Ketoacidosis and Hyperosmolarity: Rodriguez
Learning Objectives:
1. Explain the pathogenesis of diabetic ketoacidosis (DKA)
2. Describe the main differences in the epidemiology and pathophysiology of DKA and hyperosmolar
(hyperglycemic non-ketotic) syndrome (HHNS)
3. Describe the common precipitating causes and laboratory features of DKA and HHNS
4. Recognize the clinical signs and symptoms of DKA and HHNS
5. Summarize the principles of management of hyperglycemic crises in diabetes

Friday, December 14: 8:00 AM-8:50 AM


Diabetic Complications: Vinik
Learning Objectives:

PT3 Learning Objectives 2018 20


1. List the microvascular (nerves, kidney and eye) and macrovascular (coronary artery disease, stroke
and peripheral vascular disease) complications of diabetes as well as strategies to prevent the
complications.
2. Describe the modifiable cardiovascular disease (CVD) risk factors associated with diabetes and the
specific goals in treating these diseases.
3. Explain the many types of neurologic complications of that can result from diabetes including the
large and small nerve fibers.
4. Describe the renal complications from diabetes including the prevention, pathology and the
treatment.
5. Describe the retinal complications from diabetes.
6. Understand obesity and metabolic syndrome is associated with an inflammatory state, and that
inflammatory proteins predict and may contribute to CVD.

Friday, December 14: 9:00 AM-9:50 AM


Hypoglycemia: Vinik
Learning Objectives:
1. Define hypoglycemia: components and severity
2. Explain the normal counter regulatory hormone response to hypoglycemia and defects in diabetes
3. Describe hypoglycemia unawareness and possible etiologies
4. List the causes of non-diabetic hypoglycemia
5. Analyze the biochemical findings in the work-up of hypoglycemia
6. Assess the key components essential in the diagnosis and management of insulinoma and non-
insulinoma pancreatogenous hypoglycemia

WEEK 9: Diabetes and Exam 2

Monday, December 17: 10:00 AM -10:50 AM


Pharmacology of Diabetes: Zaveri

Learning Objectives:
TBA

Monday, December 17: 11:00 AM -11:50 AM


Pharmacology of Repro: Zaveri

Learning Objectives:
TBA

PT3 Learning Objectives 2018 21


PT3 Learning Objectives 2018 22

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