year-2-study-guide-2.. - School of Medicine - Trinity College Dublin
year-2-study-guide-2.. - School of Medicine - Trinity College Dublin
year-2-study-guide-2.. - School of Medicine - Trinity College Dublin
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
THE UNIVERSITY OF DUBLIN<br />
TRINITY COLLEGE<br />
SCHOOL OF MEDICINE<br />
PROGRAMME STUDY GUIDE<br />
2 nd Medical Year Study Guide 2010/2011<br />
1
TABLE OF CONTENTS<br />
1. CONTACT DETAILS…………………………………………………… Page 3<br />
<strong>2.</strong> COURSE STRUCTURE……………………………………………….. Page 4<br />
3. MOLECULAR AND TRANSLATIONAL MEDICINE……………….. Pages 5-12<br />
Lecturers<br />
Contact Hours<br />
Aims<br />
Course Content<br />
Indicative Resources<br />
Learning Outcomes<br />
Methods <strong>of</strong> Teaching and Student Learning<br />
Methods <strong>of</strong> Assessment<br />
Evaluation<br />
4. CLINICAL BIOCHEMISTRY…………………………………………… Pages 13-22<br />
Lecturers<br />
Contact Hours<br />
Aims<br />
Course Content<br />
Indicative Resources<br />
Learning Outcomes<br />
Methods <strong>of</strong> Teaching and Student Learning<br />
Methods <strong>of</strong> Assessment<br />
Evaluation<br />
5. PRINCIPLES OF PHARMACOLOGY & PRACTICAL …………….. Pages 23-26<br />
SCIENTIFIC RESEARCH<br />
Lecturers<br />
Contact Hours<br />
Aims<br />
Course Content<br />
Indicative Resources<br />
Learning Outcomes<br />
Methods <strong>of</strong> Teaching and Student Learning<br />
Methods <strong>of</strong> Assessment<br />
Evaluation<br />
6. HEAD AND NECK ANATOMY………………………………………… Pages 27-29<br />
Lecturers<br />
Contact Hours<br />
Aims<br />
Course Content<br />
Indicative Resources<br />
Learning Outcomes<br />
Methods <strong>of</strong> Teaching and Student Learning<br />
Methods <strong>of</strong> Assessment<br />
Evaluation<br />
1
7. NEUROSCIENCES……………………………………………………… Pages 30-41<br />
Lecturers<br />
Contact Hours<br />
Aims<br />
Course Content<br />
Indicative Resources<br />
Learning Outcomes<br />
Methods <strong>of</strong> Teaching and Student Learning<br />
Methods <strong>of</strong> Assessment<br />
Evaluation<br />
8. AETIOLOGY, MECHANISMS OF DISEASE…………………………… Pages 42-46<br />
Contact Hours<br />
Lecturers<br />
Aims<br />
Course Content<br />
Indicative Resources<br />
Learning Outcomes<br />
Methods <strong>of</strong> Teaching and Student Learning<br />
Methods <strong>of</strong> Assessment<br />
Evaluation<br />
9. FUNDAMENTALS OF CLINICAL AND PROFESSIONAL PRACTICE Pages 47-48<br />
Lecturer(s)<br />
Contact Hours<br />
Aims<br />
Course Content<br />
Indicative Resources<br />
Learning Outcomes<br />
Methods <strong>of</strong> Teaching and Student Learning<br />
Methods <strong>of</strong> Assessment<br />
Evaluation<br />
PERSONAL INJURY PROCEDURE Page 49<br />
MICROBIOLOGY SAFETY IN THE HOSPITAL Page 50<br />
PLAGIARISM Page 50<br />
SCHOOL OF MEDICINE POLICY Page 52<br />
SOURCES OF SUPPORT & HELP IN COLLEGE Page 53<br />
EXEMPTION FORM Page 54<br />
MED DAY Page 56<br />
2
CONTACT DETAILS<br />
Year Coordinator:<br />
To be appointed<br />
Anatomy:<br />
Mr Paul Glacken, Dept <strong>of</strong> Anatomy<br />
Tel 896 1242, pglacken@tcd.ie<br />
Biochemistry:<br />
Dr. Richard Porter,<br />
<strong>School</strong> <strong>of</strong> Biochemistry and Immunology<br />
Tel 896 1851, jscott@tcd.ie; rkporter@tcd.ie<br />
Clinical Skills:<br />
Marie Morris (AMNCH)<br />
Tel: 896 2910, morrism4@tcd.ie<br />
Phillippa Marks (AMNCH)<br />
Tel: 896 1475, pmarks@tcd.ie<br />
Clare Martin (St. James’sHospital)<br />
Tel: 896 4059, martinc4@tcd.ie<br />
Triona Flavin (St. James’s Hospital)<br />
Ext: 896 4098, tflavin@tcd.ie<br />
Microbiology:<br />
Dr. Stephen Smith<br />
Tel: 896 3713, sgsmith@tcd.ie<br />
Molecular <strong>Medicine</strong>:<br />
Neuroscience:<br />
Pr<strong>of</strong> Yuri Volkov, Dept <strong>of</strong> Clinical <strong>Medicine</strong><br />
Tel: 896 3263<br />
yvolkov@tcd.ie<br />
Pr<strong>of</strong>. Michael Rowan, Dept <strong>of</strong> Pharmacology &<br />
Therapeutics<br />
Tel: 896 1567, mrowan@tcd.ie<br />
Pathology:<br />
Head <strong>of</strong> Department, Pr<strong>of</strong>. John O’Leary<br />
Tel: 896 3283/3296<br />
Pharmacology:<br />
Dr Paul Spiers, Dept <strong>of</strong> Pharmacology & Therapeutics<br />
Tel 896 2146, spiersj@tcd.ie<br />
3
OVERVIEW<br />
Phase 2<br />
This phase extends over two <strong>year</strong>s and is designed to: -<br />
• Continue and expand the generic skills development with emphasis on the<br />
pr<strong>of</strong>essional aspects.<br />
• Emphasise critical thinking and foster insight into the essential role <strong>of</strong> research<br />
in healthcare including aspects <strong>of</strong> molecular medicine and genetics.<br />
• Commence the development <strong>of</strong> non-invasive clinical skills at the individual<br />
(history taking and physical examination) and community (health promotion)<br />
level.<br />
• Introduce students to disease processes and to global as well as national<br />
aspects <strong>of</strong> disease control<br />
• Commence the development <strong>of</strong> invasive clinical skills<br />
• Focus on pr<strong>of</strong>essional development by exploration <strong>of</strong> the legal, moral, ethical<br />
and economic aspects <strong>of</strong> safe effective medical practice.<br />
YEAR 2 MODULES<br />
There are seven modules in the 2 nd Medical <strong>year</strong> accruing 60 credits in total. The<br />
seven modules are;<br />
Module 1: Molecular & Translational <strong>Medicine</strong><br />
Module 2: Clinical Biochemistry<br />
Module 3: Principles <strong>of</strong> Pharmacology and Practical Scientific Research<br />
Module 4: Head and Neck Anatomy<br />
Module 5: Neurosciences<br />
Module 6: Aetiology, mechanisms <strong>of</strong> disease<br />
Module 7: Fundamentals <strong>of</strong> Clinical and Pr<strong>of</strong>essional Practice<br />
4
Module 1: MOLECULAR & TRANSLATIONAL MEDICINE<br />
ECTS Value<br />
5 credits<br />
Lecturers<br />
Dr. Paula Murphy<br />
Dr. Kevin Mitchell<br />
Pr<strong>of</strong>. Veronica Campbell<br />
Pr<strong>of</strong>. Yuri Volkov<br />
Pr<strong>of</strong>. Andrew Bowie<br />
Pr<strong>of</strong>. Dermot Kelleher,<br />
Dr. Maureen O’Sullivan<br />
Pr<strong>of</strong>. Mark Lawler<br />
Dr. Paul Spiers<br />
Dr. Henry Windle<br />
Dr. Derek Morris<br />
Dr. Richard Anney<br />
Contact Hours<br />
The module comprises 28 lectures given by a number <strong>of</strong> academic and clinical<br />
specialists with prominent expertise in their areas. The students will be also provided<br />
with an opportunity to carry out small group projects on the grounds <strong>of</strong> the biomedical<br />
research facilities <strong>of</strong> the <strong>Trinity</strong> <strong>College</strong>’s Institute <strong>of</strong> Molecular <strong>Medicine</strong> at St.<br />
James’s Hospital Campus. Additional tutorials dealing with specific aspects <strong>of</strong><br />
Molecular <strong>Medicine</strong> can be arranged by request. Self-<strong>study</strong> hours are expected to be<br />
determined individually by the students. If required, the students will be provided with<br />
additional explanatory comments and self-<strong>study</strong> resources by the lecturers in their<br />
relevant subjects.<br />
Aims<br />
Recent <strong>year</strong>s have witnessed a rapid accumulation <strong>of</strong> knowledge in molecular basis<br />
<strong>of</strong> human diseases, giving the rise to Molecular <strong>Medicine</strong> as a discipline providing an<br />
insight into the mechanisms <strong>of</strong> development <strong>of</strong> pathological processes at molecular<br />
level. Molecular <strong>Medicine</strong> continuously supplies new powerful tools for diagnostics,<br />
therapeutic drug development, ethiotropic and pathogenetic treatment <strong>of</strong> a wide<br />
range <strong>of</strong> ailments, including some <strong>of</strong> those, which were previously considered<br />
incurable. Medical graduates with a good knowledge <strong>of</strong> Molecular <strong>Medicine</strong> have a<br />
potential <strong>of</strong> significantly improving the current diagnostic and therapeutic routines and<br />
may form strong liaisons between hospitals, diagnostic labs, biomedical research<br />
institutions, and pharmaceutical industry for the ultimate benefit <strong>of</strong> patients’<br />
treatment. This course is aimed to provide medical students with powerful knowledge<br />
in the molecular mechanisms <strong>of</strong> human disease development and related cutting<br />
edge diagnostic tools.<br />
The module is designed for the medical students <strong>of</strong> the second <strong>year</strong> (Senior<br />
Freshman) and represents and integral component <strong>of</strong> the <strong>Trinity</strong> <strong>College</strong><br />
undergraduate medical curriculum. The attendance <strong>of</strong> the course and examinations<br />
are mandatory for all the students.<br />
5
The lecturers will provide the students with a thorough understanding <strong>of</strong> the<br />
following:<br />
• Integration <strong>of</strong> molecular and cellular biology in relation to human diseases<br />
• Operation <strong>of</strong> the human genome at a molecular level, in particular in relation to<br />
the mechanisms <strong>of</strong> disease development<br />
• Molecular mechanisms <strong>of</strong> human development and its disorders<br />
• Molecular basis <strong>of</strong> common human malignancies (cancer)<br />
• Molecular mechanisms <strong>of</strong> human host and microbial pathogens interactions<br />
• Contemporary technologies for analysis <strong>of</strong> human molecular and cellular<br />
functions and their disregulation in disease<br />
• Applications <strong>of</strong> these technologies in clinical practice<br />
• Use <strong>of</strong> knowledge on the molecular basis <strong>of</strong> human disease for the development<br />
<strong>of</strong> novel therapies, including phamacological agents or gene therapy<br />
Course Content<br />
Molecular basis <strong>of</strong> development and molecular embryology (2 lectures)<br />
Lecturer: Dr. Paula Murphy<br />
Summary <strong>of</strong> the topics covered:<br />
Introduction-what is needed to build a complex organism? Developmental regulatory<br />
genes and their function. Fruitfly Drosophila and human developmental genetics.<br />
Phases <strong>of</strong> human development and morphogenesis. Critical periods <strong>of</strong> development<br />
and teratogenes. Drugs affecting development. Chromosomal anomalies and<br />
associated developmental disorders.<br />
Neural development (2 lectures)<br />
Lecturer: Dr. Kevin Mitchell<br />
Summary <strong>of</strong> the topics covered:<br />
Molecular processes affecting development <strong>of</strong> the cerebral cortex and their defects.<br />
Specific features <strong>of</strong> nervous system development in comparison to other tissues.<br />
Role <strong>of</strong> selective gene expression, encoded proteins and their associations. Control<br />
<strong>of</strong> cell migration in the cerebral cortex. Mouse mutant models and cell migration.<br />
Neuronal guidance. Establishment <strong>of</strong> cell identities. Cerebral development<br />
abnormalities and mental disease development. Application <strong>of</strong> knowledge <strong>of</strong> cortical<br />
developmental pathways for therapeutic strategies.<br />
Molecular mechanisms <strong>of</strong> cell damage and regeneration; stem cells origin and<br />
applications (2 lectures)<br />
Lecturer: Pr<strong>of</strong>. Veronica Campbell<br />
Summary <strong>of</strong> the topics covered:<br />
Stem cell origin and functional properties. Therapeutic applications <strong>of</strong> stem cells.<br />
Ethical aspects <strong>of</strong> stem cell research and medical use. Molecular basis <strong>of</strong> neurodegeneration.<br />
Alzheimer's and Parkinson’s disease: genetics, environmental factors,<br />
molecular diagnostics and treatment approaches.<br />
6
Molecular mechanisms <strong>of</strong> cell interactions (2 lectures)<br />
Lecturer: Pr<strong>of</strong>. Yuri Volkov<br />
Summary <strong>of</strong> the topics covered:<br />
Main groups <strong>of</strong> adhesion molecules, their structural aspects and functional role.<br />
Integrins as mediators <strong>of</strong> cell interactions between each other and extracellular<br />
matrix.<br />
Immunoglobulin-like adhesion ligands. Inside-out and outside-in signals triggered in<br />
cells by integrins. Selectins, cadherins, CD44 and related molecules. Diseases<br />
associated with abnormal expression and function <strong>of</strong> adhesion molecules.<br />
Molecular mechanisms <strong>of</strong> cell interactions, leukocyte migration and<br />
recirculation (3 lectures)<br />
Pr<strong>of</strong>. Yuri Volkov<br />
Summary <strong>of</strong> the topics covered:<br />
Main groups <strong>of</strong> adhesion molecules, their structural aspects and functional role.<br />
Integrins as mediators <strong>of</strong> cell interactions between each other and extracellular<br />
matrix.<br />
Immunoglobulin-like adhesion ligands. Inside-out and outside-in signals triggered in<br />
cells by integrins. Selectins, cadherins, CD44 and related molecules. Diseases<br />
associated with abnormal expression and function <strong>of</strong> adhesion molecules.<br />
Multi-step leukocyte navigation paradigm. Mechanistic models <strong>of</strong> leukocyte migration.<br />
Membrane receptors and soluble factors affecting leukocyte homing.<br />
Chemokines, their classification and disease-specific importance. Leukocyte<br />
recirculation routes. Multi-factorial mechanisms <strong>of</strong> cell directed leukocyte recruitment<br />
from the blood vessels into disease sites.<br />
Cell signalling and transcriptional regulation <strong>of</strong> inflammation (2 lectures)<br />
Lecturer: Pr<strong>of</strong>. Andrew Bowie<br />
Summary <strong>of</strong> the topics covered:<br />
Molecular mediators <strong>of</strong> inflammation. The role <strong>of</strong> Toll-like receptors and nucleotidebinding<br />
oligomerisation domain proteins in infection and inflammation. IL-1 as a<br />
factor affecting gene expression. NFkB and inflammatory process development.<br />
Tumour necrosis factor and caspases in inflammation.<br />
Molecular mechanisms <strong>of</strong> cancer (6 lectures)<br />
Lecturer: Pr<strong>of</strong>. Dermot Kelleher, Dr. Maureen O’Sullivan<br />
Summary <strong>of</strong> the topics covered:<br />
DNA transcription and translation. Basics <strong>of</strong> genetic mutation - heritability, germline<br />
versus somatic changes and mechanistic effects <strong>of</strong> mutations. DNA repair<br />
mechanisms.<br />
Cell cycle and apopotosis. Epigenetics: DNA methylation, histones, miRNAs role in<br />
health, development and disease. Animal models <strong>of</strong> disease - xenografts, knock-out<br />
models, conditional models.<br />
Cancer – an overview. What cancer is and what it looks like – examples <strong>of</strong> tumours<br />
from different sites and the potential for diverse mechanisms <strong>of</strong> oncogenesis. Solid<br />
tumours – gastrointestinal tumours and the inflammation – cancer sequence.<br />
Haematological malignancies. Genetic abnormalities associated with blood cell<br />
malignancies. BCR-ABL and AML1 genes in leukaemia. Skin tumours and the role<br />
<strong>of</strong> UV-radiation.<br />
7
Genetics and Cancer. Oncogenes and tumor suppressor genes.Types <strong>of</strong> genetically<br />
mediated cancer. The accumulation <strong>of</strong> mutations. The Li-Frameini syndrome and the<br />
importance <strong>of</strong> p-53. Familial breast cancer and the BRCA genes. APC genes and<br />
familial adenomatous polyposis. Synthesis <strong>of</strong> the importance <strong>of</strong> familial cancers to<br />
our understanding <strong>of</strong> cancer mechanisms in sporadic tumours.<br />
Mechanisms <strong>of</strong> carcinogenesis. The stages <strong>of</strong> development <strong>of</strong> human cancers. The<br />
polyp-cancer sequence for colorectal cancer. Integration <strong>of</strong> host and environmental<br />
factors. Chemically mediated cancer. Diet and cancer – potential biochemical<br />
mechanisms. The mechanisms whereby viruses cause cancer. What viruses tell us<br />
about the cell cycle. Viruses and the inflammation- cancer sequence.<br />
Tumour cells growth and metastasis. Overview <strong>of</strong> metastatic process. How tumour<br />
cells metastasise. Angiogenesis. Metalloproteases, adhesion molecules and<br />
migration. Targeting metastasis in chemotherapy.<br />
Molecular basis <strong>of</strong> cardiovascular diseases (2 lectures)<br />
Dr. Ross Murphy<br />
Summary <strong>of</strong> the topics covered:<br />
Genetic factors and lifestyle in the development <strong>of</strong> cardiovascular disease. DNA<br />
damage, oxidative stress and chronic inflammation as main pathogenic determinants<br />
<strong>of</strong> cardiovascular pathology. Molecular basis <strong>of</strong> vascular stress response and<br />
damage, atherosclerosis and hypoxia. Molecular mechanisms <strong>of</strong> heart tissue<br />
damage and regeneration. Stem cells, adhesion molecules and small molecule<br />
based therapeutic approaches.<br />
Molecular basis <strong>of</strong> leukaemia and gene therapy (2 lectures)<br />
Lecturer: Pr<strong>of</strong>. Mark Lawler<br />
Summary <strong>of</strong> the topics covered:<br />
Classification and origin <strong>of</strong> leukaemias. Genetic abnormalities associated with blood<br />
cell malignancies. BCR-ABL and AML1 genes in leukaemia. Molecular intervention<br />
and drugs used in treatment <strong>of</strong> leukaemia. Principles <strong>of</strong> gene therapy. Mechanisms<br />
and methods <strong>of</strong> gene delivery. DNA synthesis and damage as targets for<br />
pharmacological intervention in cancer therapy.<br />
Anti-inflammatory anti anti-cancer drugs (2 lectures)<br />
Lecturer: Dr. Paul Spiers<br />
Summary <strong>of</strong> the topics covered:<br />
Molecular approaches to anti-inflammatory and anti-cancer drug development.<br />
Molecular targets for treatment <strong>of</strong> inflammation and malignant disease. Monoclonal<br />
antibodies and immuno-suppressants. Drug eluting stents.<br />
Pharmacological and non-drug induced toxicity.<br />
Nanomedicine and medical applications <strong>of</strong> molecular imaging (2 lectures)<br />
Lecturer: Pr<strong>of</strong>. Yuri Volkov<br />
Summary <strong>of</strong> the topics covered:<br />
Contemporary approaches to biomedical studies at molecular level. Tools used for<br />
visualisation <strong>of</strong> intracellular processes. Nanomedicine, nanotechnologies and novel<br />
diagnostic and drug delivery systems. High content analysis in drug development and<br />
screening.<br />
8
Medical proteomics (2 lectures)<br />
Lecturer: Dr. Henry Windle<br />
Summary <strong>of</strong> the topics covered:<br />
Introduction to medical proteomics. Proteomics in biomarker discovery. Applications<br />
<strong>of</strong> proteomics for improved medical diagnostics and drug development. Protein chips<br />
and arrays. Human proteome organisation.<br />
Molecular basis <strong>of</strong> psychiatric disorders (2 lectures)<br />
Lecturer: Dr. Derek Morris, Dr. Richard Anney<br />
Summary <strong>of</strong> the topics covered:<br />
Psychiatric diseases as complex genetic disorders. Mutations in DNA and molecular<br />
genetic <strong>of</strong> psychiatric disorders. Endophenotypes in the analysis <strong>of</strong> psychiatric<br />
diseases. Linkage and association studies.<br />
Molecular mechanisms in aetiology <strong>of</strong> ADHD. Applications <strong>of</strong> molecular genetics in<br />
diagnostics <strong>of</strong> psychiatric diseases. Mouse models <strong>of</strong> ADHD. Dopaminergic<br />
hypothesis in ADHD. Treatment approaches and their link to research in ADHD.<br />
Indicative Resources<br />
The cell: a molecular approach (Ge<strong>of</strong>frey M. Cooper)<br />
Developmental Biology (Gilbert S., 7th Edition, SinauerPress).<br />
Molecular cell biology (Harvey Lodish et al.)<br />
Molecular biology <strong>of</strong> the cell (Bruce Alberts et al.).<br />
Encyclopedia <strong>of</strong> molecular cell biology and molecular medicine (Robert A. Meyers)<br />
Molecular <strong>Medicine</strong> (R.J.Trent)<br />
Essentials <strong>of</strong> Human Embryology (Larsen)<br />
Introduction to Molecular <strong>Medicine</strong> (Ross, Dennis W.)<br />
An Introduction to Molecular <strong>Medicine</strong> and Gene Therapy (Thomas F. Kresina)<br />
Learning Outcomes<br />
The overall objective <strong>of</strong> this module is to empower the students with the knowledge<br />
<strong>of</strong> the essential aspects <strong>of</strong> molecular mechanisms <strong>of</strong> disease development<br />
accumulated over the recent <strong>year</strong>s and to enable the medics to apply this information<br />
in clinical environment for improved diagnostic and treatment <strong>of</strong> the patients.<br />
On successful completion <strong>of</strong> this module, the students will be able to:<br />
• Identify the molecular mechanisms involved in human development,<br />
developmental abnormalities, tissue damage, regeneration and recognise stem<br />
cell applications in this context;<br />
• Describe the fundamental molecular mechanisms <strong>of</strong> cell communications and key<br />
intracellular processes underlying inflammatory diseases and human host<br />
defence responses;<br />
• Explain the genetic and environmental factors involved in the development <strong>of</strong><br />
cancer and haematological malignancies and understand the key stages <strong>of</strong><br />
cancer development and progression;<br />
• Explain how structural and functional analysis <strong>of</strong> molecules can be applied to the<br />
generation <strong>of</strong> novel drugs and design <strong>of</strong> new therapies, including gene delivery<br />
and gene therapy;<br />
• Explain the molecular processes underlying common psychiatric disorders;<br />
• Discuss how contemporary molecular medicine technologies can be applied for<br />
the development <strong>of</strong> new diagnostic methods and molecular approaches for<br />
therapeutic intervention<br />
9
MOLECULAR MEDICINE<br />
Lecture Timetable for the Second Medical Year Michaelmas Term<br />
Venues: IMM Building: Robert Smith Lecture Theatre / 2039, Walton Art Theatre, Main Campus<br />
DATE: TIME: TOPIC: LECTURER: VENUE:<br />
Week 1<br />
Wed. 30 th Sept. 12:00 pm Molecular basis <strong>of</strong> development<br />
and molecular embryology 1<br />
Thurs. 1 st Oct. 9:00 am Molecular Mechanisms <strong>of</strong><br />
Cancer 1<br />
10:00 am Molecular Mechanisms <strong>of</strong><br />
Cancer 2<br />
Week 2<br />
Wed. 7 th Oct. 12:00 pm Molecular basis <strong>of</strong> development<br />
and molecular embryology 2<br />
Thurs. 8 th Oct. 9:00 am Molecular Mechanisms <strong>of</strong><br />
Cancer 3<br />
10:00 am Molecular mechanisms <strong>of</strong> cell<br />
interactions 1<br />
Week 3<br />
Wed. 14 th Oct.<br />
12:00 pm Molecular mechanisms <strong>of</strong> cell<br />
damage and regeneration; stem<br />
cells origin and applications 1<br />
10<br />
Paula Murphy<br />
Maureen O'Sullivan<br />
Maureen O'Sullivan<br />
Paula Murphy<br />
Maureen O'Sullivan<br />
Yuri Volkov<br />
Veronica Campbell<br />
2039 Walton Art Theatre<br />
IMM Building: RSL<br />
IMM Building: RSL<br />
2039 Walton Art Theatre<br />
IMM Building: RSL<br />
IMM Building: RSL<br />
2039 Walton Art Theatre<br />
Thurs. 15 th Oct. 9:00 am Molecular basis <strong>of</strong> leukaemia Mark Lawler IMM Building: RSL<br />
10:00 am Molecular basis gene therapy Mark Lawler IMM Building: RSL<br />
Week 4<br />
Wed. 21 st Oct.<br />
12:00 pm Molecular mechanisms <strong>of</strong> cell<br />
damage and regeneration; stem<br />
cells origin and applications 2<br />
Thurs. 22 nd Oct. 9:00 am Molecular mechanisms <strong>of</strong> cell<br />
interactions 2<br />
10:00 am Molecular basis <strong>of</strong> psychiatric<br />
disorders 1<br />
Veronica Campbell<br />
Yuri Volkov<br />
Derek Morris<br />
2039 Walton Art Theatre<br />
IMM Building: RSL<br />
IMM Building: RSL<br />
Week 5<br />
Wed. 28 th Oct. 12:00 pm Cell signalling and Andrew Bowie 2039 Walton Art Theatre<br />
transcriptional regulation <strong>of</strong><br />
inflammation 1<br />
Thurs. 29 th Oct. 9:00 am Medical proteomics Henry Windle IMM Building: RSL<br />
10:00 am Molecular basis <strong>of</strong> leukocyte<br />
migration and recirculation 1<br />
Yuri Volkov IMM Building: RSL<br />
Week 6<br />
Wed. 4 th Nov. 12:00 pm Cell signalling and Andrew Bowie 2039 Walton Art Theatre<br />
transcriptional regulation <strong>of</strong><br />
inflammation 2<br />
Thurs. 5 th Nov. 9:00 am Molecular basis <strong>of</strong> leukocyte Yuri Volkov IMM Building: RSL<br />
migration and recirculation 2<br />
10:00 am Medical proteomics Henry Windle IMM Building: RSL<br />
Week 7<br />
Wed. 11 th Nov. 12:00 pm Neural development 1 Kevin Mitchell 2039 Walton Art Theatre<br />
Thurs. 12 th Nov. 9:00 am Molecular basis <strong>of</strong> psychiatric Richard Anney IMM Building: RSL<br />
disorders 2<br />
10:00 am Molecular Mechanisms <strong>of</strong> Maureen O'Sullivan IMM Building: RSL<br />
Cancer 4<br />
Week 8<br />
Wed. 18 th Nov. 12:00 pm Neural development 2 Kevin Mitchell 2039 Walton Art Theatre<br />
Thurs. 19 th Nov. 9:00 am Anti-Cancer drugs Paul Spiers IMM Building: RSL<br />
10:00 am Anti-Inflammatory Drugs Paul Spiers IMM Building: RSL
Week 9<br />
Thurs. 26 th Nov. 9:00 am Molecular Mechanisms <strong>of</strong><br />
Cancer 5<br />
10:00 am Molecular Mechanisms <strong>of</strong><br />
Cancer 6<br />
Week 10<br />
Thurs. 3 rd Dec. 9:00 am Nano<strong>Medicine</strong> and medical<br />
applications <strong>of</strong> molecular<br />
imaging 1<br />
10:00 am Nano<strong>Medicine</strong> and medical<br />
applications <strong>of</strong> molecular<br />
imaging 2<br />
Dermot Kelleher<br />
Dermot Kelleher<br />
Yuri Volkov<br />
Yuri Volkov<br />
IMM Building: RSL<br />
IMM Building: RSL<br />
IMM Building: RSL<br />
IMM Building: RSL<br />
Methods <strong>of</strong> Teaching and Student Learning<br />
The course is taught for the duration <strong>of</strong> one academic term as a series <strong>of</strong> lectures<br />
dealing with a wide scope <strong>of</strong> topics in Molecular and Translational <strong>Medicine</strong> and is<br />
designed to implement the knowledge accumulated by the students in the closely<br />
related disciplines studied in parallel modules (Anatomy, Clinical Biochemistry and<br />
Molecular Immunology, Microbiology and Pharmacology) for a better understanding<br />
<strong>of</strong> molecular mechanisms <strong>of</strong> human disease and contemporary approaches to their<br />
treatment.<br />
Several lectures <strong>of</strong> the module are focused on the basic molecular mechanisms <strong>of</strong><br />
human development, intracellular communications and signalling as well as<br />
molecular, cell and tissue damage and regeneration. The fundamental knowledge<br />
accumulated from these lectures is subsequently applied for the in-depth<br />
understanding <strong>of</strong> the molecular aspects <strong>of</strong> disease-related impairs in molecular<br />
functions in the context <strong>of</strong> translation <strong>of</strong> this knowledge into clinical practice. The<br />
lectures cover such specific topics as molecular basis <strong>of</strong> inflammation, cancer,<br />
leukaemia and psychiatric disorders, all <strong>of</strong> which refer to clinical patient-related<br />
information. The students are also empowered with the cutting edge technological<br />
approaches to diagnostics and therapy, including Nanomedicine, molecular imaging<br />
and medical proteomics.<br />
Due to a wide scope <strong>of</strong> topics covered by the module, the students are expected to<br />
fully use the taught lecture material and engage in active <strong>study</strong>ing <strong>of</strong> the suggested<br />
reading resources. On specific topics, particularly relevant to the translational<br />
aspects <strong>of</strong> molecular medicine, students should expose themselves to the relevant<br />
original research and clinical publications available through the biomedical databases<br />
and library collections.<br />
Methods <strong>of</strong> Assessment<br />
Summative<br />
The students are assessed via a written examination. The exam consists <strong>of</strong> two<br />
parts. Part A <strong>of</strong>fers an essay type question (which can be chosen from the list) and<br />
constitutes 30% <strong>of</strong> the overall mark. Part B consists <strong>of</strong> short “either/or” type<br />
questions, covering the diverse scope <strong>of</strong> theoretical material <strong>of</strong> the course and<br />
including brief clinical case studies. Each <strong>of</strong> the questions must be attempted and all<br />
<strong>of</strong> them carry equal percentage <strong>of</strong> marks (e.g., value <strong>of</strong> part B is 70% <strong>of</strong> the total<br />
exam mark and comprises 7 short questions. Each <strong>of</strong> these, in this case, carries a<br />
weight <strong>of</strong> 10% <strong>of</strong> the overall mark for the exam).<br />
11
Formative<br />
Informal assessments (as a brief questionnaire or computer-assisted response<br />
collection) may be implemented in the module on some specific topics, in order to<br />
provide efficient feedback from the students to the lecturers and aimed at timely<br />
evaluation <strong>of</strong> the knowledge level achieved in the class. Feedback will be provided to<br />
the students either immediately (computer-assisted format) or upon the analysis <strong>of</strong><br />
the questionnaire responses.<br />
Evaluation<br />
The Molecular and Translational <strong>Medicine</strong> module is relatively novel to the medical<br />
curriculum; it has emerged along with the evolution <strong>of</strong> contemporary medical<br />
sciences. The course components are therefore dynamically adjusted each <strong>year</strong>, to<br />
cater for the best education <strong>of</strong> future clinicians. The changes reflect new and<br />
emerging trends in biomedical and clinical sciences and practice, as well as active<br />
feedback received from the students<br />
12
Module 2: CLINICAL BIOCHEMISTRY<br />
ECTS Value<br />
5 Credits<br />
Lecturers<br />
Biochemistry lectures cover Introduction (Porter 1 lecture)<br />
Coagulation (Preston 6 lectures)<br />
Extracellular matrix (Carroll 4 lectures)<br />
Clinical Endocrinology (Boran 8 lectures)<br />
Clinical Biochemistry (Smith 7 lectures)<br />
Immunology (Jackson/Feighery/Kelly/Doherty 10 lectures/2 tutorials)<br />
Molecular mechanisms <strong>of</strong> metabolic diseases (Nolan/ Pazderska /Wanic 4 lectures)<br />
Aims<br />
The purpose <strong>of</strong> the course is to enable the students to understand and interpret core<br />
aspects <strong>of</strong> “clinical biochemistry” and immunology that they will encounter in the<br />
course <strong>of</strong> their careers as medical doctors. Prerequisites include a knowledge <strong>of</strong> the<br />
fundamentals <strong>of</strong> biochemistry. The course is mandatory. The lecture is there to<br />
facilitate understanding <strong>of</strong> the courses provided.<br />
Course Content<br />
The Extracellular Matrix: Dr. Joe Carroll (4 lectures)<br />
1. The extracellular matrix: overview <strong>of</strong> composition; collagen, elastin and<br />
glucosaminoglycans; collagen-amino acid composition, biosynthesis, post-translation<br />
modification and processing, formation <strong>of</strong> fibres and alternative structures<br />
(particularly type IV), genetic defects in collagen structure and exon splicing<br />
<strong>2.</strong> Glycosaminoglycans: classification, synthesis and properties; genetic disorders <strong>of</strong><br />
gylcosaminoglycan metabolism<br />
3. Calcification: dietary calcium and absorption; structure <strong>of</strong> crystalline bone; vitamin<br />
D metabolism and calcium transport; regulators <strong>of</strong> osteoclast and osteoblast activity;<br />
parathyroid hormone and phosphate metabolism; regulation <strong>of</strong> calcium homeostasis;<br />
factors affecting the determination <strong>of</strong> calcium concentration<br />
4. Molecules involved in cell adhesion: fibronectin and its binding to cells, collagen<br />
and glycosaminoglycans, influences <strong>of</strong> the cell-cycle and metastasis; cell<br />
communication with the morphogenesis and proliferation; laminin, it’s high affinity for<br />
type IV collagen and role in epithelial cell function.<br />
Learning Objectives from the course ‘ Extracellular Matrix’ :<br />
The objective <strong>of</strong> this short course is to gain understanding <strong>of</strong> the extracellular<br />
macromolecular structures which are present in all tissues. These molecules<br />
(collagen, elastin and glycosaminoglycans ) determine the texture, rigidity, fluidity,<br />
strength, shape, elasticity <strong>of</strong> the tissues and serve as barriers against infection. The<br />
glycosaminoglycans influence the calcification <strong>of</strong> tissues. The extracellular matrix<br />
binds via Fibronectin to cells and forms a direct line <strong>of</strong> communication to the nucleus;<br />
Alterations to the extracellular matrix leads to changes to a cells morphology and<br />
biochemistry. Genetic diseases <strong>of</strong> the extracellular matrix have pr<strong>of</strong>ound effects on<br />
growth, learning, sight, etc. We will also examine how Calcium homeostasis is<br />
regulated.<br />
13
Blood Coagulation: Dr. Roger Preston (6 lectures)<br />
Lecture 1 - Overview <strong>of</strong> haemostasis<br />
Lecture 2 - Primary haemostasis<br />
Lecture 3 - The coagulation cascade<br />
Lecture 4 - Regulation <strong>of</strong> coagulation<br />
Lecture 5 – Fibrinolysis<br />
Lecture 6 - Coagulation and inflammation<br />
Learning Objectives<br />
1) Describe normal haemostatic mechanisms including the interaction <strong>of</strong> vessel wall,<br />
platelets and clotting factors.<br />
2) Describe the initiation and regulation <strong>of</strong> coagulation cascade.<br />
3) Discuss the clinical relevance <strong>of</strong> normal haemostasis<br />
3) Understand the molecular basis <strong>of</strong> fibrin clot formation and subsequent dissolution.<br />
4) Describe the central role played by endothelial cells in regulation <strong>of</strong> haemostasis in<br />
vivo.<br />
Clinical Endocrinology Dr. Gerard Boran (8 lectures)<br />
Learning Objectives<br />
1. To understand the basic principles underlying the laboratory biochemical<br />
investigation <strong>of</strong> common problems in clinical endocrinology.<br />
<strong>2.</strong> To know about the uses and limitations <strong>of</strong> common laboratory endocrine<br />
investigations<br />
3. To be able to interpret simple case vignettes covering common endocrine<br />
problems.<br />
1. Introduction to endocrinology. Review <strong>of</strong> structure, function and receptors for<br />
hormones <strong>of</strong> clinical interest. General principles <strong>of</strong> investigation <strong>of</strong> endocrine<br />
function. Hormone assays and the clinical biochemistry laboratory. Major<br />
hormone axes. Sources <strong>of</strong> biological variation.<br />
<strong>2.</strong> Hypothalamic and pituitary function. Hypothalamic and pituitary function.<br />
Anterior pituitary hormones. Hyperprolactinaemia. Acromegaly. Growth hormone<br />
deficiency. Posterior Pituitary hormones. Diabetes insipidus.<br />
3. Thyroid. Thyroid function tests. Biochemical investigation <strong>of</strong> thyrometabolic<br />
disorders including ultrasound and radionuclide scans. Hyperthyroidism.<br />
Hypothyroidism. Graves’ disease. Goitre. Subclinical disorders. Sick euthyroid<br />
syndrome. Overview <strong>of</strong> some rare causes <strong>of</strong> thyroid dysfunction.<br />
4. Adrenal. Adrenal function. Measurement <strong>of</strong> cortisol, ACTH and adrenal<br />
androgens. Steroid binding proteins. Investigation <strong>of</strong> adrenal disorders including<br />
dynamic function tests. Addison’s disease. Cushing’s syndrome. Congenital<br />
adrenal hyperplasia.<br />
5. Endocrine hypertension. Investigation <strong>of</strong> suspected primary hyperaldosteronism.<br />
Conn’s syndrome. Investigation <strong>of</strong> catecholamine secreting tumours.<br />
Phaeochromocytoma. Multiple endocrine neoplasia.<br />
6. Gonadal dysfunction in the male. Testicular function. Investigation <strong>of</strong> testicular<br />
function. Male hypogonadism. Erectile dysfunction. Causes <strong>of</strong> infertility.<br />
Investigation <strong>of</strong> the infertile couple. Male and female pseudohermaphroditism.<br />
14
Associated adrenal enzyme defects. Androgen receptor defects. 5α-reductase<br />
deficiency.<br />
7. Gonadal dysfunction in the female. Ovarian function. Sex hormone binding<br />
globulin. Normal and abnormal androgen production in females. The menstrual<br />
cycle and disturbances. The menopause. Ovarian failure. Amenorrhoea.<br />
Hirsutism. Virilism. Polycystic ovary syndrome. Diagnostic use <strong>of</strong> β-HCG<br />
measurements. T<br />
8. Special topic in endocrinology. B-type natriuretic peptides (BNP) and the<br />
diagnosis <strong>of</strong> heart failure.<br />
9. Effective interpretation <strong>of</strong> endocrine laboratory data. Interactive session. Optimal<br />
strategies for interpretation <strong>of</strong> clinical laboratory endocrine data. Endocrine case<br />
vignettes. Decision making based on preliminary endocrine results.<br />
10. Endocrine cases. Interactive session. Acromegaly. Growth hormone deficiency.<br />
Graves’ disease. Primary hypothyroidism. Goitre. Cushing’s syndrome. Addison’s<br />
disease. Conn’s syndrome. Phaeochromocytoma. Amenorrhoea. Hirsutism.<br />
Polycystic ovary syndrome. Ectopic and other abnormal pregnancy. Male<br />
hypogonadism. Androgen receptor disorders. Adrenal enzyme defects.<br />
Clinical Biochemistry<br />
Dr. Tom Smith (7 lectures)<br />
1. Fluid & Electrolytes: Fluid Balance: Water distribution and homeostatis,<br />
compartmental composition and concepts <strong>of</strong> balance. Effects <strong>of</strong> solutes. Osmolality.<br />
Volume receptors and the role <strong>of</strong> ADH.<br />
<strong>2.</strong> Fluid & Electrolytes: Sodium Balance: Role <strong>of</strong> renin, aldosterone and atrial<br />
natriuretic peptide. Clinical and laboratory assessment <strong>of</strong> sodium depletion or<br />
excess. Causes <strong>of</strong> Hypernatraemia and Hyponatraemia. Treatment <strong>guide</strong>lines,<br />
clinical cases.<br />
3. Fluid & Electrolytes: Potassium Balance: Disorders <strong>of</strong> potassium metabolism.<br />
Effects <strong>of</strong> acid base and endocrine status. Hyper- and Hypokalaemia, causes and<br />
treatment. Clinical cases.<br />
4. Renal Function. Glomerular and Tubular function. Role <strong>of</strong> biochemical markers.<br />
Pre-renal, renal and post-renal damage. Diabetes insipidus and investigation <strong>of</strong><br />
polyuria.<br />
Clinical cases.<br />
5. Acid Base Status. Basic concepts. Metabolic disorders. Respiratory disorders.<br />
Compensatory mechanisms. Clinical and laboratory assessment <strong>of</strong> acid base status.<br />
Case interpretation.<br />
6. Clinical Enzymology. Enzymes in plasma as markers <strong>of</strong> cellular damage.<br />
Sensitivity and specificity. Isoenzymes. Cardiac disease. Liver disease. Clinical<br />
applications and cases.<br />
7. Hyperlipidaemia. Lipoprotein metabolism and disorders. Management <strong>of</strong><br />
hyperlipidaemia. Treatment options. Clinical cases.<br />
15
LEARNING OBJECTIVES:<br />
At the end <strong>of</strong> this series <strong>of</strong> lectures students will have a basic understanding <strong>of</strong> the<br />
main core areas <strong>of</strong> Clinical Biochemistry. They will be in a position to understand and<br />
explain from a biochemical and pathophysiological point <strong>of</strong> view derangements in<br />
water, electrolyte, lipid, enzyme, acid base and renal function. Case interpretation by<br />
integration <strong>of</strong> clinical and biochemical data is a fundamental learning objective and<br />
students will be provided with the information to logically derive diagnoses and<br />
suggest patient management and treatment options in the areas covered.<br />
FUNDAMENTAL IMMUNOLOGY<br />
(14 lectures and 2 tutorials)<br />
Lecturers: Con Feighery, John Jackson, Jacinta Kelly, Derek Doherty<br />
Course Aim<br />
To impart an understanding <strong>of</strong> how the immune system works and <strong>of</strong> is importance in<br />
maintaining health and causing disease.<br />
1. Introduction to the Immune System in Health and Disease. (1 lecture) John<br />
Jackson<br />
Learning Objectives:<br />
Be familiar with the importance <strong>of</strong> the immune system in health and disease.<br />
Know the consequences <strong>of</strong> an inadequate immune system.<br />
Know about the role <strong>of</strong> barriers<br />
Understand the local and systemic inflammatory responses<br />
Be familiar with the role <strong>of</strong> immunotherapy to treat and prevent disease.<br />
Summary <strong>of</strong> topics covered:<br />
Secondary immune deficiency, role <strong>of</strong> nutrition, extremes <strong>of</strong> age, introduction to<br />
immune manipulation, active and passive immunisation, mechanical barriers, local<br />
and systemic inflammation, selected inflammatory disorders (to include sepsis,<br />
ARDS, cerebral malaria, rheumatoid arthritis, inflammatory bowel disease),<br />
mediators <strong>of</strong> inflammation (mast cells, plasma cascade pathways, arachadonic acid<br />
metabolites, prostaglandins, leukotrienes, cytokines. Introduction to anti-inflammatory<br />
therapies and new immune modulating agents.<br />
2 and 3. Structure and organization <strong>of</strong> the Immune system (2 lectures) Con<br />
Feighery<br />
Learning objectives:<br />
To gain an understanding <strong>of</strong> –<br />
Organization <strong>of</strong> the immune system<br />
Cells <strong>of</strong> the immune system<br />
Response <strong>of</strong> cells to antigen<br />
Lymphoid tissues<br />
Summary <strong>of</strong> topics covered:<br />
Role <strong>of</strong> the immune system in common diseases. Basic human biology: arterial,<br />
venous and lymphatic circulation. Bone marrow as source <strong>of</strong> cells in circulation.<br />
Function <strong>of</strong> red cells, platelets. Different types <strong>of</strong> white cells: neutrophils, monocytes,<br />
lymphocytes. Two major types <strong>of</strong> lymphocytes: T (thymus) lymphocytes; B (bursa)<br />
16
lymphocytes. Two arms <strong>of</strong> immune system: innate immunity, adaptive immunity.<br />
Clinical scenarios: defects in immune system results in infection; excess in immune<br />
response causes inflammation e.g. allergy.<br />
Overview <strong>of</strong> function <strong>of</strong> white cells. Identification <strong>of</strong> T cells and B cells. Surface<br />
molecules on these cells. Concept <strong>of</strong> antigen. Antibody molecules. Cytokines.<br />
Lymphoid tissues and lymphatic circulation. Thymus. Bursa. Bone marrow. Spleen.<br />
Lymph nodes. Tonsils. Appendix. Clinical scenarios: appendicitis; surgical removal<br />
<strong>of</strong> the spleen.<br />
4. Phagocytosis. (1 lecture) John Jackson.<br />
Learning objectives:<br />
Understand phagocytois as a primary defence mechanism.<br />
Know the stages <strong>of</strong> phagocytois.<br />
Be familiar with the concepts <strong>of</strong> opsonisation, chemotaxis.<br />
Understand the role <strong>of</strong> phagocytes in disease.<br />
Summary <strong>of</strong> topics covered:<br />
Neutrophils, macrophages, eosinophils, specialisation within phagocytic cells,<br />
production <strong>of</strong> phagocytic cells, cell adhesion, diapedesis, chemotaxis, opsonisation,<br />
ingestion, killing, degranulation <strong>of</strong> phagocytic cells, introduction to antigen<br />
presentation, abscess formation, pneumonia.<br />
5. Introduction to specific immunity John Jackson (1 lecture)<br />
Learning objectives:<br />
Know the features <strong>of</strong> specific immunity<br />
Understand the concept <strong>of</strong> clonal selection and polyclonal immune responses<br />
Be familiar with primary and secondary immune responses<br />
Understand specific antigen recognition by T and B cells.<br />
Summary <strong>of</strong> topics covered:<br />
Adaptive nature <strong>of</strong> specific immune responses, specificity, memory, clonal origin <strong>of</strong><br />
immune cells, primary and secondary immune responses, clonal selection and clonal<br />
expansion, memory cells, B and T cell activation.<br />
6 and 7. The role <strong>of</strong> T cells in the Immune system (2 lectures) Con Feighery<br />
Learning objectives:<br />
The central role <strong>of</strong> T cells in the immune response<br />
Memory T cells help protect against infection<br />
How T cells depend on other cells for their function.<br />
Summary <strong>of</strong> topics covered.<br />
How T cells respond to antigen. T cell surface structures. T cell antigen receptor.<br />
Presentation <strong>of</strong> antigens to T cells by antigen presenting cells. Different types <strong>of</strong> T<br />
cells. T helper cells. T cytotoxic cells. T cells bind to a combination <strong>of</strong> antigen and<br />
major histocompatability complex (MHC) molecules. Clinical scenarios: T cells cause<br />
chronic viral hepatitits. HIV infection and certain drugs deplete T cells.<br />
10 12 T cell clones. One clone for every antigen. T cell memory. Vaccination. The<br />
major histocompatability complex (MHC). Transplantation rejection. Two types <strong>of</strong><br />
MHC molecules. T cytotoxic cells bind to Class I molecules. T helper cells bind to<br />
Class II molecules. Types <strong>of</strong> cells which have MHC I or MHC II on cell surface.<br />
Clinical scenario: immune deficiency caused by genetic defect in synthesis <strong>of</strong> MHC.<br />
17
8. The role <strong>of</strong> cytokines in the immune system (1 lecture) Con Feighery<br />
Learning objectives:<br />
Cells which produce cytokines influence the behaviour <strong>of</strong> other cells<br />
Summary <strong>of</strong> topics covered:<br />
Nature and function <strong>of</strong> cytokines. Types <strong>of</strong> T cell cytokines. T cell cytokines which<br />
promote B cell production <strong>of</strong> antibody. Cytokines which cause chronic inflammation.<br />
Cytokines produced by other cells. Clinical scenario: blocking cytokines to control<br />
disease e.g. rheumatoid arthritis. Defect in cytokine receptors cause immune<br />
deficiency<br />
9. The importance <strong>of</strong> MHC molecules in the immune system (1 lecture) Jacinta<br />
Kelly<br />
Learning objectives:<br />
How antigen binds to MHC molecules<br />
MHC genes predispose to many inflammatory diseases.<br />
Summary <strong>of</strong> topics covered:<br />
Two different pathways for antigen to bind to MHC molecules. Endogenous antigen<br />
binds to MHC class I: antigen fragment digested by proteasome and transported by<br />
TAP1 and TAP<strong>2.</strong> Exogenous antigen binds to MHC class II: antigen binds after<br />
release <strong>of</strong> invariant chain. Clinical scenario: strong association <strong>of</strong> some inflammatory<br />
diseases with MHC molecules – HLAB27 with ankylosing spondylitis, HLA-DQ2 with<br />
coeliac disease.<br />
10. Antibody (immunoglobulin) structure and function (1 Lecture) John<br />
Jackson<br />
Learning objectives:<br />
Understand how the structure <strong>of</strong> antibodies relates to their function<br />
Know the role <strong>of</strong> antibody classes<br />
Be familiar with the different ways in which antibodies may be used in the laboratory<br />
Know about monoclonal antibodies. Be familiar with different types <strong>of</strong> antibody<br />
therapy<br />
Summary <strong>of</strong> topics covered:<br />
Four chain structure <strong>of</strong> antibodies, variable and constant regions, hypervariable<br />
regions, immunoglobulin fold, structure and function <strong>of</strong> IgG, IgA, IgM, IgE, IgD,<br />
monoclonal antibodies, laboratory tests utilising antibodies, antibodies as therapeutic<br />
agents.<br />
11-1<strong>2.</strong> Tutorials x <strong>2.</strong> Discussion <strong>of</strong> allergy, auto-immunity, immune deficiency<br />
Con Feighery, John Jackson<br />
Learning objective<br />
Revision. Importance <strong>of</strong> immune system in health.<br />
18
Metabolic diseases (4 lectures)<br />
Definition, current diagnostic criteria and classification <strong>of</strong> diabetes mellitus.<br />
Lecture 1: Introduction to diabetes mellitus (Nolan/Pazderska)<br />
pathophysiology and clinical and biochemical characteristics <strong>of</strong> type 1 and type 2<br />
diabetes mellitus. Epidemiological data regarding increasing prevalence and<br />
incidence <strong>of</strong> both main types <strong>of</strong> diabetes and obesity. Interplay between obesity,<br />
metabolic syndrome and type 2 diabetes. Stages <strong>of</strong> glucose intolerance and the main<br />
preventive strategies for developing diabetes in individuals at risk. Complications in<br />
patients with type 2 diabetes and how we can reduce their risk.<br />
Lecture 2: Cellular and molecular mechanism <strong>of</strong> diabetes mellitus (Nolan/<br />
Pazderska)<br />
Physiology <strong>of</strong> insulin secretion and its action at cellular level. Examples <strong>of</strong> monogenic<br />
forms <strong>of</strong> diabetes will be used to illustrate the effects <strong>of</strong> disrupting insulin secretion<br />
and action at various levels. Genetic background <strong>of</strong> type 1 and type 2 diabetes.<br />
Immune processes occurring in pathophysiology <strong>of</strong> type 1 diabetes and the role <strong>of</strong><br />
HLA antigens. Molecular mechanisms leading to the development <strong>of</strong> microvascular<br />
complications.<br />
Learning objectives:<br />
1. Define diabetes mellitus and discuss current classification and diagnostic<br />
criteria.<br />
<strong>2.</strong> Characterise the main differences between type 1 and 2 diabetes.<br />
3. Discuss genetic background and main differences in genetic susceptibility for<br />
type 1 and type 2 diabetes.<br />
4. Describe immune processes occurring in type 1 diabetes and the role <strong>of</strong> HLA<br />
antigens.<br />
5. Describe the interplay between obesity, insulin resistance and type 2 diabetes.<br />
References:<br />
1. "Definition, Diagnosis and Classification <strong>of</strong> Diabetes Mellitus and its<br />
Complications." Report <strong>of</strong> WHO Consultation. This is a link to where it can be<br />
downloaded: http://whqlibdoc.who.int/hq/1999/WHO_NCD_NCS_99.<strong>2.</strong>pdf<br />
<strong>2.</strong> www.easd.org<br />
3. www.diabetes.org<br />
3. The molecular genetics <strong>of</strong> type 1 diabetes:new genes and emerging mechanisms.<br />
Trends in Molecular <strong>Medicine</strong>; 2008 Jun; 14(6):268-75.Epub 2008 May 14.<br />
Lecture 3: Introduction to Obesity (Nolan/Wanic).<br />
We are going to discuss the definitions/measures, epidemiology, complications and<br />
treatment <strong>of</strong> obesity. We also will discuss the central regulation <strong>of</strong> calorie intake. We<br />
will mention co-morbidities associated with obesity. We will focus on neuroendocrine<br />
control <strong>of</strong> eating (the role <strong>of</strong> leptin etc.).<br />
19
Lecture 4: Cellular and Molecular Mechanisms <strong>of</strong> Obesity (Nolan/Wanic).<br />
Molecular basis (genetics) <strong>of</strong> obesity. Leptin and obesity. Monogenic obesity<br />
syndromes (Leptin, MC4R, PC1, POMC and others). Common forms <strong>of</strong> obesity.<br />
Genome-wide association studies (GWAS) as a powerful approach to <strong>study</strong> genetics<br />
<strong>of</strong> complex diseases (including common forms <strong>of</strong> obesity).<br />
Learning objectives:<br />
1) Discuss causes <strong>of</strong> obesity.<br />
2) Describe the neuroendocrine control <strong>of</strong> eating.<br />
3) Discuss the central regulation <strong>of</strong> calorie intake.<br />
4) Discuss the known genetic background <strong>of</strong> obesity.<br />
References:<br />
All standard textbooks in Internal (General) <strong>Medicine</strong> contain sections re obesity.<br />
20
Module 2: Clinical Biochemistry (5 ECTS)<br />
Lecture Timetable for the Second Medical Year, Semester 1 (Michaelmas)<br />
Venues 2037 (Emmett Lecture Theatre, Arts Block, TCD Campus));2043 (Davis Lecture Theatre, Arts<br />
Block) JOLY 4 Lecture Theatre (Hamilton Building, TCD Campus) 2039 (Arts Block, TCD Campus)<br />
Week Day/Date Time Topic Venue Lecturer<br />
1 Mon 27 Sep 10am Introduction 2037 PORTER<br />
12noon Extracellular Matrix 2043 CARROLL<br />
Wed 29 Sep 3pm Extracellular Matrix JOLY 4 CARROLL<br />
Thur 30 Sep 12noon Extracellular Matrix 2043 CARROLL<br />
Fri 1 Oct 12noon Extracellular Matrix 2043 CARROLL<br />
2 Mon 4 Oct 12noon Extracellular Matrix 2043 CARROLL<br />
Wed 6 Oct 3pm Coagulation JOLY 4 PRESTON<br />
Thur 7 Oct 12noon Coagulation 2043 PRESTON<br />
Fri 8 Oct 12noon Coagulation 2043 PRESTON<br />
3 Mon 11 Oct 12noon Coagulation 2043 PRESTON<br />
Wed 13 Oct 3pm Coagulation JOLY 4 PRESTON<br />
Thur 14 Oct 12noon Coagulation 2043 PRESTON<br />
Fri 15 Oct 12noon Immune System 2043 FEIGHERY<br />
4 Mon 18 Oct 10am Immune System 2037 FEIGHERY<br />
12noon Immune System 2043 FEIGHERY<br />
Wed 20 Oct 3pm Immune System JOLY 4 FEIGHERY<br />
Thur 21 Oct 12noon Immune System 2043 FEIGHERY<br />
Fri 22 Oct 12noon Immune System 2043 JACKSON<br />
5 Mon 25 Oct BANK HOLIDAY<br />
Wed 27 Oct 3pm Immune System JOLY 4 JACKSON<br />
Thur 28 Oct 12noon Immune System 2043 JACKSON<br />
Fri 29 Oct 12noon Immune System 2043 JACKSON<br />
6 Mon 1 Nov 12noon Immune System 2043 DOHERTY<br />
Thurs 4 Nov 12noon Immune System 2043 DOHERTY<br />
7 Mon 8 Nov 10am Immune System 2037 KELLY<br />
12noon Clinical Endocrinology 2043 BORAN<br />
Thur 11 Nov 12noon Clinical Endocrinology 2043 BORAN<br />
Fri 12 Nov 12noon Clinical Endocrinology 2043 BORAN<br />
8 Mon 15 Nov 10am Clinical Endocrinology 2037 BORAN<br />
12noon Clinical Endocrinology 2043 BORAN<br />
Wed 17 Nov 3pm Clinical Endocrinology JOLY 4 BORAN<br />
Thur 18 Nov 12noon Clinical Endocrinology 2043 BORAN<br />
Fri 19 Nov 12noon Clinical Biochemistry 2043 SMITH<br />
9 Mon 22 Nov 10am Clinical Endocrinology 2037 BORAN<br />
12noon Clinical Biochemistry 2043 SMITH<br />
Wed 24 Nov 12noon Clinical Biochemistry 2039 SMITH<br />
3pm JOLY 4<br />
Thur 25 Nov 12noon Clinical Biochemistry 2043 SMITH<br />
Fri 26 Nov 11am Clinical Biochemistry 2039 SMITH<br />
12noon Molecular mechanisms 2043 PAZDERSKA/WANIC<br />
10 Mon 29 Nov 9am 2037<br />
10am Clinical Biochemistry 2037 SMITH<br />
Mon 29 Nov 12noon Molecular Mechanisms 2043 PAZDERSKA/WANIC<br />
Wed 1 December<br />
NO LECTURES OPEN DAY SCIENCE/MED<br />
Thur 2 Dec 12noon Clinical Biochemistry 2043 SMITH<br />
Fri 3 Dec 11am Molecular Mechanisms 2039 PAZDERSKA/WANIC<br />
12noon Molecular Mechanisms 2043 PAZDERSKA/WANIC<br />
11 REVISION WEEK – no lectures Mon 6 December – Friday 10 December<br />
12 Examination week – Monday 13 December – Friday 17 December<br />
The Examination in “Clinical Biochemistry” will be at the end <strong>of</strong> Semester 1, comprising<br />
One 3-hour paper in two sections: Section A: Essay questions, do 2 from 5, Section B: Clinical questions,<br />
do 3 from 6 (Immunology,Endocrinology, Clinical Biochemistry).<br />
Section A accounts for 25%; Section B accounts for 75%<br />
“Pass/Fail” and “Distinction” Viva Voce exams early in Semester 2 (Hilary)<br />
Venue: <strong>School</strong> <strong>of</strong> Biochemistry, Wellcome Building, TCD campus, Date to be finalised.<br />
21
Methods <strong>of</strong> Teaching and Student Learning<br />
Lectures, Tutorials and Informal Discussions<br />
Methods <strong>of</strong> Assessment<br />
Course co-ordinators and lecturers can be contacted with any reasonable requests<br />
about the course, the students progress and the examinations at any time during the<br />
<strong>year</strong>.<br />
The Examination in “Clinical Biochemistry” will be at the end <strong>of</strong> Semester 1.<br />
One 3hour paper two sections:<br />
Section A: Essay questions do 2 from 5<br />
Section B: Clinical questions do 3 from 6 (immunology/endocrinology/clinical<br />
biochemistry)<br />
Section A accounts for 25%; section B accounts for 75%<br />
“Pass/Fail” and “Distinction” viva voce examinations in Hilary term.<br />
Venue: <strong>School</strong> <strong>of</strong> Biochemistry. Date to be finalised.<br />
Evaluation<br />
A lecturer based feedback form is distributed to students. The data is collated, plotted<br />
and analyzed evaluations are given to the lecturers.<br />
Version 13 September 2010 - Porter<br />
22
Module 3: PRINCIPLES OF PHARMACOLOGY & PRACTICAL<br />
SCIENTIFIC RESEARCH<br />
ECTS Value<br />
10 Credits<br />
Contact Hours<br />
46 hrs lectures<br />
2 tutorials 3 hr<br />
2 computer sessions 4.5 hr<br />
2 wet laboratory practical 4.5 hr<br />
Research projects 100 hr<br />
Time for tutorial preparation 3 hr<br />
Time for self <strong>study</strong> relating to research projects 10 hr<br />
Lecturers<br />
Dr Paul Spiers (Course and Research Co-ordinator)<br />
Pr<strong>of</strong>essor Michael Rowan<br />
Dr Michael Barry<br />
Dr Margaret Lucitt<br />
Dr Jennifer Kieran<br />
Pr<strong>of</strong>essor Michael Lambert<br />
Dr Mary Teeling<br />
Mr Alan Kennedy<br />
Aims<br />
This mandatory course is aimed at developing knowledge and understanding <strong>of</strong> the<br />
pharmacological basis <strong>of</strong> therapeutics in order that the student will gain a critical and<br />
intelligent insight into the scientific underpinnings <strong>of</strong> drug use and abuse. The course<br />
comprises a series <strong>of</strong> lectures, tutorials and student practicals. In addition, students<br />
undertake a research project over a 14-week period during which they generate and<br />
analyse their own data, with a view to learning scientific method and reasoning. This<br />
usually involves <strong>study</strong> design, generating personal data, quality control, statistical<br />
evaluation, interpretation <strong>of</strong> results and presentation to an audience by poster.<br />
Students must also demonstrate the ability to evaluate literature in the form <strong>of</strong><br />
submitting a short research paper based upon their project.<br />
23
COURSE CONTENT<br />
Fundamental Principles<br />
• Principles <strong>of</strong> Drug Action I (Introduction to Pharmacology)<br />
• Principles <strong>of</strong> Drug Action II (Receptor Pharmacology)<br />
• Pharmacokinetics I (Drug Absorption, Distribution and Metabolism)<br />
• Pharmacokinetics II (Drug Excretion and Clearance)<br />
• Pharmacogenomics<br />
• Drug Delivery Mechanisms<br />
Principles <strong>of</strong> Autonomic Pharmacology<br />
• Cholinergic Pharmacology (3 Lectures)<br />
• Adrenergic Pharmacology (2 Lectures)<br />
• Pharmacological Modulation <strong>of</strong> the Presynaptic Adrenergic Neurone<br />
• 5-Hydroxytryptamine and Peptides<br />
Principles <strong>of</strong> Cardiovascular Pharmacology<br />
• Pharmacology <strong>of</strong> Cardiac Rhythm<br />
• Pharmacology <strong>of</strong> Cardiac Contractility<br />
• Pharmacology <strong>of</strong> Vascular Tone<br />
• Pharmacology <strong>of</strong> Volume Regulation<br />
• Drugs for the Control <strong>of</strong> Haemorrhage<br />
• Anticoagulants and Thrombolytics<br />
• Integrated Cardiovascular Pharmacology<br />
Principles <strong>of</strong> Endocrine Pharmacology<br />
• Thyroid Hormone Production and Nuclear Receptor Interactions<br />
• Pharmacology <strong>of</strong> Cholesterol and Lipoprotein Metabolism<br />
• Pharmacology <strong>of</strong> Calcium Homeostasis<br />
• Basic Pharmacology <strong>of</strong> Insulin and Oral Hypoglycaemics<br />
• Pharmacology <strong>of</strong> Hypothalamic and Pituitary Hormones<br />
• Adrenocorticosteroids and Antiadrenocorticosteroids<br />
• Revision Lecture<br />
• Pharmacology <strong>of</strong> Reproduction (2 Lectures)<br />
Principles <strong>of</strong> Immune Pharmacology<br />
• Histamine Pharmacology<br />
• Pharmacology <strong>of</strong> Prostaglandins and Leukotrienes<br />
• Molecular Targets in Inflammatory Disease (Molecular <strong>Medicine</strong> Course)<br />
• Integrative Inflammation Pharmacology: Gout and Arthritis<br />
• Integrative Inflammation Pharmacology: Asthma & Eye<br />
Principles <strong>of</strong> Chemotherapy<br />
• Molecular Targets in Cancer (Molecular <strong>Medicine</strong> Course)<br />
• Pharmacology <strong>of</strong> Cancer: Signal Transduction<br />
• Pharmacology <strong>of</strong> Viral Replication<br />
• Pharmacology <strong>of</strong> Malaria and Anti-malarial Drugs<br />
• Drugs for Protozoal and Helminthic Blood Infection<br />
Gastro-Intestinal Pharmacology<br />
• Pharmacology <strong>of</strong> Agents Modulating Gastrointestinal Motility<br />
• Cellular Pharmacology <strong>of</strong> Antacids and Anti-ulcer Agents<br />
24
Principles <strong>of</strong> Toxicology<br />
• Molecular Toxicology and Teratogenic Drug Effects<br />
• Adverse Drug Reactions<br />
• Non-Drug Poisoning<br />
• Drug Overdose<br />
Clinical Pharmacology<br />
• Drug Licensing<br />
• Prescribing<br />
• Introduction to Clinical Pharmacology<br />
Non-lecture components:<br />
• Computer based practicals (2)<br />
• Tutorials (2)<br />
• Laboratory based practicals (2)<br />
• Research projects run over the 2 nd Semester<br />
Indicative Resources<br />
• Rang H P, Dale M M, Ritter, J M & Gardner PG. (2007) Pharmacology, Sixth Ed.<br />
(main text)<br />
• Howland and Mycek (2008) Lippincott’s Illustrated Reviews in Pharmacology, 4 th<br />
Edition (alternative main text)<br />
• Neal M J (2009) Medical Pharmacology at a glance 6 th Ed. Blackwell (good for<br />
outlines only)<br />
• Web resources:<br />
o http://www.medicine.tcd.ie/pharmacology_therapeutics/courses/stu<br />
dent_area/2nd<strong>year</strong>/index.php<br />
Learning Outcomes<br />
On successful completion <strong>of</strong> this course, students will be able to:<br />
• Display an understanding <strong>of</strong> the terminology used to describe basic pharmacologic<br />
principles and drug classification.<br />
• Explain the basic pharmacokinetic principles governing uptake, distribution, metabolism<br />
and elimination <strong>of</strong> drugs.<br />
• Describe and explain pharmacodynamic concepts <strong>of</strong> drug-receptor interaction to<br />
accurately predict drug responses at all levels <strong>of</strong> biological organization<br />
• Demonstrate an understanding <strong>of</strong> the basic mechanisms <strong>of</strong> drug-induced toxicity and<br />
drug interactions.<br />
• Describe the effects exerted by major drug groups on cells, tissues, organ systems, and<br />
patients and be able to explain the mechanisms underlying these effects at various levels<br />
<strong>of</strong> biological organization.<br />
• Show an understanding <strong>of</strong> the basic mechanisms involved in modification <strong>of</strong> drug<br />
responses by disease and genetics.<br />
• Utilize appropriate research approaches (e.g. laboratory, database and literature<br />
sources) to investigate a research question and present it as a short paper.<br />
25
Methods <strong>of</strong> Teaching and Student Learning<br />
Current teaching practices employ a range <strong>of</strong> strategies to encourage student<br />
engagement and facilitate an inclusive curriculum. These include:<br />
1. Computer assisted learning packages<br />
<strong>2.</strong> Case based scenarios in lectures<br />
3. Hands on laboratory practicals<br />
4. Structured case based tutorials<br />
5. Research projects<br />
Methods <strong>of</strong> Assessment<br />
Students are examined in the form <strong>of</strong> written examinations at the end <strong>of</strong> the 1 st semester<br />
(30%), and 2 nd semester (70%). In order to pass the <strong>year</strong>, students are required to have an<br />
accumulative mark <strong>of</strong> 50% or greater. The format and breakdown <strong>of</strong> the marks for the<br />
examinations are as follows:<br />
Semester 1 (30%)<br />
50 Multiple Choice Questions 15%<br />
10 Short Answer Questions 15%<br />
Semester 2 (70%)<br />
50 Multiple Choice Questions 16%<br />
10 Short Answer Questions 16%<br />
2 Essays (choice out <strong>of</strong> 4) 16%<br />
Research project<br />
22% (19% for research paper, 3% for log book)<br />
The 2 nd Semester examination will assess topics covered in both semesters. A viva voce<br />
examination will be held after the 2 nd Semester Examination for students who are border line<br />
pass/fail or pass/honour.<br />
The Supplemental Examination (100%) has the same structure as the 2 nd Semester<br />
examination, but will NOT include a contribution from the research project. In the case <strong>of</strong><br />
students allowed to sit this examination for the first time on medical grounds, the total will<br />
account for 70%, with the remaining 30% coming from the 1 st semester examination.<br />
Students who have not attained sufficient marks to pass the supplemental examination, but<br />
who are deemed borderline, will be invited for a marginal viva.<br />
Sample questions: Available on the <strong>Trinity</strong> web site:<br />
http://www.tcd.ie/Local/Exam_Papers/index.html<br />
Evaluation<br />
Student evaluation will be collected through CAPSL and where feasible feedback will be<br />
used to improve the course.<br />
26
DEPARTMENT OF ANATOMY<br />
Module 4:<br />
ANATOMY OF THE HEAD AND NECK<br />
ECTS VALUE 5<br />
LECTURERS<br />
Mr Paul Glacken 896 1242 pglacken@tcd.ie<br />
Dr William Ryan 896 1353 wmryan@tcd.ie<br />
Dr Nicholas Mahony 896 3580 njmahony@tcd.ie<br />
Dr Paul Tierney 896 1280 ptierney@tcd.ie<br />
TECHNICAL STAFF<br />
Ms Siobhan Ward 896 1295 sward@tcd.ie<br />
Ms Philomena McAteer 896 1295 pmcateer@tcd.ie<br />
MsMary Lynch 896 1352 lynchmc@tcd.ie<br />
Ms Claire Murphy 896 1352 clmurphy@tcd.ie<br />
EXECUTIVE OFFICER<br />
Ms Clare O’Farrell 896 1182 <strong>of</strong>arrec@tcd.ie<br />
CONTACT HOURS<br />
Lectures<br />
Practical Classes<br />
21 hours<br />
27 hours (9 x 3-hour classes)<br />
RATIONALE AND AIMS<br />
This module provides detailed instruction on the gross anatomy <strong>of</strong> the head and neck<br />
and its embryologic development.<br />
It is intended for students <strong>of</strong> <strong>Medicine</strong>, for whom it is mandatory. The module<br />
supports the academic programme <strong>of</strong> the Medical <strong>School</strong>.<br />
COURSE CONTENT<br />
The cervical vertebrae and skull, with their joints and ligaments<br />
The muscles and nerves <strong>of</strong> the region, in functional groups<br />
The visceral and endocrine structures <strong>of</strong> the head and neck<br />
The organs <strong>of</strong> the special senses (vision, hearing, taste)<br />
The arteries, veins and lymphatics <strong>of</strong> the region<br />
Radiology <strong>of</strong> the head and neck<br />
Embryologic development <strong>of</strong> the cervical and crani<strong>of</strong>acial regions<br />
Clinical applications <strong>of</strong> anatomy <strong>of</strong> the region<br />
RESOURCES<br />
1 Textbooks<br />
A main textbook, anatomy atlas and embryology textbook from the following:<br />
Main Textbooks<br />
Gray’s Anatomy for Students: Drake, Vogl and Mitchell: Elsevier<br />
Clinical Anatomy: Monkhouse: Churchill Livingstone<br />
Last’s Anatomy: Sinnatamby: Churchill Livingstone<br />
27
Atlases<br />
Atlas <strong>of</strong> Human Anatomy: Netter: CIBA-Geigy<br />
A Colour Atlas <strong>of</strong> Human Anatomy: McMinn & Hutchings: Wolfe<br />
Human Anatomy: Gosling et al: Mosby<br />
Grant’s Atlas <strong>of</strong> Human Anatomy: Grant: Williams & Wilkins<br />
Embryology<br />
Langman’s Medical Embryology: Sadler: Williams & Wilkins<br />
Reference<br />
Gray’s Anatomy: Williams et al: Longman<br />
Essentials <strong>of</strong> Human Embryology; Larsen<br />
Human Embryology and Developmental Anatomy: Carlson: Mosby<br />
2 WebCT<br />
WebCT is a web-based teaching resource available to all students.<br />
Among other useful features it contains the detailed content <strong>of</strong> each lecture and<br />
practical class.<br />
LEARNING OUTCOMES<br />
On successful completion <strong>of</strong> this module the student will be able to:<br />
• Recognise, describe and classify bones and joints <strong>of</strong> the head and neck.<br />
• Recognise and describe the gross structure and functions <strong>of</strong> its muscles and<br />
nerves <strong>of</strong> the region.<br />
• Recognise and describe its visceral and endocrine structures<br />
• Recognise and describe the organs <strong>of</strong> the special senses<br />
• Recognise and describe its blood supply and lymphatic drainage.<br />
• Recognise and describe the radiologic features <strong>of</strong> the head and neck.<br />
• Describe the development <strong>of</strong> the head and neck and related congenital<br />
abnormalities.<br />
• Apply anatomical knowledge to explain the pathogenesis and natural history <strong>of</strong><br />
common clinical disorders <strong>of</strong> the region.<br />
METHODS OF TEACHING AND STUDENT LEARNING<br />
Teaching delivery is primarily through lectures and practical classes, in which all<br />
students are required to participate.<br />
METHODS OF ASSESSMENT (SF MEDICINE)<br />
ANATOMY OF THE HEAD AND NECK<br />
Assessment is by in-course assessment (Spot Examination, Table Project and<br />
Practical Examination), and an Essay Paper at the end <strong>of</strong> Michaelmas.<br />
In a Spot Examination students are asked to identify anatomical structures in the<br />
Dissecting Room and answer functional and clinical questions.<br />
The Table Project is a group exercise in dissection <strong>of</strong> the neck.<br />
The Practical Examination is a viva voce examination (one-to-one interview) with a<br />
member <strong>of</strong> Staff <strong>of</strong> the Department.<br />
28
The Essay has four questions, all to be answered in 90 minutes. One <strong>of</strong> the four<br />
questions will contain internal choices (do A or B).<br />
Weighting<br />
Spot Examination Michaelmas 10%<br />
Table Project Michaelmas 10%<br />
Practical Examination Michaelmas 40%<br />
Essay Paper Michaelmas 40%<br />
Pass Criteria<br />
In order to pass, students must achieve an overall mark <strong>of</strong> 50%. (It is not necessary<br />
to pass any <strong>of</strong> the individual elements.)<br />
Students with an overall mark <strong>of</strong> 45% -
Module 5:<br />
NEUROSCIENCES<br />
ECTS Value<br />
15 Credits<br />
Contact Hours<br />
This module consists <strong>of</strong> lectures, practicals and interactive workshops.<br />
Lecturers<br />
Lecturers in the disciplines <strong>of</strong> anatomy, biochemistry, pharmacology and<br />
therapeutics, physiology and psychiatry all participate in lectures.<br />
Other teachers from within <strong>College</strong> and associated hospitals, in neurology for<br />
example, will also be involved.<br />
Aims<br />
The overall aim is to consider all aspects <strong>of</strong> the nervous system, from biophysics to<br />
behaviour, in health and disease.<br />
In view <strong>of</strong> the complexity <strong>of</strong> the nervous system the subject is taught in a<br />
multidisciplinary and interdisciplinary manner. Approaches taken include molecular,<br />
biochemical biophysical, cellular, genetic, physiological, pharmacological, structural,<br />
behavioural and psychological. The Psychiatry/Psychology component gives special<br />
emphasis to covering topics across the ages.<br />
It is important that students try to <strong>study</strong> the different aspects <strong>of</strong> the thematic areas in<br />
an integrated way. Related topics in Molecular <strong>Medicine</strong> and Pharmacology are also<br />
relevant to gain a good understanding <strong>of</strong> Neuroscience.<br />
Thematic areas covered include:<br />
Nervous System Development<br />
Cellular and Molecular Neuroscience: Synaptic and Ionic Mechanisms<br />
Neurodegeneration: Common mechanisms<br />
Sensory Systems: Central Sensory / Perceptual pathways and Information<br />
Processing<br />
Behavioural & Cognitive neuroscience: Cognition and Language / Speech<br />
Motor Systems: Central Motor Pathways and Control<br />
General Topography <strong>of</strong> the Nervous System<br />
Regulatory Systems: CNS Arousal / Activation Mechanisms<br />
Regulatory Systems: Affect (Motivation and Emotion)<br />
30
Course Content<br />
LECTURES<br />
WEEK 1<br />
(Biochemistry) Cell-types in the brain and their functions.<br />
Introduction. Glial cell diversity and specialisation. Neurone-glial cell interdependence.<br />
Organelle transport (anterograde & retrograde). Neurotransmitter diversity & criteria.<br />
(Anatomy) Introduction: CNS development<br />
Ectodermal origin <strong>of</strong> the neural plate, neural folds and neural tube; Formation <strong>of</strong> brain and<br />
spinal cord; Alar and basal plates; Motor and sensory neurons; Rhombencephalon<br />
(myelencephalon and metencephalon), mesencephalon and prosencephalon (diencephalon<br />
and telencephalon); Formation <strong>of</strong> the medulla, pons, midbrain, cerebellum, basal ganglia,<br />
thalamus, hypothalamus, pituitary and the cerebral hemispheres; Development <strong>of</strong> the<br />
ventricular system.<br />
(Physiology) Ionic channels 1<br />
-properties <strong>of</strong> ionic channels, especially Na, Ca K and Cl channels<br />
-involvement <strong>of</strong> voltage gated channels in generation <strong>of</strong> action potential<br />
(Anatomy) Cerebral hemispheres: topography<br />
Meninges; Sulci; Gyri; Frontal, parietal, temporal, occipital and limbic lobes; Inferior aspect <strong>of</strong><br />
brain; Insula; Cortical areas (Brodmann); Primary motor cortex; Premotor cortex;<br />
Supplementary motor area; Primary sensory cortex; Auditory cortex and language areas;<br />
Visual cortex; Association cortex; Commisural, projection and association fibres; Structural<br />
aspects; laminar organisation <strong>of</strong> the cerebral cortex; Isocortex and neocortex.<br />
(Physiology) Ionic channels 2<br />
Ionic channels continued.<br />
(Biochemistry) Neuro-Techniques and Brain Metabolism. Methods for <strong>study</strong>ing<br />
neurotransmission. Synaptosomes, cultured cells and other model systems. Tracing and<br />
identification <strong>of</strong> tracts. Composition, types, bioenergetics, storage and transport, exocitosis.<br />
Synaptic vesicles (SSVs and LDCVs).<br />
(Psychiatry) Brain and Mind- Would this lecture (given by Ian Robertson work as a nice<br />
overview to the whole course? I could send him on details or a slide indicating the areas<br />
represented on the course.<br />
What we know about the interaction between brain processes and mental states. The<br />
interactions between the physical and the mental and between biological and psychological.<br />
(Psychiatry) Cognitive development I<br />
Piaget’s theory as the main theory <strong>of</strong> cognitive development, how theories <strong>of</strong> development<br />
might inform clinical work, Intelligence and its measurement, the concept <strong>of</strong> IQ and its<br />
advantages and limitations.<br />
(Biochemistry) Acetylcholine neurotransmission. NMJ. Docking proteins and evidence from<br />
botilinus and tetanus toxins. Stimulation <strong>of</strong> release by chemical, neurotoxic, ionic and<br />
electrical means. Mechanisms and control <strong>of</strong> release - the role <strong>of</strong> calcium ions and <strong>of</strong><br />
phosphorylation events.<br />
(Anatomy) Ventricles and CSF<br />
Lateral ventricle: Central part, with frontal, occipital and temporal horns; interventricular<br />
foramen; relationship with caudate nucleus, septum pellucidum, corpus callosum, fornix,<br />
thalamus, forceps major, calcar avis, amygdala, hippocampus and tela choroidea. Third<br />
31
ventricle: Relationship with the fornix, corpus callosum, thalamus and interthalamic adhesion,<br />
hypothalamus, anterior commisure, lamina terminalis, optic chiasm, posterior commisure,<br />
pineal gland, cerebral aqueduct and tela choroidea. Interpeduncular fossa: Tuber cinereum,<br />
infundibulum, pituitary gland, mamillary bodies, posterior perforated substance. Fourth<br />
ventricle: Lateral boundaries, ro<strong>of</strong> and floor; lateral and dorsal recesses; Median aperture (<strong>of</strong><br />
Magendie), lateral apertures (<strong>of</strong> Luschka); Median sulcus, medial eminences, sulcus limitans;<br />
Superior fovea, facial colliculus, locus coeruleus, striae medullares (taeniae), inferior fovea;<br />
Hypoglossal triangle (trigone), vagal triangle, vestibular area, auditory tubercle. CSF<br />
Pathways<br />
(Physiology) Synaptic transmission and neurotransmitter receptors 1<br />
-general properties <strong>of</strong> synaptic transmission<br />
-general properties <strong>of</strong> neurotransmitter receptors, including ionic and metabotropic receptors<br />
-ionotropic transmitter channels, including generation <strong>of</strong> fast synaptic potentials and<br />
properties <strong>of</strong> ionic-receptor channels, including nicotinic acetylcholine receptors, glutamate<br />
AMPA receptors, glutamate NMDAR receptors and GABAergic receptors<br />
-long-term potentiation <strong>of</strong> synaptic transmission<br />
-metabotropic transmitter channels, including generation <strong>of</strong> slow synaptic potentials and<br />
properties <strong>of</strong> metabotropic-receptor channels<br />
WEEK 2<br />
(Pharmacology) Drugs and synaptic transmission I<br />
Psycho- and Neuro-pharmacology,<br />
Classifications <strong>of</strong> drugs acting on the central nervous system<br />
Blood-brain barrier to drugs.<br />
State-dependence <strong>of</strong> drug action and effects. Placebo effect.<br />
Arousal continuum. Mood continuum.<br />
Neurotransmission and sites <strong>of</strong> drug action.<br />
Targets for drugs at the CNS synapse –excitatory and inhibitory circuitry.<br />
Pre- and post-synaptic interference (positive or negative) with receptors / effectors,<br />
synthesis, storage, release, reuptake / transporters and degradation.<br />
Drugs acting at synapses: Amino acid receptors including glutamate, GABA and glycine.<br />
Subtypes <strong>of</strong> amino acid receptors and selective drugs.<br />
(Biochemistry) Aminergic Transmission 1. Synthesis <strong>of</strong> catecholamines and serotonin;<br />
properties <strong>of</strong> the enzymes involved, nature and control <strong>of</strong> these processes and the effects <strong>of</strong><br />
drugs. Post-synaptic events, metabotropic and ionotropic receptor biochemistry and the<br />
roles <strong>of</strong> second messengers. Trace amines. False transmitters. Catabolism-vesicle<br />
competition.<br />
(Anatomy) The thalamus and geniculate bodies<br />
Anatomic subdivision into lateral (dorsal and ventral tiers), mediodorsal and anterior groups<br />
<strong>of</strong> nuclei; Functional subdivision into specific, non-specific and association nuclei; Thalamic<br />
peduncles (radiations) and their connections.<br />
(Physiology) Synaptic transmission and neurotransmitter receptors 2<br />
Synaptic transmission and neurotransmitter receptors continued.<br />
(Pharmacology) Drugs and synaptic transmission II<br />
Drugs and synaptic transmission continued.<br />
(Anatomy) The internal capsule; the basal ganglia<br />
Internal capsule: Location and relations; anterior limb, genu, posterior limb retrolentiform and<br />
sublentiform parts; Fibre groupings (Anterior, superior, posterior and lateral thalamic<br />
radiations; Pontocerebellar fibres; Corticonuclear and corticospinal fibres); Blood supply;<br />
Correlations with clinical syndromes following stroke. Basal Nuclei (Ganglia): Caudate<br />
32
nucleus, putamen, lentiform nucleus, globus pallidus, substantia nigra, subthalamic nucleus<br />
and the nucleus accumbens; Connections and basic circuits; Hypokinesia, hyperkinesia,<br />
tremor and rigidity; Information from clinical disorders such as Parkinson's Disease,<br />
Huntington's chorea and hemiballismus.<br />
(Physiology) Synaptic transmission and neurotransmitter receptors 3<br />
Synaptic transmission and neurotransmitter receptors continued.<br />
(Biochemistry) Aminergic Transmission <strong>2.</strong> Dopamine neurotransmission. Consequences <strong>of</strong><br />
its disruption (MPTP and Parkinson's disease). Consequences <strong>of</strong> enzyme inhibition in<br />
depression, mania, Parkinson's disease. The role <strong>of</strong> catechol-O-methyltransferase and<br />
possible consequences <strong>of</strong> its inhibition.<br />
(Psychiatry) Cognitive development II<br />
Emotional intelligence, a popular concept in recent <strong>year</strong>s; the evidence to support the<br />
concept. The development <strong>of</strong> social cognition is discussed, for example empathy, self-control<br />
etc., and how these are related to the concept <strong>of</strong> emotional intelligence.<br />
(Psychiatry) The Psychology <strong>of</strong> Memory<br />
Normal memory and forgetting, the effects <strong>of</strong> stress and psychological state on memory.<br />
False memories.<br />
(Biochemistry) The amino-acid transmitters (glutamate, GABA and glycine).<br />
Glutamate and GABA neurotransmission. Criteria and experimental investigation <strong>of</strong> putative<br />
neurotransmitters. Epilepsy and anti-convulsants. Similarities and differences between<br />
different systems (amines, acetylcholine, amino acids and peptides). Uptake mechanisms,<br />
enzymic inactivation (intracellular and extracellular). Reversal <strong>of</strong> uptake in ischaemia.<br />
(Anatomy) Ascending pathways<br />
Spinal ganglia; Modalities <strong>of</strong> sensation and their segregation; Posterior grey horn; Laminae<br />
<strong>of</strong> Rexed; Clarke's thoracic nucleus; Spinothalamic pathway; Posterior column/ medial<br />
lemniscal pathway; Spinoreticular tract; Spino-olivary tract; Spinotectal tract; Posterior<br />
spinocerebellar and cuneocerebellar tracts; Anterior spinocerebellar and rostral<br />
spinocerebellar tracts; Dissociated anaesthesia; Brown-Séquard syndrome.<br />
(Physiology) (Physiology) Synaptic transmission and neurotransmitter receptors 4<br />
Synaptic transmission and neurotransmitter receptors continued.<br />
WEEK 3<br />
(Pharmacology) Local Anaesthetics<br />
General properties <strong>of</strong> local anaesthetics, their pharmacokinetics, pharmacodynamics and<br />
actions on various body systems.<br />
Factors affecting differential nerve sensitivity including use-dependent block. Side effects <strong>of</strong><br />
local anaesthetics and those associated with accompanying use <strong>of</strong> vasoconstrictors. Amides<br />
and ester classification.<br />
Methods / routes <strong>of</strong> administration.<br />
(Biochemistry) Some other transmitters<br />
Hypoxia and ischemia responses - excitotoxic and re-perfusion damage. Formation,<br />
functions and possible toxicity <strong>of</strong> NO. Possible functions <strong>of</strong> D-serine. CO. Other possible<br />
retrograde messengers.<br />
(Anatomy) Descending pathways<br />
Anatomy <strong>of</strong> anterior grey horn; Tonic and phasic alpha-motor neurons; Renshaw cells; Spinal<br />
reflexes; Corticospinal tract; reticulospinal, vestibulospinal, tectospinal and olivospinal tracts;<br />
Raphespinal tract, aminergic pathways and sentral autonomic pathway; Upper and lower<br />
33
motor neuron lesions; Stroke; Transection <strong>of</strong> the cord; Anterior poliomyelitis; Motor Neuron<br />
Disease;<br />
(Physiology) Processing <strong>of</strong> somatic sensory information by the CNS 1<br />
-introduction to sensory processing in the CNS<br />
-principles <strong>of</strong> non-pain somatosensory processing, including pathways and areas <strong>of</strong> CNS<br />
involved in processing non-pain stimuli,<br />
-physiological mechanisms <strong>of</strong> processing somatosensory stimuli, including somatotopic<br />
maps, spatiotemporal processing, divergence, convergence, ascending versus descending<br />
processing.<br />
-pain processing, including pathways and areas <strong>of</strong> CNS involved in processing pain stimuli,<br />
-physiological mechanisms <strong>of</strong> processing pain stimuli<br />
-endogenous mechanisms <strong>of</strong> analgesia, involvement <strong>of</strong> pathways and specific transmitters.<br />
-electrically induced analgesia, phantom pain, central pain syndrome<br />
(Pharmacology) General Anaesthetics I<br />
Definitions. Aims and stages <strong>of</strong> general anaesthesia – Guedel’s signs.<br />
Inhalational anaesthetics –advantages and disadvantages:<br />
Nitrous oxide (analgesia), halothane, sev<strong>of</strong>lurane.<br />
Minimum alveolar concentration (MAC) and factors influencing it.<br />
Intravenous anaesthetics–advantages and disadvantages:<br />
Ultra short acting barbiturates: thiopentone.<br />
Nonbarbiturates: ketamine, prop<strong>of</strong>ol, neurosteroids.<br />
Sites and mechanisms <strong>of</strong> action.<br />
Adverse effects, pharmacokinetics and drug interactions. Malignant hyperthermia.<br />
Balanced anaesthesia, conscious sedation. Peri-anaesthetic drugs<br />
Centrally and peripherally acting spasmolytics. Sites and mechanisms <strong>of</strong> action.<br />
Progabide, diazepam, bacl<strong>of</strong>en, tizanidine, dantrolene.<br />
(Anatomy) The visual pathways<br />
Retinal layers, photoreceptors, bipolar cells, ganglion cells, horizontal cells and amacrine<br />
cells; macula lutea, fovea and optic disk; Central visual pathway, including the optic nerve,<br />
chiasma and tract, lateral geniculate nucleus and geniculocalcarine tract; Visual cortex and<br />
its blood supply; Visual association cortex; Visual reflexes; Lesions <strong>of</strong> the visual pathways.<br />
(Physiology) Processing <strong>of</strong> somatic sensory information by the CNS 2<br />
Processing <strong>of</strong> somatic sensory information by the CNS continued.<br />
(Biochemistry) . Purinergic and other putative neurotransmitters. Neuropeptides<br />
Common neurodegenerative mechanisms. Protein aggregation diseases (PD, AD, HD).<br />
Apoptosis/Necrosis.<br />
(Psychiatry) Genetic aspects <strong>of</strong> personality and mental illness<br />
Basic principles <strong>of</strong> behavioural genetics, major and minor genes, twin and adoption studies,<br />
interactions between genes and the environment, genetic aspects <strong>of</strong> psychiatric disorders<br />
and behavioural traits, quantitative traits, recent developments in the molecular genetics <strong>of</strong><br />
psychiatric disorders.<br />
(Biochemistry) Brain growth & development<br />
Neurone-glial cell recognition and interactions. Recognition proteins and growth-factors;<br />
differentiation, development. Neurogenesis in the adult brain. Embryonic stem cells. Neural<br />
stem cell development. Stem cells as therapy for CNS disorders.<br />
(Anatomy) The cerebellum<br />
Gross anatomy: Median vermis, right and left hemispheres; Anterior, posterior and<br />
34
flocculonodular lobes; Lobules and folia<br />
Functional subdivisions: Vestibulocerebellum (Archecerebellum), Spinocerebellum<br />
(Palaeocerebellum), Pontocerebellum (Neocerebellum)<br />
Nuclei: Fastigial nucleus, Nucleus interpositus (globose and emboliform nuclei), Dentate<br />
nucleus<br />
Cortical structure and cell types: Granular layer; Granular cells, receiving mossy fibres from<br />
all sources except the ION, Golgi cells Piriform layer; Purkinje cells, receiving parallel fibres<br />
from the granular cells and climbing fibres from the ION Molecular layer; Stellate and basket<br />
cells, receiving parallel fibres and synapsing on Purkinje cells, Afferent (A) and efferent (E)<br />
connections: Superior peduncle: Anterior spinocerebellar tract (A); Tectocerebellar tract (A);<br />
Rubrocerebellar tract (A); Trigeminal afferents (A); Dentato-rubro-thalamic tract (E); Uncinate<br />
fasciculus (E) Middle cerebellar peduncle: Cortico-ponto-cerebellar tract (A); Inferior<br />
cerebellar peduncle: Posterior spinocerebellar tract (A); Cuneocerebellar tract (A); Rostral<br />
spinocerebellar tracts (A); Reticulocerebellar tract (A&E); Vestibulocerebellar tracts (A&E);<br />
Olivocerebellar tract (A); Functional aspects and applied anatomy: Overall function <strong>of</strong> the<br />
cerebellum in planning and co-ordinating movement; its role in learning new movements,<br />
Ataxia, intention tremor, dysmetria, dysdiadochokinesis, scannng spreech, nystagmus,<br />
hypotonia, gait abnormalities, etc; Effects <strong>of</strong> midline versus lateral lesions <strong>of</strong> the cerebellum.<br />
(Physiology) Processing <strong>of</strong> somatic sensory information by the CNS 3<br />
Processing <strong>of</strong> somatic sensory information by the CNS continued.<br />
WEEK 4<br />
(Pharmacology) General Anaesthetics II<br />
General Anaesthetics I continued.<br />
(Psychiatry) Introduction to Neurology. An introduction to the main neurological disorders<br />
including seizure disorders, motor disorders and multiple sclerosis.<br />
(Anatomy) The blood supply <strong>of</strong> the brain<br />
Vertebral and carotid arteries; Circle <strong>of</strong> Willis; Cortical and central branches; Territories <strong>of</strong> the<br />
anterior, middle and posterior cerebral arteries; Vertebro-basilar branches; Venous drainage<br />
<strong>of</strong> the brain; Arterial occlusion and haemorrhage.<br />
(Physiology) Processing <strong>of</strong> visual information 1<br />
-the retina. Photoreceptors and generation <strong>of</strong> sensory receptor potentials<br />
-processing <strong>of</strong> visual information in retina, especially by ganglion cells.<br />
-processing <strong>of</strong> visual information in visual areas <strong>of</strong> occipital lobe and in higher visual areas in<br />
temporal and parietal lobe.<br />
-receptive fields in different visual areas.<br />
(Pharmacology) Narcotic analgesics<br />
Distribution and effects mediated by different opioid receptor subtypes. Characteristics <strong>of</strong><br />
main groups <strong>of</strong> narcotic analgesics. Sites and mechanisms <strong>of</strong> action <strong>of</strong> opioids.<br />
Pharmacological actions and effects <strong>of</strong> morphine and receptor subtype selective agents.<br />
Opioid receptor antagonists Pharmacokinetics, adverse effects.<br />
(Anatomy) The brain-stem: topography<br />
Midbrain; Crus cerebri and interpeduncular fossa, substania nigra, red nucleus, superior and<br />
inferior colliculi, cerebral aqueduct, periaqueductal grey matter, central tegmental tract,<br />
superior cerebellar peduncles and their decussation. Pons; Basilar pons, corticopontine and<br />
corticospinal fibres, pontine nuclei, transverse fibres <strong>of</strong> the pontocerebellar pathway entering<br />
the middle cerebellar peduncles, medial lemniscus, spinal lemniscus, trigeminothalamic tract,<br />
lateral lemniscus, central tegmental tract,nuclei and roots <strong>of</strong> the trigeminal nerve.<br />
35
Medulla; Pyramids and their decussation, olives, gracile and cuneate tubercles and fasciculi.<br />
Sites <strong>of</strong> emergence <strong>of</strong> cranial nerves III - XII; Blood supply <strong>of</strong> the brainstem.<br />
Corticospinal pathway; Cortico-ponto-cerebellar pathway; Cortico-rubro-olivo-cerebellar<br />
pathway; Dentato-rubro-thalamo-cortical pathway.<br />
(Physiology) Processing <strong>of</strong> visual information 2<br />
Processing <strong>of</strong> visual information continued.<br />
(Psychiatry) Functional and structural imaging in Neuropsychiatry. A <strong>guide</strong> to the main<br />
approaches to neuroimaging in research and clinical practice.<br />
(Psychiatry) Epilepsy. Describing the aetiology, diagnosis and treatment <strong>of</strong> epilepsy.<br />
(Pharmacology) Non-narcotic analgesics<br />
Comparison <strong>of</strong> pharmacological actions and adverse effects <strong>of</strong> non-steroidal antiinflammatory<br />
drugs. Mechanisms <strong>of</strong> action. Subtype selective COX inhibitors. Salicylates<br />
and paracetamol. Adverse effects and drug interactions. Compound analgesic preparations.<br />
Other agents. Pharmacokinetics.<br />
(Anatomy) The brain-stem: nuclei and tracts<br />
Nuclei <strong>of</strong> cranial nerves III - XII:<br />
General somatic efferent: III, IV, VI, XII<br />
General somatic afferent: Sensory nuclei <strong>of</strong> V (Spinal, Pontine & Mesencephalic)<br />
Special somatic afferent: Cochlear and vestibular nuclei<br />
General visceral efferent: E-W (III), Superior & inferior salivatory<br />
nuclei (VII, IX), Dorsal motor nucleus <strong>of</strong> X, Cardioinhibitory nucleus (X)<br />
Special visceral efferent: Motor nucleus <strong>of</strong> V, Motor nucleus <strong>of</strong> VII,<br />
Nucleus ambiguus (IX, X & XI) Spinal nucleus <strong>of</strong> XI<br />
General visceral afferent: Commisural Nucleus Special visceral afferent:<br />
Nucleus <strong>of</strong> the solitary tract<br />
Nuclei <strong>of</strong> pathways ascending from spinal cord: Nucleus gracilis, nucleus cuneatus<br />
Nuclei <strong>of</strong> pathways to and from the cerebellum: Accessory cuneate nucleus, Inferior olivary<br />
nucleus, Pontine nuclei; Red nucleus<br />
(Physiology) Motor control by the brain 1<br />
-introduction to physiology <strong>of</strong> brain motor areas<br />
-primary motor cortex, including motor maps, columnar organisation and brain/machine<br />
interface for initiating movement<br />
-cerebellum -physiology and involvement in motor control and learning<br />
-basal ganglia -physiology and involvement in motor control and learning, Physiological<br />
changes in Parkinson’s disease and alleviation by deep brain stimulation<br />
-premotor cortical areas. Physiology and involvement in motor control.<br />
-frontal cortex and free will <strong>of</strong> movement<br />
WEEK 5<br />
(Pharmacology) Antidepressants and mood-stabilising drugs<br />
Types <strong>of</strong> antidepressant drugs. Therapeutic and toxic effects<br />
Modes <strong>of</strong> acute and delayed actions.<br />
Tricyclics, MAO inhibitors (including RIMA), SSRIs, SNRIs. Novel agents.<br />
Mania. Lithium and other agents. Therapeutic and toxic actions<br />
(Anatomy) The spinal cord and its blood supply<br />
General topography and features <strong>of</strong> the spinal cord; Extent; Cervical and lumbar swellings;<br />
Meninges; Anterior median fissure, posterior median sulcus; Central canal; Anterolateral and<br />
posterolateral sulci; Grey and white matter; Anterior and posterior commisures; Cell types;<br />
Blood supply <strong>of</strong> spinal cord;<br />
36
(Physiology) Motor control by the brain 2<br />
Motor control by the brain continued.<br />
(Pharmacology) Neuroleptics<br />
Neurolepsis and antipsychotic effects. Types, actions (dopaminergic pathways and receptor<br />
subtypes, 5-HT) and effects. Neuroleptanalgesia. Motor and endocrine side effects. Atypical<br />
agents. Chlorpromazine, haloperidol, sulpiride, thioridazine, rispiridone, clozapine)<br />
(Anatomy) Hearing and balance<br />
Brief review <strong>of</strong> cochlea and vestibular apparatus. Central Auditory Pathway: Cochlear neural<br />
connections; Cochlear nuclei; Trapezoid body; Superior olivary nucleus [SON]; Lateral<br />
lemniscus; Inferior colliculus; Inferior brachium; Medial geniculate nucleus; Primary auditory<br />
cortex; Acoustic reflexes; Descending auditory pathways; Deafness. Vestibular nuclear<br />
connections; Vestibular nuclei; Lateral and medial vestibulospinal tracts; Medial longitudinal<br />
fasciculus; Vestibulospinal and vestibulo-ocular reflexes; Vestibulocortical pathway;<br />
Vestibulocerebellar connections; Nystagmus; Unilateral and bilateral vestibular disease;<br />
Meniéres disease.<br />
(Physiology) Motor control by the brain 3<br />
Motor control by the brain continued.<br />
(Psychiatry) Normal ageing and neurodegeneration. Normal brain ageing. The main<br />
neurodegenerative disorders including the dementias.<br />
(Psychiatry) Neuroimmunology. A clinical perspective on neuroimmunological disorders<br />
including multiple sclerosis.<br />
(Pharmacology) Anticonvulsants<br />
Classification <strong>of</strong> seizures according to drug sensitivity.<br />
Convulsant drugs and animal models.<br />
Anticonvulsant drugs and classification. Mechanisms <strong>of</strong> action.<br />
Sodium channel block. Phenytoin, carbamazepine.<br />
Calcium channel block. Ethosuxamide, trimethadione.<br />
GABA-ergic agents. Gabapentin,vigabatrin, tiagabine, phenobarbitone, clonazepam.<br />
Miscellaneous agents. Valproate, acetazolamide. Side Effects.<br />
(Anatomy) Language centres; aphasias<br />
History <strong>of</strong> the development <strong>of</strong> our current ideas about language; Brief review <strong>of</strong> the auditory<br />
and visual pathways to the primary sensory cortex; Wernicke's area; Supramarginal gyrus<br />
and arcuate fasciculus; Broca's area and its projections to the primary motor cortex; Cortical<br />
connections to Wernicke's and Broca's areas; Visual association cortex and the angular<br />
gyrus; pathways involved in reading aloud; Wernicke's aphasia; Broca's aphasia; Global<br />
aphasia; Transcortical aphasias; Anomia; Alexia with and without agraphia ; Dyslexia; Kana<br />
and Kanji; Aprosodia.<br />
(Physiology) Monitoring brain activation, sleep and memory 1<br />
-techniques and uses <strong>of</strong> monitoring and stimulating population brain activation, including<br />
fMRI, real time fMRI, Squid, optical imaging, electroencephalogram, sensory evoked scalp<br />
potentials<br />
-sleep, including changes in EEG, role <strong>of</strong> transmitters, sleep disorders<br />
-mechanisms <strong>of</strong> short-term working memory and long-term memory<br />
-memory deficits<br />
37
WEEK 6<br />
(Pharmacology) Drug dependence and psychotropic drugs <strong>of</strong> abuse I<br />
Psychological and physical dependence, tolerance. Withdrawal syndromes.<br />
Agents: Opiates; CNS depressants (including ethanol), amphetamine, MDMA and cocaine;<br />
psychotomimetics, cannabinoids, anticholinergic deliriants, nicotine, caffeine. Patterns <strong>of</strong><br />
abuse and dependence.<br />
Mechanisms (including reward pathways).<br />
Pharmacological treatments including disulfiram, clonidine, naltrexone, acamprosate,<br />
methadone, diazepam.<br />
(Physiology Monitoring brain activation, sleep and memory 2<br />
Monitoring brain activation, sleep and memory continued.<br />
(Anatomy) The limbic system<br />
Olfactory pathway; Olfactory nerves; Olfactory bulb and tract; Olfactory striae; Primary<br />
olfactory cortex; Anosmia. Septal area; Cingulate and parahippocampal gyri; Hippocampal<br />
formation; Amygdaloid nucleus; Mamillary bodies; Anterior thalamic nucleus; Papez' circuit;<br />
Afferent and efferent connections; Functional aspects; Memory; Drive-related behaviour;<br />
Temporal lobe ebilepsy; Klüver-Bucy syndrome.<br />
(Pharmacology) Drug dependence and psychotropic drugs <strong>of</strong> abuse II.<br />
Drug dependence continued.<br />
(Anatomy) The autonomic nervous system<br />
General organisation <strong>of</strong> the autonomic nervous system; Hypothalamus; Sympathetic and<br />
parasympathetic systems; Enteric system; Visceral afferent and efferent pathways; Visceral<br />
vs. somatic pain<br />
(Physiology) The reward motor circuit,<br />
-anatomy <strong>of</strong> circuit, role <strong>of</strong> dopamine and associative learning, addiction<br />
(Psychiatry) Neurobiology <strong>of</strong> sleep and related disorders- I had planned to scrap this<br />
because Roger covers the same area in some detail.<br />
The functions <strong>of</strong> sleep, the sleep stages and electrical changes in the brain, Physiological<br />
changes, control <strong>of</strong> sleep, sleep disorders.<br />
(Psychiatry) Attention and Perception.<br />
(Pharmacology) Anxiolytic and sedative/hypnotics<br />
Definitions. Anxiogenic agents and drug-induced insomnia. Mechanisms.<br />
Benzodiazepines and related compounds. Therapeutic and adverse effects, kinetics, sites<br />
and mechanism <strong>of</strong> action (GABA, Benzodiazepine receptor subtypes, agonists, antagonists<br />
and inverse agonists). Chlordiazepoxide and diazepam. Barbiturates. Zolpidem. Flumazenil.<br />
ß-Blockers, Azapirones and novel compounds.<br />
(Anatomy) Anatomical basis <strong>of</strong> clinical signs<br />
A general review <strong>of</strong> the CNS to show how a knowledge <strong>of</strong> neuroanatomy assists in clinical<br />
neurological diagnosis; Numerous examples.<br />
(Physiology) Prefrontal cortex, consciousness<br />
-role <strong>of</strong> different areas <strong>of</strong> prefrontal cortex, including dorsolateral prefrontal cortex,<br />
orbit<strong>of</strong>rontal cortex, ventromedial prefrontal cortex and insula<br />
-physiological mechanisms underlying consciousness<br />
(Psychiatry) The development <strong>of</strong> personality The definition <strong>of</strong> personality, personality<br />
development during childhood and adolescences.<br />
38
(Psychiatry) The Psychology <strong>of</strong> stress and coping.<br />
The psychophysiology <strong>of</strong> arousal, individual vulnerability to psychosomatic symptoms and<br />
hysteria in relation to personality, the environment and the mind-body interface.<br />
(Psychiatry) The neurobiology <strong>of</strong> mood and psychosis<br />
This lecture deals with the neurochemical basis for the pharmacological treatment <strong>of</strong><br />
schizophrenia and depression. In schizophrenia, the dopamine and dopamine serotonin<br />
hypothesis <strong>of</strong> this disorder is outlined and the modern history <strong>of</strong> neuroleptic development in<br />
this area is explored. The different biochemical theories <strong>of</strong> depression are dealt with and our<br />
current understanding <strong>of</strong> how antidepressants actually work is discussed.<br />
(Psychiatry) The neurobiology <strong>of</strong> memory<br />
INTERDEPARTMENTAL NEUROSCIENCE WORKSHOPS<br />
Five inter-departmental workshops are held during the term on topics <strong>of</strong> clinical interest. The<br />
primary aim <strong>of</strong> these workshops is to provide students with the opportunity to critically<br />
discuss neurobiological aspects <strong>of</strong> topics such as Alzheimer’s disease, Parkinson’s disease,<br />
drug addiction and ischaemic brain damage/ stroke. A series <strong>of</strong> short (~10 minute)<br />
presentations by members <strong>of</strong> staff provide a focus <strong>of</strong> discussion for each workshop.<br />
1. Brain development and Schizophrenia (Primarily Psychiatry and Genetics)<br />
<strong>2.</strong> Ischemic brain damage / stroke Workshop (Primarily Medical Gerontology,<br />
Biochemistry and Pharmacology)<br />
Types <strong>of</strong> stroke. Behavioural and psychological impact. Multi-infarct dementia.<br />
Biochemistry and pharmacology <strong>of</strong> oxidative stress and excitotoxicity. Cardiovascular<br />
drugs in the prophylaxis and treatment <strong>of</strong> stroke.<br />
3. Parkinson’s disease / Movement Disorder Workshop (Primarily Psychiatry and<br />
Neurology)<br />
Motor and non-motor aspects. Biochemical and genetic aspects. Dopaminergic drugs<br />
and other pharmacological approaches. Drug-induced Parkinsonism.<br />
4. Drug addiction (Primarily Psychiatry, Psychology and Pharmacology)<br />
Patterns <strong>of</strong> drug addiction in the community. Animal models. Imaging brain<br />
mechanisms in addicts. Present and future treatments.<br />
5. Alzheimer’s disease Workshop (Primarily Psychiatry, Biochemistry and<br />
Pharmacology)<br />
Normal ageing. Case histories. Pathophysiology and genetic factors. Interdisciplinary<br />
discussion including present (donepazil) and future pharmacological treatments.<br />
Potential disease modifying drugs.<br />
Indicative Resources<br />
Some aspects <strong>of</strong> this unit are dealt with in the recommended texts for Anatomy,<br />
Biochemistry, Physiology and Pharmacology (Rang et al). Other specific reading may be<br />
recommended during the course.<br />
NEUROANATOMY<br />
A textbook and an anatomy atlas are essential. Pick one <strong>of</strong> each from the list below<br />
Clinical Neuroanatomy and related Neuroscience: FitzGerald and Folan-Curran: W B<br />
Saunders<br />
Neuroanatomy - An Illustrated Colour Text: Crossman & Neary: Churchill Livingstone<br />
Atlases<br />
Atlas <strong>of</strong> Anatomy: Gilroy, MacPherson, Ross: Thieme<br />
Atlas <strong>of</strong> Human Anatomy: Netter: CIBA-Geigy<br />
Reference<br />
Principles <strong>of</strong> Neural Science: Kandel, Schwartz and Jessel [Ed]: McGraw Hill<br />
39
Neurochemistry:<br />
There is no small book on the subject that can be recommended. The standard textbooks<br />
(e.g., Voet & Voet) contain a chapter on neurochemistry, which should give you most <strong>of</strong> what<br />
you need to supplement the lectures. The list below is for those who want to find out much<br />
more.<br />
Principles <strong>of</strong> Neural Science (3rd. Edition) by E.R. Kandel, J.R. Schwartz & T.M. Jessel<br />
(2000) -Enormous but very good coverage <strong>of</strong> most aspects <strong>of</strong> neuroscience in general.<br />
Basic Neurochemistry by G.J. Siegel et al. (1999). Raven Press, New York – uneven in<br />
quality but a handy reference source. . Available for free online through the PubMed website<br />
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=bnchm.TOC&depth=2<br />
Neuroscience (2 nd edition) by Purves, Augustine, Fitzpatrick and Katz. Available for free<br />
online through the PubMed website<br />
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=neurosci.TOC&depth=2<br />
Proteins, Transmitters and Synapses by D.G. Nicholls (1994) Blackwell, Oxford. Out <strong>of</strong> print<br />
but in the library. For advanced stuff only.<br />
Essential Psychopharmacology by S.S. Stahl (2000). Cambridge University Press, London.<br />
-idiosyncratic but fun.<br />
Some Web Sites<br />
Some <strong>of</strong> these can be quite fun and informative, if you have some time to spare.<br />
http://faculty.washington.edu/chudler/neurok.html - Neuroscience for kids; despite the name<br />
well worth looking at.<br />
http://pegasus.cc.ucf.edu/~Brainmd1/brain.html - brain model tutorial; basic but worth a view<br />
http://web.indstate.edu/thcme/mwking/nerves.html - Biochemistry <strong>of</strong> neurotransmitters; very<br />
simple<br />
Learning Outcomes<br />
NEUROANATOMY<br />
On successful completion <strong>of</strong> this module the student will be able to:<br />
• Recognise and describe the major subdivisions <strong>of</strong> the central nervous system<br />
(CNS).<br />
• Recognise and describe the ventricular system and the production, circulation,<br />
absorption and role <strong>of</strong> cerebrospinal fluid.<br />
• Recognise and describe the structures associated with sensory and motor<br />
systems and their connections.<br />
• Recognise and describe the structures associated with language and their<br />
connections.<br />
• Recognise and describe the limbic system and its connections.<br />
• Recognise and classify cranial and spinal nerves and their connections.<br />
• Recognise and describe the blood supply <strong>of</strong> the CNS.<br />
• Apply anatomical knowledge to explain the normal function <strong>of</strong> the CNS.<br />
• Apply anatomical knowledge to explain the pathogenesis and natural history <strong>of</strong><br />
common clinical disorders <strong>of</strong> the CNS.<br />
40
Neurochemistry<br />
• A description <strong>of</strong> the cell types in the brain and common techniques that enable<br />
chemicals with neurotransmitter-like properties to be identified<br />
• The criteria that need to be satisifed in order for a chemical to be classified as<br />
a neurotransmitter<br />
• A knowledge <strong>of</strong> the biogenic amines (acetylcholine, dopamine, noradrenaline,<br />
adrenaline, serotonin) and the properties that allow them to be classified as<br />
neurotransmitters<br />
• A knowledge <strong>of</strong> glutamate and GABA and the properties that allow them to be<br />
classified as neurotransmitters<br />
• A knowledge <strong>of</strong> atypical neurotransmitters (NO, CO, D-serine, neuropeptides,<br />
purines) and the properties that allow them to be classified as<br />
neurotransmitters<br />
• The role that apoptotic and necrotic cell death play in neurodevelopment and<br />
neurodegeneration.<br />
Neuropharmacology<br />
• Describe and evaluate the scientific basis <strong>of</strong> current and novel<br />
pharmacological approaches to the treatment <strong>of</strong> neurological and psychiatric<br />
illnesses, including drug efficacy and major side effects<br />
• Assess the pharmacological evidence for the involvement <strong>of</strong> different<br />
mechanisms in normal and abnormal functioning <strong>of</strong> the nervous system.<br />
• Define efficacy goals and differences between different classes and subclasses<br />
<strong>of</strong> centrally acting drugs including:<br />
• Hypnotics, sedatives and anxiolytics<br />
• General and local anaesthetics, anticonvulsants<br />
• Narcotic and non-narcotic analgesics<br />
• Antipsychotic and antidepressants<br />
• Relate the different effects <strong>of</strong> classes <strong>of</strong> CNS drugs to their sites and<br />
mechanisms <strong>of</strong> action.<br />
• Distinguish acute and chronic effecst <strong>of</strong> CNS active drugs and the basis <strong>of</strong><br />
physical and psychological dependence.<br />
Methods <strong>of</strong> Assessment<br />
The methods <strong>of</strong> assessment are under review. Last <strong>year</strong> they consisted <strong>of</strong> the<br />
following:<br />
Written Papers<br />
Paper 1 (<strong>2.</strong>5 hours):<br />
Physiology, Pharmacology, Psychiatry (EMQs, MCQs )<br />
Paper 2 (2 hours):<br />
Biochemistry( Answer one essay question from a choice <strong>of</strong> two),<br />
Neuroanatomy (Four SAQs)<br />
Neuroanatomy Practical Examination<br />
This is a viva voce examination (one-to-one interview) with a member <strong>of</strong> Staff <strong>of</strong> the<br />
Department<br />
Distribution <strong>of</strong> Marks<br />
Paper 1: Physiology (20%), Pharmacology (20%), Psychiatry (20%)<br />
Paper 2: Biochemistry (20%), Neuroanatomy (10% paper, 10% practical)<br />
Overall Total: 100%<br />
41
MODULE 6:<br />
AETIOLOGY, MECHANISMS OF DISEASE<br />
ECTS Value: 10 Credits<br />
Contact Hours<br />
Microbiology<br />
Lectures 27h<br />
Practicals 12h<br />
Pathology<br />
Lectures 23 hours<br />
Lecturers<br />
Microbiology<br />
Dr Stephen Smith sgsmith@tcd.ie - coordinator for Microbiology<br />
Pr<strong>of</strong> Tom Rogers<br />
Pr<strong>of</strong> Philip Murphy<br />
Pr<strong>of</strong> Celia Holland<br />
Dr Frederick Falkiner<br />
Dr Brian O’Connell<br />
Pathology<br />
Pr<strong>of</strong> John O’Leary<br />
Pr<strong>of</strong> Orla Sheils<br />
Pr<strong>of</strong>, Sean O’Briain<br />
Dr Charles D’Adhemar<br />
Dr Aoife Canney<br />
Pr<strong>of</strong> Pete Humphries<br />
Pr<strong>of</strong> Con Feighery<br />
olearyjj@tcd.ie<br />
osheils@tcd.ie<br />
dobriain@tcd.ie<br />
dadhemc@tcd.ie<br />
canneya@tcd.ie<br />
pete.humphries@tcd.ie<br />
con.feighery@tcd.ie<br />
Aims<br />
Microbiology<br />
The main purpose <strong>of</strong> this module is to acquaint the student with the major groups <strong>of</strong><br />
pathogenic microbes, to relate these organisms with particular diseases and to<br />
describe methods to control these microbes. A firm grounding in these areas is an<br />
absolute essential prerequisite for complete understanding <strong>of</strong> the clinical<br />
microbiology course which is delivered in <strong>year</strong> 3.<br />
The microbiological aspects <strong>of</strong> AETIOLOGY, MECHANISMS OF DISEASE are<br />
aimed at students who have had no formal training in graduate level microbiology.<br />
This course is mandatory.<br />
Pathology<br />
This module is an introductory course in general pathology. Its purpose is to enable<br />
students familiarise themselves with pathological processes as they pertain to<br />
general disease pathways. It is intended to provide a foundation and form a bridging<br />
tool between basic science and clinical practice. The course will provide a basic<br />
groundwork upon which systemic pathology will be taught in the ensuing <strong>year</strong>(s).<br />
This course is mandatory and will be assessed in a hurdle examination – failure to<br />
pass will prevent a student proceeding to the next <strong>year</strong>.<br />
42
Course Content<br />
Microbiology<br />
• Bacterial, fungal and viral structure and function.<br />
• Control <strong>of</strong> microbes and microbial disease.<br />
o Sterilization<br />
o Disinfection<br />
o Antimicrobial chemotherapy<br />
• Medically important Gram negative bacteria.<br />
o The enterobacteria<br />
o Pseudomonads<br />
o Campylobacter and helicobacter<br />
o Neisseriae<br />
o Spirochetes<br />
• Gram positive bacteria <strong>of</strong> clinical importance.<br />
o The Staphylococci<br />
o The Streptococci<br />
o Anaerobes<br />
• Other bacteria<br />
o Chlamydiae<br />
o Rickettsiae<br />
o Mycobacteria<br />
• Fungal Infections<br />
• Viral diseases<br />
o HIV<br />
o Papillomaviruese<br />
o Herpes viruses<br />
o Influenza viruses<br />
• Medical parasitology<br />
o Toxoplasmosis<br />
o Malaria<br />
o Schistosomiasis<br />
o Helminths<br />
• Laboratory diagnosis<br />
43
Pathology<br />
The course will explain the principles <strong>of</strong> general pathology, focussing upon:<br />
Aetiology and cause<br />
Pathogenesis<br />
Morphologic Changes<br />
Functional Derangements and Clinical Significance<br />
Examples <strong>of</strong> topics to be addressed include:<br />
Cell injury<br />
Causes<br />
Types<br />
Responses<br />
Cell Death<br />
Necrosis<br />
Apoptosis<br />
Cellular Adaptations, Intracellular accumulations and Ageing<br />
Acute and Chronic inflammation<br />
Healing<br />
Haemdynamic Disorders:<br />
Thrombosis and Shock<br />
Genetic Disorders<br />
Diseases <strong>of</strong> immunity<br />
Neoplasia<br />
Indicative Resources<br />
Microbiology<br />
Medical Microbiology:<br />
by Patrick R. Murray PhD, Ken S. Rosenthal PhD , Michael A. Pfaller MD Publisher:<br />
Mosby; 6 edition, ISBN-10: 0323054706, ISBN-13: 978-0323054706<br />
Or<br />
Medical Microbiology: A Guide to Microbial Infections: Pathogenesis,<br />
Immunity, Laboratory Diagnosis and Control.<br />
by David Greenwood Richard C. B. Slack F. Peutherer Michael R. Barer<br />
Publisher: Churchill Livingstone; 17 edition, ISBN-10: 0443102090, ISBN-13: 978-<br />
0443102097<br />
Both <strong>of</strong> these texts are in colour and have on-line access at:<br />
www.studentconsult.com/<br />
Pathology<br />
WebPath®:<br />
http://medlib.med.utah.edu/WebPath/webpath.html<br />
The Virtual Slide Box:<br />
http://www.path.uiowa.edu/virtualslidebox<br />
The Virtual Microscope:<br />
http://vmic.unibas.ch/index.html<br />
44
Text books:<br />
Underwood:<br />
General & Systematic Pathology<br />
4th edition<br />
ISBN 0443073341 ·<br />
Paperback 856 Pages<br />
Churchill Livingstone · Published July 2004<br />
Basic Pathology: Updated Version by<br />
Kumar, Stanley L. Robbins, Ramzi S. Cotran<br />
Publisher: Elsevier Science<br />
Pub. Date: February 2005 ISBN-13: 9781416025344, 904pp<br />
Learning Outcomes<br />
Microbiology<br />
“On successful completion <strong>of</strong> this course, students will be able to…”<br />
• Connect specific microbial pathogens with particular disease states and vice<br />
versa<br />
• Propose means and methods required to control microbial pathogens and<br />
parasites<br />
• Specify the key elements needed to conclusively identify a microbial pathogen<br />
• Manipulate bacteria and fungi in the laboratory at a basic level.<br />
Pathology<br />
“On successful completion <strong>of</strong> this course, students will be able to…”<br />
• Define and explain different forms <strong>of</strong> cell injury and their consequences<br />
• Appreciate disease progression at cellular and tissue levels.<br />
• Describe the mechanistic basis <strong>of</strong> disease.<br />
• Characterise and differentiate the biology <strong>of</strong> normal and cancer cell growth at<br />
gross, microscopic and molecular levels.<br />
• Communicate the acquired expertise in seminars, meetings, and other<br />
scholarly activities such as written reports and/or with engagement in<br />
pr<strong>of</strong>essional practice.<br />
•<br />
Methods <strong>of</strong> Teaching and Student Learning<br />
Microbiology<br />
In <strong>year</strong> 2 the microbiology course is “organism-based” whereas in <strong>year</strong> 3 the course<br />
become “disease focused”; to this end the major groupings <strong>of</strong> pathogenic organisms<br />
are introduced in <strong>year</strong> <strong>2.</strong> This strategy ensures that a student is adequately prepared<br />
for <strong>year</strong> 3. The didactic lectures given in Microbiology interdigitate with a series <strong>of</strong> six<br />
practical classes. These practical classes emphasise the major facets <strong>of</strong><br />
microbiology; observation, microscopy, laboratory diagnosis and control <strong>of</strong><br />
microbes. In addition, most content will be available on-line at<br />
http://www.tcdmoodle.ie/login/index.php<br />
Pathology<br />
The teaching strategy essentially involves didactic lectures. However, informal<br />
interaction is usual and students are expected to participate in question-and-answer<br />
and problem solving sessions.<br />
45
Methods <strong>of</strong> Assessment<br />
Microbiology 50%<br />
Summative assessments<br />
(1) MCQ assessment <strong>of</strong> material delivered in lectures. This accounts for 33% ex<br />
50% <strong>of</strong> the Aetiology and Mechanisms <strong>of</strong> Disease. It comprises <strong>of</strong> 70 MCQ<br />
questions, each question has five possible answers <strong>of</strong> which only one is<br />
correct.<br />
(2) MCQ assessment <strong>of</strong> the practical course. This accounts for 17% ex 50% <strong>of</strong><br />
the Aetiology and Mechanisms <strong>of</strong> Disease. It comprises <strong>of</strong> 30 MCQ questions,<br />
each question has five possible answers <strong>of</strong> which only one is correct.<br />
Formative assessments: Students are required to answer up 15 questions per<br />
practical session. These are contained within a practical manual provided and<br />
answered directly into this manual.<br />
Pathology 50%<br />
Summative – MCQ assessment <strong>of</strong> material taught during module. The examination<br />
is 2 hours in duration and comprises 200 statements which the student must mark as<br />
true/false in addition to a series <strong>of</strong> extended matching questions.<br />
Grading Pass >/= 50%<br />
0-39 Fail- poor grasp <strong>of</strong> basic material<br />
40-49 Fail – Some understanding <strong>of</strong> basic concepts<br />
50-59 Pass – Adequate grasp <strong>of</strong> material.<br />
60-69 Pass – Demonstrates clear understanding <strong>of</strong> material<br />
70-100 Pass – Excellent understanding <strong>of</strong> basic material with ability to integrate<br />
disparate topics.<br />
Formative – informal question and answer session to be completed during lecture<br />
slots with sample MCQs to be answered.<br />
Evaluation<br />
Feedback is collected via a web-based survey which is held every second <strong>year</strong>. This<br />
survey analyses students’ perception <strong>of</strong> the course, lectures, lecturers and practical<br />
classes. The recommendations garnered from these evaluations inform subsequent<br />
teaching practice.<br />
46
Module 7: FUNDAMENTALS OF CLINICAL AND PROFESSIONAL<br />
PRACTICE<br />
ECTS Value<br />
10 Credits<br />
Clinical Skills<br />
Tutors<br />
SJH<br />
AMNCH<br />
Ms Clare Martin<br />
Ms Triona Flavin<br />
Dr. Jim Woo<br />
Ms Phillippa Marks<br />
Ms Marie Morris<br />
Contact Hours<br />
Time: Tuesday 9- 4pm in term time.<br />
Venue: Standardised program on two sites St James Hospital (SJH) and Adelaide and<br />
Meath Hospital (AMNCH)<br />
Aims<br />
The Year 2 Introduction to Clinical Practice & Clinical Skills course is mandatory and aims to<br />
introduce students to the basic elements <strong>of</strong> clinical practice so that students can maximise<br />
their learning opportunities as they proceed through the clinical undergraduate <strong>year</strong>s.<br />
• To develop, at first in a laboratory setting, the technical skills essential for the delivery<br />
<strong>of</strong> a safe effective service to patients. Students learn a range <strong>of</strong> practical skills<br />
including taking a clinical history, performing an examination and interpreting simple<br />
investigations<br />
• To focus directly on the range <strong>of</strong> skills necessary to ensure that students have<br />
rational and empathetic interactions with patients, in particular excellent listening<br />
and communication skills<br />
• To assist the development <strong>of</strong> the student as a member <strong>of</strong> a multidisciplinary health<br />
care team<br />
Course Content<br />
The program aims to deliver<br />
• Systems based bedside Clinical Examination<br />
• Practical Clinical Skills contact time<br />
• Shadowing allied health pr<strong>of</strong>essionals and learning the skills <strong>of</strong> multidisciplinary team<br />
working<br />
• Communication Skills training<br />
• OPD exposure<br />
• History taking, preparation and case presentations<br />
• Series <strong>of</strong> seminars e.g. ECG, X-ray, Blood Pr<strong>of</strong>iles, Health & Safety, Hand Washing,<br />
Wound Care<br />
47
Practical Classroom Skills Content<br />
• Vital Sign assessment<br />
• Basic life support- Adult<br />
• Basic suturing skills including ties<br />
• Intravenous line insertion<br />
• Principles <strong>of</strong> point <strong>of</strong> care testing using urine and blood glucose monitoring as<br />
examples<br />
• Testicular examination<br />
• Breast examination<br />
• Examination <strong>of</strong> Lumps and cervical lymphatics<br />
• Fundoscopy, Auroscopy<br />
Indicative Resources<br />
• Dedicated Clinical Skills Tutors<br />
• Clinical Skills Laboratories equipped with simulators, manikins and practice models.<br />
• Practical classroom skills sessions are supported with written reading materials<br />
• Dedicated Clinical Skills Web site.<br />
Learning Outcomes<br />
At the end <strong>of</strong> <strong>year</strong> 2 clinical skills course students should be able to:<br />
• Take a comprehensive clinical history<br />
• Be able to perform a systematic and thorough clinical examination<br />
• Be capable <strong>of</strong> summarising and presenting their findings, facilitating discussion <strong>of</strong> the<br />
important aspects <strong>of</strong> each case.<br />
• Have an understanding <strong>of</strong> routine tests and investigations in common practice such<br />
as: CXR , ECG, Blood pr<strong>of</strong>iles<br />
• Display an understanding <strong>of</strong> Clinical Skills and demonstrate each practical skill on<br />
simulated models in the Clinical Skills Laboratory.<br />
• Be introduced to aspects <strong>of</strong> medical pr<strong>of</strong>essionalism such as:<br />
Multidisciplinary team working, Communication skills, Patient safety<br />
Methods <strong>of</strong> Teaching and Student Learning<br />
• Small group teaching sessions<br />
• Didactic course material<br />
• Procedural demonstration<br />
• Individual practice repetitions<br />
Methods <strong>of</strong> Assessment<br />
• Presently students are required to submit a log book as a mandatory record <strong>of</strong><br />
attendance, participation and achievement <strong>of</strong> essential activities.<br />
• End <strong>of</strong> <strong>year</strong> summative assessment is in the form <strong>of</strong> a Objective Structured Clinical<br />
Examination (OSCE) which incorporates a series <strong>of</strong> practical and written stations.<br />
The pass mark is reference based and is common with OSCE examinations.<br />
• Failure <strong>of</strong> supplemental OSCE is a barrier to progression into 3 rd <strong>year</strong>.<br />
(N15 University <strong>of</strong> <strong>Dublin</strong> Calendar).<br />
Evaluation<br />
• Student evaluation <strong>of</strong> each aspect <strong>of</strong> the course/ skills programme is collected and<br />
analysed on a cyclical basis.<br />
• Evaluation comments are taken into account when considering course improvement<br />
and delivery.<br />
• Collection <strong>of</strong> data sets are utilised in research activities<br />
48
PERSONAL INJURY PROCEDURE<br />
Practical Schedule<br />
Please read carefully the information below concerning safety in the laboratory and in the<br />
clinical situation.<br />
Safety in the Laboratory<br />
• Make yourself aware <strong>of</strong> the emergency exists from the laboratory<br />
• In the event <strong>of</strong> evacuation specific instructions will be given<br />
Many cultures used in the laboratory are potentially pathogenic. It is therefore vital that good<br />
safe laboratory practice and aseptic technique should become second nature to the student.<br />
It is good practice to follow the same safety rules irrespective <strong>of</strong> the degree <strong>of</strong> hazard<br />
involved.<br />
• You are required to own and wear a Howie style laboratory coat (sold in the Student’s<br />
Union Shop) at all practical sessions. Failure to do so will exclude you from the practical<br />
session. The coat must be buttoned up at all times. This is to protect your normal<br />
clothes from contamination and damage. This must not be worn on the wards or<br />
elsewhere.<br />
• No smoking, eating or drinking s permitted in the laboratory.<br />
• If you spill cultures report the fact immediately to a demonstrator, who will give you<br />
further instructions.<br />
• All materials should be handled so that there is no inadvertent contamination <strong>of</strong> the<br />
environment or yourself. For example, wet preparations <strong>of</strong> bacteria on sides and used<br />
pipettes should be submerged in disinfectant immediately after use to prevent<br />
contamination on the bench. Do not work with bacterial cultures or chemicals over a<br />
laboratory manual or notebook.<br />
• Do not rush around or carry sharp items around the laboratory. At any sign <strong>of</strong><br />
misconduct you will be asked to leave the laboratory.<br />
• Always leave the bench clean and tidy. Always remember that in shared laboratory<br />
areas other students will be using the bench and their safety should not be put at risk.<br />
• Always wash hands with Hibiscrub before leaving the laboratory. Dry them thoroughly<br />
with a paper towel.<br />
• Report any accident/incident, even if trivial, to a demonstrator.<br />
49
MICROBIOLOGY SAFETY IN THE HOSPITAL<br />
Each individual is responsible for his/her own safety and that <strong>of</strong> others, whether patient or<br />
staff. Most safety precautions are common-sense. Hand washing is <strong>of</strong> utmost importance –<br />
wash your hands before and after attending each patient.<br />
Ensure that you are immunised against infectious diseases such as polio, rubella, TB and<br />
Hepatitis B.<br />
You must observe strictly the <strong>guide</strong>lines set out for the management <strong>of</strong> patients with<br />
hepatitis, or who are suspected <strong>of</strong> suffering from hepatitis. In such cases, it is essential that<br />
body fluids, especially blood, are carefully handled and that needles and syringes are<br />
correctly disposed <strong>of</strong>.<br />
Each ward has been provided with <strong>guide</strong>lines for the isolation and management <strong>of</strong> infective<br />
diseases. Also available are policies concerning the use <strong>of</strong> antimicrobials and disinfectants,<br />
the maintenance <strong>of</strong> closed urinary drainage and i.v. catheterisation. Consult these<br />
documents and abide by the policies contained in them.<br />
PLAGIARISM<br />
The following text is reprinted from the <strong>College</strong> Calendar Academic Progress (pages G12-14)<br />
and should be borne in mind by all students:<br />
“…Plagiarism is interpreted by the University as the act <strong>of</strong> presenting the work <strong>of</strong> others as<br />
one’s own work, without acknowledgement. Plagiarism is considered as academically<br />
fraudulent, and an <strong>of</strong>fence against University discipline. The University considers plagiarism<br />
to be a major <strong>of</strong>fence, and subject to the disciplinary procedures <strong>of</strong> the University.<br />
Plagiarism can arise from deliberate actions and also through careless thinking and/or<br />
methodology. The <strong>of</strong>fence lies not in the attitude or intention <strong>of</strong> the perpetrator, but in the<br />
action and in its consequences.<br />
Plagiarism can arise from actions such as:<br />
(a) copying another student’s work;<br />
(b) enlisting another person or persons to complete an assignment on the<br />
student’s behalf.<br />
(c) quoting directly, without acknowledgement, from books, articles or other<br />
sources, either in printed, recorded or electronic format;<br />
(d) paraphrasing, without acknowledgement, the writings <strong>of</strong> other authors;<br />
Examples (c) and (d) in particular can arise through careless thinking and/or methodology<br />
where students:<br />
(i)<br />
(ii)<br />
(iii)<br />
(iv)<br />
fail to distinguish between their own ideas and those <strong>of</strong> others.<br />
fail to take proper notes during preliminary research and therefore lose track <strong>of</strong> the<br />
sources from which the notes were drawn;<br />
fail to distinguish between information which needs no acknowledgement because it<br />
is firmly in the public domain, and information which might be widely known, but<br />
which nevertheless requires some sort <strong>of</strong> acknowledgement;<br />
come across a distinctive methodology or idea and fail to record its source;<br />
All the above serve only as examples and are not exhaustive. Students should submit work<br />
done in co-operation with other students only when it is done with the full knowledge and<br />
50
permission <strong>of</strong> the lecturer concerned. Without this, work submitted which is the product <strong>of</strong><br />
collusion with other students may be considered to be plagiarism. It is clearly understood<br />
that all members <strong>of</strong> the academic community use and build on the work <strong>of</strong> others. It is<br />
commonly accepted also, however, that we build on the work <strong>of</strong> others in an open and<br />
explicit manner, and with due acknowledgement. Many cases <strong>of</strong> plagiarism that arise could<br />
be avoided by following some simple <strong>guide</strong>lines:<br />
(i)<br />
(ii)<br />
(iii)<br />
Any material used in a piece <strong>of</strong> work, <strong>of</strong> any form, that is not the original thought <strong>of</strong><br />
the author should be fully referenced in the work and attributed to its source. The<br />
material should either be quoted directly or paraphrased. Either way, an explicit<br />
citation <strong>of</strong> the work referred to should be provided, in the text, in a footnote, or both.<br />
Not to do so is to commit plagiarism.<br />
When taking notes from any source it is very important to record the precise words or<br />
ideas that are being used and their precise sources.<br />
While the Internet <strong>of</strong>ten <strong>of</strong>fers a wider range <strong>of</strong> possibilities for researching particular<br />
themes, it also requires particular attention to be paid to the distinction between one’s<br />
own<br />
work and the work <strong>of</strong> others. Particular care should be taken to keep track <strong>of</strong> the<br />
source <strong>of</strong> the electronic information obtained from the Internet or other electronic<br />
sources and ensure that it is explicitly and correctly acknowledged.<br />
It is the responsibility <strong>of</strong> the author <strong>of</strong> any work to ensure that he/she does not commit<br />
plagiarism. Students should ensure the integrity <strong>of</strong> their work by seeking advice from their<br />
lecturers, tutor or supervisor on avoiding plagiarism. All departments should include, in their<br />
handbooks or other literature given to students, advice on the appropriate methodology for<br />
the kind <strong>of</strong> work that students will be expected to undertake.<br />
If plagiarism as referred to above is suspected, the Head <strong>of</strong> Department will arrange an<br />
informal meeting with the student, the student’s tutor, and the lecturer concerned, to put their<br />
suspicions to the student and give the student the opportunity to respond.<br />
If the Head <strong>of</strong> Department forms the view that plagiarism has taken place, he/she must notify<br />
the Senior Lecturer in writing <strong>of</strong> the facts <strong>of</strong> the case and suggested remedies, who will then<br />
advise the Junior Dean. The Junior Dean will interview the student if the facts <strong>of</strong> the case<br />
are in dispute. Whether or not the facts <strong>of</strong> the case are in dispute, the Junior Dean may<br />
implement the procedures set out in CONDUCT AND COLLEGE REGULATIONS §2….”<br />
51
SCHOOL OF MEDICINE POLICY<br />
ABSENT LECTURER PROCEDURE<br />
In the event that students are present for a teaching session and a lecturer does not<br />
arrive, please notify the class representative who should then notify the relevant<br />
departmental Secretary. Department contact details below,<br />
Anatomy<br />
Clare O’Farrell<br />
Tel: 01 896 1182<br />
Biochemistry<br />
Miriam Wilson<br />
Tel: 01 896 1851<br />
Microbiology<br />
Muriel Gowing<br />
Tel: 01 896 2138<br />
Molecular <strong>Medicine</strong><br />
Amanda Duggan, AMNCH<br />
Tel: 01 896 3844<br />
Mary Kavanagh, SJH<br />
Tel: 01 896 2100<br />
Neuroscience<br />
Geraldine Quinn<br />
Tel: 01 896 2241<br />
Pathology<br />
Jean Freeman<br />
Tel: 8962396<br />
Pharmacology<br />
Geraldine Power<br />
Tel: 01 896 1563<br />
STUDENT ABSENCE<br />
If absent from any timetabled teaching and/or examinations students are required to<br />
submit a Medical Certificate to Student Affairs, <strong>School</strong> <strong>of</strong> <strong>Medicine</strong>, Chemistry<br />
Building, <strong>School</strong> <strong>of</strong> <strong>Medicine</strong>, TCD. Immediately.<br />
52
SOURCES OF SUPPORT AND HELP IN COLLEGE<br />
• Student Counselling Service – 199 - 200 Pearse Street, Tel:<br />
896 1407, or email: student-counselling@tcd.ie Emergency<br />
appointments are available. (Entrance to the Service via <strong>College</strong><br />
Campus adjacent to the Creche). This service is confidential and<br />
free to students.<br />
• Chaplains – House 27, chaplaincy@tcd.ie. Tel: Kieran Dunne<br />
and Paddy Gleeson : + 353 1 896 1260, Alan McCormack : + 353<br />
1 896 1402 ; Katherine Meyer : + 353 1 896 1901 - The<br />
Chaplains run a Bereavement Support Group for those who have<br />
experienced loss (please contact the Chaplains). The Chaplains<br />
will also help you make contact with other religious communities<br />
in <strong>Dublin</strong>.<br />
• <strong>College</strong> Health Service – House 47 (beside the rugby pitch),<br />
Tel: + 353 1 896 1556. Appointments may be made in person or<br />
by telephone. This service is free to most students.<br />
http://www.tcd.ie/<strong>College</strong>_Health<br />
• <strong>College</strong> Tutors and Senior Tutor’s Office, House 27. Tel: 896<br />
2551. stosec@tcd.ie. You can find your tutor's name and contact<br />
number on the Student Information System :<br />
http://isservices.tcd.ie/portal<br />
• Niteline - A confidential help-line for students run by students is<br />
available during term-time, by telephone between 9pm and<br />
<strong>2.</strong>30am from Thursday to Sunday at 1800 793 793.<br />
• Student 2 Student - A group <strong>of</strong> <strong>Trinity</strong> students trained in<br />
listening and support skills who are available for face-to-face<br />
supportive chats. Confidential, free, and flexible. Email:<br />
peer@tcd.ie, phone: 896 2438.<br />
_________________________________________________________________________<br />
53
TRINITY COLLEGE DUBLIN<br />
<strong>School</strong> <strong>of</strong> <strong>Medicine</strong><br />
Student Subject Exemption Form<br />
__________________________________________________________________________<br />
Please refer to your student handbook/<strong>study</strong> <strong>guide</strong> for further information regarding<br />
the granting <strong>of</strong> exemptions<br />
Must be returned to the Medical <strong>School</strong> Office by Friday, 6 th November 2009<br />
Exemptions cannot be approved after this date<br />
STUDENT NAME:<br />
_________________________________________________________________________<br />
COURSE: _________________________ I.D. NUMBER:_____ _____________________<br />
YEAR:___________________________TUTOR:_____________ ___________________<br />
EXEMPTION SOUGHT FROM (subject)<br />
______________________________________________<br />
It is assumed that this exemption is sought from both examinations/assessment,<br />
coursework etc. Should the case be otherwise, e.g. exemption from coursework only,<br />
please state (otherwise leave<br />
blank):_________________________________________________________________<br />
JUSTIFICATION (include relevant academic qualifications and evidence <strong>of</strong> primary<br />
degree in the subject):<br />
__________________________________________________________________________<br />
__________________________________________________________________________<br />
__________________________________________________________________________<br />
__________________________________________________________________________<br />
__________________________________________________________________________<br />
STUDENT’S SIGNATURE:____________________ DATE:____________________<br />
55
TUTOR’SCOMMENTS:_______________________________________________________<br />
______________<br />
__________________________________________________________________________<br />
________________<br />
SIGNATURE: _____________________________ DATE:<br />
_________________________________________<br />
COMMENT FROM RELEVANT COURSE COORDINATOR:<br />
__________________________________________________________________________<br />
__________________________________________________________________________<br />
________________________________<br />
SIGNATURE:____________________________________________________DATE:_____<br />
______________<br />
SIGNATURE:____________________________________________________DATE:_____<br />
______________<br />
DIRECTOR OF UNDERGRADUATE TEACHING & LEARNING’S APPROVAL<br />
EXEMPTION FROM _________________________<br />
EXEMPTION FROM COURSEWORK AND EXAMS<br />
EXEMPTION FROM COURSEWORK ONLY<br />
SIGNATURE:<br />
_____________________________________DATE:___________________________<br />
56
This <strong>year</strong>, TAKE TO THE STREETS to support:<br />
November 5th 2010<br />
The Burns Unit, SJH<br />
Colorectal Cancer Screening, AMNCH<br />
The Cancer Care Fund, AMNCH<br />
<strong>Trinity</strong> Access Programme (TAP)<br />
Street Collection, Campus Games, Talent Show, Night Out,<br />
Med Cup and much more!<br />
Get involved early. Email medday@tcd.ie<br />
57