Behavior Science Block (50%)

Lecture 10.5. Introduction to Behavior Science and the BPS Model

Session Learning Objectives:
1. Describe the components of the biopsychosocial model and its utility in clinical practice
2. Explain the stress diathesis model and its application to mental health
3. Appreciate the complex interplay between mental health and general medical conditions
4. Briefly describe classical conditioning, operant conditioning, and modeling as forms of learning
behaviors.
5. Define the terms habituation, sensitization, shaping, extinction, and fading in the context of
behavioral conditioning.
6. Describe the various form of reinforcement schedules for behavioral conditioning
7. Explain the animal (behavioral) model for depression including “learned helplessness.”
8. Review study tips for MS2 students as they learn about psychiatric illness
Session Resource:
https://www.youtube.com/watch?app=desktop&v=PRdCowYEtAg&ab_channel=NeuralA
cademy

Reflection Session 10.1: TED Talk Elyn Saks: The Center Cannot Hold
Session Learning Objectives:
1. Appreciate social stigma and barriers to mental health care experienced by individuals with
schizophrenia.
2. Recognize psychiatric phenomena that occurs in schizophrenia including positive symptoms.

Lecture 10.6. Biological Psychiatry: Neurobiology of Mental Illness

Session Learning Objectives:
1. Identify brain structures related to emotional regulation and behavior including components of
the Papez circuit.
2. Explain aberrations in structure and functioning of these brain structures in individuals with
mental illness.
3. Describe the role of the hypothalamic-adrenal-pituitary axis in the behavioral response to
stress.
4. Explain the role of epigenetics in psychiatric illness.

Lecture 10.7. Biological Psychiatry: Neurotransmitters

Session Learning Objectives:
1. Review the process of neurotransmission and differentiate electric from chemical
neurotransmission
2. Identify the different types of receptors that are affected by psychoactive medications or
substances
3. Describe the primary types of neurotransmitters seen in psychopharmacology including their
synthesis, receptors-binding, and potential clinical effects

TBL 10.1: Learning and Memory

Session Learning Objectives:
1. Differentiate between declarative and non-declarative memory.
2. Identify those structures believed to be involved in memory formation and storage.
3. Compare and contrast anterograde and retrograde amnesia. Identify the various causes of
memory loss.
4. Define long-term potentiation (LTP) and discuss the hippocampal circuitry involved in the
induction of LTP.
5. Discuss LTP as a model of learning and memory.
 6. Describe the molecular basis of LTP and the relative role of NMDA and non-NMDA glutamate
receptors in the response.
7. Discuss the importance of the hippocampus in the storage and processing of spatial memory.
8. Describe the classification of memory as implicit or explicit and discuss how some forms of
learning involve both types of memory.
9. Name the critical brain structures for processing implicit and explicit and memories.

Lecture 10.8. Psychometrics & Neuropsychiatric Assessment

Session Learning Objectives:
1. Define the concepts of 'standardization,' 'reliability,' and 'validity' as these apply to methods of
psychological and neuropsychological assessment.
2. Discuss the concept of intelligence and the uses and limitations of formal intelligence testing,
and the expected characteristics of individuals falling within each IQ range.
3. Outline the areas assessed by neuropsychological tests such as the Wechsler Adult Intelligence
Scale, Wisconsin Card Sorting Test, Category Test, Wechsler Memory Scale and Halstead-
Reitan Battery.
4. Discuss the use of rating scales for assessing severity of functional impairment or psychiatric
symptoms such as the Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating
Scale, and Hamilton Anxiety Rating Scale.

Lecture 10.9. Physiological and Behavioral Responses to Stress

Session Learning Objectives:
1. Discuss the concept of stress and its relationship to physiological, behavioral, and
psychological homeostatic mechanisms.
2. Understand the psychological and emotional contributions to stress responses, including
“bottom-up” and “top-down” stress mechanisms, and the severe stress resulting from a dual
perception of a threat and limited coping resources.
3. Describe the physiological and psychological stress and the progressive involvement of
peripheral reflexes, the spinal cord, medulla, hypothalamus, and higher cortical centers in
mediating the stress response in different situations.
4. Diagram the brain mechanisms of emotions and stress responses, and the important roles of
CRF and glucocorticoid hormones in mediating stress.

TBL 11.1: Suicidality

Session Learning Objectives:
1. Students will be able to identify risk and protective factors for suicide in a patient presenting in
psychiatric distress.
2. Students will be able to distinguish between static and dynamic risk factors for suicide.
3. Students will be able to identify treatment interventions to mitigate dynamic risk factors and
enhance protective factors for suicide.
4. Students will be able to assess and discuss the need for hospitalization in patients presenting
with suicidal ideation.

Lecture 11.1: Mood Disorders

Session Learning Objectives:
1. Describe the roles of neurotransmitters in the perception of mood
2. Explain dysregulation of serotonin in mood disorders
3. Explore pharmaceutical and non-pharmacological therapies in the treatment of mood disorders

Lecture 11.2. Defense Mechanisms

Session Learning Objectives:
1. Describe the function of id, ego, and superego.
2. Explain the purpose of defense mechanisms.
3. Describe various types of defense mechanism.
Lecture 11.3 Personality Disorders
Session Learning Objectives:
1. Define personality.
2. Understand the etiology of personality disorders.
3. Describe key features of personality disorders.
4. Discuss objective and projective methods of personality assessment.
5. Summarize the evidence regarding the inheritability of personality.

Lecture 11.4. Anxiety Disorders

Session Learning Objectives:
1. Recognize the purpose of anxiety and identify when it is considered to be dysfunctional
2. Review the diagnostic criteria for Anxiety Disorders listed in the DSM-V including Generalized
3. Anxiety Disorder, Panic Disorder, Agoraphobia, Specific Phobia, Social Anxiety Disorder, and
Adjustment Disorder.
4. Identify the prevalence of anxiety disorders in the general population.
5. Review the typical age of onset, genetic disposition, and natural history of anxiety disorders.
6. Identify the structures of the brain involved in the production of panic.
7. Review the utility of antidepressants and anxiolytics in the treatment of anxiety disorders.
8. Review the utility of psychotherapies for the treatment of anxiety disorders.

ABL11.1. Psychotherapy
Session Learning Objectives:
1. Differentiate between cognitive behavioral therapy (CBT), behavioral therapy, interpersonal
therapy (IPT), dialectical behavioral therapy (DBT), supportive therapy, and psychodynamic
therapy
2. Define the terms systematic desensitization, flooding, and implosion
3. Define the terms free association, transference, countertransference and resistance
4. Describe the utility of group therapy

ABL 11.2. Anxiolytics and Sedative Hypnotics

Session Learning Objectives:
1. Describe the effects of various sedative/hypnotic/anxiolytic drugs on GABAA function.
2. Describe the available agents and agent classes used in the management of anxiety/obsessive
compulsive disorders and insomnia.
3. List the signs and symptoms of barbiturate and benzodiazepine overdose and its treatment.
Including, how flumazenil might be used, and the rationale for its use.
4. Describe the side effects and drug interactions of the various classes of drugs used as
hypnotics, sedatives and anxiolytics, including dependency and withdrawal syndromes.
5. List the therapeutic uses of benzodiazepines, and prototypes for each use and explain how
pharmacokinetics of various benzodiazepines relates to their therapeutic utility.

L11.5. Mood Stabilizers & Antidepressants

Session Learning Objectives:
1. Describe the treatment of acute manic episodes and the maintenance treatment of bipolar
disorder.
2. List the most commonly used mood stabilizing medications.
3. Describe the use of mood stabilizers and antipsychotics in bipolar disorder.
4. Discuss the pharmacokinetics and toxicities of lithium.
5. Identify the major classes of antidepressant drugs (AD) and their primary cellular targets:
tricyclic antidepressants, SSRIs (selective serotonin reuptake inhibitors), SNRIs (selective
serotonin-norepinephrine reuptake inhibitors), 5-HT2 (serotonin) receptor modulators, MAOIs
(monoamine oxidase inhibitors), and atypical antidepressants.
6. Explain the mechanisms that could account for the delay in therapeutic actions of
antidepressants.
 7. Discuss the utility of the various classes of antidepressants for other indications: obsessive
compulsive disorder, panic disorder, generalized anxiety disorder, post-traumatic stress
disorder, neuropathic pain, smoking cessation, and enuresis.
8. Describe the contraindications, adverse effects, drug and dietary interactions of the agents in
each class of antidepressants.
9. Explain the factors involved in the selection of appropriate drug(s) for a given patient.

TBL 12.1: Addiction Model

Session Learning Objectives:
1. Differentiate between substance use disorder, physical dependence, and analgesic tolerance.
2. Distinguish between the various substance use disorders and how to determine their severity.
3. Describe the epidemiology and etiology of substance use disorders.
4. Discuss the stages of change, identify signs of each stage, and discuss their clinical
implications.
5. Describe common medical and mental health co-morbidities of substance use disorders.
6. Discuss the major genetic and social contributors to addiction.
7. Describe the multiple trajectories of addiction.

Lecture 12.1. Cannabis for Medical Doctors

Session Learning Objectives:
1. Describe the cultural and medical history of cannabis.
2. Differentiate the chemical components of Cannabis (THC, CBD, Terpenes, Flavonoids) and
their mechanisms of action, as currently understood.
3. Diagram the endocannabinoid system, including important receptors, effectors, inhibitors, and
the overall physiological responses elicited.
4. Examine the current evidence for potential therapeutic benefit and harm of cannabinoids.
5. Describe the rationale for classifying individuals who should not use cannabis.
6. Describe current laws and procedures for to access Medical Cannabis in Florida.

Lecture 12.2. Trauma and Neglect

Session Learning Objectives:
1. Discuss the clinical terminology associated with trauma and how it is currently defined in the
DSM-5.
2. Understand the role of childhood neglect as a stressor, its impact on psychosocial development
and how to identify behavioral evidence of neglect.
3. Describe the current consensus diagnoses of trauma- and stressor-related disorders.
4. Discuss the epidemiology, comorbidity, clinical presentation and treatment of trauma- and
stressor-related disorders.
5. Examine the role of social support networks as buffers against trauma and stress.

CBL 12.1: Pain Management

Session Learning Objectives:
1. Identify components of a comprehensive pain evaluation.
2. Distinguish the signs and symptoms associated with acute vs. chronic pain.
3. Construct a pain management algorithm for common musculoskeletal and neuropathic pain
scenarios.
4. Identify the key considerations for opioid prescribing.
5. Describe risk/benefit analyses for prescribing opioid-based analgesics and prioritize pain
management modalities (opioid vs non-opioid).

CBL 121: Intoxication & Withdrawal

Session Learning Objectives:
1. Differentiate drug tolerance, drug dependence and drug addiction.
2. Describe the toxic effects and withdrawal symptoms in patients dependent upon sedative-
hypnotics, opioid analgesics and stimulants.
 3. Discuss management of both toxicity and withdrawal symptoms in patients dependent upon
sedative-hypnotics: alcohol, barbiturates, benzodiazepines, GHB (gamma-hydroxybutyrate).
4. Explain the management of both acute toxicity and withdrawal symptoms in patients
dependent upon opioid analgesics.
5. Discuss management of both toxicity and withdrawal symptoms in patients dependent upon
stimulants: cocaine, amphetamines, MDMA (3,4-methylenedioxymethamphetamine).

Lecture 12.3. Opioid Pharmacology

Session Learning Objectives:
1. Identify the endogenous opioid ligands, receptor subtypes, and their physiological functions.
2. Outline the role of opioid transmission in the pain experience and how opioid agonists induce
analgesia.
3. Classify opioid drugs as agonists, mixed receptor agonist-antagonists, antagonists and discuss
their clinical indications.
4. Describe the central and peripheral side-effects of opioids, the development of tolerance, and
the pharmacologic mechanisms that mediate these effects.
5. Explain what is meant by the term “ceiling effect”, its therapeutic significance and the drugs to
which it applies.

Lecture 12.4. Drugs of Abuse

Session Learning Objectives:
1. Explain the pharmacodynamics and pharmacokinetics of the alcohols (ethanol, methanol).
2. Describe the immediate and long-term effects of alcohol consumption on organ systems.
3. Describe the clinical manifestations of alcohol withdrawal syndrome.
4. Outline the therapeutic options for the treatment of alcohol withdrawal and dependency.
5. Explain the mechanism of action, CNS and peripheral effects of the major drugs of abuse a)
stimulants: cocaine, methamphetamines b) club drugs: flunitrazepam, GHB (gamma-
hydroxybutyrate, MDMA (3,4-methylenedioxymethamphetamine) c) hallucinogens: ketamine,
LSD (d-lysergic acid diethylamide) PCP (phencyclidine) peyote, psilocybin d) designer drugs:
mephedrone, flakka (α-pyrrolidinopentiophenone) e) inhalants: hydrocarbon solvents,
aerosols, anesthetics f) nicotine and marijuana (cannabis)
6. Identify the signs and symptoms of withdrawal caused by the major drugs of abuse (see
above)

Lecture 12.5. The Opioid Epidemic

Session Learning Objectives:
1. Recognize the epidemiological evidence underscoring pain and substance use disorders as a
public health problem/emergency.
2. Discuss the historical perspective on the use and abuse of opioids.
3. Understand the origins and evolution of the current opioid crisis.
4. Describe contemporary public health and pharmaceutical approaches to addressing opioid
abuse.
5. Discuss the role of public health evidence in shaping policy designed to address opioid use
disorders.

Lecture 12.6: The Blood-Brain Barrier

Session Learning Objectives:
1. Describe the structure and function of the blood-brain barrier.
2. Relate perturbation of the blood-brain barrier to disease states.
3. Discuss the glypmphatic system (Brains waste disposal mechanism) and its relationship with
BBB.

Lecture 12.7. Eating Disorders

Session Learning Objectives:
 1. Review the DSM-V diagnostic criteria for anorexia nervosa, bulimia nervosa, and binge eating
disorder.
2. Review the epidemiology of eating disorders (typical age of onset, risk factors, co-morbid
disorders).
3. Summarize the behavioral and pharmacologic treatment options for eating disorders.
4. Identify the medical complications of anorexia nervosa and bulimia nervosa.
5. Discuss the pathophysiology, diagnosis, and management of re-feeding syndrome.
6. Describe the clinical signs and lab findings typically seen in anorexia nervosa and bulimia
nervosa.

L12.8 Somatic Symptom and Related Disorders

Session Learning Objectives:
1. Compare and contrast factitious disorder and malingering, including commonalities and
differences in epidemiology and clinical presentation.
2. Discuss typical clinical presentations that may make one suspect a diagnosis of factitious
disorder.
3. Compare and contrast illness anxiety disorder, conversion disorder (also known as functional
neurologic disorder, body dysmorphic disorder, and somatic symptom disorder including
similarities and differences in epidemiology, presentation, course of illness, and management.
4. Identify interprofessional collaborative strategies in treating DSM-5 “Somatic Symptom and
Related Disorders.”

Lecture 13.1. Genetics of Neurological Disorders

Session Learning Objectives:
1. Distinguish multifactorial inheritance from single-gene inheritance.
2. Describe how risk is determined in multifactorial inheritance.
3. Describe how twin and adoption studies are used for determination of heritability of genetic
traits.
4. Determine the relative contributions of genes and environment to multifactorial
diseases/traits.
5. Describe the role of multifactorial inheritance in neurologic disorders, like Alzheimer disease.
6. Describe the multifactorial and autosomal dominant basis of Alzheimer disease.
7. Identify the role of apolipoprotein E (APOE) locus and the association of the APOE e4 allele and
environmental factors to neurodegenerative disease. (Alzheimer disease)
8. Describe the role of amyloid precursor protein (APP) and Presenilin genes (PSEN1; PSEN2) in
Alzheimer disease.

Lecture 13.2 Management of Substance Use Disorders

Session Learning Objectives:
1. Describe the signs and symptoms of substance use disorders, including screening methods.
2. Differentiate substance abuse from dependence.
3. Discuss the major strategies and techniques used in the treatment of substance abuse.
4. Discuss the benefits and limitations of 12-step recovery programs.

CBL 13.1: Childhood Psychiatric Disorders

Session Learning Objectives:
1. Discuss the approach to the pediatric or adolescent psychiatric patient.
2. Compare and contrast adult and pediatric or adolescent psychiatric patients in terms of
diagnosis and management.
3. Recognize the clinical presentation and diagnosis of psychiatric disorders originating in infancy
and childhood, including reactive attachment disorder, attention-deficit/hyperactivity disorder,
oppositional defiant disorder, conduct disorder, and childhood psychoses.

Lecture 13.3 Environmental Factors that Impact Development

Session Learning Objectives:
1. Discuss the changes in the brain that occur during adolescence and how they impact behavior.
 2. Describe the role of epigenetic changes on the development of human behavior.
3. Explain what is meant by the “ecological context” of human development.
4. Describe the relationship between the various major categories of environmental factors that
have been shown to affect behavioral development, including toxins, noise, crowding, and the
quality of social contexts.

Lecture 13.4. Postpartum Psychosis: Physiology and Clinical Features

Session Learning Objectives:
1. Describe the relevant neuro-chemical and hormonal changes that occur in the mother
postpartum.
2. Differentiate the classifications of the “baby blues”, postpartum depression, and postpartum
psychosis.
3. Identify the diagnostic criteria, key clinical findings, and implications for postpartum psychosis.
4. Describe appropriate treatments and support for mothers suffering with postpartum psychosis.
5. Elucidate how health disparities in maternal care in the US affect the diagnosis of postpartum
depression.

Lecture 13.5. Pharmacology of Antipsychotics

Session Learning Objectives:
1. Identify “typical” (1st generation) and “atypical” (2nd and 3rd generation) antipsychotic
agents and describe the developmental evolution of this drug class.
2. Compare and contrast the mechanism(s) of action between a typical antipsychotic, an atypical
antipsychotic and the partial agonist aripiprazole.
3. Discuss the four dopaminergic pathways in the brain as they relate to antipsychotic drug
action and side effects.
4. Describe the contraindications, drug interactions, and adverse effects of available
antipsychotics.

Lecture 13.6: Consent and Brain Death

Session Learning Objectives:
1. Compare and contrast minimally conscious state, persistent vegetative state, and brain death.
2. Describe controversies about the diagnosis of brain death.
3. Discuss appropriate communication with surrogates, family, and caregivers regarding
catastrophic neurologic damage.

Lecture 13.7. Cognitive Aging

Session Learning Objectives:
1. Relate the normal changes that occur in the aging brain to changes in cognitive function.
2. Contrast normal aging with disease states that affect cognitive function in aging patients.
3. Discuss environmental and lifestyle adaptations that can mitigate the effects of cognitive
decline in the elderly.
4. Describe the available evidence for interventions and behaviors that have been shown to
preserve cognitive function across the lifespan.

Lecture 13.8. Human Sexuality

Session Learning Objectives:
1. Describe the components of sexual functioning.
2. Explain the development of human sexuality throughout the lifespan.
3. Describe physiologic changes that occur throughout the lifespan and their effect sexual
functioning.
4. Identify sexual disorders commonly seen in men and women.

Lecture 13.9. General Anesthesia

Session Learning Objectives:
1. Define general anesthesia, the different stages, and the approach to anesthetic management.
 2. Discuss how the blood: gas coefficient influences the onset of action of & emergence from,
inhaled anesthetics.
3. Describe how ventilation rate and pulmonary blood flow affects onset of action of inhaled
anesthesia.
4. Define the minimum alveolar concentration (MAC) and its significance with regards to volatile
anesthetics.
5. Describe the mechanisms of action (MOAs), advantages, disadvantages, clinical indications,
contraindications and adverse effects for the general anesthetic, sedative, and analgesics
agents listed in section III (drug list).
6. Describe how the pharmacokinetic properties of ultrashort-acting hypnotic drugs such as
thiopental & methohexital make them desirable and popular as general anesthetic agents.

Wk13 Reflection Session: Susannah Cahalan: Brain on Fire

Session Learning Objectives:
1. Understand the challenges faced by individuals presenting with psychiatric symptoms, and
what barriers to appropriate medical care they may encounter.
2. Explore alternative etiology of psychiatric symptomatology other than a primary psychiatric
disorder.
3. Appreciate the effects and benefits of exploring non-standard diagnoses and keeping a
patient-centered care approach.
4. Explore strategies for engaging the interprofessional healthcare team to coordinate
appropriate care for patients.

TBL 14.1: Clinical Approach to the Geriatric Patient

Session Learning Objectives:
1. Compare and contrast dementia and delirium.
2. Discuss the differential diagnosis and treatment of dementia and delirium, and the various
neurodegenerative disorders that are associated with dementia.
3. Discuss psychosocial and environmental concerns for patients with dementia in an outpatient
setting.
4. Describe non-pharmacological therapies for patients with dementia and their caregivers.

Lecture 14.1. Health Disparities

Session Learning Objectives:
1. Classify health disparities and identify populations as risk on inequity.
2. Review the historical context of racial discrimination in medicine and biomedical research
(including the perpetuation of medical misconceptions)
3. Describe the role of implicit bias in medical errors and substandard care within the healthcare
system
4. Describe the relationships between the various major categories of socioeconomic and
environmental factors that have been shown to disproportionately affect health outcomes for
people of color, and other marginalized groups
5. Explore individual and institutional actions that can mitigate health disparities in emergency,
hospital and primary healthcare settings.

Lecture 14.2. Pharmacology in Geriatric Patients and Polypharmacy

Session Learning Objectives:
1. Describe the pharmacokinetic and pharmacodynamic changes associated with the elderly
population and identify drugs displaying altered effects in the elderly (examples discussed in
class).
2. Distinguish adverse drug reactions (ADRs) from adverse drug events (ADEs).
3. Identify potentially inappropriate medications (PIMs) for older adults based on the 2019
American Geriatrics Society Beers Criteria.
4. Identify clinically important drug-drug interactions in the elderly population based on the 2019
American Geriatrics Society Beers Criteria.
5. Define polypharmacy and explain how it is best avoided in the elderly population.
Neurology Block (25%)

Lecture 5.1 Intro to Clinical Neuroscience

Session Learning Objectives:
1. Describe the functional roles of the nervous system, recognizing the involvement of sensory,
motor, autonomic and motivational systems in human behavior.
2. Describe the essential structural and functional elements of neurons and the relationship
between neuronal morphology and function.
3. Summarize the functional roles of central and peripheral glial cells.
4. Discuss neuronal synthesis of macromolecules and the forms of axonal transport.
5. Describe how ion concentrations and movements across the neuronal membrane contribute to
the membrane potential and the production of electrical signals.
6. Describe the generation and propagation of neuronal action potentials.
7. Discuss the clinical significance of alterations in ion channel structure and function.
8. Describe the encoding of stimuli and how stimulus intensity is represented within the nervous
system.
9. Describe the functional properties of neuronal synapses and the mechanisms mediating
neurotransmitter release.
10. Discuss the basic elements of synaptic signaling (pre- and post-) including ionotropic and
metabotropic receptors.
11. Describe the basic computational properties of neurons including excitatory, inhibitory and
modulatory synaptic signaling and the temporal and spatial summation of synaptic inputs.
12. Describe the basic functional principles of neural circuits and how they contribute to the
organization of the nervous system.
13. Identify the major anatomical regions of the central nervous system: spinal cord, medulla,
pons, cerebellum, midbrain, diencephalon and the cerebral hemispheres.
14. Recognize the relationship between abnormal structural and functional changes (lesions) in
the nervous system and clinical findings.

Lecture 5.2. Histology and Cell Biology of the Nervous System

Session Learning Objectives:
1. Compare and contrast ependymal cells and tanycytes.
2. Compare and contrast the axon and dendrite, both morphologically
and functionally.
3. Compare and contrast the organization, histology, and function of
neuron to neuron synapses and neuron to non-neuron synapses.
4. Describe the epineurium, perineurium, and endoneurium, and identify
the non-neuronal cells involved in the formation of these layers.
5. Describe the organization, histology, and functional relevance of the
meninges, ventricles (with their ependymal lining), choroid plexus,
blood-brain barrier, arachnoid villi and cerebrospinal fluid (CSF).
6. Describe the structure/function of neuron-specific intermediate
filaments, vesicles, and transport mechanisms.
7. Describe the structure of a neuron at the light microscopic level.
8. Discuss and identify the morphology of supporting cells including
neuroglia, microglia, Schwann cells, and satellite cells, with their
location (CNS vs. PNS), histogenesis and function.

Lecture 5.3 Neuroembryology

Session Learning Objectives:
 1. Describe the processes of Gastrulation, Notochord Formation, Neurulation and their role in
Neural development including Neural Tube Defects.
2. Describe Primitive Brain formation and the derivatives of the Brain Vesicles.
3. Describe the formation and function of the Ventricular System.
4. Understand the development of the Spinal Cord and Spinal Nerves including Myelination.
5. Describe the formation and development of the Autonomic Nervous System.

Lecture 5.4 Neuropathies and Peripheral Nerve Injury

Session Learning Objectives:
1. Distinguish between mononeuropathy, mononeuropathy multiplex, polyneuropathy, and
radiculopathy.
2. Describe the causes and clinical features of common neuropathic diseases, including diabetic
neuropathy and acute inflammatory demyelinating polyneuropathy (Guillan-Barré syndrome).
3. Discuss mechanical causes of nerve injury including extrinsic compression, entrapment,
traction, and laceration.

TBL 5.1: Autonomic Nervous System Physiology

Session Learning Objectives:
1. Compare and contrast the major physiological and anatomical features of the efferent divisions
of ANS with the somatic nervous system.
2. Describe the receptors and neurotransmitters that function in autonomic pathways.
3. Discuss the reciprocal nature and physiological actions of the sympathetic and
parasympathetic systems.
4. Distinguish between first, second, and third order Horners syndrome.
5. Review Horners syndrome and the various lesions which lead to it.

Lecture 5.5 Peripheral Nervous System Disease

Session Learning Objectives:
1. Review relevant facts about structure and function of the peripheral nerves.
2. Classify the reactions to peripheral nerve injury, explain their
etiopathogenesis and describe their morphology.
3. Define the term Neuropathy and classify neuropathies according to the
anatomic distribution of involvement and the associated neurological deficits.
4. Explain the etiopathogenesis and describe the morphology and clinical course
of inflammatory neuropathy (Guillain-Barr Syndrome), infectious
neuropathies, diabetic neuropathy, nutritional neuropathies; inherited
neuropathies (Charcot-Marie-Tooth (CMT) Disease), and neuropathies
associated with malignancy.
5. List examples of peripheral nerve sheath tumors, explain the
etiopathogenesis and describe the morphology & clinical features of
Schwannoma, neurofibroma, and malignant peripheral nerve sheath tumors.

Lecture 5.6 Neuromuscular Disease

Session Learning Objectives:
1. Describe the neuromuscular junction and explain the possible mechanisms
for the disruption of neuromuscular transmission.
2. Explain the pathogenesis and describe the morphology and clinical course of
the neuromuscular diseases including botulism, myasthenia gravis, Lambert-
Eaton myasthenic syndrome, and congenital myasthenic syndromes.
 3. Explain the pathogenesis and describe the morphology and clinical course of
muscle ion myopathies (channelopathies) including hypokalemic and
hyperkalemic periodic paralysis, and Anderson-Tawil Syndrome.
4. Explain the pathogenesis and describe the morphology and clinical course of
motor neuron diseases including amyotrophic lateral sclerosis and spinal
muscular atrophy.

TBL 6.1: Cholinergic Pharmacology

Session Learning Objectives:
1. Explain the indications and mechanisms of direct acting cholinergic agonists
and antagonists.
2. Describe the mechanisms of action of indirect acting cholinergic agonists.
3. List and describe the function of the cholinergic receptors in the autonomic
nervous system.
4. Identify the contraindications and adverse effects of cholinergic agonists and
antagonists.
5. Describe the physiologic consequences of activation of and inhibition of
muscarinic receptors in several important systems including the
cardiovascular, respiratory, genitourinary, visual and central nervous
systems.

Lecture 6.1. Fungal Infections of the CNS

Session Learning Objectives:
1. Characterize the morphology, structure, epidemiology, pathogenesis, clinical features,
laboratory diagnosis, and treatment and public health importance of the following CNS
mushroom poisonings: Ergotism, Mycetismus cerebralis, Mycetismus nervosa, and Mycetismus
sanguinarius
2. Characterize the morphology, structure, epidemiology, pathogenesis, clinical features,
laboratory diagnosis, and treatment and public health importance of CNS infections caused by
the following organisms: Mucorales species and Cryptococcus neoformans
3. Recognize the role of the following fungi in CNS disease: Candida, Pseudallescheria, Madurella,
Sporothrix, Rhodotorula, Saccharomyces, Schizosaccharomyces, Aspergillus, Blastomyces,
Histoplasma, and Coccidiodes

Lecture 6.2. Parasitic Infections of the CNS

Session Learning Objectives:
1. Characterize the morphology, structure, physiology, epidemiology, pathogenesis, clinical
features, laboratory diagnosis, treatment and public health importance of CNS infections
caused by the following parasitic organisms:
a. Trichinella spiralis,
b. Naegleria fowleri,
c. Toxoplasma gondii,
d. Trypanosoma brucei, and
e. Acanthamoeba

Lecture 6.3 Adrenergic Pharmacology

Session Learning Objectives:
1. Describe types and subtypes of adrenergic receptors, their locations,
and physiologic response to activation.
2. Describe the receptor selectivity of norepinephrine, epinephrine and
isoproterenol and predict the cardiovascular responses of each.
 3. Describe the uses of alpha-1, alpha-2, beta-1 and beta-2 selective
agonists.
4. Explain mechanisms and adverse effects of select indirect acting
sympathomimetics such as amphetamine, tyramine, cocaine and
ephedrine (mixed & indirect acting)
5. Compare and contrast the actions and uses of selective and non-
selective alpha adrenergic receptor antagonists.
6. Explain the clinically relevant differences in the receptor selectivity and
properties of various beta-adrenergic antagonists.
7. Describe the contraindications/adverse effects of beta and alpha
adrenergic antagonists.

TBL 6.2: Local Anesthetics

Session Learning Objectives:
1. Explain the mechanism of local anesthetic action, and how the characteristics of benzocaine
differ from that of other primary agents.
2. Discuss how pH affects the solubility, absorption, onset, and interaction of local anesthetics
with their receptor.
3. Describe the effect of vasoconstrictors on local anesthetic action and the potential undesired
side effects.
4. Compare and contrast the pharmacokinetics, clinical uses, and systemic toxicities of ester and
amide local anesthetics: A. Esters: benzocaine, cocaine, chloroprocaine, procaine, tetracaine
B. Amides: bupivacaine, mepivacaine, lidocaine, ropivacaine, EMLA (prilocaine+ lidocaine)
5. Differentiate between surface, infiltration, peripheral nerve block, spinal, and epidural
anesthesia based on onset, duration of action, potential complications, and techniques utilized
for these types of local anesthesia.

Lecture 6.4. Neoplasms of the Nervous System

Session Learning Objectives:
1. Discuss the general effects and the focal and non-focal symptoms and signs of neurological
tumors.
2. Discuss the pathological features, types, effects and prognoses of astrocytomas.
3. Discuss the incidence, morphologic changes, effects, clinical features, and prognosis of
oligodendrogliomas.
4. Discuss the incidence, morphologic changes, effects, clinical features, and prognosis of
ependymomas.
5. Discuss the incidence, morphologic changes, effects, clinical features, and prognosis of
medulloblastomas.
6. Discuss the incidence, morphologic changes, effects, clinical features, and prognosis of
meningiomas.

Lecture 6.5. Pathology of Demyelinating Diseases

Session Learning Objectives:
1. Define the term Demyelinating Disease and describe its natural history.
2. Explain the etiopathogenesis and describe the morphology and clinical course of
Multiple sclerosis.
3. Explain the etiopathogenesis and describe the morphology and clinical course of
Neuromyelitis optica, acute disseminated encephalomyelitis, Acute necrotizing
hemorrhagic encephalomyelitis, and Central pontine myelinolysis.

Lecture 7.1. Biology of Vision and Eye Disorders

Session Learning Objectives:
 1. Compare and contrast the dilator and constrictor pupillae muscles.
2. Describe the retinal pigment epithelium (RPE) including its location and function.
3. Describe the structure and function of the cornea, lens, iris, and ciliary body in light
transmission and focusing in vision.
4. Describe the uvea and its components (choroidea, ciliary body, iris).
5. Diagram the general cellular and anatomical organization of the retina and its blood
supply.
6. Discuss the pathophysiology and clinical presentation of retinal disorders including
hypertensive retinopathy, chorioretinitis, retinal detachment, retinitis pigmentosa,
night blindness, and vascular disorders affecting the retina.
7. Identify the five layers of the cornea, and describe their morphological and functional
characteristics.
8. Identify the three main layers of the eye (retina, uvea, sclera/cornea) and describe
their function.
9. Understand the function of retinal photoreceptors and the mechanism of color blindness.

Lecture 7.2. Special Senses

Session Learning Objectives:
1. Compare the causes of conductive and sensorineural hearing loss.
2. Describe how sound is transduced to electrical activity in the cochlea.
3. Describe the properties of sound.
4. Describe the tonotopical organization of the auditory pathway.
5. Explain how pitch and loudness of the sound are coded in the auditory pathways.
6. Explain how the receptors in the semicircular canals detect rotational acceleration
and how the receptors in the saccule and utricle detect linear acceleration.
7. Explain the roles of the tympanic membrane, the auditory ossicles (malleus, incus,
and stapes), and scala vestibule in sound transmission.

CBL 7.1: HEENT Clinical Correlates

Session Learning Objectives:
1. Apply anatomical and clinic-pathological reasoning to epistaxis
2. Differentiate clinical conditions of acute painful enlarged thyroid gland
3. Differentiate common ear pathology, hearing loss, tinnitus and vertigo
4. Recognize common benign mouth pathology seen in peds and adults
5. Recognize common complications and clinical-pathological infections of the pharynx and
sinuses.

Lecture 7.3. Diseases of the Eye

Session Learning Objectives:
1. Discuss common infectious and inflammatory disorders of the eye.
2. Compare and contrast structural disorders of the eye and eyelid including pterygium, lacrimal
system disorders, and refractive disorders.
3. Describe common disorders of the pupil, iris, and extraocular muscles, including amblyopia
and strabismus.
4. Discuss the normal processes associated with aging in the human eye.
5. Explain the mechanisms of presbyopia and how it impacts vision.
6. Describe the pathophysiology and clinical presentation of common age-related eye disorders,
including cataract and age-related macular degeneration
7. Understand the effect of posterior vitreous detachment on vision.

Lecture 7.4 Brachial Plexus Injuries

Session Learning Objectives:
1. Describe the etiology of brachial plexus injuries.
2. Discuss the physical exam findings of brachial plexus injuries.
3. Recognize the presentation and the evaluation of the brachial plexus injured patient.
4. Describe the treatment of the brachial plexus patient.

TBL 7.1: Central Vision Pathways

Session Learning Objectives:
1. 1. Trace the visual pathways from the retina to the occipital lobe visual cortex.
2. Describe the optic radiations, as they pass form the lateral geniculate of thalamus,
through the parietal and temporal lobes, including Meyers loop, on their way to the
primary visual cortex.
3. Describe how the visual fields are organized, within the primary visual cortex of the
occipital lobes.
4. Describe the location and function of the superior colliculi, with respect to initiating
reflexive orienting movements of head and eyes.
5. Describe the blood supply to the visual pathways and primary visual cortex.
6. Discuss visual field deficits that occur with common lesions, disrupting the flow of
information through the visual pathways or visual cortex, and the clinical terms used
to define them.
7. Describe the normal direct and consensual pupillary light reflexes and their clinical
importance.
8. Trace the direct and consensual pupillary light reflex pathways, from the retina to
the sphincter muscles of the iris.
9. Describe how lesions (structural or pharmacological), along the direct or consensual
pupillary light pathways will change the normal reflex response.

Lecture 7.4 Neurocutaneous Syndromes

Session Learning Objectives:
1. Define neurocutaneous syndromes as they relate to various organ systems.
2. Describe the genetic and environmental factors that impact the development of
neurocutaneous syndromes.
3. Compare the pathophysiology and clinical presentations (especially those identifiable by
HEENT examination) of various neurocutaneous syndromes:
o neurofibromatosis type 1 (NF1) & type 2 (NF2),
o Legius syndrome,
o Schwannomatosis,
o Unilateral vestibular schwannoma,
o Tuberous Sclerosis Complex (TSC),
o Von Hippel Lindau syndrome (VHL),
o Incontinentia Pigmenti,
o Hereditary hemorrhagic telangiectasia (HHT),
o Cutis marmorata telangiectatica congenita (CMTC),
o Sturge-Weber syndrome,
o Xeroderma Pigmentosum.
4. Discuss relevant clinical treatments for neurocutaneous syndromes

Lecture 7.6 Clinical Management of Hearing and Balance Disorders

Session Learning Objectives:
1. Describe the diagnostic approach to patients with hearing abnormalities.
2. Discuss interventions for patients with auditory dysfunction.
3. Explain the diagnostic approach to patients with balance deficits.
4. Outline the appropriate treatment options for patients with balance dysfunction.
TBL 8.1: Cranial Nerve Exam
Session Learning Objectives:
1. Apply knowledge of cranial nerve anatomy and function to interpret findings in patients.
2. Describe reflex testing of cranial nerve function in the neurologic exam.
3. Describe the brainstem circuits responsible for control of pupil constriction and dilation,
discuss lesions within these circuits that result in altered pupillary function and recognize how
this can be clinically assessed.
4. Describe the brainstem circuits responsible for horizontal eye movements, and discuss lesions
within these circuits that result in impaired horizontal gaze.
5. Describe the brainstem circuits responsible for vertical eye movements and vergence.
6. Identify common clinical conditions affecting cranial nerve function.
7. Recognize the differences in upper motor neuron and lower motor neuron findings in cranial
nerve lesions.
8. Review cranial nerve anatomy, nomenclature, and function.

Lecture 8.1: Brainstem Regulation of Autonomic Function & Consciousness

Session Learning Objectives:
1. Describe the dynamic regulation of autonomic nervous system function by corticolimbic
innervation of the brainstem
2. Discuss the current understanding of the role of the brainstem in consciousness.
3. Discuss the clinical relevance of brainstem function in medical conditions that impact level of
consciousness
4. Discuss the vestibulo-ocular reflex and the importance of this reflex in assessing the
unconscious patient.

Lecture 8.2. Cerebellar Anatomy

Session Learning Objectives:
1. Describe the organization of the gray and white matter of the cerebellum.
2. Describe the functional zones of the cerebellum.
3. Describe the circuits formed between the cerebellum and thalamus/cerebral
cortex/pons/spinal cord, etc.
4. Describe the contents of the cerebellar peduncles.
5. Review the blood supply of the brainstem and cerebellum.
6. Describe the different types of brain herniation and Arnold Chiari syndrome.
7. Describe the signs of cerebellar dysfunction and the various syndromes associated with
pathological changes in the cerebellum.
8. Discuss the deficits associated with damage to the flocculonodular lobe, vermis, and
hemispheres of the cerebellum.
9. Compare and contrast deficits associated with lower motor neurons, upper motor neurons, and
cerebellar damage.

Lecture 8.3. The Limbic System

Session Learning Objectives:
1. Define the limbic system and its associated brain structures.
2. Understand the role of the limbic system in homeostasis, olfaction, memory, and emotions.
3. Describe clinical conditions that affect limbic system function.
4. Discuss the range of approaches to the treatment of clinical conditions affecting the limbic
system.

Lecture 8.4. Basal Ganglia and Movement Disorders

Session Learning Objectives:
1. Diagram the structures and circuits of the basal nuclei (a.k.a., basal ganglia).
2. Describe the normal function of the basal nuclei including the function of the motor, executive,
motivational, and visuomotor loops.
 3. Explain the clinical manifestations of basal ganglia dysfunction, including hypokinetic and
hyperkinetic movement.
4. Discuss the etiology of movement disorders involving the basal nuclei.

Lecture 8.5. Treatment of Movement Disorders

Session Learning Objectives:
1. Discuss current hypotheses about the etiology and pathophysiology of Parkinson disease.
2. Describe the molecular mechanism of action of each primary drug used for Parkinson disease.
3. Describe the similarities and differences in the adverse effect profiles of L- DOPA/carbidopa,
COMT inhibitors, MAOB inhibitors and direct dopamine agonists, including drug interactions.
4. Discuss the use of other classes of drugs in treating Parkinson's disease: direct DA receptor
agonists, anticholinergics, MAO inhibitors, COMT inhibitors, and amantadine.
5. Describe Huntington's chorea and discuss drugs available for its treatment and their
effectiveness and adverse effects.

Activity Based Lecture 8.1. CSF and Intracranial Environs

Session Learning Objectives:
1. Describe the gross and cellular anatomy of the intracranial space
2. Describe the anatomy of the ventricular system and recognize its clinical significance.
3. Discuss the production and flow of cerebrospinal fluid and clinical conditions that impact its
normal balance and function.
4. Discuss the glymphatic system and its proposed role in health and disease.

Activity Based Lecture 8.2. Paroxysmal Disorders: Headaches

Session Learning Objectives:
1. Compare and contrast vascular and tension type headache.
2. Discuss the pathophysiology, clinical presentation, and treatment of headache, including
migraine, mixed, tension, ice-pick, and cluster headache.
3. Differentiate the common types of headache from those associated with idiopathic intracranial
hypertension (a.k.a., pseudotumor cerebri), temporal arteritis, and mass effect.
4. Describe headache due to medication or caffeine withdrawal.

TBL 9.1: CNS Infectious Disease

Session Learning Objectives:
1. Compare and contrast meningitis, encephalitis and meningoencephalitis.
2. Describe the morphology, structure, physiology, epidemiology, pathogenesis, clinical features,
laboratory diagnosis, treatment and public health importance of the following viruses with CNS
importance:
o picornaviruses (enteroviruses): poliovirus
o togaviruses (alphavirus group): Western equine encephalitis virus, Eastern equine
encephalitis virus
o flaviviruses: West Nile virus
o herpesviruses: HSV-1/2
3. Characterize the morphology, structure, physiology, epidemiology, pathogenesis, clinical
features, laboratory diagnosis, treatment and public health importance of the following
bacteria with CNS importance:
o Neisseria meningitidis
o Listeria monocytogenes

Lecture 9.1. Pathology of CNS Infections

Session Learning Objectives:
 1. Review the structure and function of the meninges, explain the etiopathogenesis, and describe
the morphology and clinical course of Acute Pyogenic (Bacterial) Meningitis and Acute Aseptic
(Viral) Meningitis.
2. Explain the etiopathogenesis and describe the morphology and clinical course of Acute Focal
Suppurative Infections including Brain Abscess, Subdural Empyema, and Extradural Abscess.
3. Explain the etiopathogenesis and describe the morphology and clinical course of Chronic
Bacterial Meningoencephalitis including Tuberculosis, Neurosyphilis, and Neuroborreliosis (Lyme
Disease).
4. Explain the etiopathogenesis and describe the morphology and clinical course of Viral
Meningoencephalitis including Arthropod-Borne Viral Encephalitis, Herpes Simplex Virus Type 1
& 2, Varicella-Zoster Virus (Herpes Zoster), Cytomegalovirus, Poliomyelitis, Rabies, and HIV; as
well as those of Progressive Multifocal Leukoencephalopathy, and Subacute Sclerosing
Panencephalitis.
5. Describe Fungal Meningoencephalitis, Cerebral Toxoplasmosis, Cerebral Amebiasis, and Cerebral
Malarias.

Lecture 9.2.(moved to 10.4) Traumatic Injury of the CNS

Session Learning Objectives:
1. Describe the clinical features of central nervous system trauma, comparing coup and
contrecoup injury.
2. Compare and contrast concussion and diffuse axonal injury; describe the consequences of
each.
3. Compare and contrast epidural hematoma and subdural hematoma, including location and
time course, and describe the use of radiologic imaging for diagnosis.
4. Discuss the clinical management of patients with traumatic brain injuries.

Lecture 9.3 Pathology of Cerebrovascular Disease

Session Learning Objectives:
1. Describe the type of vascular lesions occurring in the gray and white substance of the brain
and oppose the small vessels lesions (amyloid angiopathy & arteriolosclerosis / lipohyalinosis)
to the large vessels lesions (atheroma).
2. Explain the concepts of ischemic stroke, hemorrhagic stroke and transient ischemic attacks
and their pathogenesis.
3. Describe the pathologic features of cerebral infarction and understand the time course of these
changes.
4. Describe the pathologic features of arterio-venous malformations and their role in sub-
arachnoid hemorrhages.
5. Describe the pathologic features of cerebral aneurysms and their role in sub-arachnoid
hemorrhages and hemorrhagic cerebral infarcts.

CBL 9.1: Neuroimaging

Session Learning Objectives:
1. Describe neuroimaging modalities and their indications for use.
2. Distinguish normal and pathologic abnormalities of the nervous system by diagnostic imaging.
3. Relate the underlying pathophysiology of neurological disorders to their radiographic
appearance.
4. Construct an imaging algorithm for common diagnostic scenarios.

Lecture 9.4. Neurodegenerative Disorders

Session Learning Objectives:
 1. Describe the common pathologic process among neurodegenerative diseases and compare the
different types of these diseases according to the clinical course, anatomic CNS sites affected,
the genetic causes, and the types of inclusions/abnormal structures observed.
2. Explain the etiopathogenesis and describe the morphology and clinical course of: Alzheimer
disease, Frontotemporal lobe degenerations, Parkinson disease, Dementia with Lewy bodies,
and Huntington disease.
3. Explain the etiopathogenesis and describe the morphology and clinical course of: Multiple
system atrophy, Spinocerebellar ataxia, Friedreich ataxia, Ataxia-Telangiectasia, and
Amyotrophic lateral sclerosis.
4. List the diseases that cause dementia and classify them as frequent and less frequent causes.
5. Explain the etiopathogenesis and describe the morphology and clinical course of Prion Disease.

CBL 10.1: Lesion Localization Activity

Session Learning Objectives:
1. Identify common clinical conditions, the underlying lesion(s) responsible, and be able to
explain the reasoning for the diagnostic impression, based on a brief patient history,
presenting clinical signs and symptoms, and initial physical examination findings.
2. Describe clinically important neural pathways and potential consequences of lesions appearing
at the level of the neuromuscular junctions, peripheral nerves, cranial nerves, spinal cord,
brainstem, cerebellum, and cerebral hemispheres.

Lecture 10.1 Neurobiology of Pain

Session Learning Objectives:
1. Define and distinguish the following terms for common pain symptoms: allodynia, analgesia,
dysesthesia, hyperalgesia, hyperesthesia, hyperpathia, hypoalgesia, and hypoesthesia.
2. Review the role of nociceptors and C and A-delta fiber groups in the perception of pain.
3. Review the role of the anterolateral system (spinothalamic tract) in the conveyance of
nociceptive stimuli.
4. Review the pain and temperature pathways for the face.
5. Discuss the role of the dorsal column-medial lemniscus pathway in the transmission of visceral
pain.
6. Distinguish between nociplastic, neuropathic, and nociceptive pain.
7. Describe the role of the anterolateral system (spinothalamic tract) in the affective response to
pain.
8. Describe the modulation of pain by spinal, brainstem, and brain circuitry, including the role of
endogenous opioids.

Lecture 10.2 Encephalopathy and Cerebral Infarction

Session Learning Objectives:
1. Explain the concepts of the basic pathophysiologic states of ischemic encephalopathy and
cerebral infarction.
2. Describe the major pathological features of:
o global cerebral ischemia.
o focal cerebral ischemia.
o hypertensive cerebrovascular disease.

Lecture 10.3 Sleep & Sleep Disorders

Session Learning Objectives:
1. Discuss the circadian cycle of sleep and wakefulness and the role of melatonin.
2. Describe the succession of identifiable stages in normal sleep, recognizing that sleep is an
active and rhythmic neural process.
3. Define REM sleep and discuss its biological significance.
 4. Discuss the neuroanatomical loci involved in the regulation of REM and non-REM sleep.
5. Describe the two activity states of thalamocortical neuron projections and their relationship to
EEG activity.
6. Discuss the clinical presentation and pathophysiology of insomnia, sleep apnea, sleep terror
disorder and sleepwalking, restless legs syndrome and narcolepsy.

Lecture 10.4 (moved to 9.2) Epilepsy and Seizures

Session Learning Objectives:
1. Categorize seizures based on ILAE 2017 criteria.
2. Describe appropriate interventions when witnessing a seizure in a patient.
3. Explain the neuroscientific underpinnings of seizures.
4. Identify clinical symptoms that lead to suspicion of seizure.
5. Identify risk factors for seizures.
6. Review seizure descriptors and terminology.

Activity Based Lecture 10.1 Language, Aphasias & Higher-Order Brain

Function
Session Learning Objectives:
1. Compare and contrast association cortices (unimodal and heteromodal) with sensory and
motor cortices.
2. Discuss cerebral localization and the lateralization of function.
3. Diagram the anatomy of language areas in the brain.
4. Compare and contrast the aphasias, including Broca, Wernicke, conduction, and global types
5. Discuss the functions of the parietal, frontal, and temporal association cortices and the deficits
that can occur with lesions to each.
6. Describe disconnection syndromes and the role of the corpus callosum.
7. Discuss the role of the non-dominant hemisphere in spatial processing, attention, and the
phenomenon of neglect.

Activity Based Lecture 10.2: Anticonvulsants

Session Learning Objectives:
1. Describe the therapeutic uses, pharmacokinetic properties, toxicities, adverse effects, and
drug interactions of antiseizure drugs.
2. Discuss the four main mechanisms of action of antiseizure drugs, including the fact that
several have multiple mechanisms of action.
3. Discuss the relationship between types of seizure and the selection of therapeutic drugs.

Musculoskeletal and Dermatologic Block (25%)

Lecture 1.1. Integumentary & NMSK Embryology

Session Learning Objectives:
1. Describe the embryologic origins and development of hair, nails and the layers of the skin.
2. Discuss the formation of the sweat, sebaceous and apocrine glands.
3. Recognize the structure and function of desmosomes & hemidesmosomes.
4. Identify skin disorders that occur during embryogenesis.
5. Explain the embryologic origins of the skeleton and skeletal muscle.
6. Describe the processes of long bone formation and ossification.
7. Identify musculoskeletal disorders that occur during embryogenesis.
8. Recognize developmental and embryological abnormalities of the fingers and toes.
9. Describe the structure and functions of the epidermis, dermis, and hypodermis.
10. Review the types of cells in each layer of skin and identify important histological features.
TBL 1.1: Viral and Fungal Skin Conditions
Session Learning Objectives:
1. Describe the epidemiology, pathogenesis, clinical features, laboratory diagnosis, and treatment
of the following exanthematous viral infections:
i. roseola infantum (HHV 6)
ii. smallpox & pox diseases (molluscum contagiosum)
iii. erythema infectiosum (parvovirus B19)
iv. measles
v. rubella
vi. HSV 1/2, VZV
2. Characterize the morphology, clinical syndromes, laboratory diagnosis, and treatment of the
superficial fungi causing pityriasis versicolor, tinea nigra, white piedra, and black piedra.
3. Describe cell structure and, where appropriate, the anamorphic and teleomorphic forms of each
of the superficial fungi.
4. Compare and contrast the morphology, clinical syndromes, laboratory diagnosis, and treatment
of the dermatophytes (Epidermophyton, Microsporum, and Trichophyton).

Lecture 1.2. Sensory Transduction & Physiology of the Integumentary System

Session Learning Objectives:
1. Describe the steps involved in sensory transduction and action potential generation in
cutaneous mechanoreceptors and nociceptors.
2. Explain the basic elements of sensory coding including modality, location, intensity, and
duration and how these properties relate to receptor specificity, receptive field, and receptor
adaptation.
3. Compare the pathway that mediates sensory input from touch, proprioceptive, and vibratory
senses to that mediating information from nociceptors and thermoreceptors.
4. Describe the deficits caused by lesions of ascending sensory pathways that mediate touch, pain,
and temperature.
5. Distinguish between the acute and chronic pain and describe the mechanisms underlying the
development of chronic nociceptive and chronic neuropathic pain.
6. Describe processes involved in modulation of transmission in pain pathways.

Lecture 1.3. Pathology of Skin Infection

Session Learning Objectives:
1. Describe the structure and functions of the skin.
2. List the key macroscopic and microscopic features of skin pathology.
3. Describe the pathology of erythrasma, impetigo, folliculitis, erysipelas, and cellulitis.
4. Describe the pathology of warts and molluscum contagiosum.
5. List the common superficial infections caused by dermatophytes.
6. List the common superficial infections caused by yeasts.

Lecture 1.4. Pathology of Integumentary Disease

Session Learning Objectives:
1. Discuss the etiology and microscopic features of diseases of the epidermis.
2. Describe the gross and microscopic features of bullous diseases of the skin.
 3. Describe the etiology and morphology of psoriasis, lichen planus, lupus erythematosus, acne
vulgaris and scleroderma.
4. Discuss the pathology of and the findings with immunofluorescence testing of various blistering
disorders.
5. Discuss the pathology and findings of inflammatory diseases of the vascular bed.

Lecture 1.5. Neoplastic Conditions of the Skin

Session Learning Objectives:
1. Describe the clinicopathologic features of benign epithelial tumors.
2. Describe the clinicopathologic features of dermatofibroma and dermatofibrosarcoma
protuberans.
3. Describe the clinicopathologic features of actinic keratosis.
4. Describe the clinical features and gross and microscopic appearances of mycosis fungoides,
mastocytosis, and histiocytosis X.

Lecture 1.6. Malignant Tumors of the Skin

Session Learning Objectives:
1. Discuss the predisposing factors, morphology, and prognosis of squamous cell carcinoma of the
skin.
2. Discuss the predisposing factors, morphology and prognosis of basal cell carcinoma.
3. Describe the histologic classification of nevi.
4. Describe the variants of nevocellular nevus.
5. Discuss the characteristics and morphology of dysplastic nevi.
6. Discuss the pathogenesis and clinicopathologic features of malignant melanoma.
7. Describe the radial and vertical growth phases of malignant melanoma.

ABL 1.1. Cell Biology of Bone & Cartilage and Clinical Applications
Session Learning Objectives:
1. Relate the structure of hyaline, elastic, and fibrous cartilage to their functions.
2. Describe the role of chondrocytes in the synthesis and maintenance of cartilage extracellular
matrix.
3. Name the three primary bone cells and their functions.
4. Differentiate between the steps in the formation of intramembranous and endochondral bone.
5. Describe the roles of calcium and phosphate in the processes of bone formation and bone
resorption.
6. Describe the functions of the osteoblasts and the osteoclasts in bone remodeling and the factors
that regulate their activities.
7. Describe the relationship between growth hormone (GH) and the insulin-like growth factors
(IGF) and their binding proteins in the regulation of growth.
8. Identify the target organs or cell types for insulin-like growth factors that account for
longitudinal growth.
9. Discuss the feedback loop involved in the GH-IGF axis.
10. Describe the biological consequences of under-secretion and over-secretion of the
hormones that regulate growth
11. Describe the clinical implications of bone and cartilage disorders

ABL 1.2: Histology of Connective Tissue and Bone

Session Learning Objectives:
 1. Describe the types of collagen and their roles in cartilage and bone structure.
2. Differentiate the histological features of hyaline, elastic, and fibrous cartilage.
3. Describe the general structure of bones, including cell types, extracellular matrix, surfaces, lining
structures, periosteum, endosteum, bone marrow, and blood supply.
4. Identify bone cell types derived from mesenchyme vs. those derived from monocytes/CFU-GM
(colony-forming unit–granulocyte/macrophage).
5. Describe the structure of adult compact and spongy (a.k.a., cancellous or trabecular) bone.
6. Compare and contrast mature (lamellar) and immature (woven) bone.
7. Compare and contrast the three functional states of osteocytes (quiescent, formative and
resorptive).
8. Compare and contrast the histological features of osteopetrosis and osteoporosis.
9. Identify bone types and their components from microscopic images.

TBL 2.1: Dermatologic Pharmacology

Session Learning Objectives:
1. Discuss the factors that affect the pharmacologic response to drugs applied to the skin.
2. Describe the common local reactions to topical dermatologic medications.
3. Outline the types and mechanisms of dermatologic drug vehicles.
4. Explain the mechanisms of action, common adverse effects, contraindications, and potential
drug interactions of representative members of agents used to treat common dermatologic
conditions.

CBL2.1: Clinical Dermatology

Session Learning Objectives:
1. Accurately describe skin lesions including morphology, configuration and distribution.
2. Apply knowledge of skin structure and function to an understanding of clinical and diagnostic
features of diseases of the skin.

Lecture 2.1. Pathology of Osteoporosis, Rickets and Osteomalacia

Session Learning Objectives:
1. Define osteoporosis and list disorders associated with this condition
2. Discuss the causes, clinical and pathological features of:
i. Osteomalacia
ii. Rickets
8. Describe the effects of hyperparathyroidism on bone
9. List the effects on bone of renal osteodystrophy

Lecture 2.2. Pathology of Bone Disorders

Session Learning Objectives:
1. Discuss the description, pathogenesis, pathology, and clinical presentation of:
i. Paget Disease
ii. Fibrous Dysplasia
iii. Non-Ossifying Fibroma.
iv. Hypertrophic Osteoarthropathy.

Lecture 2.3. Bone Fractures

Session Learning Objectives:
1. Describe the biology of fracture healing and the mechanisms of bone formation
 2. Understand the nomenclature for describing fractures on radiographs
3. Understand the radiographic features of common fractures
4. Describe the basic treatment principles for common fractures

Lecture 2.4. Pathology of Bone Tumors & Tumor-Like Lesions

Session Learning Objectives:
1. List the selected benign neoplasms of bone and describe their clinical features
2. Describe gross and microscopic appearances of osteoma, osteoid osteoma, osteoblastoma,
chondroblastoma, chondroma, and chondromyxoid fibroma
3. Describe the clinical presentation of osteosarcoma, its common locations, age, and sex
incidence, gross appearance, and histology
4. Compare the clinical and morphologic features of chondrosarcoma with those of osteosarcoma
5. Describe the clinical presentation, pathology, spread and prognosis of Ewing sarcoma
6. Describe the common sites, clinical features, gross and microscopic features of giant cell tumor
of bone

Lecture 2.5. Pathology of Osteoarthritis, Rheumatoid Arthritis and Gout

Session Learning Objectives:
1. Review structure and function of joints, classify them, and describe their different types.
2. Explain the etiopathogenesis and describe the morphology and clinical course of osteoarthritis,
rheumatoid arthritis, and juvenile idiopathic arthritis.
3. Compare between osteoarthritis, rheumatoid arthritis, and juvenile idiopathic arthritis in terms
of pathogenesis, morphology, and joint involvement.
4. Review uric acid metabolism and list the causes of hyperuricemia.
5. Explain the etiopathogenesis and describe the morphology and clinical course of gout and
pseudogout.

Interactive Session S2.1: Biomedical Informatics Thread Session

Session Learning Objectives:
1. Describe the key features of Medical Imaging Informatics
2. Discuss the principles, functions, advantages, and disadvantages of DICOM, PACS, RIS, HIS, CAD,
and CBIR
3. Understand the basic features of radiological and imaging informatics workflow
4. Discuss the future of imaging informatics
5. Apply basic concepts to perform primary functions on an imaging informatics platform

Lecture 2.6. Pathology of Joint Disorders

Session Learning Objectives:
1. Describe the etiology, clinical presentation, and morphologic features of suppurative arthritis
and TB arthritis.
2. Describe the pathology of ankylosing spondylitis and its association with HLA-B27.
3. Describe the pathology of reactive arthritis, pigmented villonodular synovitis, giant cell tumor of
the tendon sheath, and synovial sarcoma.

Lecture 2.7. Pharmacological Management of Bone & Joint Conditions

Session Learning Objectives:
1. Understand the therapeutic approaches to provide symptomatic relief and inhibit progression of
rheumatoid arthritis.
 2. Explain the use of non-steroidal anti-inflammatory agents and glucocorticoids in rheumatoid
arthritis including the limits to their use and adverse effects.
3. Describe the pharmacodynamics, therapeutic uses, and adverse effects of nonbiologic disease-
modifying antirheumatic drugs such as azathioprine, methotrexate, cyclophosphamide,
cyclosporine, mycophenolate mofetil, chloroquine, hydroxychloroquine, leflunomide,
sulfasalazine, tofacitinib.
4. Describe the pharmacodynamics, therapeutic uses in the treatment of arthritis, and adverse
effects of the biologic response modifying agents such as infliximab, etanercept, adalimumab,
certolizumab, anakinra, golimumab, abatacept, rituximab, tocilizumab.
Lecture 3.1 Physiology of Skeletal Muscle
Session Learning Objectives:
1. Define the elements of the sarcomere responsible for striated muscle contraction.
2. Explain how muscle length influences force of contraction.
3. Discuss the pathophysiology of malignant hyperthermia.
4. Define a motor unit and explain how skeletal muscles use them to create graded contractions.
5. Describe the different skeletal muscle fiber types (i.e., types I, IIA, and IIB/ IIX).
6. Define the physiological basis of electrodiagnostic evaluation of skeletal muscle function.
7. Identify the components, function, and afferent nerve fibers of the muscle spindle.
8. Explain how the activity of γ-motor neurons alters the response to muscle stretch.
9. Describe the role of Golgi tendon organs in the control of skeletal muscle.

Lecture 3.2. Muscle Metabolism

Session Learning Objectives:
1. Describe the different categories of muscle (skeletal, cardiac, smooth).
2. Describe the differences in fast (white) and slow (red) twitch muscles.
3. Describe the properties of specific proteins found in thin and thick filaments of skeletal muscle.
4. Describe the cyclic attachment and detachment of myosin to the f-actin + troponin and
tropomyosin complex.
5. Describe the ATPase of the myosin head group and participation of creatine phosphate in
energy metabolism in muscle.
6. Describe the differences seen in smooth muscle and P-light-chain kinase plus calmodulin
participation in control of smooth muscle contraction.
7. Describe the control of muscle contraction by calcium ion concentration.
8. Describe the structure, properties and role of titin.

Lecture 3.3 Biochemistry of Neurotransmitters and their Receptors

Session Learning Objectives:
1. Compare and contrast the structure and function of small nitrogen-containing
neurotransmitters (specifically: catecholamines (epinephrine, norepinephrine, dopamine),
serotonin, histamine, acetylcholine, glutamate, GABA, aspartate, glycine, and nitric oxide).
2. Describe the metabolism (synthesis from precursors and inactivation), storage, and secretion of
each of the small nitrogen-containing neurotransmitters.
3. Discuss the biological significance of tyramine in the clinical use of MAO inhibitors.
4. Describe the biosynthesis of opioid neuropeptides (enkephalins, beta-endorphins, and
dynorphins) from precursor peptides and identify common structural features of the genes and
peptides.

TBL 3.1: Clinical Electrophysiology

Session Learning Objectives:
1. Understand how nerve conduction studies help to elucidate the nature and extent of
neuropathies involving motor and/or sensory nerves.
2. Understand how needle electromyography examination can be used to define the etiology of
muscle weakness.
3. Recognize the most common causes of axonal neuropathies.
4. Compare and contrast the general patterns of sensory loss and clinical symptoms associated
with mononeuropathy, radiculopathy and polyneuropathy.
5. Describe clinical signs and symptoms of Carpal tunnel syndrome.
6. Describe how Carpal tunnel syndrome is diagnosed including electrophysiological testing.

Wk4. Histology Lab: Skeletal Musculoskeletal Histology

Session Learning Objectives:
1. Compare and contrast skeletal muscle with cardiac and smooth muscle in terms of histological
appearance, structure, function and innervation.
2. Describe the development, growth, regeneration and presence of stem cells in skeletal muscle.
3. Describe the basal lamina (external lamina) and the connective tissue wrappings of skeletal
muscle.
4. List the components of a sarcomere and how it changes with contraction.
5. Describe and compare the cytoskeleton and membrane components of skeletal and cardiac
muscle.
6. Relate motor-end plates, lower motor neurons, denervation, and muscle fiber types.
7. Compare normal muscle to selected muscle pathologies.

CBL 4.1 Musculoskeletal Imaging and Disease

Session Learning Objectives:
1. Recognize common musculoskeletal disorders and their clinical features.
2. Relate the underlying pathophysiology of musculoskeletal disorders to their clinical
presentation.
3. Discuss the diagnostic approach to common musculoskeletal diseases.
4. Describe the rationale for treatment of common musculoskeletal diseases.
5. Describe the etiology, presentation, and treatment of patients with:
i. Gout
ii. Compartment syndrome
iii. Hyperparathyroidism
iv. necrotizing fasciitis
v. gonococcal arthritis of the wrist
vi. Amyotrophic lateral sclerosis
vii. Osteoarthritis of the thumb CMC joint
viii. Osteoporosis
ix. Ulnar neuropathy
x. Tenosynovitis

Lecture 4.1. Exercise Physiology

Session Learning Objectives:
1. Identify the key elements of integrated physiological response to exercise and their role in
meeting the homeostatic challenges triggered by exercise.
 2. Compare and contrast metabolic pathways for ATP production during aerobic and anaerobic
exercise.
3. Describe the main adaptive responses of skeletal muscle to the endurance and strength types of
exercise.
4. Compare and contrast pathologic and physiologic cardiac growth and remodeling.
5. Explain the changes that occur in cardiac output, tissue blood flow, and blood pressure in
response to dynamic exercise.
6. Describe how oxygen consumption and ventilation change during and after exercise, and explain
how these changes take place.
7. Describe the homeostatic thermoregulatory responses and mechanisms that take place during
periods of exercise.
8. Describe the selected physiological mechanisms that have been shown to mediate the influence
of exercise on various aspects of health.

Lecture 4.2 Enteric Nervous System

Session Learning Objectives:
1. Identify the main components of the enteric nervous system and their role in integrated
response to a meal.
2. Describe the role of interaction of specific components of enteric, autonomic and central
nervous system in regulation of gastrointestinal function.
3. Describe the different types of enteric neurons and their function.
4. Identify the key neurotransmitters utilized by enteric neurons and understand their actions.
5. Describe the involvement of enteric nervous system in neurological diseases that affect the
gastrointestinal tract.

Lecture 4.3. MSK Infections

Session Learning Objectives:
1. Characterize the epidemiology, pathogenesis, clinical features, laboratory diagnosis, and
treatment of Clostridium perfringens myonecrosis; compare and contrast dry and wet gas
gangrene.
2. Characterize the etiology, epidemiology, pathogenesis, clinical features, laboratory diagnosis,
and treatment of necrotizing fasciitis.
3. Discuss the morphology, physiology, epidemiology, pathogenesis, clinical features, laboratory
diagnosis, and treatment of Clostridium tetani and Clostridium botulinum.
4. Recognize the role of bacteria in the following musculoskeletal infectious diseases:
a. Bacterial myositis
b. Discitis
c. Tuberculous spondylitis
d. Septic arthritis

Lecture 4.4. Soft Tissue Tumors

Session Learning Objectives:
1. Describe the general characteristics, gross aspects, histologic morphology, and cytogenetic
abnormalities of tumors and tumor-like conditions of fibrous origin, mainly nodular fasciitis,
deep and superficial fibromatoses, fibrosarcoma, and undifferentiated pleomorphic sarcoma
(malignant fibrous histiocytoma).
2. Describe the general characteristics, pathogenesis, gross aspects, histologic morphology, and
cytogenetic abnormalities of tumors of adipose tissue, mainly lipomas and liposarcomas.
 3. Describe the general characteristics, gross aspects, the various histologic types, and cytogenetic
abnormalities of rhabdomyosarcomas, tumors of the striated muscle.
4. Describe the general characteristics, gross aspects, and histologic morphology of tumors of the
smooth muscle.
5. Describe the general characteristics, pathogenesis, gross aspects, histologic morphology, and
cytogenetic abnormalities of synovial sarcoma.

TBL 4.1 Somatic Pharmacology

Session Learning Objectives:
1. Name the two major classes of neuromuscular blockers, the drugs in each class and the
mechanisms by which they exert their therapeutic and adverse effects.
2. Explain what is meant by phase I and phase II block and mechanism by which each occurs.
3. Describe the mechanism of action and clinical uses of the direct acting muscle relaxants.
4. Identify the short, intermediate and long acting nondepolarizing neuromuscular blockers and
any advantages or disadvantages one might have over another.
5. Name the centrally acting spasmolytic and antispasmodic drugs and explain the mechanisms of
action behind their therapeutic and adverse effects.
6. Explain the rationale for using dantrolene in malignant hyperthermia.
7. Explain the methods used to reverse neuromuscular junction blockade.

CBL 4.2: Approach to the Patient with Rheumatic Disease

Session Learning Objectives:
1. Differentiate arthralgia from arthritis.
2. Characterize the signs and symptoms of arthropathy.
3. Identify appropriate diagnostic investigations for rheumatic disorders, including synovial fluid
analysis.
4. Utilize clinical presentation and diagnostic markers to differentiate between inflammatory and
noninflammatory disorders.