SCHOOL OF PHARMACY AND MEDICINE
COURSE OF LABORATORY MEDICINE
Degree in Medicine and Surgery
Outline of the Lectures given by Prof. ANDREA BELLELLI
2) Organizzation of the Courses:
- The student work is measured in Crediti Formativi Universitari (CFU). Every CFU should correspond to 25 hours of student work. Some types of CFU require that the 25 hours/CFU are entirely carried out under teacher supervision, in hospitals or laboratories; other types of CFU require only partial supervision, and the rest of the time is used for autonomous work of the student (lectures typically imply 12 hours/CFU plus 13 hours/CFU for self-organized study).
- On average the student work should be 60 CFU / year (1500 hours of student work, in two semesters). Every year, on average, should include 6 exams. EU rules require that medical students receive at least 5500 hours of tutored learning over 6 years.
- The duration of the Medical Course is 6 years.
- Structure of the academic calendar:
| 1 october - 31 january | lectures of the I semester (students enrolling to the I year may start later due to the time required for the elaboration of the admission exam) |
| circa 23 december - circa 7 january | Accademic holidays for Christmas (actual dates are decided every year with a decree of the Rector) |
| 1 - 28 (29) february | winter exam session |
| 1 march - 31 may | lecture of the II semester |
| Easter holidays usually fro Thursday to Tuesday | Academic holidays for Easter |
| 1 june - 31 july | summer exam session |
| 1 - 31 august | teaching stops (holidays) |
| 1 - 30 september | fall exam session |
- Exams: every year at least 7 exams should be organized: 2 in february; 3 in the summer session (june and july); 2 in september. It is not always possible to organize extraordinary exams during the Christmas and/or Easter holidays because every teacher has many courses and the holiday time may not be sufficient. In order to give the exam registration of the Infostud website is required. All exams appear on Infostud. It is possible that an exam is delayed by a few days due to the necessities of the teachers. The screenshot below shows how the exam is organized within the Infostud platform:
The exam consists in an oral or written interview on different subjects treated during the course. The dates of the exam are indicated on Infostud where the student is requested to apply; postponements of a few days may be required because of other duties of the teachers. The winter session (in February) is reserved to students of the IV year and later, but it is possible for students of the III year to take a partial examination on the subjects discussed in the first semester, only in the February session.
A typical exam question may be as follows: a breast-fed baby presents retarded growth. The hemocytometric analysis reveals:
Hemoglobin 8 g/dL
Erythrocyte count 2.7 millions/uL
Mean corpuscular volume 107 fL.
Name this condition; write down at least three possible causes; indicate the laboratory tests to distinguish among the cause you indicated.
Expected answer: the condition is macrocytic anemia. Possible causes of macrocytic anemia are:
folate deficicency
vitamin B12 deficiency
orotic aciduria due to inhierited deficiency of the enzyme .
Appropriate laboratory tests are: measurement of folate and vitamin B12 cocentration in the serum and urine; Schilling test; measurement of orotic acid in the serum and urine; sequencing of the gene of orotate PRPP transferase. Since the baby is breast-fed it is advisable to screen his/her mother for the same diseases, and his/her father for orotic aciduria.
The 2nd semester Laboratory Medicine Course begins on March 4 at 11,00 in classroom D; lectures are given on Tuesdays (11,00-13,00) and Fridays (9,00-12,00).
Programme and timetable of the course - 2nd semester
The lectures of this course are as follows:
1) The statistical bases of Laboratory Medicine.
1b) Biochemical bases of human variability: an exercise.
2) Prenatal and perinatal clinical analyses.
3) Methods in Laboratory Medicine.
3b) Biochemical methods for proteins and macromolecules.
4) Nosography: the classification of human diseases
5) Laboratory Analyses in Toxicology.
6) Hemostasis and Thrombosis.
7) Anemias and hemoglobinopathies.
8) Disorders of Nucleotide Metabolism; Gout.
9) Porphyrias (abilitated for on-line attendance registration).
10) Heme degradation; bilirubin and icterus (jaundice); liver functions. (abilitated for on-line attendance registration).
11) Plasma Proteins (abilitated for on-line attendance registration).
12) Lipoproteins and dislipidemias; functions of the adipose tissue; obesity (abilitated for on-line attendance registration).
13) Disturbances of the homeostasis of water and electrolytes; kidney functions. (abilitated for on-line attendance registration).
14) Disturbances of the homeostasis of respiratory gases and pH; lung functions. (abilitated for on-line attendance registration).
15) Disturbances of glucose metabolism (abilitated for on-line attendance registration).
16) Disturbances of the urea cycle (abilitated for on-line attendance registration).
17) Laboratory analyses for endocrine disorders (abilitated for on-line attendance registration).
18) Genetic defects of metabolism (abilitated for on-line attendance registration).
18b) The biochemistry of inherited enzymatic defects (an older version of the same).
19) Genetic defects of metabolism of aminoacids (abilitated for on-line attendance registration).
20) Genetic defects of metabolism of sugars and fat; other inheritable diseases (abilitated for on-line attendance registration).
22) Other inherited diseases (in preparation)
23) Hypervitaminoses and hypovitaminoses
24) Principles of clinical reasoning; the problem of cancer
25) Standard blood tests (abilitated for on-line attendance registration).
Self evaluation tests
Clinical reasoning exercise 1
Clinical reasoning exercise 2
Clinical reasoning exercise 3
Some clinical cases
Questions and comments
Electives (0.2 CFU):
1) Epidemics: statistical considerations (abilitated for on-line attendance registration). An interactive program to explore the effect of vaccines, quarantine and more is available at: this link.
Web resources for Medical Education
Access Medicine: institutional access to the platform Access Medicine by McGraw-Hill (a resource provided by Sapienza to all students and teachers; follow instructions on the web page). Direct link.
Several medical journals may be accessed via the institutional subscription of Sapienza University; log in via the Sistema Bibliotecario Sapienza (SBS).
Several interesting resources are available on the site of Medscape; click the link "DRUGS & DISEASES" to access a collection of clinical cases and exercises (you should register to access all contents; registration is free).
The American Association of Clinical Chemistry (AACC) maintains an excellent website, and provides useful teaching resources, e.g. a long list of clinical case examples.
The School of Medicine of the University of Pennsylvania collectes a very interesting series of clinical case studies.
The website of the American Society of Clinical Pathology (ASCP), hosted by Oxford Academic Press, has a series of interesting clincal case articles.
The American Medical Association (AMA), besides publishing several important nedical journals, notably JAMA, has a website with plentiful of learning resources. To view the proposed clinical cases go to this link, then click on the icon in the upper left corner and select the "Clinical Challenge" menu.
Two very simple online programs that can guide you to the diagnosis of common diseases: symptomate, and diagnosaurus, which is part of the suite Access Medicine.
Programme and timetable of the course - 1st semester
Programme and timetable of the course - 2nd semester
Suggested Text
M. Laposata "Laboratory Medicine", Lange - McGraw Hill (also available via the Access Medicine platform).
Further readings
E.A. Murphy "The Logic of Medicine", The Johns Hopkins University Press
P.J. Rees, J. Pattison, and C. Kosky "100 cases for clinical medicine" CRC Press
Students can visit me at the Dipartimento di Scienze Biochimiche, Sapienza University of Rome, every Thursday afternoon, 14,00 to 16,30, except during the examination sessions.
Go to: Non Scientific Medical Theories; Digital Library of the Italian Society of Biochemistry; Teaching subjects.