Musculoskeletal/Integument

Total Contact Hours:

36 hours

Course Director:

Larry J. Ream, Ph.D., Associate Professor of Neuroscience, Cell Biology and Physiology
Julian Trevino, M.D., Associate Professor of Dermatology

Course Description:

This course presents the common diseases and illnesses affecting the skin and musculoskeletal systems, including infectious, neoplastic, environmental, and immunologic. Through laboratory exercises, case discussions, and team-based learning modules, diagnostic and therapeutic approaches are discussed.

Course Objectives & Integration with the Educational Objectives:

By the conclusion of this course, the student will demonstrate the ability to:

K1 The normal structure and function of skeletal muscle, including the ability to:

• Describe the basic structure of the a motor neuron and the neuromuscular junction
• Describe how the neuromuscular junction conducts an action potential from the nerve terminal to the muscle fiber
• Explain the role of the T tubular system and the SR in muscle EC coupling and know the structure of the triadic junction
• Explain the sliding filament hypothesis and how a skeletal muscle generates tension
• Understand excitation-contraction coupling and muscle relaxation
• Differentiate isometric from isotonic contraction and twitch versus a tetanus
• Explain the length-tension curve and the force-velocity curve
• Describe the three types of skeletal muscle fibers and their characteristics

K2 Disorders of skeletal muscle, including the ability to:

• Explain the pathogenesis, inheritance pattern, and clinical features of Duchenne, Becker, and limb girdle muscular dystrophies
• Explain the genetic mechanisms underlying myotonic dystrophy
• Explain how mutations in mitochondrial DNA are related to morphologic changes in skeletal muscle fibers
• Describe the pathogenesis of ion channel myopathies
• Define nemaline myopathy by its microscopic features and clinical signs
• Explain myopathic glycogen storage disease, including the dysfunction in the glycolytic pathway and enzyme deficiencies which give rise to myopathic glycogenoses
• Describe the pathogenetic immune mechanisms that alter normal neuromuscular junction physiology in myasthenia gravis and Lambert-Eaton syndrome
• Compare and contrast the pathology of polymyositis with dermatomyositis, including classifications, demographics, and clinical features
• Describe the pathogenic events and anatomic pathways leading to trichinellosis in skeletal muscle
• Describe the variants of rhabdomyosarcoma
• Discuss various drug myopathies, including those due to corticosteroids, alcohol, and lipid-lowering drugs
• Discuss mimickers of inflammatory myopathies, including polymyalgia rheumatica and fibromyalgia syndrome

K3 Peripheral nerve injury, including the ability to:

• Describe the pathophysiology of peripheral nerve injury and recovery, and the relationship of the pathophysiology to clinical signs and symptoms
• Explain the role of electromyography and nerve conduction studies
• Interpret physical findings and present the localizing signs for clinical syndromes including radiculopathy, brachial plexopathy, carpal tunnel syndrome, ulnar neuropathy, radial neuropathy, and peroneal neuropathy

K4 The skeletal system, including the ability to:

• Describe and recognize the morphologic arrangement of cells and fibers in tendons and ligaments
• Compare the histology of the three types of cartilage, and discuss the role of hyaline cartilage in bone growth
• Compare the mobility of the three types of joints
• Explain the movements that can occur at various types of synovial joints, and give examples of each type of synovial joint
• Discuss the chemical composition of bone and the relative advantages conferred by the organic and inorganic components
• Describe the process of long bone growth that occurs at the epiphyseal plates
• Compare the locations and remodeling functions of the osteoblasts, osteocytes, and osteoclasts
• Explain how hormones and physical stress regulate bone remodeling

K5 Bone fractures and fracture healing, including the ability to:

• Explain the importance of adequate blood supply and adequate mechanical stability as prerequisites for bone fracture healing
• List and describe the stages of fracture healing, including soft callus, hard callus, and remodeling of the callus
• Explain the mechanisms for direct (primary) and indirect (secondary) bone healing
• Discuss the local regulation of bone healing, including growth factors, cytokines, prostaglandins, leukotrienes, and hormones
• Describe local anatomic features and systemic factors that influence fracture healing

K6 Disorders of the skeletal system, including the ability to:

• Describe genetic abnormalities in bone, including synpolydactyly, achondroplasia, osteogenesis imperfecta, mucopolysaccharidoses, and osteopetrosis
• Describe the pathogenesis and clinical symptoms of osteoporosis and Paget disease
• Describe the pathogenesis and clinical features of osteonecrosis and osteomyelitis
• Describe the pathogenesis and clinical features of osteochondroma, osteoid osteoma, chondrosarcoma, osteosarcoma, chordoma, and Ewing sarcoma
• Compare and contrast the pathogenesis and clinical features of osteoarthritis and rheumatoid arthritis
• Describe the pathogenesis and clinical features of adipose tumors, fibrous lesions and muscle tumors
• Describe and compare the pathophysiologic basis, clinical presentation, treatment and diagnostic criteria for soft tissue rheumatism, including tenosynovitis, epicondylitis, bursitis, tendinitis, and capsulitis
• Describe and compare the pathophysiologic basis, clinical presentation, treatment and diagnostic criteria for common joint disorders, including:
• Infectious disorders (e.g., septic arthritis)
• Degenerative disorders (e.g., osteoarthritis)
• Immunologic disorders (e.g., rheumatoid arthritis, ankylosing spondylitis, polymyositis, systemic lupus erythematosus, dermatomyositis)
• Neoplastic disorders (e.g., osteochondromas)
• Metabolic disorders (e.g., gout, pseudogout)
• Vascular disorders (e.g., polyarteritis nodosa)

K7 Common dermatologic conditions, including the ability to describe and compare the pathophysiologic basis, clinical presentation, treatment and diagnostic criteria for:

• Acne
• Psoriasis
• Atopic dermatitis
• Bacterial infections (e.g., impetigo, ecthyma, carbuncle, cellulitis)
• Viral infections (e.g., HPV infections, molluscum, HSV infections, herpes zoster infections)
• Dermatophytosis (e.g., tinea)
• Parasitic infections (e.g., scabies)

K8 The mechanisms of action, use, and adverse effects of drugs used for the treatment of disorders of the skin, including:

• Antibacterials
• Antifungals
• Antivirals
• Corticosteroids
• Keratolytics
• Immune response modifiers
• Antipruritic agents
• Hair growth agents
• Non-opioid analgesics (e.g., acetaminophen, NSAIDs, COX-2 inhibitors)

K9 Description and comparison of the pathophysiologic basis, clinical presentation, treatment, and diagnostic criteria for tumors of the skin, including:

• Tumors of the epidermal keratinocytes and skin appendages (e.g., seborrheic keratosis, actinic keratosis, squamous cell carcinoma, basal cell carcinoma, syringoma)
• Tumors of the dermis (e.g., histiocytoma, xanthoma)
• Vascular tumors (e.g., hemangiomas, Kaposi sarcoma)
• Tumors and disorders of melanocytes (e.g., vitiligo, nevi, melanoma)
• Tumors of cellular immigrants to the skin (e.g., Langerhans cell histiocytosis, T-cell lymphoma)

C1 Interpersonal communication, including the ability to:

• Work effectively in teams in the Team-Based Learning module on skin cancer
• Work effectively in the Case-Based Clinical Learning modules on low back pain and carpal tunnel syndrome
• Work effectively in the Differential Diagnosis modules on low back pain, multiple joint aches, arthritis, and shoulder pain

P1 Professionalism, including the ability to:

• Be punctual and attend required events

• Complete assignments in a timely fashion
• Be truthful
• Demonstrate scholarship in the form of contributing to a positive learning environment, collaborating with colleagues, and performing self-assessment and self-directed learning
• Be courteous to patients, staff, colleagues, faculty, and other health professionals involved in the administration of this course
• Maintain confidentiality regarding patient care
• Demonstrate respect, empathy, responsiveness, and concern regardless of the patient’s clinical problems, personal characteristics, or cultural background

Learning Activities:

Presentations, Team-Based Learning, small group discussion on cases.

Syllabi

• Course materials
• Schedule

Assessment:

One MCQ exam, Team-Based Learning.