3rd YEAR 1st

SEMESTER

Lectures start on Monday 5th October

Ortopediche), 1 p.m

2015 Classroom B (Ex Officine

Schedule
III Year, I Semester CLASSROOM: B, Ex Officine Ortopediche Citt Universitaria
Sapienza Universit di Roma

Time Monday
9-10
1011
1112
1213
1314
1415
1516
1617
1718

Lab Med
1
Lab Med
1

Tuesday
Pathology
1
Pathology
1
Immunolo
gy
Immunolo
gy

Wednesday

Clinical
Methods
Clinical
Methods
Clinical
methods

Thursday
Immunolo
gy
Immunolo
gy
Immunolo
gy
Pathology
1
Pathology
1

Physiology
3
Physiology Methods3
groups
Methodsgroups
Methodsgroups

Friday

Lab Med
1
Lab Med
1

Coordinators

Course
coordinators
I Semester

Coordinators of
semester
G. Palmieri

Human Physiology (III)(1038229)

S. Ferraina

Immunology and Immunopathology(1038231)

A. Santoni

Laboratory Medicine (I)(1038232)

A. Angeloni

Clinical Scientific Methods (V)(1038230)

Pathology and Pathophysiology (I)(1038247)

M. Arca
M.P. Felli

Textbooks
Physiology III Textbooks:
JH Hall: Guyton and Hall Medical Physiology. Saunders Elsevier. ISBN: 978-1-4160-44574-8
BM Koeppen, BA Stanton: Berne & Levy Physiology. Mosby Elsevier 2010. ISBN: 978-0-323-07362-2
DU Silverthorn: Human Physiology. 6th edition. Benjamin Cummings. ISBN: 978-0321750006
Immunology Textbooks:
Cellular and Molecular Immunology, 7th Edition (2011, Elsevier)
Abul K. Abbas, Andrew H. Lichtman, & Shiv Pillai
Kuby Immunology, Seventh Edition (2012, W.H. Freeman and Company)
J. Owen, J. Punt, S. Stransford
IMMUNOLOGY, 8th Edition (2012, Elsevier)
David Male, Jonathan Brostoff, David Roth, Ivan Roitt
Janeways Immunobiology, 8th Edition (2011, Garland Science, Taylor Francis Group)
Kenneth M. Murphy
Clinical Scientific Methods Textbooks:
Bates' Guide to Physical Examination and History-Taking - Lippincott Williams & Wilkins - Lynn
Bickley MD (Author), or
Goldmans Cecil medicine 24th edition
Pathology Textbooks:
1. Pathologic Basis of Disease. Robbins & Cotran. Eight Edition. Editor: W B Saunders Co, 2009
2. Understanding pathophysiology. S. Huether, K. McCance. Elsevier, 2012
3. Cells, Tissues and Disease. Principles of general pathology. G. Majno, I. Joris. Oxford University Press,
2004.

4. Rubins Pathology. Clinicopathologic foundation of medicine. Rubin & Straier.

Lippincott Raven; 6 Har/Psc, ed. , 2011.

Laboratory Medicine Textbook:

Michael Laposata: Laboratory Medicine: The Diagnosis of Disease in the Clinical Laboratory (LANGE
Basic Science)

Programs
Human Physiology (III)
Sensory receptors: neural circuits for processing information.
Somatic Sensations: I. General organization: senses of touch and position.
Somatic Sensations: II. Pain, headache and temperature.
The Eye: I. Vision optics. The Eye II. Function of the eye and retinal nerve. The eye III. Central
neurophysiology of vision.
The sense of hearing. The chemical senses: taste and smell.
Motor functions of the spinal cord: spinal reflexes. Control of motor function in the cortex and the
brainstem. The cerebellum, basal ganglia and overall control of the movement.
The cerebral cortex: intellectual functions of the brain, learning and memory. Mechanisms of
behavior and motivation of the brain: the limbic system and hypothalamus. Brain activity states:
sleep, brain waves, epilepsy, psychosis.
Exam: oral
Immunology
Main teaching objectives:
To understand the molecular and cellular basis of the immune response. To understand the
fundamental mechanisms responsible for protection and for tissue damage, and to comprehend their
specific role in the resistance against pathogens, the immune surveillance against tumors, and
immune-mediated diseases.
Formal teaching subjects:
General aspects of the immune system: cellular and molecular participants to innate and adaptive
immune responses.
Cytokines and their receptors.
Innate immunity: cellular and molecular components, cell differentiation, activation, and effector
functions.
The molecular basis of antigenicity, antigen receptors and the generation of diversity.
The Major Histocompatibility Complex and antigen presentation.
Maturation, activation and effector functions of B and T lymphocytes.
Biology of T cell subsets: helper (Th), cytotoxic (CTL), and regulatory (T reg).
Antibodies: molecular structure, effector functions, Fc receptors, the antigen/antibody reaction.
The complement cascade: activation pathways and regulation.
NK cells.
Hematopoiesis, lymphoid organs, leukocyte migration and trafficking.
Mucosal immunology.
Development and regulation of immune responses.

Immune responses against different classes of pathogens: viruses, bacteria, fungi and parasites, and
mechanisms of pathogen evasion.
Principles of vaccination.
Immune responses against tumors and principles of immunotherapy.
Type I hypersensitivity reactions (allergies).
Type II hypersensitivity reactions and elements of immunohematology.
Type III and type IV (delayed-type) hypersensitivity reactions.
Mechanisms of central and peripheral tolerance; autoimmune diseases.
Transplantation immunology.
Primary and acquired immunodeficiencies.
The most common immunological techniques.
Interactive teaching: guided discussion of clinical cases (with the participation of clinical
teachers), as a mean to illustrate the major subjects of immunopathology.
Exam: Oral

Pathology
Main teaching objectives:
Knowledge of the etiology and the pathogenetic mechanisms of human diseases, basic
pathophysiological mechanisms of major organs and systems.
Interpretation of basic pathophysiological and pathogenetic mechanisms of human disease.
Ability to analyze the fundamental pathophysiological mechanisms of human diseases and
interpret their results.
Knowledge of the pathogenetic basis of disease and pathophysiological processes as the essential
substrate for subsequent clinical approach to human diseases.
Pathology and Pathophysiology (I)
Etiology: Main concepts of health, pathologic process and disease; etiology, pathogenesis,
evolution, resolution (exitus). General environmental pathology. Pathology by physical and
chemical agents. Biological agents of disease: bacterial exotoxins and endotoxins. Non-hereditary
congenital disease. Teratogenesis.
Genetic disorders: Gene mutation and disease. Genetic inheritance patterns. The major
chromosomal and gene disorders. Genetics of multifactorial diseases. Kariotype analysis and
methods for genetic diseases. Models of human genetic disorders.
Molecular Pathology: Molecular pathology of proteins. Hemoglobinopathies. Pathology by
enzyme deficiencies. Molecular pathology of the plasma membrane: receptors, channels,
transduction mechanisms. Molecular pathology of the components of the connective tissue.
Molecular pathology of mitochondria.
Inflammation: The basics of inflammation, acute and chronic inflammation. Innate immunity
and inflammation. Inflammation as a transcriptional program. Inflammatory cells. Chemical
mediators of inflammation of cellular and plasma origins. Acute inflammation: the vascular
phenomena of inflammation, the mechanisms of formation of exudate, the various types of
exudative inflammation. Chronic inflammation: mechanisms of granuloma formation. Foreign-body
granulomas. The main immunological granulomas. Systemic manifestations of inflammation: acute
phase proteins, erythrocyte sedimentation rate, and leukocytosis. Pathophysiology of

thermoregulation and fever. Tissue repair and granulation tissue. Pathological aspects of wound
healing: keloids, scars.
Pathology of cell structures: the cell's response to injury: cellular stress, cellular adaptations
(hypertrophy, hyperplasia, atrophy, metaplasia), intracellular storage diseases (steatosis, lysosomal
diseases). Molecular mechanisms of cellular damage. Cell death: necrosis and apoptosis. Renewal,
regeneration and tissue repair. Growth factors. Aging.
Abnormalities of the extracellular matrix: Beta-fibrillosis. Localized and systemic fibrosis. The
diseases of collagen and other basement membrane components.

Laboratory Medicine
Main teaching objectives:
understand the application of the most relevant techniques in Biochemistry, Molecular Biology,
Microbiology, Parasitology, Clinical Pathology, Immunology and Immunohematology;
be able to decide which clinical laboratory analyses are appropriate for the patient under study.
be aware of the usefulness and limits of the clinical information provided by the clinical
laboratory analyses.
Formal Teaching (Topics)
The request of clinical analyses - Urgent and routine analyses - The concepts of prevention, early
medical diagnosis and follow up - Methods to obtain biological samples and their application.
Collection and validity of biological samples - Quality control in the clinical laboratory, between
laboratory and on a global scale - Sensitivity and specificity of clinical methods. Significance and
diagnostic relevance of the analysis results - Methods for clinical microbiology and parasitology.
Timeline and interpretation of the results - Clinical microbiology of infectious diseases of organs
and apparatuses - Blood parasites; intestinal parasites. - Biochemical characterization of
dysmetabolic conditions - Laboratory medicine for the evaluation of the cardiovascular, renal,
endocrine apparatuses; assays to monitor liver pathophysiology; Transfusion Medicine - Laboratory
Medicine of Immune Disorders. Histocompatibility Testing and Transplantation.
Interactive teaching (goals)
Selection of the analysis to be carried out, in relation to the patient's disease.
Evaluation of the quantitative and qualitative alterations of the most relevant analytes.
Apprenticeship (practical laboratory)
How to effect a standard laboratory analysis of the urine (physical, chemical and
microbiological).
How to prepare a blood smear; how to read a hemocytometric (non-pathological) test
Exam: oral
ADEs

3rd YEAR - 1st SEMESTER

Teacher- Type of Elective- Subject- Credits- Hours

HUMAN PHYSIOLOGY (III)
1st Year Skill

Integrated Course

Doing an informatic library

research
Analyzing tools for scientific
papers: How to use eportfolio tools
Using and interpreting of
common statistical tests
Constructing and reading a
pedigree

2
3
4

Signature and stamp of the

responsible Professor
Basic Medical Scientific
Methods (I)
Basic Medical Scientific
Methods (I)
Basic Medical Scientific
Methods (I)
Biology and Genetics

Ferraina- Seminar - Neurophysiology approaches to cognitive functions - 0,2 - 2

S. Ferraina - Elective placement Laboratory
IMMUNOLOGY AND IMMUNOPATHOLOGY
Seminar - Tumor immunotherapy - 0,2 - 2
Seminar - Immunotherapy of hemathological malignancies - 0,2 - 2
Seminar - Osteoimmunology and immune-mediated diseases of the bone - 0,2 - 2
Elective placement Laboratory
PATHOLOGY AND PATHOPHYSIOLOGY (I)
A. Campese - Seminar - Animal models of human disease - 0,2 - 2
L. Ravenna - Seminar - Oxygen sensing, homeostasis amd disease - 0,2 - 2

APPs WE HAVE TO DO TILL NOW

2nd Year Skill

Integrated Course

Identifying cells, tissues and

organs with an optic
microscope
Recording a 12-lead ECG and
BLS
Reading and critical analysis

6
7

Signature and stamp of the

responsible Professor
Human Anatomy
Clinical Scientific Methods
(IV)
Scientific English

S.

of scientific papers

3rd Year Skill

Integrated Course

Obtaining a medical history

Performing a physical
examination
Sampling arterial and venous
blood on a simulator
Doing intramuscular and
subcutaneous injection on a
simulator
Interpreting the results of
urinanalysis

10
11

12

13

Interpreting the results of

blood tests: Normal and
abnormal values

Signature and stamp of the

responsible Professor
Clinical Scientific Methods
(V-VI)
Clinical Scientific Methods
(VI)
Clinical Scientific Methods
(VI)
Clinical Scientific Methods
(VI)
Laboratory Medicine
Laboratory Medicine

EXAM QUESTIONS

IMMUNOLOGY
Palmieri
Hypersensitivity type I
Inflammatory bowel disease
Hygiene Hypothesis
Interleukines
Germinal center
Asthma
Type 3 hypers
(-usual removal of IC: by complement-> talk about complement classic activ.
-genetic or environm factors influencing type 3 onset: size IC ecc; genetic def C2,4, C1q Inh...)
*Ab produced in SLE: against nucleic acid and prot bound to nuc acids; RBC; PLT.
Easy to make against nucl ac: bcs of TLR (and other rec to nucl acid).
SLE may be due to genetic predisposition (complement defic; FcgRIIB; properdin)
phagocytosis (-innate imm syst rec + receptors for opsonins: CR and talk about them; Fc;
-which are the profess phagoc: neutro and macroph;
non professionals: are the DC
-Methods of killing O2 dep and indep

Imm resp to tumors

(-types of tumor Ag->
specific: tumor specific and oncoviral;
associated: overexpression, splice variant, differentiation...)
*spleen
Ab titer in blood (lag log plateau decline + type of Ab; in both Primary and secondary presentation
of Ag; somatic hypermutation and affinity maturation in secondary resp (more affinity bcs also
effector ones undergo again somatic hypervariab.)
Type 1 hyper
Innate and adaptive resp in viral infxn
(Answ: mucus both physical and chemical-> eg gut: proteases; paneth's defensins and IgA; DC
releases IFNg and epith IFNb. Downstream action of rec ifn type 1)
CD4 subsets and special Th17 and Th2: producing IL22 and IL9.
Treg: central and peripheral production
Autoimmune diseases:
genetic (infxn: mimicry and strepto; barrier destrx; superAg
and environm. causes (Only MHC problems wt IDDM and celiac)
Vaccines, vaccines everywhere!
- what kind of response they induce, characteristics of each vaccine
- about live attenuated which are the risk and why (both possible pathogenicity and transmission)
- about killed why they don't onduce CD8+
- then she asked about DNA vaccines, recombinant viral vectors, passive immunization
- preventive and therapeutical vaccines
-Transplantation
IgA and viruses (mechanisms of defense in mucosal decretions)
Phagocytosis receptors
Response to viral infection
Location of toll like receptors
TLRs types important for detection of viruses
Where does a virus go when infecting a cell?
Sensors for viral components into the cytoplasm/response sensors for nucleic acids
Interferon production by different cells and their function
Antibodies (?)
Immunodeficiency2/Why do you form bilirubin?
Mucosal immunity
Role of immunoglobulins
Type 4 Hypersensitivity (Delayed-type)
-Contact Dermitis, TB

MHC Class Molecules

Treg (Regulatory T cells)
Palmieri asked specific questions,
antibody response (she asked me to be general without details)- lag/log/plateau diagram
what changes do we see in the diagram in the case of t-dependent vs t-independent antigens (and
also how they differed in primary and secondary responses) and why?
why do we have only IgM in t-independent and not other isotypes?
i started talking about isotype switching and CD40/CD40L, so she was like "what if we have
mutations in this process?" so i talked about x-linked hyper IgM, and autosomal recessive mutations
(in AID or uracil N-glycosylase)
How would we see these mutations anatomically if we had a lymph node cross-section?
-> no germinal centres
IgE in normal responses ( protection against parasites) and pathological (allergies). Types of Fc
receptors. Mast cell degranulation and its products. I talked about allergic asthma and she asked me
about leukotrienes in disease and its protective role (induce intestinal hypermotility in combination
with other mediators in order to remove pathogens). Finally, she asked me for any drugs for allergic
asthma (bronchodilators/2 agonists and corticosteroids).
role of macrophages during apoptosis with names of specific enzymes and their activating pathway
in great detail.Also exactly what kind of bonds they cleaved in the microbes. then she asked me
about granulomatous disease
Leukocyte migration
Different homing-phenotypes in skin and gut
LADs (all three types w/ different mutated genes and pathologic consequences)
Tumor immunity (almost everything). What's the immune response to tumors: cells involved and
mechanism of action, cytokines, reasons for recognition (tumors derive from self cells, so what
makes them get recognized).
Immunoediting. Tumor evasion mechanisms and possible effects of the host immune system in
favouring tumor growth.

Mardente
function of Ab, especially IgA;
celiac disease: CD71 expressed apically!
DTH
type 2 hypers
DTH with reference to contact dermatitis and Mantoux vaccine.
Formation of granuloma and histologic/immunologic features of granulomas in TB patients.
Role, morphologic features and development of T regulatory cells.

hyper of type II
- differences between IgM and IgG action during hyper of type II
- CD4+ subsets
- T regulatory cells
- CTLA-4
Type 3 hypersensitivity
An example? i started to talk about lupus, then she interrupted me and told me to talk about lung
farmer's disease instead, whatever that was
Type 1 hypersensitivity,
CD4 subsets of cells
CD4 subsets and role and hypersensitivity type 3
Type II Hypersensitivity w/ examples
ABO blood group antigens
Transfusion reactions
What causes hemolysis in transfusion reaction and in allergic reaction to penicillin
Role of Abs in hyperacute graft rejection
Primary and secondary Ab responses
Type 3 Hypersensitivity everything and examples (farmer's lung disease, artus reaction and serum
sickness).
Th1 responses, polarization from naive and activation of macrophages (cytokines involved), Type 2
Hypersensitivity (I explained it giving some examples of diseases)..

PATHOLOGY I
Desmaele
He asked me regulation of body temperature, hypothermia and hypertermia, degree of burns.
Then about fever; following, the chronic inflammation; lastly, the cellular adaptations to stresses
(hypertrophy, hyperplasia...) inflammation, tissue repair and radiations.

Felli
Alcohol and its effect on the brain
Chronic inflammation
Inflammation
Leukocyte migration
Amyloidosis (Alzheimer disease) she wanted to know the type of scan you do to diagnose it
Hyperocholesterolemia

asked me the difference between hypoxia and ischemia, causes of ischemia (starting from within the
blood vessel like a thrombus or embolus, thickening of blood vessel's wall, something outside the
blood vessel like a tumoral mass compressing it), effects of alcohol and Alzheimer disease.
inflammation and interrupted me with very specific questions especially about the arachidonic acid
pathways, with leukotrienes and prostaglandinds, about their synthesis and role, also about cox 1 vs
cox 2 and the role of aspiring and inhibition of platelet aggregation. role of other inhibitors of the
pathway. the asked me about hepatitis in the liver, acoholic and non alcoholic liver disease and how
you can diagnose the two clinically. Then bout cystic fibrosis. She wanted to know things in great
detail and liked to ask very spicy questions.
Boh
He asked me a broad question about inflammation, and I start to talk about differences between
chronic and acute inflammation. Then he asked me about the initial step in the acute inflammation
(vascular reaction, with associated cytokines and factors that cause it, and they leukocyte
migration). Then he ask me about radiation, different type of radiation (ioninzing and non), and how
intense should be a radiation to be comsidered ionizing (10 eV) and then radiation induce injury,
amd ultimately I talk about apoptosis.

PHYSIOLOGY III
Sleep arousal system
Mirror neurons
Dorsal stream
Short-term memory and prefrontal cortex
Muscle tone
Cerebellum: learning and complex spike
Parietal cortex
Mirror neurons
Motor cortex- topographic organiz.
Reflexes
Basal ganglia DA-R
Color perception, premotor cortex, sleep and arousal system, frontal eye field
he asked me first about eye movements and reflexes with great detail and then to describe him the
mechanism though which we perceive motion (every neuron in the pathway and specific questions
about the different cortical areas involved). then asked me about the premotor ares.
colour perception, types of cells
-receptive fields on/off off/on centres
-colour perception at cortical layers

premotor cortex
-mirror neutrons
-proprioception
-divergence/convergence process (visual fields)
Primary motor cortex
-inputs to the cerebellum:different types of fivers in the layers
-primary visual cortex
-posture (muscle tone control and basal ganglia)
perception of depth (binocular cells)
-retinal disparity
-different mechanism of perception of depth
-prefrontal cortex
sleep controls: description of cycles/stages, neurological control centres and mechanism.
-receptive fields: description and ON/OFF system
eye movements
memory
pain and it's modulation at different levels
Premotor area and mirror neurons
LAB MED I (esonero)
There might be up to 5 different Professors testing you... (and you are tested by each one)

Angeloni:
> Prenatal and perinatal screening. The 4 mandatory screening exams performed to newborns (in
Italy): Phenylketonuria/Alkaptonuria, Cystic fibrosis, Hypothiroidism (TSH) and Galactosemia.
Bellelli
> Anemias and specifically Iron Deficiency Anemia and beta Thalassemia: their differential
diagnosis.
Modiano
> Toxoplasma Gondi: impotance of its diagnosis during pregnancy. Diagnosis of entamoeba
Histolytica and Dispar.
Valenti
> Iron metabolism: roles of ferritin, transferritin, ferroportin and lactoferrin in healthy patients and
during inflammatory conditions.
Valenti: hemoculture

Modiano: toxoplasma, entamoeba dispar and histolytica, malaria ( all the diagnosis morphology and
for toxoplasma why is it important in pregnancy)
BelElli: electrophorogram
Mainiero: hla genes, transplant, typing, ABO