Pre-Clinical Courses Synopsis

 

The Integrated Foundations Course provides background information in the context of clinical cases, using the Clinical Presentation model (see course objectives). Thus, the course uses common diseases or clinical conditions which affect those organ systems fundamental to the overall study of veterinary medicine.

The cases studied include:

Respiratory System

The clinical cases chosen provide a comprehensive knowledge base of the pre-clinical science material required to understand the Respiratory system and the diseases of this organ system.

Students, transported to a large feedlot, observe the veterinarian in charge conduct a clinical examination and collection of samples (blood and nasal discharge). They also tour the facility to observe

  • animal density,
  • pen sizes,
  • handling facilities,
  • feeding practices and
  • other relevant information.
The presence of nasal secretions and elevated temperature indicate the respiratory tract is the target of an infection so, after the field trip, the students hear a presentation of the gross and microscopic pathology of the upper and lower respiratory tract in a case similar to this one. They also evaluate clinical pathology data. Having concluded the respiratory tract is the system involved, a discussion of the underlying concepts in the various scientific disciplines begins. This diagram summarizes the sequence of those subjects.

After learning the necessary background to understand the basis of the conditions provided by anatomy, biochemistry, physiology, microbiology and pathology, the students reach a diagnosis for the primary and the secondary cases. These would be

  • shipping fever for the calf,
  • aspergillosis for the chicken and
  • pneumonia for the pig.

After covering all the sections, a detailed discussion of the primary and secondary cases occurs. Students learn how very important the pre-clinical material is as a basis for understanding the cases.

Cardiovascular System

The second set of selected clinical presentations provides an understanding of Cardiovascular system.

The clinician in charge presents a very lethargic dog. After taking an appropriate history, the clinical examination begins by listening to heart sounds using a stethoscope. The students use diagnostic imaging techniques (radiographs, electrocardiograms and other advanced imaging techniques) to evaluate any abnormalities, leading them to the cardiovascular system. This diagram indicates the sequence of the presented topics.

Congestive heart failure best explains the dog's lethargy and could have several etiologies including mitral valve insufficiency.

From this section of their studies, students have the background necessary to understand the most important principles related to the cardiovascular system including the pressure relationships (vessel permeability and rupture and the clotting process). In addition, the cases provide an opportunity to introduce them to veterinary ethics as well as a number of professional and clinical skills.

Musculoskeletal System

The selected clinical cases provide an understanding of the Musculoskeletal system.

The clinician presents two horses with similar symptoms of lameness. The students give the animals a thorough physical examination and take blood samples for total and differential leukocyte counts as well as mineral and electrolyte analysis. If one of the patients has swelling, they collect a synovial fluid sample for bacteriology and virology. They also take radiographs. The clinician discusses some possible causes of these conditions. This diagram summarizes the sequence of the presented topics.

These two lameness conditions have different etiologies.

  • The first case is any kind of lameness in a horse.
  • The second horse has a calcium deficiency or very abnormal Ca:P ratios in the diet which results in hypocalcaemia, excessive bone demineralization leading to lameness and possibly bone fractures--a classical nutritional secondary hyperparathyroidism.

Students study the muscles, bones, nerves and blood vessels of the horse's limbs as well as the comparative anatomy of other species (the dog). They devote special attention to the embryology and gross anatomy of the hoof. Since lameness can result from spinal injuries, they also study the structure of the spinal column, the spinal cord and spinal nerves.

A detailed discussion of the cases emphasizes the application of the pre-clinical material in understanding the clinical conditions.

Integument

The clinical cases chosen provide a comprehensive knowledge base of the Integument.

The clinician presents a horse with an open skin wound. Students record a complete history and the clinician offers some scenarios as to how to treat the case. Since the diagnosis is obvious, the principle objectives are

  • to understand the structure and function of the integument,
  • to understand the healing process in animals with physical or other skin lesions and
  • to explore treatment options.
This diagram indicates the sequence of the presented topics.

In the case of the horse with the skin lesion creating an open wound, treatment options vary and include

  • closing the wound,
  • irrigation,
  • drainage,
  • drug therapy and
  • deciding on a long term treatment regime.
This section provides important background on the skin and related integuments. In addition, it provides for hands-on use of analgesics and anaesthetics and introduces students to some surgical principles and procedures.

Nervous System

The selected clinical cases provide a comprehensive knowledge base for the Nervous system.

Since the cow's symptoms are somewhat unusual, the clinician may present the case as a video supplemented with slides. The students note the abnormal movement and contrast it with abnormal gaits observed in typical lameness cases. The secondary case is a dog showing signs of partial paralysis perhaps accompanied by fits of twitching. This animal is listless and has poor appetite. The students take complete histories for each animal and if there are live animals do clinical examinations and collect appropriate blood samples for clinical chemistry. In the case of the dog, they collect nasal, oral or orbital smears for microbiology. This diagram indicates the sequence of the presented topics.

Symptoms in both animals lead students to the central nervous system and therefore, a study of the anatomy of the brain, spinal cord and related tissues including the vasculature of those structures. The students learn that defects in the cranial nerves and lesions at neuromuscular junctions could also lead to these symptoms.

Based on the evidence, diagnoses are bovine spongiform encephalopathy (BSE) in the cow and distemper in the dog.

This section puts a primary focus on the anatomy of the central nervous system and includes information on agents that can cause changes in the CNS. It also provides an excellent opportunity to introduce Regulatory Health issues.

Hematopoietic System

The selected clinical case provides coverage of the Hematopoietic system.

Students see a cat which the client says has had various recent illnesses. They examine the animal and find several healed skin wounds. The patient, with enlarged lymph nodes, shows signs of chronic oral infection. The students perform a complete physical examination and collect blood samples for clinical pathology. This diagram indicates the sequence of the presented topics.

The diagnosis for this case is either Feline Immunodeficiency virus or Feline Leukemia virus. Both these retroviral infections have similar characteristics and there are no pharmacological agents to eliminate the virus.

Emphasis is on the chronic nature of the conditions which clients manage by

  • avoiding possible infections,
  • providing a clean environment
  • providing excellent nutrition and overall care.
The students also discuss the possibility of vaccination in disease prevention.

Gastrointestinal System

The selected clinical cases provide a comprehensive understanding of the Gastrointestinal system.

Students visit a dairy farm or veterinary clinic and observe a young calf with a severe case of watery diarrhea. Their examination reveals the animal is

  • very lethargic,
  • has difficulty standing,
  • appears to be dehydrated and
  • has an elevated temperature.
They take a complete history and collect samples of blood and feces. On returning to the classroom, the clinician leads the class through a discussion of the symptoms and considers what symptomatic treatment to initiate. This diagram indicates the sequence of the presented topics.

This is a straightforward case of neonatal calf scours and leads to a discussion of various preventive and treatment options.

This is a broadly-based section dealing with the anatomy and physiology of the gastrointestinal tract in a range of mammalian species. The students learn

  • the biochemistry of rumen fermentation
  • the important role of rumen and caecal fermentation products
  • about the microbiology and pathobiology of rumen and intestinal organisms
Treatment options for both situations emphasize fluid and acid-base therapy.

Renal System

The selected case illustrates the pre-clinical science which underpins the Renal system so students appreciate the differences between acute and chronic renal disease and understand the principles of treating diseases of the kidney.

The clinician in charge presents students with a 9 year old cat which

  • is lethargic,
  • has lost weight recently,
  • produces excessive amounts of urine and
  • drinks much more that usual.
The students ask the client about the animal's diet. They conduct a thorough clinical examination, collect a blood sample (analyzed for glucose, electrolytes, creatinine and urea) and a urine sample for urinalysis. This diagram indicates the sequence of the presented topics.

Based on the patient's history, the clinical chemistry, and the discussion of all aspects of kidney anatomy and function, the students make a diagnosis of chronic renal failure. They also discuss congenital kidney diseases such as polycystic kidney disease and renal aplasia.

This renal case provides the platform for an understanding of the anatomy and function of the kidney. We emphasize perfusion, filtration and reabsorption as well as the role of the kidney in acid-base regulation. The students also discuss various kidney diseases and their treatment.

Endocrinology

The selected clinical cases provide coverage of the Endocrine pancreas and the pituitary.

A client brings a dog to the clinic and states the animal wakes them at night because it needs to urinate and it also drinks more than normal. On examination, the dog seems relatively normal but the client recalls it has a larger than normal appetite. Students collect blood and urine samples for metabolite and electrolyte analysis. This diagram indicates the sequence of the presented topics.

Due to the hyperglycemia and glycosuria coupled with increased urine production and some degree of academia, the students disagnose the condition as diabetes mellitus (lack of insulin secretion). This leads to the clinical condition called polyuria/poldypsia. They eliminate the possibility of diabetes insipidus because of the presence of glucose in the urine.

These selected cases give students an understanding of the way in which pancreatic insulin deficiency results in a series of important metabolic changes

  • increased glucose synthesis in the liver,
  • fat mobilization (resulting in liver pathology and causing an osmotic diuresis triggered by the hyperglycemia)
The Cushing's disease case provides an understanding of the hypothalamic/pituitary axis and the role of the adrenal cortex in secretion of both gluco- and mineralo-corticoids. The physiological and pharmacological functions of the adrenal steroids complete the section.

Reproduction

The selected cases provide a broadly-based understanding of Reproductive processes in several species.

Students examine this herd-based problem (infertility) when a local cattle producer notices that even after the bull has run with his cow herd for 3 months, he still sees quite a few cows showing estrus. The class visits the farm and finds the cows in poor body condition and the pasture over-grazed. Rectal examination of several cows reveals 6 of 10 have a fetus (about 50 days old) while the rest are not in calf (ovaries may not have a functional corpus luteum). The ratio of bulls to cows is about 1 to 25 and the bulls appear in good health. Students collect reproductive tract lavages from several non-pregnant animals to determine if they have pathogenic organisms known to cause abortions. This diagram indicates the sequence of the presented topics.

With a sound footing in the pre-clinical sciences, the students discuss the possible causes of this condition and suggest additional testing (could include fertility tests on the bulls). The nutritional condition of the animals implies they are in a prolonged postpartum anestrus. In this case, better nutrition is the treatment.

These cases provide a comprehensive view of all aspects of reproduction in a variety of species. Since reproduction is such an important aspect of veterinary medicine, several cases in the Comparative Systems courses supplements this background information.

Evaluation:

Examinations, at the conclusion of the Integrative Foundation course, test students on basic science material and on its relationship to the clinical manifestation of disease. As with all other examinations in this program, grading is pass/fail.

 


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