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This is a mandatory course of study, which is one of the basic theoretical subjects of the profiling foundation. By completing it, the student will acquire knowledge and skills in the field of pathophysiology, which are a prerequisite for further successful study in higher years. Within the course, the student will, for example, have the following knowledge, skills and competencies:
- is able to explain the functions and regulatory mechanisms of the human organism, organs and their parts in health, with a view to understanding the basics of dysfunctions in disease. Familiarity with the basic features of pathological processes and their possible emergence from a physiological basis.
- describe the structures of the human body and, above all, the mechanisms that participate in the control of its functions, from the molecular to the organ level. Apply knowledge of basic scientific medical disciplines in their clinical judgment and in the indication of appropriate interventions and examinations. Last update: MAXOH6A2 (24.09.2025)
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Explanation of the function of the human organism in pathological conditions. Mastering the basics of clinical thinking so that the student is prepared to master effective diagnostic and therapeutic procedures in clinical subjects. Last update: MAXOH6A2 (24.09.2025)
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The course concludes with an oral comprehensive exam. Receiving credit for both the winter and summer semesters is a prerequisite for admission to the exam. Students cannot take the exam unless credits for both semesters are recorded in SIS. It is the student’s responsibility to ensure that credits are recorded in SIS in a timely manner. The requirements for receiving credit include continuous and active participation throughout the semester and the successful completion of four basic academic requirements: 1. Attendance at seminars 2. Group presentations 3. Written tests 4. Colloquia
Ongoing Monitoring and Recording of Academic Performance: Students can continuously monitor all attendance records, scores from written tests, evaluations of group presentations and worksheets, as well as colloquium results directly within the Moodle platform.
Exam Schedule: A complete overview of all exam dates for the given academic year will be published in SIS at the beginning of the summer semester. Early Exam Dates: These take place before the start of the regular exam period (usually beginning in the 13th week of the summer semester) and offer students who meet the following criteria the opportunity to complete the course early: • Absences and Attendance: Attendance at seminars preceding the exam date is required such that the total number of absences for the entire semester does not exceed the allowed limit of 2 absences (seminars missed after taking the early exam are also counted toward this limit). Therefore, if a student takes the early exam in the 13th week before the seminar for their group has taken place, they forfeit the remaining 2 seminars and must therefore have had no absences during the previous part of the semester. If they take it after the seminar in the 13th week or before the seminar in the 14th week, they may have had at most one previous absence. If a student takes the early exam in the 14th week after their seminar has taken place, they may have used up their standard allowance of two absences for the semester. Classes canceled due to national holidays or days off declared by the rector or dean do not count toward absences. • Schedule Conflicts: Students must ensure that the selected early exam date does not conflict with required classes for other courses. Taking an early exam is not a valid reason for excusing an absence from another course. • Group presentations: Students must ensure that all assigned worksheets for the given semester are properly completed and presented as part of their group. • Formative assessments: Students must successfully complete all colloquia and all formative written tests, scoring above the specified minimum threshold. • Deadline: All requirements must be met, and the course credit must be recorded in SIS no later than the day before the actual exam date.
Regular exam period: June: The vast majority of exam dates are scheduled. July and August: Several exam dates are scheduled. September: One exam date is scheduled each week until the end of the exam period. 3. Exam Dates (Second Retake Attempts): Exams are conducted before an exam committee that includes an external member (usually a representative from the Institute of Physiology at the Second Faculty of Medicine, Charles University).
Exam Structure and Procedure: Before the exam begins, the student draws one practical task and a set of three theoretical questions. This is followed by sufficient time for independent preparation (a “sweat session”), during which the student is not permitted to use any personal study materials, aids, or electronic devices. After preparation, the oral exam itself takes place, consisting of two consecutive parts:
Practical Part: The exam begins with the independent completion of a practical task, with an emphasis on clinical and pathophysiological interpretation (e.g., interpretation of an ECG trace, spirometry record, assessment of internal environment and acid-base balance, or comprehensive laboratory findings). Significant gaps in knowledge in this section may result in the immediate termination of the entire exam with a grade of “fail.”
Theoretical Section: After successfully completing the practical task, the student engages in an oral discussion based on a randomly selected set of three theoretical questions, which evenly cover both general and specialized pathophysiology.
Grading: The overall result of the rigorous examination is determined by the examiner based on a comprehensive evaluation of both the practical and theoretical sections (taking into account the student’s ongoing performance and work throughout the academic year) according to a four-point grading scale: excellent (1) very good (2) good (3) failed (4). In the event of a “failed” grade, the student must always retake the entire exam in its entirety during the make-up period, including a new drawing of the practical task and the theoretical triplet (individual parts of the exam are neither carried over nor recognized). A complete overview of the theoretical exam questions and topics for the practical portion, effective as of the 2026/2027 academic year, is provided below.
RIGOROUS QUESTIONS IN PATHOLOGICAL PHYSIOLOGY AND TOPICS FOR THE PRACTICAL EXAM IN PATHOLOGICAL PHYSIOLOGY—revised, effective as of the 2026/2027 academic year 111 questions = 37 triplets
GENERAL PATHOPHYSIOLOGY 1. Health, Disease, Death 2. Disorders of Body Temperature Regulation 3. Types of Hypoxia, Consequences 4. Ischemia, Ischemic-Reperfusion Injury 5. Oxidative Stress, Cellular Trauma 6. Inflammation—SIRS, Sepsis 7. Intoxication 8. Critical developmental periods
PATHOPHYSIOLOGY OF THE INTERNAL ENVIRONMENT 9. Dehydration 10. Hyperhydration 11. Disorders of potassium and chloride metabolism, relationship to acid-base balance 12. Disorders of calcium and phosphate metabolism 13. Acidosis 14. Alkalosis 15. Assessment of acid-base balance PATHOPHYSIOLOGY OF BLOOD 16. Anemic syndrome 17. Anemia due to increased blood loss 18. Anemia due to reduced hematopoiesis 19. Hyperviscosity syndrome 20. Blood coagulation and its disorders 21. DIC 22. Hematological Tests
PATHOPHYSIOLOGY OF THE CARDIOVASCULAR SYSTEM 23. Atherosclerosis and Other Arterial Diseases 24. Capillary Disorders, Edema—Types and Causes 25. Venous Disorders, Venous Thrombosis 26. Primary Hypertension 27. Secondary Hypertension 28. Hypovolemic Shock, Compensatory Mechanisms 29. Distributive Shock 30. Acute Heart Failure 31. Chronic heart failure 32. Myocardial ischemia, clinical forms of ischemic heart disease 33. Acute coronary syndrome 34. Hemodynamics of congenital heart defects 35. Hemodynamics of valvular heart disease 36. Cardiac conduction disorders and arrhythmias, including ECG changes 37. Examination of the cardiovascular system 38. Description of changes in the ECG recording during pathological conditions
PATHOPHYSIOLOGY OF THE KIDNEYS AND URINARY TRACT 39. Disorders of renal perfusion 40. Disorders of glomerular filtration 41. Nephrotic and nephritic syndromes 42. Tubular dysfunction 43. Acute kidney failure 44. Chronic kidney failure 45. Disorders of the urinary tract (urolithiasis, obstruction) 46. Renal replacement therapy (dialysis and kidney transplantation) 47. Renal Function Tests
PATHOPHYSIOLOGY OF THE RESPIRATORY SYSTEM 48. Changes in Lung and Respiratory System Compliance 49. Changes in Airway Resistance 50. Pneumothorax 51. Protective respiratory reflexes 52. Regulation of respiration in disorders of the respiratory system 53. Disorders of alveolar ventilation, respiratory failure 54. Disorders of the ventilation-perfusion ratio 55. Diffusion disorders, pulmonary edema 56. Pulmonary hypertension and cor pulmonale 57. Pulmonary Embolism 58. Bronchial Asthma 59. COPD 60. Restrictive Lung Diseases 61. Hypobaric and Hyperbaric Conditions 62. Mechanical Ventilation, Oxygen Therapy 63. Pulmonary function testing
PATHOPHYSIOLOGY OF THE ENDOCRINE SYSTEM 64. Disorders of hormonal regulation 65. Disorders of the hypothalamus and adenohypophysis 66. Hyperthyroidism 67. Hypothyroidism 68. Cushing’s syndrome 69. Addison’s disease, mineralocorticoid disorders 70. Adrenal medulla—role in the stress response, functional disorders 71. Parathyroid gland disorders 72. Sex hormone disorders in ontogenesis, DSD 73. Examination of the Endocrine Glands
PATHOPHYSIOLOGY OF NUTRITION AND METABOLISM 74. Metabolic and Endocrine Responses to Stress and Starvation 75. Malnutrition—primary and secondary, causes, pathogenesis, consequences 76. Eating Disorders 77. Obesity 78. Metabolic syndrome, gout 79. Consequences of vitamin deficiency and hypervitaminosis 80. Diabetes mellitus, classification, and acute complications 81. Chronic complications of diabetes mellitus
PATHOPHYSIOLOGY OF THE GASTROINTESTINAL TRACT 82. Disorders of the esophagus and stomach 83. Vomiting, Diarrhea 84. Maldigestion and Malabsorption 85. Transit Disorders (Constipation, Ileus) 86. Pancreatic Disorders (Acute and Chronic Pancreatitis) 87. Disorders of the Gallbladder and Biliary Tract (Biliary Colic) 88. Acute Liver Failure and Its Complications 89. Chronic Liver Failure and Its Complications 90. Jaundice 91. Liver and Pancreatic Function Tests
PATHOPHYSIOLOGY OF THE NERVOUS SYSTEM 92. Cerebrovascular Disease 93. Intracranial Hypertension and Hypotension Syndromes 94. Cerebral Edema, the Blood-Brain Barrier, and Its Disorders 95. Epilepsy and Epileptic Seizures 96. Sleep and Consciousness Disorders 97. Neurocognitive Disorders 98. Schizophrenia and Affective Disorders 99. Motor Disorders (Extrapyramidal Disorders, Dystonia, Tic Disorders) 100. Central Paralysis 101. Peripheral Paralysis 102. Disorders of Neuromuscular Transmission and Muscles 103. Spinal Shock and Spinal Syndromes 104. Somatosensory disorders 105. Pain 106. Basal ganglia disorders 107. Cerebellar disorders 108. Visual disorders 109. Hearing disorders 110. Disorders of the vestibular system, smell, and taste 111. Diagnostic Methods in Neurology
TOPICS FOR THE PRACTICAL EXAM IN PATHOPHYSIOLOGY 1. Description of ECG waveforms (physiological vs. basic pathological findings) 2. Description of hemodynamic changes (heart failure, valvular defects, hypertension, hypotension) 3. Interpretation of pulmonary function tests (physiological vs. basic pathological findings) 4. Physical principles in the pathophysiology of respiration (compliance, elasticity, static and dynamic respiratory work, hypobaric conditions, hyperbaric conditions) 5. Principles of dialysis 6. Description of EMG—conduction velocity, H reflex 7. Description of the oGTT procedure (typical course vs. diabetes mellitus, malabsorption, hyperthyroidism) 8. Interpretation of laboratory findings—reasoning (reference values vs. patient’s values) 9. Case studies—interpretation of medical history, physical examination, and laboratory values Last update: Maxová Hana, doc. MUDr., Ph.D. (21.09.2026)
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RECOMMENDED READING AND SIMULATION PROGRAMS 1. Basic Materials: Pathological Physiology Review – There is a single official and up-to-date version prepared by the department, which is fully available to students on Moodle. Electronic teaching materials and resources published on Moodle—presentations, case studies, worksheet assignments, and supplementary study texts.
2. USMLE materials First Aid for the USMLE Step 1 (especially the General Principles and Organ Systems sections). USMLE-Rx—an interactive testing and learning platform: usmle-rx.com.
3. Textbooks: HAMMER, Gary D. and MCPHEE, Stephen J. (eds.). Pathophysiology of Disease: An Introduction to Clinical Medicine. Eighth edition. A Lange Medical Book. New York: McGraw-Hill Education, [2019]. ISBN 978-1-260-02650-4. SILBERNAGL, Stefan and LANG, Florian. Color Atlas of Pathophysiology. 3rd edition. Translated by Geraldine O’SULLIVAN, illustrated by Wolf-Rüdiger GAY, illustrated by Astried ROTHENBURGER. Stuttgart: Thieme, [2016]. ISBN 978-3-13-116553-4. BARRETT, Kim E.; BARMAN, Susan M.; BROOKS, Heddwen L., and YUAN, Jason X.-J. Ganong’s Review of Medical Physiology. Twenty-sixth edition. A Lange Medical Book. New York: McGraw-Hill Education, [2019]. ISBN 978-1-260-56666-6. HALL, John E. Guyton and Hall Physiology Review. Fourth edition. St. Louis: Elsevier, [2021]. ISBN 978-0-323-63999-6. NORRIS, Tommie L. Porth’s Pathophysiology: Concepts of Altered Health States. Eleventh edition. International Edition. Philadelphia, PA: Wolters Kluwer, [2025]. ISBN 978-1-975176-84-6. MCCANCE, Kathryn L.; HUETHER, Sue E.; BRASHERS, Valentina L.; and ROTE, Neal S. (eds.). *Pathophysiology: The Biological Basis for Disease in Adults and Children*. 7th ed. St. Louis, MO: Elsevier, c2014. ISBN 978-0-323-08854-1. COSTANZO, Linda S. *Costanzo Physiology*. 7th ed. Philadelphia: Elsevier, [2022]. ISBN 978-0-323-79333-9.
4. Electronic and multimedia resources: WikiSkripta / WikiLectures – pathophysiology overviews (Dr. Raška). YouTube channel Decoiled by Coiled – instructional videos focused on pathophysiological mechanisms and clinical contexts (Dr. Raška) Instructional videos on medical neurobiology – https://www.youtube.com/playlist?list=PLAXSVuGaw0Kz_FW4VzH9eKJiNE26_J0HV MEFANET LFP UK Portal – multimedia support for teaching theoretical and clinical disciplines: https://mefanet.lfp.cuni.cz/ Deranged Physiology – a highly regarded international clinical-pathophysiological portal: https://derangedphysiology.com/
5. Simulation Programs Aplysia CardioVascular Lab The interactive simulation software Aplysia CardioVascular Lab is used for advanced modeling of cardiovascular hemodynamics and demonstration of key pathophysiological conditions: Modeled clinical conditions: systemic and pulmonary hypertension, acute and chronic heart failure, valvular defects, and arrhythmias. Hemodynamic monitoring: real-time monitoring and interpretation of physiological and pathological parameters (arterial pressure, central venous pressure, heart rate, cardiac output, vascular resistance). Diagnostic and interventional procedures: virtual right heart catheterization, including measurement of pulmonary capillary wedge pressure (PCWP), simulation of cardiopulmonary resuscitation, and dynamic assessment of the circulatory system’s response to the administration of selected medications. Last update: Maxová Hana, doc. MUDr., Ph.D. (21.09.2026)
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The requirement for receiving credit is continuous and active participation throughout the entire semester and the successful fulfillment of four basic academic requirements:
1. Absences and Seminar Attendance: Attendance at seminars is mandatory. In accordance with Dean’s Regulation No. 4/2022, two absences per semester are permitted. Based on mutual trust, it is not necessary to provide written justification for these absences. If the limit of two absences per semester is exceeded, the head of the department, or a person authorized by him or her, will determine the form of make-up work. It is possible to attend a seminar with a different group during the given teaching week. Due to capacity limitations, prior arrangement with the instructor of the respective seminar group is always required. If a seminar is canceled due to a national holiday or a day off declared by the rector or dean (i.e., not due to the department’s fault), the instructor may, by mutual agreement with the students, schedule a make-up seminar on a different date. Attendance at the make-up seminar is optional.
2. Group Presentations (Worksheets): Each group will present a total of 5 assigned worksheets during the winter semester and 4 during the summer semester. The specific schedule of seminars and topics for individual groups is listed in the detailed course schedule for the respective semester. Grading: Each presentation is graded on a scale of 0 points (failed), 1 point (passed), and 2 points (excellent performance). If a student is absent on the day of their group’s presentation, the instructor in charge will determine the method of evaluation. To earn credit, students must earn at least 5 points per semester. If this minimum point total is not met, the head of the department, or a person authorized by him or her, will determine the form of make-up activity.
3. Written Tests in Seminars – MANDATORY: During the winter semester, students take a total of 5 mandatory tests. Each test is graded on a scale of 0 to 4 points, with scores awarded in 0.5-point increments. The passing score is at least 3 points. Students have a total of 3 attempts for each test (1 regular attempt and 2 make-up attempts). All retakes are recorded. The dates for retakes are set by the seminar instructor in consultation with the students (usually before the start of the next seminar, or during the exam week at the end of the semester). Any exceptions are handled by the department chair or a person authorized by the chair.
4. Colloquia: A colloquium is a formative oral assessment conducted in a small group. Its purpose is to provide mutual feedback, verify academic progress, and support effective exam preparation. The goal is not to test encyclopedic details, but to assess the ability to think logically, apply pathophysiological principles in practice, and integrate acquired knowledge. Format and Procedure: The examination takes place in groups before a committee consisting of a professor or associate professor and a seminar instructor on the department’s premises (Building C, 4th floor, Plzeňská Campus). Exam Content: Emphasis is placed on the analysis of case studies and practical tasks (e.g., interpretation of a complete blood count, calculation of the anion gap, assessment of acid-base balance and blood gases, or diagnostic reasoning exercises from seminars). Prerequisites for Participation: Students may participate in the colloquium even if they have not yet completed the ongoing written tests.
Ongoing Monitoring and Recording of Academic Performance: Students can continuously monitor all attendance records, points earned on written tests, evaluations of group presentations of worksheets, and colloquium results directly within the Moodle platform. Last update: Maxová Hana, doc. MUDr., Ph.D. (21.09.2026)
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Course Structure Effective as of the 2026/27 Academic Year I. General Pathophysiology • Health, Disease, Death • Thermoregulation and Its Disorders (Fever, Hyperthermia, Hypothermia) • Hypoxia, ischemia, ischemia-reperfusion injury • Oxidative stress, cellular trauma • Inflammation, SIRS, and sepsis • Intoxication • Critical developmental periods
II. Pathophysiology of the Internal Environment • Disturbances in water and osmotic balance (hyperhydration, dehydration) • Ion metabolism disorders (Na⁺, K⁺, Cl⁻, Ca²⁺, phosphates) • Acid-base balance disorders (acidosis, alkalosis, testing)
III. Pathophysiology of the Blood • Anemia (types and mechanisms, anemic syndrome) • Hyperviscosity syndrome • Coagulation disorders and DIC • Blood tests and hematological examinations
IV. Pathophysiology of the cardiovascular system • Atherosclerosis, other arterial diseases • Capillary disorders (permeability disorders—edema) • Venous System Disorders (varicose veins, thrombosis) • Hypertension (primary and secondary) • Shock • Heart Failure • Ischemic Heart Disease and Acute Coronary Syndrome • Valvular Heart Disease and Congenital Heart Defects • Arrhythmias • ECG changes • Examination of the cardiovascular system
V. Pathophysiology of the Kidneys and Urinary Tract • Disorders of renal perfusion • Disorders of glomerular filtration (nephrotic and nephritic syndromes) • Disorders of tubular function • Acute kidney failure • Chronic kidney failure • Disorders of the urinary tract (urolithiasis, obstruction) • Renal replacement therapy (dialysis and kidney transplantation) • Assessment of renal function
VI. Pathophysiology of the Respiratory System • Changes in compliance and resistance in the respiratory system • Pneumothorax • Disorders of alveolar ventilation, respiratory failure • Regulation of respiration and protective reflexes • Disorders of the ventilation-perfusion ratio • Diffusion disorders, pulmonary edema • Pulmonary circulation and its disorders (pulmonary hypertension and cor pulmonale, pulmonary embolism) • Obstructive lung diseases (bronchial asthma, COPD) • Restrictive lung diseases • Hypobaric and hyperbaric conditions • Mechanical ventilation, oxygen therapy • Pulmonary function testing
VII. Pathophysiology of the Endocrine System • Disorders of hormonal regulation • Disorders of the hypothalamus and anterior pituitary • Thyroid disorders (hypothyroidism, thyrotoxicosis) • Adrenal cortex disorders • Adrenal medulla—role in the stress response, functional disorders • Parathyroid disorders • Disorders of Sex Hormones in Ontogenesis, DSD • Evaluation of Endocrine Gland Function
VIII. Pathophysiology of Nutrition and Metabolism • Metabolic and Endocrine Responses to Stress and Starvation • Nutritional Disorders (Primary Malnutrition, Secondary Disorders) • Eating disorders • Obesity • Metabolic syndrome • Purine metabolism disorders (hyperuricemia, gout) • Consequences of vitamin deficiency • Hypervitaminosis • Diabetes mellitus (types, acute and chronic complications) • Testing for metabolic disorders (blood glucose, HbA1c, OGTT, lipid profile, BMI, waist circumference, nutritional screening)
IX. Pathophysiology of the Gastrointestinal Tract • Disorders of the esophagus and stomach (e.g., dysphagia, gastritis, peptic ulcer, reflux) • Vomiting, diarrhea • Maldigestion and malabsorption • Transit disorders (constipation, ileus) • Pancreatic disorders (acute and chronic pancreatitis) • Gallbladder and biliary tract disorders • Liver disorders (acute and chronic failure, including complications) • Jaundice • Liver and pancreatic function tests
X. Pathophysiology of the Nervous System • Cerebrovascular disease • Intracranial hypertension and hypotension syndromes • Cerebral edema and blood-brain barrier disorders • Epilepsy and epileptic seizures (including status epilepticus, developmental and epileptic encephalopathies) • Disorders of consciousness • Sleep disorders • Neurocognitive disorders (dementia, mild cognitive impairment) • Schizophrenia, affective disorders • Motor disorders (extrapyramidal disorders, Parkinson’s disease, Huntington’s disease, dystonia, tic disorders) • Central and peripheral paralysis • Muscle disorders (myopathies) • Spinal shock and spinal syndromes • Somatosensory disorders • Pain (nociceptive, neuropathic, nociplast) • Neuromuscular transmission disorders (myasthenia gravis, Lambert-Eaton syndrome, botulism) • Basal ganglia disorders (hypokinetics and hyperkinesis syndromes) • Cerebellar disorders (ataxia, balance disorders, speech disorders) • Sensory perception disorders—vision, hearing, smell, taste, vestibular system • Diagnostic methods in neurology (neurological examination, CT/MRI, EEG, EMG, cerebrospinal fluid analysis, polysomnography, evoked potentials, PET/SPECT, neurocognitive tests) Last update: Maxová Hana, doc. MUDr., Ph.D. (21.09.2026)
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Course Objectives Effective as of the 2026/27 Academic Year
I. General Pathophysiology – Course Objectives The student understands the basic concepts of general pathophysiology, particularly the difference between health and disease, the basic types of cellular damage, and the body’s defensive responses. Students can describe and explain the mechanisms of hypoxia, ischemia, ischemia-reperfusion injury, and oxidative stress. They have a command of the principles of inflammation, the systemic inflammatory response syndrome (SIRS), and sepsis. They can describe the consequences of cellular trauma and intoxication. They can apply this knowledge to interpret simple clinical situations and distinguish the basic pathophysiological mechanisms in acute conditions. Students are familiar with the regulation of body temperature and can explain the pathophysiology of thermoregulatory disorders (fever, hyperthermia, heatstroke, malignant hyperthermia, hypothermia), including the differences between fever and hyperthermia, their main causes, mechanisms, and clinical consequences. They understand the significance of critical developmental periods as time windows of increased sensitivity of the organism and are able to explain how early insults (nutrition, toxins, stress, hypoxia) lead to irreversible phenotypic changes and long-term health consequences (fetal alcohol syndrome, IUGR, Barker’s hypothesis) . The goal is to prepare students to quickly orient themselves regarding general disorders of the body and to integrate the knowledge they have acquired. A. Memorization – What You Must Know by Heart (Definitions, Terms): • Definitions of health, disease, and death. • Basic principles for distinguishing between clinical and biological death and determining brain death. • Basic mechanisms leading to tissue hypoxia and their relationship to hypoxemia, oxygen transport, perfusion, and cellular oxygen utilization. • Basic causes of ischemia. • Definition of ischemia-reperfusion injury. • What are free radicals and oxidative stress? • Types of cellular trauma (reversible, irreversible damage). • Phases of acute inflammation. • Definitions of SIRS and sepsis. • Basic examples of intoxications. • Definitions of fever, hyperthermia, and hypothermia. • Basic examples of critical developmental periods (prenatal, perinatal). B. Understanding – What you must understand and be able to explain: • The difference between hypoxia and ischemia and their mechanisms. • How ischemic-reperfusion injury develops and how it relates to oxidative stress. • The significance of calcium overload, mitochondrial dysfunction, and endogenous protective mechanisms during ischemia and reperfusion. • How cells respond to hypoxia and oxidative stress (adaptation, damage, death). • The principle of cellular adaptation to hypoxia and the importance of hypoxia-induced regulatory pathways (particularly HIF). • How acute inflammation arises and progresses, and when it transitions to SIRS. • Mechanisms of healing and the transition from acute to chronic inflammation, including its systemic consequences. • What are the main pathophysiological steps in the development of sepsis. • The dynamics of a dysregulated immune response in sepsis, including possible subsequent immunosuppression and catabolism. • How symptoms of intoxication arise and why they are life-threatening. • General principles of xenobiotic biotransformation, toxic damage, and the rational use of specific antidotes. • The difference between fever and hyperthermia, and the principle of hypothalamic set-point shift. • The pathophysiology of heatstroke and malignant hyperthermia. • The importance of critical developmental periods for long-term health. C. Application – What you must be able to apply using examples: • Explain hypoxia and ischemia using the example of myocardial infarction. • Describe ischemic-reperfusion injury following cardiac arrest. • Explain the role of free radicals in reoxygenation following shock. • Identify risk factors for the development of SIRS (e.g., polytrauma, pancreatitis). • Match clinical symptoms to the progression of sepsis. • Recognize the basic manifestations of intoxication based on clinical scenarios. • Using heatstroke as an example, explain the failure of thermoregulatory mechanisms. • Using fetal alcohol syndrome as an example, explain the consequences of critical periods. D. Analysis – What you will analyze and distinguish: • Causes and consequences of hypoxia in various clinical conditions (e.g., anemia vs. myocardial infarction). • Differences between localized and systemic inflammation. • Factors that determine the progression of an infection to sepsis. • Critical moments in the treatment of SIRS and sepsis (circulatory support, oxygenation). • Distinguish between fever and hyperthermia based on their underlying mechanisms. • Factors influencing the course of development during critical periods. E. Synthesis – What you will be able to construct and connect: • Construct a diagram of the progression from hypoxia to cell death. • Explain the development of SIRS following an infectious or non-infectious insult. • Propose basic preventive measures against ischemia-reperfusion injury. • Create a diagram of body temperature regulation and its disturbances. • Relate prenatal and postnatal factors to long-term consequences (Barker’s hypothesis). F. Evaluation – What you will be able to critically evaluate: • Assess the clinical severity of hypoxia based on symptoms and laboratory data. • Assess the risk of sepsis development based on the patient’s clinical condition. • Critically evaluate the role of oxidative stress in tissue damage and ways to modulate it. • Critically distinguish between fever and hyperthermia from a therapeutic perspective. • Assess the risks of long-term consequences of damage during critical developmental periods.
General Pathophysiology – Prerequisites Before beginning the course in general pathophysiology, students are expected to have a basic understanding of anatomy, biology, biochemistry, and physiology necessary to comprehend the processes leading to dysfunction of cells and organ systems. Students should understand the structure and function of cells, the principles of substance transport, energy metabolism, and the regulation of the internal environment. They must be able to explain the importance of oxygen for cells and the organism, and be familiar with the basics of blood circulation, respiration, and the immune response. This knowledge is essential for understanding key mechanisms such as hypoxia, ischemia, oxidative stress, cellular damage, inflammation, the systemic inflammatory response syndrome (SIRS), sepsis, thermoregulatory disorders, and the importance of critical developmental periods. Required knowledge: • The structure and functions of cellular organelles (cell membrane, mitochondria, endoplasmic reticulum, nucleus, lysosomes). • The principles of passive and active transport of substances across the cell membrane (including the importance of osmotic and hydrostatic pressure). • Fundamentals of energy metabolism (glycolysis, the Krebs cycle, oxidative phosphorylation, ATP production). • The role of oxygen in cellular metabolism and the principles of oxygen transport in the blood (function of hemoglobin, saturation, partial pressure of oxygen). • Mechanisms of body temperature regulation (thermogenesis and heat loss). • Basic principles of innate and adaptive immunity, the function of the main cells of the immune system, and the basic principles of cytokine signaling. • Fundamentals of redox reactions in cellular metabolism and the function of the mitochondrial respiratory chain. • The principle of homeostasis and the body’s basic compensatory mechanisms in response to disturbances in the internal environment. • The anatomy and physiology of the circulatory and respiratory systems. • A basic overview of human prenatal and postnatal development and its key stages (organogenesis, the perinatal period, early childhood). • Knowledge of factors that can influence fetal and neonatal development (nutrition, hypoxia, toxins, infections).
II. Pathophysiology of the Internal Environment – Learning Objectives The student understands the principles of maintaining the body’s internal environment and the mechanisms of its disturbances. They can explain the nature and consequences of disturbances in water distribution among compartments, disturbances in ion metabolism (sodium, potassium, chloride, calcium, and phosphate), and acid-base balance. They can describe compensatory mechanisms in acidosis and alkalosis. They are able to apply this knowledge to the assessment of basic clinical conditions (dehydration, hyperhydration, ion balance disorders, acid-base balance disorders) and interpret basic laboratory findings in the context of internal environment disorders. A. Memorization – What You Must Know by Heart (Definitions, Terms): • Definitions of osmolality and tonicity. • Types of fluid distribution disorders: dehydration (hypotonic, hypertonic, isotonic), hyperhydration (hypotonic, hypertonic, isotonic). • Normal blood levels of major ions (Na⁺, K⁺, Cl⁻, Ca²⁺, phosphates). • Definitions of acidosis and alkalosis. • Distinction between respiratory and metabolic ABR disorders. B. Understanding – What you must understand and be able to explain: • Mechanisms of fluid shifts between compartments (intracellular and extracellular). • The difference between total body water, osmolality, and effective circulating volume, and their independent changes in clinical conditions. • Causes and consequences of hypo- and hypernatremia, hypo- and hyperkalemia, and calcium and phosphate disorders. • The difference between the total ion pool in the body and its current plasma concentration; the effect of shifts between the intracellular and extracellular spaces on serum potassium levels. • The mechanism underlying the development of metabolic and respiratory acidosis and alkalosis. • Compensatory mechanisms in ABR disorders (buffer systems, respiratory and renal compensation). C. Application – What you must be able to apply using examples: • Apply knowledge of ion imbalances to clinical scenarios (e.g., hypokalemia due to vomiting, hyperkalemia due to renal failure). • Interpret basic blood gas results (pH, pCO₂, HCO₃⁻) and determine the type of acid-base disorder. • Use the anion gap and BE (base excess) in the basic differential diagnosis of metabolic acid-base balance disorders. • Explain the development of edema based on changes in hydrostatic and osmotic pressure. • Apply the principles of fluid distribution to explain the development of dehydration or edema. D. Analysis – What You Will Analyze and Distinguish: • Distinguish between different types of dehydration and hyperhydration based on the clinical presentation and laboratory findings. • Analyze combined acid-base balance (ABB) disorders (e.g., concurrent metabolic acidosis and respiratory alkalosis). • Analyze the differences between hypoosmolar and hyperosmolar dehydration. E. Synthesis – What you will be able to synthesize and connect: • Develop a procedure for interpreting blood gas and ionogram results. • Synthesize the relationships between electrolyte imbalances, changes in fluid volume, and acid-base balance. • Propose basic therapeutic measures for internal environment disorders (e.g., correction of dehydration, electrolyte abnormalities). F. Evaluation – What you will be able to critically evaluate: • Assess the severity of internal environment disorders based on clinical and laboratory findings. • Evaluate the effectiveness of compensatory mechanisms in acid-base disorders. • Critically assess the risk of complications associated with electrolyte and volume imbalances. • Evaluate the risks of too rapid correction of severe osmolality and sodium levels, particularly neurological complications.
Pathophysiology of the Internal Environment – Prerequisites Before beginning the course on the pathophysiology of the internal environment, students should have a basic understanding of the composition and regulation of body fluids, the principles of ion balance, acid-base balance, and the mechanisms of substance transport across membranes. Furthermore, students should be familiar with the basics of renal function in maintaining fluid volume and acid-base balance and have an overview of diagnostic methods for the internal environment (blood ion profile, blood gases). Required Knowledge: • Structure and function of cell membranes (principles of passive and active transport, osmotic and hydrostatic pressure). • Distribution of body fluids (intracellular and extracellular spaces). • Normal composition of blood plasma (major ions: Na⁺, K⁺, Cl⁻, Ca²⁺, phosphates). • Fundamentals of renal function: filtration, reabsorption, secretion, concentrating ability. • Principles of acid-base balance and buffer systems (bicarbonate, phosphate, proteins). • The significance of blood gases (pH, pCO₂, pO₂, bicarbonate). • Physiological regulation of sodium and potassium, including the role of the kidneys and the main hormonal regulatory mechanisms. • The fundamental relationship between alveolar ventilation, CO₂ production and elimination, and acid-base balance.
III. Pathophysiology of Blood – Learning Objectives The student understands the basic mechanisms of blood component disorders, particularly the development of anemias, hyperviscosity syndrome, and blood coagulation disorders, including disseminated intravascular coagulation (DIC). Students can explain the causes, consequences, and basic manifestations of these conditions. They can apply this knowledge when interpreting laboratory results of blood tests (complete blood count, coagulation tests) and in the evaluation of clinical situations associated with hemocoagulation disorders or anemia. The student has a basic understanding of diagnostic methods in hematology. A. Memorization – What You Must Know by Heart (definitions, terms): • Definition of anemic syndrome. • Types of anemia by cause (loss-related, production-related, hemolytic). • Definition of hyperviscosity syndrome. • Basic components of hemostasis (primary and secondary). • Definition of DIC. B. Understanding – What you must understand and be able to explain: • Principles of anemia development due to bleeding, reduced hematopoesis, and increased red blood cell destruction. • Mechanisms of erythropoiesis disorders in iron, vitamin B12, and folate deficiencies, and the role of hepcidin in regulating iron availability. • The difference between intravascular and extravascular hemolysis and the basic principles of congenital and acquired hemolytic anemias and hemoglobinopathies. • How changes in blood viscosity affect circulatory conditions. • The mechanism of activation of the coagulation cascade and its regulation. • The role of platelets and von Willebrand factor in primary hemostasis and the relationship between primary and secondary hemostasis disorders and the clinical picture of bleeding. • How DIC develops and what its clinical manifestations are. C. Application – What you must be able to apply using examples: • Interpret basic blood count parameters in various types of anemia. • Explain the development of hyperviscosity syndrome in polycythemia. • Match clinical manifestations to specific types of coagulation disorders. • Explain the results of basic coagulation tests (PT, APTT, fibrinogen). • Interpret basic laboratory signs of hemolysis and distinguish between impaired erythrocyte production and increased erythrocyte destruction. D. Analysis – What you will analyze and distinguish: • Distinguish between types of anemia based on laboratory findings (e.g., MCV, MCHC). • Analyze the differences between bleeding disorders and thrombophilic conditions. • Analyze the main mechanisms of thrombophilic conditions in the context of Virchow’s triad and physiological anticoagulant systems. • Analysis of clinical and laboratory findings in DIC. E. Synthesis – What you will be able to compile and connect: • Compile a classification scheme for anemias based on their mechanism of origin. • Propose a basic diagnostic approach for suspected DIC. • Synthesize knowledge of primary and secondary hemostasis when managing bleeding disorders. F. Evaluation – What you will be able to critically evaluate: • Assess the severity of anemia based on clinical symptoms and laboratory data. • Critically assess the risk of thrombosis in hyperviscosity syndrome. • Assess the prognosis in a patient with DIC based on the dynamics of laboratory markers.
Pathophysiology of Blood – Prerequisites Before beginning the study of blood pathophysiology, students should have a basic understanding of the structure and function of blood, the principles of blood cell formation, and the mechanisms of hemostasis. They must understand the composition of the complete blood count, the basic parameters of red blood cells, and plasma clotting factors. This knowledge is essential for understanding the pathophysiological changes associated with anemias, coagulation disorders, and hyperviscosity syndrome. Required knowledge: • Structure and function of red blood cells, white blood cells, and platelets. • Fundamentals of hematopoiesis (development of blood cells). • Principles of the complete blood count and the significance of its parameters (MCV, MCH, Hb, Ht). • Plasma composition and the functions of major plasma proteins. • Basic principles of hemostasis (primary—platelet phase; secondary—coagulation cascade). • Functions of basic coagulation factors and the significance of anticoagulation systems. • The physiology of erythropoiesis and its regulation by erythropoietin. • Basic iron metabolism and the role of transferrin, ferritin, vitamin B12, and folate in hematopoiesis. • The structure and function of hemoglobin and the basic metabolic properties of erythrocytes.
IV. Pathophysiology of the Cardiovascular System – Learning Objectives The student understands the mechanisms of cardiac and vascular dysfunction, particularly the pathogenesis of hypertension, atherosclerosis, heart failure, shock states, and arrhythmias. They can explain the causes and consequences of impaired blood flow, changes in blood pressure, impaired capillary permeability, and changes in hemodynamics in congenital and acquired heart defects. They can apply this knowledge when analyzing clinical situations and interpreting basic ECG findings. The student is able to identify the main pathophysiological mechanisms of acute and chronic cardiovascular disorders. A. Memorization – What You Must Know by Heart (definitions, terms): • Definitions and classification of hypertension (primary and secondary). • Basic terms: atherosclerosis, ischemic heart disease (IHD), heart failure. • Types of shock (hypovolemic, cardiogenic, distributive, obstructive). • Definitions of edema and thrombosis. • Basic types of arrhythmias and conduction disturbances. B. Understanding – What you must understand and be able to explain: • The pathophysiology of primary and secondary hypertension. • The formation of atherosclerotic plaques and their complications. • The relationship between coronary blood flow, myocardial oxygen supply and consumption, and the mechanisms underlying ischemia when supply does not meet demand. • The principles underlying the development of acute and chronic heart failure. • The pathogenesis of individual types of shock and the differences between them. • The development of edema based on changes in capillary permeability and hydrostatic/osmotic pressure. • The mechanisms underlying the development of arrhythmias and their impact on cardiac output. C. Application – What you must be able to apply using examples: • Apply knowledge of the pathogenesis of hypertension when explaining organ damage (heart, kidneys, brain). • Explain the clinical presentation of myocardial infarction based on knowledge of myocardial ischemia. • Relate the mechanism of coronary ischemia to the temporal progression of functional, electrical, and structural changes in the myocardium and to the complications of acute coronary syndrome. • Interpret basic ECG findings (ischemia, infarction, arrhythmias). • Apply knowledge of shock states when evaluating hypotension in a clinical scenario. • Explain the cause of pulmonary edema in left-sided heart failure. D. Analysis – What you will analyze and distinguish: • Distinguish between types of shock based on clinical symptoms. • Distinguish between deep vein thrombosis and thrombophlebitis • Analyze the pathophysiological differences between systolic and diastolic heart failure. • Analyze hemodynamic changes in valvular heart disease and congenital heart defects. • Distinguish between the consequences of pressure and volume overload on the heart and the hemodynamic consequences of left-to-right and right-to-left shunts. E. Synthesis – What you will be able to construct and connect: • Construct a model of atherosclerosis progression from early changes to acute coronary syndrome. • Synthesize the hemodynamic consequences of various types of heart failure. • Outline basic acute care procedures for individual types of shock. F. Evaluation – What you will be able to critically evaluate: • Assess the severity of hypertension and its organ-specific consequences. • Evaluate the prognosis of a patient with acute coronary syndrome based on an ECG and clinical parameters. • Critically assess the risk of thrombosis in a patient with atherosclerosis.
Pathophysiology of the Cardiovascular System – Prerequisites Before beginning the study of the pathophysiology of the cardiovascular system, students should have a basic understanding of the anatomy and physiology of the heart and blood vessels, as well as the principles of blood pressure regulation, cardiac output, and vascular resistance. They must understand the mechanisms of action potential generation in the heart and its propagation and be familiar with basic cardiovascular reflexes and the principles of blood volume regulation. Required knowledge: • Anatomy of the heart, systemic and pulmonary circulation. • Basic principles of the cardiac cycle and cardiac output generation. • Mechanism of the action potential in the working myocardium and the conduction system. • Regulation of blood pressure (baroreceptor reflex, RAAS system). • Factors influencing cardiac contractility, preload, and afterload. • Principles of hemodynamics (blood flow, vascular resistance, blood pressure). • Physiology of coronary circulation and basic determinants of myocardial oxygen supply and consumption. • Principles of microcirculation and fluid exchange across the capillary wall. • Physiological function of the heart valves and relationships between pressure and volume during the cardiac cycle.
V. Pathophysiology of the Kidneys and Urinary Tract – Learning Objectives The student understands the basic pathophysiological mechanisms of disorders of the kidneys and the urinary tract. The student is able to explain the nature of disorders of renal perfusion, the glomerular filter, tubular function, the development of acute and chronic kidney failure, and nephrotic and nephritic syndromes. They understand the principles of urinary tract obstruction, the development of urolithiasis, and the resulting consequences. They can apply this knowledge when interpreting clinical conditions and laboratory findings. Students have a basic understanding of the indications for dialysis treatment and transplantation approaches. A. Memorization – What You Must Know by Heart (Definitions, Terms): • Definitions of acute and chronic kidney failure. • Definitions of nephrotic and nephritic syndromes. • Classification of causes of acute kidney failure (prerenal, renal, postrenal). • Definition and basic characteristics of urolithiasis. • Basic concepts of dialysis (hemodialysis, peritoneal dialysis). B. Understanding – What you must understand and be able to explain: • Mechanisms underlying the development of acute and chronic kidney failure. • The mechanism of maladaptive hyperfiltration by the remaining nephrons and its significance for the progression of chronic kidney disease. • Pathophysiology of nephrotic and nephritic syndromes (protein loss, hematuria, edema). • Consequences of impaired glomerular filtration and tubular reabsorption. • Mechanisms underlying glomerular and tubular proteinuria and the significance of impaired selectivity of the glomerular filtration barrier. • The development and consequences of urinary tract obstruction. • Basic mechanisms of tubular disorders, including impairments in urine concentration and renal acidification, and their consequences for the internal environment. • Basic principles of dialysis and indications for its initiation. • Systemic consequences of advanced chronic kidney disease and uremic syndrome, including anemia and disorders of mineral and bone metabolism. C. Application – What you must be able to do using examples: • Interpret laboratory findings in acute and chronic kidney failure (creatinine, urea, ions). • Apply the principles of clearance and fractional excretion in the assessment of glomerular and tubular function and in the differentiation of selected prerenal and renal conditions. • Recognize the clinical symptoms of nephrotic and nephritic syndromes. • Explain the development of edema in nephrotic syndrome. • Apply knowledge of urinary tract obstruction to explain the development of hydronephrosis. • Explain the basic mechanisms of bladder filling and emptying disorders and the consequences of vesicoureteral reflux. • Describe the basic procedure for indicating acute dialysis. D. Analysis – What you will analyze and distinguish: • Distinguish between prerenal, renal, and postrenal kidney failure based on clinical and laboratory data. • Analyze the differences between nephrotic and nephritic syndromes. • Analyze the effects of urolithiasis on kidney and urinary tract function. E. Synthesis – What you will be able to construct and connect: • Construct a logical sequence of events leading to the development of acute renal failure. • Propose a diagram illustrating the progression of edema in various kidney disorders. • Synthesize the relationships between urinary tract obstruction, changes in intrarenal pressure, and reduced glomerular filtration rate. F. Evaluation – What you will be able to critically evaluate: • Assess the severity of renal dysfunction based on laboratory and clinical data. • Critically assess the risk of progressive loss of renal function in chronic renal insufficiency. • Evaluate the indications for acute dialysis therapy.
Pathophysiology of the Kidneys and Urinary Tract—Prerequisites Before beginning the study of the pathophysiology of the kidneys and urinary tract, students should have a basic understanding of the anatomy and physiology of the kidneys and urinary tract, the principles of glomerular filtration, tubular reabsorption and secretion, the regulation of body fluid volume and osmolality, and the basic principles of acid-base balance. Required Knowledge: • Anatomy of the kidneys, urinary tract, and renal blood supply. • Principles of glomerular filtration and tubular function. • Regulation of fluid and ion volume (ADH, RAAS, natriuretic peptides). • Mechanisms of urine concentration (countercurrent mechanism, action of ADH). • Basic principles of acid-base regulation by the kidneys. • The significance of creatinine and urea as markers of kidney function. • Basic principles of renal hemodynamics, glomerular filtration rate (GFR), and clearance. • The physiology of bladder filling and emptying and the basic neural regulation of micturition.
VI. Pathophysiology of the Respiratory System – Learning Objectives The student understands the basic pathophysiological mechanisms of respiratory system disorders. The student can explain the nature of disorders of ventilation, perfusion, diffusion, and respiratory regulation. The student understands the causes of obstructive and restrictive lung diseases, pulmonary embolism, pulmonary edema, and pneumothorax. They can apply this knowledge to interpret clinical conditions associated with hypoxemia, hypercapnia, and respiratory failure. Students master the basics of the indications and principles of oxygen therapy and mechanical ventilation. A. Memorization – What You Must Know by Heart (definitions, terms): • Definitions of alveolar ventilation and perfusion disorders. • Definitions of hypoxemia and hypercapnia. • Classification of obstructive and restrictive lung diseases. • Basic terms: pneumothorax, pulmonary edema, pulmonary embolism, pulmonary hypertension. • Definitions of hypobaric and hyperbaric conditions. B. Understanding – What you must understand and be able to explain: • Mechanisms leading to hypoxia and hypercapnia. • How disorders of ventilation, perfusion, and diffusion lead to respiratory failure. • Principles of the pathophysiology of bronchial asthma and COPD. • Mechanisms of pulmonary edema and pneumothorax. • The development of pulmonary embolism and its hemodynamic consequences. • The principles of respiratory regulation and the impact of disorders on the respiratory pattern. C. Application – What you must be able to apply using examples: • Explain the clinical presentation of respiratory failure based on changes in pO₂ and pCO₂. • Apply knowledge of the mechanisms of hypoxia when evaluating patients with pulmonary embolism or pulmonary edema. • Explain changes in the breathing pattern in patients with damage to the respiratory center. • Recognize risk factors and clinical manifestations of obstructive pulmonary diseases. • Apply the principles of oxygen therapy and the indications for mechanical ventilation. D. Analysis – What you will analyze and distinguish: • Distinguish between hypoxic and hypercapnic respiratory failure. • Analyze the differences between obstructive and restrictive ventilatory disorders. • Analyze the hemodynamic consequences of pulmonary embolism. • Distinguish between the causes of pneumothorax and their clinical manifestations. E. Synthesis – What you will be able to synthesize and connect: • Develop a diagnostic protocol and basic management plan for acute respiratory failure. • Outline the mechanisms leading from pulmonary embolism to right-sided heart failure. • Synthesize the relationships between ventilation, perfusion, and diffusion in the context of hypoxemia development. F. Evaluation – What you will be able to critically evaluate: • Assess the severity of ventilation and perfusion disorders based on blood gas analysis and clinical symptoms. • Critically evaluate the indications for oxygen therapy and mechanical ventilation. • Assess the risks associated with hyperbaric and hypobaric environments.
Pathophysiology of the Respiratory System – Prerequisites Before beginning the study of the pathophysiology of the respiratory system, students should have a basic understanding of the anatomy of the airways and lungs, the physiology of ventilation, perfusion, and gas diffusion, the principles of respiratory regulation, and the importance of oxygen and carbon dioxide transport in the blood. Required Knowledge: • Anatomy of the airways, alveolar system, and pulmonary blood supply. • Principles of respiratory mechanics, including airway compliance and resistance. • Importance of ventilation/perfusion (V/Q ratio) and its regulation. • Principles of gas diffusion across the alveolar-capillary membrane. • Regulation of respiration (chemoreceptors, respiratory centers in the medulla oblongata). • Transport of oxygen and carbon dioxide in the blood (role of hemoglobin, O₂ saturation, pCO₂). • Basic spirometric volumes, capacities, and flow parameters and their physiological significance. • Basic physiology of pulmonary circulation, including hypoxic pulmonary vasoconstriction.
VII. Pathophysiology of the Endocrine System – Learning Objectives The student understands the basic pathophysiological mechanisms of endocrine regulation disorders. The student can explain the principles of hypo- and hyperfunction of individual endocrine glands, including the pituitary gland, thyroid gland, adrenal glands, parathyroid glands, and gonads. They can describe hormonal regulatory axes and their disorders. They understand the pathophysiology of disorders of calcium-phosphate metabolism and of growth and developmental disorders caused by hormonal dysregulation and are able to interpret basic hormonal findings. They can apply this knowledge when evaluating clinical conditions associated with disorders of the endocrine system. A. Memorization – What You Must Know by Heart (Definitions, Terms): • Definitions of hyperfunction and hypofunction of the endocrine glands. • Definitions of primary, secondary, and tertiary endocrine disorders. • Definitions of Cushing’s syndrome and Addison’s disease. • Definitions of hypothyroidism and thyrotoxicosis. • Definitions of hypocalcemia and hypercalcemia. • Definitions of acromegaly, gigantism, and hypopituitarism. • Basic disorders of sexual development. B. Comprehension – What You Must Understand and Be Able to Explain • Mechanisms underlying pituitary hypo- and hyperfunction. • Pathophysiology of growth hormone disorders. • Mechanisms underlying hypothyroidism and hyperthyroidism. • Mechanisms underlying adrenal insufficiency and hyperadrenocorticism. • Pathophysiology of parathyroid disorders. • Causes and consequences of hypocalcemia and hypercalcemia. • Mechanisms of sex hormone disorders during development and in adulthood. • Principles of hormonal regulatory axes and feedback mechanisms. C. Application – What You Must Be Able to Apply Using Examples • Apply knowledge to explain the clinical symptoms of hypothyroidism and thyrotoxicosis. • Interpret hormonal test results when pituitary insufficiency is suspected. • Recognize the symptoms of Cushing’s syndrome and Addison’s disease. • Explain the development of tetany in hypocalcemia. • Explain the development of osteoporosis in hormonal disorders. • Apply knowledge when evaluating disorders of puberty and fertility. D. Analysis – What you will analyze and differentiate • Distinguish between primary, secondary, and tertiary disorders of the endocrine glands. • Analyze laboratory findings in the diagnosis of thyroid disorders. • Analyze laboratory findings in the diagnosis of adrenal disorders. • Analyze the causes of hypocalcemia and hypercalcemia. • Distinguishing the causes of growth and sexual development disorders. E. Synthesis – What you will be able to construct and connect • Construct a diagram of the hypothalamic-pituitary regulatory axes. • Connect hormonal disorders with the clinical manifestations of individual organ systems. • Synthesize the relationships between disorders of calcium-phosphate metabolism and bone changes. • Propose a diagram of hormonal regulation of growth and reproduction. F. Evaluation – What you will be able to critically evaluate • Assess the severity of hormonal dysregulation based on clinical and laboratory findings. • Evaluate the significance of hormonal changes for growth, reproduction, and the body’s homeostasis. • Critically assess the risks of long-term complications of endocrine diseases. • Evaluate the impact of hormonal disorders on a patient’s quality of life and prognosis.
Pathophysiology of the Endocrine System – Prerequisites Before beginning the study of the pathophysiology of the endocrine system, students should be familiar with the basic anatomy of the endocrine organs, the principles of hormonal regulation and feedback, and the physiological effects of major hormones. They should understand the basics of hormone synthesis, transport, and cellular action, as well as their role in regulating metabolism, growth, reproduction, and the internal environment. Required Knowledge • Anatomy of the hypothalamus and pituitary gland. • Anatomy of the thyroid gland, parathyroid glands, adrenal glands, and gonads. • Principles of hormonal regulation and feedback. • Functions of thyroid hormones, cortisol, aldosterone, parathyroid hormone, calcitonin, growth hormone, prolactin, estrogens, and testosterone. • Regulation of calcium-phosphate metabolism. • Physiology of growth, puberty, and reproduction. • Basic principles of hormonal regulatory axes (hypothalamus–pituitary–target gland). • Basic principles of the synthesis, transport, receptor action, and degradation of peptide and steroid hormones.
VIII. Pathophysiology of Nutrition and Metabolism – Learning Objectives The student understands the physiological and pathophysiological mechanisms regulating energy balance, food intake, and nutrient metabolism. The student understands the body’s metabolic response to stress and starvation and can explain the causes and consequences of malnutrition, obesity, metabolic syndrome, and eating disorders. The student is familiar with the role of vitamins in the body and understands the consequences of both their deficiency and excess. The student is proficient in the classification of diabetes mellitus, its pathogenesis, and its acute and chronic complications. They can apply this knowledge when interpreting clinical situations related to nutritional and metabolic disorders and understand their significance in the development of chronic lifestyle-related diseases. A. Memorization – What You Must Know by Heart (Definitions, Terms) • Definition of the body’s stress response. • Definition of starvation, malnutrition, and cachexia. • Difference between marasmus and kwashiorkor. • Definition of obesity and BMI. • Criteria for metabolic syndrome. • Definition of hyperuricemia and gout. • Basic types of eating disorders. • Main manifestations of deficiencies in vitamins A, D, K, B1, B12, C, and folic acid. • Main manifestations of hypervitaminosis A and D. • Classification of diabetes mellitus (DM1, DM2, gestational diabetes, other specific types). • Definitions of diabetic ketoacidosis, hyperosmolar hyperglycemic state, and hypoglycemia. • Basic chronic complications of diabetes (retinopathy, nephropathy, neuropathy, macroangiopathy). B. Understanding – What You Must Understand and Be Able to Explain • The body’s metabolic response to stress and starvation. • Mechanisms of adaptation to short-term and long-term starvation. • The difference between primary and secondary malnutrition. • Pathophysiological mechanisms underlying the development of obesity. • The relationship between obesity, insulin resistance, and metabolic syndrome. • The mechanism underlying the development of hyperuricemia and a gout attack. • The metabolic consequences of anorexia nervosa and bulimia. • The importance of vitamins for normal bodily function. • The pathogenesis of type 1 and type 2 diabetes. • Mechanisms underlying the development of acute and chronic complications of diabetes. C. Application – What You Must Be Able to Do Using Examples • Explain the metabolic changes that occur during starvation. • Recognize the signs of malnutrition and determine their probable cause. • Interpret the link between obesity and the development of type 2 diabetes. • Explain the development of metabolic syndrome in a specific patient. • Recognize the manifestations of vitamin deficiencies in clinical scenarios. • Identify the symptoms of acute complications of diabetes. • Explain the development of diabetic neuropathy, nephropathy, or retinopathy using a clinical example. • Assess the risk factors for the development of gout. D. Analysis – What You Will Analyze and Distinguish • Differences between marasmus, kwashiorkor, and cachexia. • Causes of primary and secondary malnutrition. • Factors leading to the development of obesity and metabolic syndrome. • Differences between type 1 and type 2 diabetes. • Differences between diabetic ketoacidosis and hyperosmolar hyperglycemic state. • Mechanisms underlying the development of microangiopathic and macroangiopathic complications of diabetes. • Differences between various eating disorders. • Clinical consequences of deficiencies in specific vitamins. E. Synthesis – What You Will Be Able to Compile and Connect • Compile a diagram of the metabolic response to stress and starvation. • Connect nutritional disorders with their organ-specific consequences. • Synthesize the relationship between obesity, insulin resistance, metabolic syndrome, and type 2 diabetes. • Create a diagram of the onset and progression of diabetic complications. • Relate eating disorders to their metabolic and organ-specific consequences. • Propose basic preventive measures to reduce the risk of metabolic diseases. F. Assessment – What You Will Be Able to Critically Evaluate • Assess the severity of malnutrition based on clinical and laboratory data. • Evaluate the risk of developing metabolic syndrome and diabetes. • Evaluate the clinical significance of obesity and its complications. • Assess the risk of acute complications of diabetes based on the clinical presentation. • Assess the significance of chronic hyperglycemia for the development of organ damage. • Critically evaluate the significance of vitamin deficiencies and their long-term consequences. • Assess the relationship between lifestyle and the development of metabolic diseases.
Pathophysiology of Nutrition and Metabolism – Prerequisites Before beginning this chapter, students are expected to have a solid grasp of the fundamentals of biochemistry and the physiology of carbohydrate, lipid, and protein metabolism. They understand the principles of energy balance, hormonal regulation of metabolism, and the physiology of digestion and nutrient absorption. They have a basic understanding of the role of vitamins and trace elements in the body and are familiar with the physiology of the endocrine system, particularly the regulation of glucose homeostasis. Required Knowledge: • Digestion and absorption of carbohydrates, lipids, and proteins. • Fundamentals of energy metabolism (glycolysis, glycogenolysis, gluconeogenesis, lipolysis, ketogenesis). • Functions of insulin, glucagon, cortisol, catecholamines, and growth hormone. • Regulation of food intake and energy balance. • Physiology of adipose tissue. • Metabolism of purines and uric acid. • Basic functions of vitamins and trace elements. • Physiology of the pancreas and regulation of blood glucose levels. • Basic principles of microcirculation and vascular damage. • Fundamentals of metabolism during stress and starvation.
IX. Pathophysiology of the Gastrointestinal Tract – Learning Objectives The student understands the basic pathophysiological mechanisms of disorders of the digestive system. The student can explain the nature of disorders of the esophagus, stomach, intestines, pancreas, and liver, including disorders of motility, secretion, digestion, and absorption. They understand the pathogenesis of malabsorption syndromes, pancreatic diseases, liver failure, and portal hypertension. They can describe the pathophysiology of jaundice and complications of liver diseases. Students are able to apply this knowledge when evaluating clinical conditions and laboratory findings in patients with gastrointestinal tract diseases. A. Memorization – What You Must Know by Heart (definitions, terms): • Definitions of dysphagia, gastroesophageal reflux disease, gastritis, and peptic ulcer. • Definitions of vomiting, diarrhea, constipation, and ileus. • Definitions of malabsorption syndrome and maldigestion. • Types of liver failure. • Portal hypertension. • Definitions of jaundice and ascites. • Definition of hepatic encephalopathy. B. Comprehension – What You Must Understand and Be Able to Explain • Mechanisms of motility, secretion, digestion, and absorption disorders in the GI tract. • Principles underlying the development of vomiting, diarrhea, constipation, and intestinal obstruction. • Pathophysiology of acute and chronic pancreatitis. • Pathophysiology of exocrine pancreatic insufficiency. • Mechanism underlying the development of portal hypertension and its complications. • Pathophysiology of ascites. • The pathophysiology of acute and chronic liver failure. • The pathophysiology of jaundice (prehepatic, hepatic, posthepatic). • The mechanisms of malabsorption and maldigestion. • The development of nutritional deficiencies in gastrointestinal diseases. C. Application – What You Must Be Able to Apply Using Examples • Explain the development of jaundice based on disorders of the liver or biliary tract. • Interpret symptoms and laboratory findings in liver failure. • Recognize the clinical presentation of portal hypertension and ascites. • Explain the mechanism of diarrhea in various intestinal diseases. • Explain the development of malabsorption in celiac disease, Crohn’s disease, or following bowel resection. • Recognize the manifestations of exocrine pancreatic insufficiency. D. Analysis – What You Will Analyze and Differentiate • Differentiate between types of jaundice based on clinical and laboratory data. • Analyze the causes of ascites. • Distinguish between maldigestion and malabsorption. • Analyze symptoms and laboratory findings in acute and chronic pancreatitis. • Distinguish between the causes of diarrhea, constipation, and intestinal obstruction. E. Synthesis – What you will be able to synthesize and connect • Develop a diagram illustrating the progression of portal hypertension and its complications. • Relate liver failure to its systemic manifestations. • Propose a diagnostic approach for a patient with malabsorption. • Relate digestive and absorption disorders to the clinical manifestations of nutritional deficiencies. F. Evaluation – What you will be able to critically evaluate • Assess the severity of liver failure and the need for urgent treatment. • Assess the risk of complications from portal hypertension. • Evaluate the clinical significance of malabsorption and nutritional deficiencies. • Critically assess the severity of acute pancreatitis and its complications.
Pathophysiology of the Gastrointestinal Tract – Prerequisites Before beginning the study of the pathophysiology of the gastrointestinal tract, students should have a solid grasp of the basic anatomy and physiology of the digestive system, the principles of motility, secretion, digestion, and absorption, and the basic functions of the liver, biliary tract, and pancreas. Required Knowledge • Anatomy of the esophagus, stomach, small intestine, and large intestine. • Anatomy of the liver, biliary tract, gallbladder, and pancreas. • Mechanisms of gastrointestinal tract (GIT) motility. • Functions of digestive enzymes and secretion of digestive juices. • Principles of digestion and nutrient absorption. • Enterohepatic circulation of bile acids. • Formation and metabolism of bilirubin. • Exocrine function of the pancreas. • Basic functions of the liver in metabolism, detoxification, and synthesis of plasma proteins. • Basic nervous and hormonal regulation of gastrointestinal motility and secretion. • Anatomy and basic physiology of the portal circulation.
X. Pathophysiology of the Nervous System – Learning Objectives The student understands the basic pathophysiological mechanisms of disorders of the central and peripheral nervous systems. The student is able to explain the principles underlying the development of cerebrovascular diseases, epilepsy, disorders of consciousness, sleep, dementia, and disorders of motor function, sensation, neuromuscular transmission, and sensory perception. They can apply this knowledge when interpreting the clinical symptoms of neurological disorders and are able to analyze the basic pathophysiological mechanisms leading to acute and chronic conditions of the nervous system. A. Memorization – What You Must Know by Heart (Definitions, Terms): • Definitions of ischemic and hemorrhagic strokes (CMP). • Definitions of cerebral edema and types of edema (cytotoxic, vasogenic, interstitial). • Definitions of epilepsy and status epilepticus. • Definitions of consciousness and disorders of consciousness (quantitative and qualitative). • Types of neurocognitive disorders (e.g., Alzheimer’s disease, vascular dementia). • Types of schizophrenia and affective disorders • Types of central and peripheral paralysis. • Definitions of neuropathy, myasthenia gravis, Parkinson’s disease, and cerebellar disorders. • Types of sensory perception disorders (vision, hearing). B. Understanding – What you must understand and be able to explain: • Mechanisms underlying ischemic and hemorrhagic brain injury. • Pathophysiology of cerebral edema and its effect on intracranial pressure. • Mechanisms underlying epileptic seizures and status epilepticus. • Mechanisms of disorders of consciousness and sleep disorders. • The basics of the pathogenesis of neurodegenerative diseases leading to dementia. • The basics of the pathogenesis of schizophrenia and affective disorders • The mechanisms underlying the development of paralysis (central vs. peripheral). • The pathophysiology of neuromuscular transmission disorders (e.g., myasthenia gravis). • The development of motor disorders in Parkinson’s disease and cerebellar disorders. • Mechanisms underlying sensory perception disorders (visual and auditory disorders). C. Application – What you must be able to apply using examples: • Apply knowledge of cerebral blood supply when interpreting clinical signs of stroke. • Recognize the signs of an epileptic seizure and status epilepticus. • Interpret the signs of central vs. peripheral paralysis. • Apply knowledge of the pathophysiology of dementia when evaluating cognitive impairments. • Explain the clinical presentation of Parkinson’s disease based on basal ganglia dysfunction. • Recognize symptoms of sensory perception disorders in a clinical context. D. Analysis – What you will analyze and distinguish: • Distinguish between ischemic and hemorrhagic stroke based on clinical symptoms. • Analyze the causes and consequences of increased intracranial pressure. • Distinguish between the symptoms of central and peripheral paralysis. • Analyze the differences between various types of epileptic seizures. • Distinguishing between types of dementia based on clinical and pathophysiological features. E. Synthesis – What you will be able to synthesize and connect: • Create a diagram illustrating the progression of cerebral edema and its clinical consequences. • Outline the diagnostic procedure and first aid for an epileptic seizure. • Synthesize the relationships between damage to specific areas of the brain and manifestations of motor and sensory disorders. • Create a diagram of neuromuscular transmission disorders. F. Evaluation – What you will be able to critically evaluate: • Assess a patient’s prognosis following an ischemic stroke based on the extent of the lesion. • Evaluate the risk of developing epilepsy following a traumatic brain injury. • Critically assess the severity of disturbances in consciousness and the need for urgent intervention. • Evaluate the clinical severity of dementia based on the degree of impairment of cognitive functions.
Pathophysiology of the Nervous System—Prerequisites Before beginning the study of the pathophysiology of the nervous system, students should have a basic understanding of the anatomy and physiology of the central and peripheral nervous systems, the functional anatomy of brain regions, and the fundamentals of reflex activity, motor control, consciousness, and sensory perception. Required knowledge: • Anatomy of the brain (cortex, basal ganglia, cerebellum, brainstem), spinal cord, and peripheral nerves. • Blood supply to the brain and basic vascular territories. • Resting and action potentials, nerve impulse conduction, and the basic principles of synaptic transmission. • Functional classification of motor and sensory pathways. • Physiology of sleep, consciousness, and cognitive functions. • Principles of sensory perception (vision, hearing, touch). • Physiology of neuromuscular transmission. • Physiology of cerebrospinal fluid, intracranial pressure, and the basic function of the blood-brain barrier. • Basic organization of the autonomic nervous system. • Basic principles of nociception and pain modulation. Last update: Maxová Hana, doc. MUDr., Ph.D. (21.09.2026)
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