VM3100 Function and Dysfunction

Course Guide
2021/2022

Acknowledgement
This course is based on Cornell University's College of Veterinary Medicine Function and
Dysfunction course. Our team is greatly indebted to the Cornell course design group and all
Cornell faculty who contributed to the implementation of this course at City University.
Special thanks to Drs. Caroline Yancey, Richard Rawson, Katherine Edmondson, Antonia
Jameson-Jordan, Marnie FitzMaurice, Kelly Lyboldt, Isabelle Louge, and many other
colleagues for advising us and sharing their teaching materials.
Course Team
Lecturers:
Dr. Ákos Kenéz (physiology) – course leader
Dr. Runsheng Li (physiology)
Dr. Jeanine Sandy (pathology)
Dr. Scott Edwards (pharmacology)
Dr. Guan Yang (physiology)
Guest speakers from CityU VMC and CityU VDL

PBL Tutors:
Dr. Cherry Lee
Dr. Brett MacKinnon
Dr. Peter Schiff
Dr. Francesca Rizzo
Dr. Roger Hancock
Dr. Karen Chan

Course Goals
The course “Function and Dysfunction” integrates the disciplines of physiology,
pathophysiology, pharmacology, anatomic pathology, and clinical pathology. These
disciplines, particularly the latter two, provide a bridge between the basic sciences and clinical
medicine. Broadly, the overall goal of this course is that:

Students will gain a competent understanding of the integrated function and

dysfunction of body systems from the molecular/cellular level to the whole
organism.Within this context, students will appreciate the fundamental basis
of relevant diagnostic techniques and appropriate therapeutic strategies.

The animal body comprises a large set of highly complex, but integrated, biological
systems that operate over a wide range of levels, from the molecular to the whole animal.
These systems provide mechanisms for gathering information from and interacting with both
the external and internal environment, maintaining stability of the internal environment, and
repairing structures and mechanisms that have undergone injury. This course is designed to
develop an understanding of how an animal maintains itself as a functional organism in the
face of environmental challenges, disease entities, functional and structural disorders, and
injuries of all sorts. It is concerned with understanding how body systems work, how they are
controlled and regulated, how veterinarians assess their function, what can go wrong with
them, how they undergo repair, and how the veterinarian can aid the repair process.

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Function and Dysfunction Knowledge Structure
The following 5-point outline provides the vital structure for the knowledge you will
acquire in this course. Using this structure, you will build a database of knowledge that is
transferable (useful) no matter the body system or species. This knowledge structure should
be used to organize your studying and the way you think about clinical cases, and as a means
of self-assessment.

1. Whole animal level

• What “services” does this system provide for the animal?
• What clinical signs are commonly associated with dysfunction of this system?

2. System/organ level
• What are the organs in this system?
• What are the functions of the organs and tissues in this system?
• What control mechanisms(s) exist to regulate the functions(s) of this system?
• What factors (internal and external) can perturb the control mechanism?
• What are the consequences of loss of control of this system?
• How is the function of this system related to the function of other systems?
• How does this organ handle both exogenous and endogenous compounds?

3. Tissue/cell level
• What is the specialized structure of each of the various cell types in this organ?
• How are cells in this system specialized (structurally and functionally) to carry out the
functions of the system?
• How are the different cell types organized (spatially and/or temporally) with respect to one
another?
• What functions do the specialized cell types and the organization of those cell types confer on
the organ?

4. Injury/Repair
• What are the various ways in which this system can undergo injury?
• What lesions are commonly encountered and what is the etiology and pathogenesis of each?
• How do the tissues in this organ respond to injury?
• How do uninjured cells respond in the presence of injured cells in this organ?
• How is the function of this organ affected by injury to its cells?
• How are other systems affected by cellular injury in this organ?
• What are the clinical consequences of injury to this organ system?
• How is cellular injury (organ dysfunction) in this organ detected clinically?
• What is the prognosis for organ or whole animal function given a specific injury to this system?

5. Modulation
• What subcellular functions of the cells in this system are subject to modulation by exogenous
and endogenous factors (drugs, toxins, neurotransmitters, hormones, etc.)?
• How is system function affected by modulation of subcellular functions?
• What factors enhance or impede the access of pharmacologic agents to the cells in this
system?

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Course Structure and Format
The various disciplines that contribute to this course are organized into the following
sections: Nervous System and General Pharmacology, Skeletal Muscle, Blood, Urinary System,
Cardiovascular System, Respiratory System, Gastrointestinal Tract, Liver, Pancreas, Endocrine
System, Reproductive System, and Ruminants. Each section of the course will address the
relevant physiology, pathology, and pharmacology of the system of interest using a problem-
based approach.

Tutorial cases
Problem-based learning (PBL) tutorial sessions are a major component of Function and
Dysfunction. They are designed to reveal the principal concepts (objectives) for each section
and provide a vehicle for developing a deeper understanding of “big ideas”. Tasks embedded
within case material provide additional explicit guidance for students regarding the content
focus of the case. Note that the focus of learning during tutorial sessions is not diagnosis or
treatment, per se, but the basic medical science that underlies and explains the
development, presence, and treatment of clinical signs. In this way, a solid foundation for
the practice of medicine is developed.
Learning content (facts) in this course is not sufficient simply because veterinarians
require skills that go beyond memorization. The following clinical reasoning process will be
learned and used routinely during tutorial sessions:
1. Create diagnostically and therapeutically useful problem lists.
2. Generate multiple pathophysiological hypotheses to explain diseases and
disorders.
3. Perform diagnostic tests to distinguish among proposed hypotheses.
4. Utilize rational therapeutic management strategies.
5. Manage patients over extended periods of time.
6. Develop life-long strategies for extending their expertise after leaving veterinary
college.

Lectures
In Function and Dysfunction, lectures are fewer in number and have a different role
from lectures in many other courses that students have taken. They do not define the course
content. Lectures serve to:
1. elaborate concepts that the faculty knows are difficult for students.
2. introduce and expand on topics that are not addressed by the small-group
activities, but that are essential components of the veterinarian’s database of
knowledge.

Laboratories
In addition to lectures, laboratories complete the didactic teaching component of the
course. Mainly dry labs in physiology and pharmacology, and wet labs in pathology help
students master these disciplines in an application-oriented context.

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Resources / Textbooks
Students will probably decide to purchase a limited number of texts, including one
physiology textbook, and each text has its own particular strengths and weaknesses. Here,
we offer some recommendations based on student feedback and the teaching experience
and expertise of faculty. In addition to answering the question, “which books should I buy?”,
the following discussion of textbooks serves as guidance regarding the best places to find
answers to questions and learning issues that arise during your tutorial sessions.

Physiology
It is recommended that students purchase a copy of Costanzo’s Physiology1. Its level of
detail is adequately deep, while it is still “digestible” for students learning physiology for the
first time. Costanzo’s is a human physiology text, it still “works” for us because this course is
comparative in nature and, of course, humans are animals. When using a human physiology
text, you will still need to consult supplementary texts that address topics of rumen function
and animal reproduction. This book is available in several copies in the PBL rooms.
The 13th edition of Dukes’ Physiology of the Domestic Animals2 is another good resource
for the course. Dukes’ frequently invokes veterinary applications, covers basic physiological
principles well, and includes self-evaluation questions at the end of each chapter. This book
is also available in the PBL rooms, as well as online through the CityU Library’s website. In
addition, Senger’s Pathways to Pregnancy and Parturition3 is a good source of information on
veterinary reproduction.
Boron and Boulpaep’s Medical Physiology4 is a highly detailed human physiology text
for further reading. Its level of depth is beyond our course’s scope but it might be useful for
looking up selected details. The e-book version is available through the CityU Library’s
website.
For general information, Ettinger’s Textbook of Veterinary Internal Medicine5 is
designed foremost as a clinical text but contains much valuable pathophysiology and will be
very useful during your tenure in veterinary school as well as after you graduate. The first 150
chapters or so are very short discussions of single topics (e.g., pulse alterations, vomiting,
syncope) that are very useful in Function and Dysfunction. Since new editions are published
approximately every five or six years, many students opt to wait on purchasing Ettinger until
the newest version comes out. The eighth edition was released in early in 2017.

1
Costanzo, L.S. (2018). Physiology, 6th ed. Philadelphia: Saunders.
2
Reece, W.O., Erickson, H.H., Goff, J.P., Uemura, E.E., ed. (2015) Dukes' Physiology of the Domestic Animals.
13th ed. Ames, IA: Wiley.
3
Senger, P.L. (2012). Pathways to pregnancy and parturition 3rd ed., Pullman, WA: Current Conceptions.
4
Boron, W. F. and E. L. Boulpaep. (2016) Medical Physiology: A Cellular and Molecular Approach. 3rd ed.
Philadelphia: Saunders.
5
Ettinger, S.J., Feldman, E.C., and Cote, E. (2017) Textbook of Veterinary Internal Medicine. 8th ed. Philadelphia:
Elsevier.

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Anatomic and clinical pathology
Zachary’s Pathologic Basis of Veterinary Disease6 is the most appropriate source for
information on both gross and microscopic pathology. This text is available in the PBL rooms
as well as through the CityU Library’s website.
For clinical pathology, Stockham and Scott’s Fundamentals of Veterinary Clinical
Pathology7 is the text that is resident in tutor rooms. Furthermore, the eclinpath.com website,
created by Cornell’s clinical pathologists, is a resource that is extraordinarily useful, fast, and
easy to use.

Pharmacology
Rang and Dale’s Pharmacology8 is an excellent and comprehensive resource for
pharmacology. Its breadth and depth is beyond the scope of our course, but it contains a great
collection of basic principles of pharmacology. Hsu’s Handbook of Veterinary Pharmacology9
is another good resource for the pharmacology topics in Function and Dysfunction. Both texts
are available in the PBL rooms.
It should be pointed out that the pharmacology component of this course is focused on
the mechanism of action of drugs, as they interact with physiological and pathological
mechanisms that are core subjects in Function and Dysfunction. Students are not expected to
learn dosages or drug regimens of particular diseases at this point of their curriculum. The
Clinical Pharmacology and Toxicology course in Semester 7 heavily builds on the general
pharmacology and mechanism of action of drugs studied in Function and Dysfunction.
On a note of learning drug names, as a veterinarian, you will be expected to know the
names, uses, and mechanisms of action of a large number of drugs. The generic (also known
as nonproprietary) name of a drug is more informative than the trade name and is the one
that you will find in pharmacology books and internal medicine texts, among others.
However, practicing veterinarians often use the proprietary (trade) names of drugs and
formulations. Therefore, being familiar with both names will be important, but knowing the
drugs by their generic name is sufficient at this point.

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Zachary JF, eds. (2017). Pathologic Basis of Veterinary Disease. 6th ed. St. Louis, MO: Elsevier; Elsevier Health
Sciences.
7
Stockham, S. L. and Scott, M.A. (2008) Fundamentals of Veterinary Clinical Pathology. 2nd ed. Ames, IA: Iowa
State Press
8
Rang H, Ritter J, Flower R, Henderson G (2016). Rang & Dale's Pharmacology 8th ed. London: Elsevier
Churchill Livingstone.
9
Hsu, W.H., ed. (2008) Handbook of Veterinary Pharmacology. Wiley-Blackwell

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Assessment
Academic Integrity:
For all assignments, students are required to abide by CityU’s Rules of Academic
Honesty. Further, each student in this course is expected to abide by CityU JCC’s BVM Honor
Code. Any work submitted by a student in this course for academic credit will be the student’s
own work. Article III of the Honor code lists rules of conduct for students and is available for
review in the student handbook. Specifically, the following rules apply for all examinations in
Function and Dysfunction:

1. You must do your own work. Talking or discussion is not permitted nor may you
compare papers, copy from other students or collaborate in anyway.
2. Examinations, both past and present, are not to be copied or shared with other
students. You may not print or record questions or answers from online
examinations.
3. Past examinations may not be viewed or used for study purposes.
4. Examinations are closed book. Closed book means that no other resources may
be used including, for example, books, class notes, electronic materials, or
communication with other students.
5. With the exception of information specifically associated with an examination,
accessing digital (electronic) data, including text, images, video, or audio
(including music), during an examination is not permitted.
6. Any awareness of violations of the Honor Code should be reported to the course
leader immediately.

Quizzes
There will be one quiz approximately every two weeks during the course. Together, they
will be worth 25% of the final grade. Quizzes are part of the continuous assessment and test
knowledge of one or two weeks’ material. They will be a combination of multiple-choice and
short answer questions, and will draw on material from tutorial cases, lectures, and labs. All
quizzes are closed-book. Quizzes will be taken at the scheduled time on campus in the
designated lecture room.

Mid-term exam
There will be one mid-term exam, which will be worth another 25% of the final grade.
The mid-term is also part of the continuous assessment and it test knowledge on the content
of the first half of the course. The mid-term will be mainly case-based, containing mostly
short-essay questions. Hence, it will test application of medical knowledge and clinical
reasoning in a similar way as practiced in PBL tutorials, in addition to assessing factual
knowledge. The mid-term is also a closed-book exam, and it will be taken at the scheduled
time on campus in the designated lecture room.

Final examination
The final examination will be comprehensive and worth 50% of the final grade. The
exam at the end of the semester will include all disciplines and all organ systems handled
during the course. The exam will consist of multiple-choice and short answer questions as

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well as case-based questions, containing short-essay questions. Accordingly, your PBL tutorial
sessions will provide excellent preparation for the final examination. It should be pointed out
that simply knowing a lot of facts is insufficient preparation for the exam. Most of the
questions on the exam require students to apply, integrate, and synthesize concepts. These
are skills that require a lot of practice and you should approach your PBL tutorials with this in
mind. The final examination is also a closed-book exercise. Other details concerning the final
exam, including grading criteria, will be announced later in the course.

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A short glossary of abbreviations

BLOOD CHEMISTRY

SODIUM POTASSIUM CHLORIDE TOT CO2 CALCIUM

total CO2

PHOSPHATE ALBUMIN GLOBULIN A/G UREA N

phosphate albumin/globulin blood urea
or ratio nitrogen (BUN)
phosphorus

CREATININ GLUC CHOLESTER LIPASE ALT

creatinine glucose cholesterol alanine
amino
transferase

AST ALK PHOS GGT TOT BILI CK

aspartate alkaline gamma total bilirubin creatine kinase
amino- phosphatase glutamyl
transferase transferase

Na:K ANION GAP TOT PROT

Na:K ratio total protein

Iron TIBC %SAT

total iron % saturation of
binding capacity transferrin

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BLOOD GAS ANALYSIS
pH = pH

PCO2 = partial pressure of CO2

PO2 = partial pressure of O2

HCO -3 = bicarbonate

TCO2 = total CO2 (dissolved CO2 + bicarbonate = (0.03 x PCO2) + bicarb)

SBE = standard base excess (base excess of extracellular fluid)

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CBC
complete blood count

HCT HB RBC MCV MCH

hematocrit hemoglobin red blood cell mean mean
PCV count corpuscular corpuscular
packed cell vol. volume hemoglobin

MCHC RDW WBC SEG N BAND

mean red cell white cell count segmented band neutrophils
corpuscular distribution neutrophils
hemoglobin width
conc.

LYMPH MONO EOSIN BASO PLAT SMEAR

lymphocytes monocytes eosinophils basophils estimate of
platelet numbers

S+IV PLAT TP-REF NUCL RBC RETICU

platelet count total protein nucleated rbc reticulocytes
onS+IV using
counter refractometer

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CENTESIS FLUID (CYTOLOGY)
SPECIMEN SUMMARY:
Peritoneal Fluid, EDTA

SMEAR TYPE SAMPLE VOL QL-SMEAR CELLS-SMR COLOR

quality of the *
smear

TURBIDITY TP-REF NUCL CELL TOTAL RBC TP-CSF

total protein nucleated cells total red blood total protein
using cells cerebral spinal
refractometer fluid

* CELLS-SMR is a subjective rating of the numbers of cells seen on the smear. Not used by
clinicians very often if at all.

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URINALYSIS
COLOR TURBIDITY SP. GRAVITY pH-STIX PROT-STIX
specific gravity pH using stick protein using
stick

GLUC-STIX KET-STIX BILI-STIX BLOOD-STIX PROT-SSA

glucose using ketones bilirubin using blood using stick protein using
stick using stick sulfosalicylic
stick acid

WBC/HPF RBC/HPF BACTERIA EPITH CELL SPERM

white blood cells red blood cells epithelial cells
per high power per high power
field field

FAT DROP DEBRIS CASTS CRYSTALS

fat droplets

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FURTHER COMMON ABBREVIATIONS
AV
atrio-ventricular (valves)

CRF
chronic renal failure (being replaced with “chronic kidney disease”)

CRT
capillary refill time

GFR
glomerular filtration rate

PCV
packed cell volume (hematocrit or “crit”)

PMI
point of maximal intensity

QAT
quick assessment test

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