APPLYING THE BASIC SCIENCES TO CLINICAL MEDICINE
3
PART 1. APPROACH TO LEARNING BIOCHEMISTRY
Biochemistry is best learned by a systematic approach, first by learning the
language
of the discipline and then by understanding the
function
of the var-
ious processes. Increasingly, cellular and molecular biology play an important
role in the understanding of disease processes and also in the treatment of dis-
ease. Initially, some of the terminology must be memorized in the same way
that the alphabet must be learned by rote; however, the appreciation of the way
that the biochemical words are constructed requires an understanding of mech-
anisms and a manipulation of the information.
PART 2. APPROACH TO DISEASE
Physicians usually tackle clinical situations by taking a history (asking ques-
tions), performing a physical examination, obtaining selective laboratory and
imaging tests, and then formulating a diagnosis. The conglomeration of the
history, physician examination, and laboratory tests is called the
clinical data-
base.
After reaching a diagnosis, a treatment plan is usually initiated, and the
patient is followed for a clinical response. Rational understanding of disease
and plans for treatment are best acquired by learning about the normal human
processes on a basic science level; likewise, being aware of how disease alters
the normal physiologic processes is understood on a basic science level.
PART 3. APPROACH TO READING
There are six key questions that help to stimulate the application of basic sci-
ence information to the clinical setting. These are:
1.
What is the most likely biochemical mechanism for the disease
causing the patient’s symptom or physical examination finding?
2.
Which biochemical marker will be affected by treating a certain
disease, and why?
3.
Looking at graphical data, what is the most likely biochemical
explanation for the results?
4.
Based on the deoxyribonucleic acid (DNA) sequence, what is the
most likely amino acid or protein result, and how will it be mani-
fest in a clinical setting?
5.
What hormone-receptor interaction is likely?
6.
How does the presence or absence of enzyme activity affect the bio-
chemical (molecular) conditions, and how does that in turn affect
the patient’s symptoms?
1.
What is the most likely biochemical mechanism for the disease
causing the patient’s symptom or physical examination finding?
This is the fundamental question that basic scientists strive to
answer—the underlying cause of a certain disease or symptom. Once
this underlying mechanism is discovered, then progress can be made
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