Warwick
Medical School
MB ChB Phase I
Essentials of Clinical Medicine
Essentials of Clinical Medicine
Module Leader
Module LeaderDr Alex Conner – Assistant Professor
Warwick Medical School
Co- Module Lead –Dr David Tweedie - Clinical Tutor for WMS
Contact details for all the lecturers in this module are contained at the top of their session pages.
Introduction
The module Essentials of Clinical Medicine is designed to underpin the MBChB course by providing an introduction to major topics that feature in the integrated curriculum that occur in Phase I, such as, the nervous system and neurobiology, musculoskeletal system, infection and immunity, the respiratory and cardiovascular systems. This module will also introduce generic subjects such as anatomical terminology, medical imaging, histology, metabolism (nutrition), early embryonic development, and pathology. It will also provide the essential basic understanding to support student’s knowledge base as they move through Phase I modules.
Aim
The aims of the module are to enable students to
- Provide an understanding of major topics that will feature in the integrated curriculum undertaken in Phase I.
- Address the essential components of basic body system ‘ultra’ and ‘gross’ structure in order to be able to evaluate and understand the complexities arising across subsequent modules.
- Promote a conceptual and information based understanding of body systems and pathology.
- Broaden students knowledge base of basic principles and skills relevant to the core modules in Phase I
Pre-requisites
Before each lecture and group work, students should read the relevant section of the handbook and web pages, download any necessary handouts from the web and examine any appropriate text to support their understanding of the topic(s) to be addressed.
Summary of Intended Learning Outcomes
- It should be noted specific detailed learning outcomes will also be addressed within the specific topics. Overall on completion of this module, students should be able to:
- Use and understand appropriate basic terminology across body systems (Gastrointestinal tract, cardiovascular system, Nervous System, Respiratory) in the description of both normal and pathological conditions
- Describe and understand the fundamentals of normal function of cellular systems and pathogenic consequences
- Understand basic medical terminology for use in anatomy, medical imaging, histology and immunity and infection.
- Explain the fundamentals of the organisation of organ systems in health (Cardiovascular system, Nervous System, Respiratory system). This would include an ability to describe the basic histology of epithelia, connective tissue and mucosa.
- Outline the basic pathology of organ damage
- Describe mechanisms responsible for intracellular regulation and homeostasis in health and disease.
- Explain the medical basis of pathological conditions and influences on health to identify better models of patient care and clinical perspectives.
- Describe normal neo-natal development and metabolism and evaluate the consequences for pre-term nutrition
- Understand the fundamentals of drug interaction and the consequences for prescribing
Sessional Structure & Teaching Methods
Sessions will contain a mixture of lectures and group-work based sessions. A typical session will comprise of a lecture followed by group work. The lecturing staff will provide the relevant case histories or associated questions related to the specific sessions, with students expected to act as discussants. Teaching staff will guide and moderate subsequent discussion as and when deemed appropriate to the session.
Assessment
Material from this module will be included in the End of Semester (ESA) written assessments and Objective Structured Clinical Examinations (OSCE) and may be included in all subsequent assessments in Phase I.
Suggested Reading
Clinical Medicine
By P Kumar, M Clark, and W.B Saunders
Edition: 6 illustrated, Published by Elsevier Saunders UK, 2006
ISBN: 0702027634
Clinically Oriented Anatomy: Student CD-ROM [CD-ROM].
By K.L. Moore, A.F Dalley, A.M.R Agur.
Edition: 5, illustrated.
Published by Lippincott Williams & Wilkins UK, 2006
ISBN 0781736390, 9780781736398
Illustrated Clinical Anatomy.
By P Abrahams, J. Craven andJ Lumley
Edition: 1, illustrated
Published by Hodder Arnold UK, 2005.
ISBN 0340807431
Human Physiology: The Basis of Medicine,
By G Pocock and C.D Richards,
Edition: 3, illustrated.
Published by: Oxford University Press UK, 2006
ISBN 0198568789
Introduction to Clinical Examination
By M.J Ford, I Hennessy, A Japp
Elsevier 2005
Pathophysiology of Heart Disease
By L.S Lily
Edition: 4
Published by Lippincott, Williams & Wilkins UK, 2006
ISBN 0781763215
Pathology.
By A. Stevens and J Lowe
Edition: 2
Publisher: Mosby UK, 2000
ISBN 0-723432007
Sessions during Induction Week
All sessions will take place in the MTC Lecture Theatre
DATE / SESSSION / TITLE / LECTURER7 September / 1
2 / Introduction to Essentials of Clinical Medicine
1.45 – 2.15pm
Introduction to the Terminology of Medicine
2.15 – 5.00pm / Dr Alex Conner and Dr David Tweedie
Professor Peter Abrahams
8 September / 3
4 / Embryology
9.00am – 12.15pm
Introduction to Molecules
1.45 – 4.00pm / Dr Carolyn Rodgers
Dr Sinclair Steele
9 September / 5
6 / Introduction to Pathology
9.00am – 12.15pm
Histology, chemical pathology, haematology and microbiology
1.45 – 5.00pm / Dr Paul Matthews
Dr Paul Matthews
10 September / 7
8 / Introduction to Clinical Skills: What is a sign – The Physical Examination
9.00am – 12.15pm
Integrated Learning Session – Putting the week together
1.45 – 5.00pm / Dr Linda Maxwell
The Clinical Education Fellows
Semester 1 Timetable
All sessions are on Tuesday afternoons in the MTC LT 1.45 – 5.00pm
DATE / SESSION / TITLE / LECTURER14 September / 9 / Introduction to Clinical Scenarios and Evidence Based Medicine / Dr Jeremy Shearman
21 September / 10 / Introduction to Physiology / Dr David Tweedie and Dr Barney Ward
28 September / 11 / Introduction to Molecules / Dr Sinclair Steele
5 October / 12 / Respiratory & Cardiovascular Anatomy / Dr David Tweedie
12 October / 13 / Cell Physiology / Dr Alex Conner
19 October / 14 / Introduction to Neurobiology / Dr Dawn Collins
26 October / 15 / Introduction to Imaging Techniques / Dr Fraser Millard
2 November / 16 / Molecules in the Human Body / Dr Graham Ladds
9 November / 17 / Homoestatis / Professor Peter Stanfield
16 November / 18 / Integrated Session* / Clinical Education Fellows
23 November / 19 / Clinical Skills 1
MedLine Training / Samantha Johnson
30 November / 20 / Clinical Skills 1
Evidence Based Medicine Training / Samantha Johnson
- Students to meet in LT at 1.45pm for briefing by CEFS. Break into groups and go with an identified CEF to work on an area covered by EoCM. Students to have e-mailed in advance if they want a particular area covered.
Session 1
Date:7 September 2010
Introduction to the module
Module Leaders: Dr Alex Conner – Assistant Professor
Dr David Tweedie – Clinical Tutor WMS
Email:
Overview
This module was started in 2008 and is undergoing constant development. It has been changed in the light of comments from both students and staff involved in the 2009 cohort running. Your feedback throughout the running of the module is important and you do not have to wait until the end to let us know what is working really well and those areas that you feel require further attention/revision
Aims
To explain the rationale behind the planning of the module including the different educational backgrounds of students in your cohort.
To encourage students with limited scientific background to understand very basic concepts.
To encourage students with more substantial scientific backgrounds to help their colleagues in group work.
To stress the clinical importance of this knowledge.
Intended Learning Outcomes
After this session you should:
- Appreciate the principles underlying the module
- Appreciate the relevance of the material to clinical medicine
Session 2
Date: 7 September 2010
Introduction to the Terminology of Anatomy and Anatomy Group Work
Session Leader:Professor Peter Abrahams
Email:
Overview
A lecture will introduce about 100 common anatomical terms which form the basis of medicine. During the next three years most of you will DOUBLE your vocabulary and in this first week will use about 300 new terms.These terms are the very basis of medical practice and knowing about their origins will make it easier to work out the meaning in years to come. A special section on imaging and radiological terminology will also been provided at a future session.
Teaching Aims
Togain insight into the use of medical / anatomical terminology as used throughout your future medical practice.
Intended Learning Outcomes
By the end of the session or at least by the end of the first two weeks you should be able to:
1.“Translate” half a dozen typical case histories from medical terminology into common language.
2.Be able to write a description of a person in a certain position or injury so that a fellow student could make themselves into that stance.
3.Be aware of the range of new terms especially prefix and suffixes that often give clues to meaning.
Structure of the Session:
1.Lectures with video clips etc. to illustrate the many terms used.
2.Group work based on “Chinese Whispers”. Pictures of anatomical odd patients which you will have to describe and pass to the next group who will then enact the position you have written down . They will do the same for you from a different set of pictures.
3.Plenary session translating the written word into actions and making “statues”.
Cross-Modular Themes
Every new term used in these sessions will be used constantly over the next 30 years of your medical career.
Suggested Reading
Anyanatomy text book- the first chapter or two on terminology.
Illustrated Clinical Anatomy, ISBN 0 340 80743 1 by Abrahams Craven Lumley Hodders. This also has a website with 1000 downloadable jpeg files of anatomy and clinical medicine.
Another similar short book recommended is Essential Clinical Anatomy by Moore and Agur Williams Wilkins. An atlas is a very good way of seeing and learning anatomy and there are many on the market- some have lots of clinical cases and pictures on DVDs.
Terminology used in Anatomy is the foundation language and cornerstone of all medical practice, it is the language that one doctor uses to describe accurately a clinical situation to another person in the team.. Most average people have a normal Englishvocabulary of around 5000 words. Your new medical vocabulary will have doubled that figure in the next few years - so the sooner you start learning it the easier all medical subjects will seem. Learning precision in clinical medicine starts today with the anatomical words, their origins and definitions. By the end of just your first afternoon you will have gained approximately 300-400 new terms and be able to use them in a correct context. Learning this new medical language will make reading and lectures so much more comprehensible day by day so that in future you will be able to work out new terms from first principles. Many of you will feel overloaded with new facts at the end of these sessions but do not worry- it does get easier as time passes- believe me!
Group Work in Tutorial rooms
Each group of students will be given one photo with two different numbered anatomical everyday poses on it.
You will then WRITE a description of that person’s position in anatomical / medical terminology (5-10 minutes) and then pass on the written text and number to the group next door.
They will then swap with you their written descriptions of their numbered positions.
You will then take their description and work out the position of their photos (5-10 minutes). With these two positions you will then send members of your group to act out in the lecture theatre at the plenary session for all to see how accurate your interpretations are.
It is like Chinese Whispers with Medical Terminology
PREFIXES
PREFIX / MEANING / EXAMPLEa-,ab- / away from / abduction
ad, ac-, af-, al- / to, towards, near / Afferent nerve fibres
ambi- / both, double / ambidextrous
ante- / before, in front / antebrachium
bi, bin-, bis- / two, double, both / biceps
circum- / around / circumflexion
co-, col-, com-, con-,cor- / together, with, very, thoroughly / Contraction
contra- / against, opposed / Contraceptive
de- / away from, down, absent / Depression
dis-, dif-, di- / apart, away / Dissect
ex-, e-, ef- / out of, away from / Emission
extra- / (on the) outside, beyond, outward / Extracranial
in-, il-, im-, ir- / Not, in, into, very, thoroughly / indigestible, immersion, intoxicate
infra- / below, beneath / Infracostal
inter- / between / Intercostals
intra- / inside, within / Intrauterine
intro- / into, inward / Introflexion
non- / not / non-toxic
post- / after, behind / post-traumatic
sub-, suf-, sup- / under / Subcutaneous
super-, supra- / above, excess / Suprapubic
trans- / across, through / Transvenous
SUFFIXES
SUFFIX / MEANING / FUNCTION FORMS/INDICATES / EXAMPLE-al / pertaining to / adjectives / Facial
-an / pertaining to / adjectives / Median
-ar, -ary / pertaining to / adjectives / fibrillar, fibrillary
-ation / condition, state / nouns (indicates process or action) / Ossification
-ion / act of / nouns / Contraction
-ive / pertaining to / adjectives / Antitussive
-ous / pertaining to / adjectives / Pyogenous
-or / agent, person, instrument
MATCH THESE / nouns / Respirator
LIST A / LIST B
- abduction
- adduct
- adrenal
- antero-inferior
- anterolateral
- bilateral
- dextrad
- dorsiduction
- extracystic
- extroversion
- interdental
- intero-inferior
- interrenal
- intra-articular
median plane of the body
- intracardiac
- intracerebral
- intra-oral
- intra-osseous
- intravenous
- intravesical
- mediolateral
- postbrachial
- postero-anterior
- posterolateral
- sinistrad
- subcutaneous
- sublingual
- superoposterior
- suprarenal
- transvesical
1.A 50-year-old man was admitted to hospital. He was is hypovolaemic (Latin: volumen: volume) shock. Haematemesis and bleeding perrectum were conditions reported by the paramedic.
On admission his haemoglobin count was found to be low, and thrombocytopenia as well as deranged clotting of blood was noticed.
In spite of being resuscitated with packed red blood cells and frozen plasma, haemorrhage and deterioration in his coagulopathy occurred (coagulation: clumping together of blood cells; clotting) the following day. An upper gastrointestinal endoscopy was performed. This revealed a large quantity of blood in the patient’s stomach and oesophagus, as well as oesophageal varices. The patient’s condition deteriorated further and he died.
A post-mortem was held. The pathologist noted in his report the body of a middle-aged man, deeply jaundiced with gynaecomastia, the abdomen markedly distended and moderate oedema. A large quantity of straw coloured fluid was present in the peritoneal cavity and numerous varices were found in the distal end of the oesophagus. Hepatic cirrhosis and splenomegaly were noticeable. Blood was found in all parts of the intestinal tract. Histology of oesophageal tissues indicated large-scale submucosal venous dilatation while the liver showed micronodular cirrhosis (cirrhosis; end-stage liver disease characterised by nodular regeneration).
2.A 70-year-old man visited his physician complaining of dysphagia and dyspnoea. He also referred to a swelling in his neck, suspecting a goitre.
After physical examination, a needle biopsy and an ultrasound scan the physician diagnosed thyroid cancer.
He recommended an immediate thyroidectomy and a dissection of the neck to search for and remove enlarged lymph nodes.
3.A 36-year-old woman visited her physician complaining about pain in the right side of her thorax and some apnoea. During the physical examination the physician observed tachypnoea and evidence of shock. He also noted varicose veins, especially in her right thigh and calf and on questioning she told him that she had had painful varicose veins in her lower limbs for some time. On cardiac examination he detected tachycardia and arrhythmia. The physician performed an ECG and also requested a pulmonary angiogram and fluoroscopy. Fluoroscopy of the patient’s lungs revealed poor or absent pulsations in the descending branch of the right pulmonary artery and relative anaemia of the right lung.
Diagnosis: a thrombus from a varicose vein in the lower limb caused pulmonary thromboembolism.
4.A markedly obese woman visited the physician for a right-sided abdominal pain. The pain dated from two years ago when, at first, intermittent episodes of epigastic pain lasting two to four hours occurred. At the time cholecystitis with cholelithiasis was diagnosed and a cholecystectomy was performed. Five large gallstones were found. Since then everything had gone well until about four months ago when right-sided pain taking a crescendo pattern started again. It did not cause nausea or emesis and there was no urge to defaecate. Apart from the cholecystectomy mentioned, her past medical history was only marked by an appendicectomy a tonsillectomy and an arthroplasty. A physical examination confirmed her obesity. She was, anicteric. Her neck revealed no lymphadenopathy or thyromegaly. No hepato-or splenomegaly could be observed and a haemo-negative stool was registered. No oedema was apparent. Laboratory tests indicated no gastrointestinal abnormalities and the kidneys showed no signs of hydronephrosis
Diagnosis: As physical examination and laboratory tests did not suggest specific abnormalities or deviations, an occult nephrolithiasis could be diagnosed.
5.Mrs Fairburn (59) was admitted to hospital complaining of severe pain in the upper right part of the abdomen. She was anorexic, febrile and nauseous. She also complained of intermittent emesis. Although her sclerae (outer layer of eyeballs) were yellow she was not particularly jaundiced. Tenderness and guarding were present in the upper quadrant of the anterior abdominal wall.
Radiological and laboratory tests were performed and cholecystits resulting from calculi in the gallbladder was diagnosed. A cholecystectomy was performed by laparoscopy and a gallstone was removed from the bile duct after choledocholithotomy