Tutorial: Sarah Rosenthal MF1 Respirology

Part 1, Medical Foundation 1, Respirology, Week 2

Sarah Rosenthal, a 63-year-old woman, has been a smoker for many years and has noticed a gradual reduction in her exercise tolerance over the last three years, finding it more difficult to garden and to walk to her synagogue. She has been able to modify her activities in response to the limitations imposed by her breathlessness but her family has noted her weight has been increasing. When her family noticed that her legs were becoming more swollen and that she was not as "sharp" as usual, they decided to bring her to the emergency room. Her family reports that Sarah has recently visited her family physician and was prescribed a diuretic for her ankle swelling.

Active Large Group Session: Food Security

Part 1, Medical Foundation 1, Introduction to Medicine, Week 2

Mapping of food resources across Hamilton including supermarkets, community gardens and Food banks and to do the same for Niagara and Waterloo regions. We hope this leads to discussion about disparities in food access across communities and may tap into the concept of food deserts.

Clinical Skills Sessions: Introduction and Overview of Volume Status Exam

Part 2, Medical Foundation 2, Renal, Week 1

To discuss and to practice the components of the Volume status history and physical examination.

Tutorial: Maxwell Greenfield MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 1

Maxwell Greenfield is a 32 M was admitted under the general medicine service last night with gastroenteritis. It is your first day on the hematology rotation and you are called to provide a consult for new onset pancytopenia in Maxwell. Maxwell has a history of Crohn’s disease, diagnosed at the age of 28. He is currently on methotrexate 20 mg subcut weekly to control his disease, which he has been on for the last two years. He does not take any other medications at home. He has no other medical problems. Maxwell initially presented to hospital with nausea, vomiting, and diarrhea after eating some old chicken he found at the back of the fridge. He did not have any blood in his bowel movements or mucous. He has note noted any fever.

Tutorial: Li Chin and Baby Albini MF3 Reproduction

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 4

Li Chin is a 19-year-old woman from Hong Kong who has been in Canada for one year studying Computer Science at McMaster University. She is a known carrier of Hepatitis B, but is otherwise healthy and on no medication. You are a family physician working at Student Health Services at the university. Li came to see you today for a routine prenatal appointment at 28 weeks gestational age. You inquire as to Li's plans for feeding her baby after birth. She is uncertain and has not yet considered this. When you recommend that she breastfeed her baby, she asks why. She doesn’t know anyone who has breastfed. She is uncertain as to whether or not she would be able to do it.

Tutorial: All MF3 Gastroenterology and Nutrition tutorial problems

Part 3, Medical Foundation 3, Gastroenterology and Nutrition

Large Group Session: Ask Me Anything: Concepts, Tools and Key Issues for Nutrition and Health

Part 3, Medical Foundation 3, Gastroenterology and Nutrition

The major topics will be: Nutrition for growth and development; Nutrition for prevention of diabetes and cardiovascular disease; Nutrition for prevention of cancer

Tutorial: Nick DeMarco MF3 Gastroenterology and Nutrition

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 1

Nick DeMarco is a 51 year old physical education teacher at a local elementary school. He has noticed increasing fatigue with exertion and complains about feeling exhausted at the end of the school day. He explains that he has been experiencing epigastric discomfort after eating and he has tried taking Advil for pain relief. He states the pain and regurgitation wakes him up at night. He reports that he is usually able to get back to sleep after taking antacids and a glass of milk.

Tutorial: Jane Deglutinato MF3 Gastroenterology and Nutrition

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 1

Jane Deglutinato is a 50-year-old female with a 4-month history of progressive dysphagia, symptomatic heartburn and regurgitation that has not responded to the use of regular non-prescription oral antacid medications. She has also noticed some general joint discomfort and painful swelling of her fingers with occasional pain and discoloration of the fingertips. She also reports having lost approximately 9 lbs of weight over that period of time related to a reduction in her appetite. Her bowel movements continue to be formed with no evidence of blood or fatty stool. On examination, her vitals are within normal limits and she is afebrile. Her weight is 55 kg. You notice that she has some tightening of the skin around her mouth as well as her fingers and toes, with pitting and some ulceration of the fingertips on both hands and toes of both feet. You also note several telangiectasias over her chest and upper torso. Cardiac and respiratory as well as abdominal examinations are unremarkable.

Tutorial: Hannah Rosen Part 1 MF3 Gastroenterology and Nutrition

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 1

Hannah, a 1-year-old girl, is brought to the clinic for a routine immunization by her mother. Mr. and Mrs. Rosen have a healthy 5-year-old boy at home. The pregnancy with Hannah was uneventful and a fetal ultrasound done at 16 weeks gestation was normal. The baby was born by spontaneous vaginal delivery, breathed immediately, and was placed on the breast for mom to nurse. Hannah's birth weight was 3.4 Kg. After seeming to feed normally for 24 hours, Hannah vomited bile and the abdomen was noted to be distended. An x-ray was interpreted as showing a distal small bowel obstruction. Further contrast x-rays of the colon showed a microcolon and inspissated meconium in the proximal colon, making a diagnosis of meconium ileus. Genetic testing confirmed cystic fibrosis. After a lengthy hospitalization to correct the bowel obstruction, Hannah was discharged home receiving exclusive breast milk. At 4 months of age, Hannah was switched to a cow's milk formula. Her mother noticed that she cried a lot. Hannah's mom attributed the symptoms to a milk allergy and progressed through a variety of cow's milk and soy formulae. At present Hannah is taking 1 litre of Rice milk and a small variety of foods daily. She has one small formed stool per day. She weighs 8.5 kg and is 74 cm tall.

Tutorial: James Cork MF3 Gastroenterology and Nutrition

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 2

Dr. James Cork, a 26 year old dentist, has been unwell for over 1 year. During this time he reports he has had diarrhea characterized by four to six loose, bulky stools per day without blood, mucus, or pus. He has been up at least once each night to move his bowels. James has lost 7 kg despite a very good appetite. He has not travelled outside of southern Ontario or been camping. His partner of 7 years, Richard, is in good health and has not suffered any of these symptoms, nor has James been in contact with anyone else with similar symptoms. His family physician found that his hemoglobin is low.

Clinical Skills Sessions: Abdominal Exam Practice Case - Weight loss or diarrhea.

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 3

Practice the Abdominal history and physical examination. This case should be used to practice & to consolidate Abdominal history & physical exam as it pertains to Weight Loss/Diarrhea

Tutorial: John Franks MF3 Gastroenterology and Nutrition

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 3

John Franks is a 66-year-old male with a complicated course of Crohn’s disease over 30 years, requiring multiple surgical resections of his small bowel due to inflammation and obstruction. He has been treated with several immunosuppressive and biological treatments for his IBD, but has had a loss of response to these medications despite some temporary improvement in his disease activity. Despite currently being on ustekinumab (Stelara), John has had evidence of active disease and is currently on a tapering course of prednisone for a recent flare of his IBD. He was recently admitted to hospital with another partial small bowel obstruction and he is worried that he may need further surgery. "They’ve removed so much of my small intestine already that I am worried that I’m going to get short bowel syndrome." You discuss optimizing his dosages of his treatments in an attempt to induce remission of his disease, and to avoid the need for further surgery. He asks: "If I do have short bowel syndrome, what kind of special diet will I need to go on to maximize my nutrition?"

Tutorial: Lauren Bick MF3 Endocrinology

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 4

Lauren Bick is a 13-year-old girl who presents to her family physician's office with a 6-month history of weight loss. Her mother is concerned because she has noticed that Lauren has lost at least 10 pounds since her last doctor's visit which she had just before she started at her new school. Although Lauren has always been a "petite" girl, she is now the shortest in her class. The doctor asks Lauren's mom to give her a few minutes alone with Lauren. Once Lauren's mom has left the room, the doctor reviews the limits of confidentiality with Lauren and asks her about her weight loss. Lauren explains that she has met a new group of friends who do not believe that it is healthy to eat animals so she has joined them in following a vegan diet. She also reports that she's recently joined the long distance running club at her school. Lauren indicates that despite her mother's wishes, Lauren's goal is to get her weight down to 25 kg in the next few months. Lauren requests that you don't tell her mother this as it will likely cause them to argue. Lauren's menarche was at age 11 and she had been having regular menstrual periods but in the last 4 months, she has not had a period. Lauren indicates that she has not been sexually active. On questioning, she reports some constipation and says that she often feels cold.

Tutorial: Amanda Porter MF3 Endocrinology

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 4

Amanda, a 12 year old girl, has been accompanied by her mother to see her family doctor for a routine check-up. Her mother is a single mom who works shift work as an R.N. at the local E.R. department. She and Amanda currently reside in a suburban neighbourhood of Hamilton. Amanda attends a public school in her neighbourhood and complains of being constantly teased by her classmates for being "bigger". According to her mom, Amanda participates in gym class, but does not get much more physical activity than that. Amanda spends a lot of time alone while her mother works shifts. She admits to watching approximately 3 hours of television per day on weekdays and 5 hours on the weekends. She is also on the internet, chatting on MSN, for 1-2 hours per day. Her mother is also obese and is not worried about her daughter's current weight or the sedentary lifestyle and is rather pleased that Amanda is a "good girl". Amanda does not express interest in participating in local clubs or extracurricular activities and indicates that she is simply not an "athletic type" of individual.

Tutorial: Stephen Golding MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 1

Stephen Golding, a 22 year old man presents to the emergency department with nausea, vomiting, abdominal pain and a 3-day history of polyuria, polydipsia, and weight loss. He states that he has "junvenille insulin-dependent" diabetes but stopped taking his insulin 5-days ago.

Tutorial: Emily Bradstone MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 2

A 55 year old female, Emily Bradstone, is seen by a hematologist for easy bruising. No hematological problem was found. An internist also saw the patient. There has been a one-year history of easy bruising, weight gain, worsening of diabetes, difficulty climbing stairs and edema of the ankles

Tutorial: Adam Pajek MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 2

A 40-year old man, Adam Pajek, was seen in a walk-in clinic complaining of palpitations, heat intolerance (felt hot when others were comfortable or cold), sweating, anxiety, weight loss, fatigue, and sleeplessness for two months. He reports that his sister has a hypothyroid problem for which she takes Eltroxin pills.

Tutorial: Julian Knight MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 3

Mr. Knight is a 65-year-old obese male of African descent who works as a miner in Yellowknife, NWT. He smokes one pack of cigarettes per day. Outside of work he is generally sedentary and tends not to leave his home unless it is really necessary. He has a past medical history of type 2 diabetes mellitus, chronic kidney disease and COPD. His medications include metformin, sitagliptin and the inhalers ipratropium and fluticasone. He recently completed a course of prednisone for a COPD exacerbation, which he has a few times per year. He presented to the local Emergency Department after a fall at work. He tripped over a drill bit and fell on his outstretched hand. He felt a snap, followed by severe pain in the left wrist with noticeable swelling and bruising.

Clinical Skills Sessions: Adrenal Exam Practice Case - Adrenocortical disorders

Part 3, Medical Foundation 3, Endocrinology, Week 3

Examples: Cushing’s syndrome, Addison’s disease. Observations of a student(s) taking a history from a patient with adrenocortical disorder. Demonstration by preceptor of examination of a patient with adrenal disorder. Example: blood pressure, skin assessment, pigmentation, weight loss/gain, face and neck assessment. Observation of a student(s) examining a patient with adrenal disorder.

Tutorial: Katherine Cornish MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 1

Katherine is a 16-year-old female attending high school who presents to you with complaints of depressed mood, increased appetite, and weight gain of 30 pounds. She lives with her parents and is an only child. Her mother indicates that her problems started less than one year ago when she was admitted to the hospital for several weeks after fighting at school. She was getting less than 4 hours of sleep for ten days because she was working on her new YouTube videos about fashion. She started getting suspicious of her family and friends, believing they were trying to poison her, so she stopped eating and lost 10 pounds in less than a week. She had several days of irritability and agitation to the point of pacing all night for three nights in a row before her admission. She was also yelling at family and friends (on her cellphone) all hours of the night. She had been using marijuana daily for about two years leading up to this hospitalization but stopped using while in hospital. She has not returned to marijuana use. Her psychiatrist treated Katherine with lithium 1200 mg po qhs and olanzapine 10 mg po qhs in hospital. She stopped her olanzapine after about two months but remained on the lithium. She had been taking her medications consistently until she gained 30 pounds. She is 5’4” and weighs 170 pounds.

Tutorial: Lan Chen MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 1

You are a family doctor in Thunder Bay. On your day schedule you note that Lan Chen is booked to see you about "fatigue". She is a devout, hardworking nurse who has in the past year developed hypertension, hypercholesterolemia and Type II Diabetes. She is 45, has been married for 18 years and has three healthy sons, ages 10, 8, and 6. The patient presents as tense, tired, and clearly distressed. Ms. Chen complains of feeling "wiped out", constantly fatigued despite sleeping up to 12 hours at a time. She describes herself as feeling "useless" because she is falling behind on her work at home and is worried about her work at the hospital because she is having trouble focusing: "my thoughts keep jumping around and I'm never really sure what I've done. I keep checking things over and over to make sure I'm not making mistakes". She feels overwhelmed by the many decisions she has to make every day in the hospital, and the demands on her at home. She used to love her work, her family, and coaching soccer. Now she describes feeling intense dread driving to work, at times crying in the car, knowing how busy and intense the day will be. She likewise dreads coaching her soccer team: "This year's group is different, they're a bunch of lazy little brats". She is very upset because she yelled at two of the girls at the last game, and is even more upset because she is yelling at her own sons "all the time".

Tutorial: Diane Bainbridge MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 2

Diane Bainbridge, a 32 year old woman, complains of fatigue and weakness, lower back, and hip pain which she describes as a gnawing ache. She has noticed that this has become progressively worse over the past few months and she finds that getting up from a chair is difficult. She has noticed that her gait has changed. She has known celiac disease and has had associated weight loss and intermittent diarrhea

Tutorial: Andrea Holmes MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 2

Andrea, an 84-year-old woman, is accompanied by her niece to her family physician's office. Andrea has been living on her own ever since her husband died 10 years ago. Her niece Bev would occasionally pick up some groceries for her aunt. Andrea was always proud to be independent. As she got older, Bev noted that her aunt was a bit forgetful, but put that down to simply getting older. Last month her aunt's neighbour called Bev to tell her that her aunt's hydro was disconnected. Bev was surprised. Her aunt hadn't called her that there was any trouble. Bev noted that her aunt hadn't really called her much over the last few months. Bev went over to her aunt's house. Her aunt greeted her at the door. Her aunt was surprised to see her, even though Bev had called her that day to tell her that she was coming to visit. Bev was surprised to see that her aunt had lost a fair amount of weight. She was even more surprised about the unkempt nature of her aunt's house. This was a woman who prided herself on organization and cleanliness. After much discussion and arguing, Andrea agreed to see her family physician for a routine checkup. She hadn't been to the doctor's for some time.

PC Session: Health Inequities: Early Childhood Development

Part 4, Professional Competencies 4, Week 1

In this session, we will continue the conversation on the complex topic of the Social Determinants of Health with a focus on early childhood.

Tutorial: P.J. Peters (Part 2) IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 2

When you see Mr. Peters next, you learn that he had continued to take his HAART faithfully an additional 6 months after he last saw you. He had been feeling physically well and figured his virus was under control (as he recalled it had last been "non-detectable") and so began questioning the need to continue his medications. He was concerned about long-term side effects of therapy and figured he could diminish his risk by reducing his exposure to HAART. Moreover he had started a new job around that time and did not want anyone to inadvertently find out about his diagnosis of HIV. He therefore elected to stop taking his anti-retrovirals. Mr. Peters was reluctant to tell his physicians about his decision and so he had not come back for his follow ups. He returns today complaining of a new painful rash on his chest that appeared 2 days prior. Additionally he notes a 3-month history of increasing fatigue as well as intermittent fevers, night sweats and a 20 lb weight loss. On examination his temperature is 37.2º C, blood pressure 135/80, pulse 79. There are 2 cm nodes palpable in the cervical and axillary areas bilaterally. His throat is clear. When you examine his chest you notice a vesicular rash over the right side of his chest extending from the midline towards his right axilla at the level of his nipple. Examination of his respiratory and cardiovascular system are unremarkable. His abdomen is soft with no palpable masses or organomegaly. Examination of his extremities is unremarkable.

Tutorial: Adrian Scholtz Part 2

Part 5, Integration Foundation, Maternal Health Risks/Aging-Related Care, Week 4

Adrian was admitted to the ICU 24 hours ago. Since that time, additional investigations and bloodwork has been ordered. Adrian underwent a CT chest to rule out pulmonary pathology and septic embolic in the lungs are confirmed. Blood cultures are positive for Methicillin-resistant Staphylococcus aureus (MSSA). After an infectious disease consult, Adrian is started on IV Ancef. The Cardiology team led by Dr. Sibbald and the Cardiac Surgery team led by Dr. Semelhago agrees that the patient requires a repeat heart valve replacement. In addition, the nurses observe Adrian to appear to be volume overloaded with worsening swelling. Despite copious IV fluids, Adrian is not making much urine (<200mL/day). A nasogastric tube was inserted for methadone administration. The nurse and dietician are requesting consideration for total parenteral nutrition based on recent laboratory results demonstrating malnutrition and hypoproteinemia. Ophthalmology is consulted for concerns of septic emboli following completion of an MRI of the brain. Nephrology consulted and believes dialysis may help the patient, but it is not the definitive treatment. They will only start dialysis if the patient is under consideration for repeat heart valve surgery.

Tutorial: Ali Khan IF Chronicity and Complexity

Part 5, Integration Foundation, Complexity and Chronicity, Week 2

Ali is an 8-year-old boy who is a patient in the pediatric clinic. Ali’s parents have brought him to the clinic today because they are concerned about his ongoing vomiting. You briefly review Ali’s medical record to familiarize yourself with his medical issues: Past Medical History: Cerebral palsy, spastic quadriplegic GMFCS Level V; Severe intellectual disability; Microcephaly; Scoliosis; Visual impairment; Epilepsy; Gastroesophageal reflux disease.

Essential Clinical Experience: Anesthesia and the obese patient

Anesthesia Rotation

Clinical Exposure: Gastrointestinal Presentations

Clerkship, Family Medicine Rotation

Abdominal pain. Pelvic pain. AnalAbdominal paracentesisrectal symptoms. Blood in stool. Changes in bowel habits. Decreased appetite. Heartburn. Nausea and vomiting. Weight loss.

Clinical Exposure: Hypo/hyperthyroidism

Clerkship, Internal Medicine Rotation

Clinical Exposure: Obesity

Clerkship, Internal Medicine Rotation

Clinical Exposure: Weight loss

Clerkship, Internal Medicine Rotation

Self-Directed Study: Lactation

Clerkship, Obstetrics and Gynecology Rotation

Tutorial: Lactation

Clerkship, Obstetrics and Gynecology Rotation

Essential Clinical Experience: Obesity, Pediatric

Pediatrics Rotation

Tutorial: Eating Disorders and Child and Adolescent Psychiatry

Clerkship, Psychiatry Rotation

Apply knowledge of the expected changes across the lifespan in the care of patients with psychiatric disorders and medical conditions; Apply knowledge of the major psychiatric disorders in the care of pediatric patients (including but not exclusive to mood disorders, anxiety disorders such as separation anxiety disorder, reactive attachment disorders, etc.); Prioritize a differential diagnosis by applying knowledge of psychopathology and medical illnesses;Apply knowledge of potential signs/symptoms of abuse when developing treatment plans, including when to report suspected abuse.

e-Learning Module: Bariatric surgery and obesity

Clerkship, Surgery Rotation

In this module, you will learn about morbid obesity including the surgical options for weight loss and the control of weight related co-morbidities.

Clinical Skills Sessions: Review of diabetic exam

Observation of a student(s) taking history from a patient with diabetes (polyuria, polydipsia, fatigue, etc.) and performing appropriate physical examination. JAMA article review: Does this patient have diabetic neuropathy?