Clinical Skills Sessions: Head and Neck Exam: Practice Case - Sore Throat

Part 1, Medical Foundation 1, Cardiology, Week 4

Objective: To discuss and to practice the Head and Neck history and physical exam, with a focus on the oropharyngeal exam. Pro-Comp Connection: Poverty - the disproportionate burden of Rheumatic Heart Disease on marginalized populations.

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: Calvin Shin MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 2

Dr. Jones has been following Calvin Shin for several years for obstructive sleep apnea. He had been doing well with reduced symptoms of daytime sleepiness since he had been using his CPAP machine. Dr. Jones was reviewing John's chart in his clinic. He missed his appointment several months ago but booked an urgent appointment through his family doctor. Calvin explains that he thinks his tongue, nose and lips have been getting thicker. He also states that he seems to be sweating and his skin feels thicker and oilier than it used to.

Tutorial: Jane Young MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 3

Jane Young is a 3 1/2 year-old girl, brought to the Pediatric Medicine Clinic by her mother. For the past 10 days, her right knee has been swollen and stiff. There was no preceding trauma. She seems to have most symptoms in the morning, getting better when she is up and about playing. She seems to have less energy since the swelling was first noted. Her mother has been giving her children's Tylenol but has not noticed any improvement in her symptoms. Her mother thinks her ankles are also "puffy" at times. On examination, Jane appears well, afebrile and is on the 50th percentile for height and weight. No fever or skin rashes. Cardiovascular, respiratory and abdominal examinations unremarkable. Right knee is swollen, warm and effused and Jane stands with this knee slightly flexed. There are mild effusions of both ankles which are also slightly swollen. The pediatrician decides to order a few investigations. Baseline CBC, renal and liver function is unremarkable. ESR moderately elevated at 30. Rheumatoid Factor is negative, but Antinuclear Antibody (ANA) is positive at 1:160.

Tutorial: Theodore McIntyre MF4 MSK

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

Mr. McIntyre, a 69 year old man, has developed a new onset right-sided headache for the last 5 days. He has some pain when he chews his food and has been feeling increasingly fatigued. He has had stiffness in his shoulders and his hips so much so that it takes him at least an hour to get up and move around first thing in the morning. He has started to develop some double vision. He has tenderness when he combs his hair on the right side of his temple. Physical exam reveals a BP of 120/70 (right arm) and 126/68 (left arm), HR 75/min, temp 37. He has tenderness along his R temporal region and the R temporal artery feels thickened.

Tutorial: Neil Wartson (Part 2) MF4 Neuro

Part 4, Medical Foundation 4, Neuroscience, Week 1

Neil Wartson is brought back to his family doctor 6 months later. The MRI has still not been performed, but the audiology testing confirmed severe sensorineural hearing loss on the right. Upon entering the office, Neil’s mother is very upset and agitated. Over the last month, she has noticed that Neil has become clumsier and is falling frequently. He also has started to rub his eye a lot and complains that things are “fuzzy”. She also reports that, since the last visit, Neil’s father has been investigated for his hearing loss. He is currently being worked up for Neurofibromatosis Type II. Neil’s mother has looked this up on the internet and is convinced that Neil has this as well.

Tutorial: Mandy Wallsmith (Part 2) MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 1

Six months after her previous presentation of transverse myelitis, from which she completely recovered, Mandy Wallsmith returns with complaints of bilateral visual loss (worse on the right). The problem started two days ago with pain in and behind her right eye, worse when she would look to the left or right. Yesterday, she began to notice that she wasn't seeing well out of her right eye. Today her vision seems worse, although the pain is a little better. On examination, her visual acuity is found to be 20/80 in the left eye (OS) and 20/400 in the right eye (OD). Visual field appears to be normal in the left eye, but she can only detect hand motion (not finger counting) in all quadrants with the right eye. She finds that colours look less vivid with her right eye - especially red, which looks "kind of gray".

Large Group Session: Intro to Neurology subunit and Intro to Neurosciences

Part 4, Medical Foundation 4, Neuroscience, Week 1

How much Neuro do you need to know? What do residency program directors expect? Weekly themes: Week 1:Muscle, NMJ, Nerve. Week 2: spinal cord, brainstem. Week 3: Basal Ganglia, Limbic system. Week 4: Cerebral cortex. Muscle. Localization. Neuromuscular junction. Nerve. Resting potential. Post-synaptic potentials. Anterior horn. Central vs. peripheral nervous system. Spinal cord. Brainstem. Cerebellum. Limbic system. Basal Ganglia. Cerebral cortex.

Tutorial: Ivan Nettar MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 2

Ivan is a 68 year old man who has enjoyed excellent health in the past. His only medication is hydrochlorothiazide for mild hypertension. For the past few weeks he noticed that by the end of the day he had difficulty focusing his eyes and keeping them open. He decided to see his family physician when the other day his vision became double. On the day of the visit, Ivan was feeling even worse. His double vision was present shortly after lunch and he felt generally weak. On observation, it was clear that Ivan had a right-sided ptosis. He kept closing one eye and then the other, complaining that otherwise his vision was double. His voice seemed mildly hoarse. Blood pressure was normal at 135/80. General physical examination of the heart, lungs, and abdomen was normal. Neurological examination showed that the pupils were equal and reactive. A prominent ptosis was present on the right. The extra ocular movements were abnormal with dysconjugate gaze present intermittently and not consistently on lateral, upward, and downward gaze. The other cranial nerves were normal. Tone was normal in the limbs. He had some difficulty holding up his arms in the air for more than a couple of minutes. He had some difficulty doing more that 5 deep knee bends. Sensation was normal and the reflexes were all present and symmetric. The plantar responses were down going. You ask Ivan to close his eyes and rest them for a few minutes while you make some notes. You ask him then to open his eyes and temporarily the double vision is much better and the ptosis is almost gone! A referral is made to the neurologist on call. She asks that you send Ivan to the emergency room so that she can perform a tensilon test to confirm the diagnosis.

Clinical Skills Sessions: Neurology Exam: Practice Cases – Vertigo, Headache

Part 4, Medical Foundation 4, Neuroscience, Week 2

Discuss and practice the components of the history and physical exam for a patient presenting with vertigo. Discuss and practice the components of the history and physical exam for a patient presenting with headache.

Anatomy Lectures: Motor Pathways

Part 4, Medical Foundation 4, Neuroscience, Week 2

Parts of the central nervous system. Cerebral cortex: thinking, memory, voluntary motor movements sensory perception. White matter vs. grey matter. Superficial features of the cerebrum: fissures, sulci and gyri. Lateralization of function in the cerebral cortex. Frontal lobe. Parietal lobe. Occipital lobe. Temporal lobe. Spinal cord reflexes. Corticospinal tracts. Upper and lower motor neuron lesions. Corticobulbar tracts. Coordination of movement. Influence of Basal ganglia.

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.

e-Learning Module: Red Eye

Clerkship, Emergency Medicine Rotation

In this module you'll learn about the approach to the red eye.

Clinical Exposure: EM Medical Expert (presenting problems)

Clerkship, Emergency Medicine Rotation

Demonstrate an approach to patients presenting to the ED with the following problems listed below (including basic differential diagnosis, initial investigations, and initial treatments)

Clinical Exposure: Ophthalmology

Clerkship, Family Medicine Rotation

Tutorial: Ophthalmology

Clerkship, Family Medicine Rotation

Clinical Exposure: Cellulitis

Clerkship, Internal Medicine Rotation

Clinical Exposure: Cerebrovascular disease

Clerkship, Internal Medicine Rotation

Essential Clinical Experience: Fundoscopy

Pediatrics Rotation

Large Group Session: Neurosurgery

Clerkship, Surgery Rotation

Epidural hematoma. Subdural hematoma. Cerebral Contusion. Basal Skull Fractures. Intracranial Hemorrhage. Diffuse Axonal Injury. Pathophysiology of supratentorial brain herniation. Grading of consciousness - Glasgow Coma Scale (GCS). Clinical classification of Traumatic Brain Injury (TBI). ICP = Intracranial Pressure. Munro-Kellie doctrine. Brain tumor. Intracerebral hemorrhage. Management of severe pediatric TBI.

Large Group Session: Ophthalmology

Clerkship, Surgery Rotation

Approach to the Red Eye. Common Retinal Problems. Urgent diagnosis of Eye problems: Diabetes mellitus; Temporal arteritis; Thyroid orbitopathy; Optic neuritis; Papilledema.

Concept Integration and Review: Microbiology and Infectious Disease

Post-clerkship, Concept Integration and Review

Infectious diseases. Transmission. Gram Stain. Microbiology. Infections head to toe.

Concept Integration and Review: Endocrinology

Post-clerkship, Concept Integration and Review, Week 4

Thyroid disorders: Hypothyroidism; Thyrotoxicosis (Graves, toxic nodule, thyroiditis); Thyroid Nodules. Pituitary Disorders: Pituitary disorder manifests clinically in 3 ways: Hyperfunction: too much hormones; Hypofunction: too little hormones; Local mass effects; Acromegalia. Posterior Pituitary dysfunction: ADH. Adrenal Disorders.

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?