Anatomy Demonstrations: Introduction to Chest Imaging

Part 1, Medical Foundation 1, Respirology, Week 1

Some anatomical structures in the chest should be assessed on every chest image. Using a systemic approach to reviewing chest images.

Active Large Group Session: Intro to Radiology

Part 1, Medical Foundation 1, Respirology, Week 2

Tutorial: John Fumer MF1 Respirology

Part 1, Medical Foundation 1, Respirology, Week 2

John Fumer is a 54 year old man who began smoking at the age of 14 and has averaged a pack a day since then. Five years ago, he noticed that heavy exertion such as climbing 2 flights of stairs would leave him more "winded" than usual but there was no major impact on his lifestyle (including smoking!) Over the last 18 months, he has noticed increasing restriction on his activities. When a friend pointed out that he could no longer "walk and talk at the same time", he decided to seek help from his family physician.

Active Large Group Session: Approach to the chest x-ray

Part 1, Medical Foundation 1, Respirology, Week 2

Large Group Session: Integrated Radiology - Anatomy - Respiratory System

Part 1, Medical Foundation 1, Respirology, Week 3

Nasal skull. Sinuses. Pharynx. Larynx. Chest. Upper abdomen.

Anatomy Demonstrations: Ultrasound (Cardiac Anatomy)

Part 1, Cardiology, Week 3

Tutorial: Teresa J Part 2 MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 4

You are called to see a patient in the ER who has presented with shortness of breath. You immediately recognize Teresa J, the 65-year-old female who was previously admitted for several weeks with acute lung injury earlier in the year. A quick review of her chart reminds you that she also has a history of poorly controlled diabetes and premature CAD with a prior MI at age 62. She looks distressed and is only able to talk in short phrases. She describes chest pain on the left side that gets worse when she coughs or moves. She has been getting weaker over the last 3 days. Her sputum is yellow, but she denies hemoptysis. She stopped taking all of her medications a week ago (furosemide, ASA, antihyperglycemics, metoprolol).

Large Group Session: Integrated Radiology - Anatomy - Cardiovascular System

Part 1, Medical Foundation 1, Cardiology, Week 4

Active Large Group Session: Point of Care Ultrasound (POCUS)

Part 2, Medical Foundation 2, Renal

Basic introduction of how ultrasound works. Ultrasound transducer types. Ultrasound imaging planes, orientation and resolution. Basic ultrasound imaging terminology. Basic right and left renal anatomy.

Tutorial: Celia and Maria MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 1

Maria is a 33 year old single woman who is concerned about the health of her 2 year old daughter Celia. Since three months of age Celia has been treated with multiple course of antibiotics for episodes of fever and irritability. Maria wants the doctor to check a urine sample because she thinks it might be a "urine infection" since Celia's wet diapers have a bad smell

Tutorial: Maria Rossi MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 2

Maria Rossi is a 21-year-old woman who comes to the emergency department for treatment of a headache. She has been having worsening headaches for several weeks and today the pain is severe and has not responded to Tylenol. The triage nurse measures her blood pressure and finds it to be 220/110. Maria is put on a monitor and full examination by the emergency room physician reveals retinal exudates and an abdominal bruit. Blood work is sent to the lab.

Tutorial: Shane Mosley MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 2

Shane Mosley an 18-month-old boy was brought to the emergency room by the baby sitter for treatment of a swollen and tender right knee that had developed suddenly within the previous three hours. The knee began to swell soon after Shane tripped on the family room carpet. Physical examination reveals an apparently healthy child who is crying and favouring his right leg. The knee is swollen and held in partial flexion. Shane has a few old, superficial bruises over shins, chest wall and his back. The physician in the ER concludes that there is fluid in the knee and because of the sudden onset and absence of fever, thinks this is most likely due to a joint bleed. The physician wonders about an underlying systemic bleeding disorder as the cause of Shane's joint bleed. A complete blood count, "hemostasis screen" and an x-ray of the knee are ordered.

Active Large Group Session: Abnormal Uterine Bleeding (AUB)

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 1

Prevalence of Abnormal Uterine Bleeding. Impact of Abnormal Uterine Bleeding (AUB) on Women. Clinical, Economic, and Lifestyle. Pathogenesis of AUB. A brief look at causality. Investigation and treatment of women with AUB. What to do, when to do it.

Active Large Group Session: GI-GU-Pelvic Imaging

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 2

Essentials of gastrointestinal and gynecologic imaging.

Tutorial: Rosemary and Tony MF3 Reproduction

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

Rosemary, a 38-year-old G2A1, is seen with her 42-year-old husband for their first antenatal visit. She is 10 weeks 1 day pregnant by an LMP of January 18th. She is sure of the date and her periods were 4 days every 28-30 days. She states that she is trying to eat quite well because she does not believe in taking vitamins. She says that she tries to have a gluten-free diet. Rosemary had a therapeutic abortion when she was 27. She and her husband are both healthy. She is on no medications. Both of their families are from Ireland and they do not know of any family health problems. Their GP discusses issues regarding the pregnancy with them, including dietary issues and the potential benefits of a prenatal vitamin and an iron supplement. Rosemary’s prenatal bloodwork is normal. She is booked for an ultrasound, which is done at 12 weeks. The ultrasound is normal and shows a single embryo with measurements consistent with her LMP. At 17 weeks, her GP calls to tell her that her IPS test is positive for Down syndrome and she would like the couple to go to the University hospital to discuss their options. They are devastated with the news and do not know what to do as they are both Roman Catholic.

Tutorial: JoAnne Wright MF3 Reproduction

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

JoAnne is a 28-year-old G4T1A2L1 Inuk from Baker Lake, Nunavut. Her last menstrual period was February 11. She has a regular, 28-day cycle and had a positive home urine test on March 14. She tells you that she is concerned because she had a DVT in her last pregnancy and was told that she has antiphospholipid antibody syndrome. She has been on warfarin since her son was born 2 years ago. She had 2 miscarriages at 8 and 10 weeks prior to her son being born. She is concerned about the effect of the medicine on her baby and also her risk of developing another clot.

Large Group Session: Gastrointestinal Radiology

Part 3, Medical Foundation 3, Gastroenterology and Nutrition

Radiology Procedures: Plain Films, Barium Studies, Angiography, US, CT, MRI, Nuclear medicine, Endoscopy, ERCP. Barium Studies: Barium Swallow, Upper GI Series, Small Bowel Follow-Through, Small Bowel Enema, Barium (Large bowel) enema.

Anatomy Demonstrations: GI and Endocrine Ultrasound Imaging

Part 3, Medical Foundation 3, Endocrinology

Active Large Group Session: Integrated Radiology - Anatomy - Musculoskeletal System

Part 4, Medical Foundation 4, Musculoskeletal Medicine

Review x-ray anatomy of shoulder, elbow, wrist, hip/pelvis, knee, ankle / foot

Tutorial: Mike Chiasson MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 1

Mike is a 45 year old man who has worked as a labourer at one of the steel plants in Hamilton for years. The work requires frequent heavy lifting, particularly overhead. Mike smokes 1 pack of cigarettes per day. He has had a 1 year history of shoulder pain, which seems to be getting gradually worse. He has had to give up baseball and now is having trouble performing his job. He has not tried any treatment for his shoulder, other than Tylenol plain and icing it. On physical exam there is no muscle wasting. He is tender over the anterolateral aspect of the humeral head. Range of motion is good, but terminal flexion and abduction reproduce his typical pain. Muscle strength testing shows weakness in abduction, which also reproduces his typical pain. Provocative tests for impingement syndrome are positive, but provocative A-C joint and biceps tendon tests are negative. X-rays are done to evaluate the bony anatomy, and an ultrasound is performed to evaluate the rotator cuff.

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: Amy Field MF4 MSK

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

Part One: A thin 65-year-old woman presents complaining of back pain that began 5 days ago while lifting her wash. The pain becomes worse when she rolls over in bed or when she stands up. She has noticed that the hems of her skirts seem longer and on measurement she appears to have lost 6 cm in height. Part Two: The patient reports she got over that last "attack" after around 3 months. She was commenced on a bisphosphonate, calcium, and vitamin D. She now returns 2 years later because of another attack of acute back pain after falling on the ground.

Tutorial: Daniel Gatto MF4 MSK

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

Daniel Gatto is a 41-year-old stockbroker. Once a top level soccer player, he now plays the game only over weekends, though he is sometimes able to get out for his club's midweek practice session. He enters your walk-in clinic on a Tuesday morning, limping slightly and reporting that he has been having increasing problems with his right knee over the past month. The knee has been intermittently painful and has seemed swollen from time to time. He has also been concerned about what he describes as "a feeling of weakness" of the knee, as though it was about to "give way"

Tutorial: Joan Spaulding MF4 MSK

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

Joan Spaulding is a 32 year old lady who arrives at your clinic with a history of joint pains in the hand. The pain in her hands was predated by a viral flu that manifested itself as generalized arthralgias and fatigue. The pain has been ongoing for 10 weeks and transformed itself from generalized arthralgias to symptoms in the hands and feet associated with morning stiffness that lasts approximately 1 hour.

Tutorial: Giuseppe Carnivale MF4 MSK

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

Giuseppe Carnivale is a 42 year old construction worker who presents with the complaint of gradually increasing weakness in his legs. He has noted difficulty climbing stairs. He feels the strength in his arms is normal, except when working over his head. He admits to mild aching in his muscles, but has no muscle pain or tenderness. The weakness has been insidious. A rash has been present on his face and upper chest for several months.

Tutorial: Jake Gamble MF4 MSK

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

Part One: Jake Gamble, an obese 65-year-old man, presents complaining of back pain that began 5 days ago while shovelling snow. The pain becomes worse when he stands. Part Two: The patient reports he got over that last "attack" in less than a week but has had low back pain ever since. He now returns 2 years later because of another attack of acute back pain after chopping wood. Part Three: The patient returns in 6 weeks because the pain has not decreased. His legs feel "heavy," and he has had some incontinence in the last week.

Active Large Group Session: MSK Radiology

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

Compare and contrast how various imaging modalities can be best utilized to image the different components of the musculoskeletal system. Develop an approach to the interpretation of MSK radiographs. Develop an approach to the interpretation of the cervical spine radiograph. Compare and contrast the appropriate use of various imaging modalities in the work up of the following cases: Scaphoid fracture; Acute knee pain; Ankle trauma; C-spine trauma.

Tutorial: Brenda Farnett MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 1

Brenda Farnett, an 82-year-old right-handed woman, was reviewed in the stroke prevention clinic for a possible TIA. Her past medical history included hypertension, treated hypothyroidism, and diet-controlled type II diabetes. Her medications included ASA, HCTZ, and eltroxin. She was initially referred from her family physician's office for evaluation of an episode of right-sided weakness and numbness, mostly involving the arm, lasting about 15 minutes. Her examination in the clinic showed her to be mildly hypertensive at 150/90, and with a regular pulse at 76. Her neurological examination was normal. Her EKG done that day was normal (sinus rhythm). An urgent carotid ultrasound was arranged and she was started on clopidogrel 75 mg OD, ramipril 2.5 mg OD, and atorvastatin 10 mg OD. On the following morning she awoke with mild right-sided weakness and an inability to speak. Her husband immediately called 911. She was taken to the nearest hospital.

Large Group Session: Neuroimaging

Part 4, Medical Foundation 4, Neuroscience, Week 2

Tutorial: Carmen Shellinger MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 3

Carmen Shellinger is a 32-year-old office manager at a local law firm. Her regular office duties include transcription for the senior partner. Over the past few weeks she has noticed pain in the right wrist at the end of the day. On some occasions she has been awakened at night by pain, tingling and numbness in the right hand. After shaking the hand, the symptoms seem to settle down and she has been able to fall asleep. Her symptoms have become more persistent and she decides to seek her doctor's help. Carmen is otherwise healthy and general inquiry identifies only occasional neck and shoulder pain. The results from the neurological examination are normal. Phalen's manoeuvre reproduces her symptoms in the right hand that she has experienced at night. Tinel's sign provokes numbness into the lateral 3 fingers of the right hand.

Clinical Pathology Conferences (CPC): Neuro Week 4

Part 4, Medical Foundation 4, Neuroscience, Week 4

Nancy: 50-year-old female, one year of involuntary movements. The movements wax and wane during the day, but completely stops while asleep. Movements were initially subtle but progressive over time. Five years ago, she was fired from her job due to impulsivity and anger issues. Since this time, she has been unemployed, withdrawn, and depressed

Tutorial: Ethel MacConkey IF Host Defence and Neoplasia

Integration Foundation, Host Defense and Neoplasia, Week 1

Ethel is a 76 year old widow. She has a history of hypertension (treated with a thiazide diuretic and a calcium channel blocker), hyperlipidemia (treated with an HMGCoA reductase inhibitor), and obesity. Apart from this, she has been relatively healthy, and plays an active role with her 3 grandchildren as well as her church. Unfortunately, over the past few years, she has had increasing difficulty walking because of pain from osteoarthritis in her hips (especially her right hip) and, to a lesser extent, her knees. She therefore undergoes a right total hip arthroplasty. After 6 days in hospital, she is transferred to the rehab ward for further physiotherapy to improve her mobility. Five weeks into her rehab stay she develops a fever of 38.7 C. Additionally her physiotherapist has noticed that over the past 7-8 days Ethel has been less willing to participate in her exercises due to complaints of pain in her right hip. Concerned about Ethel's fever, the nurses give her acetaminophen and call the attending physiatrist to assess the patient for a potential infectious source.

Tutorial: Godlewski Family IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 3

Paula Godlewski is a 50 year old Jewish woman of east European descent. She comes to the appointment with her daughter Anna. She has come to be assessed by a medical oncologist for consideration of systemic therapy following the diagnosis of a node positive breast cancer. Anna, who is 25 years old, asks if this cancer is inherited and whether she will get breast or ovarian cancer. she asks whether she should have prophylactic mastectomies and oophorectomies if her tests were to be positive.

Tutorial: Claire McFadden Part 1 IF Maternal and Child Health Risks

Part 5, Integration Foundation, Maternal Health Risks/Aging-Related Care, Week 1

Claire McFadden is a 16- year-old high school student, living with T1D since age 10, who is currently pregnant (G1). Claire has struggled with her diabetes management in the past but is trying to keep her sugars at target now that she knows she is pregnant. Her most recent HbA1C was 7.8%, and she is using an insulin pump. Claire is being followed concurrently by her endocrinologist and has had microalbuminuria and mild non-proliferative retinopathy but no other diabetic complications. She has been normotensive with a usual BP of 110/70. She was told to start prenatal vitamins with extra folate as well as to discontinue her ACE inhibitor when her pregnancy test was found to be positive. Claire was also started on low-dose ASA (LDASA) at 12 weeks. Her partner, Dave, is 18 years old and is unemployed, having graduated high school in the summer. Claire is living with Dave in her aunt’s apartment. Her pregnancy was unplanned, but she is now excited to become a mother. She is planning to take a year off from high school and then return to complete her high school diploma. Dave is unhappy about this and feels she should stay at home to take care of the baby. They have argued about this, and Dave feels it is Claire’s own fault if she does not like making sacrifices as she could have gotten an abortion like he wanted. Claire worries about Dave’s temper, explaining that when he found out she was pregnant, he yelled at her and then disappeared for a week. She thinks he will come around once the baby is born.

Tutorial: Claire McFadden Part 2 IF Maternal and Child Health Risks

Part 5, Integration Foundation, Maternal Health Risks/Aging-Related Care, Week 1

Claire is a 35-year-old G1 with Type 1 DM. She had an episode of pyelonephritis at 26 weeks gestation and did well following this, and was last seen at 30 weeks. At 32 weeks Claire presents in St. Catharines with a headache and RUQ pain. Her husband says that Claire’s swelling, especially in her face, has worsened over the past 2 days. BP is 160/105. FH is normal. She has 4+ urine protein. Hb 142 g/L, platelets 152, AST 67, ALT 75, INR/PTT normal, fibrinogen 5.8 g/L, glucose 6.5 mM/L, creatinine 100 uM, urea 4.2 mM. Urinary ketones are negative. She is given morphine and oral labetalol. Her symptoms settle and BP is 145/95. Ultrasound shows a cephalic fetus with normal head and femur measurements but the abdominal measurement lags by 3 weeks. There is marked oligohydramnios. Doppler studies are abnormal. MUMC is called and a decision is made to transfer Claire. On arrival, she complains of severe RUQ pain. BP is 170/110. She has made very little urine and it is dark tea coloured. Hb 137 g/L, platelets 100, AST 265, ALT 310. Her urinary protein to creatinine ratio is 500 mg/mmol. She is given a dose of nifedipine and MgSO4 is started. A decision is made to do an immediate C/S with spinal.

e-Learning Module: Integration Foundation Rapid Fire Cases: Medical decision making in the acute care setting

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

12-15 cases of rapid action required or immediate clinical decision making. Content of these modules: Internal Medicine, Surgery, Obstetrics, Paediatrics, Geriatrics and Radiology.

Tutorial: Myles Downie IF Chronicity and Complexity

Part 5, Integration Foundation, Complexity and Chronicity, Week 4

Myles is a 24-year-old male arriving at a tertiary trauma centre from Manitoulin Island after a witnessed jump off a local railway crossing bridge. Myles was initially brought to the local community hospital where ATLS protocol was initiated by the rural ER physician. He was found to be hypotensive 82/45 mmHG, tachycadiac 120 bpm, and hypothermic at 34.5 C. X-rays revealed a pelvic fracture, a pneumothorax requiring a chest tube and bilateral open calcaneal fractures. Myles was then stabilized and transferred to the nearest tertiary centre 2 hours away via helicopter. Myles is well known to the local ER team in his home community of Zhiibaahaasing First Nations on Manitoulin Island for persistent suicidal ideation episodes. Myles comes from a large close-knit family with many of his relatives reunited over the past few years due to their own issues with being victims of the Residential School Act in their early years. Myles has tried to take his own life on several occasions, stating “I cannot take the pain forward from my ancestors anymore, it must die with me”. According to his sister and uncle, Myles began consuming more illicit substances and marijuana after his father took his own life 10 years ago and his mother was unable to take care of Myles and his siblings. His mother moved away, and Myles and his siblings were split up amongst several family members and placed in foster care. Despite leaving high school in grade 10, Myles has had some landscaping jobs and tree planting jobs over the past few years. Myles has been sent on two occasions to rehabilitation centres in Ottawa for substance abuse, but feels his problems are not addressed in these environments due to lack of cultural awareness. Myles enters the ER setting intubated with a chest tube in situ as well as a pelvic binder on. His lower extremities are in soft splints with dressings applied. The transfer team established additional IV access and has administered 2L of crystalloid fluids on route as well as rewarmed patient as he was quite cold when he left the Manitoulin hospital with a temperature of 35.4 degrees. They also report that Myles was given antibiotics and tetanus before leaving

e-Learning Module: Transition to Clerkship Self-Directed Learning Path

Transition to Clerkship, Clerkship

Includes: Navigating an admission. N95 Mask Education. Prescription for a Lawsuit. Infection Control Review. Diagnostic Imaging Quality and Safety

Clerkship Teaching Session: Radiology in Emergency Medicine

Clerkship, Emergency Medicine Rotation

To learn how to approach common imaging in the emergency department. A review of: Salter Harris Classification; MSK Xrays (shoulder, elbow, wrist, ankle, foot); C-spine xrays; CXR; Abdominal Xray; FAST U/S; CT Head

Clinical Exposure: Interpretive skills in the ER

Clerkship, Emergency Medicine Rotation

EM Medical Expert technical skills interpretation.

Essential Clinical Experience: CXR abnormalities

Internal Medicine Rotation

Large Group Session: Ultrasound during Pregnancy

Clerkship, Obstetrics and Gynecology Rotation

Use of ultrasound in Obstetrics. Assess gestational age, fetal anatomy & growth, fetal wellbeing, etc. Invasive procedure: diagnostic/therapeutic. Labour and Delivery

Clinical Exposure: Order and Interpret Imaging Investigations

Clerkship, Surgery Rotation

Large Group Session: Pediatric Surgery

Clerkship, Surgery Rotation

Pediatric IV Fluid requirements. Appendicitis. Intussusception. Hernia. Hydrocele. Pyloric stenosis. Umbilical hernia. Neonatal congenital anomalies. Bowel obstruction in newborn. Hirschsprung’s Disease. Congenital neck masses.

Concept Integration and Review: Approach to Cough

Post-clerkship, Concept Integration and Review

What is cough? Cough reflex. Definition of acute cough, subacute cough and chronic cough. Complications of cough. Approach to chronic cough. Basic investigations (Chest x-ray, spirometry)

Concept Integration and Review: Topics in Radiology

Post-clerkship, Concept Integration and Review

A 50 question multiple choice quiz and take up which is used as both a tool for teaching and as a measure of which areas need improvement in the radiology curriculum at McMaster.