e-Learning Module: American Academy of Dermatology Part 1

Part 1, Medical Foundation 1

The Skin Exam. Basic Science of the Skin. Morphology. Dermatologic Therapies.

Clinical Skills Practice Sessions: Respiratory Exam

Part 1, Medical Foundation 1

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

Large Group Session: Area of Focused Professional Development (AFPD)

Part 1, Medical Foundation 1

Longitudinal professional development in one of four areas: Health Innovation; Service-Learning; Leadership; Research and Scholarship.

Clinical Skills Practice Sessions: Cardiac Exam

Part 1, Medical Foundation 1

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

e-Learning Module: Intro to Dermatology

Part 1, Medical Foundation 1

Approximately 7% of all adult outpatients have a primary skin complaint, and 60% of outpatient visits for skin disease are made to non-dermatologists. With dermatological conditions being so prevalent, it is important that medical students have a minimum core of dermatological knowledge at the time of graduation.

Large Group Session: Service Learning Opportunities

Part 1, Medical Foundation 1

Define and describe service-learning for medical students. Review goals and benefits of service-learning. Describe the process for participating in service-learning. Service learning is a structured learning experience that combines community service with preparation and reflection.

e-Learning Module: Integrated Pain and Opioid Curriculum Course 1 - Introduction

Part 1, Medical Foundation 1

A longitudinal integrated pain and opioid curriculum. Students must complete this learning path of 7 online courses throughout the program, in addition to other formal and experiential learning activities.

Tutorial: All MF1 Respirology tutorial problems

Part 1, Medical Foundation 1, Respirology

Watching a Video: Introduction to Clinical Measurement

Part 1, Medical Foundation 1, Respirology

Why measure blood pressure? We perform measurement in patients when the measurement tells us something useful about the patient’s health that may be influenced by therapy or some intervention : the measurement should benefit the patient. Measurement involves observers and/or instruments; both can introduce error. Measurement findings can be assembled into categories, defined as present or absent or used as absolute number to predict disease. Likelihood ratios are a useful way of discriminating among diagnostic tests.

Anatomy Demonstrations: Orientation and upper airway

Part 1, Medical Foundation 1, Respirology, Week 1

Nasal skull. The Pharynx and larynx.

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.

Tutorial: Luke Tomczak MF1 Respirology

Part 1, Medical Foundation 1, Respirology, Week 1

Luke, a 47 year old gentleman with a history of chronic alcoholism and poor eating habits, goes to the ER with a complaint of chest pain. He smokes two packs of cigarettes daily. He has not been feeling well for over one week due to an upper respiratory infection. Two days ago he developed a fever, chills and a sharp pain over his right chest that is worse when he breathes in. Luke had a dry cough initially, but today he has coughed up rusty sputum with some blood in it. Although Luke is not normally short of breath, he has had difficulty climbing the stairs to the office because of breathlessness.

Active Large Group Session: Approach to Pulmonary Function Tests

Part 1, Medical Foundation 1, Respirology, Week 1

What are Pulmonary Function Tests? Noninvasive measure of lung volume, capacity, flow rates and gas exchange.

Large Group Session: Family Medicine Orientation

Part 1, Medical Foundation 1, Respirology, Week 1

To introduce and expose students to some of the unique qualities of Family Medicine. To offer early clinical experiences. To expose student to the clinical setting and to health care professionals at work, in order that they gain an understanding of professional roles, and develop comfort in the setting. To allow students to practice professional skills, including communication and physical exam skills, as well as to begin developing their own professionalism. To provide students with a sense of the nature of family medicine with both its challenges and its rewards.

Large Group Session: Canadian Healthcare Elective Presentation

Part 1, Medical Foundation 1, Respirology, Week 1

Clinical Skills Sessions: History Taking and Integration Week

Part 1, Medical Foundation 1, Respirology, Week 1

To discuss and to practice history taking and patient-centered communication skills.

Active Large Group Session: Introduction to ABGs

Part 1, Medical Foundation 1, Respirology, Week 1

Clinical Skills Practice Sessions: Vital Signs and General Appearance

Part 1, Medical Foundation 1, Respirology, Week 2

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

Clinical Skills Sessions: Introduction to the Patient-Centred Physical Exam and Vital Signs

Part 1, Medical Foundation 1, Respirology, Week 2

Introduce what a physical examination is, and the basics on how to perform one in a patient-centred way as a group discussion. Discuss proper technique, the importance of consent, privacy, draping and use of appropriate medical equipment (i.e., stethoscope, blood pressure cuff, etc.) Introduce Vital Signs, including normal and abnormal values. Discuss factors that affect vital signs. Pro comp connection: Patients of Varying Body Habitus. Patients presenting to medical professionals for clinical care represent a variety of body habituses. Body mass index (BMI) is used as a clinical indicator of body habitus, calculated based on a person’s height and weight. Patients are classified according to their BMI as underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (25.0-29.9) and obese (>30.0). Note that although BMI is used clinically, it was originally a population health measure and was derived from a homogenous group (Belgian population). Therefore, its utility for individual patient care may be limited. Epidemiological studies have shown a correlation where the risk of hypertension, type 2 diabetes, sleep apnea, cancer and a variety of other conditions increases as BMI increases; therefore, the classification system is meant to capture increasing health risks. It is important to note that a causal relationship between BMI and these health conditions has not been shown.

Active Large Group Session: Intro to Radiology

Part 1, Medical Foundation 1, Respirology, Week 2

Tutorial: Thomas Gagnon MF1 Respirology

Part 1, Medical Foundation 1, Respirology, Week 2

Thomas Gagnon, a 12 year old boy diagnosed with asthma 1 year ago, traditionally experienced minimal respiratory symptoms. In the past, he had used inhaled salbutamol sparingly, generally during soccer games, with excellent therapeutic effect. During a late September soccer game being held in a rural area, Thomas developed sudden onset dyspnea, wheeze, and chest discomfort. Earlier in the day he had visited with family members who smoke and have three pet cats. His symptoms were mostly relieved with repeated doses of salbutamol. He awakes the following night with ongoing symptoms that are not responsive to inhaled salbutamol, despite frequent dosing. His parents are alarmed and take him to the emergency department.

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.

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: Approach to the chest x-ray

Part 1, Medical Foundation 1, Respirology, Week 2

Tutorial: Arthur N. MF1 Respirology

Part 1, Medical Foundation 1, Respirology, Week 3

Arthur N., a 64-year-old gentleman, presents to his family physician because he is noticing increasing difficulty walking because of breathlessness. He states that he cannot put a finger on when it first began "except that he is aware that he was not as fit" as he should be. Arthur has always enjoyed his walking. However, over the last six months, he has noticed that any incline will make him breathless to the point that friends will remark on it, and he simply has to stop walking. In addition, climbing stairs has become quite difficult. He remarks that he has not been breathless at rest, nor at night-time. He has not noticed any swelling of his ankles. Arthur states that he smoked lightly about twenty years ago. His occupational history is unremarkable and there is no history of heart disease.

Tutorial: Teresa J. MF1 Respirology

Part 1, Medical Foundation 1, Respirology, Week 3

Teresa, a 65-year-old woman, is brought to the emergency room by a friend who was unable to arouse Teresa completely. Her friend reports that Teresa had been unwell for three days with persistent vomiting. In the emergency room, Teresa is only semi-rousable. Her pulse is 130 and blood pressure is 100/70. Her breathing is rapid and deep. Teresa’s medical record indicates a history of poorly controlled diabetes and premature coronary artery disease, with a prior myocardial infarction at age 49. She is described as “treatment non-compliant” and is noted to have a “difficult psychosocial situation”.

Anatomy Demonstrations: Lower Airway

Part 1, Medical Foundation 1, Respirology, Week 3

Thoracic cage and relationship of surface structures. Lung structures. Pleura. Diaphragm.

Anatomy Lectures: Respiratory System Anatomy

Part 1, Medical Foundation 1, Respirology, Week 3

Control of breathing. Chest wall, diaphragm. The airway.

Clinical Skills Sessions: Respiratory Exam: Practice Case – Dyspnea & Wheeze

Part 1, Medical Foundation 1, Respirology, Week 3

Discuss and practice the components of the respiratory history and physical examination. Practice an approach to the environmental exposure history using the CH2 OPD2 format. Pro-Comp Connection – Health Effects of Climate Change: : Climate change presents a fundamental threat to human health, with the potential to undermine and reverse decades of health progress. Increasingly frequent disruptions caused by climate change may overwhelm the efforts of the healthcare system to address social determinants of health, if those latter efforts ignore the changing environment. Climate change impacts health both directly and indirectly and is strongly mediated by structural determinants of health.

Tutorial: Tutorial Skills Tune-up MF1

Part 1, Medical Foundation 1, Respirology, Week 3

Active Large Group Session: Integrated Radiology - Anatomy - Respiratory System (IARS)

Part 1, Medical Foundation 1, Respirology, Week 3

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

Tutorial: All MF1 Cardiology tutorial problems

Part 1, Medical Foundation 1, Cardiology

Tutorial: Pauli Emboli MF1 Cardiology

Part 1, Medical Foundation 1, Cardiology

Pauli is a 70 year old female, previously healthy, who presented with mild central pleuritic chest pain and a feeling of light-headedness with minimal activity. Past medical history is significant for systemic arterial hypertension (controlled with diet). Takes no medications other than occasional Tylenol. At baseline, patient is an active person who exercises regularly. Usual HR is in the 50-58 bpm and BP averages 130/85 mmhg. Examination reveals a woman in mild distress with the following vitals on presentation: HR 125 bpm, BP 105/60mmHg, O2 saturation 88% on room air, and respiratory rate of 25/min. Temperature was 37.5°C.

Tutorial: Wael M. MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 1

Wael M. is a 78-year-old man who is brought to the emergency room after collapsing at the casino. The last thing he recalls before losing consciousness is drawing an ace while sitting at the blackjack table. His past medical history is unremarkable and he is on no medications. On arrival to the ER, his heart rate is 30 bpm with a blood pressure of 80/50 mmHg. He is alert and oriented, but feels lightheaded. His JVP is not elevated, but cannon a-waves are occasionally seen. There are no carotid bruits. The remainder of the physical examination, including a neurological examination, is normal. In the ER, a temporary transvenous pacemaker is inserted via the right internal jugular vein and positioned into the right ventricular apex. The pacemaker is turned on and set to pace at 60 bpm. At this rate, Wael M.'s BP increases to 100/70 mmHg and his light-headedness resolves. The next morning, Wael M. has a dual chamber permanent pacemaker inserted. His 12-lead EKG post implant shows paced ventricular beats with a left bundle branch block pattern.

Tutorial: Usha L. MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 1

Usha L. is a 16 year-old male who attended a routine follow up visit at his family doctor’s office. He would like to start playing competitive soccer and the coach asked for a doctor’s clearance. The patient’s family was pleased with the proactive approach the coach demonstrated, as they were also worried about the small but real risk of sudden collapse sometimes resulting in death in young elite athletes without previous diagnosis of heart disease. The coach was particularly concerned about ruling out any type of heart disease. Usha is active, athletic and asymptomatic. His past medical history is unremarkable. There is no family history of cardiac disease. He doesn’t smoke or use street drugs.

Clinical Skills Sessions: Introduction to the Cardiac Examination

Part 1, Medical Foundation 1, Cardiology, Week 1

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

Tutorial: Janet Woo MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 1

Janet Woo is a 50-year-old woman with a history of intermittent palpitations. Over the last five years, she can recall infrequent and transient episodes of her heart "pounding in her chest". These episodes would not produce any other symptoms and would last no longer than a couple of minutes at a time, so she never sought medical attention. Earlier this evening, while watching television, she developed palpitations that did not resolve. She became diaphoretic, felt dizzy and somewhat short of breath and so called 911 and was brought to the ER.

Anatomy Demonstrations: Vascular Anatomy

Part 1, Medical Foundation 1, Cardiology, Week 1

Vasculature. Anastomoses, Veins without valves, and fenestrated capillaries. Atherosclerosis. Deep vein thrombosis.

Anatomy Lectures: Cardiovascular System Anatomy

Part 1, Medical Foundation 1, Cardiology, Week 1

Embryology of the heart. Mediastinum. Pericardium. Heart chambers and valves. Auscultation of the cardiac valves. Echocardiogram. Coronary vessels. Coronary arteries and veins. Coronary artery origins. Coronary sinus. Cardiac conduction system. Autonomic innervation of the heart.

Active Large Group Session: EKG Practice Session

Part 1, Medical Foundation 1, Cardiology, Week 1

Clinical Skills Sessions: Cardiac Exam: Practice Case - Chest Pain

Part 1, Medical Foundation 1, Cardiology, Week 2

To practice the Cardiac history and physical exam. Pro Comp connection care for Adults with Intellectual and Developmental Disabilities (IDD).

Tutorial: Alessandra W. MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 2

Alessandra W. is a 70-year-old lady referred to you for shortness of breath. She was previously fairly healthy until 2 months ago when she began noticing mild dyspnea with walking one to two blocks, climbing two flights of stairs, and while swimming at her local pool. Her symptoms have progressed since then to the point where she was forced to give up her swimming, which she had been doing regularly for the last several years. She also could no longer climb more than one flight of stairs without stopping. Over the last few days, she has noticed swelling in her ankles. She has become particularly concerned because she has been waking up at night short of breath and for the first time yesterday was forced to sleep sitting in her recliner. She denies any chest pain, fever, or cough.

Active Large Group Session: Clinical Pharmacology

Part 1, Medical Foundation 1, Cardiology, Week 2

Provide an introduction to the field of clinical pharmacology and therapeutics. To discuss what will be covered throughout the MD Program curriculum. To discuss pharmacodynamics and pharmacokinetic concepts.

Watching a Video: Introduction to Therapy Studies

Part 1, Medical Foundation 1, Cardiology, Week 2

Absolute risk reduction. Relative risk reduction. Number needed to treat. Calculating harm. Balancing risk / benefit. Communicating results. Relative risk. Odds ratio.

Tutorial: Liam D. MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 3

A 10-day-old infant is brought to the emergency room of your hospital by his mother with a history of progressive irritability and poor breastfeeding. On history, the infant was born by uncomplicated spontaneous vaginal delivery at 40 weeks gestation following a completely unremarkable pregnancy. Birth weight was 3.5 kg. The infant was well after birth and breast feeding was initiated by his mother without any problems. He was discharged home on day 2 of life. Over the subsequent days, the infant had increasing irritability and poor feeding; his mother describes him as having more difficulty at the breast, sucking for only a few seconds and then seeming short of breath. She also notices that he seems to be getting more tired and that his lips turn purple during feeding. In the emergency room, the baby is irritable and cyanotic-looking. Vital signs show a respiratory rate of 36 breaths per minute, heart rate of 195 bpm; BP 75/30 mmHg; oxygen saturation 75% on room air. He is noted to be warm and well perfused, but persistently cyanotic. On exam, he has palpable femoral pulses bilaterally, and normal breath sounds. Lung fields are clear to auscultation. He has a harsh systolic murmur best appreciated on the left upper sternal border. You provide 100% oxygen by face mask and order bloodwork, EKG and a chest X-ray.

Anatomy Demonstrations: Ultrasound (Cardiac Anatomy)

Part 1, Cardiology, Week 3

Tutorial: Novak B. Part 3 MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 3

Novak B. was discharged home following his myocardial infarction. He felt well for 4 days. He then developed an episode of dull retrosternal chest pain lasting for 2 hours. He felt this was somewhat different than the chest pain he had presented to hospital with during his MI. He felt unwell and was pale and diaphoretic on arrival at the ER. In the ER, his BP dropped to 85/55 mmHg, RR 32, HR 135 bpm, his JVP was elevated at 10 cm above the sternal angle. His lungs were clear to auscultation. Precordial examination demonstrated soft heart sounds. An EKG demonstrated sinus tachycardia with generalized low voltages and no new ST segment abnormalities. An echocardiogram was performed immediately and demonstrated a large pericardial effusion.

Tutorial: Novak B Part 1 MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 3

Novak B. is a 55-year-old man with a history of type 2 diabetes mellitus, hypertension and hyperlipidemia. He presents himself at your office because he has been experiencing chest pain for several days, but has been reluctant to come to the office. He first noted it 6 weeks ago while shoveling snow. The discomfort was mid-sternal and radiated to his jaw. It resolved with rest. Since then, he has noted 3 similar episodes each occurring while climbing the 2 flights of stairs from his basement to the bedroom. Upon further questioning, he also tells you that he feels cramps in both of his calves whenever he walks for more than 500 meters. If he stops walking, his symptoms resolve within 2-3 minutes. On examination, he is mildly obese. His pedal artery and posterior tibial artery pulses are significantly decreased in volume bilaterally. The remainder of the examination is normal. You diagnose him with angina and prescribe aspirin, a beta-blocker, a statin and nitroglycerin. You also make a referral to a dietician.

Tutorial: Novak B. Part 2 MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 3

Three years have now gone by and Novak B. has done very well. He has used his Nitroglycerin only once since you prescribed it, when he had to run for a bus. One night, you happen to be working an ER night shift at the local hospital when Novak is brought in by an ambulance. He is complaining of severe retrosternal chest pain, which started one hour ago. An EKG is obtained immediately and confirms an acute myocardial infarction (AMI). A chest X-ray is normal, as is his first Troponin T. You give him 162 mg of aspirin to chew, along with 180 mg of ticagrelor and enoxaparin 80 mg subcutaneously every 12 hours, as a starting dose. On examination, he is in distress from the pain and looks dyspneic. His pulse is 90 bpm and his respiratory rate is 24. His blood pressure is 100/70 mmHg in both arms. His O2 saturation is 90% on 2L oxygen via nasal prongs. His JVP is 5 cm above the sternal angle. He has bibasilar inspiratory crackles. His heart sounds are obscured by the ambient noise in the ER, but no obvious murmurs are heard. He has no peripheral edema. You briefly discuss percutaneous coronary intervention (PCI) and thrombolytic therapy. Novak does not consent to thrombolysis, but agrees to PCI.

Clinical Skills Sessions: Head and Neck Exam: Practice Case - Hearing Loss

Part 1, Medical Foundation 1, Cardiology, Week 3

Discuss and to practice the Head and Neck history and physical exam, with a focus on the ear and nose exam. Note: The ENT exam includes the Ear, Nose and Throat. We will not focus on the Thyroid exam as it is covered in MF3, nor the Lymph Node exam as it is explored in MF2.

Anatomy Demonstrations: Cardiac Anatomy

Part 1, Medical Foundation 1, Cardiology, Week 3

Surface anatomy. Mediastinal contents and pericardium. Fetal circulation. Coronary circulation and valve structure.

Tutorial: Sade A. MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 4

Sade A. is a 54-year-old woman known to have hypertrophic cardiomyopathy. She was diagnosed at age 18 when she had a syncopal episode. She was told to avoid any competitive or physically demanding sports. Her brother was also diagnosed with the same condition. Her echocardiograms have shown increased septal thickness and obstruction to flow at the left ventricular outflow level. She is on metoprolol to decrease the degree of outflow obstruction. She was well until a few weeks prior to consultation when she started to feel her heart racing and felt frequent irregular heartbeats. Since then, her heart rate has been consistently around 110-120 bpm. She has also noticed effort intolerance. She used to be able to walk her dog, but now she becomes short of breath as soon as she reaches an incline and has to slow down. On exam, her heart rate is 105-110 bpm and irregular, blood pressure 118/68 mmHg, JVP is not elevated, she is acyanotic. You can hear crackles at both lung bases, no peripheral edema, precordial exam reveals a sustained apical impulse and a grade 3/6 systolic murmur which increases with the Valsalva maneuver.

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).

Tutorial: Terrance K. MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 4

Terrance K. is a 60-year-old gentleman who comes to the emergency room after experiencing an episode of retrosternal chest discomfort. This occurred while he was walking on his treadmill at home. The pain was mid-sternal, non-radiating, and resolved approximately two minutes after he stopped his treadmill. He admits to several recent episodes of similar chest discomfort, each occurring during exercise. His first episode occurred 6 months ago, though they have become more frequent over the last month. He has noted these episodes only with exertion and never at rest. He became particularly alarmed with today's episode because he also felt quite lightheaded and thought he was going to faint. His past medical history is unremarkable, though he admits to not having been to a doctor in over 30 years. He is on no medications and denies any drug allergies. On examination, his heart rate is 76 bpm and regular, his BP is 110/70 mmHg, and his respiratory rate is 12. He is afebrile with a temperature of 36.8 degrees Celsius. His JVP is elevated at 5 cm above the sternal angle. His carotid pulse is somewhat delayed and with a diminished upstroke. There is a palpable thrill over both carotids. His chest reveals bibasilar crackles on auscultation. His cardiac exam reveals a sustained but not displaced point of maximal impulse. There is a palpable S4. The first heart sound is normal though the second heart sound is diminished in intensity. There is an easily heard fourth heart sound. There is also a harsh, grade 3/6, crescendo-decrescendo systolic murmur that peaks late in systole. The murmur radiates into both subclavian arteries as well as both carotids. It is also heard throughout the precordium.

Active Large Group Session: Introduction to Pain

Part 1, Medical Foundation 1, Cardiology, Week 4

This session is intended to generate a discussion towards formulating a basic early understanding of pain for future physicians. It is also intended to serve as a framework for future learning about how pain manifests in the context of health or disease, be it acute, chronic, or terminal, and to consider how it might be managed. Finally, this session is intended to begin illustrating how psychological, environmental and social factors can influence the experience of pain and its management thus resulting in the potential need for an interdisciplinary approach in that regard.

Tutorial: Amanda VP MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 4

Amanda VP. is a 44-year-old Russian immigrant whom you first meet at family health team where you are completing your core training as a family medicine resident. Amanda presents to the clinic because she’s had a two-week history of fevers, chills, malaise and shortness of breath on exertion. She became particularly concerned earlier today when she experienced a brief episode of left arm weakness that lasted for approximately 5 minutes and then completely resolved. Amanda, one of four children, grew up in the former Soviet Union, in a poor household with her extended family (cousins, aunt and uncle, and grandparents). Amanda VP.’s short stature makes you wonder if she was malnourished as a child and if so, what other effects this may have had on her health. Her past medical history seems unremarkable. She has been hospitalized once when she delivered healthy twin girls twenty years ago. She does recall having been told by her obstetrician that she had a heart murmur. She is married and works as a dental assistant in her husband's office. She smokes one pack of cigarettes daily and has done so for 30 years. She does not drink alcohol. On examination, she looks unwell. She is febrile with a temperature of 38.8 degrees Celsius. Her heart rate is 110 bpm with a BP of 100/65 mmHg. Head and neck examination reveals bilateral conjunctival petechiae. Her JVP is 4 cm above the sternal angle. Her chest is clear. Heart sounds reveal a grade 3/6 pan-systolic murmur best heard at the apex and an S3 with gallop. Her point of maximal impulse is enlarged and palpated in the anterior axillary line. She has mild bilateral pedal edema. Neurological examination, including fundoscopy, is completely normal as is the dermatologic exam. You decide to admit her to hospital, order blood work, a chest X-ray, and an echocardiogram.

Active Large Group Session: A Focus on Insurance and Budgeting

Part 1, Medical Foundation 1, Cardiology, Week 4

Different types of insurance. Personal budgets.

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.

Clinical Skills Sessions: Respiratory Exam: Practice Case - Dyspnea and Cough

Part 1, Medical Foundation 1, Respirology, Week 4

Discuss and to practice the components of the respiratory history and physical examination. Practice an approach to the environmental exposure history using the CH2OPD2 format. Pro Comp Connection – Health Effects of Climate Change.

Large Group Session: Physician Humanity Panel #2

Part 1, Medical Foundation 1, Respirology, Week 4

Why I became a doctor... or NOT. Exploring Different paths' to Happiness.

PC Session: What is Pro Comp?

Part 1, Professional Competencies 1, Week 1

This session will introduce students to the Professional Competencies course structure and expectations. It will allow students and LFs to start to get to know each other, to begin to form as a group, and to establish norms for working together.

PC Session: Ethics - Consent

Part 1, Professional Competencies 1, Week 2

By the end of this session, students will be able to demonstrate an understanding of the concept of informed consent; describe the limitations of informed consent in relation to issues of voluntariness and coercion; explain the relationship between age and capacity for consen

PC Session: History of Medicine

Part 1, Professional Competencies 1, Week 3

Appreciate a historical perspective for understanding medicine and its relationship to technology, medical education, and the relationship of body to mind; Gain an understanding of how society has viewed and reacted to doctors and medical practice; Learn how medicine has intersected with the law to define the human being; Consider how different theories of the body have produced particular medical procedures, approaches to patients, criminal punishment, and medical ethics.

PC Session: Ethics - Confidentiality

Part 1, Professional Competencies 1, Week 4

Medical students are as responsible for maintaining patient confidentiality as fully licensed professionals are. This session will help you prepare to apply privacy rules and legislation.

PC Session: Communication Skills 1

Part 1, Professional Competencies 1, Week 5

This session will provide students with their first opportunity to work with Standardized Patients while developing their communication skills.

PC Session: Ethical Decision-making

Part 1, Professional Competencies 1, Week 6

In this session you will do two things: 1) discuss codes of medical ethics and the theory that informs them; and 2) become familiar with the Hamilton Health Sciences (HHS) Ethics Framework as a tool for analysis of ethical issues and case studies in medical ethics.

PC Session: Anti-Oppressive Practice

Part 1, Professional Competencies 1, Week 7

This session will assist students to critically analyze the social structures of power and privilege and how these may be operating in ways that marginalize less powerful groups.

PC Session: Trauma Informed Care

Part 1, Professional Competencies 1, Week 8

This session will introduce the concepts of trauma and trauma-informed care to medical students. This session emphasizes the importance of identifying trauma and the impact on health. It builds on and extends the skills learned in the communication domain and reinforces concepts from the session on narrative medicine by emphasizing the importance of respectful and effective interactions with trauma survivors and helping students to appreciate the healing power in these interactions.

Active Large Group Session: Money and Medical School

Part 1, Medical Foundation 1, Introduction to Medicine

Active Large Group Session: EDI (Equity, Diversity, Inclusion) and Indigenous Reconciliation (part 1)

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

Equity may be considered both an approach and a process that recognizes the existence of systemic social inequalities and introduces actions to proactively reduce, if not remove, institutional structural and cultural barriers to equal opportunity and inclusion. Diversity is a state or condition that reflects the broad ‘mix’ and layers, of differences in any community. In the university setting, compositional diversity refers to the numeric and proportional representation of different peoples, across many intersecting dimensions of sociocultural group identities. Inclusion is a sense of belonging and dignity, as well as the experience of meaningful engagement, empowerment, and equality of opportunity in a community.

Large Group Session: Student Assessment in the MD Program

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

Introduction to MD program assessment and philosophy and methods of assessment. Assessment tools used in the MD program. Setting yourself up for success. Recognizing difficulty and getting help.

Tutorial: T. Petty MF1 Respirology

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

A youth is brought into the emergency department by paramedics after being found unconscious lying on a sewer grate. No further history is available. In the triage unit, the patient’s respiratory rate is 8 breaths per minute, and breaths are shallow. Heart rate is 50 beats per minute. Oxygen saturation by pulse oximetry is 90% on room air. Pupils are constricted and fixed. “Track marks” are noted on the forearms. The triage nurse applies oxygen by mask and the emergency resident orders a medication given through an intravenous line. Three minutes later the patient is awake, agitated, and complaining of severe generalized pain. Respiratory rate is 30 breaths per minute. When the medicine resident arrives at the bedside an hour later to admit the patient, the youth is once more unconscious, breathing slowly and shallowly as on arrival in triage.

Large Group Session: Finances & Financial Aid

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

OSAP, Provincial Funding, McMaster General Bursary & Donor Bursaries, Conference Funding, Conference Funding, Clerkship stipend.

Active Large Group Session: Decolonization of Anatomy

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

Bias in anatomy.

Active Large Group Session: Communication Skills With Improvisation and Drama

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

Large Group Session: Professionalism Session 2: Intro to Ethics

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

Students will have the opportunity to broadly understand ethical principles and the ethical climate in healthcare. Appreciate the intersection of professionalism, character, and individual moral agency. Explore the role and responsibility of medical students and physicians regarding ethical issues, with specific consideration to privacy, confidentiality, trust and vulnerability.

Large Group Session: Introduction to Problem Based Learning

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

Understanding problem based learning. The why. The process. Roles and resources.

Clinical Skills Sessions: Introduction to History Taking

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

To describe how to perform the components of the medical history.

Large Group Session: Approach to Library Resources

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

Accessing the library. Health Sciences Library. Library services. Resources for MF 1 and beyond.

Active Large Group Session: EDI (Equity, Diversity, Inclusion) and Indigenous Reconciliation (part 2)

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

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.

Tutorial: Nabil Assad MF1 Respirology

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

Salim takes Nabil, his 7-year-old son, to see Dr. Lockwood, his family doctor, because both of them have a sore throat. Nabil’s younger brother had a sore throat and runny nose a week ago, but he improved quickly. Salim is concerned about Nabil because he seems to be taking longer to improve. Dr. Lockwood asks more details and learns that both Nabil and Salim are mostly having swallowing difficulties but feel otherwise quite well. Salim has a mild cough, but Nabil does not. There have been no rigors, just slight chills last night.

Active Large Group Session: Introduction to Immunology

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

Tutorial: Edwin McKenzie MF1 Respirology

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

Edwin is a 4-year-old boy enjoying a day at the Caledonia Fall Fair. He is walking around, enjoying the sights while eating a hot dog, when he suddenly begins to choke. Bystanders look on, horrified. An alert medical student, who happens to be taking a break from studying, is on the scene. She rushes over, comes up behind Edwin and administers an abdominal thrust. The piece of hot dog is expelled from Edwin, and he takes a big breath.He is fine, the medical student is relieved and congratulations are offered all around at this happy ending. In speaking with Edwin’s parents after the incident, the medical student notices a colorful circular pin on his mother’s jacket. The medical student inquires about the pin, and Edwin’s mother states the pin represents the Medicine Wheel, an important concept for their family’s health.

Tutorial: Rana Osman MF1 Respirology

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

Rana Osman is a 2-year-old girl who has been previously well. She has had a barky, seal-like cough for 2 days but tonight has become acutely worse. In the emergency room, she is found to be sitting "bolt upright", with pronounced stridor on inspiration. Her inspiratory phase is prolonged. She has intercostal indrawing and suprasternal indrawing.

Large Group Session: Professionalism Session 1: Intro to Professionalism in Practice

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

An introduction to the Professionalism in Practice document.

Large Group Session: Learning Strategies

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

Active Large Group Session: Intro to Oxygen Delivery

Part 1, Medical Foundation 1, Introduction to Medicine, Week 3

Why do we need Oxygen? How do we use Oxygen? How do we get Oxygen?

Tutorial: Devi Gopal MF1 Respirology

Part 1, Medical Foundation 1, Introduction to Medicine, Week 3

A 55 year-old lady is reviewed in the Respirology clinic because she has become increasingly breathless and can no longer keep up with her friends when walking. The referral letter notes that she has no history of heart disease. She denies any cough, wheezing, or chest pain. She does say that she spends a lot of her time lying down in bed because this eases her breathlessness.

Active Large Group Session: Code Red

Part 1, Medical Foundation 1, Introduction to Medicine, Week 3

In 2010 Dr Neil Johnston collaborated with a journalist from the Hamilton Spectator to produce an award-winning series of investigative reports which shone the spotlight on social and health inequities across Hamilton neighbourhoods. His writing and advocacy have influenced health and education sectors, as well as policy makers.

Clinical Skills Sessions: Introduction to Effective Physician-Patient Communication

Part 1, Medical Foundation 1, Introduction to Medicine, Week 3

To describe and to practice applying effective patient-centered communication skills as part of history-taking to assist with building and strengthening the patient-physician relationship.

Large Group Session: Student Affairs and Wellness

Part 1, Medical Foundation 1, Introduction to Medicine, Week 3

Introduction to Student Affairs and Wellness resources available to students in UGME

Active Large Group Session: Concepts of Evidence Based Medicine for UGME

Part 1, Medical Foundation 1, Introduction to Medicine, Week 3

To identify why evidence-based medicine is critical for clinical practice. Describe the steps in generating a question. Compare and contrast methodological approaches for research. Use critical appraisal skills to decide when to apply evidence for caring for patients.

Large Group Session: Physician Humanity Panel #1

Part 1, Medical Foundation 1, Introduction to Medicine, Week 3

The Ups and Downs of Medical School

Large Group Session: Learning Assistance

Part 1, Medical Foundation 1, Introduction to Medicine, Week 3

Tutorial: Ron Chen MF1 Respirology

Part 1, Medical Foundation 1, Introduction to Medicine, Week 3

Ron Chen is a 25 year old computer sciences post-graduate student who had been previously well. Three weeks ago he suffered a viral gastroenteritis from which he has recovered. Over the past week, he has noticed increasing weakness of his limbs, starting with his legs, and progressing to involve his arms. He reports he has experienced patchy areas of sensory loss, symmetrically. He has also noticed occasional clumsy speech and facial weakness.

Small Group Session: Study Design

Part 2, Medical Foundation 2

e-Learning Module: American Academy of Dermatology Part 2

Part 2, Medical Foundation 2

Atopic Dermatitis. Contact Dermatitis. Petechiae, Purpura and Vasculitis. Chronic Itch.

Clinical Skills Practice Sessions: Renal Examination and Volume Assessment

Part 2, Medical Foundation 2, Renal

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

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: All MF2 Renal tutorial problems

Part 2, Medical Foundation 2, Renal

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: 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

Anatomy Lectures: Renal System Anatomy

Part 2, Medical Foundation 2, Renal, Week 1

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules). Surface anatomy of the Kidneys. Relationship of the kidneys to vertebrae and ribs. Blood supply to the kindeys. Renal artery. Renal stone. Ureter. Blood supply to the Ureter, Innervation of the bladder. Urethra.

Tutorial: Michelle Broyer MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 1

Ms. Broyer is a 22-year-old female who moved to the local area and enrolled in your practice. Past medical history is significant for several episodes of muscle cramps and intermittent muscle weakness.

Tutorial: Matthew Clarke MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 1

Matthew Clarke, a 4-year-old boy, developed periorbital edema for the first time three weeks ago, and despite being treated for allergies he showed increasing edema and weight gain. He now has ankle and leg edema, a distended abdomen, and can only sleep at night if propped up with three or four pillows.

Anatomy Lectures: Vascular System Anatomy

Part 2, Medical Foundation 2, Renal, Week 1

Vasculogenesis. The capillaries. Capillary permeability. Arteries. Veins. Muscular arteries. Aortic branches of the Thorax. Arteries to the head and neck. Subclavian Artery Stenosis. Branches of the Abdominal Aorta. Abdominal Aortic Aneurysm. Atherosclerosis of the abdominal aorta. Abomidable arteries. Venous System. Caval system. Hepatic portal system. Vertebral Venous System. Arterial and Venous circulation of the legs. Deep vein thrombosis (DVT). Varicose Veins.

Tutorial: George Haycock MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 1

Mr. Haycock is a 20-year-old student who presented to ER with a 5 day history of diarrhea and vomiting which started at the end of his trip to the Caribbean. Past medical history is significant for epilepsy controlled with carbamazepine. Vital signs: HR – 100/min, RR – 15/min, BP – 80/50 mmHg, Saturation – 99% in room air. Physical examination revealed dry mucous membranes, prolonged capillary refill time of 4 seconds.

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: Amir Boutros MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 2

Amir Boutros is a 30 year old man with a history of Crohn's disease who presents to the hospital with a recent history of increased pain and diarrhea. He is very weak, dizzy and short of breath. His BP is 80/50 with a heart rate of 120 and respiratory rate of 24. His chest X-ray is normal.

Tutorial: Elena Christakos MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 2

Elena Christakos is a 54 yr old lady who presents to the Emergency Room with a 48 hr history of fever (temp up to 39.6 degrees celsius), chills, and weakness. Her condition in the ER deteriorates; BP falls to 80/50 and she becomes anuric. She is thought to be developing septic shock and is transferred to the ICU.

Small Group Session: Kidney Day

Part 2, Medical Foundation 2, Renal, Week 2

Clinical Skills Sessions: Volume Status Exam: Practice Case – Dehydration, Volume Overload

Part 2, Medical Foundation 2, Renal, Week 2

To practice the Volume Status history and physical examination.

Tutorial: Ivan Horvath MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 2

Ivan Horvath is a 70-year-old male with poorly controlled hypertension for approximately 20 years, dyslipidemia, and peripheral vascular disease. He has a 60 pack-year history of smoking. He has difficulty walking more than one block due to the development of pain in his legs. He has recently moved and you see him with his new family physician. He currently takes amlodipine (calcium channel blocker) and chlorthalidone (thiazide diuretic) for his hypertension.

Active Large Group Session: Acid Base Disorders

Part 2, Medical Foundation 2, Renal, Week 2

Respiratory acidosis. Metabolic acidosis. Respiratory Alkalosis. Metabolic Alkalosis.

Active Large Group Session: Electrolytes - Sodium and Potassium

Part 2, Medical Foundation 2, Renal, Week 3

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

Tutorial: Yong Mun Park MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 3

Yong Mun Park is a 22 year old woman who has a 2 year history of recurrent urinary tract infections. These continue despite conservative measures and her family doctor elects to try her on a course of prophylactic antibiotics. She is allergic to sulpha medications, so she is prescribed cephalexin 250 mg daily. She is taking an oral contraceptive, but no other medications. Ten days after starting this antibiotic, she returns to her family doctor with a macular, red rash on her trunk and arms, general malaise, and nausea.

Active Large Group Session: Introduction to the Basic Skin Exam

Part 2, Medical Foundation 2, Renal, Week 3

Morphology in Dermatology. How to describe a lesion / rash.

Clinical Skills Sessions: Renal Exam Practice Case - Renal Colic

Part 2, Medical Foundation 2, Renal, Week 3

Practice the history and physical exam as it pertains to nephrolithiasis. Standardized case of 44 year old male with flank pain.

Tutorial: Nancy Jones MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 3

Nancy Jones is a 34-year-old Mohawk, Turtle Clan woman who has been well until four days prior to hospital admission when she developed abrupt onset of chills, rigors, and a productive cough. Subsequently Mrs. Jones became progressively short of breath, was obtunded and bedridden and was brought to the hospital emergency room. On arrival, her vital signs were blood pressure 80/60 mmHg, heart rate 148 beats/min, respiratory rate 42/min, temperature 39.6o C, and oxygen saturation 79% on room air. She was confused. Crackles were heard on auscultation throughout her chest. Heart sounds were normal with no murmur, JVP was flat, mucous membranes were dry and there was no peripheral edema. Abdominal examination was normal. The patient was intubated and transferred to the ICU.

Tutorial: Martin Barratt MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 3

Martin Barratt is a 40-year-old male with Autosomal Dominant Polycystic Kidney Disease (ADPKD). He was diagnosed at the age of 15 years when he was found to have bilateral cysts on renal MRI. The diagnosis was confirmed genetically (see attached result) and there is a strong family history of this condition. His mother is on dialysis and maternal grandfather had a kidney transplant and died from a ‘brain bleed’. Martin’s creatinine was elevated for a number of years and was measured at around 350 µmol/L (eGFR 18 ml/min/1.73m2) 3 years ago. Unfortunately, he was lost for nephrology follow up and was recently re-referred by his FD. He is seen by the nephrologist today and complains of fatigue and pruritus. Current medications include allopurinol 75 mg/daily. ROS was significant for erectile dysfunction and recent forearm fracture after a minor fall. He is also worried that his 15-year-old daughter could have the same condition and asks whether she needs to be tested. Physical examination shows a pale, malnourished male with BP of 169/92 mm Hg.

Active Large Group Session: Case-Based Nephrology

Part 2, Medical Foundation 2, Renal, Week 3

Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease

Clinical Skills Practice Sessions: Introduction to Hematological Exam

Part 2, Medical Foundation 2, Hematology

Active Large Group Session: Introduction to Inclusive Clinical Skills

Part 2, Medical Foundation 2, Hematology

Describe a Trauma-Informed Care approach as a medical student participating in direct patient care, with a focus on following the five guiding principles of trauma- informed care (safety, choice, collaboration, trustworthiness, and empowerment). Apply an inclusive approach to patient-centered medical interviewing, with a focus on patient introductions and collaborative agenda-setting. Demonstrate patient-centered communication skills to optimize patient understanding before, during and after a physical examination. Demonstrate how to appropriately drape patients and the importance of draping in the patient-provider interaction, including accommodations that can be made in common clinical scenarios. Apply an inclusive approach to physical examinations for patients of varying body habitus, with a focus on modifications to specific physical exam maneuvers, as well as to describe instances of fatphobia in medicine.

Active Large Group Session: Immunology in MF2

Part 2, Medical Foundation 2, Hematology

Active Large Group Session: Entrepreneurship in Medicine

Part 2, Medical Foundation 2, Hematology

Explore the opportunities an MD degree can open up for them outside of medicine. Analyze options outside of the medical realm with respect to their future career. Contrast the utility of other degrees on top of an MD in developing one’s career.

Tutorial: Henrietta Turnbull MF2 Hematology

Part 2, Medical Foundation 2, Hematology

Henrietta Turnbull is a 42 who was admitted to hospital 8 days ago with a bacterial pneumonia. You are on the consultant hematology team and have been asked to assess her for new onset thrombocytopenia, platelets of 33 x 109/L.

Large Group Session: Research and Database searching

Part 1, Medical Foundation 1, Hematology

Student involvement in research projects. Types of health research studies. Information coding and retrieval. Ovid interface and individual accounts.

Tutorial: Terrance Pacheco MF2 Hematology

Part 2, Medical Foundation 2, Hematology

Terrance Pacheco is a 64 year old gentleman you have been asked to see in the ER with new onset thrombocytopenia and anemia. Terrance was brought into the ER by his family with new onset confusion that started 3 days ago. They have also noted easy bruising and presents with extensive ecchymoses on his lower shins. Terrance’s past medical history includes hypertension and dyslipidemia. He is on amlodipine 10 mg daily and atorvastatin 20 mg daily. He is otherwise well.

Tutorial: All MF1 Hematology tutorial problems

Part 1, Medical Foundation 1, Hematology

Anatomy Demonstrations: Applied Cardiovascular Pathology

Part 1, Hematology, Week 1

Anatomy Demonstrations: Pig Pluck

Part 1, Medical Foundation 1, Hematology, Week 1

Heart and lung dissection of porcine tissue

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: Carmine Garcia MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 1

Mr. Garcia is a 57-year-old retired banker who loves to play golf and garden. Despite chronic hip pain for which he takes aspirin on a regular basis, he plays golf 2-3 times a week in the spring and summer. His wife has encouraged him to see you today because over the past 3-4 months he has felt increasingly tired, and in fact, has not done his usual summer plantings. She also finds him very irritable. With some reluctance, Carmine tells you that he has been short of breath on the green on a couple of occasions over the last week, and that he really feels too fatigued to garden for any length of time. This worries him, as he has some friends with cancer, and they seemed to have the same symptoms prior to their diagnosis.

Tutorial: Alexandria Vardalos MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 1

You are on elective at a Health Clinic in downtown Hamilton with a multicultural patient population. Your supervisor asks you to see Alexandria Vardalos. Alexandria is an 8-month-old baby girl who is brought in by her parents. She was healthy at birth, but over the last 2 months, she has not been growing as fast as her sister did at the same age. She is frequently irritable and has difficulty feeding. On physical examination, Alexandria is pale, but in no apparent distress. She is afebrile with HR 125, RR 45, BP 90/60 mmHg and oxygen saturation 98% on room air. She is at the 5th percentile for both weight and height. When you palpate her abdomen, you notice that she has an enlarged liver and spleen. Her peripheral blood smear shows microcytosis, hypochromia and poikilocytosis. Hemoglobin electrophoresis shows Hb F 99.2%, Hb A2 0.8%, Hb A 0%. You inform the parents that their baby appears to be anemic and may have an inherited blood disorder. Her mother states: ‘I’m anemic – I inherited it from my mother and her family back in India. I didn’t think our children would get this because my husband’s family is Greek.”

Clinical Skills Sessions: Renal Exam Practice Case - Hematuria

Part 2, Medical Foundation 2, Renal, Hematology, Week 1, Week 4

Practice the Renal history and physical examination as it pertains to Hematuria. Pro Comp connection Indigenous Health - The case of Brian Sinclair is an important example of a fatal consequence of systemic racism in the Canadian Healthcare System. He was a 45-year-old First Nations man who died of a treatable bladder infection in 2008, after being ignored for 34 hours in the emergency.

Clinical Skills Sessions: Introduction and Overview of the Lymph Node Examination

Part 2, Medical Foundation 2, Hematology, Week 2

To discuss and to practice the components of the Lymph Node history and physical examination.

Active Large Group Session: Introduction to Renal Pathology

Part 2, Medical Foundation 2, Hematology, Week 2

Tutorial: Judy Patterson MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 2

Judy Patterson is a 22 year-old university student who presented to the Student Health Clinic with a rash on her lower legs. Her past medical history is unremarkable except for a urinary tract infection diagnosed 6 days ago for which she is taking trimethoprim-sulfamethoxazole. The only other medication she takes is the occasional dose of ibuprofen for headaches. She has never had any dental extractions or surgeries. On examination, she has no lymphadenopathy or splenomegaly, but she does have petechiae on her lower legs. You ask to look inside her mouth and there you see a blood blister on the inside of her cheek. She says she must have bitten it by accident.

Anatomy Lectures: Lymphatic System

Part 2, Medical Foundation 2, Hematology, Week 2

The lymphatic system consists of lymphatic tissues (Thymus, Lymph nodes, Spleen) and lymphatic vessels (vessels which assist in returning tissue fluid to the blood). Thymus Gland. Type of cells in a lymph node. Lymph node and lymphatic vessel. Popliteal lymph nodes and vessels. Femoral and external iliac lymph nodes and vessels. Female and male pelvic lymph nodes.

Tutorial: Sana Gupta MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 2

Sana is an 18-year-old female who presents to the emergency room with prolonged bleeding following extraction of a wisdom tooth. The extraction was performed earlier that day and she was sent home with packing to be removed 1 hour later. She bled through the packing by the time she got home and has continued to bleed for the past 2 hours. This is her first tooth extraction and she has no previous history of surgical procedures. On questioning, she describes her periods as “heavy”, but her mother and grandmother reported a similar experience so she assumed that was normal. Physical examination reveals constant oozing from the site of extraction, severe edema of her cheek and a large ecchymosis along her jaw line.

Tutorial: Ms. LW MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 2

Part 1: You are working in the Red Blood Cell Disorders Clinic at McMaster. You are asked to see Ms. LW by your preceptor for routine follow up. Ms. LW is a 43-year-old cisgender woman who was diagnosed with sickle cell disease as a child while living in Guyana. Part 2: It is a few months later and you are on a rotation working in the emergency department. You see Ms. LW’s name on the tracker and remember seeing her in the RBC Disorders Clinic. You pull the triage assessment and read that Ms. LW is presenting with a 2-day history of jaundice and pain in her arms and back, which has been unresponsive to oral hydromorphone at home. Vitals in triage reveal HR 110, BP 110/65, T 36°C, RR 16, SpO2 99% on room air.

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: Anemia and Approach to Bleeding

Part 2, Medical Foundation 2, Hematology, Week 3

Clinical Skills Sessions: Lymph Node Exam: Practice Case – Lymphadenopathy

Part 2, Medical Foundation 2, Hematology, Week 3

To practice the Lymph Node history and physical examination.

Tutorial: Eva Foster MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 3

Mrs. Foster is a 50-year-old female who comes to the ER complaining about some chest discomfort that seems worse when she takes a breath in and shortness of breath. She also feels like her heart is racing. Her past medical history is unremarkable except for mild hypertension. She usually takes an aspirin a day because she heard it was a good idea to take it, but she stopped taking it one week ago when she noticed some blood in her stool. She thinks her mother may have had a blood clot in her leg during one of her pregnancies. Mrs. Foster is married with no children. On physical examination in the emergency room, her HR is 110/min, RR 28/min, BP 122/70, oxygen saturation 86% on room air. Her chest and precordial exam are normal. Her left leg is normal in colour, slightly warm and edematous. The circumference of her left calf is 3 cm larger the circumference of her right calf. She complains of pain when you palpate behind her knee. Her pedal pulses are palpable. The ER staff person calculates her Wells Score and based on the result, orders a D-dimer blood test.

Tutorial: Charlotte Bouchard MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 4

Charlotte Bouchard is a 31 year old female who has presented to the ER with new onset shortness of breath. She is previously healthy with no history of medical problems and is not on any medications. She tells you her chest pain and shortness of breath started roughly six weeks prior and have gotten worse to the point she can barely take a few steps without having to stop. She’s also lost about 15 lbs in this time and has noted night sweats such that she has had to change her pajamas during the night. On exam, her pulse is 105, BP 115/87, SpO2 97% on R/A, Temp 37.2. She is not visibly distressed. Respiratory exam reveals decreased air entry on the left and you are able to palpate lymph nodes along her bilateral cervical chains and supraclavicular regions. You also appreciate enlarged lymph nodes in her bilateral axillae and inguinal regions. Her spleen is palpable 5 cm below the costal margin. Chest x-ray performed in the ER reveals a left-sided pleural effusion and is suspicious for a mediastinal mass. You order a follow up CT and this confirms a 15.3 cm mediastinal mass as well as diffuse hilar and axillary adenopathy.

Active Large Group Session: Palliative Care: A Good Death

Part 2, Medical Foundation 2, Hematology, Week 4

Active Large Group Session: Introduction to Oncology

Part 2, Medical Foundation 2, Hematology, Week 4

Clinical Skills Sessions: Hematological Exam Practice Case - Fatigue

Part 2, Medical Foundation 2, Hematology, Week 4

Standardized case 30 year old female with fatigue.

Tutorial: Jesse Knox MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 4

Mr. Knox is a 22-year-old male undergoing chemotherapy treatment for Acute Myeloid Leukemia. He was seen in clinic last week for chemotherapy, and he was relieved to see that his neutrophil count was back up above 1 (ANC 1000). He had no evidence of bleeding, and his platelet count was 110. He tolerated his intravenous chemotherapy and anti-emetics well, and went home to recover for the weekend. Eight days later, Jesse is feeling unwell and checks his temperature as he has been taught to do – it reads 38.5 deg C orally, so he presents to the ER as instructed. Apart from the fever, his only complaint is a sore mouth. He denies cough, shortness of breath, dysuria or change in bowel movements. Physical exam reveals a tired and pale-looking young man. His blood pressure is 105/60, heart rate 125 bpm, respiratory rate 18 and a temperature of 38.9 deg C. His tongue has a white coating and his gums look sore. His central line catheter site appears clean.

Tutorial: Billy Elliot MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 5

Billy Elliot, an 18 year old male music store employee was brought into your emergency department after being involved in a motor vehicle accident at about 2:00 a.m. The paramedics that brought him in stated that he was the driver of a vehicle involved in a three car accident. The rescue squad required the "jaws of life" to extricate him from the car. The airbags were deployed, but the car sustained significant damage and the steering wheel was noted to be inches from the front seat after Billy was extricated. The paramedics conveyed that the patient was alert and talking at the scene and an IV was started. However, en route to the hospital, they noted that his pulse rate began to increase and the patient was diaphoretic.

Small Group Session: Hematology Day

Part 2, Medical Foundation 2, Hematology, Week 4, Week 5

Clinical Skills Sessions: Peripheral Vascular Exam – Practice Case: Peripheral Vascular Disease

Part 2, Medical Foundation 2, Hematology, Week 5

To discuss and to practice the components of the Peripheral Vascular history and physical examination.

PC Session: Introduction to Evidence Based Medicine at Point of Care: Part 1

Part 2, Professional Competencies 2, Week 1

This session will explore issues related to how we incorporate various pieces of information (i.e. from research, from patients) to make medical decisions.

PC Session: Epistemology

Part 2, Professional Competencies 2, Week 2

This session will introduce the concept of epistemology (the study of knowledge and justified belief). Epistemology asks questions such as how do we know what we know? Where does knowledge come from? What are the sufficient conditions of knowledge? What are its limitations? How do we make knowledge?

PC Session: Patient Safety

Part 2, Professional Competencies 2, Week 3

Patient safety is about managing and reducing risk to ensure that the care patients receive is as safe as possible. In clerkship, students will become actively involved in the delivery of patient care. As members of the health care team, students at the clerkship level need to be aware of key concepts in patient safety. They also need to develop an understanding of how to communicate about patient safety issues to each other, to health care team members and to patients.

PC Session: Introduction to Indigenous People's Health

Part 2, Professional Competencies 2, Week 4

This session addresses the health of Indigenous people and the important determinants from an Indigenous perspective. Through this session students will begin to address the First Nations, Inuit and Metis Health Core Competencies in the area of Medical Expert and Professional.

PC Session: Narrative in Medicine

Part 2, Professional Competencies 2, Week 5

Stories are the way in which humans make sense of the world and share experience with each other. They are as important in sickness, suffering, recovery, health, and medical practice as in any other area of human life. This session will introduce students to the richness of narrative in medicine.

PC Session: Communication Skills 2

Part 2, Professional Competencies 2, Week 6

This is the second session during which students will practice communicating with Standardized Patients.

PC Session: Intro to Canadian Health Care System

Part 2, Medical Foundation 2, Professional Competencies 2, Week 7

Health care systems are complex organizations comprising regulatory, funding and service provision bodies that provide access to health care in accordance with societal goals and values. This session will introduce students to the organization of the Canadian health care system, the principles of the Canada Health Act and some of the current issues and debates regarding funding and health care costs.

PC Session: Inter-professional Education and end of MF2 Assessment

Part 2, Professional Competencies 2, Week 8

Students will be introduced to the Interprofessional Education requirements of the program.

Active Large Group Session: Integrated Radiology - Anatomy - Gastrointestinal / Genitourinary / Gynecology (IARS)

Part 3, Medical Foundation 3

e-Learning Module: Integrated Pain and Opioid Curriculum Course 2 - Pathophysiology of Pain and Pharmacology of Opioids

Part 3, Medical Foundation 3

In this module, you will review the types of pain and the basic mechanisms of pain signalling. You will also learn about the pharmacology of opioids, and how their primary effects are mediated by interactions with opioid receptors; and about the range of serious adverse effects associated with opioids. (c) AFMC, v. June 30 2023.

Clinical Skills Sessions: Shortness of Breath: renal, cardiac, respiratory

Part 3, Medical Foundation 3

Observations of a student(s) taking a history from a patient with shortness of breath. Demonstration by preceptor of examination of a patient with shortness of breath. Discussion regarding shortness of breath. Etiology, differential diagnosis, investigations, etc.

e-Learning Module: American Academy of Dermatology Part 3

Part 3, Medical Foundation 3

Stasis Dermatitis. Bacterial Skin Infections. Blisters. Sexual and Gender Diverse (SGD) Dermatology

Anatomy Demonstrations: Male Reproductive System

Part 3, Medical Foundation 3, Renal, Week 2

Clinical Skills Sessions: Edema

Part 3, Medical Foundation 3

Practice the history and physical exam as it pertains to edema.

Clinical Skills Practice Sessions: Breast and Lymph Node Examination

Part 3, Medical Foundation 3, Reproduction and Pregnancy

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

Clinical Skills Practice Sessions: Male Genital Exam (using models)

Part 3, Medical Foundation 3, Reproduction and Pregnancy

Active Large Group Session: Labour

Part 3, Medical Foundation 3, Reproduction and Pregnancy

Intrapartum management of spontaneous labour. Fetal health surveillance in labour. Operative vaginal birth. Indications for caesarean sections. Management of pregnancy at 41+0 to 42+0 weeks

Active Large Group Session: CisWoman's Sexual Health and Cervical Cancer Screening

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

Tutorial: Manuel Pereira MF3 Reproduction

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

Manuel Pereira and his wife have been trying to conceive a child for 16 months. After 12 months of trying, Michelle sought medical advice and so far, her investigations have been negative. You have suggested that since it takes two to make a baby, Manuel should undergo evaluation. Manuel reluctantly attends your clinic. He is quite certain that their inability to conceive can not be "his fault" because he fathered a child, by mistake, when he was 18

Anatomy Demonstrations: Reproduction and Pregnancy

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

Tutorial: Susan Weiss MF3 Reproduction

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

Susan Weiss is a 53 year old woman (G3P3) who presents to her family doctor stating she is having difficulty sleeping. She is waking up drenched through the night. She complains of having sweating episodes throughout the day that are debilitating and embarrassing. She is irritable with her family and states they do not understand "the change". It has been 18 months since her last period. She has no libido and when she tries to be intimate with her partner, she is extremely dry.

Clinical Skills Sessions: Adolescent History Practice Case - Behaviour Problems

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

Discuss and practice the components of the Adolescent history, with a focus on the SSHADESS screening assessment. Pro-Comp Connection – Child Maltreatment

Tutorial: Mei Wang MF3 Reproduction

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

Mei Wang, a 24-year-old fitness instructor, stopped taking the oral contraceptive pill (OCP) 12 months ago, in order to conceive. She has remained amenorrheic since then. Mei's puberty was appropriate in terms of timing and secondary sexual development. However, she has always had infrequent and at times extremely heavy menstrual bleeding. As a teenager, she was prescribed the OCP to regulate her periods. She has been on the OCP ever since.

Anatomy Lectures: Perineum and Pelvis, Male and Female genital organs and breast

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

Perineum and Pelvis, Male and Female genital organs and breast

Active Large Group Session: Early Pregnancy Management

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

Consider the techniques and implications of therapeutic abortion. Define different types of miscarriages and how they present in early pregnancy.

Tutorial: Shalini Mehta MF3 Reproduction

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

Shalini Mehta is a successful 35-year-old lawyer who married five years ago. Her partner Varun is a 56-year-old judge who left his former wife to be with Shalini. He has three grown children and one grandchild. Varun was never as keen on starting a new family as Shalini, but he loves her and "wants what she wants". For the first three years of their marriage, Shalini continued on the birth control pill, as she wanted to focus on establishing her career further. She states that she had been on the pill since she was 18. Two years ago she stopped the pill and had hopes that she would be trying for her second baby by now.

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.

Clinical Skills Sessions: Gynecological / Sexual History

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

Discuss and practice the components of the Gynecological and Sexual histories. Pro-Comp Connection – LGBT2SQ+ Patients. LGBTQ2S+ patients in Canada experience worse health outcomes than their heterosexual, cisgender peers.

Tutorial: Mary Jane Morrison MF3 Reproduction

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

Mary Jane, a healthy 22-year-old woman, is seen in a walk-in clinic for abnormal vaginal discharge. She is otherwise healthy and not taking any medications. Her immunizations are up to date, though she is unsure if she received the HPV vaccination as a teen. Mary Jane has been sexually active for 2 years. She has never had a Pap smear. She tells you that she has tried the birth control pill in the past but is not taking it because it “makes her sad”. She uses condoms instead. Three months ago, she had unprotected sex one time with her current partner. She confides in you that she thinks her current partner "sleeps around" on her and she’s here today because she wants to get “checked”. When taking a detailed sexual history, you discover that she has intermittently experienced pain during sexual intercourse and some post-coital bleeding. Mary Jane minimizes these symptoms and tells you that this is normal for her. On examination she looks well but is very nervous. Vitals signs are within normal limits. Head and neck, respiratory and cardiac examinations are all normal. Abdominal exam does not reveal any masses or areas of tenderness. Skin and joints are all normal. Genital examination does not reveal any lesions. Pelvic examination reveals some purulent discharge from the cervical os. Swabs are collected from the cervical os and result in bleeding. Bimanual examination does not elicit any cervical or adnexal tenderness. You discuss the role of cervical cancer screening and how it relates to HPV, a sexually transmitted infection. Mary Jane agrees to return in 2 weeks for a Pap smear.

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: Rachel Kowalski MF3 Reproduction

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

Rachel is a 15-year-old grade 9 student who has come to the walk-in clinic requesting ‘the pill’. She has been dating John, who has not accompanied her, for 6 months and she feels that it is time for them to have sex. She has never had intercourse. John is 18 and will finish grade 12 this year. Rachel lives with her mother and two younger brothers. She has always been healthy and is on no medications. She states that she smokes occasionally and sometimes drinks. After a discussion regarding the implications of her decision and the issues of the options available, Rachel is given three months of oral contraceptives (OCP) and instructions. There is a plan to follow-up with her family doctor for a refill and a pap smear. Three months later, Rachel experiences heavy vaginal bleeding accompanied by suprapubic pain. She is very frightened and comes to the ER with her mother. She states that she thinks her last period was a month ago but it was not really normal and she has had spotting intermittently since starting the pill. She says that she is not on any other medications but two months ago she was on an antibiotic for 5 days for a bad cough. The antibiotic made her very nauseated.

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.

Tutorial: Samira Shah 2 MF3 Reproduction

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

One hour after giving birth to baby Varkey, Mrs. Shah states that she feels lightheaded as she sits upright for the first time. Her midwife who has been monitoring her closely following the delivery helps her to lay back down. She notes that Samira is somewhat pale and that her pulse is rapid and thready. She palpates the uterus and finds the fundus is above the umbilicus. As the midwife massages the fundus, a large grapefruit size blood clot is expressed followed by blood that soaks the bed sheets. As summoned help arrives, Samira’s BP is found to be 85/50 and her heart rate 120.

Tutorial: Samira Shah 1 MF3 Reproduction

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

Samira Shah is a 27 year old woman who works as a waitress in a local restaurant and is in her first pregnancy. She is slightly overweight (pre-pregnancy BMI 28.5). Her prenatal care has been unremarkable although she was found to be rubella non-immune and had a positive glucose challenge test (GCT) followed by a negative glucose tolerance test (GTT). Now at 38 weeks, she has abdominal cramping and slight bright red vaginal bleeding. Her husband, Sunny, informs Hanna’s midwife of this. Her midwife comes to their apartment to assess Samira.

Clinical Skills Sessions: Obstetrical History: Practice Case – Intrapartum Care, Labour and Delivery Triage

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

To discuss and to practice the components of the Obstetrical history as it pertains to Intrapartum Care. To apply key terminology appropriately in intrapartum care, including: Diagnosis and stages of labour, including differentiating term from preterm labour. Diagnosis of rupture of membranes (ROM), including differentiating spontaneous rupture of membranes (SROM), prelabour rupture of membranes (PROM) and preterm prelabour rupture of membranes (PPROM). Practice taking a focused history in an intrapartum care setting, with a focus on four essential triage visit questions (Contractions/labour; Fluid/rupture of membranes; Bleeding; and Fetal Movements). Demonstrate use of gender-inclusive perinatal language (e.g. parental leave, birthing parent, chest-feeding). Practice navigating key challenges in delivery of intrapartum care in rural and remote settings, including recognizing limitations of scope of practice to inform shared decision-making. Pro-Comp Connection – Indigenous Health and Prenatal / Intrapartum Care

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: Savita Singh MF3 Reproduction

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

Savita Singh, a 33-year-old married woman, is seeing her physician for amenorrhea. She was suspected of having diabetes mellitus 6 months ago after a round of routine blood tests. The diagnosis of diabetes mellitus was confirmed with repeat testing soon thereafter. Savita was immediately counselled on the importance of lifestyle modification, with special attention to weight loss and exercise at least 3 times per week. Since then, Savita has found it very challenging to integrate these recommendations into her busy lifestyle and says she has “only lost 3 pounds.” Savita has always had irregular menstrual cycles since menarche at age 11, generally having periods once every 1-3 months on average. She could not reliably predict when a period would start or end. Her menses were sometimes very light and sometimes extremely heavy. For the past 6 months, however, she has had no period whatsoever. Savita has never been on any medications. Her family history is significant for type 2 diabetes and premature coronary artery disease, with her father having had a myocardial infarction at the age of 45. On physical examination, Savita has a weight of 77 kg and height of 153 cm. Her abdominal circumference is measured at 93 cm at the umbilicus. There are small skin tags and hyperpigmentation noted at the back of her neck and in both axillae. Her abdomen has some striae but they are pale, thin and not depressed. She has excessive hair growth on the upper arms, upper chest, abdomen, lower back and face with a Ferriman-Gallwey score of 16/36. There is mild acne and her hairline appears to be receding. There are no virilizing signs on exam. Fundoscopic examination reveals changes consistent with early non-proliferative diabetic retinopathy. Examination of the feet does not show any signs of neuropathy.

Active Large Group Session: Inclusive Clinical Skills Part 2

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

PC Session: Planetary Health

Part 3, Professional Competencies 3, Week 1

The World Health Organization has declared climate change as the single greatest health threat facing humanity. Healthcare providers are already seeing the downstream consequences of the climate emergency in their clinical practices (worsening heat-related illness, injuries due to extreme weather events, exacerbation of respiratory disease, etc)

PC Session: Shared Decision Making

Part 3, Professional Competencies 3, Week 2

This session focuses on developing skills to engage in Shared Decision Making(SDM) conversations with patients to negotiate their treatment planning. Shared decision making(SDM) is usually defined as conversations physicians have with their patients reviewing relevant evidence from the scientific literature and then sharing in the decision making based on the evidence. This was the original conception of EBM here at McMaster, Dept. of Medicine envisioned by Dr. David Sackett and continued by Dr. Gordon Guyatt. At the McMaster MD program; and in the Professional Competencies curriculum, we build on their rich legacy recognizing that any encounter with our patients will also draw heavily on ethical decision making, anti-oppressive practices, self-awareness/reflection and effective communication skills. Shared Decision Making(SDM) is a complex skill that evolves with lifelong learning and practice across the Clerkship and beyond into the Postgrad. Here our goal is only to provide a survey of some of the relevant literature surrounding SDM, summarize some underlying principles and begin practicing with simulated cases in the Large Group Session and Small Group Sessions.

PC Session: Research Ethics

Part 3, Professional Competencies 3, Week 3

This session will provide an introduction to ethical concepts in research including case-based exploration of core principles. The rationale and principles for the ethical conduct of clinical research.

PC Session: Anti-Black Racism and Black Exclusion in Medicine

Part 3, Professional Competencies 3, Week 4

The purpose of this session is to explore the dimensions of white supremacy, anti-black racism and black exclusion in medicine.

PC Session: Introduction to Population Health

Part 3, Professional Competencies 3, Week 5

This session will explore a population health approach to addressing health issues with a focus on health promotion and illness prevention.

PC Session: Using Evidence-Based Medicine at Point of Care Part 2

Part 3, Professional Competencies 3, Week 6

Practice advising a patient on the risks and benefits of screening, using screening mammography as an example. Use differing approaches to the decision making process (including paternalism and shared decision making), to understand how different approaches may lead to different decisions. Be aware of the “framing effect” and how it might affect the way a patient is advised of the research evidence.

PC Session: LGBTQ2S Health

Part 3, Professional Competencies 3, Week 7

The purpose of this session is to increase the capacity of medical students to respond compassionately, effectively and professionally to the health and well-being of LGBTQ2S patients.

PC Session: Poverty and Health

Part 3, Professional Competencies 3, Week 8

This session is a continuation of our examination of Health Inequities which began with the Code Red presentation in August. It will provide a review of the Social Determinants of Health and consider health indicators, with a special focus on income and social status.

PC Session: Ethical Issues in Reproductive Health Care

Part 3, Professional Competencies 3, Week 9

Probably the most sensitive area of health care ethics, human reproduction raises a number of difficult issues. Central of course are challenges raised by the abortion debate. No topic has been more polarized, with so-called pro-choice and pro-life proponents at either end. Somewhere in the middle is a grey zone that merits exploration.

PC Session: Communication Skills 3

Part 3, Professional Competencies 3, Week 10

In this session and the second one later in MF3, students will explore the last three essential tasks/skills in reasonable depth and gradually refine them with increasing complexity as they move through the Program.

PC Session: Culture and Health: Newcomers to Canada

Part 3, Professional Competencies 3, Week 11

This session explores various aspects of culture. We begin with a large group session that examines the ideas behind the notion of "cultural competence", using a social science perspective. The focus then turns to cross-cultural communication skills, and the development of a practical framework that can be used to enhance communication across cultural barriers. In the small group sessions, we will be welcoming visitors who are newcomers to Canada.

PC Session: Inter-professional Education and MF3 Assessment

Part 3, Professional Competencies 3, Week 12

This session will provide an opportunity for students to explore interprofessional education. Students and LFs should also spend some time providing each other with feedback and the group should consider how well it is functioning and whether improvements could be made.

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

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.

Clinical Skills Practice Sessions: Abdominal Exam

Part 3, Medical Foundation 3, Gastroenterology and Nutrition

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

Tutorial: All MF3 Gastroenterology and Nutrition tutorial problems

Part 3, Medical Foundation 3, Gastroenterology and Nutrition

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: 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.

Anatomy Lectures: Gastrointestinal System Anatomy

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

Abdominal wall, peritoneum, esophagus and stomach.

Clinical Skills Sessions: Abdominal Exam Practice Case - Abdominal pain

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

Discuss and practice the Abdominal history and physical exam, with a focus on acute gastrointestinal symptoms. Examples: Acute cholycystitis; Acute appendicitis; Traumatic acute abdomen. Observation of student taking a history from a patient with abdominal pain. Demonstration by preceptor of examination of a patient with abdominal pain. Observation of students examining a patient with abdominal pain. Discussion regarding abdominal pain.

Active Large Group Session: Hepatobiliary system

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

Understand the two major physiological functions of the hepatobiliary system. Secretory and excretory functions of the liver. Control of energy metabolic function of liver. Examine measures of hepatobiliary function and dysfunction. Review examples of hepatobiliary disease.

Active Large Group Session: Autoimmunity

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

Tutorial: Mike Bayuk MF3 Gastroenterology and Nutrition

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

Mike Bayuk, a 55 year old businessman, presents to the ER in Hagersville with severe abdominal pain. He indicates that the pain is located in the epigastric area and radiates into his back. He finds the pain is relieved when he sits up with his trunk flexed and his knees bent. He rates the pain as "11 out of 10".

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

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

Practice the Abdominal history and physical exam, with a focus on chronic gastrointestinal symptoms . This case should be used to practice and to consolidate Abdominal history & physical exam as it pertains to Weight Loss/Diarrhea

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.

Tutorial: Ted Mitchell MF3 Gastroenterology and Nutrition

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

Ted Mitchell is a 38 year old male who is homeless. He has been on and off the streets for the last 15 years. As a teenager, he started hanging out with "the wrong crowd" and his father, Dr. Ted Mitchell Sr. told him he could not return home till "you have cleaned up your act". Ted continues to abuse drugs, and any money he can get, has gone toward purchasing alcohol, his drug of choice.

Anatomy Lectures: Gastrointestinal System Anatomy Part 2

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

Liver, gall bladder, biliary tree, pancreas and small intestine.

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: Philip Cheung MF3 Gastroenterology and Nutrition

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

Mr. Cheung presents to the emergency department with a 2 day history of worsening pain in the right upper quadrant of his abdomen. He had been in the ER last year with pain in his right flank, but while that pain was colicky in nature, he currently describes a more constant pain. The right flank pain a year ago was accompanied by hematuria and he ended up passing a kidney stone. Currently, he has felt nauseated but has not vomited and he has been anorexic for over 24 hours. He finally came to ER after developing some fevers and chills.

Clinical Skills Sessions: Abdominal Exam Practice Case - Jaundice/liver disease.

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

Practice the Abdominal history and physical exam, with a focus on jaundice and liver disease . Sam has been feeling unwell for about 4 months. They are complaining of a yellowing of their skin and swelling of their feet which has been getting progressively worse over the last 4 months. Pro Comp connection – Patients with Skin of Colour.

Clinical Skills Sessions: Diabetes Exam: Practice Case – A Patient with Diabetes

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

Discuss and to practice the components of the Diabetes history and physical exam, with a focus on acute presentations.

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: 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: Vivian Patel MF3 Gastroenterology and Nutrition

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

Vivian Patel is a 35-year-old computer programmer who presents to the ER with a 10- hour history of profuse vomiting, watery non-bloody diarrhea and abdominal cramps. She first tried to fight this illness on her own by drinking water, however her symptoms were persistent and her husband brought her to the emergency room. She was first seen by the triage nurse, who noted that she was febrile with a temperature of 38.6 C. Given her presentation, the nurse decided that she should be isolated with "enteric precautions” and she was subsequently seen by the ER physician. Vivian is an otherwise healthy woman with no known medical problems and only takes a multivitamin daily. The day prior to her presentation with these symptoms, she had attended her 5-year-old niece's birthday party. She cannot recall any sick contacts, although is unsure if anyone else from the party has developed similar symptoms. Additionally, she had recently returned from a trip to India 5 days ago. She went on a business trip for a week and stayed to travel the country for another 3 thereafter. She did not receive any pre-travel advice or prophylaxis.

Anatomy Demonstrations: GI and Endocrine Ultrasound Imaging

Part 3, Medical Foundation 3, Endocrinology

Active Large Group Session: GI and Thyroid Ultrasound

Part 3, Medical Foundation 3, Endocrinology

Anatomy Lectures: Gastrointestinal System Anatomy Part 3

Part 3, Medical Foundation 3, Endocrinology

Large bowel, blood supply and lymph drainage of the GI system.

Active Large Group Session: Growth: Hormonal Considerations

Part 3, Medical Foundation 3, Endocrinology

Anatomy Lectures: Endocrine System Anatomy

Part 3, Medical Foundation 3, Endocrinology

Endocrine system anatomy

Anatomy Demonstrations: Endocrine System Anatomy

Part 3, Medical Foundation 3, Endocrinology

Tutorial: All MF3 Endocrinology tutorial problems

Part 3, Medical Foundation 3, Endocrinology

Clinical Skills Practice Sessions: Endocrine, Rectal Inguinal Exam

Part 3, Medical Foundation 3, Endocrinology

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

Clinical Skills Sessions: Diabetes Exam: Practice Case – A Patient with Diabetes

Part 3, Medical Foundation 3, Endocrinology, Week 1

To practice the components of the Diabetes history and physical exam, with a focus on chronic presentations. Pro Comp connection – Indigenous Health and Diabetes Mellitus – Strengths-Based Approaches: Diabetes Canada, in its 2018 guidelines highlight social determinants of health play an important role in risk of diabetes and complications. It is important to understand more holistically the structural determinants of health, particularly colonialism, and its cascading effects on the social determinants of health including access to nutrition, employment, education and experiences in healthcare, and how these structural and social determinants impact the risk of diabetes in Indigenous population.

Tutorial: Susanna Green Part 1 MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 1

Susanna Green is a 59-year-old member of the Six Nations of the Grand River. She has a strong family history of type 2 diabetes mellitus. Until two years ago, Susanna had been closely followed since she was diagnosed with diabetes mellitus 28 years ago. Unfortunately, Susanna has not been seen for two years while she was living in the United States. She has self-reported "good" control of her sugars, though she admits that she uses her glucometer only infrequently. Several years ago, she had laser therapy for diabetic retinopathy, but her vision is now stable. She has mild orthostatic hypotension and numbness of her toes. She also has a history of coronary artery bypass grafting following a myocardial infarction six years ago. She has no symptoms to suggest cardiac ischemia, and her exercise tolerance is not restricted. Her medications include metformin, sitagliptin and gliclazide for blood sugar control. Her hypertension, diagnosed about 5 years ago, is currently treated with amlodipine and ramipril. She is taking rosuvastatin to control her cholesterol. Examination reveals a well-looking woman with blood pressure of 155/93 mmHg, BMI of 32.5, increased waist to hip circumference ratio, normal chest and cardiac examination, trace edema to her ankles, normal cardiorespiratory examination. No acute changes are present on fundoscopy, though there the telltale findings of a history of laser photocoagulation are present.

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.

Active Large Group Session: Overview of Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 1

Active Large Group Session: Running a Practice and the Costs Associated

Part 3, Medical Foundation 3, Endocrinology, Week 2

Remuneration models. OHIP vs private billing. Costs associated with working in a hospital vs a clinic. Benefits of Medical Professional Corporation.

Clinical Skills Sessions: Thyroid Exam Practice Case - Thyroid disease

Part 3, Medical Foundation 3, Endocrinology, Week 2

Goiter (hypothyroidism and hyperthyroidism). Observations of a student(s) examining a patient with hyper or hypothyroidism. Discussions of examination of the thyroid by the preceptor. Example: the gland itself, lid lag, tremor. Observation of a student(s) examining a patient with thyroid disorder.

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: Pia Meta MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 2

Pia Meta is a 21-year-old female university student with paroxysmal attacks of palpitations, dizziness, blurring of vision and headache over the past 6 months. Each attack persists for a few minutes to half an hour. They occur irregularly with essentially no warning. She reports that during one of her attacks, she went to the emergency department and was found to have a blood pressure of 210/140 mmHg. She was told that she was having a panic attack. She was previously well and has no significant family history. Pia occasionally consumes alcohol on weekends only. She denies the use of any medications or recreational drugs, particularly methamphetamines or other sympathomimetics. She has one cup of coffee per day unless she is studying for exams, in which case she drinks 2-3 cups per day at most. She lives with roommates with whom she attends McMaster University. She has been performing well at school and has an active social life. On examination in the clinic, she has no abnormal physical findings.

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: 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.

Tutorial: Michel Dupois MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 3

Mr. Dupois is a 35-year-old French-Canadian man born in rural Quebec who moved to Hamilton with his wife a few years ago. His family physician noted a persistent rash around his eyes that he identified as xanthelasma. This prompted some blood tests and a referral to the Lipid Clinic. He is rather reluctant to see you at the Lipid Clinic because he is completely asymptomatic. He denies any significant medical history and is taking no medications. He is a lifelong non-smoker who faithfully walks to work for 1 km with no problems. A family history indicates that Mr. Dupois’ father died suddenly at the age of 46 with no clear explanation. He has multiple family members on his father’s side had a history of heart attacks, some at an unusually young age. His mother is healthy. On physical exam he has soft, velvety, yellowish, non-tender plaques in the palpebral area. Thickening of the Achilles tendons bilaterally were also noted. His blood pressure was 145/90 and waist circumference 98 cm.

Tutorial: Riley Walker MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 3

A healthy 3.6-kg baby boy, Riley, is born to a 25-year-old nulliparous mother in a community hospital. The family doctor notes that the boy's genital development is somewhat atypical. Her examination reveals that the infant has hypospadias, chordee and undescended testes. A plan is put in place for the infant to be seen by a pediatric urologist in 6 weeks with a view to eventual surgical correction. At one week of age, the infant is brought to the family physician's office for routine follow up. Riley's mother comments that he seems to be breastfeeding poorly. She describes him as increasingly uninterested in feeding and is concerned that he seems to be "spitting up" a lot. The infant now weighs 3.1 kg. A recommendation is made to begin some formula supplementation to help support weight gain. At 10 days of age, Riley's mother finds him in his crib, non-rousable, cool, mottled and covered in vomit. Riley is rushed to the emergency department via ambulance. In the emergency room, resuscitative measures are initiated. The airway is suctioned. He is intubated and hand-bagged to achieve ventilation. A 20 mL/kg bolus of normal saline is administered.

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: Awat Khali MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 3

Awat Khali, a 3.2 kg female infant, is born to a 28 year old mother at 41 weeks gestation. The family is Muslim and has recently immigrated from the Kurdish region of Turkey. Her parents are first cousins. Each parent has numerous brothers and sisters and most have already had children. Everybody is reported as healthy and well. At delivery the child is noted to have atypical genital development. The clitoris is prominent, length being approximately 1.5 cm. There is posterior fusion of the labia.

Clinical Skills Sessions: Newborn History Practice Case - Failure to thrive

Part 3, Medical Foundation 3, Endocrinology, Week 4

To discuss and to practice the components of the Newborn history. Pro-Comp Connection – food and housing insecurity.

Tutorial: Kate Smith MF3 Reproduction

Part 3, Medical Foundation 3, Endocrinology, Week 4

Kate Smith is a 15 year old girl. Her mother brings her to the family physician because she has not yet had her first menstrual period. Kate has been well throughout her childhood. Kate has a healthy appetite and weight. She does not receive any medications.

Tutorial: Pit Parapan MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 4

A 32-year-old female was seen in emergency department for abdominal pain, nausea and diarrhea. Her serum calcium was found to be elevated at 2.94 mmol/L (normal 2.15-2.55 mmol/L). She was treated with intravenous fluids. Her calcium improved to 2.65 mmol/L and she was discharged home to care for her 6-year-old son. She was referred urgently to an outpatient clinic to investigate her elevated calcium. She was also prescribed pantoprazole for worsening heartburn. In the clinic, Ms. Parapan reported a 2-year history of abdominal pain that was getting worse over time. The pantoprazole she was prescribed was modestly helpful in easing her heartburn and abdominal pain. She denied symptoms of polyuria, polydipsia, confusion or mood changes. There is no history of kidney stones. She had a fracture of her humerus at age 15 due to a ski accident. She was taking pantoprazole and a multivitamin daily. Ms. Parapan’s family history is significant for a father who had a pancreatic tumour, though she does not know any more details about his condition. Both her sister and her paternal aunt had a parathyroidectomy. The same aunt had a pituitary tumour requiring surgery.

Tutorial: Chantal Landry and Keanu Clarke MF3 Reproduction

Part 3, Medical Foundation 3, Endocrinology, Week 4

You are on a horizontal elective with a pediatric endocrinologist at MUMC when you and your preceptor see your first patient of the day, Chantal. Chantal is a 5-year-2-month-old child presenting with advanced breast development over the past seven months and scant pubic hair growth. This has been associated with rapid growth and intermittent "spotting" over the last two days. Aside from occasional emotional outbursts (crying, arguments with her 9-year-old sister and her mother), there are no other reported concerns. Chantal's mother, a 36-year-old schoolteacher, has a height at the 50th percentile and experienced menarche at age 13. Chantal’s father, a 44-year-old lawyer, also has a height at the 50th percentile and began shaving around age 15 or 16. He has mild hypertension. The family history is negative for early puberty. The parents are not consanguineous. On examination, Chantal's height and weight are both above the 97th percentile. She has grown 9.6 cm in the past year. Physical findings are depicted in the associated media. A bone age radiograph shows a skeletal maturity equivalent to that of a 9-year-old girl. Keanu is a 14-year-old youth who was referred two months ago after repeated attempts to access medical gender-affirming care. Keanu identifies as gender diverse and transfeminine, preferring she/her or they/them pronouns. At Keanu’s last visit, the use of GnRH agonists and gender-affirming hormone therapy (GAHT) was discussed with Keanu and their parents. During today’s appointment, they wish to understand whether the effects of puberty blockers are permanent and to learn about potential health outcomes related to their use.

e-Learning Module: American Academy of Dermatology Part 4

Part 4, Medical Foundation 4

Red Scaly Rash. Drug Reactions. Urticaria. Psoriasis.

e-Learning Module: Integrated Pain and Opioid Curriculum Course 3 - Opioid Use Disorder: Principles of Assessment and Management

Part 4, Medical Foundation 4

Review the role of opioids in the brain and the signs and symptoms of withdrawal. Learn how to identify patients with opioid use disorder and review the various management options including how to manage patients in primary care with opioid agonist therapy with buprenorphine. Educate patients on strategies to prevent opioid overdose including the use of naloxone, a vital tool for overdose prevention. This should be completed by the end of MF4.

Tutorial: All MF4 Brain and Behaviour tutorial problems

Part 4, Medical Foundation 4, Brain and Behaviour

Active Large Group Session: Substance Use Disorders

Part 4, Medical Foundation 4, Brain and Behaviour

e-Learning Module: Developmental Disabilities

Part 4, Medical Foundation 4, Brain and Behaviour

An interactive, self-directed web-based resource regarding developmental disabilities for medical students and residents. This project includes introductory information about the topic of developmental disabilities, including information about terminology, definitions, adaptive skills, and levels of developmental disability.

e-Learning Module: MSE part 1: Assessment of mood and anxiety

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

Principles of mood assessment. Mood episodes and disorders: Depressive, manic, mixed, hypomanic. Screening for depression. Psychiatric history. Anxiety.

e-Learning Module: Intro to the Mental Status Exam

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

Know the role of the Mental Status exam (MSE) in the assessment and management of the patient. Understand the differences between the MSE, the MMSE, and the psychiatric interview. Elicit elements of the MSE during the psychiatric interview. Verbal report and write up of the psychiatric interview, including MSE.

Anatomy Lectures: Limbic System

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

The Limbic system: olfaction, memory, emotions, drives, homeostatic function. The emotional brain. Amygdala. Hippocampus. Cingulum. Septal nuclei. Olfaction/Olfactory cortex. The hippocampus facilitates the consolidation of new memories. Amygdala responsible for emotions and drives. Hypothalamus responsible for homeostasis and autonomic and neuroendocrine control. Limbic system clinical correlates: memory disorders (amnesia, dementia); seizure disorders (epilepsy); psychiatric disorders (schizophrenia, depression, mania, OCD).

Active Large Group Session: Introduction to Psychiatry

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

Epidemiology. Nosology. Brain and behaviour. Medical Psychiatry. PBL cases. Five steps to differential diagnosis. Sub-unit overview.

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 making Tik Toks 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.

Clinical Skills Sessions: Assessment of mood and anxiety

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

Assessment of Mood. Key concepts: Symptoms, syndromes, episodes, and disorders. Depressive symptoms. Manic Symptoms. Mood Episodes and Disorders: Major Depressive Disorder, Bipolar Disorder. Screening for depression. Assessment of Anxiety. Main Anxiety Disorders: Specific Phobia; Social Phobia (aka social anxiety disorder); Panic Disorder with/without Agoraphobia; Generalized Anxiety Disorder; Obsessive Compulsive Disorder; Post-traumatic Stress Disorder.

Tutorial: Binh Hau MF4 Brain and Behaviour

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

Mr. Hau is a 56-year-old male, married with two teenaged children. He is employed as a pharmacist and his wife is a receptionist in a dental office. He has no formal psychiatric history. About three months ago, Binh's personality began to change in subtle ways. Previously an optimistic, outgoing individual, he gradually became serious, irritable and socially withdrawn. His family noticed that he was sleeping poorly, sometimes pacing the house all night. At times he was observed mumbling to himself as if he were conversing with someone who wasn't there. His family grew increasingly concerned.

e-Learning Module: Social determinants of child mental health

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

An outlined approach to understanding and assessing social determinants of health by examining how children's environments affect their biology and their pathways in health.

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: Tammy Polk MF5 Brain and Behaviour

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

Mrs. Tammy Polk is very difficult to interview. She is an extremely vague and difficult historian. Her family tell you that she was diagnosed with breast cancer 5 years ago and had a mastectomy at that time. Her husband died 6 months ago and she has never really recovered. Over the past week, the family have been worried that she is "developing Alzheimer's" because of memory problems and agitation. Past psychiatric history is notable for mild depression, treated with paroxetine 20mg daily, and sleep difficulties that are chronic and date back to her days as an alcoholic. One month ago, she was started on 50 mg of quetiapine at bedtime for sleep by her family doctor. Two weeks ago, she was given Oxybutinin (Ditropan) to help with some urinary incontinence, with good effect on her bladder problem. She is admitted to hospital for further medical work-up. The 1 pm nursing note reads: "quiet, resting comfortably, oriented x 3." The results of CBC, serum electrolytes and urinalysis are pending. The medical resident calls for psychiatric consultation at 4:05 pm because the patient has become agitated and has voiced suicidal ideation. The consult note reads: "medically cleared, please transfer to psychiatry for treatment of emotional instability and psychotic depression." The psychiatric resident arrives at 5 pm and finds that the patient is visually hallucinating and disoriented.

e-Learning Module: MSE part 3: Assessment of suicide and violence risk

Part 4, Medical Foundation 4, Brain and Behaviour, Week 2

While psychiatric disorders are common, and many can be deadly, they are also treatable. You can make an enormous difference in morbidity and mortality through proper suicide assessment. Suicidal intent is a medical emergency.

Tutorial: Fergie Greer MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 2

Fergie is a 23-year-old single woman with no children who lives with her parents. She completed university with difficulty, taking time off frequently but eventually completing her degree. She reports having difficulties with relationships since middle school and not knowing who she really is affects her mood, attention and concentration. This had an impact upon her schooling but she managed to finish with a huge effort. However, she has been unable to ever work in any capacity since finishing University a year ago. Fergie was referred by her family physician for a psychiatric consultation because she frequently presented to the family physician or student health with low mood and suicidal ideations. At times her family doctor had to send her to ER for urgent assessment following disclosure of taking an overdose or cutting her arms. She is hoping that some medications like an antidepressants will be prescribed for her and that you will believe she is unwell and needing help. She has a huge hope that you will see her regularly, and provide her with answers as to why she is not feeling happy, why she feels empty, and why she is unable to control her anger. She is also considering bipolar disorder as she heard from student health counsellor that she may have a bipolar disorder because she reported increased spending, increased sexual activity, and reckless driving. And she also informed you that she has an eating disorder when she binge eats at times. She is well read on mental health and has attended many counsellors since middle school including private therapists that her parents took her to see.

Tutorial: Benjamin Nuri MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 2

Benjamin Nuri is a 45 year old Caucasian male who presents at the emergency room accompanied by his wife. He has been to the emergency room on two occasions prior to today . He reports that for the past year and a half he has experienced transient episodes of chest pain, shortness of breath, sweating nausea, numbess in the left side of his face and left arm as well as dizziness.

Tutorial: Laila Nair MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 2

Anatomy Lectures: Autonomics

Part 4, Medical Foundation 4, Brain and Behaviour, Week 2

The sympathetic nervous system. Adrenergic receptors. Autonomic reflexes. Most of the homeostatic functions (blood pressure, digestion, defecation, urination) of the body are regulated by autonomic reflexes. The communication between the endocrine system and the ANS is critical in managing our stress response. Imbalance between SNS and PSNS are critical problems for those with SCI.

Large Group Session: What to Expect at Your First OCSE

Part 4, Medical Foundation 4, Brain and Behaviour, Week 2

Tutorial: Desta Ayo MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 2

Desta Ayo is a 42 year old woman, on disability pension and married to a disabled man. She was brought to the hospital by ambulance after she called 911 to report she was dying. After running a few tests, the ER physician could not find anything wrong with her. He referred her to psychiatry because the problem was obviously "all in her head." On interview, Desta sits motionless in the chair, opening her eyes and speaking with dramatic effort. She believes she is again suffering with another kidney infection, like the one that almost killed her 10 years ago. She describes "passing out" almost every day for the last 2 weeks, feeling too weak to walk, and experiencing crippling back pain. She denies anxiety and depression but continues to take paroxetine for chronic pain and Trazodone for sleep. She says she has arthritis throughout her back, frequent migraines, temperomandibular joint pain, chronic fatigue, and recurrent sinusitis that eats away at her nasal bones. She also reports a history of gynaecological problems since age 22, with breast cyst and ovarian cyst surgery, endometriosis, and uterine fibroids. She reports an early childhood history of sexual and physical abuse. She remembers her mother as an alcoholic, a distant and cruel woman. Inquiries about current stress in her life reveal major financial problems and an argument with her mother on the phone 2 weeks ago. She says that she doesn't think her mother will ever talk to her again.

Clinical Skills Sessions: Suicide Risk Assessment

Part 4, Medical Foundation 4, Brain and Behaviour, Week 2

By the completion of this presentation, attendees will be able to describe risk factors for suicide; be familiar with key components of a suicide risk assessment; be aware of questions to use in a suicide risk assessment.

Clinical Skills Sessions: Psychiatry Exam: Practice Cases - Eating Disorders and Suicidality Assessment

Part 4, Medical Foundation 4, Brain and Behaviour, Week 2

To discuss and to practice the components of the psychiatric history for a patient presenting with an eating disorder. To discuss and to practice the components of the psychiatric history for a patient presenting with depression and suicidality, including risk assessment. To develop an approach and to practice the mental status examination.

Clinical Skills Sessions: Assessment of Psychosis & Delirium

Part 4, Medical Foundation 4, Brain and Behaviour, Week 3

Interviewing psychotic patients. Dealing with psychosis and intense affect. Dealing with poor insight. Dealing with indifference. Screening questions for psychotic-like experiences. Delirium.

e-Learning Module: MSE part 2: Assessment of psychosis

Part 4, Medical Foundation 4, Brain and Behaviour, Week 3

Psychotic symptoms are common in a wide variety of medical, psychiatric, and substance-induced disorders. They are important to illicit and have important implications for diagnosis, treatment and management.

e-Learning Module: Form 1 of the Mental Health Act

Part 4, Medical Foundation 4, Brain and Behaviour, Week 3

This will provide you with a review of the legislation and the methods that are used to bring a person to hospital in Ontario, as well as some of the key aspects of completing the Form 1 of the Mental Health Act, including the examination, criteria for dangerousness, concept of mentor disorder, time-sensitive issues, and invalid Form 1's. A Guided Tour and Examples of the Form 1 and Form 42. Common errors in filling out the Form that we encounter in practice.

Active Large Group Session: Personality Disorders

Part 4, Medical Foundation 4, Brain and Behaviour, Week 3

Tutorial: Malcolm Lowry MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 3

Malcolm Lowry presents to the ED of the Hamilton General Hospital accompanied by his wife, Vita. He is seen by a second-year resident in Emergency Medicine and a clinical clerk. Mr. Lowry is a 47-year-old businessman. This afternoon, he collapsed in front of his wife, who observed that both arms and legs were shaking and that his eyes were rolled back. After 30-60 seconds the shaking stopped, but he was unresponsive for several minutes and remained drowsy and confused for half an hour. Vita called 911 and Malcolm was taken to the Emergency Department. The patient states that this has never happened to him before. He had no warning symptoms prior to collapsing. He does not remember collapsing. He did not soil himself or bite his tongue, but his muscles are sore. His past health has been good. He does not have hypertension, diabetes or other chronic health problems. He has never been hospitalized and he is not on any medications. He denies recent head trauma, febrile illness, headache or neurological symptoms. He has no family history of epilepsy. Vita states that Malcolm has been drinking alcohol heavily for a number of months but stopped two days ago after she removed all the alcohol from the house. Today he was so tremulous that he could hardly button his shirt. Malcolm points out that he has stopped alcohol for a day or two several times in the past few months, and although he has felt shaky he has never had a seizure.

Tutorial: Beau Chandler MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 3

Beau is a 3-year-old boy, the youngest of three children. His father manages a local bank and his mother is a stay-at-home mom. He has two older sisters, Theresa age 7 and Gracie age 9. His parents are in their late 30s. Beau is the focus of the entire family's attention and the apple of everyone's eye. His sisters behave like 2 additional mothers, to the point that they anticipate his every need. His parents have even noted that his language development seemed slightly slower than his sisters' as he did not need to use language to have his needs met. He now speaks well but it just seemed to be slower than his sisters (who his mother described as early talkers). Beau's mother's pregnancy was unexpected but welcomed. The pregnancy was uneventful with no history of substance use. Beau was full term and the delivery was uneventful. Beau was a cute and cuddly infant. He breastfed well and developed predictable routines for both sleeping and feeding. He appears quite adaptable. For instance, when family visits other family or friends, Beau smiles, plays and amiably engages children and adults alike. He has even slept well at these homes if needed. He needed only his favourite blanket in those situations to assist him with settling down to sleep.

Tutorial: Skylar and Siobhan Aidan MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 3

Today, Siobhan came in sobbing, dragging a reluctant 8-year-old Skylar behind her. She wailed, "He's turning out just like his Dad. Before you know it he'll be in jail for assault, I'm scared of both of them." Siobhan explains that Skylar punched a boy in the face today and was suspended for 3 days. Evidently, there have been numerous incidents at school where the Grade 3 teacher claimed Skylar was the aggressor. This implied information about Skylar 's father was news to you and you suspect that there was more going on in the home than Siobhan had shared with you in the past. You wonder how to approach Siobhan about this.

Clinical Skills Sessions: Teaching OSCE (Psychology)

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

3 station Teaching OSCE. Each station is 15 minutes long. Students alternate interviewing and observing a patient.

Tutorial: Shelley Williams MF4 Brain and Behaviour

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

Shelley is an 18-year-old female who lives with her parents and her younger brother. She had graduated from a local high school in June. Shelley received ODSP (Ontario Disability Support) when she turned 18 years of age because of her intellectual disability. Soon after, this young woman started working part-time at a local grocery store after completing a work placement but had taken a sick leave as of November. Her hobbies included painting, journaling, and video games. She has a few close friends she has known from grade 8 whom she sees over Skype. She has a younger brother, 16 years of age, Tom. Tom has always excelled in school, is popular, and plays on many sports teams. Her parents are Jennifer (42 years of age) and Peter (43 years of age). Her parents are Black Caribbean first-generation immigrants from Trinidad. Her father worked full time in the steel industry for many years until about a year ago when he took sick leave due to cardiovascular disease. Her father was described as being somewhat distant and critical of Shelley. Shelley described a very close relationship with her mother, who provided most of the instrumental and emotional support to Shelley over the years. Her mother was recently laid off in March from a restaurant where she worked as a waitress. Then she was quarantined for two weeks at home in her room in March with COVID. Shelley’s mother had residual fatigue and cough after recuperating from the acute symptoms of COVID. None of the other family members tested positive for COVID, but they all had vitamin D deficiency and started taking supplements.

Active Large Group Session: Autism and Attention Deficit Disorder

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

Active Large Group Session: Integrated Radiology - Anatomy - Musculoskeletal System (IARS)

Part 4, Medical Foundation 4, Musculoskeletal Medicine

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

Watching a Video: GALS (Gait, Arms, Legs, Spine)

Part 4, Medical Foundation 4, Musculoskeletal Medicine

Anatomy Demonstrations: Upper Limb

Part 4, Medical Foundation 4, Musculoskeletal Medicine

Anatomy Demonstrations: Plexi, Plexus and Compartments

Part 4, Medical Foundation 4, Musculoskeletal Medicine

Clinical Skills Practice Sessions: MSK Clinical Skills

Part 4, Medical Foundation 4, Musculoskeletal Medicine

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

Anatomy Demonstrations: Axial skeleton, spine and back

Part 4, Medical Foundation 4, Musculoskeletal Medicine

Anatomy Demonstrations: Lower Limb

Part 4, Medical Foundation 4, Musculoskeletal Medicine

Tutorial: Brock Martel MF4 MSK

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

Brock is a 25-year-old man who sustained a laceration to the upper third of his right forearm when he accidentally put his arm through a plate glass window. He presents to the emergency room. On examination, the ER physician finds Brock has significant weakness dorsal and palmar interossei, resulting in weakness of abduction and adduction of the index, middle and ring finger of the right hand.

Tutorial: Gayle Parker MF4 MSK

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

Gayle Parker is a 12-year-old girl who was recently noted by her dance instructor to have shoulder asymmetry. She has no pain, neurological symptoms such as dysesthesias, or bladder/bowel dysfunction. The deformity has not changed since it was first noticed.Gayle has recently started her menses

Tutorial: Joshua Song MF4 MSK

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

Joshua is a 48-year-old man who suffered a motor vehicle accident while riding his motorcycle. Joshua was unable to stop in time at a red light and rear-ended into an SUV, causing him to be thrown from his motorcycle, landing on his right side. He has a large laceration to the lateral thigh. He also notices some weakness to certain movements of his right lower extremity. He is taken to the trauma centre and the physical exam reveals that he is unable to dorsiflex his ankle, evert the foot, and extend the toes on the right side. All other muscles are normal. On sensory examination, it is noted that sensation is slightly impaired over the front of the leg and foot. An x-ray reveals that he has sustained a mid-femur shaft non-displaced fracture.

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.

Clinical Skills Sessions: Hip and Knee Pain

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

Discuss and practice the components of the history and physical exam for the Hip and Knee.

Tutorial: Ronnie Olchuk MF4 MSK

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

Ronnie Olchuk is a 6-year-old boy who was hit by a car while crossing the street. A witness at the scene said he was hit on the left side and thrown approximately 20 m. He is healthy, has no allergies, and has never had surgery. He last ate eight hours ago. He has been stabilized by the trauma team, is alert and oriented, and has no injuries except to his right forearm and left thigh. His distal right forearm is badly deformed. His left thigh has a 2 cm laceration located medially and is also badly deformed. He is in excruciating pain, especially in the right forearm.

Tutorial: Ryan Smith MF4 MSK

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

Ryan Smith is a two week old baby brought to your office by his parents. He was noted to have bilateral feet abnormalities on prenatal ultrasound. Family is anxious and worried about whether the child "Will walk, play soccer etc." Physical exam show that both feet are adducted, supinated, equines and the hindfoot is in varus. The feet are moderately flexible but not completely correctable

Active Large Group Session: Introduction to Adult and Pediatric Orthopedics

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

Opportunity to consolidate knowledge acquired through PBL cases. Review of high yield orthopedic clinical pearls. Opportunity to actively practice relevant clinical skills such as reading imaging (within the confines of virtual learning).

Clinical Skills Sessions: Shoulder and Elbow Pain

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

Discuss and practice the components of the history and physical exam for the Shoulder and Elbow.

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: 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: 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: Ann Green MF4 MSK

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

Ann Green is a 66-year-old woman who was referred to the rheumatology outpatient clinic by her family physician, Dr. Mac Grad. In his referral note, Dr. Grad states that Mrs. Green has been experiencing joint achiness for the past several years, involving mostly her hands and knees. From time to time, she has also reported low back pain. Her symptoms have always been relatively mild and have never stopped her from carrying on with her general daily activities or her charitable work in the community. What currently concerns Dr. Grad is that Mrs. Green's symptoms have progressed. Usually a rather stoic person, she is now complaining of increased pain in her fingers and both knees. Because of her knee pain, she is having increasing difficulty walking. Whereas previously her pain would always settle after she took some Tylenol, this is no longer the case. On physical examination, Dr. Grad elicits tenderness at several of the proximal (PIP) and distal interphalangeal (DIP) joints of both hands and at the carpometacarpal joint of the left thumb. Heberden's nodes are evident at the DIP joints bilaterally. Tenderness is also present at the joint lines of both knees; and there is (chronic) puffiness on both sides, but more pronounced on the left. Knee flexion is reduced and there is bony crepitus. Radiographs demonstrate osteoarthritic changes at the wrists, the PIP and DIP articulations of the fingers, and moderately severe (tri-compartmental) degenerative changes at both knees.

Active Large Group Session: Inflammatory Arthritis

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

Tutorial: Richard Strang MF4 MSK

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

Richard Strang, a 50-year-old male with a two-day history of sudden onset of acute pain and swelling of the left great toe, is seen at his family physician's office. It seemed to suddenly start when he awoke two days ago. It is so painful that he could not even tolerate the bed-sheet touching it. Richard works in construction, and routinely enjoys a few beers at the end of the day with his buddies. He had a similar attack in the right knee about 3 months ago, and right 1st MTP about 6 months. He was told that he had "the gout".

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: 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: Cindy Edsworth MF4 MSK

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

Mrs. Cindy Edsworth is a 30 year old African Canadian lady who describes the onset of joint pains which have been on going for 3 months. She describes that the small joints of her hands are constantly aching and over the past 4 weeks she describes having swelling in the PIP and DIP joints of both hands. Over the past week she points out that she is having significant swelling affecting the feet that reaches the ankles. With the onset of the joint pains she developed alopecia and a scarring type rash over the scalp. She has been quite fatigued. She finds she is exhausted when she awakens in the morning and by 6:00 pm she has to go to bed because of persistent fatigue. Cindy also finds that she has become quite irritable. Her temper is easily disturbed and she is also becoming quite argumentative with her husband. Her husband is disturbed by her recent change in mood.

Clinical Skills Sessions: Wrist, Hand and Ankle, Foot Pain

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