BL MESS CR2 Handbook: 2011-2012

CR2 MODULE HANDBOOK

BL MESS CR2 Handbook: 2011-2012

Dear Second year teachers, Please find enclosed a complete timetable with regards to the CR2 module. Second year MESS will be running in a slightly different fashion to 1st year MESS: Firstly, it will take place on alternate Thursdays at 5pm in the Milton Lecture Theatre. Secondly, we shall only be covering the PBLs and lectures which students have classically found difficult.

This booklet has been produced so that we all know what should be covered within a MESS session. As with 1st year MESS, these sessions are NOT a substitute for normal teaching provided by the medical school but it is more an opportunity for students to revise material they understand, and more importantly, gain a better understanding of any material they did not grasp the first time round. Students should not be encouraged to substitute normal teaching with MESS but use these sessions as their opportunity to gain a deeper understanding of the material in hand, and to ask any questions they have. As second year MESS will be predominantly concerned with PBLS, we should all make use of this opportunity to cover the important learning objectives (as provided by the Medical school) of any relevant lectures. Throughout this booklet, I have made attempts to refer you to the relevant lectures and learning objectives. Wherever the MESS committee has made recommendations about PBL learning objectives, these should be followed. However, under no circumstances should PBL objectives be given to students. Students should be encouraged to follow their individual group learning objectives and cross compare the two. We are using the PBL scenarios as a method of teaching the relevant material from the relevant lectures. When we do teach specific lectures, it is essential we follow the official lecture objectives as outlined in the module handbook, as provided on Blackboard. Since MESS will only run every alternate week, it is essential that all teachers arrive promptly for the session. If at all possible, we prefer you to arrive at 5pm regardless of when you are teaching. This helps ensure the timetable runs as smoothly as possible without any long gaps. In addition, it is nice to be present while your co-teachers lecture, so as to provide some moral support. The timetable will outline the times when we expect subsequent lectures to begin. Please ensure you have arrived at least 20 minutes before the suggested time. For example, if you are teaching PBL2 (which is scheduled to begin at 6pm), please ensure you have arrived by 5.40 at the very latest. CR2 is a difficult but very important module, so it is essential we teach it to the best of our abilities. MESS is proud of our society and the support it provides fellow students, in addition to the quality of our teachers. I will be uploading the MESS CR2 timetable (as shown in this booklet) on the Year 2 MESS Teacher Facebook group. Once I have uploaded the timetable, please comment on the picture saying which lecture you would like to teach. Lectures will be awarded on a first come first basis, expect in exceptional circumstances. While choosing a lecture, please ensure that it is a topic you understand and are comfortable to be asked questions about. In addition, please ensure you are definitely available on the day concerned. Wherever possible, we would like each session to be taught by 3

BL MESS CR2 Handbook: 2011-2012

different teachers. However if you feel you would like to lead a particular session single handed, please feel free to do so. I understand there will be occasions when you will have to pull out of teaching at short notice. Please try to avoid this from occurring. However, if you do need to cancel, for whatever reason, you need to text and email both myself and Misbah, no later than 2 days before the day you are lecturing. Our contact details are as follows: Misbah (MESS PRESIDENT) 07771826201/ ha09052@qmul.ac.uk Rakesh (2nd year Co-ordinator) 07855455492 / ha09742@qmul.ac.uk Feel free to contact me should you have any questions. Good luck teaching! Kind Regards Rakesh Dattani (2nd Year Co-Ordinator)

BL MESS CR2 Handbook: 2011-2012

CR2 Module Timetable (subject to change) Date Lecture Teacher

Misbah Sam rigby Ara Faz Adam Faux Sam rigby Ali Bakir Tish Tim Year 4 Teacher Ali Jawad Misbah Shahrzad

Estimated times
5 -5.45pm 5.45pm - 6.45 pm 7pm-8pm 5-7 pm 5 -5.45pm 5.45pm - 6.45 pm 7pm-8pm 5 -6pm 6.10-7pm 7pm-8pm 5pm 5.45pm 6.45pm

06/10/2011 PBL1 - Atrial Fibrilation PBL2 - Shock PBL3 - Angina The ECG: Basic Physiology and Interpretations : Cardiovascular 13/10/2011 Society 20/10/2011 PBL4 -Pneumothorax PBL5 - DVT PBL6 - Asthma 27/10/2011 PBL7 - TB PBL8 - Blood Transfusions PBL9 - Thalassemia 03/11/2011 Myocardial infarction Lecture Heart Failure Lecture Upper and lower Respiratory tract infections

BL MESS CR2 Handbook: 2011-2012

PBL1: The dizzy swimmer

Laura is 66 and is having treatment for an overactive thyroid. Apart from that, she says she is in general good health. She exercises regularly, goes jogging once or twice a week and swims at the local swimming pool about once a week. She goes to see her GP because of bouts of dizziness and shortness of breath. On questioning her, he establishes that these occur only after jogging or swims. After her swim last week she experienced severe dizziness and palpitations, which rather alarmed her. On examination, her peak flow was within the normal range and no abnormal sounds were noted on chest auscultation. Her heart rate at rest was 100 and her blood pressure 160/90. She admitted that she still smokes occasionally (although she is trying to give up) and drinks alcohol rather more than she should, varying between 20-28 units a week. The GP sends her off for further tests at the heart and chest clinic at the local hospital. Here she is fitted with a 24-hour ECG Holter monitor and asked to go jogging while wearing it. The monitor gives a definite diagnosis, and Laura is sent home with medication that seems to resolve the problem. However, she is warned that if the dizziness recurs, more active intervention may be necessary in the future. Teacher Notes: Key associated lectures. o ECG and Data Handling: Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. Highlighted in yellow are the key points in the PBL scenario, which should be covered within the session. Ensure students are aware of normal results of the tests mentioned. Overview of ECG data interpretation Please refer to the CR2 lecture entitled Data handling and ECG Analysis. Review of normal conduction system of the heart. The diagnosis here is that of Atrial Fibrilation, include: definition, risk factors, signs and symptoms, diagnosis, treatment (Conservative, Medical and Surgical) and prognosis. Reassure Students that they will cover Thyroid Physiology in Met 2.

BL MESS CR2 Handbook: 2011-2012

PBL 2: A casualty of war

Two soldiers received similar wounds during a battle, and they each lost a substantial amount of blood. Neither was able to receive any treatment other than medication for pain. Each soldier was noted to have a mean arterial blood pressure of about 50 mm Hg shortly after being wounded. Their blood pressures gradually increased for the first 2 hours. Thereafter, soldier A's blood pressure continued to improve, and within 4 or 5 hours, his blood pressure was almost normal. He ultimately survived. However, soldier B's blood pressure reached a peak value of only about 65 mm Hg a few hours after he had been wounded. His blood pressure then gradually declined, and he died about 10 hours after first being wounded. Teacher Notes: Key associated lectures. o Introduction to Haemorrhage & Shock: Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. Highlighted in yellow are the key points in the PBL scenario, which should be covered within the session. Overview of Haemorrhage and Shock: Please refer to the CR2 lecture entitled Introductions to haemorrhage and shock. Review of shock: o Definition of shock and types. Concentrating on hypovolaemic shock. o Pathophysiology of shock. o Signs and symptoms of the different stages of shock. o Bodys compensatory mechanisms to blood loss. o Diagnosis. o Treatment include the pain medication and fluid replacement therapy.

BL MESS CR2 Handbook: 2011-2012

PBL3: An unemployed man with chest pain

Omar Mehta is 53 and lives on the second floor of a block of flats in Tower Hamlets. He lost his job at Ford of Dagenham three years ago, and since then has been unemployed. His wife works and is the family provider. He was diagnosed a type 2 diabetic 15 years ago, and was prescribed metformin, which he still takes. He is also being treated for hypertension with diuretics and ACE inhibitors He visits his GP to say that he is now getting chest pains when he walks up the stairs to his flat. The last time he saw the doctor was 6 months ago and since then he has put on 3 stone (19kg) in weight. He says he is generally compliant with his medications but forgets sometimes. On questioning he admits to a large appetite and a sweet tooth and a 30 pack year habit of tobacco smoking. However he rarely drinks alcohol. Based on the interview he is admitted to the A&E for further tests and treatment.

Teacher Notes: Key associated lectures. o Atherosclerosis: Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. o Angina - Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. o Hypertension - Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. Highlighted in yellow are the key points in the PBL scenario, which should be covered within the session. Ensure students are aware of normal results of the tests mentioned. Overview of atherosclerosis: formation, risk factors, diagnosis, treatment (Conservative, Medical and Surgical) Please refer to the CR2 lecture entitled Atherosclerosis. Overview of Angina: different types and the differences in presentation and diagnosis. Cover risk factors, signs and symptoms, diagnosis and treatment (conservative, medical and surgical) Review hypertension: definitions, compensatory mechanisms (neural and hormonal regulation), complications of long term hypertension and treatment concentrating on the medical treatment.

BL MESS CR2 Handbook: 2011-2012

PBL4: The Marathon Runner

Chris Williams is 20 years old and works in an office in the city. He is a keen runner and is training hard for the London Marathon. He goes out every morning before work for a 4-6 mile run. He has no history of cardiovascular or respiratory problems. He is 1.9 m tall and weighs 78 kg. One morning near the end of his run, he has a sudden sharp pain in his right chest and back. The pain is so bad he has to stop his run and limps home, feeling very short of breath. As the pain and shortness of breath do not go away, he takes a taxi to his local A&E department. There he is noted to have tachycardia and tachypnea, with repeated dry coughing. His blood pressure is 110/78 and there are reduced breath sounds in the right chest. He is sent for a chest x-ray which gives a definite diagnosis. He is told he will have to stay in hospital for perhaps a week for observation, and will be given oxygen which should relieve his symptoms. His condition may resolve spontaneously, but if not, a minor surgical procedure will be necessary. Teacher Notes: Key associated lectures. o Chest X-rays and Lung anatomy: Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. o Lung Mechanics - Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. o Respiratory Clinical Skills - Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. Highlighted in yellow are the key points in the PBL scenario, which should be covered within the session. Ensure students are aware of normal results of the tests mentioned. The diagnosis here is that of pneumothorax. Overview of lung anatomy and x-ray interpretation Please refer to the CR2 lecture entitled Chest X-rays and Lung anatomy. Overview of Pneumothorax: different types and differences in presentation and diagnosis. Cover risk factors, signs and symptoms, diagnosis and treatment (conservative, medical and surgical) o Ensure students understand: The interpretation of reduced breath sounds in the right chest. How oxygen therapy may relieve symptoms. Minor surgical procedure involved.

BL MESS CR2 Handbook: 2011-2012

PBL5: Pregnant with a Painful Leg

Patricia Aledambo is 36 years old and in general good health, although she has been overweight since her teens. She says her husband likes her that way and she has no plans to diet. However, she has stopped smoking now that she is pregnant with her second child. Two weeks ago she returned from a visit to her parents in South Africa. Her blood pressure was slightly raised at a routine antenatal examination just after she returned, so she has been taking it easy and having plenty of bed rest since then. She visits her GP because of persisting pain in her left leg, which gets worse on standing or walking. On examination her leg is found to be swollen, warm, and painful to palpation between the knee and ankle. There is pitting oedema in the swollen leg. The GP refers her urgently to the local A&E department. During examination in the A&E a Wells score was calculated at 3. A detailed history revealed that her mother had had a pulmonary embolus after Patricia had been born. She was given an injection and warned that she would need injections on a daily basis for the time being. She was then sent home after being booked in for her injection and further tests the next day.

Teacher Notes: Key associated lectures. o Venous Thromboembolism: Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. Highlighted in yellow are the key points in the PBL scenario, which should be covered within the session. Ensure students are aware of normal results of the tests mentioned. The diagnosis here is that of DVT. o Ensure students are aware of: The difference between arterial and venous thrombosis. Causes of thrombosis. Types of DVT (distal and proximal). The importance of the family history: Coagulation abnormalities with hereditary causes: Factor V Leiden, prothrombin Variant, antithrombin deficiency, and protein C/S deficiency. Clinical features of DVT (include clinical features of PE if time permits) Diagnosis of DVT/PE: pre-test probability (wells score and its interpretation), D Dimer blood test and its interpretation. Differential diagnosis: anti-coagulation therapy: heparin (LMW vs. Unfractionated comparison) and warfarin include mechanism of action, side effects. Teratogenic effects of warfarin.

BL MESS CR2 Handbook: 2011-2012

PBL6: Meeras Asthma

9-year-old Meera is a new patient who attends your GP practice for the first time for a repeat prescription for asthma. Her father, who accompanies her, says they moved into the area about 2 months ago. He admits their accommodation is in a poorly maintained building, but hopes to move as soon as he can get a better job. Neither parent has asthma or allergies, but both parents smoke. The father says that Meera has woken up 3-4 times a night for the last month or so gasping for air, and has had difficulty catching her breath. Her attacks are controlled by using the blue puffer given to Meera by her last GP, which the father says works immediately and is great. Past medical history reveals several previous exacerbations requiring two hospitalizations in the last year. Her father states she is not allergic to any medications, but has occasional eczema. Examining her, you note Meera is dyspnoeic, tachypnoeic, her breathing is mildly laboured, and she is audibly wheezing, particularly on exhalation. There is an extended forced expiratory phase to her breathing cycle, with moderate air exchange at the top end of the total lung capacity. Her nostrils occasionally flare and at times she uses her accessory muscles of ventilation. Tests in the surgery show that peak expiratory flow rate is 65% of the predicted normal range. An ear lobe pulse oximeter gives a value for the haemoglobin saturation of 94%. Spirometry shows decreased FEV1, decreased FVC and an increased residual volume. An arterial blood sample is taken for blood gas testing and comes back with values: pH = 7.2 (Normal 7.36-7.44) PaO2 = 10 kPa (Normal 13.2-13.9) PaCO2 = 8 kPa (Normal 5.3) Bicarbonate = 35 mmol/L (Normal 18-23) Haemoglobin = 15 g/dL (Normal female 11.5-15.5) She is treated in the surgery with oxygen, a nebulized 2-agonist and an injection of prednisolone. Her audible wheezing is completely resolved by this medication. Once stabilized, you note Meera is a talkative 9-year old who mentions she wants to be a vet when she is older and has many pets at home, most of which were found or given to her by friends. The family have not attended any asthma education programme and do not regularly check and record peak expiratory flow values and do not use a spacer. Teacher Notes: Key associated lectures. o Asthma: Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard.

BL MESS CR2 Handbook: 2011-2012

Obstructive and Restrictive Disease: Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. o Lung Function Testing: Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. Highlighted in yellow are the key points in the PBL scenario, which should be covered within the session. Ensure students are aware of normal results of the tests mentioned. The PBL scenario is concerned with Asthma o Ensure students are aware of: Asthma Pathophysiology: Th2 cell activation, IL4 production, IgE production, histamine release leading to bronchial inflammation. Phases of Asthma: Immediate and Late phase Reaction. Ensure students are able to explain the signs and symptoms as Asthma: especially those mentioned in the scenario: Acid reflux, cough, wheezing. Asthma Classification: Extrinsic (a definite external cause) Vs. Intrinsic (No causative agent can be identified). Asthma Diagnosis: Lung function tests (Peak expiratory flow: diurnal variation, Spirometry: difference between obstructive and restrictive lung diseases, Bronchial challenge test, and trial of corticosteroids treatment. Explanation of blood gas testing: Shows the patient to be in respiratory acidosis. Drug treatment: stepwise treatment of asthma (stages 1 to 6). Modes of action of the following: B2 agonists, antimuscarinics, phosphodiesterase inhibitors, corticosteroids. Special emphasis should be placed on Meeras treatment. Meeras prognosis.

BL MESS CR2 Handbook: 2011-2012

PBL7: The Homeless Prisoner

Charlie Dewsbury (age 62) is being examined by the prison doctor at Pentonville Jail. He has complained of a persistent cough which stops him sleeping. Recently he has been coughing up lots of phlegm. The doctor sees from his notes that Charlie is homeless, and is being held on remand having been arrested a month ago for threatening behaviour and being drunk and disorderly. A careful history establishes that Charlie has also been suffering from night sweats and a loss of appetite. The doctor weighs him and measures his height. He weighs 58 kg and is 1.72 m tall. A physical examination reveals swollen lymph glands in both axillae. The doctor arranges for a chest x-ray and a skin test. When he has inspected the x-ray, the doctor arranges for a sputum test. In the meantime he prescribes medication for Charlie which he will have to take under supervision of a nurse in the prison infirmary. Finally he reports the details of Charlies case to the CCDC. Teacher Notes: Key associated lectures. o Tuberculosis: Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. o CR2 Respiratory Microanatomy - Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. Highlighted in yellow are the key points in the PBL scenario, which should be covered within the session. Ensure students are aware of normal results of the tests mentioned. The diagnosis here is that of TB. Overview of TB: different types and differences in presentation and diagnosis. Cover risk factors, signs and symptoms, diagnosis and treatment (conservative, medical and surgical) o Ensure students understand: Mycobacterial characteristics and why it is a superbug. Routes of infection and risk factors for infection. Stages of TB infection: Primary, progressive Primary, Secondary and Miliary TB. Presentation of TB and difficulties in diagnosing. Investigations in diagnosis: CXR, histology, culturing bacteria, sputum analysis, skin tests for tuberculin hyper-reactivity: Mantoux test and Heaf test. Treatment of TB: 6 months regimen: include mode of action of drugs and side effects. Axillae lymph nodes. What is the CCDC?

BL MESS CR2 Handbook: 2011-2012

PBL8: A Wrong Blood Incident

Mr Smith, aged 51, attended the local A&E department complaining of feeling short of breath on exertion and light-headed. On further questioning, he admitted that his stool appeared darker than usual. He had a history of heartburn, for which he took Gaviscon. On examination, he was pale and had tenderness in his epigastrium. Rectal examination revealed a black tarry stool (melaena) on the glove. His blood pressure (BP) was 110/80 and heart rate was regular at 110 beats per minute (bpm). The results of the initial investigations were as follows:
_______________________________________________________________________

Hb
Plts

6.9g/dL

(Normal 13.5 17.5)

MCV 80fL

(Normal 80 96)

WBC 6.1 x 109/L (Normal 4.0 11.0) 360 x 109/L (Normal 150 400)

ECG sinus tachycardia 110 ________________________________________________________________________ Mr Smith was admitted for further investigation of the anaemia and for a blood transfusion. Blood was sent to the laboratory for blood grouping, antibody screen and cross-match. A few minutes after the start of the blood transfusion, Mr Smith complained of back pain, started to shiver and was gasping for breath. His observations showed a temperature of 39.5oC, a BP of 94/60, a heart rate of 130bpm and oxygen saturation of 92% on air. The blood transfusion was stopped and appropriate management and investigation initiated. Teacher Notes: Key associated lectures. o Blood groups and blood transfusions: Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. Highlighted in yellow are the key points in the PBL scenario, which should be covered within the session. Ensure students are aware of normal results of the tests mentioned. The PBL scenario is concerned with Blood transfusions. Reassure students the gastro symptoms will be covered in the Met2B module. Overview of Blood grouping: The ABO and Rhesus blood grouping systems should be covered o Antigen and Antibodies - Agglutination. o Organising a blood transfusion: Antibody Screen, Cross matching, and electronic crossmatch. Protocol of transfusion: identify patient by name, DOB and hospital no., 2 individuals to confirm identity, blood group of patient/ of the unit of the blood.

BL MESS CR2 Handbook: 2011-2012

o Investigation of a possible transfusion reaction. o Principles of ABO mismatching and how it can be prevented. o Treatment of a transfusion reaction. Need to discuss acute haemolytic transfusion reaction: intravascular haemolysis and extravascular haemolysis. Mr Smith has had an intravascular Haemolysis.

BL MESS CR2 Handbook: 2011-2012

PBL9: A Poorly Child

Kadeer, aged 8 months, was the first born of parents who came from the same region of Pakistan. He had been a full-term normal delivery. He was successfully breast fed and initially thrived normally. However, over the past 2-3 months his parents had noticed that he was feeding poorly and that he appeared pale and had a swollen abdomen. On examination, he was clinically anaemic and his conjunctivae were mildly jaundiced. He had very little subcutaneous fat and a protuberant abdomen. The latter was due to a palpably enlarged liver and spleen. He was admitted for investigation and diagnosis. The results of the initial tests were as follows: 1) Blood count: Component Hb MCV MCH Reticulocytes WBC Plts Kadeer 6.1g/dL 67fL 21pg 150 x 109/L 11.6 x 109/L 300 x 109/L Normal for age 11.0 14.0 70 - 85 25 - 30 30 - 100 6.0 16.0 200 - 550

2) Blood film and bone marrow morphology: The blood film confirmed the presence of hypochromic microcytic red cells and the presence of circulating nucleated red cells. The bone marrow aspirate from the right posterior iliac crest showed a marked increase in erythropoiesis. There was increased macrophage activity with evidence of erythroid debris and iron in the cytoplasm.

3) Biochemistry: Renal function normal Liver function was normal apart from the following:Serum bilirubin 30 micromol/L (Normal less than 17) Serum lactic acid dehydrogenase (LDH) 1500 U/L (Normal 240 480) Further investigations of Kadeer and his parents were carried out.

BL MESS CR2 Handbook: 2011-2012

4) Parent blood count Component Hb MCV Reticulocytes Serum ferritin Mother 10.5g/dL (11.5-15.5) 67fL (80-96) Normal Normal Father 11.0g/dL (13.5-17.5) 68fL (80-96) Normal Normal

5) Hb A, Hb A2 and Hb F levels were measured.

Component Hb A Hb A2 (Normal <3.5) Hb F (Normal <1.0)

Mother 94% 5% 1%

Father 95% 4% 1%

Kadeer 5% 5% 90%

Blood samples were sent to the National Haemoglobinopathy Service for DNA studies. When the results came back the Consultant Paediatric Haematologist explained to Kadeers parents a definitive diagnosis. Teacher Notes: Key associated lectures. o Haemoglobinopathies: Please refer to Barts CR2 module handbook, in the core document section of year 2 on Blackboard. Highlighted in yellow are the key points in the PBL scenario, which should be covered within the session. Ensure students are aware of normal results of the tests mentioned. The diagnosis here is that of Thalassemia. Overview of Thalassemia: different types and differences in presentation and diagnosis. Cover risk factors, signs and symptoms, diagnosis and treatment (conservative, medical and surgical) Relevance of parents being from nearby areas in Pakistan. Encourage students to interpret test results themselves and to further investigate each one in detail. Outline erythropoiesis and the aspiration from the right posterior iliac crest.

BL MESS CR2 Handbook: 2011-2012

Lectures: The ECG: Basic Physiology and Interpretations : Cardiovascular Society Review of CR Clinical Skills Myocardial Infarction Heart failure Upper and Lower respiratory tract infections.
The ECG: Basic Physiology and Interpretations : Cardiovascular Society Key associated lectures. o ECG and Data Handling: Please refer to Barts CR2 module handbook, in the core document section of year 2 on black board. Why the ECG is a *picture of the electrical activity* of the heart Voltages that cause deflections on the ECG: What is recorded on an ECG when a cardiac muscle depolarisation wave travels towards an ECG lead Explaining the ECG leads- what do they mean, how are they arranged: Einthoven's triangle. The chest leads. Which leads look at what particular parts of the heart A step by step diagrammatic walkthrough of how the depolarisation wave travels through the heart and the parts of the ECG waveform that this corresponds with, and how this shows up on different leads. The Cardiac Axis- how to measure both through basic method and the vectorial analysis method explained in the practical sessions Right and left axis deviation- causes, how to interpret The time dimension of the ECG- interpreting the ECG paper to measure HR etc The normal conduction intervals Heart block (excluding bundle branch block) Bradycardias- escape beats, extrasystoles Tachycardias Fibrillation- including a thorough explanation of AF and how it is different to Atrial Flutter ST elevations, depressions. What do they mean and the physiology behind them, how they change over time Right and Left Bundle Branch Block Mechanisms of Arrhythmogenesis

Review of CR Clinical Skills: This session is still to be confirmed. Key associated lectures. o Introduction to Cardiovascular Clinical Skills: Please refer to Barts CR2 module handbook, in the core document section of year 2 on black board.

BL MESS CR2 Handbook: 2011-2012

Introduction to Respiratory Clinical Skills: Please refer to Barts CR2 module handbook, in the core document section of year 2 on black board.

This session, will take place in the form of a live demo in which the teacher will carry out a cardiovascular and respiratory examination on a stimulated patient. Both clinical examinations, will be followed by an extensive discussion as to some of the possible causes of any present pathological signs we look for during the general examination or specific cardiovascular or respiratory examinations. This session is not intended to be a practice session for year 2 students. Encourage students to practice at home from now, as repeated practice will help build their confidence levels. Let students know, MESS will be carrying out practice sessions prior to their Part D examinations.

Myocardial Infarction: Key associated lectures. o Myocardial Infarction: Please refer to Barts CR2 module handbook, in the core document section of year 2 on black board. o Angina: Please refer to Barts CR2 module handbook, in the core document section of year 2 on black board. Overview of MI: o Differentiate between STEMI and NON-STEMI types of MI. o Ensure students understand the difference between Angina and MI in terms of pathophysiology and presentation. o Pathophysiology of MI and long term outcomes. o Risk factors for MI. o How to diagnose MI including interpretation of investigative tests. o Primary management of MI. o Secondary management of MI.

Heart Failure: Key associated lectures. o Heart Failure: Please refer to Barts CR2 module handbook, in the core document section of year 2 on black board. Overview of heart failure: o Pathophysiology of heart failure and differences in presentation between left and right HF. o How to diagnose HF and the interpretation of diagnostic tests. o Symptoms related to heart failure and why they occur. o Management of heart failure. o Prognosis of a patient diagnosed with heart failure.

BL MESS CR2 Handbook: 2011-2012

Upper and Lower respiratory infections. Key associated lectures. o Upper respiratory tract infections: Please refer to Barts CR2 module handbook, in the core document section of year 2 on black board. Lower respiratory tract infections: Please refer to Barts CR2 module handbook, in the core document section of year 2 on black board. Overview of URT-I: o Discuss common URT-Infections and the nature of the viruses. o How viral diseases affect other respiratory conditions. o Interventions against viral disease. Overview of Lower respiratory tract infections: o LRT-Infections and its association with morbitiy and mortality. o Causes of lower respiratory tract infections, including key morphology. o Diagnosis and treatment of the causes mentioned in bullet point 2. o

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