Year 4 Medicine Resources

A collection of helpful resources for clinical learning about medicine

year 4 medicine

Year 4 Medicine Syllabus

A topic by topic and week by week experiential and revision guide to ensure that you cover the key knowledge, skill and attitudinal requirements.

Your Check List

Topic Based Weekly Syllabus

Select the Week you are engaged with and find out what you should be reviewing.

This is the Year 4 part of the phase 3 learning framework proposed by the discipline of medicine. It details the knowledge and understanding of the basic biomedical and clinical science to be applied by medical students to the diagnosis, management and prevention of those conditions commonly or urgently treated by specialist physicians.

The topics in this framework build upon your learning from phase 1 and phase 2. The aim of Phase 3 is to consolidate your knowledge within the context of clinical medicine. Teaching will be embedded within your clinical placement to allow the application of your knowledge to medical practice.

Placements in clinical settings include learning opportunities during ward rounds, clinics, procedural labs and departmental meetings.  Learning opportunities within the placement should focus on knowledge-based learning, clinical practice, professional skills and understanding of health systems, society and the environment.

Learning points within a Topic can also be achieved across multiple weeks, across the whole rotation, and revised or expanded on across the year.

Self-directed learning can be focussed by week across the course depending on the requirements of your placement.

Week 1:            Topic 1- Cardiovascular and Respiratory medicine

Week 2:            Topic 2- Gastroenterology and Renal medicine

Week 3:            Topic 3- Neurology, Endocrinology and Diabetes

Week 4:            Topic 4-Rheumatology and Dermatology

Week 5:            Topic 5- Infectious disease, microbiology, immunology, sexual health

Week 5:            Topic 6- Acute medicine, therapeutics, older person’s health, medical genetics and palliative care medicine

Week 6:            Topic 7- Oncology and Haematology

Links have been provided to quality learning resources to allow efficient use of your time.

The additional resources are meant to broaden your understanding of the topics and are not intended as learning points.

Learning Points

Clinical Practice
Demonstrate the knowledge and skills to identify, assess and manage:

A patient with palpitations

  • Red flag symptoms and signs
  • Classification and pathophysiology of arrhythmias
  • Common causes and appropriate investigations
  • Emergency management of common arrhythmias

A patient with an incidental murmur

  • Red flag symptoms and signs
  • Clinical features of systolic, diastolic and continuous murmurs
  • Clinically determine the severity of disease
  • Common causes and appropriate investigations
  • Clinical signs and complications of prosthetic valves

A well patient with fast atrial fibrillation

  • Red flag symptoms and signs
  • Common causes and appropriate investigations
  • Indications and contraindications for anticoagulation
  • Understand the evidence for prevention of stroke

Acute deterioration with respiratory failure

  • Causes of respiratory distress due to airway obstruction, lung disease and non-respiratory causes
  • Define Type 1 and type 2 respiratory failure
  • Indications for oxygen, non-invasive and invasive ventilation
  • Emergency management of tension pneumothorax

A patient with acute haemoptysis

  • Red flag symptoms and signs
  • Taking a careful history of haemoptysis
  • Common risk factors, causes and investigations
  • Emergency management of large haemoptysis

A patient with daytime somnolence and morning headache

  • Taking a sleep history
  • Risk factors and causes of OSA
  • Screening and investigations for OSA
  • Complications of OSA and brief management
 
Science & Scholarship

Diagnose arrhythmias on ECG

  • Diagnose the common arrhythmias
  • Explain the ECG findings for Wolff-Parkinson-White
  • Describe Brugada syndrome

Describe how drugs can cause or treat arrhythmias

  • Outline the anti-arrhythmogenic drugs and their uses
  • Amiodarone side-effects
  • List pro-arrhythmogenic drugs

Calculate CHA2DS2-VA score and determine need for anticoagulation
[Brieger, MJA 2018]

Explain safe oxygen delivery

  • What are the limitations of pulse oximetry in practice?
  • Compare and contrast the devices used to deliver oxygen

Identify abnormalities on CXR

  • Pneumothorax and lung collapse
  • Changes of tuberculosis

Investigate a pleural collection

  • Causes of an effusion, empyema, haemothorax and chylothorax
  • Causes and investigation of a transudate and exudate including Light’s criteria

Interpret TB investigations

  • Mantoux / quantaferon gold test
Health, Society & Environment

Identify the risk factors for Rheumatic heart disease and justify the rationale for the NSW RHD register
[NSW RHD Register]

Evaluate the use of antibiotic prophylaxis for infective endocarditis
[AIMED – Choosing wisely: Antibiotic prophylaxis for prevention of infective endocarditis 2015]

Evaluate the global impact of TB, the growing problem of drug resistance and the link between TB and HIV
[World Health Organization Fact Sheets, 2018]

Professional Development

Justify why investigations should be rationalised for a patient presenting with palpitations
[Ling, Clinical investigations from the RACP 2015]

Demonstrate how you would communicate the implications of a new diagnosis of OSA to a truck driver
[Austroads – AP-G56-17]

Additional  resources

Review the diagnosis of arrhythmias
[Life in the fast lane ECG library]

Explore the Emergency Care Institute ECG guide app
[Emergency Care Institute NSW]

Review the Australasian guidelines for atrial fibrillation
[Brieger, MJA 2018]

Review the oxygen guidelines for acute use in adults
[Thoracic Society of Australia and New Zealand – Clinical Practice Guideline, 2015]

Read the article on obstructive sleep apnoea
[Mansfield, MJA 2013]

Learning Points

Clinical Practice
Demonstrate the knowledge and skills to identify, assess and manage

A patient with dysphagia

  • Red flag symptoms and signs
  • Contrast dysphagia, globus and odynophagia
  • Common causes, investigations and management of oral, pharyngeal and oesophageal dysphagia

 A patient with symptoms of heartburn and epigastric discomfort

  • Red flag symptoms and signs
  • Contrast GORD and dyspepsia
  • List common triggers for GORD
  • Testing and eradication of H. Pylori
  • Indications for endoscopy

A patient with nausea and vomiting

  • Red flag symptoms and signs
  • Categorise the common causes and investigations
  • Acute management and side-effects of antiemetic drugs

A patient with bloody diarrhoea

  • Red flag symptoms and signs
  • Common causes and appropriate investigations
  • Clinical features and management of possible IBD
  • Indications for antibiotics in bloody diarrhoea
  • Management of acute exacerbation of IBD
  • Acute and chronic complications of IBD

A patient vomiting blood

  • Red flag symptoms and signs
  • Common causes and appropriate investigations
  • Compare the management of a bleed from a peptic ulcer and from oesophageal varices

A patient with bloating, discomfort and loose stool

  • Red flag symptoms and signs
  • Common causes and appropriate investigations
  • Evidence-based management of IBS

A patient with abdominal pain and severely deranged liver function

  • Define acute liver failure
  • Common causes and appropriate investigations
  • Initial management of acute liver failure including paracetamol overdose

A patient with reduced urine output and acute renal failure

  • Definition of acute kidney failure
  • Categorise the common causes of acute kidney failure (pre-renal, renal and post-renal) and appropriate investigations
  • Causes and differential diagnosis of metabolic acidosis
  • Management of acute kidney failure including rhabdomyolysis
  • Emergency management of hyperkalemia

A well patient with deteriorating renal function

  • Define the causes and stages of chronic renal failure
  • Appropriate initial investigations of chronic renal failure
  • Describe investigations of haematuria and proteinuria
  • Discuss management of chronic renal failure
  • Prescribing in renal disease

A well patient with a positive dipstick test for blood in their urine

  • Red flag symptoms and signs
  • Categorise the causes, investigation and management of haematuria (micro/macroscopic) from kidney and renal tract
  • Note the causes of haemoglobinuria and myoglobinuria.
Science & Scholarship

Formulate your own diagnostic algorithm for nausea and vomiting
[UpToDate – approach to the adult with nausea and vomiting]

Assess a patient’s stool using the Bristol stool chart
[Continence Foundation of Australia]

Calculate and interpret the adapted Rockall score
[MDCalc – Rockall Score for Upper GI Bleeding (pre-endoscopy]

Interpret hepatitis B serology to stratify risk
[Australasian Society for HIV Medicine, Decision making in HBV, 2015]

Accurately examine fluid status
– Clinical features of dehydration and fluid overload
– Contrast biochemical tests that suggest dehydration with those that suggest an enteral protein load e.g. from upper GI bleed

Identify features of electrolyte disturbance on ECG
– Features of hyperkalaemia
– Features of hypokalaemia

Health, Society & Environment

Evaluate the Australian bowel cancer screening program for asymptomatic patients and barriers to uptake. Define the appropriate actions that should be undertaken if a faecal occult blood test is positive
[Cancer Council Australia – Clinical practice guidelines for the prevention, early detection and management of colorectal cancer, 2017]

Evaluate the impact of doctors overprescribing proton pump inhibitors
[Bytzer, MJA 2018]

Describe how Hepatitis C can be eradicated in Australia. Explain the ways in which the barriers to accessing treatment have been addressed
[Kwon, Journal of Viral Hepatitis 2018]

Explain the differences in prevalence of chronic kidney disease in indigenous Australians and general population.

Draw and label an algorithm flow chart of a kidney health check
[Kidney Health Australia – Algorithm for initial detection of CKD, 2015]

Professional Development

Formulate different strategies for displaying and delivering written information about a medical condition to suit varying levels of health literacy. Use this IBS information sheet as an example
[Gastroenterological Society of Australia, 2013]

Evaluate how doctors should best deliver evidence-based information to their patients. Use the management options for end-stage CKD as an example

[Kidney Health Australia – ‘My Kidneys My Choice’ decision aid]

Additional resources

Read about the investigation of dysphagia
[Diagnostic Imaging Pathways – WA Health]

Read about the management of GORD
[NPS Medicinewise – for Health Professionals]

 Read about the management of functional dyspepsia
[NPS Medicinewise – for Health Professionals]

Read about the management of paracetamol overdose
[Chiew, MJA 2015]

Read about the evaluation and differential diagnosis of glomerular disease

[UpToDate – Glomerular disease: evaluation and differential diagnosis in adults]

Read about prescribing in renal disease

[NPS Medicinewise – Australian Prescriber ‘Prescribing in renal disease’ 2007]

Learning Points

Clinical Practice
Demonstrate the knowledge and skills to identify, assess and manage

A patient with a new history of a fit

  • Compare seizure with vasovagal and cardiac syncope
  • Common causes of drug-induced seizures
  • Describe the types of seizure
  • Appropriate initial investigations of a first fit
  • Emergency management of a generalised convulsive seizure

A patient with headache

  • Red flag symptoms and signs
  • Characteristics of common primary and secondary cause
  • Concerning features / risk factors for serious secondary causes
  • Appropriate investigations and management

A patient with a diplopia or ptosis

  • Clinical findings and causes of unilateral and bilateral ophthalmoplegia
  • Pathophysiology of intranuclear ophthalmoplegia, clinical features and investigation of multiple sclerosis
  • Causes of a unilateral and bilateral ptosis
  • Contrast Horner’ syndrome and 3rd nerve palsy
  • Appropriate initial investigations and management of ophthalmoplegia or ptosis

A patient with features of a mononeuropathy

  • Causes, assessment, management of unilateral and bilateral facial nerve palsy
  • Causes, assessment, management of wasting of the small muscles of the hand
  • Causes, assessment, management of carpal tunnel syndrome
  • Causes, assessment, management of foot drop

A patient with a polyneuropathy (distal generalised peripheral neuropathy)

  • Red flag symptoms and signs
  • Common causes of peripheral neuropathy
  • Compare with mononeuritis multiplex
  • Appropriate investigations and management

A patient with muscle weakness without sensory features

  • Red flag symptoms and signs
  • Causes, appropriate investigations of proximal myopathy
  • Compare myasthenia gravis and Lambert-Eaton syndrome

A patient suddenly stopping long-term glucocorticoid therapy

  • Clinical features of Cushing’s syndrome
  • Acute and chronic side effects of corticosteroid therapy
  • Primary and secondary causes of adrenal insufficiency
  • Describe the autoimmune polyglandular syndromes
  • Emergency management of adrenal insufficiency

An unwell patient complaining of thirst

  • Causes of polydipsia and polyuria
  • Clinical features, causes, investigation and emergency management of hypercalcaemia
  • Emergency management of DKA and HHS

A patient with a ‘funny turn’ and unremarkable cardiac and neurological investigations

  • History and initial investigations of ‘anxiety and palpitations’; ‘flushing and diarrhoea’; or ‘hunger and shaking’
  • Extrathyroidal features of Grave’s disease
  • Investigations to differentiate Grave’s disease, thyroiditis, toxic nodule and multinodular goitre.

A patient with an incidental pituitary mass found on imaging

  • Symptoms and signs of anterior pituitary failure
  • Signs of mass effect from a pituitary macroadenoma
  • Syndromes associated with functioning pituitary tumours 

A patient with osteoporosis / osteomalacia

  • Causes, appropriate investigations, lifestyle and dietary advice
  • Indications for medication e.g. calcium, vitamin D, anti-resorptive agents and side-effects

A patient with testosterone deficiency

  • Symptoms, signs and investigation of testosterone deficiency
  • Clinical features of Klinefelter’s syndrome
  • Initiation of testosterone and estrogen therapy for cis-gender and trans or gender diverse people
Science & Scholarship

Outline the drugs used to prevent or terminate epileptic seizures

  • Common drugs and interventions
  • Monitoring and side-effects

[National Institute for Clinical and Health Excellence – Epilepsy overview 2019]

Correctly prescribe glucocorticoids in and emergency

  • List the corticosteroid equivalents?
  • Describe how to prescribe glucocorticoid medication in an unwell patient

[Gargya, Internal Medicine Journal 2016]

Assess plasma and urine osmolarity

  • Calculate plasma osmolarity
  • Understand why this calculation can differ from measured omolarity
  • What is an appropriate urine osmolarity in a dehydrated patient?
  • Interpret urine specific gravity

[MDCalc Serum osmolarity]

Request appropriate thyroid imaging

  • List the indications for Technetium pertechnetate
  • List the indications for thyroid ultrasound

[Lee, Australian Family Physician 2012]

Learn to calculate the fracture risk
[FRAX WHO
[Garvan Institute]

Health, Society & Environment

Evaluate the global impact of leprosy, as one of the leading causes of peripheral neuropathy in the developing world, and explain the challenges in controlling this disease
[World Health Organization – Fact sheets, 2019]

Evaluate how discrimination impacts the health of the trans and gender diverse community in NSW, using the ‘NSW Blueprint for TGD health’ as a resource.

[ACON NSW 2019 ISBN-13: 978-1-86356-007-8]

Professional Development
Learning

Justify the principals of assessing cost-effectiveness before approving new treatment, using multiple sclerosis as an example
[Broadley, MJA 2015]

Formulate a strategy to support doctors in making a diagnosis of an uncommon condition, using motor neurone disease as an example
[MND Australia, 2016]

Formulate an effective strategy for communication between different parts of the health service, using this resource as an example

[HNE Community healthpathways – Long-term therapeutic glucocorticoids (steroids)]

Additional resources

Read about first seizures in adults
[Angus-Leppan BMJ, 2014]

Read about taking a headache history
[HNE community healthpathways – useful questions for headache diagnosis]

…and the classification of common headache syndromes
[HNE community healthpathways –headaches]

Read about how to spot and treat ‘dangerous ptosis’
[Bilyk, Review of Ophthalmology 2012]

Read about how to approach a patient with Bell’s palsy
[Phan, Australian Family Physician 2016]

Review the common presenting symptoms of endocrine disease
[Endobible]

 Read about the assessment and management of androgen deficiency
[Ng Tang Fui, Australian Family Physician 2014]

Read about the hormonal management of transgender and gender diverse individuals
[Cheung, MJA 2019]

Read about ‘diabetes of the exocrine pancreas’. How common is it? What are the causes? How is it different from other types of diabetes?
[Wynne, Journal of Gastroenterology and Hepatology 2018]

Learning Points

Clinical Practice
Demonstrate the knowledge and skills to identify, assess and manage:

A patient with a sudden-onset single painful joint

  • Red flag symptoms and signs
  • Common causes and clinical features
  • Risk factors for septic arthritis
  • Appropriate investigation and initial management

A patient with non-inflammatory joint pain and swelling

  • Red flag symptoms and signs
  • Compare and contrast the features of non-inflammatory and inflammatory joint pain
  • Appropriate investigations and evidence-based management

A patient with joint inflammation and pain

  • Red flag symptoms and signs
  • Clinical features, distribution and extra-articular features of the common causes of inflammatory arthritis
  • Appropriate investigation and brief management options

A patient with muscle pain in the neck and shoulders

  • Red flag symptoms and signs of giant cell arteritis
  • Consider a differential diagnoses and investigations
  • Clinical features and initial management of polymyalgia rheumatic or giant cell arteritis

A patient with itching

  • Primary dermatological causes and secondary systemic causes of pruritus with appropriate investigations
  • Describe the clinical presentations and brief management of psoriasis
  • Describe the clinical presentations and brief management of eczema and dermatitis

A patient with a sun-sensitive rash

  • Clinical features of common causes of photosensitive rash, investigations and brief management

A patient with a change in skin colour

  • Clinical features of common causes of abnormal skin, pigmentation, investigations and brief management

A patient with skin thickening

  • Clinical features of common causes of dermal plaque, investigations and brief management

Science and Scholarship

Interpret the results of synovial fluid aspiration

  • Understand the procedure for safe joint aspiration
  • Appearance, WCC, RBC, microscopy and culture, protein, LDH, glucose, crystals

[Tidy, Patient Info – Professional Articles – acute monoarthritis 2017]


Outline the clinical features and pathophysiology of the vasculitis disorders.

  • List the general signs and symptoms of vasculitis
  • Categorise by vessel size
  • Categorise by organ effected

[Australasian Society of Clinical Immunology and Allergy – vasculitis disorders]

Identify the dermatological conditions associated with systemic disease

  • Describe the skin conditions associated with systemic disease
  • Identify skin conditions that may herald underlying malignancy

[Lee, Australian Family Physician 2009]

Health, Society & Environment

Evaluate the cost of osteoarthritis in Australia and the population-based health strategies
[University of Sydney – news – ‘How to cut the $23 billion bill for osteoarthritis’, 2018]

Evaluate the contribution of skin conditions to the global burden of disease
[Karimkhani, JAMA Dermatology 2017]

Professional Development

Understand that not all diseases fit into a specific pattern. Describe how this might impact on the patient, using systemic rheumatic diseases and overlap syndromes as an example
[UpToDate – undifferentiated systemic rheumatic (connective tissue) diseases and overlap syndromes]

Evaluate the psychological impact of diseases that are visible to others, using vitiligo as an example
[Wittal, Australasian College of Dermatologists A to Z of skin – vitiligo, accessed 2019]

Additional resources

Read about ‘Acute Monoarthritis’
[Tidy, Patient Info – Professional Articles – acute monoarthritis 2017]

Read about ‘Assessing peripheral musculoskeletal symptoms in adults’
[eTG complete ‘musculoskeletal symptoms in adults]

Answer the questions about this case of a patient with a skin rash and limb weakness
[Grillo, Australasian Family Physician 2012]

Leaning Points

Clinical Practice
Demonstrate the knowledge and skills to identify, assess and manage

A patient with sudden-onset diarrhoea, fever and abdominal pain

  • Red flag symptoms and signs
  • Common causes, characteristics and appropriate investigations
  • Emergency management of hypokalaemia

A patient with fever of unknown origin

  • Define fever of unknown origin
  • Categorise the common causes and clinical features (including pattern of fever)
  • Appropriate initial and further investigations

A patient with recurrent pneumonia

  • Differential diagnosis and investigations for recurrent infection
  • Indications for HIV testing
  • Clinical features of acute retroviral syndrome
  • Common opportunistic infection in AIDS
Science & Scholarship

Prioritise the investigations for infectious gastroenteritis
[HNE Community healthpathways – Infectious gastroenteritis control – testing guide]

Outline the use of antiviral agents in influenza

  • Benefits and adverse effects

[Jones, The Cochrane Database of Systematic Reviews 2012]

Explain the role of PrEP

  • Assess a patient for PrEP
  • Discuss the importance of patient education and opportunistic screening

[Australasian Society for HIV Medicine, Decision making in PrEP – NSW, 2015]

 

Health Society & Environment

Outline the strategies used to prepare for influenza pandemics, using the resource as an example
[Royal College of General Practice – Managing pandemic influenza in general practice]

Evaluate the impact of HIV / AIDS as a major global health issue
[World Health Organization Fact sheets – HIV/AIDS, 2019]

Professional Development

Describe the responsibility of medical practitioners to inform the public health unit of notable diseases
[NSW Health – Disease notification, accessed 2019]

Describe best practice for informed consent when testing for HIV
[Australasian Society for HIV Medicine, Informed consent for HIV testing, 2017]

Additional resources

Read this case report of fever of unknown origin
[‘A skin lesion and fever of unknown origin’, Australian Family Physician 2012]

Review the resources for HIV management in Australia
[Australasian Society for HIV MedicineHIV management in Australasia, 2016]

Learning Points

Clinical Practice
Demonstrate the knowledge and skills to identify, assess and manage:

A patient with poisoning

  • Red flag symptoms and signs
  • Assess the potential for toxicity
  • Clinical features of toxidromes and drug withdrawal
  • Emergency management of overdose of known cause

A patient with hypothermia

  • Red flag symptoms and signs
  • Common causes of hypothermia
  • Severity of hypothermia and complications
  • Appropriate investigations and emergency management

An elderly person is admitted with signs of malnourishment

  • Red flag symptoms and signs for elder abuse
  • Types of elder abuse and questions to elicit disclosure
  • Clinical features of malnutrition and vitamin deficiency
  • Emergency management of refeeding syndrome

A young person presents with chest pain and has a history of sudden cardiac death in his younger cousin

  • Red flag symptoms and signs for aortic dissection
  • Clinical features of Marfan’s syndrome / Myotonic dystrophy
  • Differential diagnoses for sudden cardiac death in a young person and referral for genetic testing

A patient has end-stage chronic disease and is in the last days of life

  • Define symptoms and signs of dying
  • Management of agitation, bowel obstruction, breathlessness, nausea, seizures and pain
  • Rationalisation of investigations of routine medications
Learning Points: Science & Scholarship

Explain the causes of chronic pain
[NSW Government – Agency for Clinical Innovation – Brainman Pain Management Resources, 2015]

Accurately draw a genetic pedigree

  • What are the symptoms of Huntingdon’s chorea
  • Draw a family tree for a female patient if the patient’s grandmother (deceased), father and sister had the disease.

[Health Education England – Genomics education program – Taking and drawing a family tree]

Explain anticipatory prescribing in palliative care

  • List the medications prescribed and their use

[Clinical Excellence Commission, Last Days of Life Anticipatory Prescribing Recommendations, 2017]

Health, Society & Environment

Justify the deprescribing of medication in the frail elderly
[NPS Medicinewise Hilmer and Gnjidic 2017]

Evaluate the effectiveness of the Clinical Excellence Commission ‘End of Life’ program. Describe the principles of care.
[Clinical Excellence Commission, Last Days of Life, Summary report from pilot project2017]

Professional Development

Formulate a strategy to promote an evidence-based change in practice, using prescribing opiates as an example
[Hunter New England Health District, 2014]

Demonstrate how to approach a consultation with a patient who has a life-limiting chronic disease and is identified as being in their last year of life. Evaluate their physical and psychological needs
[Caresearch – palliative care knowledge network, 2017]

Additional resources

Read about serotonin toxicity
[Isbister, MJA 2017] 

Read about the importance of screening for genetic cardiac disorders in young Australians
[Doolan, MJA 2014]

Read about how to prescribe medication in the last days of life for palliative care
[Clinical Excellence Commission, Guidance for Prescribing Last Days of Life Medicine, 2017] 

Read about how to care for Aboriginal or Torres Strait Islander people through death and dying
[Sad News, Sorry Business: Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying (version 2)]

Learning Points:

Clinical Practice
Demonstrate the knowledge and skills to identify, assess and manage:

A patient with dyspnoea and a mass on chest radiography

  • Pulmonary and extra-pulmonary features of lung cancer
  • Common sites for metastases
  • Paraneoplastic syndromes and electrolyte disturbance
  • Appropriate investigations, staging and management

A patient with a change in bowel habit and abdominal mass

  • Red flag symptoms and signs
  • Clinical features of colorectal cancer and metastases
  • Appropriate investigations, staging and management

Emergency oncological complications

  • Clinical features, investigation and emergency management of spinal cord compression, pathological fracture and hypercalcaemia of malignancy
  • Clinical features, investigation and emergency management of mediastinal compression and superior vena cava obstruction

A patient with severe anaemia

  • Red flag symptoms and signs
  • Common causes of macrocytic, normocytic and microcytic anaemia
  • Pathophysiology of anaemia of chronic disease
  • Features and cause of haemolysis and pancytopenia

A patient with neutrophilia

  • Clinical features suggesting acute leukaemia
  • Categorise acute and chronic leukaemia
  • Appropriate investigations, staging and management

A patient with hepatosplenomegaly and renal impairment

  • Differential diagnoses of hepatosplenomegaly
  • Clinical features of multiple myeloma
  • Appropriate investigations, staging and management

An unwell patient with lymphadenopathy

  • Clinical features suggesting lymphoma
  • Appropriate investigations, staging and management

A patient with diabetes and raised ferritin

  • Clinical features of haemochromatosis
  • Appropriate investigation and brief management
  • Screening of first and second degree relatives

A patient with persistently elevated haemoglobin

  • Red flag symptoms and signs
  • Clinical features of primary polycythaemia
  • Secondary causes of polycythaemia
  • Appropriate investigation and brief management
Science & Scholarship

Outline the investigation of symptoms and signs that raise a suspicion of cancer

  • List signs and symptoms e.g. haemoptysis, hoarse voice, change in bowel habit, blood mixed in stool, unexplained anaemia, breast lump, difficulty swallowing etc.
  • List other potential causes and appropriate investigations

 [Iversen Scheel, SJPHC 2015]

Identify the patients that require cancer genetics assessment

  • Understand who needs referral for genetic counselling and risk management advice

[NSW Government – eviQ – General practitioner guidelines for cancer genetics assessment 2017]

Interpret the full blood count in anaemia
Explain abnormalities in the following parameters:

  • Cell counts
  • MCV
  • Reticulocyte count
  • Blood film 

Differentiate the causes of lymphadenopathy

  • Describe the characteristics of lymph nodes that you should identify on examination?
  • List the causes of generalised, cervical, supraclavicular, axillary and inguinal lymphadenopathy
  • Outline appropriate investigations
Health, Society & Environment

Outline the causes for unwarranted clinical variation in cancer survival across Australia. Identify factors that could be addressed to ‘Close the Gap’, using the resource as an example
[Page, Internal Medicine Journal 2016]

Justify a management plan for vaccination and prophylactic antibiotics in a patient who has undergone splenectomy, using the resource as an example
[Looke, MJA 2012]

Professional Development

Formulate a strategy to support ‘shared decision-making’ in cancer care or non-malignant medical conditions. Reflect on your own practice, using the resource as an example
[Hoffmann, MJA 2014]

Discuss the potential impact of working with severely unwell or dying patients. Develop strategies to support junior doctors, using this resource as an example
[NSW Government – ‘Your training and wellbeing matters’ NSW JMO survey 2018]

Additional Resources

Review an algorithm for investigating the symptoms of lung cancer
[Cancer Australia – Investigating lung cancer: a guide for GPs 2012]

Review an algorithm for investigating the symptoms of colorectal cancer
[Cancer council – Optimal care pathway for people with colorectal cancer, accessed 2019]

Answer the questions about this case of a patient with weight loss and lymphadenopathy
[Morton, Australian Family Physician 2013]

Explore possible causes for a raised ferritin on the ‘High Ferritin’ App
[Australian Red Cross Blood Service, High Ferritin App, 2019]

Supplementary Resources

Online supplemental resources have been provided to support your learning during the pause to clinical placement. This includes tutorials, patient stories, learning modules and clinical cases. These resources should be used in conjunction with other reliable sources such as the eTG and NPS to address the learning objectives. The ‘Challenge yourself’ topics are intended to be challenging and present a case report followed by an insight into diagnosis, investigations and management. These cases, or the links to patient stories, may be used as a basis for the Case-based learning tutorials.

Learning Points: Clinical Practice


A patient with palpitations  and a well patient with fast atrial fibrillation

https://onlinemeded.org Topics >> Cardiology >> ACLS Rhythms

https://onlinemeded.org Topics >> Cardiology >> ACLS Easy 

A patient with an incidental murmur

https://onlinemeded.org Topics >> Cardiology >> valvular disease 

https://onlinemeded.org Topics >> Infectious disease >> infective endocarditis

Acute deterioration with respiratory failure

PATIENT STORIES (Lung Foundation Australia)

A patient with acute haemoptysis

https://onlinemeded.org Topics >> Pulmonology >> lung cancer

https://onlinemeded.org Topics >> Pulmonology >> pleural effusion

Challenge Yourself


BMJ endgames ‘A young man with palpitations and pre-syncope’ (via the library)
BMJ endgames ‘Progressive shortness of breath’ (via the library)                    
BMJ endgames ‘A man with Wegner’s granulomatosis and acute haemoptysis (via the library)
BMJ endgames ‘Fast and furious’ (via the library)
BMJ endgames ‘A man with hypertension and two murmurs’ (via the library)
BMJ endgames ‘A heart stopping performance’ (via the library)
BMJ endgames ‘A young athlete with bradycardia’ (via the library)
BMJ endgames ‘A 64 year old woman with headache and breathlessness’ (via the library)

Learning Points: Clinical Practice

 

A patient with dysphagia
https://onlinemeded.org Topics >> Gastroenterology >> esophagus

A patient with symptoms of heartburn and epigastric discomfort

https://onlinemeded.org Topics >> Gastroenterology >> Esophagitis
https://onlinemeded.org Topics >> Gastroenterology >> GERD
https://onlinemeded.org Topics >> Gastroenterology >> Peptic ulcer 

A patient with nausea and vomiting & A patient with bloody diarrhoea

https://onlinemeded.org Topics >> Gastroenterology >> acute diarrhoea 
https://onlinemeded.org Topics >> Gastroenterology >> chronic diarrhoea 
https://onlinemeded.org Topics >> Gastroenterology >> IBD 

A patient vomiting blood
https://onlinemeded.org Topics >> Gastroenterology >> GI bleed

A patient with abdominal pain and severely deranged liver function
https://onlinemeded.org Topics >> Gastroenterology >> Cirrhosis
https://onlinemeded.org Topics >> Gastroenterology >> Cirrhosis complications
https://onlinemeded.org Topics >> Gastroenterology >> Jaundice
https://onlinemeded.org Topics à Gastroenterology à Viral hepatitis
PATIENT STORIES (Hepatitis Australia)

A patient with reduced urine output and acute renal failure
https://onlinemeded.org Topics >> Nephrology >> Acute kidney injury

A patient with deteriorating renal function
https://onlinemeded.org Topics >> Nephrology >> Chronic kidney injury
PATIENT STORIES (Kidney Health Australia)

 

Challenge yourself:

NEJM ‘A 89 year old man with recurrent abdominal pain and bloody stools’ (via the library)
BMJ endgames ‘The tired patient’ (via the library)
BMJ endgames ‘Persistent diarrhoea in a young women’ (via the library)
BMJ endgames ‘A massive haematemesis’ (via the library)
BMJ endgames ‘A man with bloody diarrhoea’ (via the library)

Learning Points: Clinical Practice

A patient with a new history of a fit
https://onlinemeded.org Topics>>Neurology>>Seizure 
 
A patient with headache

https://onlinemeded.org Topics >> Neurology >> Headache

https://headacheaustralia.org.au/2018-headache-documentary/
PATIENT STORIES 2018 headache documentary by brainfoundation

A patient with muscle weakness without sensory features

https://onlinemeded.org Topics >> Neurology >> weakness
PATIENT STORIES ‘The enemy within’ (ABC 2018)

An unwell patient complaining of thirst

https://appadvice.com/app/thinksulin/1359457527 Free App by the Agency for Clinical Innovation
https://onlinemeded.org Topics >> Nephrology >> calcium 
https://onlinemeded.org Topics >> Endocrine >> posterior pituitary
https://onlinemeded.org Topics >> Endocrine >> diabetic emergencies

A patient with a ‘funny turn’ and unremarkable cardiac and neurological investigations

https://onlinemeded.org Topics >> Endocrine >> adrenal 
https://onlinemeded.org Topics >> Endocrine >> thyroid 
https://onlinemeded.org Topics >> Endocrine >> thyroid nodules 
https://onlinemeded.org Topics >> Endocrine >> MEN Syndromes

A patient with an incidental pituitary mass found on imaging

https://onlinemeded.org Topics >> Endocrine >> anterior pituitary (https://www.pituitary.org.uk/support-for-you/peer-support/patient-stories/ PATIENT STORIES (Pituitary Foundation, UK)

Challenge yourself:

BMJ endgames ‘An unconscious patient’ (ResearchGate)
BMJ endgames ‘a man with anxiety, confusion and red eyes’ (ResearchGate)
BMJ endgames ‘A case of severe hyponatraemia’ (ResearchGate)
NEJM ‘A 36 year old man with episodes of confusion and hypoglycemia’ (via the library)
NEJM ‘A 39 year old woman with palpitations, abdominal pain and vomiting’ (via the library)
BMJ endgames ‘Unequal pupils and ptosis’ (via the library)
BMJ endgames ‘A case of diplopia and arm weakness’ (via the library)
BMJ endgames ‘A woman with cough and difficulty walking’ (via the library)
BMJ endgames ‘A woman with episodic sweating, headache and palpitations’ (via the library)
BMJ endgames ‘A 90 year old man with difficulty swallowing and proximal weakness’ (via the library)
BMJ endgames ‘Pigmentation and confusion’ (via the library)

Learning Points: Clinical Practice

A patient with a sudden-onset single painful joint

https://onlinemeded.org Topics>>Rheumatology>>approach to joint pain 
https://onlinemeded.org Topics>>Rheumatology>>monoarticuloarthropathy 

A patient with joint inflammation and pain

https://onlinemeded.org Topics>>Rheumatology>>rheumatoid arthritis
https://onlinemeded.org Topics>>Rheumatology>>lupus
https://onlinemeded.org Topics>>Rheumatology>>seronegative arthritis
PATIENT STORIES (Arthritis Australia)

A patient with muscle pain in the neck and shoulders

https://onlinemeded.org Topics>>Rheumatology>>other connective tissue
https://onlinemeded.org Topics>>Rheumatology>>vasculitits

A patient with itching

https://onlinemeded.org Topics>>Dermatology>>Papulosquamous
https://onlinemeded.org Topics>>Dermatology>>Eczematous rashes
https://onlinemeded.org Topics>>Dermatology>>Bullous diseases
https://onlinemeded.org Topics>>Dermatology>>hypersensitivity

Challenge yourself

BMJ endgames ‘A swollen red finger’ (via the library)
BMJ endgames ‘Tattoo trouble’ (via the library)
BMJ endgames ‘An acutely swollen knee’ (via the library)
BMJ endgames ‘A patient with bilateral shoulder and pelvic girdle aching’ (via the library)
BMJ endgames ‘Taught a lesson by taut skin’ (via the library)      
BMJ endgames ‘A skin rash to remember’ (via the library)
BMJ endgames ‘A difficult case of ectopic eczema’ (via the library)
BMJ endgames ‘A patient with muscle weakness’ (via the library)

Learning Points: Clinical Practice

Geriatric Assessment
http://vgmtp.anzsgm.org/Assessment/ (Comprehensive geriatric assessment, who would benefit, who would be involved, specific aspects, frailty, instruments, developing a management plan)

Medications and prescribing
http://vgmtp.anzsgm.org/medications/ (Age-related physical changes, adverse drug reactions, polypharmacy and de-prescribing, adherence to therapy, legal responsibilities)

Legal and ethical issues
PATIENT STORY (Short film about elder abuse made for Comic Relief 2009)
http://vgmtp.anzsgm.org/legal/index.html (legal issues, how the law protects rights, capacity, legal instruments, consent and refusal, the doctor’s role, the older driver, elder abuse) 

Falls and balance
PATIENT STORY (Age UK)
http://vgmtp.anzsgm.org/Mobility/ (Why falls are important, risk factors, intervention)

 

Challenge yourself:

NEJM ‘An 83 year old woman with nausea, vomiting, and confusion‘ (via the library)
BMJ endgames ‘The management of accidental hypothermia’ (via the library)
BMJ endgames ‘An unusual case of fever of unknown origin’ (via the library)

Learning Points: Clinical Practice

Emergency oncological complications
Introduction to oncological emergencies (Oncology for Medical Students)
Superior Vena Cava Syndrome (Oncology for Medical Students)
Metastatic spinal cord compression (Oncology for Medical Students)
Hypercalcaemia of malignancy (Oncology for Medical Students)
Tumour lysis syndrome (Oncology for Medical Students)
Neutropenic sepsis (Oncology for Medical Students)

A patient with severe anaemia
https://onlinemeded.org Topics >> Hematology Oncology >> Anemia approach 
https://onlinemeded.org Topics >> Hematology Oncology >> Macrocytic anemia
https://onlinemeded.org Topics >> Hematology Oncology >> Microcytic anemia
https://onlinemeded.org Topics >> Hematology Oncology >> Normocytic anemia 

A patient with neutrophilia
https://onlinemeded.org Topics >> Hematology Oncology >> Leukaemia
PATIENT STORIES (Leukaemia Foundation)

A patient with lymphadenopathy
https://onlinemeded.org Topics >> Hematology Oncology >> Lymphoma
PATIENT STORIES (Leukaemia Foundation)

A patient with hepatosplenomegaly and renal impairment
https://onlinemeded.org Topics >> Hematology Oncology >> Plasma cell
PATIENT STORIES (Leukaemia Foundation)

Challenge yourself:

BMJ endgames ‘Constitutional symptoms in a young person’ (via the library)
BMJ endgames ‘An older man with thoracic back pain’ (via the library)
BMJ endgames ‘Anaemia in a 17 year old student’ (via the library)
BMJ endgames ‘An odd cause of dysphagia’ (via the library)
BMJ endgames ‘Kidney failure with a diagnostic chest x-ray’ (via the library)    
BMJ endgames ‘Another patient with low back pain’ (via the library)
BMJ endgames ‘A sinister cause of shoulder pain, with numbness and weakness in the ipsilateral hand’ (via the library)
BMJ endgames ‘A student with macrocytic anaemia’ (via the library)
BMJ endgames ‘An unusual case of anaemia and lymphocytosis’ (via the library)

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