Jr Sx

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Hand Book >> http://www.mediafire.com/view/?vbfri98105bst2u

PAEDS: Announcement & Exam Format

Please note that the TMRI lecture has been broken down into two groups.  On the first Fri students who are assigned to the wards are expected to attend and at the second sitting those whoare currently in Well baby/Casualty are to attend

A. Garbutt

 ______________________________________________________________________________

Paediatric OSCE

The exam is 15 minutes long, your examiner will be with you observing you elicit your history, you will be given 13 minutes to do so. In the final two minutes you will be required to SUMMARIZE the key features of the history and give a differential diagnosis. There will be a whistle blow to indicate the start of your station, a further whistle blow at 13 minutes when you must stop your history taking, SUMMARIZE the key points for the examiner and give a differential diagnosis. There will be a final double blow of the whistle at 15 minutes to indicate the end of the exam. You will not be required to present your full history nor to give in a written record of your history. There however will be paper available to make jottings during your history taking but these must be left with the examiner.

Paediatric MCQ

The exam consists of 80 questions. Each has 5 options; you are to select the best option. Duration of MCQ exam is 90 mins. This is an online exam. Ensure from ealry that you are able to log into OurVle.

Both MCQ and OSce are UWI exams. Hence they are conducted in similar fashion to other UWI exams: no cell phones, paper etc

Dr. A Garbutt

Paediatric Tutorial Questions (C - Groups C&D)

Tutorial Questions

The Dehydrated Child

CASE SCENARIO

An 11 month old male infant is brought to casualty by his mother with a one day history of vomiting, a two day history of watery stools and poor oral intake.

1.      What further historical information would you like to know?

2.      What are the clinical features of mild, moderate and severe dehydration?

Examination reveals a lethargic, drowsy infant. Temperature of 38°C, Weight          is 10kg

       Pulse is weak, rate of 160/min. Blood pressure 60/40

Capillary refill > 2 seconds, his eyes and anterior fontanelle are sunken and there is no salivary pool.

3.      Classify the severity of this patient’s dehydration.

4.      Calculate the fluid deficit.

5.      Does this patient need oral or IV fluid therapy?

6.      What investigations would you do and why?

7.      What are the principles of rehydration therapy?

Child with a rash 

A 4 year old child presents to your practice with a two day history of fever, headache, vomiting and sore throat.  Temperature recorded by mom was initially 101 degrees F responsive to paracetamol given every 4 hours.  The following day the temperature increased to 103 degrees F with the appearance of a fine papular 

rash which started in the neck and armpits but spread to the entire body after a few hours. 

(1)     What is the likely diagnosis in this patient?

(2)     What is characteristic about the rash in the above scenario? 

(3)     How does the timing of onset and nature of a rash assist you in arriving at a diagnosis?

(4)      What are the common clinical scenarios in paediatrics where a rash is characteristic?

(5)     Outline options for treatment based on likely pathophysiology                                                                   

Well Child Care

A teenage mother is visiting you for the first time.  She has recently moved to Kingston with her 6 month old child.  During your first visit as you enquire about what her “son is currently doing”, she seems unaware of what you are asking about.

1.      Explain to Mother the purpose of her Well baby visit and what all it should entail

2.      Provide explanations  as to what is developmental surveillance and its importance

3.      Provide age appropriate anticipatory guidance to mother.

Mrs Martin presents to you with her 24 month old daughter whom she is concerned about as she is not yet “talking”.  As you explore her history, outline important aspects that need to be addressed in her history as well as possible diagnoses.

You are asked to address a group of parents at a local kindergarten on temper tantrums.  What important points should you make?

 “The Child with Cold, Cough and Shortness of Breath ”

Instructions to students:

Seek out as many patients as you can who present to clinic, casualty or wards with cold, cough with or without shortness of breath and answer the following questions.

How does the clinical presentation (symptoms and signs) of a child with cold and cough help in arriving at a diagnosis?

How does the etiology of various conditions with symptoms of cold and cough with or without shortness of breath affect diagnosis investigation and treatment?

How does the pathophysiology and prognosis of these conditions help to direct treatment?

Bring your cases, books/resource materials to the tutorial.

Recommended Reading: See resources on OurVLE

THE INFANT OR CHILD WITH FEVER

Objectives:

At the end of the tutorial(s) the student should be able to:

1.      Define fever

2.      Describe the pathophysiology of fever

3.      Classify fever and explain the significance according to the classification

4.      Describe the aetiology of fever with respect to pattern of fever and certain patient factors e.g. age group

5.      Describe the complications of fever

6.      Define febrile seizures

7.      Decribe the pathophysiology of febrile seizures

8.      Describe the management of the infant/ child with fever

The following case scenarios have been developed to emphasise the above learning points.

Case scenario 1

A mother brings a 10-month-old male infant to casualty, with a complaint that he has been having fever for the past 5 days. The fever is intermittent and worse at night. She used a thermometer at home and the highest temperature recorded was 39.8 ⁰ C. She tried sponging the infant with cold water, but he began shivering. His appetite has been decreased and he is irritable.

a)      How would you determine if this child has fever (state methods and interpretation)?

b)      How does the body produce fever? (Be prepared to explain this process to parents and colleagues.)

c)      What other causes of elevated body temperature exist and how do they differ from true fever?

d)      How can fever be classified? What is the relevance of these classification systems?

e)      What additional history do you need to determine the cause of this infant’s problem? Give reasons for each historical point.

f)       What important examination findings would lead you to a diagnosis?

g)      What other historical data should you elicit if the boy was less than one month old and older than 3 years old?

h)      What features in the examination would support a diagnosis of meningitis? How do these features change with age?

i)        What are the common causes of fever in children less than one month old, 3-36 months old, older than 3 years old?

j)        What groups of children are considered high risk when they have fever?

k)      What investigations would you do? Do investigations vary with age? Explain why?

l)        What complications may occur with fever?

m)   How is fever treated?

Jr. Surgery

Allocation List - Group B

Books for Print from Dr Thomas

As you go onward, just a reminder about ordering your books from early:

Books available are as below. Hopefully with time we may be able to increase the range of books offered.

	List of Books for Medical Students Available for Print
	Title	Price (JA$)
1	Roop Gynaecology	1800
2	Roop Obstetrics	2000
3	Roop Obstetrics + Bassaw Review	2300
4	OnG question book	1700
	MBBS 2008 - 2011
5	Medicine Questions	2900
6	Surgery Questions	2300
7	MBBS Compilation 90s – 2007	3800
8	Get Through Medical School	700
9	Harrison's Principles of Internal Medicine	2400
10	Notes in Paediatrics	700
11	Notes in Surgery	500
12	Aids to Undergraduate Medicine	500
13	Cases in Chemical Pathology	1500

Contact: Dr. Daniel Thomas #352-1885 or getmymedbooks@gmail.com

Summary and recommendations:

For your 3^rd Year clerkships the followings books are recommended:

1.       Aids in Undergraduate Medicine (a handy companion for medical clerkship especially for the OSCE, a definite must for any medical student entering their clinical years)

2.       Notes in Paediatrics (foundation topics and principles for the Paediatric rotation)

3.       Notes in Surgery (foundation topics and principles for the Surgery rotation)

4.     Notes in General Surgery

5.       Get Through Medical School (1000 Questions to carry you through your 4 chief rotations, namely Medicine, Surgery, Paediatrics, and Obs & Gyn. A priceless tool in the preparation for end of clerkship exams as well as final MBBS.)

Also you may want to consider getting one or all of the following:

1.       MBBS compilation 90s to 2007

2.       Medicine Questions (Includes: MBBS 2008 – 11; End of clerkship exams)

3.       Surgery Questions (Includes: MBBS 2008- 11; 100 Cases in surgery)

For your 4^th Year clerkships:

1.       Roopnarinesingh Obstetrics Text +/- Dr. Bassaw’s Essentials of Obstetrics. (Dr. Bassaw is a Trinidadian OnG consultant, one of the examiners and also sets the MBBS OnG paper when Trinidad is assigned.)

2.       Obstetrics and Gynaecology Question book (Includes: MBBS question 2008 – 11; Roop MCQs; and more)

3.       Cases in Chemical Pathology (4^th year Pathology and Microbiology rotation)

In final year you commence Gynaecology and would then require the Roopnarinesingh Gynaecology text.

Harrison’s Principles of Internal Medicine: Board Review is recommended for those who want further questions to practice for MBBS also for USMLEs. Divided into questions based on medical subspecialties, it will definitely prove to be a useful study tool.

ORDER HERE:   https://docs.google.com/spreadsheet/viewform?formkey=dE5lUXVaUGkxRkg1czFnVEVnc0dKNHc6MQ

Jnr Surgery

Lectures http://www.mediafire.com/?rhbe0yhvozsc6

Dengue Fever Surveillance Protocol

MINISTRY OF HEALTH

2 – 4 KING STREET, KINGSTON, JAMAICA.

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DENGUE FEVER SURVEILLANCE PROTOCOL

-         revised 31 August 2012.

Dengue Fever is a Class I Notifiable Disease for notification purposes, in order to assist with enhanced monitoring. Dengue Fever (DF), Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) cases must be reported immediately on suspicion. There is currently enhanced surveillance for DF, DHF and DSS.

The protocol below shall be adhered to for surveillance activities and reporting.

v  There shall be daily reporting of ALL suspected cases of DF, DHF and DSS from all health care facilities (including sentinel and non-sentinel sites, private and public hospitals, and private practitioners’ offices).

v  These reports must be sent daily to the Parish Health Department from where they will be forwarded to the Regional Health Authorities and the National Surveillance Unit (NSU).

v  A Class 1 Notification Form must be filled out for all suspected cases of DF, DHF and DSS. 

v  All suspected DF, DHF and DSS cases shall also be recorded on the standard Ministry of Health Line Listing form, providing information on: age, gender, parish of residence, date of onset of illness, signs and symptoms, whether or not the patient has been hospitalized, whether or not a sample was sent off (including date, type and result of test), travel history and care site.

v  The updated line listing must be submitted by the Parish Health Department to the NSU at 10:00 am each day.    

v  A Dengue Haemorrhagic Fever Case Investigation form must also be filled out for each suspected case of DHF and DSS. ( See attachment)

v  All cases of DHF and DSS must be admitted to hospital, investigated and managed in accordance with the standard clinical guidelines.

v  All suspected dengue-related deaths must be reported and investigated within 72 hours.

v  All suspected cases of DHF and DSS must have a blood sample taken for dengue testing.

v  In addition, there must be 1:10 sampling of all suspected DF cases. Take the sample from the first suspected case that presents each day and every 10^th suspected case thereafter.

v  For all DF, DHF and DSS samples, five (5) mls. of blood should be collected in a red top tube and stored at 4° C in the refrigerator. Do not freeze the specimen. The sample(s) must be transported on ice in an igloo to the National Public Health Laboratory (NPHL) within 48 hrs.

v  For samples that are scheduled to arrive after 4:30 p.m. Monday to Friday and on weekends, contact is to be made with the NPHL, via telephone (Tel. No.: 967-2234).  

v  Samples are NOT to be sent to any private laboratories or directly to the University Hospital of the West Indies Laboratory.

v  Private practitioners should contact the Parish Medical Officer (Health) at the relevant Parish Health Departments for transportation of samples.

v  The Medical Officer (Health) must ensure that Class 1 Notification Forms and updated Line Listing Forms are forwarded to the Regional Health Authorities and the National Surveillance Unit, on a daily basis. In addition, follow-up on the dispatch of samples, receipt of results and in-patient management and outcome is also to be ensured.

v  The Regional Technical Director, in collaboration with the Regional Medical Epidemiologist, must ensure that the Class 1 Notification Forms and the Updated Line Listing Forms are forwarded to the National Surveillance Unit, on a daily basis. In addition, follow-up on the dispatch of samples, receipt of results and in-patient management and outcome is also to be ensured.

For further information, please contact the National Surveillance Unit, Ministry of Health.

 Telephone numbers: 924-9668 or 967-1110 / 1101 / 1103 / 1105 / 1107 / 1109.

Jnr Surgery

Handout from Medical Diseases in the Surgical Patient

http://www.mediafire.com/?qzbry7yegu0n6t6



Timetable for specialist lectures also available

http://www.mediafire.com/view/?6pmbjb3l4qg98gh