Download Faculty of Medicine

Faculty of Medicine
King Abdulaziz University
DEPARTMENT OF MEDICINE
6th YEAR STUDY GUIDE
1
TABLE OF CONTENTS
Topic
Page
THE OUTCOMES OF THE UNDERGRADUATE CURRICULUM
CURRICULUM MAP
STRUCTURE OF 6TH YEAR – INTERNAL MEDICINE
INTRODUCTION
AIMS & OBJECTIVES
TEACHERS CONTACTS
ASSESSMENT
ICONS
TOPIC OUTLINES
2
OUTCOMES OF THE 6TH YEAR MEDICAL CURRICULUM
1) Knowledge
The main purposes of the clinical course in the 6th year are as follows:
1. Students develop the ability to take and report a full history
2. Acquire skills in performing a complete physical examination
3. Discuss cases at bed side teaching / clinical rounds to emphasize
pathophysiology of symptoms and signs.
4. Students should be familiar with the usual instruments in clinical
practice; i.e. stethoscope, sphygmomanometer, reflex hammer,
ophthalmoscope, etc.
5. Students should be familiar with x-rays, pathology jars, slides and
instruments
6. Students develops the ability to outline management
2) Skills
1. Clerk all patients of the firm to which they are attached and follow the progress of
these patients and be able to manage them and are expected to present these
patients to the consultant during clinical rounds.
2. Participate in the discussion of one or more cases. The cases discussed should
be looked up in the recommended or any other appropriate textbooks
3. Be prepared to present a case of a clerked patient during any teaching round
3) Other Activities
The clinical teaching sessions are run 5 days a week from Saturday to
Wednesday. During the 5 days, the 6th year student should always be available in
the medical ward from 8:00 - 5:00, except for lecture time. Timetable for their
activities such as: clinic rotation, rounds, tutorials is provided.
No. of Days per Week:
5 days teaching with academic staff
1 tutorial session or bedside clinical sessions
3 rounds with consultants
6 clinics to attend
No. of week per posting:
8 weeks
Attendance during all sessions (clerking and teaching rounds) is mandatory.
Any missed session will result in one mark deduction. Students who are absent
more than 10% of the sessions are not illegible to sit for final exam.
Attendance card should be signed by the teacher at each session. Teachers
should reschedule missed sessions if any.
3
4) Attitude
Student should have the attitude of
a. Respect for every human being and abide by relevant Islamic
ethics
b. A desire to ease pain and suffering
c. Willingness to work in a team with other health professionals
d. Responsibility to remain a life-long learner and maintain the
highest ethical and professional standards
e. Referring patients to other health professional when needed
f. A realization that it is not always in the interest of patients to
pursue every diagnostic or therapeutic possibility
4
CURRICULUM MAP
LECTURES:
Content Titles
1.
Cardiovascular System
2.
Respiratory System
3.
Gastroenterology (GIT)
4.
Neurology
5.
Endocrinology
6.
Infectious Diseases
7.
Nephrology
8.
Dermatology
9.
Haematology
No. of Lecture
5
LECTURES (TITLES)
A. General Medicine Lectures' Title:
1.
Curriculum for 6th Year
2.
Allergic Emergencies
3.
Vasculitides
4.
Scleroderma + Dermatomyositis
5.
Atrial arrythmia
6.
Ventricular Arrythmia + Heart Block
7.
Acute Poisoning
8.
Pyrexia of Unknown Origin
9.
Infections in the Immunocompromised
10.
Management of Diabetes Mellitus and Its Complications
11.
Gastrointestinal (GI) Tumours
12.
Management of Thyroid Disorders
13.
Management of Chronic Hepatitis
14.
Disturbances of Acid-Based Balance
15.
Endocrine Emergencies
16.
Motor Neuron Disease and Multiple Sclerosis
17.
Myopathy and Muscular Dystrophies
18.
Neuro-Muscular Disorders
19.
Parathyroid Disorders
20.
Osteoporosis and Osteomalacia
21.
Respiratory Failure
22.
Interstitial Lung Disease and Bronchiectasis
23.
Leukemias
24.
Approach to Unconscious Patients
25.
Thrombophilia & Hypercoagulable State
26.
AIDS
27.
Transfusion Medicine
B. Dermatology Lectures' Title:
1.
2.
3.
4.
5.
Introduction and definition
Mycology
Papulosquamous skin diseases
Bullous dermatosis
Andrology I and II
6
B. Others
CLINICAL TEACHING AND CLINICAL ROUNDS:
Students are distributed in small sub-groups with various
consultant firms. Clinical teaching is conducted by an academic staff
member. The students are also expected to be fully integrated with
these firms, clerking patients and presenting them on scheduled rounds
to the consultants in the firm. They are also expected to divide the
patients of the firm they are attending with amongst themselves and
each student is expected to fully clerk and follow-up patient's progress
and records it in the patient's file. They are supervised by the
concerned consultant as well as residents attached to the firm.
TUTORIALS:
Students are taught on specific interesting case of patients for 1
hour, at least, once very week by a consultant in the firm they are
attached to.
CLINIC ROTATION:
Students are required to attend at least 6 clinics during the 8
weeks rotations.
7
STRUCTURE OF 6TH YEAR INTERNAL MEDICINE
8
INTRODUCTION
Students should continue during this year what they have started
in 4th and 5th years with their lectures, the tutorials and clinical bedside
teaching. The lecturers, due to the limitation of allocated time, will put
emphasis on certain parts of the topic.
However, the students are
urged to study on their own to cover the whole subject. This will be
achieved through reading from the reference books chosen by the
Department.
Lecturers will also provide the students, whenever
needed, with further readings. During the clinical teaching, the 6th year
students should master the physical exam of the normal systems and
start to acquire knowledge and skills about their diseases and
subsequent physical changes and order important investigations and be
able to manage the patient safely. Male and female students are taught
separately in small sub-groups.
 Student needs:
Lectures
Clinical teaching session including clerking and teaching
rounds
9
AIMS & OBJECTIVES
On completion of the course, the 6th year students will be able
to:
1. Understand the lectures’ content and answer properly the
2.
3.
4.
5.
6.
related questions.
Take proper history from the patient.
Elicit all physical signs of organs in their normal state.
Elicit major physical signs of various systems in their
disease state (e.g., changes of vital signs, organomegaly,
etc…)
Interpret physical signs, order appropriate investigations
and suggest a diagnosis.
Have a minimal knowledge of management of various
diseases
10
TEACHERS CONTACTS
NAME/STATUS
PHONE #
E-mail
Male Section
1. Prof. Hassan Fatani, Professor
2. Prof. Mohd Kassimi, Professor
3. Dr. Abdullah Al-Fares, Assistant
4. Prof. Siraj Mira, Associate Professor
5. Prof. Mohamad Al-Hadramy, Professor
6. Dr. Hussein Malibary Assistant Professor
7. Prof. Tarif Zawawi, Professor
8. Prof. Khalid Marzouki, Professor
9. Dr. Sami Hamdi, Associate Professor
10. Dr. Sameer Zimmo, Associate Professor
11. Dr. Adil Khazindar, Assistant Professor
12. Dr. Saad Al-Shohaib, Associate Professor
13. Dr. Omer Al-Amoudi, Associate Professor
14. Prof. Mahmoud Al-Ahwal, Professor
15. Dr. Hisham Akbar, Associate Professor
16. Dr. Nabil Al-Ama, Assistant Professor
17. Dr. Yousif Qari, Assistant Professor
18. Dr. Omar Fathaldin, Assistant Professor
19. Dr. Emad Koshak, Associate Professor
20. Dr. Saeed Al-Ghamdi, Associate Professor
21. Dr. Tariq Madani, Associate Professor
22. Dr. Turki Al Turki, Assistant Professor
23. Dr. Sami Bahlas
24. Dr. Abdulraheem Al-Shehri
640-8245
640-8273
640-8344
640.8279
640-8278
640-8280
640-8277
640-8276
640-8249
640-8251
640-8257
640-8247
640-8246
640-8253
640-8266
640-8258
640-8477
640-8274
640-8261
640-8248
640-8348
640-8265
Female Section
1. Dr. Aisha Siddiqui, Associate Professor
2. Dr. Abeer Kawthar, Assistant Professor
3. Dr. Faiza Qari, Associate Professor
4. Prof. Daad Akbar, Professor
5. Dr. Aisha Al-Ghamdi, Associate Professor
6. Dr. Nawal Al-Ghamdi, Assistant Professor
7. Dr. Suzan Attar, Assistant Professor
8. Dr. Maimoona Mushtaq, Consultant Physician
9. Dr. Hind Fallatah, Consultant Physician/Gastroenterologist
10. Dr. Fatma Al-Beladi, Consultant Physician/Nephrologist
640-8380
640-8378
640-8371
640-8374
640-8260
640-8383
640-8235
640-8367
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ASSESSMENT
TYPE OF EXAMS:
a) End of Posting Exam
b) Final exam
50 %
100 % (50 % for Written + 50 % Clinical Exam)
End of Posting Exam comprising of:
Written Exam:


40 Multiple Choice Questions (MCQ) = 20 %
1 Problems solving
= 5%
1 Data Interpretation
= 5%
Practical Exam:2 Short Cases for the Clinical Exam = 20 %
Final exam comprising of:
Written Exam:


80 Multiple Choice Questions (MCQ) = 40 %
2 Problems solving
= 5%
2 Data Interpretation
= 5%
Practical Exam:

1 Long Case
2 Short Cases
= 25 %
= 25 %
12
Icons (standards)
The following icons have been used to help you identify the various
experiences you will be exposed to.
Learning objectives
Content of the lecture
Independent learning from textbooks
Independent learning from the CD-ROM.
The computer cluster is in the 2nd floor of the medical library,
building No. 7.
Independent learning from the Internet
Problem-Based Learning
Self- Assessment (the answer to self-assessment exercises
will be discussed in tutorial sessions)
The main concepts
13
LECTURE / TOPIC OUTLINES
Lecture 1: Curriculum for 6th Year
Student Notes:
Lecturer:
.
Dr. Abdulrahman Al-Shaikh
At the end of the lecture you should be able to:
1.
2.
3.
catch the importance of the
clinical science with medical
practice
know what are the components of
the curriculum
prepare him/her self for looking
for clinical knowledge and skills
Content:
1.
2.
3.
briefing about the lectures
briefing about the clinical sessions
including the clerking, teaching rounds,
tutorials and clinical attendance
introduction of the exam system with its
various types: i.e.
- MCQ
- Short Notes
- Assay
- Data Interpretation
- Problem Solving
- Clinical Exams
14
Lecture 2: Allergic Emergencies
Student Notes:
Lecturer:
Dr. Emad Koshak
At the end of the lecture you should be able to:
1. Diagnose and manage acute allergic
reactions – anaphylaxis.
Content:
1. Definition
2. Classification:
- IgE mediated
- Complement mediated
- Direct mast cell
- Exercise induced
- Idiopathic
3. Clinical Findings
4. Differential Diagnosis
5. Treatment:
- Acute
- Long term – resensitization
15
Lecture 3: Vasculitides
Student Notes:
Lecturer:
Dr. Sami Bahlas
At the end of the lecture you should be able to:
Content:
1. Classification – discuss each in details)
- Large and medium arteries
- Medium arteries or small vessels
- Small vessels
2. Etiology
3. Clinical Features:
- Constitution symptoms
- Heart and lungs
- Joint
- Eyes
- Skin
- Neurology
- Kidney
- GIT
16
Lecture 4: Scleroderma + Dermatomyositis
Student Notes:
Lecturer:
Dr. Omar Fathaldin
At the end of the lecture you should be able to:
Content:
A.
A.
B.
C.
D.
E.
A. SCLERODERMA:
1. Epidemiology:
- Prevalence
- Age
- Sex
- Race
- Genetics
2. Disease Mechanism
3. Pathology
4. Systemic Sclerosis Syndromes:
- Raynauds Phenomenal
- Localized Scleroderma
- Localized cutaneous Systemic
Sclerosis
- Diffuse cutaneous
Systemic Sclerosis
5. Clinical Features:
6. Diagnosis
7. Investigations
8. Differential Diagnosis of Raynauds
9. Management
10. Prognosis
B. DERMATOMYOSITIS/POLYMYOSITIS
1. Epidemiology:
- Incidence
- Age
- Sex
- Race
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Lecture 4: Scleroderma + Dermatomyositis
Student Notes:
Lecturer:
Dr. Omar Fathaldin
At the end of the lecture you should be able to:
Content: (continuation)
B. DERMATOMYOSITIS / POLYMYOSITIS
2. Disease Mechanism
3. Pathology
4. Clinical Features
- Features of Primary of polymyositis
- Features of Secondary dermatomyositis
5. Primary Mechanism / Disease Mechanism
associated with autoimmune disease
6. Primary Mechanism / Disease Mechanism
Associated with malignancies
7. Childhood onset dermatomyositis
8. Diagnosis
9. Investigations
10. Management
11. Prognosis
18
Lecture 5: Atrial Arrhythmia
Student Notes:
Lecturer:
Dr. Abdullah Al Fares
At the end of the lecture you should be able to:
1. understand the physiology of arrhythmias
2. recognize important arrhythmias on ECG traces
3. treat important ventricular arrhythmias
4. understand the clinical aspect of cardiac arrest and its
causes
Content:
1.
2.
3.
4.
Causes
ECG Finding
Complications
Treatment:
- anti-arrhythmic drugs
- anti-coagulations
- ablation
- treatment underlying disease
19
Lecture 6: Ventricular Arrhythmia + Heart Block
Student Notes:
Lecturer:
Dr. Nabil Al Ama
At the end of the lecture you should be able to:
1. understand the pathophysiology of
arrhythmia
2. understand the aetiology of arrhythmia
3. understand the ECG changes in arrhythmia
Content:
A. Ventricular Arrhythmia:
1. Definition:
- Narrow complex
- Wide complex
2. Causes
3. General Approach:
- Assessment of stability
- History
- Medication
- Physical examination
4. Investigation
- Evaluation of ECG
- Diagnostic criteria
5. Management:
- Unstable patient
- Stable patient
- Intra Cardiac Defibrillation (ICD)
B. Heart Block:
1. Types of Heart Block:
- 1st, 2nd and 3rd degree
2. Causes
3. Symptoms
4. ECG Findings
5. Treatment
20
Lecture 7: Acute Poisoning and Antidotes
Student Notes:
Lecturer:
At the end of the lecture you should be able to:
Content:
21
Lecture 8: Pyrexia of Unknown Origin
(PUO)
Student Notes:
Lecturer:
Prof. Tarif H. Zawawi
At the end of the lecture you should be able to:
The students should be able to have an objective
analytical approach to a patient with fever of
unknown origin and should develop the ability to
systematically reach a final cause of the fever
starting from the most common causes to the most
rare and unusual causes.
Content:
1.
2.
3.
4.
5.
6.
Definition
Causes
Clinical Features
Investigations
Treatment
Prognosis
22
Lecture 9: Infections in the Immunocompromised
Student Notes:
Lecturer:
Dr. Tariq Madani
At the end of the lecture you should be able to:
1. evaluate clinically the state of
immunocompromisation
2. know various causes of immunosuppression
3. diagnose the state of immunosuppression
4. understand how to deal with an
immonocompromised patient
5. treat common infections that affect an
immunocompromised patient
Content:
1. Definition
2. Mechanisms of Host Defense
3. Importance of Host Defense
4. Causes of Immune Defects
5. Diagnosis: Clinical Findings
Laboratory Investigations
Radiological Investigations
6. Complications of severe sepsis
7. Definition and stages of SIRS (Systemic
Inflammatory Response Syndrome)
8. Therapy: General and Supportive
Antibiotics regimens
23
Lecture 10: Management of DM and Its Complications
Student Notes:
Lecturer:
Dr. Abdulrahman Al Shaikh
At the end of the lecture you should be able to:
1. To clarify main management
2. Plans for IDDM and NIDDM
Content:
A. ACUTE COMPLICATIONS:
1. Hypoglycemia:
- Causes
- Diagnosis
- Clinical Features
- Treatment
2. Diabetic Keto Acidosis (DKA)
- Precipitating factors
- Clinical Examination
- Investigation
- Treatment
3. Hyperosmolar Non-ketotic coma
- Precipitating factors
- Clinical Features
- Investigations
- Treatment
4. Lactic acidosis
B. CHRONIC COMPLICATIONS
1. Macrovascular:
- Stroke
- MI
- Peripheral Vascular Disease
- Foot Problem
24
Lecture 10: Management of DM and Its Complications
Student Notes:
Lecturer:
Dr. Abdulrahman Al Shaikh
Content: (continuation)
B. CHRONIC COMPLICATIONS
2. Microvascular:
- Retinopathy
- Nephropathy
- Neuropathy
- Foot Problems
C. MANAGEMENT OF CHRONIC
COMPLICATION:
- Education
- Diet
- Monitoring glucose control
- Exercise
- ASA
- Control of Lipids
- Annual fundus examination
25
Lecture 11: Gastrointestinal (GI) Tumours
Student Notes:
Lecturer:
Dr. Abdullah Al Fares
At the end of the lecture you should be able to:
1.
2.
3.
understand the epidemiology and clinical importance
of HCC in Saudi Arabia and world wide as well as the
factors associated with the geographical spread of
this disease
diagnose and treat HCC according to recent
developments
understand the principles involved in the follow up of
patients with chronic liver disease
Content:
1. Barrets Oesophagus:
- Disease Mechanism
- Epidemiology
- Clinical + Causes
- Investigations
- Management
- Prognosis
2. Ca Oesophagus:
- Type of cancer: Squamous adeno carcinoma
- Pathology
- Epidemiology
- Clinical Features
- Investigation
- Management
- Prognosis
3. Gastric Carcinoma:
- Causes
- Pathology + Lymphoma
- Epidemiology:
- Age
- Sex
- Prevalence
- Clinical Features
- Investigations
- Management
- Prognosis
26
Lecture 11: Gastrointestinal (GI) Tumours
Student Notes:
Lecturer:
Dr. Abdullah Al Fares
Content (continuation):
4. Colonic Tumour:
- Adenomas
- Predisposing disorders:
- Adenomatous polyps
- Familial poly____
- Extensive ulcerative colitis
- Extensive Crohn's disease
- 1st degree relative
- Diet
- Investigation
- Stages
- Clinical Features
- Differential Diagnosis
- Management
- Prevention
- Screening for colorectal cancers
5. Zollinger Ellison Syndrome:
- Disease mechanism
- Clinical Features
- Investigation
- Management
6. Carcinoid Syndrome:
- Disease mechanism
- Epidemiology
- Clinical features
- Differential Diagnosis
- Investigation
- Management
27
Lecture 12:
Lecturer:
Management of Thyroid Disorders
Prof. Tarif Zawawi and
Dr. Faiza Qari
Student Notes:
At the end of the lecture you should be able to:
1. To clarify main management lines for
Thyroid Disorders including hypo and
hyperthyroidism and thyroid goiter and
nodules
Content:
1. Hypothyroid:
- Types:
- Primary Hypothyroidism
- Secondary Hypothyroidism
- Causes of both primary and secondary
- Clinical Features
- Investigations
- Treatment
- Myxoedema coma:
- Causes
- Clinical Features
- Investigation
- Management
2. Hyperthyroidism:
- Causes
- Clinical Features
- Investigation
- Treatment
- Thyrotoxic crises:
- Clinical Features
- Investigation
- Management
3. Goitre:
- Simple goitre
- Toxic goitre
- MNG
- Endocrine
28
Lecture 12:
Management of Thyroid Disorders
Student Notes:
Lecturer:
Prof. Tarif Zawawi and
Dr. Faiza Qari
Content: (continuation)
4. Thyroid Malignancies:
- Types:
- Follicular
- Medullary carcinoma
- Papillar
- Anapla__
- Causes
- Clinical Features
- Investigations
- Treatment
29
Lecture 13:
Management of Chronic Hepatitis
Student Notes:
Lecturer: Dr. Hisham Akbar and
Dr. Hind Fallatah
At the end of the lecture you should be able to:
Content:
1. Causes
2. Clinical Features
3. Investigation
4. Complication
5. Management of underlying disease
30
Lecture 14:
Disturbances of Acid-Based Balance
Student Notes:
Lecturer:
Dr. Saad Shohaib
At the end of the lecture you should be able to:
1. know the physiology and regulation of acid base
status
2. know how to approach patient with acidosis
3. know how to approach patients with alkaline??
4. know how to interpret ABGs
Content:
1.
2.
3.
4.
Respiratory effects on acid-based balance
Metabollic effects on acid-based balance
Regulation of plasma patients
Respiratory acidosis + alkalosis
(causes of each)
5. Angiograph:
- Types of angiograph
- Calculation
6. Management of each disturbance
31
Lecture 15:
Endocrine Emergencies
Student Notes:
Lecturer:
Prof. Mohamad Hadramy
At the end of the lecture you should be able to:
Content:
1. Myxoedema coma:
- Epidemiology
- Clinical Features
- Investigations
- Treatment
2. Thyrotoxic crises:
- Disease mechanism
- Clinical Features
- Investigation
- Treatment
3. Adrenal crises:
- Causes
- Clinical Features
- Investigation
- Treatment
- Long-term management
32
Lecture 16:
Motor Neuron Disease & Multiple Sclerosis
Student Notes:
Lecturer:
Dr. Hussein Malibary and
Dr. Aisha Al Shareef
At the end of the lecture you should be able to:
Motor Neuron Disease
1. recognize the clinical features as regards to the
combination of lower and upper motor
neuron lesion
2. recognize the types of motor neuron disease
and age of onset
3. catch the importance of EMG in the diagnosis
4. outline the treatment which is mainly supportive
Content:
1. Prevalence
2. Age
3. Disease Mechanism
4. Clinical Features:
- Limb weakness
- Bulbar involvement
- Respiratory involvement
- UMN Symptoms
- LMN Symptoms
5. Diagnostic Criteria
6. Investigations
7. Treatment
33
Lecture 16:
Lecturer:
Motor Neuron Disease & Multiple Sclerosis
Dr. Hussein Malibary and
Student Notes:
Dr. Aisha Al Shareef
At the end of the lecture you should be able to:
Multiple Sclerosis





know the pathophysiology of multiple sclerosis
and especially the format on plaques in the
nervous system
recognize the multiplicity of the clinical features
related to the multiple location of the plaques
know the classification of various types of
multiple sclerosis
choose the appropriate diagnostic tools
outline the treatment modalities including the
Beta-interferon therapy
Content:
1. Epidemiology: Age, Sex, Race, and Genetics
2. Disease Mechanism
3. Clinical Features:
- Optic Neuritis
- Intra Nuclear Ophthalmoplegic
- Sensory symptoms
- Motor symptoms
- Cerebellar
- Brain steam and spinal cord
Involvement
4. Disease pattern:
- Relapsing remitting
- Secondary progressive
- Primary progressive
- Progressive relapsing
5. Prognostic Factors
6. Diagnosis
7. Management
34
Lecture 17:
Lecturer:
Neuro-Muscular Disorders + Myopathies
Dr. Hussein Malibary
Student Notes:
At the end of the lecture you should be able to:




know the basic anatomy and physiology of
the neuromuscular junction
recognize the various types of
neuromuscular disorders
understand the clinical features of
myasthenia gravis how to examine properly
and the treatment modalities
catch the importance of the neurophysiology
in the diagnosis of nueromuscular junction
disorders
Content:
A. Myopathies
1. Inflammatory Neuropathies:
- Dermatomyositis / Polymyositis
- Drug induced myopathies
2. Infectious Myopathies:
- Viral
- Bacteria
- Myoco bacterial
3. Muscular Dystrophy:
- Duchennes Muscular Dystrophies
- Beckers
- Links girdle
- ___ scapulae
4. Metabolic myopathies:
- Hypothyroid
- Hyperthyroid
- Cushings
- Acromegaly
5. Endocrine myopathy
- Diabetes Mellitus
35
Lecture 17:
Neuro-Muscular Disorders + Myopathies
Student Notes:
Lecturer:
Dr. Hussein Malibary
Content: (continuation)
Investigation:
- EMG
- Muscle biopsy
- Muscle Enzymes
B. Diseases of the Nerves:
- Polyneuropathy
- Guillen Barre' Syndrome:
- Clinical Features
- Investigations
- Differential Diagnosis
- Treatment
- Variation of the:
Guillen Barre' Syndrome
Miller Fishers Syndrome
C. Disease of Neuromuscular Junction
1. Myasthenia Gravis:
- Clinical Features – presenting symptoms
Occular muscles
Facial muscles
Bulbar muscles
Respiratory muscles
- Pathogenesis
- Clinical Course
- Diagnosis: Tens__ test
EMG
Chest x-ray, CT chest
- Differential Diagnosis
- Treatment
2. Amyotrophic lateral sclerosis
- Risk factors
- Pathology
36
Lecture 17:
Neuro-Muscular Disorders + Myopathies
Student Notes:
Lecturer:
Dr. Hussein Malibary
Content: (continuation)
- Clinical features:
- UMN lesion
- LMN lesion
- Autonomic symptoms
- Clinical patterns of progression
- Bulbar muscle weakness
- Progressive neuromuscular respiratory failure
- Diagnosis
- Symptoms based management
3. Eaton Lambert Myasthenic Syndrome
37
Lecture 18: Myopathy and Muscular Dystrophies
Student Notes:
Lecturer:
Dr. Hussein Malibary
At the end of the lecture you should be able to:






know the basic anatomy and physiology of the
muscles
properly examine each muscle or muscle
group for each joint movement
differentiate between the hereditary forms
(dystrophy) and the acquired ones (myopathy)
recognize the specific feature of each common
muscle disease
choose the appropriate diagnostic test
outline the basic management
Content:
38
Lecture 19:
Lecturer:
Parathyroid Disorders
Dr. Faiza Qari and
Dr. Khalid Al Shali
Student Notes:
At the end of the lecture you should be able to:
1.
2.
3.
4.
appreciate the pathogenesis of hypo and
hyperparathyroidism
recognize the clinical manifestations of both
conditions
differentiate them from conditions with
similar presentation
draw a practical management plan for a
patient suffering from either of the two
conditions including investigations and
treatment
Content:
A. Primary Parathyroidism
1. Anatomy of parathyroid gland
2. Parathyroid Hormone and its function
3. Clinical Manifestation:
- Asymptomatic – asymptomatic
hypercalcemia
- Routine evaluation for Osteopenia,
Osteoporosis and Renal stones.
- Symptomatic:
- Osteitis fibrosa cystic
- BMD
- Fractures
- Renal Stones
- Neuromuscular manifestations
- Neuropsychiatric
- Increase Blood Pressure
- GIT manifestations.
4. Investigations
5. Treatment
B. Causes of 2nd and 3rd hyperparathyroid
C. Parathyroid adenoma and carcinoma
39
Lecture 19:
Lecturer:
Parathyroid Disorders
Dr. Faiza Qari and
Dr. Khalid Al Shali
Student Notes:
Content: (continuation)
D. Clinical manifestations and diagnosis of men
I, II, IIA and IIB.
E. Hypoparathyroidism
Hypocalcemic disorders caused by
hypoparathyroidism or parathyroid hormone
resistance.
Idiopathic hypoparathyroidism
Digeorge's syndrome
Pseudohypoparathyroidism
Pseudo pseudohypoparathyroidism
Hypomagnesemia
F. Management and Investigation of
Hypocalcemia.
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Lecture 20: Osteoporosis and Osteomalacia
Lecturer:
Prof. Mohammad Al Hadramy and
Prof. Daad Akbar
Student Notes:
At the end of the lecture you should be able to:
1. be able to appreciate the pathogenesis of
oesteoporosis and osteomalacia
2. be able to recognize the clinical features of
osteoporosis and osteomalacia
3. be able to differentiate osteoporosis and
osteomalacia from conditions with similar
presentation
4. be able to draw a practical management plan
for a patient suffering from osteoporosis or
osteomalacia including investigations and
treatment
5. understand the importance of osteoporosis
and osteomalacia and should be able to
define it.
6. have a clear idea about the physiology of
bone remodeling.
7. know the list of the risk factors of
osteoporosis and osteomalacia.
8. be able to describe the different causes of
the disease.
9. know the clinical presentation of
osteoporosis and osteomalacia.
10. be able to diagnose osteoporosis and
osteomalacia
11. know in detail the different lines of
prevention and treatment of osteoporosis
and osteomalacia (to know the doses, side
effects and precautions of different
medications)
Content:
A. Osteomalacia
- Epidemiology: Age, Sex, Race
- Disease Mechanism
- Etiology
- Clinical Features
- Diagnosis
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Lecture 20: Osteoporosis and Osteomalacia
Student Notes:
Lecturer:
Prof. Mohammad Al Hadramy and
Prof. Daad Akbar
Content: (continuation)
A. Osteomalacia
- Differential Diagnosis
- Investigation
- Treatment
B. Osteoporosis
- Epidemiology: Age, Sex, Race
- Causes
- Clinical Features
- Diagnosis
- Differential Diagnosis
- Investigation
- Treatment
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Lecture 21:
Respiratory Failure
Student Notes:
Lecturer:
Dr. Omer Alamoudi
At the end of the lecture you should be able to:



know what is respiratory failure
know the common causes and mode of
presentation
know how to diagnose and manage different
types of respiratory failure
Content:
1. Types I & II
2. Causes : hypoxia without hypercapnia
hypoxia with hypercapnia
3. Clinical Features
4. Investigation
5. Long Term home oxygen therapy
6. Prognosis
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Lecture 22:
Lecturer:
Interstitial Lung Disease and Bronchiectasis
Dr. Omer Alamoudi
Student Notes:
At the end of the lecture you should be able
to:
1. know how to approach patients with
pulmonary fibrosis
2. know how to make proper investigations
3. know how to outline the current therapies
available
Content:
A. Interstitial Lung Disease
1. Definition or Introduction
2. Underlying causes – RA, IPF etc
3. Clinical presentation
- History: - Age
- Gender
- Smoking history
- Duration of illness
- Prior medication use
- Occupational history
- Environmental exposure
- Symptoms
- Examination
- Investigation
- Treatment
B. Bronchiectasis
1. Definition
2. Etiology:
- Airway obstruction
- Hypojama globulinemia
- Childhood Infections
- Cystic Fibrosis
- Young's syndrome
- Karlagners syndrome
- Rheumatic disease
- Allergic broncho
- Pulmonary aspergillosis
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Lecture 22:
Lecturer:
Interstitial Lung Disease and Bronchiectasis
Dr. Omer Alamoudi
Student Notes:
4.
Content: (continuation)
B. Bronchiectasis
3. Clinical Features
4. Diagnosis (investigation)
5. Management
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Lecture 23:
Lecturer:
Leukemias
Dr. Basem Beiruti
Student Notes:
At the end of the lecture you should be able
to:
1. understand the concept of monoclonal
proliferation
2. identify the characteristic clinical features of
acute leukemias
3. request the appropriate tests required to rule
out or confirm this diagnosis
4. understand the concepts of management
including bone marrow transplant and
chemotherapy, etc.
5. differentiate between the sub types of
leukemias
Content:
A. Acute Leukemias
1. Classification
2. Diagnosis
3. Clinical Features
4. Investigations
Myeloproliferative disorders:
- CML
- Myelofibrosis
- Essential thrombocytosis
- Primary PRV
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Lecture 24:
Lecturer:
Approach to Unconscious Patients
Dr. Hussein Malibary
Student Notes:
At the end of the lecture you should be able
to:
Content:
A. Primary Survey
1. ABC
2. Measure blood glucose
3. Oxygen
4. IV access
5. Monitor ECG
6. Check for pupils, needle tracks
7. Consider naloxone if there is evidence of opiole
_____
8. Consider Flumazenial if Benzodiazepine
overdose is suspected
- Take History
B. Secondary Survey
1. Detailed clinical examinations, CNS and General.
Prionitonities in clinical exam:
- Glasgow Coma Scale
- Signs of brainstem dysfunction – mainly pupil
size
- Fundus exam
- Eye position
- Reflexes
- Kernig's Syndrome
Investigation:
Blood tests, EEG, CT-scan and Lipid Profile
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Lecture 25:
Lecturer:
Thrombophilia & Hypercoagulable State
Dr. Mohammed Qari and
Dr. Soheir Adam
Student Notes:
At the end of the lecture you should be able
to:
Content:
- Virchow's triad
- Inherited Thrombophilia
- Acquired Thrombophilia
- Diagnosis
- Clinical + Features
- Investigations
- Management
48
Lecture 26:
Acquired-Immune Deficiency Syndrome (AIDS)
Dr. Tariq Madani
Student Notes:
Lecturer:
At the end of the lecture you should be able
to:
1. to know about the various characteristics
2. to know the risk factors of disease transmission
3. to know the high risk growth
4. to know the clinical presentation of AIDS
5. to know the suspect presence of AIDS
6. to investigate the patients with HIV
7. Differential Diagnosis
8. to know how to treat and deal patients infected
with the disease.
Content:
-
Epidemiology, ________history and
etiology
Current trends in the epidemiology of
HIV / AIDS
Molecular inspection into HIV
infection
Natural history if
immunopathogenesis of HIV disease
Immunological testing
Laboratory evaluation
Management of opportunistic infections
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Lecture 27:
Lecturer:
Transfusion Medicine
Dr. Ghazi Damanhouri and
Dr. Salwa Hindawi
Student Notes:
At the end of the lecture you should be able
to:
Content:
50
Independent learning
“Independent learning is a very essential skill for tomorrow’s doctors. We
will train you to gain this important skill by asking you to read
independently about specific topics in medical diseases ”
51
PBL (Problem-Based Learning)

PBL process
 The clinical scenario

Key information
 Explore the problem
 What you know
 What you need to know
 Identify learning issues
 Self/group study
 Share the knowledge
 Solve the problem
 Give feedback & reflect
52
RECOMMENDED TEXTBOOKS
1.
2.
3.
4.
Davidson’s Principles of Internal Medicine
Concise Middle Eastern Clinical Medicine
Harrison’s Principles of Internal Medicine
Medicine by John Axford - First edition
RECOMMENDED WEBSITE
www.emedicine.com
www.medscape.com
TUTORS: DR. MAIMOONA MUSHTAQ /
DR. SAMI BAHLAS
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