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Learning objectives - Medicine 2
By the end of this module you should be able to:
Year 3
CNS - Seizures; Syncope; CVA; Headache; Altered Mental State
1) Be competent in the indications/contra-indications of lumbar puncture [including
specific conditions – i.e. SAH] and the interpretation of results
2) Have a detailed understanding of neuro-anatomy as pertaining to stroke localisation [i.e.
middle cerebral artery]
3) Be confident in CT head interpretation for significant intra-cranial pathology – i.e. ICH;
raised ICP; SAH; space occupying lesions. Have the ability to communicate pathology
using appropriate terminology over the phone to signify urgency
3) Understand the indications for the use of specific medications [anti-microbials &
steroids] in the treatment of meningo-encephalitis
4) Have a broad differential diagnosis for peripheral neuropathy; lower limb weakness &
less common neurological conditions – Parkinsons disease; Gullian barre; MS
Renal & Infectious Diseases
1) Develop a holistic approach to the management of patients with chronic renal failure
including development of ceilings of care
2) Review therapeutic guidelines for appropriate management of specific infective
conditions [and compare with currently available treatment in FIJI]
3) Review current available literature on the approach of early goal directed therapy and
targets for management including fluid resuscitation
Haematology, Oncology & Immunology
1) Review current literature regarding indications for transfusion in correlation with
patient co-morbidities
2) Review the basic pathology underlying haematological malignancies and the way in
which they can present to the ED – pancytopenia; overwhelming sepsis; tumour lysis
syndrome; DIC
Toxicology – General Approach
1) Understand the specific drug indications for decontamination options; enhanced
elimination & antidote administration & how to administer them
2) Review the management of cardiac arrest due to toxic exposure/ingestion
Toxicology – Specific agents (most high-yield but not an exclusive list)
Be confident in the risk assessment & management of following agents:
1) Herbicides/Pesticides readily available in Fiji – Paraquat, glycophosate,
organophosphates
2) Cardiovascular drugs – Calcium channel & B-blocking agents; Na+ channel blockade
(TCA’s; Propranolol; Carbamazepine; Local anaesthetics); Digoxin
3) Altered CNS – benzodiazepines; barbiturates; toxic alcohols; oral hypogylcemics
4) Other: Paracetamol
Year 2
CNS - Seizures; Syncope; CVA; Headache; Altered Mental State
1) Understand the management of patient presenting with “First Seizure”
2) Have an approach to management of patient in status epilepticus, including; intubation,
seizure control & monitoring for complications
3) Risk assessment in patients presenting with syncope including clinical gestalt and clinical
decision rules [i.e. San-Francisco syncope rule]
4) Management of patient with syncope considering cause, condition & complications associated
with collapse
5) Be competent in assessment & management of both haemorrhagic & ischemic infarct
6) Review of neuro-anatomy and identification of haemorrhagic stroke on CT scan
7) Have an approach to diagnosis and management of headache/facial pain – including exclusion
of life-threatening causes (SAH/ICH; Encephalitis/Meningitis; Raised ICH)
8) Have an approach to diagnosis and management of patient with an altered mental state
Renal & Infectious Diseases
1) Diagnosis and management of UTI/pyelonephritis – including validity of urine dip-stick
versus laboratory microscopy and indications for admission
2) Diagnosis and management of acute renal failure including complications
3) Be confident in the Indications for emergent dialysis & treatment of hyperkalaemia
4) Understanding of potential complications of haemodialysis treatment including hypotension;
electrolyte abnormalities
5) Understanding and management of complications from chronic renal failure (uremic
encephalopathy, pericardial effusion; gastritis; non-specific complaints)
6) Have an approach to the assessment of acutely febrile patient including recognition of high
risk patients [i.e. immunocompromised]
7) Review the common infectious diseases, diagnosis & management i.e. leptospirosis; dengue &
typhoid
8) Understand the principles of early goal directed therapy in sepsis
Haematology, Oncology & Immunology
1) Have an approach to diagnosis/investigations for anaemia & thrombocytopenia
2) Recognise the indications & potential complications of blood transfusion
3) Review the diagnosis and management of acute anaphylaxis
4) Review the guidelines on the diagnosis and management of acute rheumatic fever
Toxicology – General Approach
1) Have an approach for risk assessment and prediction of toxicity in overdose
2) Understand additional treatment options are available for some drugs including
decontamination options; enhanced elimination and the use of antidotes
3) Be able to recognise and manage acute toxidromes
4) Review ECG changes associated with some toxicological agents
5) Be aware of specific drugs that have risk of causing; severe toxicity at low dose (i.e. one pill
can kill); hypoglycaemia; severe life-threatening acidosis/cardiac arrhythmias or extreme
obtundation
Toxicology – Specific Agents (most high-yield but not an exclusive list)
Be aware of the toxic effects & management of following agents:
1) Herbicides/Pesticides readily available in Fiji – Paraquat, glycophosate, organophosphates
2) Cardiovascular drugs – Calcium channel & B-blocking agents; Na+ channel blockade (TCA’s;
Propranolol; Carbemazepine; Local anaesthetics); Digoxin
3) Altered CNS – benzodiazepines; barbiturates; toxic alcohols; oral hypogylcemics
4) Other: Paracetamol