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INTRODUCTION TO THE SCIENCE OF MEDICINE PBL CASES 2013

Learning Objectives for PBL Case: Sophie Babbitt


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the main body fluid compartments and indicate the relative fluid volume and solute concentration in each of the compartments. Discuss mechanisms for the disordered movement of water and solutes across the epithelium of the small intestine (use cholera as an example) List the components of a cell and describe the major functions of each. Discuss the mechanisms by which cells transport molecules across the plasma membrane. Define the determinants of blood pressure and explain the effect of low blood volume on blood pressure and the role of the baroreceptor reflexes in short term blood pressure homeostasis. Describe the importance of ionic sodium and chloride in fluid and electrolyte balance and indicate its relationship to normal cardiovascular functioning. Describe the gross structural features and main processes taking place in the kidney, and be able to draw a nephron. Briefly describe the factors that control fluid homeostasis in the body including the initiation of thirst, release of ADH and the role of the kidney. Define the term "reference range" and have an understanding of the inherent limitations of such a term. The Doctor and Health in the Community Primary learning objective(s) Explain the role of the public health unit in investigating disease outbreaks and the importance of clinician notification Discuss the importance of a travel history and how to access information about the epidemiology of diseases worldwide Understand the potential causes of traveller's diarrhoea and their implications Identify the quarantinable diseases

Learning Objectives for PBL Case: Justin Christopoulos


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the structure adult haemoglobin and define oxyhaemoglobin, methaemoglobin and carboxyhaemoglobin. Draw a typical O2- haemoglobin dissociation curve and show how the curve is altered by H+ and PCO2, temperature, 2,3 DPG and other factors Explain why binding of CO to haemoglobin reduces its O2 carrying capacity and alters average affinity for oxygen. Outline the gross structure of the respiratory system and differentiate between the conducting and respiratory zone structures. (a) Outline in general terms the basic regulatory mechanism through which the ventilation rate is influenced by arterial oxygen and carbon dioxide levels. (b) Describe the input from neural centres that results in the rhythm of breathing. Describe the interaction and relationship between carbon dioxide and oxygen loading and unloading in red blood cells. Describe the rationale for oxygen therapy used in the treatment of carbon monoxide poisoning. Briefly describe the process of glucose oxidation via glycolysis and the citric acid cycle with focus on the number of reducing equivalents produced at each step and final number of ATP produced. Describe the roles of oxygen and ADP to the functioning of the electron transport chain and briefly describe the metabolic pathway used by cells to generate ATP in the absence of oxygen. Schematically outline the Electron Transport Chain and describe in general terms the flow of electrons from reducing equivalents to oxygen, the production of ATP and the involvement of the chemiosmotic gradient. Compare the mechanism of action of uncouplers and inhibitors of the electron transport chain (use CO as an example of an inhibitor of ETC) The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Discuss the relationship between values and behaviour. Articulate the critical link between values (ethics), behaviour and the ethical importance of good communication. Discuss how personal values can be a source of ethical conflict in medical practice. Discuss the role of personal values in ethical decision making. The Doctor and Patient Primary learning objective(s) Describe and demonstrate the practice of 'mindfulness'. Discuss the barriers to effective listening. Demonstrate a preliminary understanding of strategies to facilitate active listening - to hear the patient's story. The Doctor and Health in the Community Primary learning objective(s) Explain the role of the medical practitioner in a workers compensation claim

Outline workers compensation and OH&S requirements.

Learning Objectives for PBL Case: Hannah Zanchetti


The Doctor, Knowledge of Health and Illness Primary learning objective(s) Briefly describe the process of gastrulation Briefly describe the process of neurulation Define the three mesodermal aggregates (somites, intermediate and lateral mesoderm) and their derivatives. Briefly describe the formation and role of the extraembryonic membranes. Briefly describe the development of the face; especially the role of the frontonasal process and relate to common craniofacial abnormalities such as cleft palate. Explain the underlying developmental abnormalities leading to neural tube defects. Explain the importance of dietary supplements such as folate for normal fetal development. Define teratogen and mutagen, list examples of each and describe how they lead to birth defects. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Outline the characteristics of "personhood" and apply them in a medical scenario (dementia, abortion, intellectual impairment). Describe and differentiate between, the prevalent theoretical ethical frameworks of Principlism, Virtue Ethics, Utilitarianism and Deontology and Phenomenology. The Doctor and Patient Primary learning objective(s) Demonstrate comfort with, and developing competence in, engaging with patients and approaching the discussion of health problems and personal stories. Demonstrate an interviewing style that is respectful, warm and engaged, through the application of communications principles such as: appropriate opening and closing of an interview establishing rapport; beginning with an open question active listening understanding of the effects of nonverbal communication a patient centred approach The Doctor and Health in the Community Primary learning objective(s) Briefly discuss tests used for screening and diagnosing developmental defects in pregnancy. Discuss the requirements of a successful screening program. Define and interpret sensitivity and specificity Describe the properties of screening tests as compared to diagnostic tests and understand their interpretation. Describe the risks of alcohol, smoking and recreational drugs on pregnancy.

Describe the classification system for drugs in pregnancy. Describe the elements of pre-pregnancy counselling.

Learning Objectives for PBL Case: Norman Cavendish


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the anatomy of the heart, including chambers, valves and coronary circulation. Name the components of the conducting system of the heart, trace the pathway of normal conduction through the heart and relate to a normal ECG. Briefly describe the physiological basis of normal heart sounds and list possible causes of murmurs. Describe the three layers that typically form the wall of a blood vessel, and state the function of each. Describe what constitutes normal blood pressure (BP) and the ranges that constitute hypotensive, normotensive and hypertensive. Briefly describe the pathophysiology of ischaemic heart disease including risk factors and complications. Explain the term autoregulation and its metabolic and myogenic controls. Briefly discuss the short and long term homeostatic mechanisms determining blood pressure. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Explain how international human rights law recognises a "right to health". Differentiate between a right to health and a right to health care and apply in the Australian context. Detail that human rights are characterised by a number of elements and apply these to the right to health. Explain what occurs should a party breach the right to health. Argue positions for and against introducing a right to health into Australian domestic law. Discuss the impact that a right to health may have in addressing inequities in health care. The Doctor and Patient Primary learning objective(s) Demonstrate a systematic and diagnostically-directed approach to enabling a patient to provide a clinical history, through an awareness of the process of clinical reasoning that it informs. Demonstrate competence in exploring a patient's experience of common symptoms including: the cardinal characterist ics of the symptom and its time course relevant associated symptoms the patient's understanding of, and concerns about, what they are experi encing The Doctor and Health in the Community Primary learning objective(s) Describe the risk factor model of causation of disease as the basis for disease prevention and health promotion. Discuss the differences between associated factors and causative factors in the aetiology of disease. Outline the role of the assessment of an individual patient's risk in the management and prevention of cardiovascular disease. Include the influence of lifestyle factors on hypertension.

Briefly discuss how data used to develop cardiovascular risk assessment tools and guidelines for prevention of cardiovascular events originate from epidemiological studies.

Learning Objectives for PBL Case: Felipe Romano and Marcela Garcia
At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the structural and functional divisions of the nervous system and describe the effects of the sympathetic and parasympathetic divisions on body systems. Compare the somatic and autonomic nervous systems relative to effectors, efferent pathways and neurotransmitters. Describe neurons in terms of important structural components and how each relates to neuronal function Define resting membrane potential and describe its electrochemical basis Compare and contrast graded and action potentials and describe how action potentials are generated and propagated along neurons. Describe the factors that affect nerve conduction velocity, compare continuous and saltatory conduction and describe the formation and importance of the myelin sheath. Define adrenergic and cholinergic fibres, list their different types of receptors and the importance of drugs that mimic or inhibit their effects. Define and describe a typical synapse: (a) Distinguish between electrical and chemical synapses, structurally and functionally, and describe how synaptic events are integrated and modified. (b) Describe the events at synaptic terminals that result in the release of neurotransmitters. (c) Outline, using the common transmitters as examples, how receptors on the target cell bind the neurotransmitter and influence cell function. (d) Briefly describe the most common intracellular signal transduction mechanisms. (e) Describe the mechanisms that remove or destroy the neurotransmitter after its release, giving examples of the various mechanisms. Describe in outline the anatomy and innervation of striated and smooth muscle, and the function of the innervation. Describe the neuromuscular junction and the events that lead to the generation and propagation of an action potential in skeletal muscle. Describe the molecular mechanisms of skeletal and smooth muscle contraction including the process of excitation contraction coupling. Develop and maintain a 'P' list of drugs The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Explain the relationship between the ethical principle of autonomy and the legal concept of consent. Detail the components of informed consent/ capacity and apply them medical scenarios. Explain how the failure to obtain consent from a patient can result in action in battery or negligence. Demonstrate a clear understanding of the law espoused in Rogers v Whitaker and apply the decision in Rogers v Whitaker to new medical scenarios. Explain the law in relation to a competent adult's ability to refuse medical treatment. Explain the law in relation to a competent adult's ability to demand medical treatment that is not indicated. The Doctor and Patient Primary learning objective(s) Demonstrate competence in asking patients in an appropriate and systematic way about their personal past medical, surgical and psychiatric

history. Demonstrate competence in asking patients in an appropriate and systematic way about their family medical, surgical and psychiatric history. Demonstrate competence in asking patients in an appropriate and systematic way about the medications they take, including any over-the counter medicines and complementary therapies. Demonstrate competence in asking patients in an appropriate and systematic way about their history of any adverse reactions to drugs. Demonstrate competence in asking patients in an appropriate and systematic way about their social context. Demonstrate competence in asking patients in an appropriate and systematic way about their use of psychoactive substances including alcohol and tobacco. The Doctor and Health in the Community Primary learning objective(s) Discuss the medical implications of practicing in remote areas and be aware of the issues in providing medical services to remote communities Describe the roles of the different parts of the Australian Health Care System.

Learning Objectives for PBL Case: Kylee Nichols


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the major parts of the gastrointestinal tract (including the liver and pancreas) and list the major functions of each. Briefly outline the biochemical digestion and absorption of carbohydrates, fats and proteins. Discuss the actions of insulin on glucose uptake in hepatocytes, adipocytes and skeletal muscle cells the pathophysiology of type I diabetes the metabolic mechanisms responsible for loss of body fat and protein and ketoacidosis. Outline the physiological mechanisms underlying polyuria, polydipsia and glucosuria. Explain the fluid and electrolyte changes in uncontrolled diabetes. Compare the typical patient profile, pathogenesis and clinical features of Type 1 and Type 2 diabetes. Outline the effect of feeding and fasting on metabolism. Include alterations in the insulin:glucagon ratio and its metabolic effect, fuel sources for major tissues and any storage molecules formed in each state. Define the terms gluconeogenesis, glycogenolysis and glycogenesis and explain how these pathways are involved in the maintenance of blood glucose levels. Briefly describe how fats are metabolised for energy and how fat metabolism can lead to the generation of ketone bodies. Describe the balance between protein synthesis and degradation during a normal day and outline the fate of amino acids arising from the diet and from protein breakdown. Describe the three major buffering systems in the body (chemical, respiratory and renal) and describe how they resist pH change. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Explain the relationship between the ethical principle of autonomy and the legal concept of consent. (REVISION) Detail the law in relation to obtaining consent to treat children. Apply the case of Gillick in order to assess a child's competency. Detail the law in relation to a child's ability to refuse life-saving medical treatment. Describe the limitations on the ability of parents to consent to, or refuse, medical treatments for their children. The Doctor and Health in the Community Primary learning objective(s) List the chronic diseases of public health importance in Australia. Explain, in broad terms, the practical aspects of diabetes self care and the education of people with diabetes and their families. Describe risk taking behaviour in adolescence. Discuss common psychosocial concerns of adolescence relating to body image and disordered eating.

Describe the stages of adolescent development and how chronic disease may impact on fulfilment of these stages. Discuss how a range of biopsychosocial factors can lead to behaviour affecting the management of diabetes and other chronic illnesses. Describe the services provided by community agencies, allied health professionals and specialists, commonly used in the management of diabetes.

Learning Objectives for PBL Case: Chris Williams


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Briefly explain the effect of exercise on the cardiovascular system particularly cardiac output and blood pressure. Outline mechanisms that operate to control blood flow in working skeletal muscle via the autonomic nervous system. Outline respiratory changes which take place at the whole body level during exercise, including gas exchange at lungs and muscles as well as control of alveolar ventilation. List mechanisms that operate in working skeletal muscle to increase oxygen delivery, including changes in blood flow, local chemical factors and alterations in the haemoglobin dissociation curve. Describe the pathways/metabolic process/es that supply ATP to exercising muscles: initially during exercise; during low to moderate intensity exercise; during high intensity exercise. Describe the role of adrenaline in the regulation of muscle metabolism. Define oxygen debt and muscle fatigue. Describe the gross and microscopic structure of skeletal muscle [REVIEW]. Compare the structural and biochemical differences in various muscle fibre types and how these differences relate to exercise tolerance. Name the major bones (and their main components) of the upper and lower limbs [PRAC]. Have a basic understanding of the terminology used in naming muscles and be able to identify some examples [PRAC]. Describe the concepts of superficial and deep fascia and be able to recognise these tissues in the limbs [PRAC]. Outline the types of muscle attachments and be able to identify some examples [PRAC]. Describe selected movements at the main joints in the limbs (shoulder, elbow, wrist, hip, knee and ankle) and identify one muscle that performs each of these movements [PRAC]. Identify selected peripheral nerves in the limbs and demonstrate the main movements that are controlled by these nerves eg Sciatic, femoral, ulnar, radial and median nerves [PRAC]. List the major arteries suppling nutrients to the limbs (brachial, radial, femoral) and know where these vessels can be palpated [PRAC]. Describe the microscopic structure of bones and cartilages [PRAC]. Describe the basic types of joints and discuss the knee joint as an example of a synovial joint [PRAC]. Outline the mechanism of action of NSAIDs and adverse effects associated with their use. The Doctor and Patient Primary learning objective(s) Demonstrate competence in asking patients who have been injured, or other informants, in an appropriate and systematic way about the history of the injury and relevant associated information.

Demonstrate competence in effective infection control practices for clinical settings. The Doctor and Health in the Community Primary learning objective(s) Recognise the role of physical activity in maintaining health as a population health issue [Population health perspective] Discuss the role of physical activity in preventive medicine [Prevention perspective]. [REVIEW]

Learning Objectives for PBL Case: Emerald Tomkins


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the anatomy and histology of the male reproductive system Describe the anatomy of the female reproductive system. Describe the menstrual cycle; include fluctuations in gonadotrophin and ovarian hormone levels and the relationship this has on the ovarian and uterine cycles. Describe the clinical/hormonal changes that occur in early pregnancy (first trimester) and how these are used in the diagnosis of pregnancy. Describe the organisation of genetic material in the diploid cell, define an allele and differentiate between genotype and phenotype. Describe the normal human karyotype and the process of karyotyping. Describe the process of mitosis. Describe the normal production of gametes (meiosis) and its function in genetic diversity. Outline the range of abnormal events that can occur in meiosis, and the range of biological consequences. Discuss the genetic cause, clinical features, incidence of and risk factors for Down Syndrome. Describe the principle patterns of inheritance including dominant-recessive, sex linked, co-dominance, incomplete and multiple allele inheritance and an example of a genetic disorder for each. Outline the milestones of normal development in early childhood and be familiar with the use of the Denver Developmental Scale as a method for developmental assessment. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Describe how your view of personhood and philosophical position influence the ethical acceptability of abortion. Discuss the legality of abortion in Queensland. Discuss a doctor's professional duty to a patient should a patient request an abortion. Explain how abortion laws interact with a negligence claim for wrongful life. The Doctor and Patient Primary learning objective(s) Demonstrate competence in exploring a female patient's menstrual history including: her age of menarche, usual menstrual cycle, number of days of bleeding, intensity of bleeding, associated symptoms, age of menopause and presence of climacteric symptoms (if appropriate to the woman's age). Demonstrate competence in exploring a female patient's experience of menstrual disturbance (menorrhagia, dysmenorrhoea or amenorrhoea) including: the cardinal characteristics of the symptom and its time course; relevant associated symptoms; the patient's understanding of, and concerns about, what they are experiencing. Demonstrate competence in asking female patients in an appropriate and systematic way about their obstetric history.

Demonstrate competence in asking parents or carers in an appropriate and systematic way about the medical problems of their child Demonstrate competence in asking the parents of young children in an appropriate and systematic way about the obstetric and neonatal history of their children The Doctor and Health in the Community Primary learning objective(s) Outline current practice in population screening for Down syndrome. Describe the principles and mechanisms of the child protection scheme. Discuss the impact of childhood experiences on health throughout life.

Learning Objectives for PBL Case: Gino Lee


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Define the term cyanosis and explain the difference between central and peripheral cyanosis. Describe what is measured in pulse oximetry and describe the relationship between oxygen saturation and PO2. Outline the mechanism for depression of respiration by opiates. Review the neural and chemical factors that influence breathing. Explain how drugs exert their effects through receptors for endogenous ligands, using heroin and naloxone as examples. Explain the concept of bioavailability in relation to route of administration using heroin and naloxone as examples. Define and describe the concepts of distribution, clearance (high and low hepatic and renal) and half-life using drugs such as heroin and naloxone as examples. Explain the clinical definitions of tolerance, dependence and withdrawal and have a basic understanding of the pharmacological and physiological processes involved. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Articulate what is meant by 'professionalism', and understand why it matters in medical practice. Describe the behaviours that are inherent within good professional practice. Explain the role, purpose and limitations of Codes of Professional Behaviour and Codes of Ethics Explain why there is a need to regulate the medical profession. Describe the various ways in which the medical profession is regulated. Detail what areas of medicine are subject to self regulation. Develop an understanding of the various Federal and State statutes that regulate the medical profession. Identify the appropriate support mechanism for doctors who become addicted to restricted drugs. Explain the professional obligation to self disclose any condition that may impact upon a doctor's ability to practise medicine safely. The Doctor and Patient Primary learning objective(s) Demonstrate competence in asking patients in an appropriate and systematic way about their social context.[REVIEW] Demonstrate competence in asking patients in an appropriate and systematic way about their use of psychoactive substances including alcohol and tobacco.[REVIEW] The Doctor and Health in the Community Primary learning objective(s) Recognise the use of illicit drugs as a risk factor for disease [Population Health].

Describe the harm minimisation principle of prevention [Prevention]. Describe some of the differences between medical practice in rural or regional settings and practice in a larger city [Primary Health Care].

Learning Objectives for PBL Case: Francis Gage


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe human ageing in terms of: basic demography, prominent theories, variability, confounding factors (e.g. lifestyle). Outline the impact of ageing on key body systems. Outline the importance and difficulty in trying to distinguish potentially remedial pathology from expected irreversible age-related changes Explain how homeostatic mechanisms become less efficient with ageing, resulting in reduced functional reserves at times of stress. Describe the presentation, diagnosis and management of prostate cancer in general terms. Briefly describe the nomenclature and classification of neoplasms. Describe the characteristics of a malignant cell. Outline the microbiology of urinary tract infection and management with antibiotics. Describe the physiological control of body temperature and the pathophysiology of fever in infection. Briefly describe the structure and function of the immune system, including bone marrow, spleen, thymus and lymph nodes and cellular ontogeny. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Apply the provisions of the Guardianship and Administration Act (Qld) 2000 and the Power of Attorneys Act (Qld) 1998 to health care decision making for incompetent adults. Detail the relevant Statutory Health Authorities in relation to an incompetent adult. Explain what happens when a medical practitioner and a statutory authority disagree as to the appropriate course of action with regard to an incompetent adult. Explain the legal concept of 'best interests' as it applies to incompetent adults. Describe what is meant by a "substituted judgment" test. The Doctor and Patient Primary learning objective(s) Discuss the unique communication needs of older people. Reflect on their views about ageing and caring for the older patient. Demonstrate competence in techniques that ensure effective communication with older patients. Demonstrate competence in communicating with older patients who have challenging behaviours. The Doctor and Health in the Community Primary learning objective(s) Describe community organisations and support which may be useful to elderly patients with disability or illness [Primary health care].

Describe the burden of illness on the patient and family, especially carers, and list some of the benefits of respite care for carers [Primary health care]. Discuss the screening guidelines for early detection of prostate cancer [Public health].

Learning Objectives for PBL Case: Harry Rodin


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the acute inflammatory response. Identify the roles of histamine, kinins, prostaglandins and platelet derived growth factor (PDGF). Outline innate immunity by briefly describing (a) the classical and alternative pathway for complement activation and its role in innate defence (b) the role of surface membrane barriers (c) the contribution of phagocytosis and natural killer cells. Describe the range of clinical and pathological outcomes of acute inflammation (returned to normal function or permanent damage such as scarring). Discuss the role of pharmaceutical agents in controlling fever. Outline bacterial pathogenicity in relation to: (a) bacterial structure (b) mechanisms used to avoid host defence systems and cause disease. Describe the main classes of pneumonias (bacterial, viral and atypical) and the common causative organisms of each. Briefly describe the clinical features of pneumonia. Describe how bacteria multiply and identify the stages at which penicillin interferes with this process. List the antibiotics commonly used to treat bacterial pneumonia; place each drug in its group and briefly describe the mechanism of action of each group. The Doctor and Patient Primary learning objective(s) Discuss the dominant models for understanding neuropsychlogical development that inform communication with young people and their families in clinical setttings. Demonstrate competence in engaging with young children in order to supplement the history provided by the parents or carers. Demonstrate competence in engaging with older children and adolescents, as well as approaching the discussion of health problems and personal stories with people from these age groups.

Learning Objectives for PBL Case: Ghalib Salang


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Explain the role of T and B lymphocytes in the specific or adaptive immune response (including antigen recognition and lymphocyte activation, cellular and humoral effect or functions). Define humoral immunity and describe the process of clonal selection of B lymphocytes and the role of plasma cells and memory cells. Define cell mediated immunity and describe the process of T cell activation and clonal selection. Describe the maturation and selection processes of B and T cells that lead to immunocompetence and self tolerance. Describe the structure and function of the 5 classes of antibodies. Compare and contrast innate or natural immunity with specific or adaptive immunity. Describe the structure and pathogenicity of mycobacteria. Explain how the host responds to M. tuberculosis infection (includes T cell responses, delayed hypersensitivity, granuloma formation). Explain the various investigations undertaken to determine the cause of common respiratory infections. Describe the indications for, and problems associated with, the Mantoux test. Describe the routes by which infections spread between individuals. Discuss the role of infection control in the health care setting, taking into account routes of transmission, multi-resistant organisms, standard precautions and transmission based precautions. Explain the rational of drug therapy used to treat TB and know the definition of MDR TB (multi-drug resistant TB). Describe the differences (characteristics and consequences) between acute and chronic inflammation. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Outline the doctor's obligations under the Public Health Act (2005) in relation to the notification of notifiable and controlled notifiable conditions. Describe the mechanisms detailed in the Public Health Act (2005) which can be employed to contain an outbreak of a controlled notifiable condition. Consider the doctor's obligation to treat an infected population, even if it involves personal risk. Discuss the ethical issues relating to public health control measures in terms of public goods vs individual rights. The Doctor and Patient Primary learning objective(s) Demonstrate competence in exploring a patient's experience of cough, breathlessness and haemoptysis including: the cardinal characteristics of the symptom and its time course relevant associated symptoms patient's understanding of, and concerns about, what they are experiencing. Demonstrate competence in exploring a patient's experience of constitutional symptoms (fever, sweats, rigours, lethargy, arthralgia or

myalgia), including: the cardinal characteristics of the symptom and its time course relevant associated symptoms patient's understanding of, and concerns about, what they are experiencing. The Doctor and Health in the Community Primary learning objective(s) Describe the different health issues and needs of refugees in the context of their life experiences.[Primary Health Care]. Compare the spectrum of disease in the refugee population with that in Australian citizens.[Primary Health Care]. Outline the epidemiology of Mycobacterium tuberculosis MTB at a local and global level [Population Health] Outline the public health control of MTB (including DOT, contact tracing and screening, vaccination, transmission based precautions) [Public health]. Describe the key aspects of health screening of refugees arriving in Australia [Public health]. Describe the main global health challenges and identify the key players [Public health].

Learning Objectives for PBL Case: Kasey Newman


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Define atopy and briefly describe factors involved in the expression of atopy with reference to modifiable factors for high risk infants. With respect to Type I (IgE mediated) hypersensitivity reactions, as seen in atopic disorders such as hay fever, asthma, and food anaphylaxis, describe: the inflammatory cells and mediators which participate in the response; the pathophysiology of the response; and the associated clinical features. Describe the rationale for management of anaphylaxis based on pathophysiological principles. Interpret clinical immunology tests relevant to the case: immediate hypersensitivity skin prick tests using extracts of common allergens, RASTs for specific IgE. Explain the need for patient education: to avoid known allergens to recognise potentially life threatening reactions eg. tongue swelling, respiratory compromise, collapse to self administer adrenaline for severe allergic reaction. (Note: This LO is relevant to many themes) Recognise that mast cell degranulation can also occur by non IgE mediated mechanisms such as: physical factors (cold, pressure, exercise, skin trauma) drugs (opiates, aspirin, NSAIDS) food chemicals (natural salicylates, preservatives, colourings) complement activation (serum sickness reactions) autoimmune mechanisms. Define immunological hypersensitivity reactions and use a table to briefly compare the four Gell and Coombs categories of hypersensitivity, including a clinical example for each. Outline the pharmacology associated with the treatment of severe allergy and anaphylaxis. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Explain the relationship between the ethical principle of autonomy and the legal concept of consent. (REVISION) Detail the components of informed consent/ capacity and apply them to this medical scenario. (REVISION) Detail the law in relation to obtaining consent to treat children. (REVISION) Apply the case of Gillick in order to assess a child's competency. (REVISION) Detail the law in relation to a child's ability to refuse life-saving medical treatment. Describe the limitations on the ability of parents to consent to, or refuse, medical treatments for their children. (REVISION)

The Doctor and Patient Primary learning objective(s) Demonstrate competence in ensuring that a patient has been able to inform the clinician about all of their relevant symptoms through undertaking a 'review of systems'. Document and summarise a patient's history in appropriate style as a comprehensive written case report Demonstrate competence in summarising and communicating a patient's presenting history as a concise precis that will facilitate timely and effective communication about the person's problems and needs to colleagues. Describe their expectations and anxieties in relation to forthcoming placement in clinical settings. Articulate their awareness of how the perspective of a person with no clinical exposure differs from that of a clinician or clinician in training. Describe how and why that perspective may change as clinical experience increases.

Learning Objectives for PBL Case: Penny Lazarus 1


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Define blood flow, blood pressure and resistance and explain the relationship between them (Poiseuilles Law). Briefly explain the physiological factors that influence blood pressure and the short term neural and hormonal controls of blood pressure. Describe the physical basis of blood pressure measurement with a cuff, sphygmomanometer and stethoscope. Outline the variations in normal blood pressure, during the day and over a life time. Define hypertension and understand the differences between essential versus secondary hypertension, and the basis of treatment. Explain the physiological (as opposed to cellular) actions of thiazide diuretics, calcium channel blockers, ACE inhibitors and angiotensin IIreceptor blockers as used in hypertensive patients; briefly outline the physiological actions of -blockers, -blockers and aldosterone antagonists. Outline the normal physiological control of lipid absorption, biosynthesis and metabolism. Define hyperlipidaemia and discuss the differences between primary versus secondary hyperlipidaemia in terms of their causes and the mechanisms underlying their current treatment. Briefly outline the physiological mechanism of statins to lower plasma lipids; identify the physiological targets of other commonly used lipidlowering agents and dietary supplements. Outline current treatment targets for lipid and blood pressure control (ie mmol/L and mmHg) and describe the sequelae of poorly managed hypertension and hyperlipidaemia. Describe the histology of the blood vessels. Briefly describe the pathogenesis and consequences of atherosclerosis. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Detail the law as it pertains to the ownership of patient medical records. Detail the law as it pertains to the ability of patients to access their medical records. Demonstrate an understanding of the National Privacy principles and Information Privacy principles in relation to the collection, storage, security, use and disclosure of personal information. Explain why the Duty of Confidentiality is integral to the doctor/patient relationship. Detail the circumstances in which a doctor may breach the duty of confidentiality without attracting legal consequences. Outline whether a competent adult has a right to refuse treatment or not adhere to treatment regimes. The Doctor and Health in the Community Primary learning objective(s) Identify population issues relating to hypertension, including incidence, detection, contributing lifestyle factors. [Population health perspective] Describe the key aspects of lifestyle management strategies for hypertension. [Primary health care perspective]

Discuss obesity management strategies and approaches to changing behaviour in patients. [Primary health care perspective] Describe the lifestyle measures which may modify hyperlipidaemia.[Primary health care perspective] Explain the difference between population-wide public health interventions and interventions aimed at high risk populations, and the benefits and disadvantages of each approach. Explain primary, secondary and tertiary prevention and how they inform the public health response to disease

Learning Objectives for PBL Case: Lester Crabbe 1


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the mechanism of haemostasis. Describe the mechanism of fibrinolysis. Discuss the factors that limit clot formation and how alterations in this process can lead to pathology. Discuss the genetic and environmental factors that predispose to thrombosis. Describe the venous anatomy of the leg. Discuss the hydrodynamic forces influencing fluid movement between the intra- and extra-vascular spaces (leading to oedema). Explain the principles of diagnosis and treatment of venous thrombosis. Explain the mechanism of action of the main drugs that modify haemostasis and thrombolysis. Outline the clinical features and management of vascular disease affecting the veins of the legs e.g. varicose veins, post-phlebitic venous disease and chronic ulceration. Describe the cell cycle - the stages and controls in cell division and DNA replication. Outline the range of abnormal events that can occur in mitosis, and the range of biological, cancer-related consequences. Define caretaker, gatekeeper, proto-oncogene and tumour suppressor gene and have a brief understanding how these genes protect against carcinogenesis (include apoptosis). Describe the characteristics of a malignant cell and summarise the steps involved in the process by which a malignant neoplasm develops. Describe the nomenclature and classification of neoplasms. Describe the pathology and essential characteristics of tumours, benign or malignant. Briefly outline the issues to be considering in peri-operative anticoagulation treatment The Doctor and Patient Primary learning objective(s) Demonstrate competence in exploring a patient's experience of constitutional symptoms (fever, sweats, rigours, lethargy, arthralgia or myalgia), including: the cardinal characteristics of the symptoms and their time course; relevant associated symptoms; the patient's understanding of, and concerns about, what they are experiencing.[REVIEW] The Doctor and Health in the Community Primary learning objective(s) Outline the risk factors associated with skin cancers and how prevention concepts (primary, secondary, tertiary prevention and mass vs high risk approaches) have been applied to public health skin cancer interventions.[Public Health] Discuss when, who and how to screen for colonic cancer.[Public Health]

Learning Objectives for PBL Case: Faisal Mutallab

At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the steps in red cell production, maturation and destruction. Explain the factors that influence red cell production and half-life, describe the role of erythropoietin and briefly mention the action of colony stimulating factors. Describe the structure of fetal and adult haemoglobin and how differences in structure affect oxygen carrying capacity. Explain the importance of iron for red cell production and the processes involved in iron absorption, transport, storage and excretion. Explain the importance of vitamin B12 and folate to red cell production and the mechanism of their involvement. Discuss the dietary requirements of iron, folate and B12 and explain how requirements change with age and pregnancy. Describe the ABO and Rh blood groups and explain the basis of transfusion reactions. List the broad categories of anaemia and mechanisms of each. Describe the compensatory mechanisms in chronic anaemia involving: (a) Erythropoietin production (b) Cardiovascular changes including signs and symptoms of chronic anaemia, and (c) Role of 2-3-Diphosphoglycerate Describe the common abnormalities in full blood examination reports of patients with anaemia including: (a) The use of red cell indices (MCV, MCHC), and (b) Significance of reticulocyte number. Describe the major types of thalassaemia. Describe the broad aspects of the genetics of thalassaemia. Describe the ethnic groups at risk for thalassaemia. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Discuss whether genetic information is 'different' to other types of knowledge a patient may have concerning their health. Discuss how issues of patient confidentiality can be approached when dealing with genetic information that may have relevance beyond the individual patient. Describe the subjective nature of risk interpretations in interpreting genetic information. Critique the professional ability to provide "non-directive" counselling. Review the components of informed consent and apply them in this scenario. The Doctor and Patient Primary learning objective(s) Discuss the importance of cultural sensitivity, culturally safe health services and culturally appropriate health care. [REVISION] Describe the processes for providing effective care to people whose first language and culture are different from theirs. [REVISION] Discuss the circumstances in which professional interpretation services should be used and the process for accessing them. [REVISION] Demonstrate competence in cross-cultural communication in the clinical setting. [REVISION] Discuss aspects of cultural diversity that may bear on medical interactions with Indigenous people, including patterns of non-verbal communication, 'showing respect'.

Demonstrate comfort and competence in engaging with patients and approaching the discussion of their emotional life and psychological status. Demonstrate competence in exploring a patient's experience of altered mood, anxiety, and psychotic symptoms, including: the cardinal characteristics of the symptoms and their time course; relevant associated symptoms; the patient's understanding of, and concerns about, what they are experiencing. The Doctor and Health in the Community Primary learning objective(s) Discuss the diversity that exists amongst different racial and ethnic groups and how this will influence the delivery of effective patient care. [Primary Health Care]

Learning Objectives for PBL Case: Tricia Wakefield


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the structure of viruses and define the classification of viruses (at a basic level, e.g. herpes as a DNA virus). Describe the clinical features of several important and/or common viral illnesses eg measles, rubella, influenza, varicella, infectious mononucleosis, HIV/AIDS. Identify common viral/bacterial causes of genital inflammation and dysuria. Describe the natural history of the herpes simplex virus in the human host including the host responses ie cell mediated and humoral. Describe the mechanisms by which viral organisms are transmitted, using the herpes simplex virus as an example. Describe mechanism of action of aciclovir. Describe the basic principles of investigation, diagnosis and treatment of viral infections. Describe the body's response to vaccination and be familiar with the childhood vaccination schedule. Briefly describe the major sexually transmitted infections and how to test for them (chlamydia, gonorrhoea, genital herpes, HIV, syphilis, human papillomavirus (HPV), trichomonas). The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Explain why the Duty of Confidentiality is integral to the doctor/patient relationship. [REVISION] Detail the circumstances in which a doctor may breach the duty of confidentiality without attracting legal consequences. [REVISION] Detail the law as it pertains to the ownership of patient medical records. [REVISION] Detail the law as it pertains to the ability of patients to access their medical records. [REVISION] Briefly outline the National Privacy principles and the Information Privacy principles in relation to the collection, storage, security, use and disclosure of personal information. [REVISION] The Doctor and Patient Primary learning objective(s) Demonstrate comfort and competence in engaging with patients and approaching the discussion of sexual matters. Demonstrate competence in asking patients in an appropriate and systematic way about their sexual partners and sexual practices. Demonstrate competence in exploring a patient's experience of sexual dysfunction (changed libido, female genital dryness, erectile difficulty, orgasmic and ejaculatory problems, pain on sexual activity) including: the cardinal characteristics of the symptoms and their time course; relevant associated symptoms; the patient's understanding of, and concerns about, what they are experiencing. Demonstrate competence in exploring a patient's experience of (a)genital symptoms (ulcer, lump, discharge, pain) and (b) urinary symptoms (dysuria, polyuria, nocturia, stream problems, hesitancy, dribbling, incontinence) including: the cardinal characteristics of the symptoms and their time course; relevant associated symptoms; the patient's understanding of, and concerns about, what they are experiencing. The Doctor and Health in the Community

Primary learning objective(s) Outline the public health response to sexually transmitted infections (contact tracing, treatment and prevention). [Public Health] Describe the services offered by Queensland Health sexual health clinics.[Primary Health Care] Describe effective strategies for improving adherence with medical therapy and lifestyle advice. [Primary Health Care] Outline the epidemiology of sexually transmitted infections in Australia. [Public Health]

Learning Objectives for PBL Case: Martin James


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Outline the basic anatomy of lung apex, mediastinum and chest wall in relation to physical signs due to spread of lung malignancies. Describe the lymphatic drainage of the lungs. Identify the principle risk factors, clinical features and presentation of lung cancers. Describe the pathophysiology and diagnosis of pleural effusion and the differentiating features of transudates and exudates. Describe the pathology, mode of spread and prognosis of cancers of the lung. Define haemoptysis and outline the steps involved in performing a differential diagnosis in a patient presenting with haemoptysis. Outline the role of bronchoscopy and radiology in the investigation of lung cancers. Describe the pathophysiology and clinical findings of atelectasis. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Discuss the ethical, social and cultural aspects of death and dying. Use a patient's Advance Health Directive (AHD) to inform their end of life care. Detail the law in relation to the following: Refusal of treatment even though it will result in the death of the patient Withholding and Withdrawal of treatment from incompetent patients. The administration of palliative care Active voluntary euthanasia Differentiate between the following Murder/Manslaughter. Suicide Physician-assisted suicide. Refusal of treatment even though it will result in the death of the patient. Withholding and Withdrawal of treatment from competent and /or incompetent patients The administration of palliative care. Active voluntary euthanasia. Critique the position of the law in relation to the following: Refusal of treatment even though it will result in the death of the patient (AHD). Withholding and Withdrawal of treatment from incompetent patients. The administration of palliative care. Active voluntary euthanasia.

The Doctor and Patient Primary learning objective(s) Demonstrate competence in the interpretation of postero-anterior and lateral chest radiographs through the application of a systematic technique for differentiating normal from abnormal appearances and recognising common and 'red flag' pathological signs. The Doctor and Health in the Community Primary learning objective(s) Discuss the psychosocial impact of cancer on the adult patient, and the benefits of psychosocial support in the care of adults with cancer [Primary Health Care]. Discuss the role of palliative care services in the community [Primary Health Care].

Learning Objectives for PBL Case: Lester Crabbe 2


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) List the components of blood and explain under which circumstances each component may be used for blood replacement. Review the nomenclature and classification of neoplasms. Review the pathology and essential characteristics of tumours, benign or malignant. Describe the common causes of cancer. Compare the pathophysiology and natural history of slow growing, locally invasive tumours to that of metastatic tumours, using basal cell carcinoma and colorectal adenocarcinoma as examples. Describe the general processes of healing in tissues, including resolution, regeneration, and repair by fibrosis. Discuss the potential for regeneration of various tissues depending on whether they are made up of permanent, stable or labile cells, and on the histological structure of the tissues. Briefly describe the factors influencing repair and regeneration, including systemic and local factors such as wound infection, and controls and complications. Identify the micro-organisms commonly responsible for wound infections and know how to investigate these infections. Identify groups of antimicrobial agents commonly used to treat wound infections and the limitations of these groups of agents. Describe the systemic effects of cancer (metastasis, para-neoplastic syndrome, weight loss etc). Describe the basic principles underlying fluid management during and post-surgery, relating them to fluid compartments and fundamental physiology Briefly outline the issues to be considering in peri-operative anticoagulation treatment The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Discuss the impact of illness in a person's life beyond the physical symptoms of disease. Discuss the impact of illness on a person's identity, including: 'how' and 'who' they see themselves as; and 'how' and 'who' others regard them. Detail and apply the various elements of negligence that need to be satisfied for a successful action. Demonstrate a clear understanding of the law espoused in Rogers v Whitaker (1992) 175 CLR 479 and apply the decision in Rogers v Whitaker to new medical scenarios. Explain how the Bolam Principle can be applied in a potential negligence case. Outline the conditions that create a "duty of care". Demonstrate how provisions in the Civil Liability Act (Qld) 2003 apply to cases of negligence. List the types of medical mistakes which may lead to an action in negligence. Identify the impact of organisational culture on practitioner self-care Recognise the symptoms of burnout.

Identify a range of strategies that promote a doctor's well-being and self-care. Demonstrate knowledge of where impaired doctors can seek professional support Identify the potential outcomes of poor practitioner self-care on patient safety. The Doctor and Patient Primary learning objective(s) Demonstrate competence in exploring a patient's experience of headache including: - the cardinal characteristics of the symptom and its time course; - relevant associated symptoms; - the patient's understanding of, and concerns about, what they are experiencing Demonstrate competence in exploring a patient's experience of important gastrointestinal presentations (abdominal pain, changed appetite, unintentional weight change, nausea, vomiting, heartburn, reflux, dyspepsia, dysphagia, odynophagia, haematemesis, melaena or rectal bleeding) including: the cardinal characteristics of the symptom and its time course relevant associated symptoms the patient's understanding of, and concerns about, what they are experiencing.

SYSTEMS MEDICINE PBL CASES 2013

Learning Objectives for PBL Case: Nelly Sansbury


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Review the gross anatomy of the heart, including cardiac chambers and valves, and demonstrate an ability to interpret cardiac anatomy from cardiac imaging. Correlate the anatomy of the heart to the surface anatomy. Describe the basic anatomy of the mediastinum Describe at a basic level the normal development of the heart and major malformations. Describe the structural and functional characteristics of cardiac muscle. Describe the ion fluxes during action potentials in cardiac pacemaker cells and myocytes. Briefly describe the events of cardiac muscle contraction. Review the components of the electrical conducting system of the heart. Describe the timing and events of the cardiac cycle. Review a normal electrocardiogram tracing; name the individual waves and intervals, and indicate what each represents. Describe the determinates of cardiac output and explain the mechanism by which various factors regulate heart rate and stroke volume. Outline the anatomical and functional changes associated with cardiac hypertrophy. Briefly outline how the ECG changes with ventricular hypertrophy (lateral ST segment depression; T wave inversion). Recognise normal and abnormal heart sounds as well as regurgitant flow across incompetent valves. Describe: common congenital valve abnormalities and the risk of increased damage due to illness and infection common pathologies of cardiac valves [mitral valve prolapse, aortic stenosis, infective endocarditis, NBTE (nonbacterial thrombotic endocarditis) and rheumatic valvular diseases]. Briefly outline the management of aortic valve disease [AOVD] and endocarditis including the importance of prophylaxis and its indications (primary and secondary prevention). Outline the treatment of cardiac valve diseases and describe the importance of anticoagulant treatment for patients with prosthetic valves. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Describe the various elements of negligence that need to be satisfied for a successful action.[Review] Explain how the Bolam Principle can be applied in a potential negligence case. [Review] Demonstrate a clear understanding of the law espoused in Rogers v Whitaker and apply the decision in Rogers v Whitaker to new medical scenarios. [Review] Outline the conditions that create a "duty of care". [Review] Demonstrate how provisions in the Civil Liability Act (Qld) 2003 apply to cases of negligence. [Review]

List the types of medical mistakes which may lead to an action in negligence. [Review] Apply your knowledge of the law with respect to negligence and duty of care to this case. The Doctor and Patient Primary learning objective(s) Demonstrate competence in the examination of a patient's vital signs (pulse rate and rhythm, respiratory rate, temperature, blood pressure and oxygen saturation) for the assessment of a range of presentations. Demonstrate competence in the physical examination of a patient for the assessment of presentations suggesting cardiac, respiratory or systemic renal pathology. Recognise the common and the 'red flag' conditions giving rise to cardiorespiratory signs, then discuss the historical and examination features characteristic of each. Demonstrate competence in performing a standard 12-lead electrocardiograph, analysing an electrocardiographic trace accurately, identifying correctly and discussing the significance of common electrocardiograph abnormalities. Recognise interpret and discuss the significance of common 'red flag' electrocardiograph abnormalities. The Doctor and Health in the Community Primary learning objective(s) Discuss the epidemiology of rheumatic fever in Australia. [Public Health] Explain that Indigenous Australians have a variety of lifestyles, living conditions, health issues. [Primary Health Care] Briefly describe the major inequalities in physical and mental health status between Indigenous Australians and non-Indigenous Australians. [Public Health]

Learning Objectives for PBL Case: Penny Lazarus 2


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the anatomy of the vascular system, including the names and functions of the major arteries and veins in the trunk, limbs and neck. Describe the major branches and distribution of the coronary circulation. Describe the causes and treatment of angina. Describe the presentations of cardiac pain; use the cardiac pain pathway and pattern of referred pain to explain the underlying mechanisms of presentation. Outline the pharmacology of anti-platelet agents, nitrovasodilators and thrombolytics (including commonly occurring adverse effects). Identify nominated major alterations from normal in an ECG of a patient with a myocardial infarct. (NB: Diagnosis of infarct location from an ECG is not required). Review the histology of the heart (myocardium and coronary vessels). Outline the pathology of ischaemic heart disease including predisposing factors, microscopic and macroscopic features, and complications. Describe the use of the following techniques: Echocardiography; Ventriculography; Coronary angiography; Angioplasty & stenting. Explain the time course and significance of alterations in circulating cardiac enzymes following myocardial infarction. Outline major complications of myocardial infarction for cardiac pump function. Outline the rationale for reperfusion therapy, including the time period (therapeutic window) during which either thrombolytic therapy or angioplasty are of benefit to outcomes, and the contraindications for thrombolysis. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Discuss the impact of illness in a person's life beyond the physical symptoms of disease.[REVISION] The Doctor and Patient Primary learning objective(s) Demonstrate competence in the examination of a patient's vital signs (pulse rate and rhythm, respiratory rate, temperature, blood pressure and oxygen saturation) for the assessment of a range of presentations.[REVISION] Demonstrate competence in the physical examination of a patient for the assessment of presentations suggesting cardiac, respiratory or systemic renal pathology.[REVISION] Recognise the common and the 'red flag' conditions giving rise to cardiorespiratory signs, then discuss the historical and examination features characteristic of each.[REVISION] The Doctor and Health in the Community Primary learning objective(s) Describe the risk factors associated with coronary artery disease and myocardial infarction. [Public Health] For individual level care: synthesise the input of multiple professional colleagues, together with the beliefs, priorities and wishes of the patient

or client and their significant others, to reach consensus on optimal treatment, care and support and how it should be provided; while for community level health activity synthesise the input of multiple professional colleagues, together with the values and priorities of the community concerned, to reach consensus on optimal interventions and how they should be implemented. Describe the roles, practices and expertise of effective members of each of the other major health professions, in this case focusing on the role of the paramedic. Explain how to detect important differences in summary statistics between two study groups. [Evidence Based Medicine] Distinguish between clinically important and statistically significant effects. [Evidence Based Medicine] Explain the meaning of the commonly used measures of variation around mean and median values, including standard deviation, standard error, confidence intervals and interquartile range. [Evidence Based Medicine] Define inter-rater / interobserver reliability, know how it is measured and interpret results. [Evidence-Based Medicine]

Learning Objectives for PBL Case: Carl Johnston


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Review the anatomy of the kidney and individual nephrons. Describe the histology of the kidney. Describe the vascular system and pattern of blood flow through the kidney. Describe the process of glomerular filtration and the physical forces that determine the rate at which it occurs (GFR). Outline how GFR can be altered, measured and estimated (eGFR). Describe the general mechanisms of tubular reabsorption and secretion. Outline tubular reabsorption of amino acids, glucose, proteins, urea and other small organic molecules in terms of segments of the renal tubules and collecting ducts where they are reabsorbed and the mechanism by which reabsorption occurs. Outline renal reabsorption of bicarbonate ion and how this facilitates renal contributions to regulation of whole body pH. Outline tubular reabsorption of water in terms of segments of the renal tubules and collecting ducts where it is reabsorbed and the mechanism by which reabsorption occurs. Describe the role of the kidney, hypothalamus and posterior pituitary in maintaining whole body osmolarity. Outline tubular reabsorption of sodium and chloride in terms of segments of the renal tubules and collecting ducts where they are reabsorbed and the mechanism by which reabsorption occurs. Outline the contribution of the kidney to regulation of whole body levels of sodium and potassium plus maintenance of calcium and phosphate homeostasis. Interpret analyses of urine and explain the presence of blood, glucose and protein in urine. Outline the principles of dialysis in terms of basic functions of the kidney being replaced. Review/outline the actions of the following drugs: ramipril, amlodipine, metformin, glibenclamide, frusemide, caltrate. List the principal systemic manifestations of chronic kidney disease and uraemia. The Doctor and Patient Primary learning objective(s) Demonstrate competence in the physical examination of a patient for the assessment of presentations suggesting cardiac, respiratory or systemic renal pathology. The Doctor and Health in the Community Primary learning objective(s) List the common risk factors for developing renal failure in Australia. [Public Health]

Learning Objectives for PBL Case: Samuel Tobin


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Outline the gross and microscopic structure of the respiratory system and differentiate between the conducting and respiratory zone structures. Describe the sequence of events of inspiration and expiration in relation to changes in intrapulmonary and intrapleural pressures, thoracic volume and action of the diaphragm and intercostal muscles Describe the anatomy and function of the respiratory muscles (including the accessory muscles). Describe the cough reflex. Identify the signs and causes of upper airway obstruction Interpret respiratory noises and relate respiratory noises to location of possible obstruction and cause. Outline the mechanisms of lung humidification and the defences impeding movement of inhaled foreign bodies and particles in the conducting airways. Outline the physical law governing the behaviour of gases in tube-shaped structures. Outline the basic management of upper airway obstruction. Define asthma; describe the cardinal signs and symptoms and natural history of the disease. Describe the mechanisms of increased airway obstruction in asthma (reversible obstruction). Outline the targets and efficacy of drugs used in the treatment of asthma in particular beta 2 agonists and inhaled corticosteroids. Outline the principles of treatment of asthma in children. Outline the role of environmental and occupational factors in allergic airway disease. Review atopy and briefly describe factors involved in the expression of atopy. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Outline the law regarding a parent's obligation to act in their child's best interests with respect to seeking appropriate medical care. Identify how personal values can be a source of ethical conflict in medical practice - apply your knowledge to this medical scenario.(review) Listen to the opinions of other health professionals effectively and respectfully, valuing each contribution in relation to its usefulness for the patient, client or community concerned, rather than on the basis of the professional background of its contributor (IPL). The Doctor and Patient Primary learning objective(s) Demonstrate competence in asking parents or carers in an appropriate and systematic way about the medical problems of their child (REVISION). Demonstrate competence in asking parents of young children in an appropriate and systematic way about the obstetric and neonatal history of their children (REVISION).

Demonstrate competence in exploring a patient's experience of cough, breathlessness or haemoptysis [REVISION]. Demonstrate competence in the physical examination of a patient for the assessment of presentations suggesting cardiac, respiratory or systemic renal pathology [REVISION]. Demonstrate competence in the administration and documentation of subcutaneous and intramuscular injections. The Doctor and Health in the Community Primary learning objective(s) Outline the common side effects of childhood immunisations and their management. [Primary Health Care/Public Health] Discuss the benefits of immunisation to the individual and to the population.[Public Health] Outline environmental and medical interventions that may reduce asthma severity. [Primary Health Care] Discuss the prevalence of asthma, the incidence of asthma mortality in Australia and risk factors of asthma mortality.[Public Health] Outline the resources available in the community to help manage asthma. [Primary Health Care] Discuss the factors associated with non-adherence with medical therapy including those specific to asthma therapy, and the types of nonadherence that can interfere with successful treatment outcomes.[Primary Health Care] Outline the stages of child development and how chronic disease may impact on fulfilment of these stages.

Learning Objectives for PBL Case: Nicholas Sinclair


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the basic anatomy of the mediastinum. Describe the structure, histology and function of the lung. Outline the development of the respiratory system. Compare the foetal circulation to that of an adult and outline the sequence of events that result in adaptation to extrauterine life. Describe the basic composition and function of lung surfactant. Briefly describe the causes of respiratory distress in the newborn. Describe the relationship between perfusion and ventilation of the alveolus [ventilation-perfusion relationships (V/Q ratios)]. Explain the partial pressure gradients that govern the physiological movement of oxygen and CO2 within the body. Describe the techniques of pulse oximetry and blood gas analysis and explain the data that are gathered from each. Review the relationship among blood pH, carbon dioxide and bicarbonate (see also ISM block). Review the structure of fetal and adult haemoglobin and how differences in structure affect oxygen carrying capacity. Describe the adverse consequences for neonates exposed to high levels of oxygen. Explain the difference between central and peripheral cyanosis. Briefly outline the types, pathophysiology and clinical features of pneumothorax. Outline the neural control of ventilation including a review of the factors that influence the rate and depth of breathing. Describe the pharmacology and therapeutic use of caffeine. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Describe the potential barriers to effective teamwork and strategies through which they may be overcome. [IPL] Identify the impact of organisational culture on practitioner self-care. Recognise the triggers that increase the risk of poor health for doctors. Identify the range of behaviours that may suggest a doctor may not be taking good care of him/herself. Identify the barriers that reduce doctor's access to appropriate health care. Identify a range of strategies that promote a doctor's wellbeing and self-care. The Doctor and Patient Primary learning objective(s) Demonstrate competence in communicating with patients about health-related behaviours and assisting them to explore their ambivalence about behaviour change, utilising the techniques of motivational interviewing. Express their professional opinions competently, confidently and respectfully to colleagues in any health profession. [IPL]

The Doctor and Health in the Community Primary learning objective(s) Describe the roles, practices and expertise of effective members of other major health professions, in this case focusing on the role of the nurse [IPL]

Learning Objectives for PBL Case: Penny Lazarus 3


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) List the common cardiac causes of shortness of breath Explain Starling's law of the heart. Describe the LaPlace relationship between pressure and cardiac wall tension. Describe the relationship between cardiac dilation and cardiac valvular incompetence Describe mechanisms of capillary transport and the relationship between hydrostatic and colloid osmotic pressures in determining net fluid flux (using oedema as an example of disordered movement). Describe the pathophysiology and natural history of cardiac failure. Outline the mechanism of formation of pulmonary embolism and relate the clinical signs to the pathology. Outline the mechanisms responsible for long term control of blood pressure: Renin-Angiotensin system; Vasopressin. Explain the role of the autonomic nervous system in regulating cardiac output. Review the normal ECG and the common gross abnormalities detectable by ECG Review the components of the cardiac conducting system and describe abnormalities in conduction. Describe at a basic level, the pharmacology and rationale of medications used in the treatment of atrial fibrillation (amiodarone, sotalol, flecainide and digoxin and warfarin). Explain at a basic level the pharmacology and rationale of medications used in the treatment of heart failure (diuretics, ACE inhibitors, bblockers, inotropic agents). Review normal heart sounds and the physiological basis and significance of abnormal heart sounds. The Doctor and Patient Primary learning objective(s) Demonstrate competence in performing a standard 12-lead electrocardiograph, analysing an electocardiographic trace accurately, identifying correctly and discussing the significance of common electrocardiographic abnormalities. [REVISION] Recognise interpret and discuss the significance of common and 'red flag' electrocardiographic abnormalities. [REVISION] Demonstrate competence in the interpretation of postero-anterior and lateral chest radiographs through the application of a systematic technique for differentiating normal from abnormal appearances and recognising common and 'red flag' pathological signs. [REVISION] Demonstrate competence in the examination of a patient's vital signs (pulse rate and rhythm, respiratory rate, temperature, blood pressure and oxygen saturation) for the assessment of a range of presentations. [REVISION] Demonstrate competence in the physical examination of a patient for the assessment of presentations suggesting cardiac, respiratory or systemic renal pathology. [REVISION] Recognise the common and the 'red flag' conditions giving rise to cardiorespiratory signs, then discuss the historical and examination features characteristic of each. [REVISION]

The Doctor and Health in the Community Primary learning objective(s) Describe the epidemiology and risk factors for heart failure.[Population Health]

Learning Objectives for PBL Case: Tonia Baxter


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the nine regions and four quadrants of the abdominopelvic cavity and list the organs they contain. Describe the macroscopic anatomy of the pharynx and oesophagus. Review the microscopic organization of GIT (from Year 1) and describe the histological structure of the oesophagus in relation to its function. Describe the mechanisms of swallowing, reflux and vomiting. Describe the basic macroscopic anatomy of the stomach. Include blood supply, innervation and important immediate relations. Describe the mechanism of pain from gastric pathology (including referred pain). Describe briefly the development of the three components of GIT from endoderm to understand the basis of blood supply, innervation, lymphatic drainage and GI pain. Describe briefly the macroscopic anatomy of the salivary glands including innervation and clinically important relations. Describe the components of gastric juice, the cell types responsible for secreting its components and indicate the importance of each component in stomach activity. Describe the mechanisms of production of gastric acid by oxyntic cells in the gastric mucosa, including the major ionic mechanisms (especially the K+/H+ ATPase) Describe the neural and hormonal regulation of gastric acid secretion. Describe the mechanisms of gastrointestinal motility. Describe the neural and hormonal regulation of gastric emptying. Describe the the major mechanisms that protect the stomach from self digestion and the leakage of gastric juice into the peritoneum. Describe the role of Helicobacter pylori (H. pylori), non-steroidal anti inflammatory drugs, and smoking in the formation of ulcers. Describe the utility and limitations of imaging techniques, H. pylori tests, gastroscopy and biopsy in the diagnosis of oesophageal disease, peptic ulcer disease (PUD) and malignancy. Outline the principles of management of ulcers including antacids, H2 antagonists, acid pump inhibitors, H. pylori eradication and surgical approaches (the last in only the most intractable cases). Describe the pathology of diseases of the oesophagus, including achalasia, varices, oesophagitis and tumours; and pathology of diseases of the stomach, including gastritis, ulcer and gastric tumours. Outline the indications for use and mechanism of action of antifungal drugs. Review the mechanism of action of cyclooxygenase (COX) inhibitors and the adverse effects associated with NSAID use. The Doctor and Patient Primary learning objective(s) Demonstrate competence in exploring a patient's experience of important gastrointestinal presentations (abdominal pain, changed appetite, unintentional weight change, nausea, vomiting, heartburn, reflux, dyspepsia, dysphagia, odynophagia, haematemesis, melaena or rectal

bleeding) [REVISION] including: the cardinal characteristics of the symptom and its time course; relevant associated symptoms; the patient's understanding of, and concerns about, what they are experiencing.

Learning Objectives for PBL Case: Martine Flannagan


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the different mechanisms responsible for diarrhoea (osmotic, secretory, inflammatory, abnormal motility). List the classes of drugs commonly used to treat diarrhoea or constipation and outline the mechanisms of action of each. Update their student P- list of drugs to include the commonly occurring patient adverse effects (e.g. altered gastrointestinal motility) of different classes of drugs, relating these adverse effects to mechanism of action if possible. Describe the relevant investigations and examinations used in the initial assessment of a patient presenting with diarrhoea and outline what can be learnt from testing faecal samples (ie: identification of micro-organisms, ova, cysts and parasites, presence of red or white blood cells, culture of pathogens). Define steatorrhoea and describe the mechanisms causing steatorrhoea. Describe the anatomy and histology of the small intestine. Describe the arterial blood supply and the venous drainage of the small intestine Summarise the innervation of the small intestine and mechanisms of pain from the small intestine (including referred pain). Explain the major mechanisms underlying the propulsion and mixing of the contents of the small intestine and the factors that influence movement along the small intestine. Review the digestion and absorption of carbohydrates, fats and proteins Describe the mechanisms and locations of the absorption of vitamins and calcium, iron and bile salts. List the roles of gastrin, secretin, cholecystokinin, ghrelin, motilin, glucagon-like peptide-1 and 2 (GLP), glucose-dependent insulinotropic polypeptide (GIP) and peptide YY (PYY) in gastrointestinal function. Discuss underlying pathophysiological mechanisms and clinical presentations of intestinal malabsorption. Define coeliac disease and explain its specific pathology. Discuss relevant investigation strategies of coeliac and explain the principles of management of this condition. Describe the anatomy and histology of the pancreas Describe the endocrine and exocrine functions of the pancreas The Doctor and Patient Primary learning objective(s) Demonstrate competence in exploring a patient's experience of important gastrointestinal presentations (abdominal pain, changed appetite, unintentional weight change, nausea, vomiting, heartburn, reflux, dyspepsia, dysphagia, odynophagia, haematemesis, melaena or rectal bleeding) [REVISION] including: the cardinal characteristics of the symptom and its time course relevant associated symptoms the patient's understanding of, and concerns about, what they are experiencing

Demonstrate competence in the examination of a patient for the assessment of gastrointestinal symptoms and other presentations that might be associated with abnormalities on abdominal examination. Recognise the common and the 'red flag' conditions giving rise to abdominal signs, then discuss the historical and examination features characteristic of each. The Doctor and Health in the Community Primary learning objective(s) Discuss the role of screening for relatives of patients with coeliac disease. Discuss the importance of food labelling to patients with coeliac disease and food allergies, and the regulatory bodies that play a public health role regarding food sold and imported into Australia. Describe the roles, practices and expertise of effective members of each of the other major health professions, in this case focusing on the role of the dietitian.[IPL]

Learning Objectives for PBL Case: Neil Cornes


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the factors that influence stool consistency and list the causes of constipation. Describe what investigations might be used for a patient presenting with abdominal pain and alternating constipation/diarrhoea,. Describe the gross anatomy and histology of the large intestine. Describe the anatomy of the pelvic floor and the relationship of the large bowel to the surrounding organs. Describe the arterial blood supply and the venous drainage of the large intestine. Summarise the innervation of the large intestine and mechanisms of pain from the large intestine (including referred pain). Describe the function of the large intestine and mechanisms controlling motility and defecation. Describe the secretion and reabsorption of sodium, potassium and water in the various segments of the alimentary canal. Describe micro-organisms normally present in the bowel and the common pathogens of the gastrointestinal tract. Compare and contrast IBS, IBD, Coeliac Disease and Bacterial overgrowth. Describe diverticular disease, its complications and how it may be diagnosed. Briefly outline the aetiology, pathogenesis, morphological changes, familial occurrence, and clinical features of colorectal neoplasia. Outline the mechanisms of action and indications for use of anti-emetics. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Explain the law in relation to a competent adult's ability to demand medical treatment that is not indicated. [REVISION] Outline the problems associated with giving medical advice to friends and relatives. The Doctor and Patient Primary learning objective(s) Demonstrate competence in exploring a patient's experience of important gastrointestinal presentations (abdominal pain, changed appetite, unintentional weight change, nausea, vomiting, heartburn, reflux, dyspepsia, dysphagia, odynophagia, haematemesis, melaena or rectal bleeding) [REVISION] including: the cardinal characteristics of the symptom and its time course; relevant associated symptoms; the patient's understanding of, and concerns about, what they are experiencing. Demonstrate competence in the examination of a patient for the assessment of gastrointestinal symptoms and other presentations that might be associated with abnormalities on abdominal examination. [REVISION] Recognise the common and the 'red flag' conditions giving rise to abdominal signs, then discuss the historical and examination features characteristic of each. [REVISION] Demonstrate competence in responding effectively to and supporting patients and significant others who present with strong negative emotions in clinical settings. The Doctor and Health in the Community

Primary learning objective(s) Review the significance of a positive test for faecal occult blood (FOB) for the individual and the value of screening for FOB as a public health strategy. [Public Health]

Learning Objectives for PBL Case: Ashlee Grey


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe the basic mechanisms for the common disease states that result in jaundice. Describe the basis of liver function testing and the common alterations in liver enzymes associated with acute hepatic injury, cholestasis, cirrhosis, alcoholic liver disease, fatty liver disease and acute and chronic hepatitis. Describe the structure of the liver and biliary system at both the gross and microscopic levels. Describe the arterial blood supply and the venous drainage of the liver and biliary system. Describe the hepatic portal venous system including the sites of porto-systemic anastomoses. Summarise the innervation of the liver and biliary system and mechanisms of pain from these regions (including referred pain). Briefly describe the major groups of lymph nodes and the pattern of lymphatic drainage of abdominal viscera. Describe the process of bile production, storage and stimulus for release into the small intestine. Describe the normal metabolic functions of the liver. Differentiate between acute and chronic liver disease. Describe the pathophysiological mechanisms of portal hypertension at prehepatic, hepatic and posthepatic levels and explain the clinical features of portal hypertension. List other complications and long term consequences of liver disease. Compare and contrast cause, communicability, spread and disease progress of hepatitis A, B and C (in table format). Describe the pathology of hepatitis, cirrhosis and tumours of the liver (including patterns of alcohol and hepatitis virus-related liver injury). The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Outline the doctor's obligations under the Public Health Act (2005) in relation to the notification of notifiable and controlled notifiable conditions. Discuss the ethical issues relating to public health control measures in terms of public goods vs individual rights Recognise the social and political context of transplantation and donation. Identify potential conflicts of interest between, and importance of separating, retrieval and donation teams. Explore the medical consequences of how death is defined under the Transplantation and Anatomy Act (1979). Apply your knowledge of the Transplantation and Anatomy Act (1979) to a clinical scenario. The Doctor and Patient Primary learning objective(s) Demonstrate competence in exploring a patient's experience of important gastrointestinal presentations (abdominal pain, changed appetite, unintentional weight change, nausea, vomiting, heartburn, reflux, dyspepsia, dysphagia, odynophagia, haematemesis, melaena or rectal bleeding) [REVISION] including: the cardinal characteristics of the symptom and its time course; relevant associated symptoms; the patient's understanding of, and concerns about, what they are experiencing.

Demonstrate competence in the examination of a patient for the assessment of gastrointestinal symptoms and other presentations that might be associated with abnormalities on abdominal examination. [REVISION] Recognise the common and the 'red flag' conditions giving rise to abdominal signs, then discuss the historical and examination features characteristic of each. [REVISION] Break health-related bad news to a patient or their significant other sensitively and effectively, in a manner that facilitates their understanding and coping with the information. The Doctor and Health in the Community Primary learning objective(s) Describe the medical and psychosocial risks associated with IV drug use and alcohol abuse.[Population health / Preventive medicine] Discuss strategies for addressing and assessing patients with suspected alcohol problems in general practice.[Primary health Care] Discuss the impact of hepatitis and chronic liver disease on both a patient and family.[Primary health Care]

Learning Objectives for PBL Case: Patrick Drummond


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Describe normal respiratory volumes and capacities for adults and outline how they vary with age, obesity and disease. Describe the physical factors influencing pulmonary ventilation, including airway resistance, alveolar surface tension and lung compliance. Describe the causes and mechanisms underlying Type I respiratory failure and Type II respiratory (ventilatory) failure. Describe the pathophysiological mechanisms underlying chronic airway obstruction (fixed obstruction). Describe COPD; include the natural history, causes and clinical manifestations. Briefly outline the pathology of interstitial lung disease. Describe the pathophysiological mechanisms of cor pulmonale and the principles of treatment. Discuss the interrelated factors contributing to shortness of breath. Describe how to diagnose and assess the severity of airflow obstruction using pulmonary function testing , and differentiate patterns of obstructive and restrictive lung disease. Review the interpretation of blood gas analysis. Review how pH is maintained in the body and be able to determine simple acid base disorders. Describe the causes and clinical manifestations of sleep apnoea syndromes and sleep hypoventilation. Describe the polysomnographic test and interpret the differences in sleep patterns associated with obstructive sleep apnoea. Describe the principles of the management of obstructive sleep apnoea and chronic ventilatory failure (e.g. CPAP, weight loss, bronchodilators). Describe the targets and efficacy of drugs used in the treatment of chronic airflow limitation, in particular: inhaled beta 2 agonists and anticholinergics; oral and inhaled corticosteroids. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Discuss the legal, professional and ethical responsibilities involved in allowing someone with a condition that will impair their ability to drive. The Doctor and Patient Primary learning objective(s) Demonstrate competence in the performance and interpretation of simple spirometry, as well as the administration of common respiratory therapies in both the hospital and community settings. Recognise and challenge stereotypical views in relation to the roles, practices and expertise of particular health professions in their own thinking and in the communication of others. [IPL] Demonstrate confidence in assisting a volunteer patient to provide a focussed medical history. Demonstrate confidence in performing a limited clinical examination on a consenting volunteer patient. The Doctor and Health in the Community

Primary learning objective(s) Discuss the public health implications of sleep apnoea syndromes and sleep hypoventilation [Public health]. Discuss the factors affecting adherence with medical therapy, including patient education and behavioural change [Primary health care]. Discuss the association between smoking and respiratory disease [Public health]. Describe the roles, practices and expertise of effective members of each of the other major health professions, in this case focusing on the roles of the allied respiratory professionals [IPL].

Learning Objectives for PBL Case: Jeremy Thomas


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Review the anatomy and histology of the kidney filtration barrier Review the physiological mechanisms that regulate GFR and the molecules that are filtered in the glomerulus Review the physicochemical forces that determine fluid movement across capillary endothelium Describe the pathophysiology of nephrotic syndrome. List the common causes of nephrotic syndrome List the common causes of peripheral and pulmonary oedema Outline the basic physiological mechanisms that regulate plasma volume Outline the cardiovascular and respiratory consequences of nephrotic syndrome Outline the coagulation consequences of nephrotic syndrome. Describe the actions of thiazide, loop and potassium-sparing diuretics List the effects of glucocorticoids at pharmacological doses Briefly outline the rationale for the treatment and monitoring of patients with nephrotic syndrome. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Review the law of competency as it applies to treating minors. Review the principles of the Gillick decision as they apply to this case.

Learning Objectives for PBL Case: Gailord Julius


At the end of the case and associated sessions, students will be able to: The Doctor, Knowledge of Health and Illness Primary learning objective(s) Discuss the physiological necessity of circulating volume replacement; Frank-Starling's law of the heart (role of central venous pressure (CVP) in cardiac output). Describe the importance of ionic potassium in normal cardiovascular (and neural) functioning. Identify alternative fluids for blood volume replacement and describe the different volumes of distribution of plasma expanders and saline and glucose solutions. Describe the broad categories of shock and the underlying mechanisms of each. Compare and contrast the structure and function of arteries, veins and capillaries. Outline the pathophysiology and clinical features of aneurysmal disease. Discuss other common arterial (atherosclerosis, dissection) and venous diseases (e.g. varicose veins, post-phlebitic venous disease and chronic ulceration). Review the arterial supply and venous drainage of the head, neck, trunk and limbs (upper and lower). Review the processes involved in blood clotting Describe the different classifications of renal failure: pre renal, renal, post renal. Define the term 'acute renal injury' and outline the conditions that may lead to it. Outline the biomedical basis of dialysis and relate the composition of dialysate to the replacement of the various kidney functions. The Doctor, Law, Ethics and Professional Practice Primary learning objective(s) Detail the law in relation to consent as it applies to emergency situations. Explore the issue of capacity and consent for this patient. Outline the process of appointing a substitute decision maker when an adult is incompetent. The Doctor and Health in the Community Primary learning objective(s) Briefly discuss the key differences in access to health care and burden of illness between urban and rural populations.[Public Health] Discuss the principles of chronic disease self management.[Primary health care].