Modules

• Year 1
  • Introduction to Year 1 and Year Outcomes
  • Fundamentals of Medicine
  • Cardiorespiratory 1
  • Metabolism 1
  • Locomotor 1
  • Brain and Behaviour 1
  • Human Development 1
  • Medicine in Society 1
  • Clinical Communication Skills
  • Student Selected Component (SSC)
• Year 2
  • Introduction to Year 2 and Year Outcomes
  • Cardiorespiratory 2
  • Metabolism 2
  • Brain and Behaviour 2
  • Human Development 2
  • Human Sciences and Public Health 2
  • Locomotor 2
  • Cancer Week
  • Moving and Handling Training
  • Year 2 Lifesaver Programme
  • Clinical Communication Skills
  • Medicine in Society 2
  • Extended Patient Contact
  • Student Selected Component (SSC)
• Year 3
  • Introduction to Year 3 and Year Outcomes
  • Clinical Science and Professionalism (Weeks 1-3)
  • Cardiovascular, Respiratory and Haematology (CR3)
  • Gastroenterology and Cancer (MET3A)
  • Public Health
  • Endocrinology and Renal Medicine (MET3B)
  • General Practice and Community Care
  • Student Selected Component (SSC)
  • Clinical and Communication Skills
• Year 4
  • Introduction and Year 4 Outcomes
  • Obstetrics and Gynaecology
  • Child Health
  • HIV & Sexual Health
  • Musculoskeletal
  • Health Care of the Elderly
  • Neuroscience
  • Dermatology
  • General Practice and Community Care
  • Psychiatry
  • Ear, Nose and Throat
  • Global Health and Ethics
  • Ophthalmology
  • Clinical & Communication Skills
  • Student Selected Component (SSC)
• Year 5
  • Introduction to Year 5 and Year Outcomes
  • Teaching Week 1
  • Teaching Week 2
  • Anaesthesia & ITU (AN & ITU)
  • Breaking Bad News
  • Clinical Pharmacology & Therapeutics
  • Community Care
  • Doctors as Teachers and Educators (DATE)
  • Emergency Medicine (EMERG MED)
  • General (Internal) Medicine (G(I)M)
  • Immediate Life Support (ILS)
  • Student Assistantship
  • Simulation
  • Surgery
  • Student Selected Component (SSC)
• Year GEP 1
  • Cancer Week
  • Movement and Posture
  • Carriage of Oxygen
  • Human Sciences and Public Health
  • Digestion, Growth and Metabolism
  • Infection and Immunity
  • Ethics
  • Brain and Behaviour
  • Human Development
  • Clinical Communication Skills
  • Medicine in Society (GEP)

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Year 3 MET3B: Endocrinology and Renal Medicine (MET3B)

• Dr Tahseen Chowdhury
• 131797678218-281@studio24.net

Teaching Material for this Module

Introduction

In addition to the learning objectives given in the Year 3 Handbook, students are expected to achieve the following objectives whilst attending their MET3B placement:

1. The development of core clinical and communication skills as per the Clinical and Communication skills handbook

2. Core knowledge and skills in the metabolism system

3. Competence in relevant practical skills

4. Satisfactory completion of MET3B PBL/CBL sessions

5. Attendance at ALL MET3B lectures and teaching sessions during the introductory week

6. Attendance at ALL GP sessions

7. Satisfactory completion of the Year 3 SSCs

8. Attendance at the half day  hospice visit is compulsory.

You should be aware that the majority of your knowledge should be gained from spending time on the wards; the set teaching is there to supplement this. Be aware that patients and their diseases do not behave as the textbooks imply - in neatly defined categories. Instead they may have many features and presentations that cross systems.

KEY TO THE PRIORITY OF CONDITIONS

By the time you reach Foundation Year, you will be expected to know about the conditions in this module. The Priority codes give you an idea of their importance:

Priority * = Emergency, life threatening or serious condition. Essential to bbe able to recognise and know how to treat.

Priority 1 = Have a good knowledge of these conditions; be able to recognise them and be familiar with their treatment

Priority 2 = Have some knowledge of these conditions and their treatment

Priority 3 = Be aware of the existence of these conditions and know where to seek more information about them

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Sessions

• Lecture: Acute Kidney Injury (AKI)
  1. Define the term acute kidney injury
  2. Formulate a comprehensive list of differential diagnoses for AKI in a structured manner.
  3. Understand the pathological consequences of AKI (in particular hyperkalaemia, fluid overload and uraemia).
  4. Understand how to investigate AKI and the clinical relevance of each test.
  5. Know how to manage the life threatening complications of AKI.
  6. Know the indications for continuous veno-venous filtration/haemodialysis.
• Self Directed Learning and Clinical Exposure (SDL and CE)
  1. Be able to carry out a fluid balance assessment and understand the contributory value of bedside investigations.
  2. Understand how urinalysis and microscopy can help distinguish between causes of AKI.
  3. Understand the difference between crystalloids and colloids and their role in resuscitation of AKI.
• Lecture: Chronic Kidney Disease (CKD)
  1. Know the most common causes of CKD and their basic pathophysiology.
  2. Be familiar with the five stages of CKD and the correlating management implications.
  3. Understand the pathological systemic effects of CKD (anaemia, renal bone disease, hypertension, acid base imbalance, uraemia) and how they can be monitored.
  4. Appreciate the importance of controlling hypertension, hyperglycaemia and proteinuria.
  5. Be aware of the dietary requirements of patients with advanced CKD.
• SDL and CE
  1. Know the mechanism of action of loop and thiazide diuretics.
  2. Understand the role of the renin-angiotensin-aldosterone system and medications which have an antagonistic effect (ACE-Is, ARBs).
  3. Practise interpretation of blood tests relevant to managing anaemia, secondary and tertiary hyperparathyroidism and acid-base balance.
  4. Understand how and why proteinuria is monitored.
• Lecture: Dialysis
  1. Understand the physiological principles behind haemodialysis and peritoneal dialysis.
  2. Be able to identify dialysis access points (fistula, tunnelled dialysis line, peritoneal dialysis line).
  3. Be aware of the practical aspects of each therapy (e.g. home or hospital based, how often administered etc.) and the impact on the patients daily life.
  4. Know the main advantages and disadvantages of each therapy.
  5. Understand RRT is not appropriate for all patients and providing high quality supportive care is an important part of every CKD service.
• SDL and CE
  1. Be able to identify dialysis access points (fistula, tunnelled dialysis line, peritoneal dialysis line).
• Lecture: Kidney Transplantation
  1. Be familiar with the different types of transplant - live donor, DBD (donated after brainstem death), DCD (donated after cardiac death).
  2. Understand the basic principles of transplant immunology (blood typing, HLA mismatch).
  3. Be aware of the potential complications faced by transplant patients (rejection, malignancy, diabetes, opportunistic infections).
• SDL and CE
  1. Be aware of the major classes of immunosuppressive medications used in renal transplantation.
  2. Be able to perform an abdominal examination to elicit the presence of a renal allograft.
  3. Be aware of the ethics and challenges surrounding organ donation e.g. shortage of organs, opt in versus opt out systems; and ways to increase organ provision e.g. pool or chain donation.
• Lecture: Glomerulonephritis
  1. Know the diagnostic criteria for nephrotic syndrome and nephritic syndrome.
  2. Appreciate that these two clinical syndromes are at opposite ends of a spectrum of clinical presentations.
  3. Understand the main history and examination findings in patients with nephrotic and nephritic syndrome.
  4. Know the common differential diagnoses for a new presentation of each syndrome.
  5. Understand the relevance of each test in an acute nephritic screen.
  6. Be aware of the life threatening complications of a rapidly progressive glomerulonephritis.
• SDL and CE
  1. Be aware of the proposed pathophysiology mechanisms behind the development of oedema in nephrotic syndrome
  2. Understand the principles behind the management of nephrotic syndrome
• Lecture: Benign Prostatic Hypertrophy
  1. Understand how to assess adults with lower urinary tract symptoms.
  2. Be aware of the medical and surgical management of benign prostatic hypertrophy.
• Lecture: Urinary Tract Infection (UTI)
  1. Know the common predisposing factors for UTI.
  2. Be able to describe the common symptoms associated with UTI and differentiate them from other lower urinary tract symptoms.
  3. Be aware of the common micro-organisms that cause UTI.
  4. Understand the principles of treatment and how length and course of antibiotics may vary depending on the patient.
  5. Know the methods of investigating recurrent UTIs.
• SDL and CE
  1. Be able to perform urethral catheterisation (skills lab).
  2. Know how to interpret urine dipstick results.
• Lecture: Renal Stone Disease
  1. Describe the clinical features of a patient with renal calculi
  2. Know the risk factors for developing renal calculi.
  3. Know the investigations used to diagnose underlying predisposition to renal calculi.
  4. Understand the role of diet in management of stone disease.
  5. Describe the surgical and non-surgical approaches to treating renal calculi.
• SDL and CE
  1. Be aware of metabolic conditions that can lead to renal tract calcification.
• Lecture: Surgical Aspects of Urological Cancer
  1. Describe the clinical features associated with renal tract tumours.
  2. Describe the risk factors associated with the development of renal tract tumours
  3. Understand the investigations available to establish a diagnosis.
  4. Understand the use and limitations of prostate specific antigen (PSA) in diagnosis.
  5. Understand the surgical approach to treating renal tract tumour.
  6. Be aware of the use of chemotherapy, radiotherapy, immunotherapy and hormone therapy.
  7. Be aware of the prognosis of patients with renal tract tumours.
• SDL and CE
  1. Understand the significance of visible versus non-visible haematuria.
  2. Know how to systematically investigate a new presentation of visible haematuria.
• Lecture: Oncological Aspects of Urological Cancer
  1. Be aware of the use of chemotherapy, radiotherapy, immunotherapy and hormone therapy
  2. Be aware of the prognosis of patients with renal tract tumours
• Lecture: Breast Disease
  1. Recognise normal and physiological findings.
  2. Recognise the features of benign breast disease eg. fibroadenoma, multi-duct nipple discharge, breast cysts, cyclical mastalgia.
  3. Take a history of breast symptoms.
  4. Take a history to assess the risk factor for breast disease.
  5. Be able to carry out an examination of the breasts including examination of the axillary lymph nodes and lymph node drainage sites.
  6. Appreciate the mammographic appearance of impalpable lesions.
  7. Assess potential sites of distant disease.
  8. Be able to discuss in professional and layman's terms, surgical approaches to breast disease in order to provide informed consent.
  9. Be able to propose a diagnosis from clinical findings and plan management.
  10. Recognise the role of ultrasound, mammography and cytology in management of breast disease.
• Lecture: Breast Cancer
  1. Evaluate the role of breast screening programmes.
  2. Know the risk factors, incidence, mortality, and prevention of common breast cancers.
  3. Know the common pathological types, prognostic factors, and receptors involved.
  4. Know the clinical presentation, diagnosis, and staging of breast cancer.
  5. Understand the treatment of early breast cancer to maximise cure.
  6. Recognise and justify the differing methods of surgical treatment of breast cancer.
  7. Understand the treatment of metastatic breast cancer to optimise palliation.
  8. Be aware of some new diagnostics, drugs, and recent clinical trials in breast cancer.
  9. Be aware of the role of rehabilitation and supportive care.
  10. Be able to evaluate the role of Nurse Counsellors, pain control and terminal care; and appreciate the role of a multi-disciplinary team approach to breast cancer.
• Lecture: Diabetes Aetiology, Diagnosis, Presentation
  1. Be able to classify the types of DM and list the causes of secondary DM.
  2. Be able to differentiate between Type 1 and Type 2 DM.
  3. Recognise the contribution of genetic and environmental factors in the aetiology of Type 1 and Type 2 DM.
  4. Know the diagnostic criteria for DM, impaired fasting glycaemia (IFG), impaired glucose tolerance (IGT) and pre-diabetes.
  5. Know the presentation and initial management of diabetes.
• SDL and CE
  1. Understand the pathophysiology of obesity and insulin resistance
  2. Understand the relationship between hepatic steatosis with obesity, insulin resistance and diabetes
  3. Understand the following terms: insulin resistance; glucose tolerance; metabolic syndrome
• Lecture: Diabetic Emergencies
  1. Be able to distinguish between the following terms and conditions: hypoglycaemia; diabetic ketoacidosis; hyperglycaemia; hyperosmolar hyperglycaemic state.
  2. Know how to manage a patient with hypoglycaemia.
  3. Know how to manage a patient with diabetic ketoacidosis.
  4. Know how to manage a patient in a hyperosmolar hyperglycaemic state.
  5. Understand the precipitating factors in hyperglycaemic states
  6. Apply BRAINS&AIMS when choosing, giving and monitoring the following medication for Hypoglycaemia: 20% Glucose; Glucagon
  7. Apply BRAINS&AIMS when choosing, giving and monitoring the following medication for Hyperglycaemia: Insulin; IV Fluids; IV Potassium; Low Molecular Weight Heparin (LMWH)
• Lecture: Insulin, GLP-1 and Oral Hypoglycameic Agents
  1. Be able to describe methods for assessing glycaemic control.
  2. Understand why good glycaemic control is important, and be aware that targets for glucose control may vary between individuals.
  3. Describe the principles of management of the newly diagnosed diabetic patient including the role of diet/lifestyle.
  4. Understand the indications and side effects of the various classes of oral hypoglycaemic agents / newer injectable agents.
  5. To be able to describe common insulin regimes and prescribe insulin safely.
• Lecture: Complications of Diabetes
  1. Describe the long term complications of diabetes, microvascular, macrovascular, other
  2. Know the risk factors for development of complications.
  3. Be aware of the importance of education, preventative medicine and early recognition of complications.
  4. Know the importance of regular screening for complications of diabetes.
  5. Know the goals for treatment of hypertension, lipids and glycaemia to prevent complications.
  6. Be aware of the fungal infections that may present in patients who have diabetes.
  7. Be aware of the psycho-social impact of diabetes complications on the individual with diabetes and society in general.
• Lecture: Pituitary Disease
  1. Be able to describe the structural and functional relationships between the hypothalamus and the pituitary gland.
  2. Be able to list the hormones secreted by both the anterior and posterior pituitary and in each case explain the role of the hypothalamus in regulating their secretion.
  3. Be able to briefly outline the actions of the hormones of the posterior and anterior pituitary.
  4. Describe the clinical features and management of syndromes of pituitary hormone excess (acromegaly, Cushings, hyperprolactinaemia).
  5. Describe the clinical features and causes of hypopituitarism and outline the investigations/treatment required.
• Lecture: Thyroid Disease
  1. Describe the position and anatomical relationships of the thyroid gland.
  2. Define goitre, list the causes and briefly describe the pathology.
  3. Define the role of isotope scanning, ultrasound and fine needle cytology in the investigation of thyroid lesions.
  4. Distinguish thyroid enlargement from other lesions in the neck by examination.
  5. List the possible causes of thyroid enlargement in a euthyroid patient.
  6. Be able to describe the various benign and malignant tumours of the thyroid.
  7. Be aware of the surgical and non-surgical treatment options for thyroid tumours.
  8. Know the clinical features, investigations and management of patients with hypo- and hyperthyroidism.
• Lecture: Acid-Base Balance
  1. Understand the basic physiological principles behind acid base balance.
  2. Understand the relationship between respiratory and metabolic control of acidaemia
  3. List causes of a normal and high anion gap.
  4. Describe common causes of lactic acidosis.
• Lecture: Salt and Water Balance
  1. Understand the causes of hypernatraemia and hyponatraemia.
  2. List the causes of thirst and polyuria.
  3. Describe the initial investigations which help to distinguish cranial and nephrogenic diabetes insipidus and psychogenic polydipsia.
  4. Understand the principles of treating hypernatraemia and hyponatraemia.
• Lecture: Endocrine Hypertension and Calcium Disorders
  1. Describe the structure of the adrenal gland and relate the zones to production of hormones.
  2. Describe the blood supply to the adrenal gland and the functional relationship between the adrenal medulla and the nervous system.
  3. Know the strategy for investigation of endocrine hypertension.
  4. Outline the laboratory and radiological investigation of suspected Conn's syndrome and phaeochromocytoma.
  5. Describe the possible mechanisms of endocrine mediated hypertension with reference to phaeochromocytoma, Conn's Syndrome and renal artery stenosis.
  6. Describe the presenting clinical features of Conn's Syndrome and phaeochromocytoma.
  7. Be able to distinguish between the following terms and conditions: Hypercalcaemia; Primary hyperparathyroidism; Secondary hyperparathyroidism; Tertiary hyperparathyroidism.
  8. Describe the clinical features of acute hypercalcaemia and its initial management
  9. List the causes of hypercalcaemia and outline the diagnostic investigations
  10. Apply BRAINS & AIMS when choosing, giving and monitoring the following medication for Hypercalcaemia: Saline; Furosemide; Bisphosphonates; Prednisolone
  11. Describe the clinical features and initial management of hypocalcaemia
• Lecture: Cushing's and Addison's Disease
  1. Describe the clinical syndromes underlying causes and pathology associated with adrenocortical hypofunction.
  2. Distinguish between adrenal failure and pituitary-adrenal failure by means of clinical features assisted by laboratory investigations.
  3. Outline the maintenance treatment of adrenal insufficiency including precautions for inter-current illness.
  4. Describe the emergency management of acute adrenal insufficiency.
  5. Discuss the clinical features, causes and pathology of Cushing's Syndrome.
  6. Outline the laboratory and radiological investigations which help to distinguish pituitary, adrenal and ectopic causes of Cushing's Syndrome.
• PBL: Polycystic Ovarian Cancer (PCOS)
  1. Define PCOS and describe it’s clinical features.
  2. Be able to explain the underlying pathogenesis of PCOS, and it’s relationship with insulin resistance.
  3. Explain investigation and differential diagnosis of PCOS.
  4. Describe management strategies for PCOS, including management of infertility, irregular menses and hirsutism.

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