MedSS Notes April 9-10 & 15-17, 2011
This copy of MedSS Notes belongs to:
Introductions Welcome to MedSS 2011 – Tasha Maheu & Holden Sheffield Your MedSS Team Program Supporters Lectures (with notes included) Welcome – Tasha Maheu Heart Anatomy/Physiology, Atherosclerosis and Ischemic Heart Disease – Victor Rogozovsky Genetics and Genetic Disease – Janet Simons “Do You Really Know About Diabetes?” – Narendra Singh & Haroon Yousuf Acute Wound Evalulation – Yu Kit Li Forensic Pathology – Tasha Maheu Infectious Disease – Justin Tilak Medical/Biomedical Research – Chelsea Maedler Aging and Cognition – Tyler Chesney Radiology – Mark Niglas Additional Lectures PBL – Christine Ibrahim Approach to Respiratory Distress – Ben Tam Med Student Profiles – Tara Baxter, Leah Hillier, Emma Jeavons, Tasha Maheu, Sarah Peltz, & Matthew Tenenbaum Canadian Forces – Emily Bournival Pharmacology related to the Autonomic Nervous System – Zeeshan Ahemd Being a Doctor – Dr. Ira Price Orthopedics – Talia Varley
Clinical Skills Clinical Skills Sessions History Taking – Supreet Bhullar Abdominal Examination – Melanie Steele & Matt Conway Mental Status Exam – Cindy Liu The Respiratory Exam – Alexandra Marseu The Cardiovascular Examination – Ashish Patel Workshops Tutorial Tutorial Scenario Tutorial Groups Back Matter Pre-Program Survey Post-Program Survey Parting Words from the Executive Schedule (on back cover)
Welcome to MedSS 2011! On behalf of all the members of the MedSS 2011 committee, we would like to congratulate you for being selected by your school to participate in this year’s MedSS program. MedSS is designed specifically for you – senior high school students who are nearing the end of their secondary school education and preparing for their post-secondary studies. This is an important, exciting, and intimidating part of your career. In a few short months, some of you will be starting your undergraduate degree in university – and many of you have already started thinking about what you want to do after that degree. Not too many years ago, we were in your shoes. We are here this week to share with you our experiences, our knowledge, and our passion for medicine. We hope that in the process you will not only increase your knowledge base, but also have an exciting and memorable experience. Over the next five program days, you will meet dozens of medical students in various stages of their training. All of these medical students are volunteering their time to work with you, and are very excited to be part of your experience. Don’t be intimidated! The med students are here for you – and are more than happy to teach, talk, and answer questions. For the next week you will be attending university-style lectures in university lecture halls. This is a great chance to get used to the pace and format of live undergraduate lectures – which you might find quite different from your high school classes! Practice taking notes, keeping up and getting your questions answered in a room full of people that you don’t know. If you fall behind, don’t worry about it! Just stop, and start again. If you find you are already familiar with some of the material, don’t get frustrated. Use the opportunity to solidify your knowledge, or ask questions that will expand your understanding of the topic. We aren’t here to teach you medicine. You’ll have to wait for medical school for that! But through lectures, small group clinical skills sessions and personalized workshops, we hope to give you a better understanding of medical school itself, how we got here and how learning . . . never really ends. Take some time to get to know your classmates. You might find out that some of them will be going to the same university as you next year – and it’s always nice to see a familiar face in the halls. You probably have more in common with each other than you realize. When I was in grade 12 (way back in the days of OAC), I participated in a summer science and engineering camp – SHAD. Years later, on my first day of med school, I found out that two of the people I had met in camp were in my medical school class! Take notes, ask questions, and have fun. All of the material in this book is put together for you by the medical student volunteers (or cited if it was taken from elsewhere) to help you with the material we are presenting to you – although written carefully, we cannot guarantee the accuracy of the information in this book. It is not medical advice, nor should it be used to give medical advice. The information and views presented in this book are those of the independent presenters/authors – not of MedSS, it’s organizers, nor
McMaster University. It is really important to remember that no part of MedSS is intended to qualify you, in any way, to perform medical procedures or give medical advice. We hope that you make the most of this unique opportunity and take back some of what you learn this week to your classmates and friends. Sincerely,
Tasha-Rachelle Maheu MedSS Program Founder
When colleagues and staff found out about MedSS, they would often ask, “What is the purpose of the program?” A lot of people thought, “Why would high school students need to learn about medicine?” They were legitimate questions, and ones I would think about frequently. I would often explain that the content of the program, in reality, means very little. While the little individual bits and pieces do make up the program as a whole, they do not represent what the program stands for. The purpose of the program is to plant a seed of possibility into high school students. It is to give them a glimpse of what life as a medical student is like, and show them that they can achieve their dreams. Some of you, who attend, might have already known that you wanted to attend university, and possibly medical schools, while others might have been on the fence, or have never even considered medical school as an option. This program will give you the opportunity to explore medicine as a career. Perhaps it will introduce medicine as a very real option that you can consider, and achieve. Hopefully, above all, let the program motivate you, and open your eyes to all the possibilities that lay ahead. Medicine speaks to me because it offers so many different opportunities. Within the field of medicine, there remain a wide range of career paths. It opens far more doors then it closes. It gives me the opportunity to travel to countries I would have never dreamed of going. It is rare to find a career that offers such diversity, flexibility, and is rewarding at the same time. Hopefully you will get to experience some of this throughout the program. Sincerely,
Holden Sheffield MedSS Co-Chair
Your MedSS 2011 Team MedSS Co-Chairs Tasha Maheu Holden Sheffield MedSS Program Founder Tasha Maheu Workshop Committee Leader Dominique Yelle Clinical Skills Committee Leader Tara Baxter Interview Committee Leader Emily Bournival Lecture Committee Leader Elizabeth Birk-Urovitz Tutorial Committee Leader Deborah Kahan Undergraduate Liaison Nicholas Timmerman Helper Elf Leah Hillier Fundraising Coordinator & MedSS Notes Editor Matthew Tenenbaum
Lecturers Zeeshan Ahmed Tara Baxter Emily Bournival Tyler Chesney Leah Hillier Christine Ibrahim Emma Jeavons Yu Kit Li Chelsea Maedler Tasha Maheu Mark Niglas Sarah Peltz Dr. Ira Price Victor Rogozovsky Janet Simons Narendra Singh Ben Tam Matthew Tenenbaum Justin Tilak Talia Varley Sherman Wong Haroon Yousuf Clinical Skills Preceptors Heather Ambraska Bourne Auguste Supreet Bulhar Matt Conway Dan Goodman Cindy Liu Alexandra Marseu Mary Salib Melanie Steele Ashish Patel
Workshop Preceptors Micheal Au Stephanie Byun Marko Erak Dan Goodman Kaitlin Hesketh Ricky Jrearz Dr. Robert McCloy Mark Niglas Marisa Rossi Karen Wang Melanie Zimmerman Interview Practice Preceptors Erin Grant Leah Hillier Christina Martorelli Alexandra Marseu Janet McMordie Victoria Pila Matthew Tenenbaum
Tutorial Leaders Heather Ambraska Jennifer Brooks Mostafa El-Beheiry Kate Everdell Anusha Jahagirdar Janet McMordie Siraj Mithoowani Andrew Mulloy Richa Parashar Jenna Rebelo Kaitlynn Rigg Aviva Rostas Justine Seuradge Sherman Wong
Thank You to our
Be Safe! In order for everyone to have a safe, fun and fulfilling experience, we all need to work together to create a safe learning environment. This means waiting for instructions from your instructor before you touch equipment or material. This means following the directions you are given. This means asking for clarification if you don’t understand something; if you don’t understand, chances are there is someone else that doesn’t. This means always paying very close attention to what you are doing. This means that you need to remember that hot things are hot, sharp things are sharp, and if you think it might be a bad idea, it probably is. Just as importantly, this means washing your hands before and after touching anybody and any equipment. Every time. You would want your doctor to wash his hands before he examines you – and we want you to as well! All stations should have *FREE* alcohol-based hand sanitizer. Also, we included a personal bottle of sanitizer in your registration bags - bringing it around to each station with you is a very hygienic idea!
Accident & Fire Policy In case of an accidental injury while at MedSS, please stop and report any injury to the closest MedSS staff member. They will direct you further. Basic first aid kids are on site, but for any injury requiring medical attention, students will be taken to the emergency department, independently of MedSS. A guardian will be notified as soon as possible. In case of a fire, please follow Hamilton Health Sciences fire policy, as we will be in an HHS building.
Lectures In our first year of medical school, we generally have one or two mornings per week with lectures. Lectures are prepared and presented by physicians in the field. They are usually held in Hamilton in large groups (the entire class) and teleconferenced to the satellite campuses. This is a different style from the rest of the program â€“ which mostly occurs in small groups of around 7-10 students. The lecture topics correspond roughly with the material that we are studying in our tutorials â€“ but unlike some other medical schools whose teaching is heavily rooted in its lectures, our lectures serve more as a starting point for our reading and studying, which we do independently at home or in the library. We have tried to follow the same format in this program â€“ lectures will be attended as a class, and you will be split into smaller groups for the other activities. Lectures will be one hour each, with time for questions and/or a short break. Most of the lecturers in MedSS are medical students at various stages of their training. Much like us in our first year of training, you will find that some lectures can be quite overwhelming while others might be mostly review. Just remember to be flexible, to be patient and to remember that you do not need to learn all of the material and concepts that are being presented. You have the rest of your careers to learn all of that! You will probably find that lectures are quite different from the classroom teaching that you are used to. Use this opportunity to get used to the pace and to practice taking notes. Most importantly, ask questions!
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^ĐŚŽůĂƌƐŚŝƉƐ ,ĂǀĞĂ͞ďƵĚĚǇ͟ WƌĂĐƚŝĐĞŝŶƚĞƌǀŝĞǁŝŶŐƐŬŝůůƐ ƌĂŝŶƐƚŽƌŵ <ĞĞƉĂďĂĐŬͲƵƉƉůĂŶŝŶŵŝŶĚ ZĞƐĞĂƌĐŚ ŽůůĞŐĞƚƌĂŝŶŝŶŐ tŽƌŬŝŶƚŚĞĨŝĞůĚ <ĞĞƉĂŶŽƉĞŶŵŝŶĚ͘͘͘ŽƌǇŽƵŵŝŐŚƚŵŝƐƐŽƵƚ ŽŶ͛ƚĞǆĐůƵĚĞĂůůŽƚŚĞƌĐĂƌĞĞƌƐ ŽŶ͛ƚƐĞƚǇŽƵƌƐƉĞĐŝĂůƚǇŝŶƐƚŽŶĞ͊ǀĞŶĂƐĂŵĞĚŝĐĂů ƐƚƵĚĞŶƚ͊ ŽŶ͛ƚŐĞƚĚŝƐĐŽƵƌĂŐĞĚʹ ŐĞƚĞǆĐŝƚĞĚ͊
tŚĂƚĂƌĞƐŽŵĞƚŚŝŶŐƐǇŽƵĐĂŶĚŽ ŝŶƵŶĚĞƌŐƌĂĚ͍ ^ĞůĞĐƚƉƌŽŐƌĂŵĞůĞĐƚŝǀĞƐĐĂƌĞĨƵůůǇ ŚĞĐŬƚŚĞĂĚŵŝƐƐŝŽŶĐƌŝƚĞƌŝĂĨŽƌĂůůŽĨƚŚĞƐĐŚŽŽůƐǇŽƵŵŝŐŚƚďĞŝŶƚĞƌĞƐƚĞĚŝŶʹ ƌĞŵĞŵďĞƌ͗ĐƌŝƚĞƌŝĂĐŚĂŶŐĞ ŽǇŽƵŚĂǀĞƚŚĞƉƌĞͲƌĞƋƵŝƐŝƚĞƐĨŽƌƚŚĞƐĐŚŽŽůƐǇŽƵǁĂŶƚƚŽĂƉƉůǇƚŽ͍ ƌĞǇŽƵůĞĂǀŝŶŐǇŽƵƌƐĞůĨǁŝƚŚĂďĂĐŬͲƵƉƉůĂŶŝŶĐĂƐĞǇŽƵĚŽŶ͛ƚŐĞƚŝŶ͍ ,ĂǀĞĂďĂĐŬͲƵƉƉůĂŶ͊ ŚŽŽƐĞĞǆƚƌĂͲĐƵƌƌŝĐƵůĂƌƐ ĐĂƌĞĨƵůůǇʹ ǇŽƵĐĂŶ͛ƚĚŽĞǀĞƌǇƚŚŝŶŐ <ĞĞƉǇŽƵƌƐĞůĨǁĞůůͲƌŽƵŶĚĞĚ;ĂŶĚŶŽƚũƵƐƚƚŽŐĞƚŝŶƚŽŵĞĚƐĐŚŽŽůͿ ^ƚƌĞƚĐŚǇŽƵƌďŽƵŶĚĂƌŝĞƐʹ ƚƌǇŶĞǁƚŚŝŶŐƐ dŚĞƌĞĂƌĞŶŽ͞ŵĂŐŝĐ͟ ĞǆƚƌĂͲĐƵƌƌŝĐƵůĂƌĂĐƚŝǀŝƚŝĞƐ;ŝ͘Ğ͘ǀŽůƵŶƚĞĞƌŝŶŐŝŶĂŚŽƐƉŝƚĂůͿ ŚŽŽƐĞůĞĂĚĞƌƐŚŝƉ ŽǀĞƌƉĂƌƚŝĐŝƉĂƚŝŽŶ ǁŚĞŶƉŽƐƐŝďůĞ ƉƉůǇĨŽƌƐĐŚŽůĂƌƐŚŝƉƐĂŶĚĂǁĂƌĚƐ ŽŶƐŝĚĞƌĞǆƉůŽƌŝŶŐƌĞƐĞĂƌĐŚ KhDEdEZKZsZzd,/E'
Dd <ŶŽǁǁŚĂƚǇŽƵĂƌĞĞǆƉĞĐƚĞĚƚŽŬŶŽǁ;ƐĞĐƚŝŽŶƐŽĨDdͿ ,ĂǀĞĂƉůĂŶʹ ƐƚƵĚǇŝŶŐ͕ƌĞůĞǀĂŶƚƵŶĚĞƌŐƌĂĚĐŽƵƌƐĞƐ͕DdƉƌĞƉ ĐŽƵƌƐĞƐ͕DdďŽŽŬƐ <ŶŽǁƚŚĞƌĞͲǁƌŝƚĞƉŽůŝĐǇʹ ĂŶĚƵƐĞŝƚƚŽǇŽƵƌĂĚǀĂŶƚĂŐĞ <ŶŽǁƚŚĞŵŝŶŝŵƵŵƐĐŽƌĞƐƌĞƋƵŝƌĞĚďǇƚŚĞƐĐŚŽŽůƐǇŽƵǁĂŶƚƚŽĂƉƉůǇ ƚŽ ŚĞĐŬ;ĂŶĚƌĞͲĐŚĞĐŬͿDdĚĂƚĞƐʹ ŵĂŬĞƐƵƌĞǇŽƵǁƌŝƚĞŝƚKEd/D ^ƚĂǇŝŶĨŽƌŵĞĚĂŶĚƵƉƚŽĚĂƚĞ <ŶŽǁDdĚĞĂĚůŝŶĞƐ <ŶŽǁKD^^ĚĞĂĚůŝŶĞƐ;ƚŽƐƚĂƌƚĂŶĂĐĐŽƵŶƚ͕ƚŽƐƵďŵŝƚƌĞĨĞƌĞŶĐĞ ůĞƚƚĞƌƐ͕ƚŽĨŝŶĂůŝǌĞǇŽƵƌĂƉƉůŝĐĂƚŝŽŶ͕ƚŽƉĂǇ͘͘͘Ϳʹ Zd,Ed/Z t^/d <ŶŽǁĞĂĐŚƐĐŚŽŽůǇŽƵĂƌĞĂƉƉůǇŝŶŐĨŽƌ >ĞĂƌŶŝŶŐƉŚŝůŽƐŽƉŚǇ WZZYh/^/d^ EƵŵďĞƌŽĨǇĞĂƌƐŽĨƵŶĚĞƌŐƌĂĚƵĂƚĞĞĚƵĐĂƚŝŽŶŶĞĞĚĞĚ /ĨǇŽƵĚŽŶ͛ƚŚĂǀĞŝƚʹ ĚŽŶ͛ƚĂƉƉůǇ͊ Zd,t^/d^
EĞǀĞƌƌĞůǇŽŶƐĞĐŽŶĚͲŚĂŶĚŝŶĨŽƌŵĂƚŝŽŶ ůǁĂǇƐĐŽŶĨŝƌŵŝŶĨŽƌŵĂƚŝŽŶǇŽƵŚĞĂƌ ƐƉĞĐŝĂůůǇĚĞĂĚůŝŶĞƐĂŶĚƉƌĞͲƌĞƋƵŝƐŝƚĞƐ 'ĞƚƚŽŬŶŽǁǇŽƵƌƉƌŽĨĞƐƐŽƌƐ hƐĞŽĨĨŝĐĞŚŽƵƌƐ sŽůƵŶƚĞĞƌƚŽĚŽƌĞƐĞĂƌĐŚ ƐŬĨŽƌƌĞĨĞƌĞŶĐĞůĞƚƚĞƌƐZ>z /ŶƚĞƌǀŝĞǁƐŬŝůůƐʹ ƉƌĂĐƚŝĐĞ͕ƉƌĂĐƚŝĐĞ͕ƉƌĂĐƚŝĐĞ ĞĂďůĞƚŽƚĞůůǇŽƵƌƐƚŽƌǇĐŽŚĞƐŝǀĞůǇĂŶĚĐŽŵƉƌĞŚĞŶƐŝǀĞůǇ ,ĂǀĞĂ͞Z&ZE>ddZW<'͟ ŚŽŽƐĞƐŽŵĞŽŶĞǁŚŽŬŶŽǁƐǇŽƵǁĞůůʹ ĂǀŽŝĚŐĞŶĞƌŝĐůĞƚƚĞƌƐ ƌŝĞĨĞǆƉůĂŶĂƚŝŽŶŽĨƉƵƌƉŽƐĞŽĨůĞƚƚĞƌʹ ŝŶĐůƵĚŝŶŐǁŚŽŝƚƐŚŽƵůĚďĞ ĂĚĚƌĞƐƐĞĚƚŽ /ŶĐůƵĚĞƐƉĞĐŝĨŝĐĐƌŝƚĞƌŝĂǇŽƵĨŝŶĚŝŵƉŽƌƚĂŶƚŽƌǁŽƵůĚůŝŬĞŚŝŐŚͲůŝŐŚƚĞĚ hƉͲƚŽͲĚĂƚĞƌĞƐƵŵĞ WƌĞͲĂĚĚƌĞƐƐĞƐǆƉƌĞƐƐͲWŽƐƚĞŶǀĞůŽƉĞƐ >ŽƚƐŽĨƚŝŵĞʹ ĚŽŶ͛ƚďĞĂĨƌĂŝĚƚŽƌĞŵŝŶĚǇŽƵƌƌĞĨĞƌĞĞǁĞůůĂŚĞĂĚŽĨƚŚĞ ĚĞĂĚůŝŶĞ dŚĞďĞƚƚĞƌŝŶĨŽƌŵĂƚŝŽŶǇŽƵŐŝǀĞ͕ƚŚĞĞĂƐŝĞƌŝƚǁŝůůďĞĨŽƌƚŚĞƌĞĨĞƌĞĞƚŽ ǁƌŝƚĞǇŽƵĂŐŽŽĚ͕ƉĞƌƐŽŶĂůŝǌĞĚĂŶĚǀĂůƵĂďůĞůĞƚƚĞƌ
KE͛dƐƵďŵŝƚĂ͞WƌĂĐƚŝĐĞƉƉůŝĐĂƚŝŽŶ͟ dŚĞƌĞĂƌĞŵŽƌĞǁĂǇƐƚŽŐĞƚŝŶƚŽŵĞĚŝĐĂůƐĐŚŽŽůƚŚĂŶƚŚĞƌĞĂƌĞƐƉŽƚƐ͊dŚĞƌĞŝƐŶŽǇĞůůŽǁ ďƌŝĐŬƌŽĂĚ͘dŚĞƌĞŝƐŶŽĐŽŽŬŝĞͲĐƵƚƚĞƌ͘ /ƚŝƐĂůŽƚŽĨǁŽƌŬĂŶĚŝƚƚĂŬĞƐĂůŽƚŽĨƚŝŵĞʹ ƉůĂŶĐĂƌĞĨƵůůǇ EŽǁĂǇĂƌŽƵŶĚŝƚ ǇŽƵŶĞĞĚŐŽŽĚŵĂƌŬƐ ǇŽƵŶĞĞĚŐŽŽĚDdƐĐŽƌĞƐ ^ĞƚǇŽƵƌƐĞůĨĂƉĂƌƚͲ ůĞĂĚŝŶƐƚĞĂĚŽĨƉĂƌƚŝĐŝƉĂƚŝŶŐ ůǁĂǇƐ ŚĂǀĞƐŽŵĞŽŶĞƉƌŽŽĨͲƌĞĂĚǇŽƵƌǁŽƌŬ ZĞĐŽƌĚĂŶĚĚŽĐƵŵĞŶƚ^zKh'K EsZƌĞůǇŽŶƐĞĐŽŶĚŚĂŶĚŝŶĨŽƌŵĂƚŝŽŶ ;ŝŶĐůƵĚŝŶŐŵǇƉƌĞƐĞŶƚĂƚŝŽŶͿʹ 'KdKd,^KhZ ĞĐĂƌĞĨƵůǁŚŽǇŽƵƚĂŬĞƚŝƉƐĨƌŽŵ KE͛důŝŵŝƚǇŽƵƌƐĞůĨƚŽŽŶĞŽƌƚǁŽƐĐŚŽŽůƐʹ ĂƉƉůǇƚŽŵĂŶǇ KE͛d>d&KZEzd,/E'͙͘sZ Dd͕ĂƉƉůŝĐĂƚŝŽŶƐƵďŵŝƐƐŝŽŶƐ͕ƚƌĂŶƐĐƌŝƉƚƐ͕ĞƐƐĂǇƐ͕ƌĞĨĞƌĞŶĐĞƐ͕ŝŶƚĞƌǀŝĞǁƐ
DĂũŽƌDŽĚŝĨŝĂďůĞZŝƐŬ&ĂĐƚŽƌKĨ ƚŚĞƌŽƐĐůĞƌŽƐŝƐ ZŝƐŬ&ĂĐƚŽƌ ϭ͘,ŝŐŚ͞ĂĚ͟ ŚŽůĞƐƚĞƌŽů >Žǁ͞'ŽŽĚ͟ ŚŽůĞƐƚĞƌŽů
Ϯ͘,ŝŐŚůŽŽĚ WƌĞƐƐƵƌĞ ϯ͘^ŵŽŬŝŶŐ ϰ͘ŝĂďĞƚĞƐ ϱ͘KďĞƐŝƚǇ
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MedSS 2011, McMaster University
Speaker: Tyler Chesney
Aging and Cognition Parts of the Cerebral Cortex
Memory and three classifications
Language Fluency Â– F words
Visuospatial Draw Cube
AGING AND COGNITION What is Cognition? Cognition is all the mental processes associated with thinking. It takes place throughout the brain, usually involving complex networks in higher-order association areas. Most tasks, even simple ones, require precisely coordinated activity throughout these networks. Cognition can be broken into several cognitive functions or cognitive domains:
Attention Generalized attention is our generalized level of arousal and concentration. Selective attention is our ability to focus on one relevant set of information while ignoring irrelevant information. Brain region: various regions dependant on stimuli and type of attention
Memory Our ability to store, retain and recall information. Sensory memory is very short (milliseconds) memory of what we perceive through our senses. Short term memory is our ability to remember information for short periods of time. Long term memory allows us to store information indefinitely. Working memory allows us to actively maintain information while using it. Brain region: hippocampus involved in storing new memories.
Orientation Our awareness of time, place and person. Time includes time of day, date, month, year, day of week, season. Place may be within your home, within your neighborhood, or within a larger community and relates to our understanding of where we are in space. Brain region: uncertain, but requires brainstem and cerebrum.
Language Our ability to communicate vocally and in writing. This requires reading ability, writing ability, comprehension, and speech production. Brain region: Brocas area for speech production, Wernickes area for speech comprehension.
Visuospatial capacity Our ability to process and understand what is in our visual field. This could be recognition of objects, people and patterns, or understanding motions and organization of visual stimuli in space. Brain region: occipital lobe, dorsal pathways toward parietal lobe and ventral pathways toward temporal lobe.
Executive functions A cluster of higher-order control capacities. Our ability to initiate, plan, and sequence complex actions; organize information; make decisions; think abstractly; correct errors; change patterns of behavior; and inhibit unnecessary or inappropriate behavior. Brain region: frontal lobes
Praxis Our ability to plan and execute learned, purposeful movements. This could be carrying out a movement such as brushing our teeth, stirring a cup of tea, or blowing out a candle; or creating a plan or idea of a movement such as using a pen to write our name. Brain region: motor association areas, different dependant on type of movement
What is Normal Cognitive Aging? In general, cognition declines as we age starting in early adulthood. It is difficult to establish what is normal as this is contingent on many factors and there is great variation within the population. There are declines in many cognitive domains on specific tests, but language does not decline. In fact, language improves as we age. Despite this, there is great variation within the population, there may be other areas that do not decline or improve, and research is only beginning to answer these questions along with questions about the changes in the brain that cause these changes in cognition as we age.
Two theories attempt to explain the cognitive decline that occurs with aging.
Processing speed hypothesis The idea that all cognitive functions are limited by a maximum processing speed and that this processing speed declines as we age limiting our cognitive abilities. As tasks become more complicated our cognitive abilities cannot keep up. There is evidence that reaction time increases with aging and this supports the processing speed hypothesis.
Inhibitory deficit hypothesis The idea that to perform specific tasks our brain must inhibit activity in parts of the brain that are not useful for the task at hand and that our ability to do this declines as we age. This limits the efficiency with which we can use our cognitive abilities and this results in poor performance on demanding tasks. There is evidence that cognitive declines are greater than that explainable by just slower processing and that more areas of the brain show functioning in tasks as we age supporting the inhibitory deficit hypothesis.
Compensation by PASA and HAROLD? Posterior-Anterior Shift in Aging (PASA): shows on brain imaging that brain activation moves from the back of the brain to the front of the brain as we get older. This suggests that as our cognitive abilities decline we use more of our executive functions to compensate and actively control what used to be automatic processes. Hemispheric Asymmetry Reduction in Older Adults (HAROLD): shows on brain imaging that brain activation, which used to only happen on one side of the brain for a given task, now happens on both sides. This suggests that as our cognitive abilities decline we use more of the mirror-side of our brain to compensate and assist with task performance.
What Can Go Wrong? Although some cognitive declines are expected as we age, cognition can decline to a point that is beyond what is considered normal this is not just a part of aging. The degree of decline is measured using focused neuropsychological tests that provide information on the functioning of the cognitive domains noted above. Importantly, an individuals current functioning is compared to their peer group (same age, gender, years of education, etc.) in a standardized way to determine the degree of impairment.
MCI (Mild Cognitive Impairment) This is a clinical concept used to describe a measurable decline in a cognitive domain that is greater than normal. Importantly, this cognitive deficit does not impact on the day-to-day functioning of the person. People with MCI are at increased of risk of getting a dementia, but not all those with MCI get worse, and some even return to normal levels.
Dementia So what is it anyway? Dementia is specifically defined and includes measurable deficits in two cognitive domains and these deficits impact on day-to-day functioning of the person and these deficits cannot be better explained by another medical condition. AlzheimerÂ’s disease is the most common form of dementia; memory impairment is its earliest and most prominent feature. In AlzheimerÂ’s disease, plaques form in the brain between brain cells (neurons) and tangles form within neurons. These changes cause dysfunction in neurons and they ultimately die. This causes cognitive deficits, and the death of neurons causes the brain to shrink. Potential Signs of Dementia
Normal Cognitive Aging
Poor judgment and decision making
Making a bad decision occasionally
Inability to manage a budget
Missing a monthly payment
Losing track of the date or the season
Forgetting the day; remembering later
Difficulty having a conversation
Sometimes forgetting which word to use
Misplacing things and being unable to retrace steps to find them
Losing things from time to time; able to mentally retrace steps to find them
What should I do if I think I have a cognitive impairment? If you suspect deficits that are more than normal, or you notice deficits that are progressively getting worse over time, or if you are having difficulty doing tasks that were once not a problem you should contact your family doctor for an assessment. The Alzheimer Society is also an excellent resource for questions, concerns, and support.
How Can We Keep Our Brains Healthy? KEEP ACTIVE! Our brains stay healthy if we keep active in three ways physically, socially, and intellectually. This keeps out brains working and forming new neural connections.
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Clinical Skills Throughout our first year of medical school, we have one “clinical skills” session in a typical week. These are generally held at one of the hospitals. Our sessions are taught by residents or attending physicians – who teach us a particular set of skills. We would then go home and practice on ourselves, our family, our friends . . . and anybody who would tolerate having ten abdominal exams! This week we have organized a set of clinical skills sessions to give you an idea of the types of things we learn. We aren’t here to teach you how to do a cardiac exam so that you can diagnose your uncle’s heart murmur - we aren’t even qualified to do that! We want to share with you some of the amazing things that we get to learn. Again: after this week you will not be qualified to give any medical advice - it’s not only a bad idea, but it can be a pretty dangerous idea. You have lots to learn before you can do that. We have lots to learn before we can do that! This chapter includes a list of all the clinical skills sessions that we have planned for you this week and a description of what the instructor wants to teach you. Some of these sessions might change a little (or change entirely). We’ve also included some of the instructors’ handouts for you.
Clinical Skills Sessions Saturday April 9 History Taking Supreet Bulhar This session will begin by teaching the basic components of history taking. Using a practice scenario, we will conclude by teaching a focused approach to a common presenting complaint. Abdominal Exam Melanie Steele & Matt Conway Come learn how to perform an abdominal exam! Students will learn how to listen for bowel sounds and palpate for liver and spleen pathologies. Students will also learn to perform special tests to identify patients with appendicitis. Psychiatric Exam Cindy Liu In the Psychiatry clinical skills session, we will review basic history-taking skills, and integrate key components of a psychiatric examination. We will learn the terminology and go over the important signs and cues to look for. There will also be time to practice these skills in a relaxed setting by performing a psychiatric interview with a simulated patient.
Sunday April 10 Cardiac Exam â€“ Blood Pressure and Vital Signs Dan Goodman In this clinical skills session we will be learning how to do a proper vital status assessment of a patient. This will include learning the proper way to check for pulse rate and rhythm (at multiple sites), taking a blood pressure, respiration rate, temperature, and a discussion on saturation. Respiratory Exam Ali Marseu Crackles, ronchi and tactile fremitus! Come learn how to approach the respiratory exam! Learn the basic techniques and how to differentiate and diagnose some common presenting complaints.
Neurological Exam Mary Salib The goal of the neuro clinical skills session will be to review the basic anatomy and physiology of central and peripheral nervous systems and learn to examine the different sensory and motor modalities coordinated by the nervous system as a whole. We will focus on examining touch, pressure, vibration, temperature, pain, reflexes, and power. Time permitting, we will also examine the cranial nerves.
Sunday April 17 Musculoskeletal Exam – The Knee Bourne Auguste The knee is by far the most used joint in the body; it is needed for basic movements such as walking, running and even standing. The functionality of the knee is dependent on its associated ligaments; ligaments which are easily torn during strenuous physical activity. You will be learning the knee examination to recognize pathologies such as bursitis (inflammation of knee bursae) along with ACL, Collateral, Meniscal and PCL tears. Cardiac Exam – Heart Sounds Ashish Patel The cardiac examination is an integral part of any patient's medical evaluation. Two of the four key vital signs (blood pressure and heart rate) are directly evaluated through the cardiac exam. Carefully listening for murmurs and heart sounds help clinicians identify underlying pathology in a very non-invasive manner. After participating in the cardiac clinical skills workshop at MedSS, students will have a basic understanding of how to perform this examination. Otolaryngologic (ENT) Exam – Ears, Nose, and Throat Heather Ambraska Learn the most common exam done in family medicine - the ENT exam! We'll explore anatomy and pathology, with lots of time to look in each other's ears, noses, and throats. We'll also learn all about the lymph nodes of the head, and take a look through ophthalmoscopes at some retinas!"
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Workshops Everybody in medical school wants to become a physician. What you will quickly notice, however, is that everyone has substantially different interests. Medicine is a fascinating field – and your career can go in many different directions. Throughout medical school (and especially clerkship), students are exposed to a wide variety of specialties and have the opportunity to work with many different “types” of physicians. From these experiences, we decide which specialty we would like to practice. In our final year of medical school, we apply to the residency programs (in different specialties) that we are most interested in. Some students apply to only one field (for example, general surgery) while others apply to a number of specialties at a number of schools. Some residency spots are extremely competitive – like plastic surgery or ophthalmology – while other programs have more spaces available and can accommodate more students. We have designed the workshops to give you an opportunity to “choose” a specialty that you think interests you – and to explore it from a medical student’s perspective. Each workshop was designed by a single medical student or a small group. MedSS workshops are different than clinical skills – they are longer, they combine lectures and demonstrations and they are in small, more personal, groups. Workshops are 3 hours in length. Your workshop presenter will go over safety guidelines with you before they start – but a lot of what they are going to say is common sense. So remember – listen to instructions, follow directions, pay attention to what you are doing and have fun!
Tutorial Twice a week, we attend a small group tutorial. Our tutorials are three hours long and we are assigned a new tutorial group for each of the five units. The groups consist of six or seven medical students and one or two physicians “tutors”, who make sure we are on the right track and help us if we get stuck. Every tutorial we read through one (or two or three…) patient scenarios. We are given the patient’s relevant history, physical exam findings and lab values. As a group, we discuss the information in the case and decide what we think that we need to learn from in the form of learning objectives. Then we go home and independently research each of the objectives – different students spend different amounts of time preparing for their tutorials. Then, at our next tutorial, we discuss the objectives we made and the information we have found. We learn from each other and teach each other. When we are finished, we read through the next case and make the following tutorial’s objectives. It is really important to take the time to make good objectives. For example “what is cancer?” is not a great objective. Where do you start? When do you stop? What do you focus on? A better objective would be “what age group is most affected by breast cancer?” or “how does cigarette smoke contribute to lung cancer?” Good objectives are very clear and are precise – and will save you a lot of time and a lot of frustration when it comes time to research. It will also make sure that everyone is looking at approximately the same thing. It takes a while to learn how to make really good objectives (i.e. it takes making a lot of bad objectives, and having to spend hours of extra time researching, to learn what is not a good objective). You have all been assigned a tutorial group, which you will meet on your first day of class. Each group will have one to two medical students as “tutors” to help them form good objectives, to help guide the
discussion at the tutorial and to help fill in some of the gaps. All of the groups will work on the same case – this year we will look at myocardial infarctions (heart attacks). This chapter includes your case scenario – from which you, your group and your tutor will form learning objectives. This is your first tutorial, so you probably don’t want to make more than five or six objectives. Your tutor will help you decide what is important and what can wait. All of the groups will probably make slightly different objectives and will learn slightly different information. The group of medical students that wrote this scenario for you also came up with a list of resources for you to read or watch. It’s a good idea to start with these resources – because you’ll quickly learn that there is an overwhelming amount of information out there. You might not need other resources, but you might find ones you like better. You are not expected to spend all of your free time on your tutorial! You are only getting two nights to work on this – and your tutorial will only be two hours long. This might seem like a long time, but with six or seven students eager to share what they’ve learned, you’ll probably get a little less “floor time” than you expect. Everyone in your tutorial group will spend a different amount of time working on their tutorials. You really don’t need to spend more than a couple of hours a night preparing (less if you don’t have time) – but you might find the topics or objectives really interesting and want to work longer. As with everything, the more you work, the more you learn. If you don’t understand something, or can’t find something, don’t worry! That’s what your group is there for – to help you learn material you couldn’t and to provide you an opportunity to teach material you understand. You’ll be surprised at how much you can overestimate what you understand until you try to teach it to a peer.
Tutorial Scenario Mr. Jones is a 60 year old, overweight, retired high school teacher who lives alone. He has been smoking 1 pack of cigarettes a day since high school. He first experienced a dull, diffuse pressure one month ago which resolved with rest. Since then, he noted 3 similar episodes each occurring while climbing 2 flights of stairs from his basement to his bedroom. He went to his doctor and was diagnosed with angina. He was sent home with nitroglycerin, aspirin and atenolol. Last Friday, Mr. Jones was brought to the ER complaining of severe retrosternal chest pain while watching Family Guy. The pain radiated to his jaw and down his left arm. He describes the pain as "an elephant sitting on my chest." On examination, he is in obvious distress, diaphoretic, dyspneic, tachycardia at 120bpm and a respiratory rate of 27. His heart sounds are normal. A chest x-ray is normal, but an EKG confirmed an acute myocardial infarction. He was given stat oxygen, aspirin to chew, morphine and plavix and transferred immediately to the cath lab.
Resources Heart Anatomy Cardiovascular Consultants http://www.cardioconsult.com/Anatomy/ Heart Physiology Cardiovascular Consultants http://www.cardioconsult.com/Physiology/ Heart Function http://www.youtube.com/watch?v=hCp4hVC2fnM Conduction System of the Heart http://www.youtube.com/watch?v=gvLe2hSi84s Cardiovascular Diseases: Anatomy and Function of the Coronary Arteries University of Virgina Health System http://www.healthsystem.virginia.edu/UVaHealth/ adult_cardiac/arteries.cfm
Angina Canadian Heart and Stroke Foundation http://www.heartandstroke.on.ca/site/c.pvI3IeNW JwE/b.3581769/k.5444/Heart_Disease__Angina. htm Heart Attack and Unstable Angina â€“ Overview WebMD http://www.webmd.com/heart-disease/tc/heartattack-and-unstable-angina-overview Heart Attack (Myocardial Infarction) Medicine Net http://www.medicinenet.com/heart_attack/article. htm#
Tutorial Groups Group 1 Tutors: Jennifer Brooks & Andrew Mulloy Maya Sumaida Siddharth Dhingra Indhu Rammohan Sophia Duong Matthew Wong-Pack Olga Khudoyarova Supriya Thukral Group 2 Tutors: Janet McMordie & Jenna Rebelo Kevin Min Daniel Lemanna Emily Botelho Natasha Breward Aaron Sandhu Ramya Kancherla Cassandra Hryniewicki Group 3 Tutors: Heather Ambraska & Justine Seuradge Pengxiao Zuo Melanie MacRae Joshua Mark Manyu (Flora) Wang Fatima Lee Nguyen Esther Lee Group 4 Tutors: Kaitlynn Rigg & Sherman Wong Marissa Mark Noel Garber Cardinal Maria Quiroz Maria Nguyen Branden Scholze Valeria Michailovic
Group 5 Tutors: Mostafa El-Beheiry & Siraj Mithoowani Andrea Macikunas Robert Steele Asfia Soomro Rudy Unni Marina Ristovska Jenny Lin Group 6 Tutors: Aviva Rostas & Anusha Jahagirdar Francesca Torchia Megha Lama Josh Bradshaw Moose Memon Lisa Chalkin Jessica Guo Group 7 Tutors: Richa Parashar & Kate Everdell Karli Roberts Mire Farah Bharat Michael Jadon Alina Barnett Sarah Ziqui David Li
Med SS 2011 Pre-Programme Survey Your age ______ Your grade ______ Circle the number that best indicates how excited you are about attending Med SS: 0 1 2 3 4 5 6 7 8 9 10 I learned about Med SS from My Family My Teacher My School administration My Friend The Website Other _______________________ My Med SS tuition was paid for by My family My School Me Med SS Scholarship
If yes, which family member? _____________________________ What do they do? _____________________________ Check off the types of education you are considering completing High School College diploma Vocational School Undergraduate degree Masters Degree PhD Professional Degree I feel as though I have a good understanding of how much my education will cost Absolutely I think so Not sure I donâ€™t think so Definitely not
Other _______________________ I have a family member who works in health care Yes No
I anticipate trouble financing my education Absolutely Probably Not sure Probably not Definitely not
I am interested in the following health care professions Dentistry Nursing Physiotherapy Occupational Therapy Chiropractic Nutrition Medicine Therapeutic Massage Other ______________________ I want to be a doctor Absolutely I think so Not sure I donâ€™t think so Definitely not It is very difficult to become a doctor Absolutely I think so Not sure I donâ€™t think so Definitely not
I am smart enough to become a doctor Absolutely I think so Not sure I donâ€™t think so Definitely not
In order to become a doctor, you must complete an undergraduate degree True False In order to become a doctor, you must have a science degree True False
Med SS 2011 Post-Programme Survey Med SS was fun Absolutely Almost always Sometimes Not really Definitely not I learned from Med SS Absolutely I think so Not sure I donâ€™t think so Definitely not I would recommend Med SS to others Absolutely Probably Not sure Probably not Definitely not How was the level of information at Med SS Too difficult A little difficult Perfect A little easy Too easy
Check off the types of education you are considering completing High School College diploma Vocational School Undergraduate degree Masters Degree PhD Professional Degree I am interested in the following health care professions Dentistry Nursing Physiotherapy Occupational Therapy Chiropractic Nutrition Medicine Therapeutic Massage I want to be a doctor Absolutely I think so Not sure I donâ€™t think so Definitely not
It is very difficult to become a doctor Absolutely I think so Not sure I donâ€™t think so Definitely not I am smart enough to become a doctor Absolutely I think so Not sure I donâ€™t think so Definitely not In order to become a doctor, you must complete an undergraduate degree True False In order to become a doctor, you must have a science degree True False
My favourite part of the Med SS programme was _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ My least favourite part of the Med SS programme was _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________
Parting Words from our
Executive Tasha-Rachelle Maheu MedSS 2011 Co-Chair & Program Founder Medical Student (HBSc Forensic Science, Laurentian University)
Holden Sheffield MedSS 2011 Co-Chair Level II MD Student (Biochemistry & English, UWO)
Record everything - even if you think you will remember it later! Make a spreadsheet and record each activity that you participate in - major and minor - and update it as you go. You should include leadership endeavours, extracurricular activities - school and community, sports, research projects, presentations (not school presentations), musical accomplishments, lessons or special training, volunteer experiences, paid employment and any awards, scholarships or special recognition you receive. In addition to the activity name, it is also important to record dates of participation, approximate time spent (i.e. was it a single afternoon, or a daily commitment for three years?), and verifier information (the name, phone number and perhaps email address of the person who organized the event that can later confirm your participation). Out of courtesy, ask the verifier if they could confirm your attendance in the future. Most people will be delighted to be a part of your application however remember to confirm their willingness to act as a verifier if you are using their information several years after the initial event (i.e. on a med school application). My name is Holden Sheffield, and I am co-chair of MedSS. I am extremely excited for this year’s program. We have had amazing volunteers in the class of 2012, and 2013, who have put together an incredible five days. Hopefully, you will get to experience a little bit of what our lives are like. I’m sure you’ll see it’s certainly busy, but also rewarding. Remember, the goal behind MedSS is not the knowledge you come away with, but the ideas that it can inspire. I grew up in Thornhill, Ontario. In high school, I was a pretty big trouble maker, but somehow managed to get away with it. I loved sports then, and played on many different teams. For my first two years of undergrad, I went to the University of Western Ontario, studying biochemistry and English. For my third year, I was lucky enough to be given an opportunity to go to University of St. Andrews, in Scotland. I was the recipient of the Robert T. Jones Scholarship, which was part of an exchange program, where students from St. Andrews were also given the opportunity to come to Western. My extra-curriculars involved sports, reading, and writing for various different things. Above all, my biggest passion remains traveling. Medicine speaks to me because it offers so many different opportunities. Within the field of medicine, there remain a wide range of career paths. It opens far more doors then it closes. My advice for anyone who is interested in a career of medicine would be to pursue, pursue, and pursue. Don’t let anyone tell you you can’t do it.
Dominique Yelle Workshop Committee Leader Level I MD Student (B.Sc. Biopharmaceutical Sciences & M.Sc. Cellular and Molecular Medicine, University of Ottawa)
Most medical schools look for individuals who are successful in school and who also demonstrate a good work-life balance. Being involved in extracurricular activites is just as important as getting good grades! But most importantly, remember that there is more than one road that leads to medicine, so make sure you always enjoy what you do!
Tara Baxter Clinical Skills Commmittee Leader Level I MD Student
Make the most of your undergraduate years; Pursue the things that you enjoy, make your undertakings meaningful, and learn from every opportunity. Prior to beginning my undergraduate degree I was advised by several students and physicians that pursuing an education outside of Canada (BSc. Biology, Oakland could impact me negatively in the medical school admissions process. University [Rochester Hills, MI]) Regardless, I moved to Michigan in 2005 to compete in NCAA athletics. I am now glad to call myself a part of the class of 2013! Emily Bournival Interview Committee Leader Level I MD Student (Baccalauréat des sciences avec specialization en activité physique, University of Ottawa)
Elizabeth Birk-Urovitz Lecture Committee Leader Level II MD student
Don’t do activities just because you think they would look good on a medical school application. There is no “right” activity, club or employment, nor is their a specific number to attain. Get involved in what passions you and makes you smile. You are far more likely to gain valuable life experiences and develop useful skills that will set you apart from your peers. You will be able to draw on these amazing experiences and speak engagingly, making you a much more memorable interviewee. And as cliché as it might sound, its not the destination that matters, but the journey. Unfortunately, not everyone who hopes to get into medical school will succeed. Therefore, you will be much better served enjoying the process by doing what you love, than doing what you think will get you in. A long-term goal can seem more manageable if you divide it up into various smaller goals along the way. Look to the future, but also take things one step at a time!
(Anthropology, Biology, and Zoology, University of Toronto) Deborah Kahan Tutorial Committee Leader Level II MD Student (Bachelor of Health Sciences, McMaster University)
“When you come to the end of your rope, tie a knot and hang on.” - Franklin D. Roosevelt
Leah Hillier Helper Elf Level I MD Student
Write down your goals and the steps for how to achieve them. Put them somewhere where you'll see them often. This is how something that seems really difficult becomes attainable.
(Honours Business Administration + 1 year general science, UWO) Matthew Tenenbaum Fundraising Coordinator & MedSS Notes Editor Level I MD Student (Bachelor of Health Sciences, McMaster University)
Take everyoneâ€™s advice with a grain of salt, and donâ€™t be afraid to forge your own path. If you want to go to med school, get there on your own terms.
Schedule 8:30 9:00 10:00
11:00 Noon 1:00
3:00 4:00 5:00
Saturday April 9 Registration Lecture – Welcome (1A3) Lecture – Cardiology (1A3) Lecture – PBL (1A3) Lunch With MD Student Tutor (1A3) Lecture – Respiratory Distress (1A3) Clinical Skills (1A3, 1J7, 1J8)
Sunday April 10
Friday April 15
Saturday April 16
Sunday April 17
Intro to Project (1A3) Lecture – Genetics (1A3)
Lecture – Forensics (1A4) Lecture – Altitude (1A4) Lecture – Cognition (1A4) Trivia (1A4) Lunch (1A4) Lecture – Student Profiles (1A4) Lecture – Infectious Disease (1A4) Lecture –
Lecture – Interviews (1A3) Interviews
Lecture – Residency (1A3) Clinical Skills (1A3, 1J7, 1J8)
Lecture – Diabetes (1A3) Lunch (1A3) Lecture – Wound Evaluation (1A3) Clinical Skills (1A3/1J7/1J8)
Cdn Forces (1A4)
Break Workshops (Anatomy Lab, 1A3)
Lecture – Pharmacology (1A4)
(1A3, 1J7, 1J8, 1J9, 1J10, 1J9A, 1K10)
Lunch (1A3) Lecture – Medical Research (1A3) Lecture – Being a Doctor (1A3) Tutorial
Lunch (1A3) Lecture – Radiology (1A3) Lecture – Orthopedics (1A3) Group Time (1A3) Group (1J10, 1J7, 1J8, Presentation 1J9, 1J9A, 1K9, and Awards 2A2, 2J34B, 2J40) (2A3)
Group Time (Optional)
6:00 (to 7:00pm) This schedule is subject to change. Please check with the MedSS organizers if you need clarification.
Tutorial Group Number
Clinical Skills Group Number
Tutorial Leader Name
Disease Project Topic
Workshop Leader Name
Published on Apr 15, 2011