ca1 briefing - · pdf fileembryology unlikely to come out for meqs for now (since...

CA1 Briefingby the Academic Directorate of the Class of 2021

Notice: Change of Syllabus

● Addition of Cell Signalling and Immunology

○ Relevant documents have been added into your Dropbox folder:

■ Basic Immunology (Abbas) in “Textbooks (M1)”

■ Immunology (folder) in “Senior’s Notes”

■ Immunology (folder) in “CA1 Revision Questions by topics”

● Removed Membrane Physiology

● Carbohydrate Metabolism shifted to CA3

○ If you don’t know anything about glycolysis, don’t worry (yet)

Examination Format

M1 CA1 AY2016-17

Type Subject Marks Total

MCQ Carb Metab 16 90x1m

Foundational Biochem

24

Upper Limb 20

Lower Limb 15

Embryology 2

Histology 8

Physiology 5

MEQ Ethics 10 2x10m

Med & Soc 10

M1 CA1 AY2017-18

Type Subject Marks Total

MCQ Cell Signalling ? 50x1m

Foundational Biochem

?

Upper Limb ?

Lower Limb ?

Embryology ?

Histology ?

Immunology ?

MEQ Ethics ? 2x10m

Med & Soc ?

Colour-coding

● Red text means there’s an important take-home message

● Black text is for the normal contents that you expect from this briefing

● Grey text means the content is out there but is not the most important

Embryology

● Unlikely to come out for MEQs

○ For now (since developmental abnormalities

in the limbs are not too common clinically)

● Learn the Trilaminar Germ Disc well!

○ Given a structure, you should be able to tell

which layer(s) it originates from

● Correlate with Gross Anatomy

○ When learning Embryology in future, if you

see similarities with Gross Anatomy, do

take note, it’ll make learning both easier!

“Embryonic Development, Organogenesis”Lecture by Prof. Frank Voon (11th September)

Neuroanatomy

● Unlikely to come out in MEQs

○ You aren’t expected to know much

○ There are better things to test you

● Know the locations of cell bodies

for different types of neurons

● Understand the concept of

spinal nerves and how they

exit the vertebral canal

“Spinal Cord and Spinal Nerve”Lecture by Prof. Ng Yee Kong (4th September)

Overview of Gross Anatomy

● Basic Knowledge

○ Bones & Joints (know movements at joints)

○ Muscles (learn by grouping)

○ Nerves & Vessels (diagrams help!)

● Compartments

○ Cubital Fossa (TAN)

○ Carpal Tunnel

○ Femoral Triangle (NAVL)

○ Popliteal Fossa (NVA)

An example of a checklist you can make to help yourself study (this checklist is for Thorax though)

Bones

● Not every bony landmark is important, you should know:

○ Attachment sites for major muscles (eg. Medial epicondyle, ASIS, etc.)

○ Related to nerves/arteries/veins (eg. Radial groove, medial malleolus, etc.)

○ Have clinical significance (eg. Surgical neck of humerus, neck of fibula, etc.)

○ MOST IMPORTANTLY: Those mentioned repeatedly by the lecturers (NOT tutors)

■ Your lecturers set your papers, so. This is a recurring theme!

E.g. “...linear roughening for the attachment of the lateral head of the triceps... “ -- not important!

IMPORTANT: Deltoid tuberosity: insertion of the deltoid

muscle; radial groove: contains radial nerve

Joints (& Ligaments)

● Basic Theory of Joints

○ Classification of joints (fibrous/cartilaginous/synovial)

○ Types of synovial joints (non-axial: plane, uniaxial: hinge/pivot,

biaxial: condyloid/ellipsoid/saddle, triaxial: ball and socket)

○ Components of a synovial joint (capsule, articular disc, ligaments)

● Joints in the Upper and Lower Limbs

○ Know which joints the major movements occur at, notable examples (NOT EXHAUSTIVE):

■ Supination/Pronation of Forearm at Radio-ulnar joints

■ Locking mechanism (rotation) at Knee joint

■ Dorsi/plantarflexion of Foot at Talocrural (ankle) joint

Joints

● You can make a table to help you organise info if it helps :)

Joint Type Articulation Movements Stabilising factors Features which allow for wide range of movement

Gleno-humeral joint

Triaxial ball and socket

Head of humerus + glenoid cavity of the scapula

Flexion, extension, abduction, adduction, medial rotation, lateral rotation, circumduction

● Glenoid labrum deepens the glenoid cavity

● Ligaments: Extracapsular, coracohumeral

● Muscles: long head of the biceps brachii, rotator cuff, deltoid

● Synovial membrane loose inferiorly

● Shallow glenoid cavity receives only ⅓ of humeral head

Trivia, sometimes useful

● Note special features of joints, for example,

○ Elbow joint involves 3 separate articulations (humerus-radius, humerus-ulna, radius-ulna),

with all 3 sharing a common synovial cavity

○ Wrist can be ADducted to a greater degree than it can be ABducted (due to styloid process)

○ Carpometacarpal joint of thumb is a saddle joint unlike the others which are gliding joints

○ Locking mechanism of knee joint

○ Ankle joint is more stable when dorsiflexed

○ Support for arches of the foot (Medial Longitudinal Arch, etc.)

○ ... and so on

Ligaments

● Compartmentalise your knowledge of ligaments according to region,

take note of the important ones and their function:

○ Hip → iliofemoral, pubofemoral, ischiofemoral ligaments

○ Knee → collateral ligaments (MCL, LCL); cruciate ligaments (ACL, PCL)

○ Ankle → deltoid ligament

○ Foot → spring ligament

● It is easier to understand the cause of

ligament injuries if you draw them out!

(eg. MCL injury shown on the right)

MCL injury

Muscles

● A note about muscle attachments

○ Which is the origin and which is the insertion

is not important, just say ‘attachment’

○ Don’t obsess over the exact attachments, where

on the bone isn’t as important as which bone

○ A picture speaks a thousand words,

and is easier to remember anyway

○ Usually will not be tested in detail, if tested

at all it will only be for the major muscles

● Can make tables to test yourself if you like

(eg. muscle | origin | insertion | action)

Too much info...

Muscles (& Nerves)

● Group the muscles (eg. Anterior and posterior thigh, adductor group)

○ Muscles in the same group produce similar actions and

are usually innervated by the same nerve branches!

○ It is advisable to generalise then learn the exceptions

■ “1.5 muscles”, “LOAF” as exceptions for Median, Ulnar nerve groups

● Know the nerve supply of the various muscles

○ It is sufficient to know the main nerve branch supplying the muscle:

■ Your textbook may mention ‘posterior interosseous nerve’ as the nerve innervating

the extensor digitorum, but actually ‘radial nerve’ will suffice :)

Studying Muscles in Groups

Muscles (& Nerves)

● Know the actions of the various muscles○ Rationalise the movement of a muscle based on its location (or group) and its attachments

○ Muscles can only act on the joints that it crosses, for example:■ Adductor Magnus does not produce any action on the knee joint because

it inserts onto the adductor tubercle which is found on the femur

■ Sartorius will produce an action on the knee joint because it inserts onto

the tibia (which is ‘beyond’ the knee joint)

● Also know the clinical significance of certain muscles○ eg. Vastus Medialis for patellar stability, Gluteus Medius + Minimus for strong hip abduction to

support the hip when standing on one leg (when compromised, results in Trendelenburg’s sign)

Overview of Nerves

● Approach in order of priority:

○ Muscular innervation by nerve branch

○ Cutaneous innervation by nerve branch

○ Course of nerve branches in upper/lower limb

○ Muscular innervation by spinal root (myotome)

○ Cutaneous innervation by spinal root (dermatome)

● Limbs primarily function for movement, hence muscle innervation is most important

Nerves - Upper Limb

Nerves - Lower Limb

Only 3 main nerves:

1) Obturator n. → medial thigh compartment

(adductor muscles)

2) Femoral n. → anterior thigh compartment

(extensor muscles)

3)Sciatic n. (tibial + common fibular n) →

everything else!

Studying about cutaneous nerves such as sural

n. and saphenous n. can come in later!

Nerves: Course

● Keep practicing drawing

the brachial plexus and

naming the branches

and muscles supplied

● A lumbosacral plexus

exists for Lower Limb,

but it is not necessary to

learn unless it helps you

Nerves: Course

● Course of nerves - understand using landmarks

○ E.g Ulnar nerve passes posterior to medial epicondyle

→ enter anterior forearm → passes lateral to pisiform

and above flexor retinaculum (does not enter carpal

tunnel)

○ Less important to remember things like “ulnar n. runs

between FCU and FDP”

● Have a big picture of nerve root values +

course + its sensory & motor innervation (draw

it out if it helps)

Nerves: Myotomes

● Not necessary to know spinal root (eg. C5, C6) innervation of every muscle!

● Know generally the spinal roots involved for each major action or reflex:

○ 1, 2, Buckle my shoe (S1, 2 - Calcaneal tendon reflex)

○ 3, 4, Shut the door (L3, 4 - Quadriceps tendon reflex)

○ 5, 6, Pick up sticks (C5, 6 - Biceps tendon reflex, also Brachioradialis)

○ 7, 8, Shut the gate (C7, 8 - Triceps tendon reflex)

Nerves

● Sensory

innervation

○ Dermatomes

○ Areas of skin

innervated by

nerves (esp. Skin

overlying hand,

forearm, leg, foot)

Nerves

● Hilton’s Law - The nerve supplying the muscles extending directly across and

acting at a given joint also innervate the joint.

● Higher-order questions (nerve palsies, ulnar paradox, etc.)

● E.g. Erb’s Palsy

○ C5,C6 lesion (axillary, musculocutaneous, suprascapular nerves damaged)

○ Arm - medially rotated, hangs by side (i.e. cannot abduct)

○ Forearm - extended, pronated

Arteries

● Start from major arteries → branch to smaller arteries (Try to

draw them if you’re unsure!)

● Know the boundaries demarcating the name change (e.g. ext.

Iliac → femoral → popliteal)

○ Then add in main branches of the major arteries

● Have a general idea of the course, noting down major

landmarks nearby

○ E.g Pec. minor separates axillary a. into 3 parts

● Know locations of feel for pulses (e.g. radial, brachial, dorsalis

pedis, posterior tibial, etc)

Veins

● Superficial and deep circulations - sometimes similar

names as the arteries/nerves they travel with

● Important features of the course of the vein (drainage +

important landmarks)

○ Basilic v. + brachial v. → axillary v. (at inf. border of

teres major)

● Clinical relevance

○ Median cubital v. for venipuncture

○ Deep circulation in LL associated with DVT

○ Superficial circulation in LL assoc. with varicosities

Lymphatics

Lymphatics - trace the flow!

- Pectoral, subscapular, humeral →

central → apical lymph nodes →

subclavian lymphatic trunk

- R. subclavian lymphatic trunk →

right lymphatic trunk → venous

angle (junction of internal jugular

vein and subclavian vein)

- Left subclavian lymphatic trunk →

thoracic duct

- Superficial lymphatics (follow saphenous

veins and their branches) → drains into

superficial inguinal LNs → ext iliac LNs.

- Deep inguinal nodes - located on medial

aspect of femoral v. under deep fascia

- Popliteal LNs receive:

- 1. Lymphatics accompanying small

saphenous v.

- 2. Deep lymphatics of leg

- Drains up to deep inguinal nodes →

ext and common iliac nodes → lumbar

Lymphatics

Important spaces (e.g Anatomical Snuffbox, Cubital

Fossa)● Boundaries

● Contents

○ Using mnemonics can help

○ Important to know arrangement

of contents within compartments

(e.g medial or lateral)

● Clinical relevance

○ E.g Venipuncture via median

cubital vein → separated from

Focus on clinically significant stuff!

● Fractures → lead to other problems → nerve/artery affected → clinical

presentations

○ E.g Midshaft fracture of humerus → radial nerve affected → wrist drop

■ Don’t study blindly! Understand and picture why a midshaft fracture will result in radial

nerve being affected. Again, understand why wrist drop occurs when the radial nerve is

affected.

○ Fractures → avascular necrosis

● Nerve problems → clinical presentations

○ Work out the clinical presentation from the sensory/motor function of the nerve

○ E.g Long thoracic nerve affected → no serratus anterior → ‘winging’ of scapula

Fractures

Q. A fracture to the neck of the fibula is LIKELY to damage the common fibular (peroneal) nerve, and results in

a) Inability to flex distal phalanx of the great toeb) Inability to evert footc) Loss of plantar flexion of footd) Loss of sensation to sole of the foote) Inability to flex metatarsophalangeal joints

Some mnemonics to help you along● Bones

○ Carpal bones - Straight Line To Pinky Here Comes The Thumb

● Muscles

○ Anterior compartment of arm - BBC - innervated by musculocutaneous nerve

● Arteries

○ Axillary artery branches - Screw The Lawyers Save A Patient

● Nerves

○ Brachial plexus - Rugby Teams Drink Cold Beer

○ MARMU

○ Tendon reflex - 1 2 buckle my shoe, 3 4 kick the door, 5 6 pick up sticks, 7 8 shut the gate

Histology

Histology

● Topics tested

○ Basic cytology

○ Epithelium

○ Connective tissue

○ Bone

○ Muscle

○ Nervous system

○ Lymphoid

○ Skin

Epithelium

● Stratified vs. Simple

● Squamous vs. Cuboidal vs. Columnar

● Keratinised vs. Non-keratinised

● Special: Pseudostratified; Transitional

Things to note:

● Differentiating factors

● Major function

● Major locations

Cartilage

● Hyaline

● Fibrocartilage

● Elastic cartilage

● Types of cells

Things to note:

● Characteristics of each type

● Major functions

Major locations

Bone

● Difference between bone and cartilage

● Intramembranous ossification vs. endochondral ossification

○ Clavicle is the ONLY long bone that is formed by intramembranous ossification

○ Process of endochondral ossification

● Types of cells

● Periosteum, endosteum

● Primary bone vs. Secondary bone

Muscle

● Skeletal muscle

● Cardiac muscle

● Smooth muscle

Things to note:

● Differentiating features

● Locations

Nervous Tissue

● White matter vs. Grey matter

● Types of cells

○ Neuroglial cells

○ Oligodendrocytes, Schwann cells

○

● Structural organisation of a nerve

● Types of receptor organs (eg: Pacinian corpuscles, etc)

○ Might be less relevant now but good to know

● Oligodendrocytes vs. Schwann cells

Lymphoid Tissue

● Types of cells

○ Monocytes

○ Basophils

○ Eosinophils

○ Neutrophils

○ Lymphocytes

● Thymus

○ HASSALL’S CORPUSCLES

○ Blood-thymus barrier

Things to note:

● LINK TO IMMUNOLOGY

● Types of cells in each organ

● Characteristic features of each

organ

● How the B cells and T cells are

arranged in each organ

Skin

● Epidermis and dermis

● Accessory structures

○ Hair follicles

○ Sebaceous glands (EXOCRINE)

○ Sweat glands (EXOCRINE)

■ Merocrine

■ Aporcrine

● Mammary glands

○ Nails

● Thick skin vs. thin skin

● Cell types in the epidermis (eg:

melanocytes)

○ Likely to be less important

● Dermis

○ Papillary layer

○ Reticular layer

Question Types

● What kind of cells are not present in ___?

○ Know what kind of cells ARE present in each tissue

● ___ is found in all of the following EXCEPT?

○ Know where each type of cartilage/bone/epithelium is found

● Characteristic features

○ Helps to differentiate different tissue types from each other

○ In terms of appearance, function, etc.

○ Commonly tested in factual questions

● Exceptions

Sample Questions

Which of the following statements about the histology of lymph nodes is not true?

A. T lymphocytes are present in the lymphoid paracortex

B. Efferent lymphatic vessels are present in the hilum

C. The germinal centres of lymphatic follicles contain Hassall’s corpuscles

D. Lymphatic follicles are absent in the medulla

E. Macrophages are present in the sinuses

Answer: C. The germinal centres of lymphatic follicles contain Hassall’s corpuscles

NOTE: Hassall’s corpuscles are characteristic of the thymus.

Biochemistry

Congrats, you are not tested this! For now

JC Biology and Chemistry stuff

● pH and buffers

● Proteins and enzymes

● Enzyme kinetics

● Cellular energetics

● Central Dogma (Replication,

transcription, translation)

Types of questions

● Factual questions

● Calculation questions (Henderson-Hasselbalch equation etc.)

● Amino acid questions

● Content-heavy options questions (read them carefully!)

● Higher-order thinking questions (application of knowledge to a case

scenario/data-based question)

NEW!! Cell Signalling

● Broad picture

○ Types of signalling

○ Types of receptors

○ Clinical relevance

● Details on signalling pathways

○ Possible factual questions

○ Possible to come out as application questions

- case scenarios involving defects in

signalling pathways and the anticipated effect

Trust in Prof Kenneth Ban’s slides

Basic ImmunologyM1 CA1 Academic Briefing AY2017/18

What You Need to Know

IN PRESENCE OF PATHOGEN• Innate Immune Response• Adaptive Immune Response

• Cell-Mediated Immunity (CD8+ CTL)• Humoral Immunity (B + CD4+ T Helper)

• Important Cytokines & Receptors• Inflammation• MHC Expression• Effector T cells • CD28-B7 vs. CTLA4-B7 Interaction• PD1-PD1L Interaction• CD40-CD40L Interaction

• Downregulation of Response (Return to Homeostasis)

IN ABSENCE OF PATHOGEN

• Anatomical Organisation of Immune System• Primary (Generative) Lymphoid Organs• Lymph Node – epithelial pathogens• Spleen – blood borne pathogens

• T Cell Development (Haematopoiesis) • VDJ Recombination - Combinatorial & Junctional Diversity• Positive & Negative Selection

• B Cell Activation (Haematopoiesis)• Somatic Hypermutation • Affinity Maturation• Isotype (Heavy-Chain Switching)

Primary Lymphoid Organs (Generative)

1. Fetal Liver 2. Bone Marrow (Adult)

• B Cell Development• Lymphocyte & Myeloid

Progenitors3. Thymus (Adult)

• Migration of precursors from bone marrow into thymus

• T Cell Development

“T cells mature in ThymusB cells mature in Bone Marrow”

Secondary Lymphoid Organs (Peripheral)Lymph Node

• Migration of Dendritic Cells (APC) carrying antigens from epithelial tissue

• Occurs via High Endothelial Venules

Spleen• Filters blood – old RBC &

blood-borne antigens• Red Pulp - RBC • White Pulp - Lymphoid

Cutaneous/Mucosal• Common Sites of Infection

(e.g. Peyer’s; Tonsils)• Many lymphocytes with memory cells

→ Fast response• Does not respond to commensal flora

Lymphocyte Compartmentalisation• Follicles: B cell + FDC• Paracortex: T cell• Germinal Centre:

Plasma cell (differentiated B cell)

Immature T Cell

Immature B Cell

Naïve T Cell(CD 4+ or CD 8+)

Naïve B Cell(Centerocyte)

Effector B Cell

Effector T Cell

Th1

Th2

Th17

Tfh

TReg

IgM

IgG

IgE

IgA

Development

Development

IMMATURE MATURE

T Cell DevelopmentA. VDJ Recombination• Aim: Diversify T Cell Repertoire• Process in a Nutshell

1. Combinatorial Diversity – Different V-D-J combinations

2. Junctional Diversity – Addition of non-coded nucleotides at recombined joints between V-D-J segments

B. Positive & Negative Selection

• Aim: Naïve T cells that are committed to either CD4+ or CD8+ & only bind weakly to host MHC

B Cell ActivationA. Somatic Hypermutation• Centroblasts

Polymutations are introduced to antibodies expressed by proliferating B cells → Antibodies with Δ specificity to antigen

• Follicular Dendritic Cells (FDC) express iccosomes –“antigen packages”to centrocytes upon exposure to pathogen

B. Affinity Maturation• Centrocytes are made to compete against each other

for binding to iccosomes• Centroblasts with high affinity receptors outcompete those

with low affinity receptors• As amount of antigen ↓

Large number of B cells compete for small number of iccosomes → only strongest B cells can outcompete

Inflammation: TNF; IL1, 6, 12

3 STAGES OF INFLAMMATION1. Dilation of capillaries to increase blood flow2. Microvascular structural changes and escape of

plasma proteins (antibodies, complements)3. Leukocyte (neutrophils, monocytes) transmigration

through endothelium

PROCESS OF LEUKOCYTE TRANSMIGRATION1. Rolling: Endothelial expression of selectin → tethering of

neutrophils to the endothelium2. Adhesion: Leukocytes express integrins

• ↑ Chemokines → ↑ integrin-endothelium affinity 3. Migration: Chemokine gradient stimulates motility

Cytokines are the signalling molecules of the immune system

MHC Expression

MHC Class I - Intracellular Antigen MHC Class II – Extracellular Antigen

Aim: Antigen needs to be broken up into small peptides for display on MHC molecules → activation of T cells

All nucleated cells

Only Antigen Presenting Cells

3 Signals for Activation & Proliferation of T Cells1. MHC-Antigen Complex: Recognised by T Cell Receptor

(CD4+/CD8+)

2. Costimulatory Signals: CD28-B7 Interactions• Without costimulation, the T cell is anergised (i.e. deactivated forever)

3.Release of IL-2• Clonal Expansion• Autocrine Effect:

Activated T cells increase secretion of IL-2 & increase expression of IL-2 receptors

Activation of Naïve T Cells → Effector T Cells

Summary of Important Cytokines

1. Inflammation: TNF, IL-1, -6, -12

2. Th1: IFN-Y → Activation of Macrophages (M1)

3. Th2: IL-4 → Helminth Response

4. Th17: IL-22, IL-17 → Amplification of Leukocyte Recruitment + Barrier Response

5. IL-2: Proliferation of Naïve T Lymphocytes into Effector T Lymphocytes• Also maintains Effector Treg cells

6. Treg: IL-10, TGF-β → Shut-down of immune response (negative feedback)

http://tinyurl.com/M1CA1immunoRESOURCES

http://tinyurl.com/M1CA1immuno

http://www.youtube.com/watch?v=6KWd6lh1_Gc

Ethics & MedSoc

Ethics

A pain to study but defines who

you are as a doctor

To cover

● Professional attributes

● Sample question for Ethics MEQ

CHIRPERS

C - Compassion

H - Honesty

I - Integrity

R - Responsibility

P - Participation

E - Empathy

R - Respect

S - Sensitivity

CHIRPERS

HONESTY

● Frank

● Truthful

INTEGRITY

● Non-corruptible

● Principled

HONESTY

Prof. Ng: “Did you go for histo lab”

Honest Harriet: “No I went to play Overwatch, sorry…”

INTEGRITY

Sneaky Sherilyn: “Please sign histo lab attendance for me cos I fomo wanna go

Waacow”

Integrity Ivan: “Nope sorry I got morals one”

CHIRPERS

RESPONSIBILITY

● Fulfilling duty

PARTICIPATION

● Engage in learning and

fellowship willingly

RESPONSIBILITY

Skiving Sioh Huang: “I’m not going for histo lab”

Responsible Raj: “It’s my duty to go histo lab”

PARTICIPATION

Unethical Uma: “LOL what a waste of time looking at the histo labs”

Participatory Pek Yan: “OMG if I actually try I think I can practice for SPOTS”

CHIRPERS

RESPECT

● Recognise another’s worth - be it

patient or a fellow healthcare

worker

SENSITIVITY

● Understanding another’s

emotion

RESPECT

Uncouth Ursula: “Prof. talks super funnily LOL what a clown”

Respectful Ralph: “Prof. DOES talk funny, but he is making time to teach us how

to look at the histo slides so maybe I should listen and not mock him”

SENSITIVITY

(to Blur Beth)

Callous Clair: “hahahahaha can’t you see the lamina propria it’s so damn obvious”

Sensitive Shuo Ling: “I think I missed that part out too… OH wait here it is! Let me

show you Beth”

CHIRPERS

COMPASSION

● Moved by another’s suffering

EMPATHY

● Appreciate another’s emotions

● “To put yourself in the other

person’s shoes”

COMPASSION

Unkind Ulrich: “hahahahaha I got the earlier histo lab slot”

Compassionate Carissa: “you got the later histo lab slot didn’t you? Oh man :/”

EMPATHY

Cold Caleb: “...............................(silence).................................”

Empathetic Eric: “I can see that you are upset… If I didn’t know about histo I’d be

upset too… Thank you for telling me… We will study histo together”

(Use NURS)

CHIRPERSC - Compassion

H - Honesty

I - Integrity

R - Responsibility

P - Participation

E - Empathy

R - Respect

S - Sensitivity

● A preamble

● One question, split into subparts

○ Professional Attributes (in the context of the preamble)

○ YOUR judgement and analysis with respect to a certain action or decision

○ +/- 4 Pillars of Medical Ethics

■ Usually only one part, in the context of the scenario

A typical Ethics MEQ will consist of...

M, a student in medical school, met P, a sixteen-

year-old girl in the programme who suffers from a

severe facial rash. Keen to find out more about

the rash, M took a photograph of P's face. P,

visibly shocked, thought it was for her treatment

and did not protest. M subsequently found out

that the rash was due to a rare genetic disorder.

Intending to share his knowledge, he uploaded

the picture on his blog.

What do you understand by the terms respect and

sensitivity with respect to the professionalism

undertaking? (2m)

Respect: recognize another’s intrinsic worth

Sensitivity: to be aware of the other’s feelings and motives

Give 2 reasons why M might have failed to

demonstrate respect towards P. (2 m)(remember, get straight to the point)

Took photograph without permission – did not see her as a patient but object to

be studied

Uploaded her picture – did not RESPECT her privacy

NOT: took her photograph – did not understand she was suffering

DEFINITELY NOT: should have asked her permission before posting on the blog

Give 2 reasons why M might have failed to

demonstrate sensitivity towards P. (2 marks)Took photograph – did not appreciate she might be self-conscious

Did not notice her shock – not attuned to her emotions

DEFINITELY NOT: did not get her good side

Name one other professional attribute (other than

respect and sensitivity) that was inconsistent with

M's behaviour. Explain why this is so. (2 marks)

● Compassion – was not moved by her suffering; instead, M’s overriding

concern was to study P’s condition

Would it have been acceptable if M uploaded the

photo on a private blog accessible only to his close

friends? (2 marks)

NO! NO! NO!

Still... NOOOOO!!!!!

(give 2 reasons)

Integrity: Would have involved deception (she didn’t know so it’s okay...?) – on

principle unacceptable

Respect: No respect for her right to privacy

MedSoc

Because social studies just

wasn’t enough...

The focus...

Changing Health Behaviour

Tony & Joel’s on Dropbox

Health Belief Model

Focuses on the perception of an individual

Perceived:

● Benefits

● Costs

● Barriers

● Susceptibilities/Risks

Social Cognitive Theory

People around you and the environment affects your behaviour

● Relatives

● Workplace

● Society

Behaviour

Personal Environment

Trans-Theoretical Model

Precontemplation: Unaware there is a problem → Point out the problem

Contemplation: Aware there is a problem → Help to weigh pros and cons

Preparation: Planning to do stuff → Encourage + Move onto action

Action: Doing stuff → Reduce negative influence and temptations + Accountability

Prevent Relapse: May happen at any time → Need for accountability

● A preamble - usually involves the main character having to make a

DECISION but isn’t doing it e.g. mammogram

● One question, split into subparts

○ Possible reasons for not proceeding with the decision → HEALTH BELIEF MODEL

○ How to persuade/encourage the main character to proceed with the decision → HEALTH

BELIEF MODEL +/- (TRANS-THEORETICAL MODEL)

A typical MedSoc MEQ will consist of...

What to take note of for MedSoc...

Overall approach to Medicine & Society Question:

●The Health Belief Model is especially relevant to health screening scenarios, and thus should be

used. Other models may also be used, and credit will be given if used appropriately.

●Remembering the structure of the Health Belief Model is helpful in the structuring of your

answer for both parts of this question. The Health Belief Model outlines various factors that

affect the person’s willingness to go for a screening, and these can be tackled individually to help

to convince the person to go for screening.

Review Pointers:

●It is crucial to apply the theory in the given scenario. Basic format to follow - cite the theory

then explain it in the given context.

●DO NOT MAKE UP THE NAME OF THE BEHAVIOURAL THEORY!!!

If you don’t know what it’s called, just explain its usage.

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