med1011 study guide 2012

Faculty of Medicine, Nursing & Health Sciences MED1011 Study Guide 2012

MED1011 Study Guide 2012

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CONTENTS WEEK 1 ...................................................................................................................... 1

WEEK 2 .................................................................................................................... 19

WEEK 3 .................................................................................................................... 39

WEEK 4 .................................................................................................................... 59

WEEK 5 .................................................................................................................... 79

WEEK 6 .................................................................................................................... 99

WEEK 7 .................................................................................................................. 111

WEEK 8 .................................................................................................................. 129

WEEK 9 .................................................................................................................. 147

WEEK 10 ................................................................................................................ 165

WEEK 11 ................................................................................................................ 183

WEEK 12 ................................................................................................................ 201

READINGS ............................................................................................................. 221

MED1011 Study Guide 2012

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Faculty of Medicine, Nursing & Health Sciences

WEEK 1

MED1011 Study Guide 2012 Week 1

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WEEK 1

Weekly Learning Objectives

By the end of this week it is expected that you will be able to: • understand the MED1011 structure, teaching and learning methods and assessment. • understand the role of various learning activities in Year 1. • explain the structure of cells, their chemical composition and their relationship to the

extracellular environment. • identify and practise basic communication skills for medical interviews. • describe the structure and function of biomolecules associated with the life process. • differentiate between prokaryotes, eukaryotes and viruses. • appreciate the approaches to learning the anatomy of the human body. • define the ‘sociological imagination’ and understand how it can be used to assist in analysing

the social realities of health, illness and medicine. • recognise different sociological perspectives and how they are used to better comprehend

medicine, health and illness. • analyse similarities and differences between ethical issues in personal and professional life. • use appropriate skills to gain access to resources through the library and Moodle.


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WEEK 1 Lecture03/01-P1 – Introduction to Anatomy Theme: III Discipline: Anatomy Sub Discipline:

CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Paul McMenamin Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating successfully in this session and related activities, you should be able to:

• develop an approach to the study of anatomy using all available resources • understand the use of principles and applications in the study of anatomy • explain the difference between general, regional and systemic approaches • describe the anatomical position of reference and understand its use • describe and use terms of relationships and anatomical planes • understand that anatomy is a dynamic living and exciting discipline • understand the central position anatomy plays in the study and practice of medicine

Content synopsis: This lecture will review approaches to the study of anatomy. Explanation of how to use resources. Overview of principles and applications. Discussion of basic terms used to describe anatomical position and movement.

Keywords: principles, applications, general, regional, systemic, anatomical position, movement

Readings: Prescribed Moore, Dalley and Agur 6th ed. 2010. Introduction: pg 1-70 Eizenberg, N, Briggs, C, Adams, C, & Ahern, G, (ed.) 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapters 1 & 2.


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WEEK 1 Lecture02/01-P1 - What is Health?

Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Helen Keleher Department of Health Social Science School of Public Health & Preventive Medicine Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Associate Professor Phua Kai Lit Jeffrey Cheah School of Medicine & Health Sciences Monash University Sunway Campus Malaysia Email: [email protected]


• explain concepts of health from different perspectives • explain the concept of the social determinants of health • understand the role of Theme II in the Year One curriculum • understand the teaching framework/format of Health, Knowledge and Society

Content synopsis: In this lecture, we begin with exploration of the concept of health from different perspectives. We focus not only on the concept of health and its social and biomedical origins but also the way in which our understandings of health and illness change over time and affect the way in which medicine and healthcare are understood and practised. We will examine the pre-requisites for health drawing on the WHO Declaration of Alma Ata; the social context of health and how it influences patterns of health and illness; the concept of the social gradient and how it is reflected in patterns of health and disease; and explore primary health care as a system response to the social context of health and illness and as a model for health development both in Australia and globally. You will find that you can use this set of concepts to examine key aspects of the Australian, Malaysian or any other society. You will also be provided with a general introduction to Theme II of the curriculum, “Population, Society, Health and Illness” and delivery structure of the learning stream, “Health, Knowledge and Society”. Teaching and learning, and assessment processes, are outlined and explained.

Keywords: Health, pre-requisites of health, social context, social gradient, social determinants of health, primary health care

Readings: Huber M, Knottnerus JA, Green L, et al. How should we define health? BMJ 2011;343 Irwin, A, & Scali, E, 2007, ‘Action on the social determinants of health: A historical perspective’, Global Public Health, vol 2, no 3, pg 235–56. Keleher H, & MacDougall C, Concepts of health and primary health care. Chapter 1 in H. Keleher and C. MacDougall (2011). Understanding Health. South Melbourne, Oxford University Press.

Useful websites: The Five Elements of Primary Health Care http://www.youtube.com/watch?v=8rW8qoCP-H8 Chatham-Kent Social Determinants of Health Video: http://www.youtube.com/watch?v=NyTni-vn93Y&feature=related World Health Organization, Primary Health Care: www.who.int/topics/primary_health_care/en. This website includes a wide range of WHO resources for PHC including the Director-General’s statements of support for PHC, and country information about progress towards comprehensive PHC

Lecture will be uploaded on Moodle Yes


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WEEK 1 Tutorial_BG_02/01 – Beyond Google Theme: II Discipline: Health, Knowledge and Society Sub Discipline:

CMS Lecturer / Tutor MUSC Lecturer / Tutor Mrs Kaye Lasserre Subject Librarian Faculty of Medicine, Nursing & Health Sciences Hargrave-Andrew Library Email: [email protected]

Objectives: After participating in this session you should be able to:

• identify reliable sources of medical information • use a basic checklist to evaluate information sources • locate journal articles on a topic using OVID Medline

Content synopsis: This session will provide an overview of medical information sources, including their purpose and scope. Google provides access to a huge amount of information; however, finding reliable and relevant information can be time consuming. During the session, a range of other information sources will be explored, including databases (eg. OVID Medline). Information from these sources will be compared and evaluated, using criteria such as relevancy, currency, accuracy and authority. The use of efficient search techniques will also be covered.

Keywords: medical information sources, search skills, critical evaluation

Readings: No readings listed for this session.


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WEEK 1 Lecture03/01-P3 – Biomolecules of Life 1 Theme: III Discipline: Biochemistry Sub Discipline: CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the operation of the Theme III tutorials and practicals and appreciate the role of self-directed learning and computer assisted learning as part of the learning framework

• discuss the basic structure of water and its effect on the properties of solutes in aqueous solution

• identify the main groups of molecules associated with the life process and the structure of these in relation to their function in living cells

Content Synopsis: Introduction to biomolecules, the chemical composition and requirements of living cells, major components and trace elements. The chemical structure of small biomolecules - ie. water, glucose and phospholipids - in relation to their particular biological functions. Biological macromolecules, structure, size and properties. The relative sizes of macromolecules and simple molecules.

Keywords: biomolecules, macromolecules, polymer, diversity, monomers, glycogen, protein, nucleic acid

Readings: Prescribed Naish J, Revest P, & Syndercombe Court D, 2009, Medical Sciences, Saunders, Elseveir, Chapters 1 and 2 Sadava D, Heller HC, Orians GH, Purves WK, & Hillis DM, 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapters 2 and 3



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WEEK 1 Lecture03/01-P5 - Biomolecules of life 2 Theme: III Discipline: Biochemistry Sub Discipline: Cell Biology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• identify the main groups of molecules associated with the life process and the structure of these in relation to their function in living cells

• explain the physical and chemical properties and structures of biological macromolecules in relation to their biological roles

Content Synopsis: Introduction to biomolecules, Monomers, polymers and polymer diversity. Outline of the structure of glycogen, protein and nucleic acid in relation to their specific biological roles. Chemical diversity arising from the arrangement of monomers in linear sequence.

Keywords: biomolecules, macromolecules, polymer, diversity, monomers, glycogen, protein, nucleic acid

Readings: Prescribed Naish J, Revest P. & Syndercombe Court D. 2009, Medical Sciences, Saunders, Elseveir, Chapter 2 Sadava D, Heller HC, Orians GH, Purves WK, & Hillis DM. 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapters 2 and 3



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WEEK 1 Lecture04/01-P1 - Taking a medical history Theme: IV Discipline: Clinical Skills Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jan Coles Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the process of taking a medical history • describe appropriate questions in collecting information about a patient’s use of prescription and

non prescription medication, alcohol, and tobacco • describe how to build empathy in a medical interview

Content synopsis: This lecture follows on from the first tutorial when you began to gather information from the “patient”. The next part of taking a medical history consists of asking patients about their past medical and family history, and alcohol, tobacco and drug use.

Keywords: Direct or closed questions, CAGE test, safe drinking, smoking, medication, allergies

Readings: Prescribed Silverman J, Kurtz S, & Draper J, 2005, ‘Gathering information’ in Skills for communicating with patients, 2nd ed. Radcliffe Publishing, Oxford, pg 45-64 Silverman J, Kurtz S, & Draper J, Skills for communicating with patients. Oxford: Radcliffe Publishing, 2005. pg 77-105


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WEEK 1 Tutorial_04/01-P1 - The medical interview

Theme: IV Discipline: Clinical Skills Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• demonstrate the steps necessary to prepare for a medical interview • introduce yourself to a patient • obtain consent from a patient to perform a medical interview • establish a private and confidential environment in which to conduct your medical interview • begin to establish rapport with a patient • negotiate the multiple agenda in a medical interview • demonstrate an ability to gather patient information in an accurate and empathetic manner • begin to take a medical a history, in a role play with peers, of the patient presenting a complaint • demonstrate an ability to reflect on your role play and give effective peer feedback

Content synopsis: The steps required for the medical interview are outlined in the pre-reading material. These skills will be developed using role plays, personal and group reflection on various stages of the interview process. This tutorial will focus on the developing the skills of empathy and accuracy required when taking a patient’s information about their presenting illness. The medical interview is s crucial part of making an accurate diagnosis. A number of studies have shown that 60-80% of the diagnosis can be made on history alone. How you elicit the information is an important process, as additional and relevant information is obtained when patients can express all their concerns. Another key facet of this information gathering phase is to understand the patient’s view of the illness experience. It is important to remember the distinction developed by Kleinman et al (1978) between disease and illness. Disease refers to a physiological, biological disorder, while illness refers to a pattern of symptoms in an individual. Role plays used in this tutorial give you an opportunity to reflect on your own history taking and provide feedback for your peers.

Keywords: Empathy, presenting information, gathering information, feedback, illness and disease

Readings: Prescribed Workbook entry for this tutorial Silverman J, Kurtz S, & Draper J. Skills for communicating with patients. Oxford: Radcliffe Publishing, 2005. pg 35-55, 57-86


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WEEK 1 Lecture03/01-P2 – Biology of cells 1 Theme: III Discipline: Anatomy Sub Discipline: Cell Biology/Histology

CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor John Bertram Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating in this session and related activities, you should be able to:

• describe how unicellular organisms form colonies • recognise multicellularity associated with commune regional specialisation • recognise how specialisation reflects differences in gene activity and expression

Content synopsis: Single cells from colonies; division and incomplete cytokinesis. Cell specialisation and cooperative function. Cohesion of cell populations; internal and external surfaces. Cell communication, gene expression and cell differentiation.

Keywords: multicellular, unicellular, specialisation, gene activity, gene expression, cell communication, differentiation, cytokinesis

Readings: Prescribed Alberts B, 1994, Molecular Biology of the Cell, 3rd ed. Garland, New York, pg 17-32. Available from: http://images.lib.monash.edu.au/med1011/04109810-1.pdf http://images.lib.monash.edu.au/med1011/04109810-2.pdf Kerr JB, 2010 Functional Histology, 2nd ed. Mosby, Sydney, Ch 1.


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WEEK 1 Lecture03/01-P7 – Biology of cells 2 Theme: III Discipline: Anatomy Sub Discipline: Cell Biology/Histology

CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor John Bertram Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• outline the internal organisation of the cell and its relationship to function. • review cell activities, including import, synthesis, storage, export, collection and disposal of

wastes.

Content synopsis: The nuclear compartment. The cytoplasmic compartment, organelles, inclusions, cytoskeleton, cytosol. Dynamics, macromolecular traffic and sorting. Basic pathways: secretion, endocytosis and storage.

Keywords: nuclear compartments, secretion, endocytosis, storage, import, synthesis, export, waste disposal, waste collection

Readings: Prescribed Saladin KS, 2007, Anatomy and Physiology: The Unity of Form and Function, 4th ed. McGraw-Hill, New York, pg 90-102. Sadava D, Heller HC, Orians GH, Purves WK, & Hillis DM, 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapters 2 & 3. Kerr JB, Functional Histology, 2nd ed. Mosby, Sydney, Ch 1. Images from 1st ed. available from http://images.lib.monash.edu.au/med1011/04109667.pdf


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WEEK 1 Lecture02/01-P2 - What is Medicine? Australian and global perspectives Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A




• explain concepts of medicine from local and global perspectives • explain the concept of the social determinants of health • discuss in what ways medicine is both a scientific knowledge system and a cultural construction

Content synopsis: In this lecture, the concepts of medical cultures and sub-culture, and professional socialisation are examined. You will be introduced to Foucault’s concept of the biomedical gaze’. We then ask, how do these processes influence diagnosis, treatment and management of disease? How do they influence your definition of what it means to be a “good doctor”?

Keywords: Professional socialisation, medical gaze, social construction of health and illness

Readings: Good BJ, & DelVecchio Good M-J, 1993, ‘Learning medicine: the constructing of medical knowledge at Harvard Medical School’ in Knowledge, Power and Practice: The Anthropology of Medicine and Everyday Life, ed. S. Lindenbaum & M. Lock, University of California Press, Berkeley Irvine R, McPhee, J, & Kerridge I, 2002, ‘The challenge of cultural and ethical pluralism to medical practice,’ Medical Journal of Australia, vol.176, pg 174-175 Knight LV, and Mattick K, 2006 ‘When I first came here, I thought medicine was black and white’: making sense of medical students’ ways of knowing’ Social Science and Medicine 63: 1084-1096. R. Horton “What’s Wrong With Doctors” New York Review of Books 54 (9) May 31, 2007 http://www.nybooks.com/articles/20214 R. Shea “The Long View” Johns Hopkins Magazine Winter 2009: 34-39 http://magazine.jhu.edu/2009/12/the-long-view/



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WEEK 1 Practical_03/01-P1 - How are cells studied? Theme: III Discipline: Anatomy Sub Discipline: Cell Biology/Histology CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor John Bertram Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the different forms and use of light and electron microscopy • practise the use of a light microscope • identify various eukaryotic and prokaryotic cells • stain buccal cells from your oral cavity and view with student microscopes and fluorescence

microscopy • differentiate between the structure of animal (buccal) and bacterial cells • identify cellular morphology using micrographs

Content Synopsis: The practical session will be based on set exercises utilising images, diagrams, demonstration micrographs and basic light microscopy. The session will include the following:

• familiarisation with how to use a microscope • brief outline of the types of microscopy used in medicine, including electron microscopy • how to recognise single cells and cell associations using several stained histology slides • identification of cell types and basic ultrastructure using illustrations in the provided notes and a

range of displays in the laboratory • identification of pictures of prokaryotes and simple eukaryote cells • you will make your own buccal smears, to stain them with methylene blue/toluidene blue, and

acridine orange. The methylene blue/toluidene blue will be wet mounted and examined by individual students. The acridine orange stained slides are to be viewed with fluorescence microscopes as a group demonstration.

Keywords: light microscopy, fluorescence microscopy, micrographs, buccal cells, bacteria, cellular ultrastructure

Readings: Introductory chapter to any good Histology textbook.

Practical notes will be uploaded on Moodle Yes


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WEEK 1 Tutorial_02/01-P1 - Perspectives on the pre-requisites of health and primary health

care Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor In this tutorial, you will work in small groups to examine the readings for this week and discuss the key ideas put forward. You will be asked to consider the proposition put forward by Huber et al (2011) that health is the ability to adapt and to self manage and compare that to the social approach to health put forward by Irwin and Scali (2007). We consider the five elements of primary health care and their application to our understanding of what causes preventable illness and what we should do about it. Finally, each student is required to participate in teams of 3-4 to present tutorial topics for HKS. During this tutorial you will be asked to select your topics and teams for tutorials 2-12.


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WEEK 1 Lecture03/01-P4 - Cellular energetics and the role of enzymes as biological catalysts Theme: III Discipline: Biochemistry Sub Discipline: Cell Biology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• explain factors which govern the direction of cellular reactions • discuss the different types of chemical reactions and the role of cofactors involved in catalysis • describe the kinetics of enzyme-catalysed reactions and the different modes of enzyme

inhibition

Content Synopsis: Nature of energy and how it is involved in chemical reactions. Free energy and the equilibrium constant. Spontaneous chemical reactions and free energy. Rates of chemical reactions, activation energy and catalysis. Role of enzymes as biological catalysts. Models of enzyme action. Factors affecting enzyme activity. The role of cofactors and coenzymes.

Keywords: catalysts, catalysis, enzymes, kinetics, equilibrium constant, cofactors, coenzymes

Readings: Prescribed Naish J, Revest P, And Syndercombe Court D, 2009, Medical Sciences, Saunders, Elseveir, pg 26-30 Sadava D, Heller HC, Orians GH, Purves WK, & Hillis DM, 2008, Life – The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapter 8 Computer program “Metabolic challenges” available on Moodle



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WEEK 1 Lecture03/01-P6 - Introduction to microbes

Theme: III Discipline: Microbiology Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• describe the three domain structure of the living world • compare the structure and functions of prokaryotic and eukaryotic cells • identify the differences between bacteria and viruses • understand the different methods that bacteria and viruses use to replicate

Content synopsis:

Domain Classification • All living organisms can be divided into three domains: Bacteria, Archaae and Eukarya

Prokaryotic cells-Bacteria and Archaea-characteristics and structure • Prokaryotic cell structure: common features: a plasma membrane; cytoplasm: that contains

ribosomes, dissolved enzymes, water and small molecules and a nucleoid region with DNA • Additional components: a cell wall, outer membrane and capsule • External structures:flagella (movement) and pili/frimbriae (attachment) • Replication by binary fission

Eukaryotic cells-Eukarya-characteristics and structure • Eukaryotic cell structure: highly structured, membrane enclosed nucleus, other

membrane-enclosed organelles • Cytoskeleton:provides shape, strength and movement

Viruses-characteristics and structure • Viruses are not classified in three domain classification system. Classified by their genome,

morphology (size, shape, enveloped/unenveloped), biological properties (host range, transmission)

• Viral structure: a central core of either DNA or RNA (but not both) surrounded by a capsid, or coat, composed of one or more proteins

• Viruses are obligate intracellular parasites that reproduce only with the help of living cells Examples of medically important bacteria and viruses will be discussed briefly.

Keywords: prokaryotes, eukaryotes, bacteria, cell structure, viruses

Readings: Prescribed Goering et al. Mims Medical Microbiology-Chapters 1, 2 and 3 Recommended Murray PR, Rosenthal, KS, & Pfaller MA, 2005. Medical Microbiology, 5th ed. Elsevier Moby, Pennsylvania, USA – Chapters 3 and 6 Prescott LM, Harley JP & Klein DA, Microbiology, 6th ed. McGraw Hill – Chapters 3, 4, and 16



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WEEK 1 Lecture03/01-P6 – Cells and body fluids Theme: III Discipline: Physiology Sub Discipline: Cell Biology CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Ross Young Department of Physiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating in this lecture and reading the prescribed material, you should be able to:

• appreciate how the passive movement of water into and out of cells depends on solutes • define diffusion, filtration, osmosis and tonicity • give a simple account of the composition of fluids inside and outside the body cells • describe the major fluid compartments of the body, their volumes, inputs and outputs and the

permeabilities of the barriers that separate them • appreciate the importance of fluid, solute and electrolyte regulation and some practical

applications in clinical settings

Content synopsis: Size and composition of the intracellular and extracellular compartments. Body fluid composition and cellular functions. Osmotic balance and movement of water between compartments. “Water follows salt”

Keywords: osmolarity, ion concentrations, cellular compartments, extracellular compartments, tonicity

Readings: Prescribed Naish et al. 2009. Medical Sciences. Saunders: Ch 1, pg 10-13 Sadava D, Heller HC, Orians GH, Purves WK, &. Hillis DM, 2007, Life - The Science of Biology, 8th ed Sinauer, Sunderland, MA, pg 105-108


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WEEK 2


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WEEK 2


By the end of this week it is expected that you will be able to: • analyse similarities and differences between ethical issues in personal and professional life. • discuss the chemical processes used by cells to produce energy including the role of enzymes. • explain the concept of osmolarity and ion balance. • describe the different types of bones and their functions. • explain the role of the liver in metabolism. • understand how culture influences socialisation processes, personal and professional identity

and medical practice. • understand the relationship between ethnicity and health, disease and illness including health

service delivery. • identify key components of, and conduct, a medical history in a role-play. • learn and practise techniques associated with prevention of infection transmission. • demonstrate effective technique in hygienic hand washing and drying. • identify suitable sites for administration of injections and practice safe injecting techniques on

simulated tissue. • describe the structure and functions of the different types of joints between bones. • use this week’s CBL to integrate learning during this week.


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WEEK 2 Lecture03/01-P9 – Principles of bones Theme: III Discipline: Anatomy Sub Discipline:

CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Norman Eizenberg Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• describe the macroscopic structure of bone • understand ossification • understand the functions of bone • classify bones • describe the features of bones

Content synopsis: This lecture will review the general principles in relation to the structure, function, classification and features of bone.

Keywords: compact bone, cancellous bone, spongy bone, trabeculae, endochondral, intramembranous, epiphyses, accessory, growth plate, long bones, flat bones

Readings: Prescribed Eizenberg N, Briggs C, Adams C. & Ahern G, (ed.) 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapter 4. Moore, Dalley & Agur 6th ed. 2010. Introduction: pg 1-70



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WEEK 2 Lecture03/01-P10 – Principles of joints Theme: III Discipline: Anatomy Sub Discipline:



• describe the structure of cartilage • classify the three main types of joints • classify synovial joints • describe joint movements

Content synopsis: This lecture will review the general principles in relation to the structure, function, classification, movements and features of cartilage plus the structure, classification and function of ligaments.

Keywords: chondrocytes, matrix, fibrocartilage, elastic cartilage, hyaline cartilage, labrum, meniscus, disc, syndesmosis, gomphosis, suture, articular, ligaments, capsule, synovium, symphysis, axes, extrinsic, intrinsic, accessory, ligaments

Readings: Prescribed Eizenberg N, Briggs C, Adams C. & Ahern G, (ed.) 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapter 5. Moore, Dalley & Agur 6th ed. 2010. Introduction: pg 1-70



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WEEK 2 Lecture03/01-P11 - Fuel molecules – Part 1 Theme: III Discipline: Biochemistry Sub Discipline: Cell Biology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• describe the major biochemical pathways associated with the release of energy • compare aerobic and anaerobic metabolism of carbohydrates • discuss the central role of acetyl-CoA and the citric acid cycle in metabolism

Content Synopsis: AdenosineTriphosphate (ATP), the energy currency of the cell. The role of redox reactions in the transfer of electrons and energy. Initial processing of glucose and lipids:

• glycolysis: conversion of glucose to pyruvate; oxygen dependent conversion of pyruvate to acetyl-coa; anaerobic production of lactate

• entry of acetyl-CoA into the Citric Acid Cycle

Keywords: redox reactions, ATP, glycolysis, aerobic, anaerobic, metabolism, Citric Acid Cycle, acetyl-CoA

Readings: Prescribed Sadava D, Heller HC, Orians GH, Purves WK, & Hillis DM, 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapter 9 Naish J, Revest P, & Syndercombe Court D, 2009, Medical Sciences, Saunders, Elseveir, Chapter 3



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WEEK 2 Lecture03/01-P12 - Fuel molecules - Part 2 Theme: III Discipline: Biochemistry Sub Discipline: Cell Biology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• discuss the concepts of electron transfer and biological oxidation • describe the features of the electron transfer chain • identify the coupling between electron transfer and the synthesis of ATP

Content Synopsis: Biological electron carriers. Recycling electron carriers: the Electron Transfer Chain reactions in the mitochondria.. Uncouplers, inhibitors and metabolic poisons.

Keywords: electron transfer chain, biological oxidation, ATP, uncouplers, inhibitors, metabolic poisons

Readings: Prescribed Sadava D, Heller HC, Orians GH, Purves WK, & Hillis DM, 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapter 9 Naish J, Revest P, & Syndercombe Court D, 2009, Medical Sciences, Saunders, Elseveir, Chapter 3



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WEEK 2 Lecture03/01-P13 - Fuel molecules Part 3 Theme: III Discipline: Biochemistry Sub Discipline: Cell Biology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• describe the pathways of metabolism of triacylglycerols, fatty acids and ketones • compare and contrast digestion and mobilisation of lipids • compare the energy yield of metabolism of carbohydrates (aerobic and anaerobic) and lipids

Keywords: triacylglycerols, fatty acids and ketones, ATP, β -oxidation, Acetyl-CoA , Citric Acid Cycle, ETC

Readings: Prescribed Sadava D, Heller HC, Orians GH, Purves WK, & Hillis DM, 2008, Life-The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapter 9 Naish J, Revest P, & Syndercombe Court D, 2009, Medical Sciences, Saunders, Elseveir, Chapter 3 Computer program “Metabolic challenges” available on Moodle



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WEEK 2 Lecture03/01-P14 - Transport across membranes Theme: III Discipline: Biochemistry Sub Discipline: Cell Biology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• discuss the structure of biological membranes • explain how molecules are transported across biological membranes • identify how membrane phospholipid composition affects metabolic activity

Keywords: triacylglycerols, fatty acids and ketones, ATP, β -oxidation, Acetyl-CoA , Citric Acid Cycle, ETC

Readings: Prescribed Sadava D, Heller HC, Orians GH, Purves WK, & Hillis DM, 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapter 9 Naish J, Revest P, & Syndercombe Court D, 2009, Medical Sciences, Saunders, Elseveir, Chapter 3 Computer program “Metabolic challenges” available on Moodle



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WEEK 2 Tutorial_04/01-P2 - Taking a medical history Theme: IV Discipline: Clinical Skills Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• demonstrate taking an appropriate and empathetic medical history • use appropriate questions in collecting information about a patient’s use of prescription and non

prescription medication, alcohol, and tobacco • summarise a medical history for a medical audience • summarise a medical history for a patient

Content synopsis: This interactive tutorial develops early medical history taking skills with students through participation.

Keywords: Direct or closed questions, CAGE test, safe drinking, smoking, medication, allergies

Readings: Prescribed Workbook entry for this tutorial Silverman J, Kurtz S, & Draper J, 2005, ‘Gathering information’ in Skills for communicating with patients, 2nd ed. Radcliffe Publishing, Oxford, pg 45-64 Silverman J, Kurtz S, & Draper J, Skills for communicating with patients. Oxford: Radcliffe Publishing, 2005. pg 77-105


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WEEK 2 Tutorial_03/01-P1 - Body fluid composition, osmolarity and ion balance Theme: III Discipline: Biochemistry Sub Discipline: Cell Biology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay (Coordinator) Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating successfully in this session and related activities, students should be able to:

• identify the osmotic effects of intravenous fluids on blood cells • deduce the movement of infused fluids and their solutes between the extra- and intracellular

compartments • explain how the water content of different isotonic fluids can end up in different places in the

body • explain how this knowledge can be used to benefit patients and, conversely, how inadequate

understanding of these principles can endanger patient safety

Content synopsis:

Refer to entry in workbook for details of preparation required for class.

Keywords: osmolarity, body fluid regulation, ion balance, plasma

Syndicate session: Refer to entry in workbook for details of preparation required for syndicate.


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WEEK 2 Tutorial_ETHICS_01/01-P1 - The nature of ethics in everyday life and medicine Theme: I Discipline: Ethics Sub Discipline:

CMS Lecturer / Tutor MUSC Lecturer / Tutor Ms Dilinie Herbert Department of Medicine Alfred Hospital Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: At the end of this tutorial you should:

• have a deeper understanding of the nature of ethics, its role in medicine and what influences decision making in clinical practice

• have a deeper understanding of the clinical relationship • understand what is meant by “consent” and some of the difficulties associated with it

Content synopsis: Ethics is the body of thought that seeks to answer the question “What should I do?” In medicine, people sometimes think of ethics as something added on to the hard, scientific part, which arises only in relation to the most extreme and controversial circumstances. In fact, ethics is at the centre of everything you will ever do in medicine. It is the part of medicine within which we decide what we should do and why, what is important and valuable and what is not, and how to balance the interests of our patients, the community and others. It is the domain within which we develop our techniques of interaction and communication with our patients. It is the field within which we decide what it is that we personally wish to achieve and what contribution we seek to make.

Keywords: Ethical decision making, principles, patient autonomy

Readings: Workbook entry for this tutorial Recommended Charlesworth M, (1993) Bioethics In a Liberal Society. Cambridge, Cambridge University Press, pg 10 Frank, Arthur W, The Wounded Storyteller: Body, Illness, and Ethics. University of Chicago Press, 1997 Gillon R, Philosophical medical ethics. Chichester. Wiley, 1986 Komesaroff PA, “From bioethics to microethics: Returning bioethics to the clinic”. In Komesaroff PA, ed. Troubled bodies (Melbourne University Press, 1996) Zaner R, Troubled Voices, Pilgrim Press, 1995


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WEEK 2 Lecture03/01-P16 - Role of the liver in metabolism and detoxification 1 Theme: III Discipline: Biochemistry Sub Discipline: CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• describe the major biochemical pathways involved in carbohydrate metabolism in the liver • explain when these pathways are used by the liver • identify how these pathways are regulated • compare and contrast the digestion and mobilisation of carbohydrates

Content Synopsis: • introduction to the role of the liver in metabolism • carbohydrate metabolism • the synthesis of glycogen (glycogenesis) • breakdown of glycogen (glycogenolysis) • synthesis of glucose (gluconeogenesis) • cori cycle • glucose alanine cycle • regulation of carbohydrate metabolism • enzyme activity • hormones

Keywords: carbohydrates, glycogenesis, glycogenolysis, gluconeogenesis

Readings: Prescribed Naish J, Revest P, & Syndercombe Court D. (2009) Medical Sciences. Chapter 3 Recommended Other references used will include Baynes JW & Dominczak MH, (2009) Medical Biochemistry 3rd ed. London/New York: Elsevier/ Mosby. Chapters 13 and 29. These chapters cover the content of the lecture in more depth than is required. Nelson DL, & Cox MM, (2008) Lehningers Principles of Biochemistry 5th ed. Computer program: Biochemistry a Metabolic Challenge. http://themedicalbiochemistrypage.org/


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WEEK 2 Lecture03/01-P37 - Role of the liver in metabolism and detoxification 2 Theme: III Discipline: Biochemistry Sub Discipline: CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• summarise the fate of amino acidsa (amino groups and carbon skeleton) which enter the liver • describe the role of the liver in amino acid metabolism • explain the role of the liver in detoxification of ammonia • discuss the pathway of ketone synthesisdiscuss inborn errors of amino acid metabolism

Content Synopsis: • synthesis of proteins in the liver • amino acid metabolism in the liver • urea cycle and its importance • drug metabolism and detoxification • inborn errors of amino acid metabolism

Keywords: amino acids, transamination, urea cycle, xenobiotics

Readings: Prescribed Naish J, Revest P, & Syndercombe Court D, (2009) Medical Sciences. Chapter 3 Recommended Other references used will include Baynes JW, & Dominczak MH, (2009) Medical Biochemistry 3rd ed. London/New York: Elsevier/ Mosby. Chapters 19 and 29. Nelson DL, & Cox MM, (2008) Lehningers Principles of Biochemistry 5th ed. Computer program: Biochemistry a Metabolic Challenge. http://themedicalbiochemistrypage.org/


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WEEK 2 Lecture02/01-P3 - What determines health? Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A



Objectives: At the conclusion of this week, you should be able to:

• extend your understanding of the social determinants of health • explain the influence of education, early childhood, employment, community, gender, diversity,

discrimination and social exclusion on health and illness • explain the concept of health equity • apply theories of the determinants of health to understanding health in any society

Content synopsis: In this lecture we examine the evidence about key social determinants of health and how they influence health and patterns of illness. We will explore the levels of determinants from individual through to lifestyle/behaviours and social structure. Then we consider how the health system responds to these influences and works to change the construction, production and distribution of health and illness. The concept of health equity is explained, together with the notions of inequality, inequity, justice and fairness, and the extent to which these value-laden concepts are drivers for the way health systems are organised.

Keywords: Social determinants of health; social structure; health equity

Readings: Halfon N, Larson K, Russ S, (2010). Why Social Determinants? Healthcare Quarterly Vol.14 Special Issue October, 9-20. Marmot M, (2001) Economic and social determinants of disease. Bulletin of the World Health Organization, 79 (10), 988-989. Mikkonen J, & Raphael D, (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management. Available at http://www.thecanadianfacts.org/ Wilkinson R, Michael M, (2003). Social Determinants of Health: The Solid Facts, 2nd ed. World Health Organization, 2003 http://www.euro.who.int/document/e81384.pdf Useful websites: Commission on the Social Determinants of Health 2005-2008. http://www.who.int/social_determinants/thecommission/en/ 2011 World Conference on Social Determinants of Health http://www.who.int/sdhconference/en/ Harvard Francois-Xavier Bagnoud Centre for Health and Human Rights. http://www.harvardfxbcenter.org/ Human Rights and Equal Opportunity Commission. (n.d.). Close the Gap: Indigenous Health Campaign. Report and other materials available at: http://www.hreoc.gov.au/social_justice/health/index.html


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WEEK 2 Tutorial_02/01-P2 - The determinants of health at work Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor We begin by briefly reviewing the lecture content, then the teams for this week will present the material they have selected (15 mins) followed by discussion. Themes for student presentations to be selected from the following:

• early childhood as a determinant of health • education as a determinant of health • the social gradient • social exclusion


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WEEK 2 Self directed learning exercise: Introduction to diabetes and metabolism This exercise is to be completed before the lecture on Lipid metabolism Theme: III Discipline: Biochemistry Sub Discipline: CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After completion of the associated self directed learning activity, it is expected that students will be able to:

• discuss the function, structure and composition of lipoproteins and their roles in the enterohepatic circulation

• describe the metabolic events and controls of the absorptive and post absorptive states. • explain how hormone secretion regulates blood glucose concentrations • compare Types I and II diabetes mellitus and the biochemical abnormalities underlying these

diseases • explain the metabolic and biochemical consequences of diabetes mellitus

Content Synopsis: The CD “Nutritional and Hormonal aspects of Diabetes” will be provided to all students and contains interactive and animated tutorials, quizzes and case studies related to metabolism, nutrition and diabetes. Run the program, click on “Biochemistry of diabetes” and work through the following tutorials:

• role of insulin in regulation • biochemistry of lipoproteins • biochemistry of Type 1 diabetes • biochemistry of Type 2 diabetes • biochemistry of hyperglycaemia

These tutorials will provide you with the appropriate knowledge to complete the two case studies on “Type 1 diabetes” and “Type 2 diabetes”, respectively.

Keywords: diabetes, insulin, hyperglycaemia, metabolism, lipoproteins

Readings: Naish J, Revest P, & Syndercombe Court D, (2009) Medical Sciences. 559-564 Baynes JW, & Dominczak MH, (2009) Medical Biochemistry 2nd ed. London/New York: Elsevier/ Mosby Chapters 12, 17 & 20. Saladin KS, (2007) Anatomy and Physiology: The Unity of Form and Function. 4th ed. New York: McGraw-Hill. 1020-1022 and 1036-1038. Kumar P, & Clark M, (2005) Clinical Medicine: A Textbook for Medical Students and Doctors 6th ed. Philadelphia: Saunders Ch 19


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WEEK 2 Lecture03/01-P18 - Lipid metabolism Theme: III Discipline: Biochemistry Sub Discipline: CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating successfully in this session and related activities, you should be able to describe the pathways of lipid synthesis discuss the role and structure of lipoproteins.

Content Synopsis: • synthesis of lipids • structure and function of lipoproteins

Keywords: lipids, lipoproteins

Readings: Prescribed Naish J, Revest P, & Syndercombe Court D, (2009) Medical Sciences. Chapter 3 Recommended Other references used will include Baynes JW, & Dominczak MH, (2009) Medical Biochemistry 3rd ed. London/New York: Elsevier/Mosby. Chapters 16 and 18. Nelson DL, & Cox MM, (2008) Lehningers Principles of Biochemistry 5th ed. Computer program: Biochemistry a Metabolic Challenge. http://themedicalbiochemistrypage.org/


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WEEK 2 Lecture03/01-P15 - Structural biology Theme: III Discipline: Biochemistry Sub Discipline: Haematology CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Robert Pike Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating in this session and related activities, students should be able to:

• define and describe the structure of protein at the primary, secondary, tertiary and quaternary levels

• describe the essential structural characteristics of amino acids and the nature of peptide bonds • explain the role of hydrogen bonding in protein structure • explain the role of hydrophilic/hydrophobic interactions in protein structure • appreciate the structural significance of point mutations in the amino acid sequences of some

proteins (eg. haemoglobin)

Content synopsis: This lecture will describe the amino acid sequences that form the primary structure of proteins and the peptide bonds that link each amino acid with its neighbours in the sequence. The roles of hydrogen bonding and hydrophilic/hydrophobic interactions in determining secondary, tertiary and quaternary levels of protein structure will be explained. The importance of these higher-order structural levels to the functional characteristics of proteins will be illustrated through consideration of the oxygen-storing properties of myoglobin and haemoglobin. The structural and functional disturbances caused by point mutations in amino acid sequences will be illustrated through consideration of sickle-cell anaemia.

Keywords: amino acid, peptide bond, amino acid sequence, primary structure of protein, secondary structure of protein, tertiary structure of protein, quaternary structure of protein, hydrogen bonding, hydrophobic/hydrophilic interactions, myoglobin, haemoglobin, point mutation, sickle cell anaemia, haemoglobin S

Readings: Prescribed Nelson DL, & Cox MM, (eds) 2005, Lehninger Principles of Biochemistry, 4th ed. WH Freeman, New York, pg 78-80, pg 88-89, pg 120-125, pg 132-135, pg 162-164, pg 172-174


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WEEK 2 Lecture03/01-P105 – Introduction to Acid-Base Theme: III Discipline: Physiology Sub Discipline: CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Chris Wright Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Dr Badariah Ahmad School of Medicine and Health Sciences Monash University Sunway Malaysia Email: [email protected]

Objectives: Students should be able to:

• describe the characteristics of acids and bases • convert between units of [H+] and pH, and give a quantitative account of the effects of changes

of pH in terms of changes in [H+], with particular emphasis on the logarithmic nature of the pH scale

• explain why the molecular properties of H2O make it such a significant solute and describe its role in the regulation of [H+] and [OH-] production

• classify acidosis and alkalosis on the basis of the primary disturbance • state the amount of CO2 produced and the amount of metabolic acid produced per day • understand that there are multiple acid-base pair equilibria involved in the determination of the

body’s acid-base status

Content synopsis: This lecture will revise the relationship between pH and [H+]; Other examples of logarithmic scales such as the Richter scale, dB etc will be emphasise the nature of logarithmic scales. The Bronsted-Lowry theory of acids and bases and the Lewis approach to acids and bases will be reviewd. The definition of “neutrality” ([H+] = [OH-]), and its dependence on the temperature will be explored. The consequences of a permanently alkaline environment and the law of electroneutrality will be integrated to explain why the regulation of pH within tight limits is necessary for normal cell and body function. The chemistry of H2O and the dissociation of H2O, the change from K to Kw will also be discussed. The term acidosis will be explained. Students should appreciate the fact that although the term acidosis is used, the concentration of [OH-] is still much higher than [H+]. The amount of CO2 produced/day and the biochemical fate of CO2 if it’s not excreted will be studied. The amount of metabolic acid produced each day and the metabolic consequences if not excreted will also be covered. Alkalosis will be defined and the broad classifications of acidosis and alkalosis into metabolic and respiratory causes will conclude the lecture.

Keywords: pH, hydrogen ion, electroneutrality, acidosis, alkalosis, metabolic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis

Readings: Prescribed Chapter 1 Introduction, pg 4-13, Acid-base balance & Fluid Balance, Medical Science, Naish, Revest, Court Recommended Chapter 10 Acid-base Physiology, pg 299-325 Clinical Physiology of Acid-Base and electrolyte disorders, Burton Rose, Post, 5th ed.



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WEEK 2 Practical_INJECTING_04/01 - Handwashing and injecting Theme: IV Discipline: Clinical Skills Sub Discipline: N/A

CMS Lecturer / Tutor Dr Henry Taub Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: • define the basic terms surrounding aseptic practices • describe the strategies used by health care professionals to overcome the risk of infection

associated with surgical procedures • demonstrate sound technique in hygienic hand washing and drying • to introduce students to the procedure of administering medication by injection (intramuscular

and subcutaneous) • to discuss anatomical sites, and reasons for using them • to practice assembling and using the equipment in a sterile manner • to practice the technique of administration in a non-threatening environment • to consider issues of personal safety, including avoidance of needlestick injury, and appropriate

disposal of sharps Content synopsis: In this practical session you will observe and perform a hygienic handwash before learning how to give an injection. A patient may require medication to be administered in many different ways, one of which is by injection. This practical session will introduce students to the techniques involved. Different medication may require different anatomical sites, and the reasons for this will be discussed. The opportunity will also be used to emphasise concepts that are important in many other procedures, such as maintaining the sterility of the equipment used, and protecting the safety of the patient, the operator and co-workers. In addition you will receive a list of formative questions that is provided to guide your study and knowledge of aseptic practices in medicine. Keywords: Asepsis, hygienic handwash, injection intramuscular subcutaneous sterile sharps Readings:

Workbook entry for this tutorial Asepsis Infection Control in the Health Care Setting. The National Health & Medical Research Council http://www.nhmrc.gov.au/publications/synopses/withdrawn/ic6.pdf Once at this URL, choose the link to Full Publication Available Here in PDF (1.41MB). This authoritative document contains much information that exceeds the present objectives, but is a useful resource for future use. This document will be provided in hard copy in the Reserve Section of the Andrew Hargrave Library. Due to copyright issues, this cannot be provided in your Resources Guide but can be downloaded from the web link provided. Prescribed The above document is currently under review, see for handwashing guidelines http://www.asid.net.au/hicsigwiki/index.php?title=NHMRC_infection_control_guideline_review_2008

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WEEK 3


40

WEEK 3


By the end of this week it is expected you will be able to: • Understand the legal obligations of informed consent in clinical practice. • Identify a doctor’s legal responsibilities in the context of the tort of battery. • Demonstrate sensitivity to the patient as a person rather than an illness. • Apply your knowledge of culture, socialisation and ethnicity to specific case studies. • Explain how the genetic code directs the synthesis of proteins and how the code is perpetuated

through the cell cycle. • Appreciate the relationship of mental processes to health and begin an analysis of behaviour. • Apply knowledge of metabolic processes to situations where bodily stability is challenged. • Describe how different tissues use the metabolic pathways in different ways. • Identify further key components of, and conduct, a medical history in a role-play situation. • Appreciate the applications of genomics to medical practice. • Commence the study of muscles and the principles underlying their functions. • Use this week’s CBL to integrate learning during this week.


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WEEK 3 Lecture03/01-P19 - Integrative tissue metabolism Theme: III Discipline: Biochemistry Sub Discipline: CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• describe and compare the fuels which are used and stored by the liver, adipose tissue, skeletal and heart muscle, brain and red blood cells

• describe how different tissues use the metabolic pathways in different ways • discuss when the body uses these pathways and factors that regulate them • describe how the fuel usage of tissues varies

Content Synopsis: • central role of liver in metabolism • metabolic activities of adipose tissue • metabolic activities of muscle • metabolic activities of the brain • metabolic activities of red blood cells

Keywords: lipids, glycogen, ketone bodies

Readings: Prescribed Naish J, Revest P, & Syndercombe Court D, (2009) Medical Sciences. Chapter 3 Recommended Other references used will include Baynes JW, & Dominczak MH, (2009) Medical Biochemistry 3rd ed. London/New York: Elsevier/ Mosby. Chapter 21. Nelson DL, & Cox MM, (2008) Lehningers Principles of Biochemistry 5th ed. Computer program:Biochemistry a Metabolic Challenge. http://themedicalbiochemistrypage.org/


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WEEK 3 Lecture03/01-P20 - Understanding the relevance of genomics to medicine Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Agnes Bankier Clinical Genetic Services, Austin Health Email: [email protected]


• understand why genetics is relevant to clinical practice • understand how genetics is relevant to public health • appreciate that the science of genetics is rapidly developing and increasingly relevant to all

areas of medicine • appreciate the challenges of translating genetic advances to clinical practice • understand how genetic testing is utilised to offer choices about health and reproduction • appreciate the significance of the Human Genome Project

Content synopsis: Development of new technologies and accumulating knowledge following from the Human Genome Project are impacting on all areas of medicine. The key to identifying the genetic risk is good family information. Genetic tests help in diagnosis and carrier testing, provide emerging understanding of genetic/environmental interactions and disease susceptibility which will inform prevention and patient care. The interpretation of genetic variants is a current challenge. Testing an individual’s genetic profile will inform health prevention and make it possible to develop targeted therapies by pharmacogenetics. Gene therapy and therapeutic cloning will become further choices of treatment for individuals affected by genetic disorders and degenerative illnesses. Translational research and good health policy development will be essential for harnessing these developments and integrate them into clinical practice. It is critical to gain a thorough understanding of the cell cycle and how abnormalities arise as a result of gene mutation and chromosome abnormalities. This is the foundation for understanding genetic disorders and understanding the basis of genetic tests.

Keywords: Human Genome Project, genetic profiling, genetic variants, gene therapy, cloning, mutation, pharmacogenetics, genetic disorders

Readings: Purves WK, Sadava D, Orians GH, & Heller HC 2006, Life - The Science of Biology, 7th ed. Sinauer, Sunderland, MA, Chapter 17, pg 357-361. Powerpoint presentation on WebCT Useful links Human Genetic Society of Australasia: http://www.hgsa.com.au/ Public Health Genetics: http://www.graphint.org/ver2/ Web-based learning resources https://www.hgsa.org.au/website/wp-content/uploads/2009/06/CCResources-KNOWL-for-HGSA.pdf https://www.hgsa.org.au/website/wp-content/uploads/2009/06/CCResources-SKILLS-for-HGSA.pdf


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WEEK 3 Lecture03/01-P21 - Introduction to Health and Human Behaviour Theme: III Discipline: Medicine of the Mind Sub Discipline: Health & Human Behaviour

CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Robert Selzer Alfred Hospital Faculty of Medicine, Nursing and Health Sciences Email: [email protected]

and

Dr Glenn Melvin School of Psychology and Psychiatry Faculty of Medicine, Nursing and Health Sciences Email: [email protected]

Objectives: Students should be able to demonstrate:

• an understanding of the concepts of health • an understanding of the concepts of health psychology • an understanding of the role of behaviour in health

Content synopsis: This lecture will comprise an introduction and overview of the relationship between Health and Human Behaviour, introduce the concept of health psychology and commence discussion about the inter-relationship between behaviour and health.

Keywords: Health, illness, behaviour, health perceptions, health psychology

Readings: Prescribed Morrison V, Bennett P, Butow P, Mullan B, & White K, (2007). An Introduction to Health Psychology: An Australian Perspective. Sydney, Australia: Pearson Education Ltd: Chapter 1. What is health?



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WEEK 3 Lecture03/01-P22 - Behaviour, Health and Illness Theme: III Discipline: Medicine of the Mind Sub Discipline: Health & Human Behaviour

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Glenn Melvin School of Psychology and Psychiatry Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• an understanding of illness behaviour • an ability to describe reactions to illness and loss • an understanding of the sick role • an ability to describe coping responses to illness

Content synopsis: The lecture will consider people’s reactions to illness and health, and will introduce key psychological processes, such as emotion, cognition, perception and motivation. Normal and abnormal reactions to illness, the concept of the ‘Sick Role’, coping, with illness will be discussed. Reactions to loss, and the process of grieving will be considered.

Keywords: Illness behaviour, sick role. coping, loss

Readings: Prescribed Jones, Ken & Creedy, Debra (2008) Health and Human Behaviour. 2nd ed. Oxford University Press: South Melbourne. Chapter 2: Reactions to illness. Recommended Jones, Ken & Creedy, Debra (2008) Health and Human Behaviour. 2nd ed. Oxford University Press: South Melbourne. Chapter 3: Understanding reactions to chronic conditions.



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WEEK 3 Lecture03/01-P23 - Nucleic acids and the structure and organisation of DNA Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Rod Devenish Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• explain the structure and function of DNA • describe the key principles associated with gene and chromosome organisation • explain the concept of information flow within cells

Content synopsis: This lecture will discuss information flow in cells and the concepts of DNA as molecules of inheritance and RNA as molecules of expression. The structural relationships between nucleic acids will be detailed in terms of their chemical components and their primary and secondary structure. The lecture will also explain the base pairing rules resulting in the complementarity of nucleic acid strands. The concept of the gene (including introns and exons) will be introduced and the organisation of DNA into chromosomes will be described, distinguishing between prokaryotes and eukaryotes

Keywords: nucleotide, base pairing, DNA, double-helix, RNA, gene, intron, exon, chromosomes, chromatin

Readings: Prescribed Sadava D, Hillis DM, Heller HC, & Berenbaum MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Sunderland, MA.

Ch.13, pg 267-270, ‘What is the evidence that the gene is DNA?’ Ch.13, pg 272-276, ‘What is the structure of DNA?’ Ch.11, pg 215-216, ‘Prior to mitosis eukaryotic DNA is packed into very compact

chromosomes’ Ch.4, pg 61-64, ‘What are the chemical structures and functions of nucleic acids?’ Ch.14, pg 294-296, ‘How does information flow from genes to proteins?’ Ch.14, pg 300-301, ‘Eukaryotic genes have noncoding sequences’ Ch.14, pg 377-378, ‘Eukaryotes have gene families’



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WEEK 3 Lecture03/01-P24 - RNA synthesis Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Rod Devenish Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• explain the role of RNA in expressing genetic information • describe the synthesis of RNA in cells, with an emphasis on mRNA • outline key modes by which the control of gene expression is regulated

Content synopsis: This lecture will discuss how the processes of transcription and translation link genes to proteins and how the genetic code comprises nucleotide triplets specifying amino acids. The stages of transcription – initiation, elongation and termination – will also be detailed, along with the roles of promoters, DNA-dependent RNA polymerase and regulation. The lecture will also cover modification of mRNA in eukaryotic cells – 5’ cap, 3’ poly(A) tail, splicing, introns and exons – as well as the control of gene expression.

Keywords: RNA polymerase, mRNA, rRNA, tRNA, RNA regulation, stages of transcription, translation, control of gene expression


Ch.14, pg 296-300, ‘How is the information content in DNA transcribed to produce RNA?’ Ch.14, pg 302-304, ‘Eukaryotic gene transcripts are processed before translation’ Ch.16, pg 352-356, ‘How is eukaryotic gene transcription regulated?’ Ch.16, pg 360-362, ‘How is eukaryotic gene regulated after transcription?’



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WEEK 3 Tutorial_03/01-P2 - How does alcohol disrupt the liver? Theme: III Discipline: Biochemistry Sub Discipline: CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• explain how excessive consumption of alcohol disrupts metabolic pathways leading to hypoglycaemia and fatty liver

• discuss the detrimental effects of reactive oxygen species and breakdown products of alcohol on metabolism

• explain the effect of alcohol consumption on the absorption of vitamins

Content synopsis: This tutorial will look at metabolism, including alcohol metabolism and how the consumption of alcohol affects carbohydrate and lipid metabolism.

Refer to entry in workbook for details of preparation required for class

Syndicate session: Refer to entry in workbook for details of preparation required for syndicate

Keywords: liver, alcohol, metabolism, hypoglycaemia, lactic acidosis

Readings: Refer to entry in workbook for details of preparation required for class.


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WEEK 3 Tutorial_04/01-P3 - Building the relationship Theme: IV Discipline: Clinical Skills Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• demonstrate the ability to take a basic medical history in an accurate and empathetic manner • demonstrate the ability to establish rapport to enable the patient to feel understood, valued and

supported • demonstrate verbal and non verbal interviewing skills • actively involve the patient in the interview process

Content synopsis: In this tutorial students will observe others doing medical interviews and reflect on the communication skills of the medical interviewers. Some students will undertake their first medical contact visit to a general practice or hospital ward. On these visits students have four tasks:

1. To observe communication skills. 2. To gain some understanding of the workings of a medical environment. 3. Observe ethical and legal issues. 4. Conduct a medical interview with a real patient.

Students should record their findings in the workbook. Also in this tutorial you will look at non verbal communication skills as well as practising taking a medical history.

Keywords: Verbal and non verbal communication skills, rapport, consent and confidentiality

Readings: Prescribed Silverman J, Kurtz S, & Draper J, 2005, Skills for communicating with patients, 2nd ed. Radcliffe Publishing, Oxford: Chapter 5.


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WEEK 3 Tutorial_LAW_01/01-P1 – Introduction to law and doctor-patient communication:

obtaining patient consent Part A - An Introduction to law Theme: I Discipline: Medical Law Sub Discipline:

CMS Lecturer / Tutor MUSC Lecturer / Tutor TBA

Objectives: On completion of this tutorial, students should be able to:

• understand the relevance of law in a medical context • understand the role of courts, statutory boards and tribunals in a medical context

Content synopsis: The content for part one of this tutorial is designed to introduce students to the sources of law ie. judge made law and legislation, as well as to the concept of professional conduct in the context of regulatory boards and tribunals. Part B – Doctor-Patient Communication: obtaining patient consent to medical

treatment from competent adult patients Objectives:

• identify key components of a valid legal consent to treatment • understand the type of information which must be given to patients prior to obtaining a valid

legal consent • understand the circumstances in which a medical practitioner is not legally obliged to obtain

patient consent • understand the legal consequences of failing to obtain a valid legal consent

Content synopsis: In part two, tutorial content is concerned with the legal requirements for obtaining consent from competent, adult patients.

Readings: Please note, that the Medical Law materials contained in the workbook provide an outline only of the comprehensive version of the class materials. Consequently, this outline should not be solely relied upon as an educational source. Students are strongly advised to read the comprehensive version of the materials prior to class. The class materials may be accessed on Moodle. Cross references to corresponding sections of the comprehensive version of the Medical Law class materials are included in the workbook outline.


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WEEK 3 Lecture03/01-P25 - Protein synthesis Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Rod Devenish Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• explain the steps in the synthesis of protein using mRNA as a template • describe the role of ribosomes and tRNA in translation • describe possible post-translational modifications of proteins

Content synopsis: This lecture will discuss the basic concept of translation involving the RNA-directed synthesis of polypeptides. The structure and function of tRNA and the involvement of aminoacyl-tRNA synthetases, ribosomes and rRNA will be detailed and the stages – initiation, elongation and termination – of protein synthesis will be explained. Other aspects to be covered will explore the roles of polyribosomes and signal peptides. Mechanisms of post-translational modifications will be discussed and the overall process of protein synthesis will be compared and contrasted between eukaryotes and prokaryotes.

Keywords: translation, protein synthesis, polypeptide, initiation, elongation, termination, mRNA, rRNA, tRNA, anticodon, aminoacyl-tRNA synthetase, ribosome, polysome, regulation of transcription


Ch.14, pg 304-310, ‘How is RNA translated into proteins?’ Ch.14, pg 310-313, ‘What happens to polypeptides after translation?’



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WEEK 3 Lecture03/01-P27 - DNA replication Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Rod Devenish Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• explain the basic principles of chromosome replication • explain the steps in the replication of DNA • explain how the base sequence of DNA can be determined

Content synopsis: This lecture will introduce the concept of semi-conservative replication, explaining the mechanisms of chromosome replication and the enzymes used. The lecture will also explain how the two template strands are replicated, detailing the importance of telomeres. The mechanisms of proofreading and repair of DNA will also be described along with an explanation of how the base sequence of DNA can be determined.

Keywords: semi-conservative replication, origin of replication, DNA polymerase, helicase, RNA primer, RNA primase, template strand, leading strand, lagging strand, telomere, telomerase, proofreading, repair of DNA, DNA sequencing, di-deoxynucleotide, high-throughput sequencing


Ch. 13, pg 276-284, ‘How is DNA replicated?’ Ch. 13, pg 285-286, ‘How are errors in DNA repaired?’ Ch. 17, pg 366-370, ‘How are genomes sequenced?’



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WEEK 3 Lecture03/01-P26 – Cell cycle: proliferation, maturation and apoptosis Theme: III Discipline: Anatomy Sub Discipline: Cell Biology/Histology

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Julia Young Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• discuss the different stages of the cell cycle of a somatic cell • compare and contrast the stages of mitosis • describe the life cycle of a cell from proliferation, through maturation to eventual programmed

cell death

Content synopsis: Overview of cell division/concept of somatic cell disorders. Phases of cell cycle. Stages of mitosis. Control of cell division/permanent - stable - labile cell populations. Cell death (necrosis, apoptosis, terminal differentiation). Cell division is a requirement for growth, replacement, and reproduction. Three processes are required for cell division. These are duplication of the chromosomes, movement of the duplicated chromosomes to different parts of the cell and division of the cytoplasm to create two daughter cells. This is the process of mitosis in which chromosomes are duplicated. Phases of the cell cycle are typically described as G1, S, G2 and M. DNA synthesis occurs in the S phase and mitosis in the M phase. Stages of mitosis are recognizable under the light microscope and include prophase, prometaphase, metaphase, anaphase, and telophase. Cells may die in one of two ways. Necrosis occurs when cells are damaged. Apoptosis is genetically programmed cell death.

Keywords: mitosis, chromosome, apoptosis, necrosis, cell cycle

Readings: Prescribed Sadava D, Heller HC, Orians GH, Purves WK, & Hillis DM, 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapter 9. Kerr JB, Functional Histology, 2nd ed. Mosby, Sydney, Ch 1.


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WEEK 3 Practical_03/01-P2 - The great metabolic race Theme: III Discipline: Biochemistry Sub Discipline: CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• identify how stored macromolecules are mobilised and catabolised during physical activity (a long distance race) to provide energy for cellular function

• discuss why the body relies more upon carbohydrates as an energy source at the beginning of the race and on lipids at later stages of the race

• compare and contrast the amount of energy released from the breakdown of carbohydrates and lipids

Content synopsis: This session highlights how the body generates/ stores energy before and during a 90-minute race. Students will progress through a computer program “The Great Metabolic Race” and will have to solve, at various times during the race, a series of questions/problems related to the catabolism of macromolecules and its energy production.

Info will be provided at lecture and on Moodle.

Keywords: mobilisation, catabolism, energy, lipids, carbohydrates, macromolecules

Readings: No readings listed for this session


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WEEK 3 Tutorial_02/01-P3 - Social justice and human rights: what do they mean for health? Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor This tutorial builds on the objectives and readings of Lectures 2, and asks questions about social justice and human rights, and what they mean for health. Themes for student presentations to be selected from the following:

• the concept and practices of human rights in relation to health • the concept of social justice: what does it mean for health?


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WEEK 3 Lecture03/01-P28 - Principles of muscles Theme: III Discipline: Anatomy Sub Discipline:

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Colin McHenry Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• describe the structure and function of smooth muscle, striated (skeletal) muscle and cardiac muscle

• describe muscle action in biomechanical terms • describe the structure, function and arrangement of types of muscles (unipennate,

bipennate etc) and how this influences their actions

Content synopsis: This lecture will review the general principles in relation to the structure and function of muscles and tendons plus the structure, function and arrangement of deep fascia

Keywords: fibrils, sarcomere, belly, endomysium, epimysium, perimysium, tendon, aponeurosis, raphe, levers, prime mover, synergist, agonist, antagonist, fixator, origin, insertion, sheets, septa, retinaculum, sheaths

Readings: Prescribed Eizenberg N, Briggs C, Adams C, & Ahern G, (ed.) 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapter 6 Moore, Dalley & Agur 6th ed. 2010. Introduction: pg 29-37


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WEEK 3 Lecture03/01-P29 - Meiosis and gametogenesis Theme: III Discipline: Anatomy Sub Discipline: Cell Biology/Genetics

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Julia Young Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• describe the process of meiosis and how it generates haploid cells. • appreciate the importance of independent assortment and recombination in the generation of

genetic diversity. • discuss the different requirements of ova and sperm and the development of the gametes.

Content synopsis: Meiosis: how diploid cells produce haploid gametes. Spermatogenesis and oogenesis in humans. Oocyte development/arrest/resumption of maturation. Union of gametes at fertilisation. In sexual reproduction two haploid gametes are produced as a result of a specialized form of cell division called meiosis in which a diploid cell undergoes two divisions to give rise to four haploid gametes. In humans this process is called spermatogenesis in males and oogenesis in females and ultimately leads to the production of mature sperm and ova. During meiosis DNA may be exchanged between homologous chromosomes. At fertilization the male and female gametes join to form the zygote.

Keywords: meiosis, haploid, spermatogenesis, oogenesis, zygote, homologous, gamete

Readings: Prescribed Sadava D, Heller HC, Orians GH, Purves WK, & Hillis DM, 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapters 9 & 43. Kerr JB, Functional Histology, 2nd ed. Mosby, Sydney, Ch 1. Langman’s Medical Embryology, TW Sadler, Ch 2, Publ. LWW


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WEEK 3 Lecture03/01-P30 – Principles of skin Theme: III Discipline: Anatomy Sub Discipline:


Objectives: After participating in this session, it is expected that students will be able to:

• describe the structure of thick and thin skin • described details of each of the strata in epidermis • describe specialised cell types (melanocytes, Langerhans and Merkel) in skin and their function • explain the basis of skin colour and it’s function • describe the components of the dermis • describe the structure of the hair follicle and associated structures • differentiate eccrine and apocrine glands • describe the function of skin in the context of the above structure • discuss why we are the only naked ape and how we lost our hair • discuss the evolutionary context of becoming naked and its implications for skin colour

Content synopsis: A brief review of the structure and function of skin should help students understand the basis for common skin diseases such as malignant melanoma.

Keywords: integument, epidermis, dermis, glands

Readings: Prescribed Kerr JB, (1999). Atlas of Functional Histology. London: Mosby. Wheater’s Functional Histology Watch youtube: ‘the persisent hunt’ from ‘The Human Planet’ BBC, ‘Skin deep’ (SBS story featuring Dr Nina Jablonski’s research)


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WEEK 4


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By the end of this week it is expected that you will be able to: • reflect upon the relationship between social and medical factors with respect to issues of

lifestyle, psychological and physical health and their application to self-care. • appreciate the rapid changes in genetic/molecular biology research, eg. The Human Genome

Project, and the ethical, legal and social implications they introduce. • begin to reflect upon the ethics involved in the patient/doctor interaction and the process of

informed consent. • apply your understanding of the social construction of health and illness to better comprehend

the relationship between impairment and disability. • discuss the importance of complementary base pairing in the information flow in cells. • demonstrate an understanding of chromosome structure and behaviour during meiosis and the

basis for chromosome disruption and other types of mutagenesis. • outline the interaction of different genes, the influence of environment, polygenic inheritance

and multifactoral characteristics. • explain mutagenesis and its role in genetic defects and the affect on whole organisms and

populations. • place these processes in the context of inheritance and begin to develop an appreciation of the

nature and importance of genetic counselling. • explain pharmacological terms and the basic the mechanisms of drug action. • develop understanding of the legal and ethical obligations of confidentiality and informed

consent in clinical practice. • describe the morphology and properties of the different types of tissues that can be formed by

cells. • understand the basic structure and function of the integumentary system (skin). • use this week’s CBL to integrate learning during this week.


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WEEK 4 Lecture03/01-P31 - Chromosome disorders Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Melanie Pritchard Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• know the nomenclature used for chromosome analysis of individuals • understand the different classes of chromosomal abnormality: numerical and structural • appreciate how the different abnormalities are generated and understand the impact they have

on human health

Content synopsis: Karyotyping cells and chromosomal nomenclature. Chromosomal abnormalities: numerical (Down syndrome, Patau syndrome, Edward syndrome). Numerical abnormalities of sex chromosomes (Klinefelter, Turner). Chromosomal abnormalities: structural. Increase in chromosomal abnormalities with increasing maternal age. The human karyotype consists of 46 chromosomes, which are present in 22 homologous pairs in addition to two sex chromosomes, an X and a Y in a male and two X chromosomes in a female. Chromosomes are defined on the basis of size, morphology and banding pattern revealed by staining treated metaphase cells and are numbered 1-22 from largest to smallest in addition to the sex chromosomes. Chromosome morphology is further defined by the position of the centromere, which divides the chromosome into a short arm, p and a longer arm, q. The bands in each arm are numbered from the centromere. Chromosomal abnormalities may be numerical or structural and are important causes of congenital malformation. They also account for at least half of all spontaneous abortions. Some well-known conditions resulting from abnormality in chromosome number include Down syndrome, Turner syndrome and Klinefelter syndrome. Structural abnormality of chromosomes may result for example from deletion or duplication of part of a chromosome, transfer of material from one chromosome to another, or exchange of chromosome material between two or more chromosomes.

Keywords: karyotype, homologous, centromere, short arm, long arm, aneuploidy, polyploidy

Readings: Prescribed Sadava D., Hillis DM, Heller HC, & Berenbaum MR, 2011, Life-The Science of Biology, 9th ed. Sinauer, Freeman. Chapter 11, pg 223-229 Recommended Turnpenny & Ellard. Emery’s Elements of Medical Genetics. 13th ed. Elsevier. Chapter 3, pg 30-35, 38-40, 45-54. Chapter 18



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WEEK 4 Lecture03/01-P32 - Patterns of inheritance: Mendel’s law Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Melanie Pritchard Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the difference between dominant and recessive traits • know the inheritance patterns of autosomal dominant, autosomal recessive and X-linked traits

and disorders • appreciate the factors that may affect inheritance patterns

Content synopsis: Three main modes of inheritance: autosomal dominant; autosomal recessive; and X-linked. Clinically relevant examples of each will be used for illustration. The concepts of penetrance and variable expression. Mendel’s unit of inheritance is called a gene. Alleles are different forms of a gene. Mendelian disorders are those that occur as a result of the inheritance of a single mutant gene which has an effect on the phenotype and which is inherited according to the principles described by Mendel. These disorders are autosomal if they are determined by genes on any of chromosomes 1-22 (non sex chromosomes), and sex linked if they are determined by genes on the sex chromosomes. A condition is said to dominant if it is expressed in heterozygotes and recessive if it is expressed only in individuals who are homozygous for the mutant allele. The term ‘penetrance’ refers to the proportion of individuals in a given population with a particular genotype who show the phenotype. The term ‘expressivity’ refers to the degree to which the characteristic is expressed in any affected individual.

Keywords: genotype, phenotype, allele, dominant, recessive, penetrance, expressivity, anticipation

Readings: Prescribed Sadava D, Hillis DM, Heller HC, & Berenbaum,MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Freeman. Chapter 12, pg 236-250 Recommended Turnpenny & Ellard. Emery’s Elements of Medical Genetics. 13th ed. Elsevier. Chapter 1, pg 4-5. Chapter 7, pg 103-114. Chapter 19, pg 299-302



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WEEK 4 Lecture03/01-P33 - Mutations and single gene disorders Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Melanie Pritchard Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• identify the different causes of mutations • recognise the different types of mutations found in genes • understand how different types of mutations can cause different structural and functional effects • understand the effect of different mutations resulting in haemoglobinopathies

Content synopsis: Definition of an allele and a mutation. Concept of polymorphism. Types of mutations: substitution, deletion, insertion. Structural effects of mutations: silent, missense, nonsense, frame shift. Effects of mutations in non-coding regions. Gain-of-function mutations, loss-of-function mutations, dominant-negative mutations and haploinsufficiency. Specific known mutagens and spontaneous mutations. The term mutation refers to a change in the nucleotide sequence of a chromosome. Mutations may have no observable effect on a person or may lead to a change in the phenotype of the individual. Mutations within somatic cells are passed on to their daughter cells within the body. Mutations in cells that give rise to gametes may therefore be inherited and passed on to succeeding generations. Mutations may result for example from point mutations, deletions, insertions, or inversions of sequences of DNA. Mutations may be spontaneous or induced by mutagens such as ionizing radiation, ultraviolet light or chemicals.

Keywords: mutation, nucleotide sequence, phenotype

Readings: Prescribed Sadava D, Hillis DM, Heller HC, & Berenbaum MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Freeman. Chapter 15, pg 299, 316-323, 328 Recommended Turnpenny & Ellard. Emery’s Elements of Medical Genetics. 13th ed. Elsevier. Chapter 2, pg 22-28. Chapter 10, pg 150-157. Chapter 19, pg 291-294



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WEEK 4 Lecture02/01-P4 - The individual, society and health Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A




• understand the “structure versus agency” debate, ie. individual responsibility for health (agency) versus social inequality resulting in higher rates of poor health for certain social groups (social structure)

• understand the concepts of “health behaviour” and “illness behaviour” as they pertain to the individual

• understand Talcott Parson’s concept of the “sick role” • appreciate David Mechanic’s descriptions of the determinants of “illness behaviour” • understand the importance of adherence/compliance and factors that affect the patient’s

adherence/compliance • understand the concepts of “social stratification” and the “social gradient of health” • appreciate the strong influence of social class/socio-economic status (SES) on health • appreciate the influence of employment (hazardous jobs) and unemployment on the health of

individuals and social groups

Content synopsis: In this lecture, we begin with exploration of the “structure versus agency” debate. That is, how much blame for bad health should be attributed to the behaviour of the individual (eg. substance abuse such as smoking, food consumption patterns resulting in obesity) versus negative impact of the surrounding society (eg. advertising campaigns of tobacco companies aimed at teenagers and marketing campaigns of unhealthy foods by fast food companies). We will discuss the concepts of “health behaviour” and “illness behaviour” on the part of the individual; Talcott Parson’s concept of the “sick role” and David Mechanic’s determinants of “illness behaviour”. The effectiveness of medical intervention in the treatment and management of disease (especially for a chronic disease such as diabetes mellitus) is affected by adherence/compliance on the part of the patient. We will discuss factors that can reduce rates of adherence/compliance. The concepts of social stratification and the social gradient of health (ie. the strong link between low social position and poor health) will be examined. Various theories that attempt to account for the social gradient of health will be discussed. Finally, we will examine relationships between employment, unemployment and health in the case of individuals

Keywords: “Structure versus agency” debate, health behaviour, illness behaviour, sick role, adherence/ compliance, social stratification, social gradient, social class, socio-economic status (SES), hazardous jobs and health, unemployment and health


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Readings: Black Report (actual title: Inequalities in Health: Report of a Research Working Group). United Kingdom: DHSS, 1980 http://www.sochealth.co.uk/history/black.htm (complete text available at this website) Chee HL, Barraclough S, (eds.) (2007). Health Care in Malaysia. London: Routledge. Raphael D, Farrell SE, (2002). Beyond medicine and lifestyle: addressing the societal determinants of cardiovascular disease in North America. Leadership in Health Services 15/4, i-v. Centres for Disease Control. (2010) Healthy Youth! Six critical health behaviours, available: http://www.cdc.gov/HealthyYouth/healthtopics/index.htm Noar S, & Zimmerman R, (2005). Health Behavior Theory and cumulative knowledge regarding health behaviors: are we moving in the right direction? Health Education Research, 20 (3), 275-290

Useful websites: The Intervention http://www.youtube.com/watch?v=SUcCKfCUbjo Maid in Malaysia http://www.youtube.com/watch?v=yP1VHtqJSSs Unnatural Causes. US Public Television series on Social Class and Health http://www.unnaturalcauses.org/transcripts.php



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WEEK 4 Lecture03/01-P34 - Multifactorial inheritance Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Melanie Pritchard Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the concept of epistasis and how different genes interact with each other • know what is meant by the term ‘multifactorial’ trait or disease • understand the influence of the environment • understand the difference between continuous and discontinuous traits and how this relates to

medical conditions • recognise the value of twin and family studies in understanding multifactorial traits

Content synopsis: Interaction of genes with other genes and with environmental cues. Continuous multifactorial traits, eg. height, intelligence. Discontinuous multifactorial traits, e.g., neural tube defects. Use of twin and family studies to characterise multifactorial traits. Polygenic inherited characteristics or disorders are controlled by multiple genes. Each of the genes makes a small contribution to the observed phenotype. Multifactorial characteristics or disorders result from the interplay of multiple genes with multiple environmental factors. Identical twins develop from the same fertilised egg so any differences between them can be attributed to environmental influences. The term ‘epistasis’ refers to the modification of the phenotype of one gene by another gene.

Keywords: polygenic, multifactorial, epistasis anticipation

Readings: Prescribed Sadava D, Hillis DM, Heller HC, & Berenbaum MR, 2011, Life-The Science of Biology, 9th ed. Sinauer, Freeman. Chapter 12, pg 250-253. Chapter 15, pg 330 Recommended Turnpenny & Ellard. Emery’s Elements of Medical Genetics. 13th ed. Elsevier. Chapter 9, pg 136-139. Chapter 15, pg 219-221, 225-227



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WEEK 4 Tutorial_04/01-P4 - Medical interview skills: building rapport and briefing for medical

contact visits Theme: IV Discipline: Clinical Skills Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• demonstrate the ability to take a basic medical history in an accurate and empathetic manner • demonstrate the ability to establish rapport to enable the patient to feel understood, valued and

supported • demonstrate verbal and non verbal interviewing skills • actively involve the patient in the interview process

Content synopsis: In this tutorial students will observe others doing medical interviews and reflect on the communication skills of the medical interviewers. Some students will undertake their first medical contact visit to a general practice or hospital ward. On these visits students have four tasks:

1. To observe communication skills. 2. To gain some understanding of the workings of a medical environment. 3. Observe ethical and legal issues. 4. Conduct a medical interview with a real patient.

Students should record their findings in the workbook. Also in this tutorial you will look at non verbal communication skills as well as practising taking a medical history.

Keywords: Verbal and non verbal communication skills, rapport, consent and confidentiality

Readings: Prescribed Silverman J, Kurtz S, & Draper J, 2005, Skills for communicating with patients, 2nd ed. Radcliffe Publishing, Oxford: Chapter 5.


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WEEK 4 Tutorial_03/01-P3 - Complementary base pairing/genetic code Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the importance of complementary base pairing in the information flow in cells • have an understanding of the genetic code

Content synopsis: The tutorial presents an opportunity to review the role of complementary base pairing and the genetic code in the expression of a gene. The illustration of the inheritance of an abnormal protein variant will be used to illustrate key points.



Keywords: haemoglobin (Hb), sickle cell anemia, globin chains, codon, genetic code

Readings: Read the following before attending the tutorial to enhance your understanding of DNA structure: http://www.dnai.org/index.htm then click on Code/Finding the structure/In Putting it together look at Base pairing interactive


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WEEK 4 Tutorial_ETHICS_01/01-P2 – The nature of the clinical relationship and consent Theme: I Discipline: Ethics Sub Discipline:

CMS Lecturer / Tutor MUSC Lecturer / Tutor Ms Dilinie Herbert Department of Medicine Alfred Hospital Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: At the end of this tutorial you will be expected to:

• have an understanding of the nature of confidentiality in clinical medicine, its complexities and its limits

• understand the concept of dualities and conflicts of interest and how to analyse and respond to them

Content synopsis: Confidentiality is a fundamental but difficult issue that arises often in clinical practice. Practising physicians have always vigorously sought to protect the confidences entrusted in them by their patients. The reason for this is not difficult to see. The basis of clinical medicine is the relationship between doctor and patient. For this relationship to operate effectively it must be possible for the two parties to assume mutual openness and honesty. In coming to a doctor an individual carries out an act of trust concerning matters of considerable personal importance. The doctor, in turn, gives an implicit pledge to act exclusively in the interests of the patient. Within this framework the doctor is granted access to the private and intimate regions of the patient's body and experiences. In the privacy of the clinical relationship information is obtained, diagnoses are formulated and a therapeutic process is initiated and pursued.

Keywords: Confidentiality, conflict of interest, duality of interest

Readings: Workbook entry for this tutorial


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WEEK 4 SiteVisit_04/01-P1 - Medical contact visit Theme: IV Discipline: Clinical Skills Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating successfully in site visits, you should be able to:

• take a basic medical history in an accurate and empathetic manner from a patient • demonstrate the ability to establish rapport to enable the patient to feel understood, valued and

supported in a professional environment • actively involve the patient in the interview process • observe communication skills in a professional environment • gain some understanding of the workings of a medical environment • observe ethical and legal issues at work in a medical environment

Readings: Prescribed Levett-Jones T, & Bourgeois S, 2007. The Clinical Placement: An essential guide for nursing students. Chapter 1 Churchill Livingstone. This reading will assist you to understand and manage some of the challenges medical students face in clinical environments.


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WEEK 4 Lecture03/01-P35 - Genetics counselling Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Agnes Bankier Clinical Genetic Services, Austin Health Email: [email protected]

Objectives: After participating successfully in this session and related activities, you should be able to understand:

• why people go for genetic counselling • principles of genetic counselling • importance of family history • how to draw and interpret a pedigree • ethical considerations regarding genetic health information

Content synopsis: Genetic counselling aims to provide information and opportunity for discussion so people can address their concerns and make informed decisions about their health care. People may seek genetic counselling because of concerns regarding themselves or a condition in their family which include, cancers, neurological conditions, birth defects. Genetic services provide family-centred consultation, so the needs of all members are considered. Information is provided about the condition its management, cause and prevention and the individual is supported in helping communicate genetic information to family members. An accurate diagnosis is the key and family history information is important. The available gene tests enable not only people who have disorders to have confirmatory tests but healthy people who want to find out what the future holds for their health and the health of their children may choose to have predictive testing, carrier testing and prenatal screening or testing.

Keywords: counselling, diagnostic testing, predictive testing, prenatal diagnosis, informed choice, informed consent, ethics

Readings: Prescribed Peter S, Harper 5th ed. “Practical Genetic Counselling”, Butterworth-Heinemann (1998) Recommended Human Genetic Society of Australasia (HGSA): Guidelines for the practice of genetic counselling, 1999: http://www.hgsa.com.au/

Web-based learning resources: https://www.hgsa.org.au/website/wp-content/uploads/2009/06/CCResources-SKILLS-for-HGSA.pdf


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WEEK 4 Lecture03/01-P33 - Population genetics Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Melanie Pritchard Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• be aware of the Hardy-Weinberg law and use it to determine allele and carrier frequencies • understand the principles of positive and negative selection

Content synopsis: Hardy-Weinberg law and formula. Factors affecting Hardy-Weinberg equilibrium: non-random mating, founder effects, new mutations. Natural selection and effect of environment. Examples of positive and negative selection. The study of the distribution of genes in populations and how these gene frequencies are maintained or altered has important applications in clinical medicine. Population genetics can provide an insight into and an understanding of human evolution, the frequency and selection pressures for recessive genes. A population that is not changing genetically from generation to generation is said to be at Hardy-Weinberg equilibrium. Allele and genotype frequencies in populations remain constant from generation to generation unless they are modified by factors such as selection, and migration.

Keywords: evolution, selection pressure, population bottleneck, heterozygote advantage

Readings: Prescribed Sadava D, Hillis DM, Heller HC, & Berenbaum MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Freeman. Chapter 21, pg 440-451, 457-458 Recommended Turnpenny & Ellard. Emery’s Elements of Medical Genetics. 13th ed. Elsevier. Chapter 8, pg 122-130



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WEEK 4 Tutorial_02/01-P4 – Unnatural causes Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor In this tutorial, we explore the ideas put forward in the US Television series: Unnatural Causes. Student groups who present this week will select one or two ideas each for presentation to the class and then lead discussion. Students presenting should also use additional literature to support their points.


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WEEK 4 Practical_03/01-P13 – Integumentary system/skin Theme: III Discipline: Anatomy Sub Discipline: Histology



• describe the function of skin • describe the structure of thick and thin skin • described details of each of the strata in epidermis and how they vary in thick an thin skin • describe specialised cell types (melanocytes, Langerhans and Merkel) in skin • explain the basis of skin colour • describe the components of the dermis • describe the structure of the hair follicle and associated structures • differentiate eccrine and apocrine glands

Content synopsis: A brief review of the structure and function of skin should help students understand the basis for common skin diseases such as malignant melanoma.

Keywords: integument, epidermis, dermis, glands

Readings: Prescribed Kerr JB, (2010). Functional Histology. Mosby, Chapter 9. Wheater’s ‘Functional Histology’ (4th or 5th ed.) Churchill Livingston, Chapter 9


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WEEK 4 Lecture03/01-P37 - Origin of cells and tissues Theme: III Discipline: Anatomy Sub Discipline: Developmental Biology/

Histology CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Paul McMenamin Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• discuss the concept of stem cells/origin embryonic germ layers/body plan • describe the life history of the germ line • describe the bilaminar and trilaminar germ disc stages of development • describe gastrulation and neurulation

Content synopsis: Define stem cells by their developmental potential. Examples of totipotent, pluripotent, multipotent cells. The blastula, gastrula, ES cells, 3 germ layers and their fate. Cell differentiation; body plan and germ cell line, neural tube induction, notochord.

Readings: Langman’s ‘Medical Embryology’ TW Sadler LWW, 12th ed. Chapter 3, 4, 5.


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WEEK 4 Lecture03/01-P38 - Primary tissue types - Epithelia, glands and connective tissue Theme: III Discipline: Anatomy Sub Discipline: Histology CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jane Black Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand that all organs composed of primary tissue types. • identify the structural characteristics and basic functions ascribed to the primary tissues. • appreciate permanency, stability, lability of tissues. • recognise the evidence for plasticity or transdifferential of stem cells/progenitors within primary

tissues.

Content synopsis: How 3 germ layers in embryo become 4 primary tissues in fetus and beyond. Basic properties of epithelium, connective tissue. Similarities and differences, trans-differentiation. Adult stem cell diversion to form cells of other organs, and their clinical potential. Life expectancy of the tissue types.

Readings: Langman’s ‘Medical Embryology’ TW Sadler LWW, 12th ed. Chapter 6.


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WEEK 4 Lecture03/01-P39 - Primary tissue types - Nerve and muscle Theme: III Discipline: Anatomy Sub Discipline: Histology CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jane Black Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand that all organs composed of primary tissue types • identify the structural characteristics and basic functions ascribed to the primary tissues • appreciate permanency, stability, lability of tissues • recognise the evidence for plasticity or transdifferential of stem cells/progenitors within primary

tissues

Content synopsis: How 3 germ layers in embryo become 4 primary tissues in fetus and beyond. Basic properties of epithelium, connective tissue. Similarities and differences, trans-differentiation. Adult stem cell diversion to form cells of other organs, and their clinical potential. Life expectancy of the tissue types.

Readings: Langman’s ‘Medical Embryology’ TW Sadler LWW, 12th ed, Chapter 6.


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WEEK 5


By the end of this week it is expected that you will be able to: • reflect upon the relationship between social and medical factors with respect to issues of

lifestyle, psychological and physical health. • reflect on the impact of living with an impairment / disability on a person’s life. • reflect on what it means to work with people living with an impairment and/or disability. • apply scenario the legal framework within which the medical practice operates to a specific

legal. • outline complementary health modalities and their relevance to contemporary healthcare • appreciate how advances in biotechnology can be applied to modifying cellular function and the

diagnosis and treatment of disease. • explain the cell cycle and how cells are organized into tissues. • gain practical experience of human karyotyping. • develop understanding of the legal and ethical obligations of confidentiality and informed

consent in clinical practice. • identify strategies for dealing with strong emotions in medical interview situations. • further enhance communication skills via reflective self-appraisal. • provide constructive feedback to peers in order to create a supportive and cooperative learning

environment. • outline the process of cognition. • understand the structure and function of different types of connective tissue. • use this week’s CBL to integrate learning during this week.


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WEEK 5 Lecture01/01-P1 - Introduction to integrative medicine Theme: I Discipline: HEP Sub Discipline: Complementary Medicine CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• appreciate the relevance of CM to modern healthcare • understand the terminology relating to CM and Integrative Medicine • understand community attitudes to and usage of CM • understand the current uptake of CM among doctors in Australia • define the main modalities of CM • appreciate some of the main concerns related to CM use • appreciate the salient lessons which can be gleaned from the CM phenomenon • understand where to access further information on CM

Content synopsis: This introductory lecture will lay an initial foundation for appreciating the scope, role and place for CM in modern healthcare in Australia and overseas. Definitions, common terms, usage rates, attitudes, and reasons for use of CM will all be discussed. The most widely used classification breaks CM up into five modalities: philosophical or whole systems, mind-body approaches, manual therapies, medicinal, and bio-energetic. A spectrum of CM modalities, from those with good evidence, to those with little or no evidence, to those with a proven lack of efficacy, and to those which are potentially harmful, will be explored. Important for student and practitioner alike, is to know where to access further information and organisations which train doctors in the responsible use of various CM modalities.

Keywords: complementary medicine, integrative medicine, alternative medicine, natural medicine, community attitudes, philosophical systems, mind-body medicine, manual therapies, medicinal therapies, bio-energetic therapies

Readings: No readings listed for this session



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WEEK 5 Lecture03/01-P41 – Cognition, health and illness Theme: III Discipline: Medicine of the Mind Sub Discipline: Health & Human Behaviour

CMS Lecturer / Tutor MUSC Lecturer / Tutor Ms Helen Jeges

Objectives: Students should be able to demonstrate, at an introductory level, an understanding of:

• the basis and functions of cognition • models of health beliefs and their effect on health behaviour • clinical reasoning and decision making

Content synopsis: An information-processing model which treats cognition as the transformation of information will be considered, along with its relationship to learning and memory. Concept formation will be introduced, and will lead into the consideration of the role of prototypes in thinking. Discussion of expectancy-value theory in decision-making will lead into models of health beliefs and the stages of health behaviour change. The placebo effect and medication compliance will be used to demonstrate these principles. The cognitive basis of clinical decision-making will end the lecture.

Keywords: Cognition, rational decision making, expectancy-value theory, heuristics, health beliefs

Readings: Prescribed Jones, Ken and Creedy, Debra (2008) Health and Human Behaviour. 2nd ed. Oxford University Press: South Melbourne. Chapter 6: Cognition and health beliefs. Recommended Morrison, V, Bennett, P, Butow, P, Mullan, B, & White, K, (2007). An introduction to health psychology in Australia. Pearson Education Australia. Chapter 5: Predicting Health Behaviour (pg 104-133), Chapter 10: The Consultation and Beyond (pg 264-275).



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WEEK 5 Lecture03/01-P35 - Key recombinant DNA techniques impacting on medicine Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Rod Devenish Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• describe the basic capabilities that underpin genetic engineering (eg. to synthesise DNA chemically)

• understand the polymerase chain reaction (PCR) and how it has impacted on biomedical science

• understand the outcomes of gene targeting and why we might produce transgenic animals

Content synopsis: This lecture will present an overview of the tools of genetic engineering, discussing gene targeting and the possible production of transgenic animals, with a particular focus on the polymerase chain reaction (PCR).

Keywords: restriction enzyme, vectors, cloning, gene library, cDNA, homologous recombination, mouse gene knockout, polymerase chain reaction (PCR), antisense RNA, RNA interference

Readings: Prescribed Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Sunderland, MA.

Ch. 18, pg 387-388, ‘What is recombinant DNA?’ Ch. 18, pg 389-392, ‘How are new genes inserted into cells?’ Ch. 18, pg 392-393, ‘What sources of DNA are used in cloning?’ Ch. 18, pg 393-394, ‘Genes can be inactivated by homologous recombination’ Ch. 18, pg 394-395, ‘Complementary RNA can prevent the expression of specific genes’ Ch. 13, pg 286-287, ‘How does the polymerase chain reaction amplify DNA?’



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WEEK 5 Lecture03/01-P42 - How cells communicate Theme: III Discipline: Anatomy Sub Discipline: Histology CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jane Black Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• identify the structural and functional basis of communication between cells in tissues • describe how and why cells communicate at different levels in physiological systems

Content synopsis: • Cell junctions • Membrane receptors and cell signalling • Autocrine, paracrine and endocrine interactions • Neural connections

Readings: Prescribed Purves. WK, Sadava. D, Orians, GH, and Heller. HC, (2001) Life, The Science of Biology, Chapter 15. Alberts, B, (1994) Molecular Biology of the Cell, 3rd ed. (New York, Garland) pg 721–727 Available from: http://images.lib.monash.edu.au/med1011/ Kerr, JB, Functional Histology, 2nd ed. Mosby, Sydney, Ch 1.


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WEEK 5 Lecture03/01-P43 - Diagnostic DNA tests - technology of mutation detection and

infectious disease diagnosis Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Rod Devenish Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the basic technologies for mutation detection in DNA and their use for diagnostic applications

• appreciate the potential applications of DNA microarray technology

Content synopsis: This lecture will explain the application of the basic technologies for mutation detection in DNA and their application in diagnosis through a small number of selected examples, also covering the technology of DNA microarrays (gene chips) and their potential for use in diagnosis.

Keywords: genetic screening, pre-implantation screening, allele-specific testing, DNA fingerprinting, DNA microarrays

Readings: Prescribed Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Sunderland, MA:

Ch.15, pg 334-337, ‘How is genetic screening used todetect diseases?’ Ch.15, pg 325-326, ’DNA fingerprinting uses restriction analysis and electrophoresis’ Ch.18, pg 395-397, ‘DNA microarrays can reveal RNA expression patterns’

Alcamo, IE, 2001, DNA Technology: The Awesome Skill, 2nd ed. Academic Press, London: Ch. 7, pg 163-164, ‘Diagnosing Infectious Disease. Acquired immune deficiency syndrome’ Ch. 9, pg 208-219, ‘Medical Forensics and DNA Sleuthing’ Available from: http://images.lib.monash.edu.au/med1011/04109047.pdf



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WEEK 5 Lecture03/01-P44 - Gene and protein engineering in clinical medicine: production of

proteins for use in treatment of disease Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Rod Devenish Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand how DNA technology can be used to produce proteins to relieve disease • appreciate the basic biochemistry and cell biology applied to the manufacture of protein

products using recombinant DNA technology

Content synopsis: This lecture will present an overview of the tools for protein production, discussing how they can be used for human protein replacement (eg. human growth hormone, factor VIII, insulin) and human therapy (eg. interferon, hepatitis B vaccine).

Keywords: expression vector, host cells, human growth hormone, hepatitis B vaccine, DNA vaccines, animals as bioreactors, antisense RNA, small interfering RNA


Ch. 18, pg 397-403, ‘What is biotechnology?’ Ch. 42, pg 883-884, ‘Vaccines are an application of immunological memory’ Ch. 18, pg 394-395, ‘Complementary RNA can prevent the expression of specific genes’

Alcamo, IE, 2001, DNA Technology: The Awesome Skill, 2nd ed. Academic Press, London: Ch. 6, pg 125-129, ’Human growth hormone’; pg 141-142, ‘Hepatitis B’ Available from: http://images.lib.monash.edu.au/med1011/04109047.pdf



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WEEK 5 Tutorial_03/01-P4 - Life cycle of cells Theme: III Discipline: Biochemistry Sub Discipline: Cell Biology/

Developmental Biology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• explain the life cycle of cells • define chromosome, chromatid, homologous, centromere, aneuploidy, polyploidy, cell cycle,

mitosis, meiosis,spermatogenesis, oogenesis, apoptosis and necrosis

Content synopsis:



Keywords: chromosome, chromatid, homologous, centromere, aneuploidy, polyploidy, cell cycle, mitosis, meiosis spermatogenesis, oogenesis, apoptosis and necrosis

Readings: Go to the website: www.thelifewire.com Click on the 8th ed. companion site Click on animated tutorials Work through the Chapter 9 tutorials on Mitosis and Meiosis


88

WEEK 5 Tutorial_04/01-P5 - Medical interview skills: responding to emotion



Objectives: After this tutorial it is expected that students will be able to demonstrate:

• the ability to establish rapport to enable the patient to feel understood, valued and supported • an ability to recognise and respond to non verbal cues • respond empathetically to patient emotion • an understanding of principles involved in responding to emotion

Content synopsis: In this tutorial student will study the current best practice for responding empathetically to patients displaying strong emotions. It is expected that student will demonstrate these skills in role plays and with patients.

Keywords: Non verbal communication skills, strong emotion, grief

Readings: Prescribed Workbook entry for this tutorial Silverman, J, Kurtz, S, and Draper, J, (1998) Skills for communicating with patients. Building the relationship pg 73-88, 136-141 (Radcliffe Medical Press) Murtagh, J, (2007) Chapter 5 Counselling skills “Bereavement” in: General Practice 4th ed. (McGraw Hill) Prigerson H, Jacobs S, Table 2: “Strategies for communication with and caring for bereaved patients”. In: Caring for bereaved patients: ‘All the doctors just suddenly go’ JAMA 286 (11) pg 1326-1376, 2001 Tully, J, ‘Grief and loss: I’m not myself anymore’ In Australian Family Physician 32 (9) pg 697-700, 2003. Recommended McCord, R, et al (2002) Responding to patient anger directed at a physician. Family Medicine Journal 34 (5) 331-336 Sullivan, G, (1998) How to deal with an angry patient. RN 61 (10) 63-4 Wagner, R, et al (1997) Crying in hospitals: a survey of doctors’, nurses’ and medical students’ experience and attitudes. MJA 166 (1) 13-16 For those interested in qualitative studies Robinson, W, Prest, L, Susman, J, Rouse, J, Crabtree, B, ‘Technician, friend, detective, and healer: Family physicians’ response to emotional distress’. In The Journal of Family Practice 50 (10) pg 864-870, 2001


89

WEEK 5 Tutorial_LAW_01/01-P2 - Confidentiality in clinical practice: legal aspects Theme: I Discipline: Medical Law Sub Discipline:

CMS Lecturer / Tutor MUSC Lecturer / Tutor TBA

Objectives: On completion of this tutorial, students should be able to:

• understand the concept of the legal obligation of confidence • identify circumstances in which it is legally permissible for doctors to disclose confidential

patient information • recognize circumstances in which medical practitioners are required to comply with mandatory

reporting obligations • understand key aspects of Commonwealth and Victorian Privacy Principles • identify breaches and potential breaches of confidentiality in a health care context

Readings: Please note, that the Medical Law materials contained in the workbook provide an outline only of the comprehensive version of the class materials. Consequently, this outline should not be solely relied upon as an educational source. Students are strongly advised to read the comprehensive version of the materials prior to class. The class materials may be accessed on Moodle. Cross references to corresponding sections of the comprehensive version of the Medical Law class materials are included in the workbook outline.


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WEEK 5 Practical_03/01-P14 - Connective tissues and cartilage Theme: III Discipline: Anatomy Sub Discipline: Histology CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Paul McMenamin Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• describe where cartilage is found in the body • differentiate on a structural basis hyaline, fibro and elastic cartilage • describe the role of cartilage components in weight bearing • describe the basic morphology of the chondrocytes • describe the process by which cartilage grows • appreciate the limited capacity of cartilage to repair • understand (at a basic level) the role of cartilage in growth of long bones

Readings: Prescribed Kerr, JB, (2010) Functional Histology. Mosby, Chapter 5. Wheater’s ‘Functional Histology’ (4th or 5th ed.) Churchill Livingston.


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WEEK 5 Lecture03/01-P38 - Gene expression Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Rod Devenish Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating successfully in this session and related activities, you should be able to explain the key principles associated with gene regulation at the level of transcription and at the level of chromosome structure.

Content synopsis: This lecture will discuss the following concepts:

• Differential gene expression, detailing how proteins control gene expression at the level of transcription and including the involvement of microRNAs in gene expression.

• How nucleosomes are modified and how this influences local chromatin structure and in turn gene expression.

• DNA methylation and effects on gene expression.

Keywords: differential gene expression, regulatory proteins, transcription factors, DNA-binding proteins, dimers, co-ordinated gene control, microRNAs, chromatin, nucleosomes, histones, histone modifications, DNA methylation, genomic imprinting, epigentic programming


Ch. 16, pg 352-356, ‘How is eukaryotic gene transcription regulated?’ Ch. 16, pg 356-360, ‘How do epigenetic changes regulate gene expression?’

Clark, DP, 2005, Molecular Biology: Understanding the Genetic Revolution, Elsevier, Amsterdam, Ch. 10, pg 262-280, ‘Regulation of Transcription in Eukaryotes’



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WEEK 5 Lecture01/01-P3 - Introduction 1 – Behaviour change, lifestyle and motivation Theme: I Discipline: HEP Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• revise the basic elements of the ESSENCE model • understand the importance of lifestyle factors in the development and progression of chronic

illness • describe the role of education in healthcare, with particular emphasis on the BASK model. • understand the importance of goal setting, with particular reference to the SMART model. • describe a variety of behavioural change strategies, with particular reference to the Prochaska-

Di Clemente model of behaviour change. • appreciate some of the principles of motivational interviewing • understand how holistic lifestyle programs such as the Ornish program are integrated into

healthcare

Content synopsis: This introductory lecture will give an overview of the Health Enhancement Program and the Essence lifestyle model. It is important to appreciate the role of lifestyle factors in the development and progression of chronic illnesses such as heart disease and cancer. Chronic illnesses being primarily lifestyle related means that the management of these conditions is therefore also primarily lifestyle related. Understanding how to motivate patients and facilitate lifestyle change is therefore an important skill to learn both for one’s own personal health and also for our future patients. The lecture includes the principles and applications of the BASK model for educational interventions, the SMART model for goal setting, and the Prochaska-Di Clemente model of behaviour change.

Keywords: chronic illness, motivational interviewing, BASK model, SMART model of goal setting, Prochaska-Di Clemente model, Ornish program

Readings: Prescribed Britt E, Hudson S, Blampied M, Motivational interviewing in health related settings: a review. Patient Education and Counselling 2004; 53 (2) 147-155 Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 1-14 Hassed C, de Lisle S, Sullivan G, Pier C, Enhancing the health of medical students: outcomes of an integrated mindfulness and lifestyle program. Adv Health Sci Educ Theory Pract. 2008 May 31. [Epub ahead of print] http://dx.doi.org/10.1007/s10459-008-9125-3 Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 161-175 Ornish D, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990; 336 (8708): 129-33 Ornish D, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005; 174 (3) 1065-9


http://dx.doi.org/10.1007/s10459-008-9125-3�


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WEEK 5 Practical_03/01-P4 - Human karyotype analysis Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Melanie Pritchard Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• review the meaning of the key words listed in lectures • describe briefly the common chromosome disorders • explain how these abnormalities may arise • understand the traditional method of giemsa stain to analyse karyotypes • identify different chromosomes based on their size, position of centromere and banding pattern • have an understanding of the advances in karyotyping ie. Molecular karyotyping

Content synopsis: This practical will introduce students to the process of karyotyping human cells. Students will be supplied with an example of a normal human karyotype and use this as a template to karyotype abnormal metaphase spreads. Demonstration material will be provided displaying a range of clinically relevant chromosomal disorders, including aneuploidies, balanced and unbalanced translocations and inversions. An introduction into molecular karyotyping will also be given.

Keywords: cytogenetics, chromosome, karyotype, G-banding, ideogram, aneuploidy, polyploidy, translocation (balanced, unbalanced), inversion, deletion, duplication, insertion

Readings: No readings listed for this session Refer to entry in workbook for details of preparation required for class


94

WEEK 5 Tutorial_02/01-P5 - Concepts of equity, inequity and inequality and the social gradient Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor This tutorial will build on the objectives and content of Lecture 4, to explore concepts of equity, inequity, inequality and the social gradient. Equity and inequity are core concepts for health systems, which in turn, are concerned with policies and programs that affect health. This week, we will consider different approaches to understanding social inequality, health equity and inequities and how they affect health behaviours and personal health practices. Student-led discussion: select from the following topics:

• health equity in theory and practice • can health equity be fixed in a generation, as the “Commission on the Social Determinants of

Health” asserts?


95

WEEK 5 Lecture03/01-P47 - Introduction to pharmacology Theme: III Discipline: Pharmacology Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Wayne Hodgson Department of Pharmacology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Dr Amudha Kadirvelu School of Medicine and Health Sciences Monash University Sunway Malaysia Email: [email protected]


• explain some common pharmacological terms • describe the principles of drug nomenclature • list some useful sources of information about drugs • explain the terms pharmacodynamics and pharmacokinetics

Content synopsis: Definitions of some commonly used terms in pharmacology; drug nomenclature; examples of sources of information about drugs; where drugs act, including receptors and other sites.

Keywords: drug, agonist, antagonist, pharmacodynamic, pharmacokinetic, nomenclature, receptor, potency, efficacy

Readings: Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7h ed. Churchill Livingstone, Edinburgh. What is pharmacology? Chapter 1, pg 1-5. How drugs act: general principles: Chapter 2, pg 6-19. How drugs act: molecular aspects: Chapter 3, pg 20-48.


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WEEK 5 Lecture03/01-P48 - Introduction to pharmacodynamics Theme: III Discipline: Pharmacology Sub Discipline: N/A


Dr Sunil Gurtu School of Medicine and Health Sciences Monash University Sunway Malaysia Email: [email protected]


• describe how drug molecules bind at receptor sites • discuss receptor-effector coupling mechanisms, including those involving second messengers • describe basic concepts in pharmacodynamics, including agonists, antagonists, efficacy, partial

agonists and spare receptors, inverse agonists

Content synopsis: This lecture will describe the pharmacodynamic properties of drugs, detailing how drug molecules form chemical bonds at binding sites (receptors). Various types of receptors will be described, including ionotropic receptors, G-protein-coupled transmembrane receptors, kinase linked receptors, intracellular hormone receptors and other molecular targets of drug action. Quantitation of pharmacodynamic action will be illustrated through the concepts of concentration-response curves and log concentration-response curves. Classification of drug actions will be explained in terms of agonists, antagonists and partial agonists. The lecture will also deal with the concepts of spare receptors and receptor reserve.

Keywords: agonist, antagonist, pharmacodynamic, receptor, potency, efficacy, selectivity, second messenger

Readings: Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh. How drugs act: general principles: Chapter 2, pg 6-19. How drugs act: molecular aspects: Chapter 3, pg 20-48.



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WEEK 5 Lecture03/01-P39 - Introduction to gene therapy and therapeutic cloning Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Rod Devenish Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the basic concept of differential gene expression • outline the basic properties of totipotent cells and stem cells • understand the concept of therapeutic cloning • understand the basic concepts and strategy in gene therapy

Content synopsis: This lecture will present an overview of cell differentiation, emphasising the role of stem cells and nuclear transfer and leading to consideration of gene therapy.

Keywords: differentiation, totipotentcy, animal cloning, therapeutic cloning, embryonic stem cells, adult stem cells, induced pluripotent stem cells, gene therapy


Ch. 15, pg 337-339, ‘How are genetic diseases treated?’ Ch. 19, pg 408-412, ‘Is cell differentiation reversible?’



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WEEK 6


100

WEEK 6


By the end of this week it is expected that you will be able to: • develop understanding of the legal and ethical obligations of confidentiality and conflicts of

interest in clinical practice. • understand how issues of access influence health outcomes and clinical practice. • identify, from a number of different perspectives, how social factors influence access to health

care. • describe the modes of communication that occur between cells including the intracellular

transduction mechanisms that are activated by signalling. • proceed from an appreciation of the general phenomena of cell signalling to commence an

analysis of the special phenomenon of neural communication and the general properties of nerves.

• extend the understanding of genetic processes and mutation by investigating the methods and uses of pedigree construction and analysis.

• continue the study of pharmacological principles by understanding the ways in which drug action is modulated by the processes of absorption, distribution, metabolism and clearance.

• commence an understanding of the anatomical regions of the body and the nature of the integument.

• identify and practice culturally appropriate communications skills for medical encounters. • understand how the primary tissue types combine to form organs and how the nervous system

develops. • describe the microstructure of bone and bone growth. • use this week’s CBL to integrate learning during this week.


101

WEEK 6 Lecture03/01-P49 – Structure and function of bone Theme: III Discipline: Anatomy Sub Discipline: Histology



• describe the general morphology of adult compact and cancellous bone • describe the function of periosteum and endosteum • describe the structure and function of the osteon • understand the roles of cells that form and destroy bone • describe the processes of endochondral and intramembranous ossification • understand the role of the growth plate in longitudinal bone growth • describe the cells and tissues involved with fracture repair

Content Synopsis: The functional histology of adult bone and its development will be reviewed. Bone modelling vs. remodelling will be discussed. Biology of the growth plate and how a fracture is repaired will be presented.

Keywords: Osteoblast, osteocyte, osteoclast, endochondral/intramembranous ossification, fracture repair

Readings: Prescribed Kerr, JB, (2010) Functional Histology Chapter 10. Mosby/Elsevier, Sydney Langman’s ‘Medical Embryology’ TW Sadler LWW, 12th ed. Chapter 9 Wheater et al ‘Functional Histology’ Chapter 10


102

WEEK 6 Lecture02/01-P5 – Access to health and social care services





• understand the difference between “availability” versus “accessibility” as they pertain to health and social care services

• know about the ongoing debate between proponents of access to health and social care services as a “right” (of citizenship, for example) versus proponents of access based on the “ability to pay” (the market approach)

• appreciate the different barriers that affect reasonable access to health and social care services, ie geographical, financial, cultural, discriminatory treatment (including the behaviour of individual health and social care providers)

• appreciate the importance of innovative approaches that can impact access, eg. technological (teleconsultation and remote surgery in rich countries); the flying doctor service of outback Australia and East Malaysia; pre-paid health insurance schemes; community-based health workers; etc

• understand that current trends such as privatization and the growth of medical tourism may have a significant negative impact on access for local people

Content synopsis: In this lecture, we begin with exploration of the concepts of “availability” versus “accessibility” as they pertain to health and social care services. We note that “availability” refers to whether services are physically at hand while “accessibility” refers to whether the care-seeker is able to make use of particular services in the face of various barriers. We note the philosophical and ideological debate between proponents of access to health and social care services as a “right” (of citizenship, for example) versus proponents of access based on the “ability to pay” (the market approach). We also note that resources are not infinite and that the debate extends – beyond the public provision of a basic package of services – to what the limits to access are based on the “rights” approach.

Keywords: Availability, accessibility, barriers to access, care as a “right”, care based on “ability to pay”, privatization, medical tourism

Readings: Braveman, P, & Gruskin, S, (2003). Poverty, equity, human rights and health. Bulletin of the World Health Organization, 81, 539-545. Chee HL, Barraclough S, ed. (2007). Health Care in Malaysia. London: Routledge. Gulliford M, Morgan M, ed. (2011). Access to Health Care. London: Routledge. National Hospitals and Health Commission Report. (2010). Tackling major access and equity issues that affect health outcomes for people now. Chapter 3, Canberra, Department of Health and Ageing. Turner L, ‘Medical tourism’ and the global marketplace in health services: U.S. patients, international hospitals, and the search for affordable health care. International Journal of Health Services 2010; 40 (3): 443-467.


103

Useful websites: Online Newshour. Coping Without Health Insurance http://www.pbs.org/newshour/bb/health/july-dec05/insurance_11-28.html BBC News. China’s High-Cost Health Care http://news.bbc.co.uk/2/hi/asia-pacific/2949525.stm The Price of Health http://www.youtube.com/watch?v=qL3a57YvuJU



104

WEEK 6 Lecture03/01-P50 - Introduction to pharmacokinetics Theme: III Discipline: Pharmacology Sub Discipline: N/A




• describe the basic principles of pharmacokinetics relating to drug absorption, distribution, metabolism and excretion

• explain the advantages and disadvantages of different routes of administration

Content synopsis: Definition of pharmacokinetics, properties of drugs affecting absorption and distribution, absorption of drugs, penetration of drugs across cell membranes, factors affecting drug passage across membranes by passive diffusion, lipid solubility of drugs, drug molecular size and shape, degree of ionisation, pKa, ion trapping, factors affecting speed of oral absorption, oral bioavailability, factors that affect distribution of drugs, binding of drugs to plasma proteins, volume of distribution, first pass metabolism, renal excretion.

Keywords: pharmacokinetics, absorption, distribution, metabolism, excretion, liver, kidney, oral bioavailability, volume of distribution

Readings: Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7h ed. Churchill Livingstone, Edinburgh. Drug absorption and distribution: Chapter 8. pg 99-114. Drug metabolism and elimination: Chapter 9. pg 115-122.


105

WEEK 6 Tutorial_03/01-P5 - Pedigree construction Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay (Coordinator) Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• draw a three generation pedigree • explain the inheritance of diseases (listed below) when given the appropriate information • discuss the treatment and the rationale for the treatment of the diseases listed below

Content synopsis:



Keywords: pedigree, inheritance, generation

Readings: Refer to entry in workbook for details of preparation required for class


106

WEEK 6 Tutorial_04/01-P6 - Cross cultural communication skills Theme: IV Discipline: Clinical Skills Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating in this tutorial students should be able to:

• understand that good communication skills are culturally specific • practice culturally appropriate communication skills • review culture aspects within the medical encounter

Content synopsis: Students will explore culture in the medical encounter through role plays and videos.

Keywords: Cross cultural communication

Readings: Prescribed Workbook entry for this tutorial Cole, S, and Bird, J, (2000) Overcoming cultural and language barriers in The Medical Interview: a three function approach, pg 138-150 Eckermann, A, Dowd, T, et al. (2006) Binan Goonj Bridging Cultures in Aboriginal Health pg 111-124


107

WEEK 6 Lecture03/01-P51 - Signalling Theme: III Discipline: Biochemistry Sub Discipline: Cell Biology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Caroline Speed Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating successfully in this session and related activities, students should have learnt to:

• understand how signal transduction works • describe, in general terms, the key components of signal transduction pathways • have an appreciation of the outcomes of signal transduction

Content synopsis: • signal transduction pathways • components of signal transduction pathways • outcomes of signalling

Keywords: signal transduction pathway, receptor, ligand, transmembrane receptor, protein-linked receptor, cytoplasmic receptor, transducers, second messenger, signal effects

Readings: Recommended Sadava, D, Hillis, DM, Heller, HC, and Berenbaum MR, (2011) Life: The Science of Biology, 9th ed. (WH Freeman & Co). Read Chapter 7, pg 128-45. ‘Cell Signaling and Communication’



108

WEEK 6 Lecture03/01-P52 -Transmitters Theme: III Discipline: Pharmacology Sub Discipline: N/A




• recognise the diverse range of chemicals that have been identified as neurotransmitters • identify the major chemical transmitters in the peripheral and central nervous systems • describe the criteria that need to be satisfied for a chemical to be designated as a

neurotransmitter • describe the basic mechanisms of synthesis, storage, release and termination of action of

neurotransmitters • describe mechanisms by which neurotransmission can be modulated.

Content synopsis: Students will be introduced to the chemicals which act as transmitters within the body including: noradrenaline, acetylcholine, 5-hydroxytryptamine, adrenaline, dopamine, nitric oxide and a range of peptides. However, the lecture will focus primarily on the two main transmitters of the peripheral (ie autonomic and somatic) nervous system: noradrenaline and acetylcholine. Concepts discussed will include synthesis, storage, release, and termination of action. In addition, pre- and post-synaptic modulation will be discussed.

Keywords: neurotransmission, nerve, muscle, noradrenaline, acetylcholine, synthesis, storage, modulation, sympathetic, parasympathetic

Readings: Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh:

Chemical mediators and the autonomic nervous system: Chapter 12, pg 139-150; Cholinergic transmission: Chapter 13, pg 151-173; Noradrenergic transmission: Chapter 14, pg 174-193; 5-Hydroxytryptamine and the pharmacology of migraine: Chapter 15, pg 194-203; Purines: Chapter 16, pg 204-207; Local hormones: cytokines, biologically active lipids, amines and peptides. pg 208-220; Nitric oxide: Chapter 20, pg 237-245



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WEEK 6 Practical_03/01-P3 – Histology - Microstructure bone and normal bone growth Theme: III Discipline: Anatomy Sub Discipline:


Objectives: • students gain an understanding of the cellular and extracellular components of adult compact

bone • students understand the biology of osteoclasts, osteoblasts and osteocytes • students understand the mineralisation of matrix that makes bone and gives them their physical

properties • understand bone remodelling • understand bone growth • understand the difference between intramembranous and endochondral ossification • understand the difference between compact and cancellous bone

Readings: Kerr, JB, (2010). Functional Histology. Mosby, Chapter 10. Wheater’s ‘Functional Histology’ (4th or 5th ed.) Churchill Livingston.


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WEEK 6 Tutorial_02/01-P6 - Access and equity to health care by Aboriginal and Torres Strait

Islander People Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor

There is just one topic available for this week’s tutorial. Students leading the tutorial this week are asked to present on the following topic:

Access and equity to health care by Aboriginal and Torres Strait Islander People.

Students will need to find 4-6 key articles for review, in order to put forward key points for discussion by the whole class.

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By the end of this week it is expected that you will be able to: • Understand how issues of access influence health outcomes and clinical practice. • Understand how social factors such as unsafe substance use and abuse impact on personal

health. • Appreciate the role of lifestyle factors and behaviour change in illness and in maintaining health. • Outline the principles and applications of cognitive, behavioural and mindfulness-based

therapies. • Describe the cellular components of the CNS and the general structural organization of the

spinal cord and peripheral nerves. • Discuss the general characteristics of cancer and its effects on patients. • Obtain an elementary understanding of the barriers to infection and the body’s inborn defences

to it. • Experience the method of amplifying DNA and understand how genes are cloned. • Write basic history notes. • Discuss ethical and legal issues relevant to the doctor and patient in hospital and general

practice settings. • Demonstrate constructive feedback to peers. • Further develop communication skills via reflective self-appraisal. • Use this week’s CBL to integrate learning during this week.


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WEEK 7 Lecture01/01-P3 - Introduction 2 – Stress and mind-body interactions Theme: I Discipline: HEP Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the role of mental health in the burden of disease • understand the stress and relaxation responses • appreciate the effects of stress on mental health and lifestyle and performance • appreciate the effects of perception and cognition on stress • understand the clinical importance of mind-body medicine • appreciated the scope and clinical implications of stress • be able to integrate this knowledge with PCL’s particularly in relation to immunity, cancer and

heart disease

Content synopsis: This introductory lecture will explore the current trends in community stress, mental health and burden of disease. The basic mind-body interaction will be described with particular reference to the stress and relaxation responses and what their implications are for chronic illness. Further, the effects of stress on performance can be both positive and negative but the state for optimal and sustainable performance is associated with a focused and calm inner state. The role of cognition and perception in triggering both acute and chronic stress will also be described. The clinical applications of mind-body principles will also be illustrated.

Keywords: stress, relaxation response, mental health, burden of disease, mind-body medicine, immunity, cancer, heart disease

Readings: Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 15-49.



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Week 7 Lecture03/01-P106 - Introduction to cancer Theme: III Discipline: Biochemistry Sub Discipline: Cell Biology/Pathology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Caroline Speed Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating successfully in this session and related activities, you should be able to understand the mechanisms by which unregulated cell growth may lead to cancer.

Content synopsis: • introduce the concept of cancer • cells grow and divide at different rates • cells differentiate in response to specific stimuli by growth factors • most cancers arise from a single cell and progress through several stages resulting in loss of

cellular differentiation which may take several years • introduce the concept of clonality, where cancer cells inherit the defects and phenotype of the

mother cell • introduce the concept of tissue mass being a result of balance between cell division and cell

death

Keywords: proliferation, differentiation, clonal, tumour, growth factor

Readings: Recommended Alberts, B, et al Molecular Biology of the Cell 5th ed. Chapter 20



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WEEK 7 Lecture03/01-P50 - What effect does cancer have on the patient Theme: III Discipline: Biochemistry Sub Discipline: Cell Biology/Pathology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Caroline Speed Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• recognise the organization and behaviour of cancer at the tissue level • understand the concepts and significance of benign and malignant cancers • understand the tissue effects of localised versus metastatic cancer

Content synopsis: • benign and malignant tumours. How do they differ and how does a benign tumour progress to

malignant cancer? How do we recognise these changes? • molecular mechanisms of localised invasion and metastasis • both primary and metastatic tumours invade through surrounding tissues and require new blood

vessel formation • why do people die of cancer?

Keywords: enign, malignant, tumour, metastasis, angiogenesis

Readings: Recommended Alberts, B, et al. Molecular Biology of the Cell 5th ed. Chapter 20



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WEEK 7 Lecture03/01-P54 – Development of the nervous system

Theme: III Discipline: Anatomy Sub Discipline: Neuroscience/ Developmental Biology

CMS Lecturer / Tutor MUSC Lecturer / Tutor tba Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email:

Objectives: At the end of this lecture students will be able to:

• describe formation of embryo through first 3 weeks • describe formation of Notochordal process and development of neural plate • describe neural tube formation • explain how defects in neural tube closure occur and their consequences • describe fate of neural tube and neural crest cells

Content synopsis: In this lecture the early development of the embryo will be reviewed. This will be followed by a description of how the notochord influences the development of the neural plate and the process of closure of the neural tube. Defects resulting from failure of neural tube closure will be discussed. The concept of cell lineages in relation to neuroepithelial and neural crest cells will be described.

Keywords: neural tube, notochord, neural plate, stem cells, spina bifida, anencephaly

Readings: Prescribed Sadler “Langman’s Medical Embryology” Lippincott, Williams, Wilkins. This is a simple embryology text that will serve you well for yrs 1-2 and beyond. Chapter 17 deals with the nervous system. Suggested extra reading: For those with a deeper interest in developmental biology in general then try ‘Developmental Biology’ (Gilbert) on line at: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=dbio


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WEEK 7 Lecture03/01-P55 - Mind and body Theme: III Discipline: Medicine of the Mind Sub Discipline: Health & Human Behaviour

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Glenn Melvin School of Psychology and Psychiatry Faculty of Medicine, Nursing and Health Sciences Email: [email protected]

Dr Carina Chan Dr Paul Jambunathan


• an understanding of the link between the mind and body • an understanding of the relationship between health risk behaviours and illness • an understanding the relationship between physical and psychological health, including mental

illness • an appreciation of the interplay between neurological and immune function, and mental illness • knowledge of interventions that utilise the link between mind and body

Content synopsis: This lecture aims to exemplify the link between mind and body by outlining the interplay between physical health/illness and mental health/illness using contemporary clinical examples.

Keywords: Mind body, mental illness, physical illness, psychological health, risk behaviour

Readings: Prescribed To be advised.



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WEEK 7 Lecture01/01-P4 - Mindfulness Theme: I Discipline: HEP Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the main principles of cognitive behavioural therapy (CBT) • understand what is meant by mindfulness-based stress management and cognitive therapy • be aware of the evidence and clinical applications of mindfulness-based therapies • understand the role of mindfulness in self-care, enhanced performance and clinical skills for

doctors

Content synopsis: This lecture covers the links between stress and perception and explains the principles of cognitive therapy, behavioural therapy and mindfulness-based therapies, including the basic assumptions of mindfulness and the clinical applications of mindfulness-based therapies. The lecture looks at the application of mindfulness for a range of conditions, including depression, cancer, immunity, coping and control, chronic pain, eating disorders, sleep, and cerebral cortical plasticity. The growing role of mindfulness-based skills in the training of clinicians will also be explored.

Keywords: mindfulness-based cognitive therapy (MBCT), clinical skills, depression, chronic pain

Readings: Prescribed Krasner MS, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009 Sep 23; 302 (12): 1284-93 Melbourne Academic Mindfulness Interest Group. Mindfulness-based psychotherapies: a review of conceptual foundations, empirical evidence and practical considerations. Aust NZ J Psych 2006; 40: 285-94 Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 53-62 Recommended Books on mindfulness

• Full Catastrophe Living: Jon Kabat-Zinn • Mindfulness-Based CBT: Williams, Segal and Teasdale • The Mindful Way Through Depression • Know Thyself: Craig Hassed


http://www.ncbi.nlm.nih.gov/pubmed/19773563?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum�



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WEEK 7 Tutorial_03/01-P6 - Gene cloning Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay (Coordinator) Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• to explain aspects of how recombinant DNA technology has provided materials for use in clinical treatment of diseases

• discuss the issues regarding use of such materials • research relevant information on the web with which to answer questions

Content synopsis: The tutorial and syndicate will present opportunity for reviewing the tools for protein production in the context of human protein replacement and disease therapy using specific examples.



Keywords: expression vector, host cells, human growth hormone (HGH), hepatitis B vaccine, Humulin, DNA vaccines, antisense RNA, interferons

Readings: Prescribed Look at the following website: www.dnai.org/manipulation/techniques and www.dnai.org/manipulation/production [pieces of the puzzle and putting it together]


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WEEK 7 Tutorial_04/01-P7 - Debrief medical contact visits and written communication Theme: IV Discipline: Clinical Skills Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating successfully in this session and related activities, students will be able to:

• identify barriers to good communication in medical settings • identify and discuss legal and ethical issues relevant to the doctor and patient in a hospital ward

and general practice • demonstrate effective communication skills while recording a medical history • demonstrate the skill of writing basic medical history notes

Content synopsis: Students will present to the group the challenges they encountered while undertaking their site visit and patient interview. Students will be provided with samples of medical notes to critique before writing up their own patient encounter.

Keywords: Debrief, written communication, written abbreviations

Readings: Workbook entry for this tutorial Prescribed Medical Protection Society (UK) 2005 A complete guide for students: Keeping medical records, Medical Protection Society, London. Available from: http://www.medicalprotection.org/medical/united_kingdom/publications/booklets/default.aspx


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WEEK 7 Tutorial_HEP_01/01-P1 - Introduction HEP, ESSENCE, behaviour change, goalsetting,

mindfulness 1 Theme: I Discipline: HEP Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the HEP course structure, content and activities • set personal goals for health enhancement • identify personal strategies for stress management which have been effective • utilize sample questionnaires and baseline Measures • further appreciate the relationship between perception and stress • utilise the relaxation response • understand the basic principles of mindfulness and be able to practice a simple mindfulness

exercise

Content synopsis: Whereas the lectures focus mainly on the evidence and clinical applications of the elements of the Essence model, the tutorials focus on the practical application of skills in stress and lifestyle management. Thus they are focused on experiential and deep learning. This initial tutorial will be a chance for the groups to outline their individual and collective goals with relation to health enhancement. Topics introduced in the lectures such as the Essence model for wellbeing, the mind-body interaction, and stress response will be discussed focusing on appreciating the broad principles and how to apply them personally. An introduction to relaxation skills will be undertaken by learning a simple mindfulness exercise and students will be given a 2-CD set outlining the mindfulness program. Basic lifestyle and stress questionnaires are available in the student manual which will help to give an indication of areas which might need attention and also to follow progress throughout the HEP. Students will also keep a weekly journal of experiences, insights and questions relating to the content of the HEP. These will be handed to tutors on weeks 2-5 and tutors will return these journals on weeks 3-6 with comments and encouragement.

Keywords: mind-body interaction, stress, relaxation response, mindfulness, ESSENCE lifestyle program, goal-setting

Readings: No readings listed for this session.


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WEEK 7 SiteVisit_04/01-P2 - Medical contact visit Theme: IV Discipline: Clinical Skills Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]




Readings: Prescribed Levett-Jones, T, and Bourgeois, S, 2007. The Clinical Placement: An essential guide for nursing students. Chapter 1 Churchill Livingstone. This reading will assist you to understand and manage some of challenges medical students face in clinical environments.


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WEEK 7 Practical_03/01-P6 - Amplifying DNA Theme: III Discipline: Biochemistry Sub Discipline: Genetics CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Rod Devenish Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• view the process of detecting differences in genomic DNA of individuals using PCR and length polymorphism analysis

• understand the principles of the technology involved and its applicability to genetic diagnosis

Content synopsis: Students will have demonstrated to them the use of PCR to amplify DNA in order to detect a length polymorphism in the human alpha2 (I) collagen gene (COL1A2). The polymorphism is commonly found in normal individuals and is not associated with any known disease state. The demonstrators for this practical will show students how genomic DNA can be readily recovered from buccal cells obtained by simple mouthwash. The length of polymorphism will be shown following PCR amplification of DNA and use of gel electrophoresis to display the results.


Readings: Prescribed The detailed notes for the practical (available on Moodle) should be read before the session.


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WEEK 7 Tutorial_02/01-P7 - Access and equity to health care for refugees Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor

This tutorial builds on the objectives of Lecture 5, and the readings. There is just one topic available for this week’s tutorial. Students leading the tutorial this week are encouraged to find additional readings, to present on the following topic:

Access and equity to health care by refugees in Australia

Students will need to find 4-6 key articles for review, in order to put forward key points for discussion by the whole class.


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WEEK 7 Lecture03/01-P107 - How tissues make organs Theme: III Discipline: Anatomy Sub Discipline: Neuroscience/

Developmental Biology CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jane Black Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• identify organ primordial • understand how one tissue may be a temporary scaffold for the growth of definitive tissue,

eg. bone • recognise a gene’s program development of shape, orientation, symmetry • recognise that interactions between cells/tissues contribute to organ growth including clinical

examples, eg. congenital abnormalities

Content synopsis: • early development of organ primordia and growth stimuli • regulatory genes eg. segmental, axial, polarity • epithelial-mesenchyme interactions use morphogenesis of the kidney for induction, growth

factors, cell death, branching

Readings: Prescribed Purves. WK, Sadava. D, Orians, GH, & Heller, HC, (2001) Life, The Science of Biology pg 843-4. Saladin, KS, (2001) Anatomy and Physiology: The Unity of Form and Function 2nd ed. (McGraw-Hill). pg 240-242. Kerr, JB, 2010 Functional Histology 2nd ed. (Mosby) Due to copyright restrictions, this reading could not be digitised but the book is available from the Hargrave-Andrew library on reserve. Langman’s ‘Medical Embryology’ TW Sadler LWW, 12th ed. Chapter 5 and other ‘systems’ chapters.


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WEEK 7 Lecture03/01-P57 - Principles of organisation of peripheral spinal nerves Theme: III Discipline: Anatomy Sub Discipline: Neuroscience CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Paul McMenamin Department of Anatomy and Developmental Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the structure of peripheral spinal nerves • understand the basic organisation of a typical spinal nerve • understand the components of a typical spinal nerve • understand the basic autonomic nervous system and how it relates to above

Content synopsis: This lecture will review the general principles in relation to the structure and function of nerves

Keywords: endoneurium, perineurium, epineurium, sensory, afferent, motor, efferent, central, peripheral, autonomic, enteric, parasympathetic, sympathetic

Readings: Prescribed Eizenberg, N, et al. (ed.) 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapter 9 Moore, Dalley and Agur “Clinically Orientated Anatomy” Intro Ch pg 46-65



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WEEK 7 Lecture03/01-P58 - Resting membrane potential and action potential Theme: III Discipline: Physiology Sub Discipline: Neuroscience CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Helena C Parkington Department of Physiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Professor Ishwar Parhar Malaysia School of Medicine and Health Sciences Monash University Sunway Malaysia Email: [email protected]

Objectives: After participating successfully in this session and related activities, you should be able to understand:

• that cells have a difference in electrical charge across their membrane • how a semi-permeable membrane can create a difference in electrical charge across the

membrane and how this can be applied to the nerve cell membrane • have a general appreciation of the concept of equilibrium potentials and an idea of the value of

equilibrium potentials for Na+ and K+ in cells, the nernst equation • why the equilibrium potentials for Na+ and K+ do not adequately describe the nerve resting

membrane potential, and what information on the nerve resting membrane potential is provided by the Goldman-Hodgkin-Katz equation for calculating resting membrane potentials

• ion channels, their role in the semi-permeable membrane and how they contribute to determining the resting membrane potential

• the role of the Na+/K+ pump in maintaining the ionic concentrations across the nerve cell membrane and therefore the nerve resting membrane potential

• that changes in the resting membrane potential is critical to the functional response of nerves in response to stimulation

Content synopsis: This second lecture in the series on nerves and their function, will study the electrical charge that exists across the plasma membrane of the nerve (this is called the membrane potential). Of critical importance will be the elements involved in producing this potential difference, and how it is maintained. This will involve consideration of the structure of the plasma membrane, and ion channels and pumps. We will discuss the consequences of changing the characteristics of ion channels and pumps on the resting membrane potential. Also of importance is consideration of the use of agents that influence ion channel and pump activity for therapeutic purposes. We will also explain how many toxins and poisons bring about sickness and death via actions on ion channels and pumps. Then the lecture will go on to discuss how this potential change signals that an event has occurred, in a characteristic pattern known as the action potential (AP). Neurons then transmit this AP along their length to transmit information along their length. The transmission of the AP will be discussed in the next lecture.

Keywords: osmolarity, ion concentrations, cellular compartments, extracellular compartments, tonicity

Readings: Prescribed Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 3 HCP notes on Ion Channels



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WEEK 7 Lecture03/01-P59 - Action potential Theme: III Discipline: Physiology Sub Discipline: Neuroscience CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Helena C. Parkington Department of Physiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating successfully in this session and related activities, you should understand:

• the conditions that produce the particular change in the resting membrane potential that is known as the action potential – the AP

• the concept of threshold, and the properties of the ion channels involved • the characteristics of the AP that determine its amplitude and duration • the “sodium” AP, and its role in nerve function • the “calcium” AP, and its role in nerve function • the events that return the membrane potential to the resting level after the action potential • that ion other than sodium/calcium can be involved in the process of returning the membrane

potential of the nerve back to the resting level • the concept of refractory periods, the two refractory periods that occur after an AP. Here we will

also consider factors that limit the frequency of AP firing • the role of ion pumps/transporters in recovery • the differences between the sodium and calcium APs

Content synopsis: The fact that neurons have a difference in charge between the inside and the outside is very useful. It means that when a neuron wants to signal that something has happened, it can do so by changing this difference in charge (potential difference) across the membrane. That is exactly what neurons do. Having produced a change in the resting membrane potential to signal an “event” has occurred at one point along the neuron, the neuron can then transmit this change in membrane potential along its length, thereby transmitting information about the event that caused the initial change in membrane potential. The rest of this lecture will therefore explain how the resting membrane potential can be produced across the membrane of a neuron (as in many other cells) and how it changes to signal that an event has occurred. We will also consider how this critical system can be targeted in disease and by toxins, and how drugs can act to ameliorate some disease states.

Readings: Prescribed Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 4 HCP notes on the Action Potential


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By the end of this week it is expected that students will be able to: • begin to appreciate the way in which medical environments function. • describe the role of exercise in health management. • develop a personal healthy life plan. • understand the various perspectives regarding the relationship between social position and

health and illness. • explain the molecular basis of cancer. • describe the basis for the resting membrane and action potentials and nerve conduction. • appreciate the mechanisms of necrotic and apoptotic cell death. • distinguish between the methods for studying cells and tissues at the light and electron

microscopic levels. • recognise the origin of muscle and nerve cells and interactions between them. • discuss the concept of stem cells, the various development potentials of stem cells and proven

vs Theoretical uses of stem cells in medicine. • describe how nerve cells communicate by synaptic transmission. • distinguish the mechanisms of cell injury and cell death and the body’s acute responses to them

discuss injury, healing and regeneration from the perspective of pathology. • describe how nerve cells signal to muscle cells and the ways in which venoms affect this

process. • appreciate the interactions between neurons leading to integrated function and the functional

organization of the spinal cord. • demonstrate correct technique for taking vital signs. • outline factors which influence vital signs measurements. • use this week’s CBL to integrate learning during this week.


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WEEK 8 Lecture03/01-P60 - Propagating the action potential Theme: III Discipline: Physiology Sub Discipline: Neuroscience CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Helena C. Parkington Department of Physiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• that, from a site on the nerve cell membrane that is producing an AP, current can flow electrotonically to areas of the neuron that are still at rest

• that such electrotonic flow of current does not travel far down the neuron because the neuron is a leaky structure and so the current leaks out, and this means information about the event that elicited the AP may not travel far

• how this problem is overcome in neurons by using the electrotonic current flow to depolarise adjacent resting regions of the neuron to threshold to produce an AP at these regions, and that this “refreshes” the message through “fresh” current flow

• that the flow of current and the production of new APs is rapid so that the transmission of APs is like a wave of depolarisation spreading along the neuron from the initial site, and understand why this transmission of APs only goes in one direction under normal circumstances

• why such continual regeneration of APs is an event that slows down the flow of information down the neuron, learn the two mechanisms to speed up such transmission (ie., speed up the conduction velocity of information) and why each of these two mechanisms increases the conduction velocity

• that the two mechanisms for speeding up conduction velocity form the basis for one scheme for functional classification of neurons

• how dysfunctions of myelination can cause disruption of the transmission of information in normally-myelinated neurons

• what happens to the flow of information along a neuron when this flow reaches the neuron’s terminals (or an equivalent region for passing the information to the next cell in the chain)

Content synopsis: This fourth lecture in the lecture series on nerves and their function, will discuss how an AP, produced at one point along the nerve membrane, is propagated (transmitted) further along the neuron. Neurons produce an AP, a characteristic series of changes in the resting membrane potential, when a stimulus that is of sufficient strength is applied to a point along the neuron. Having produced a change in the resting membrane potential to signal that an “event” has occurred at one point along the neuron, the neuron then has to transmit this change in membrane potential along its length, thereby transmitting information about the event that caused the initial change in membrane potential. Only in this way can the information be signalled to another cell, either to produce a response (eg. in a muscle cell) or for further transmission and/or analysis (eg. in another nerve cell). You will study the latter process, that of transmitting information to other cells, in the next lecture series in this Theme 3.

Readings: Prescribed Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 4



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WEEK 8 Lecture03/01-P61 - Synaptic transmission Theme: III Discipline: Physiology Sub Discipline: Neuroscience CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Helena C. Parkington Department of Physiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]



• the anatomy of a chemical synapse • some of the general concepts of neurotransmitter production, the advantages of being prepared • how neurotransmitters are released and inactivated at the synapse • the major types of neurotransmission, the most common excitatory and inhibitory

neurotransmitters in the CNS • excitatory neurotransmitter receptors and the ions involved, ionotropic and metabotrpic

receptors, excitatory post-synaptic potentials (EPSPs) • inhibitory neurotransmission, the ions involved and the role of membrane potential, inhibitory

post-synaptic potentials (IPSPs) • how the activation of receptors by neurotransmitters is translated into a response, an AP, in the

receiving cell, closing the loop • longer term implications of neurotransmitter actions

Content synopsis: This session starts with an overview of chemical synaptic transmission, outlining how the release of a chemical messenger leads to a change in the postsynaptic membrane potential. The microscopic anatomy of a synapse is described along with an explanation of the mechanism of the formation and release of small molecule and peptide neurotransmitter vesicles from the presynaptic terminal. Other aspects covered include slow and fast neurotransmission, the operations of ionotropic and metabotropic receptors, and the role of postsynaptic depolarising potentials. The mechanisms involved in inhibitory transmission will be examined. Here, location is very important, as is the concentration of ions within versus outside of the neuron.

Keywords: pre and post-synaptic cell, synapse, neurotransmitters, action potential, synaptic vesicles, exocytosis, ionotropic and metabotropic receptors, postsynaptic potential

Readings: Prescribed Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 5 HCP notes on Synaptic Transmission



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WEEK 8 Lecture03/01-P62 - Acute inflammation I Theme: III Discipline: Pathology Sub Discipline: Tissue Pathology

CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Catriona McLean Department of Medicine Alfred Hospital Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: Understand what acute inflammation is and how and why it occurs.

Content synopsis: Acute inflammation is the bodies’ response to injury in the first 24 hours. This vital and common pathological response is discussed in detail using a burns patient as an example with other clinical examples.

Keywords: Acute inflammation

Readings: Prescribed General and Systemic Pathology, JCE Underwood, Chapter 10 pg 199-209



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WEEK 8 Lecture01/01-P5 - Exercise Theme: I Discipline: HEP Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the many health benefits of regular exercise and the health risks associated with physical inactivity

• understand the mechanisms whereby exercise produces health benefits • appreciate the amount and intensity of exercise associated with health benefits • understand what exercise prescriptions are and how they are used

Content synopsis: Regular, moderate exercise has a wide variety of health benefits. These include:

• Benefits for mental health including reduced depression and anxiety. • Improved memory and reduced risk of dementia. • Reduced risk of cancer and heart disease. • Improved immunity. • Weight control and reduction in diabetes risk.

This lecture will examine the research on exercise and its impact upon health and also look at the levels of exercise required to produce health benefits. Exercise can be built into clinical settings for the prevention and management of a wide variety of conditions, one way being through the use of exercise prescriptions.

Keywords: physical exercise, MET (metabolic equivalent), mental health, cancer, heart disease, immunity, weight control, obesity, diabetes

Readings: Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 90-104. Recommended Bauman A, Updating the evidence that physical activity is good for health: an epidemiological review 2000-2003. J Science and Medicine in Sport 2004; 7 (1 supp): 6-19



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WEEK 8 Lecture03/01-P75 - Neural communication and integration Theme: III Discipline: Physiology Sub Discipline: Neuroscience CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Helena C Parkington Department of Physiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


Objectives: After participating successfully in this session and related activities, you should you should understand:

• that signalling between neurons is complicated by the factors of convergence/divergence, excitation/ inhibition, fast/slow effects, and variations in the location of synapses

• the need for summation • where APs are usually produced post-synaptically, why this site is favoured, and what this

implies for the effectiveness of synapses on a neuron • how the neuron can overcome, through the processes of spatial and temporal summation of

EPSPs, the problem that a single EPSP rarely ever causes a post-synaptic AP • the neuronal distribution of voltage-gated channels • how IPSPS modulate the neuron’s ability to produce an AP in response to its excitatory inputs

(producing EPSPs) and where an action potential is first generated in a neuron • the role of inhibitory inputs in post-synaptic integration in cell signalling • the role of pre-synaptic inhibition • that a typical neuron receives thousands of synaptic inputs • how peptide neurotransmitters affect neural excitability and the roles of slow neurotransmission

Content synopsis: This session continues on from Synaptic Transmission where it is clear that activity at a single synapse is likely to have a relative small role in activity in the receiving cell. Here we discuss how activity by the one incoming neuron at multiple sites and/or activity coinciding with that from another incoming neuron interact to produce the activity characteristic of events that occur in a functioning brain. Synaptic transmission of information is a highly dynamic process that can be modulated by a number of factors, which can be generally classed as being (a) effects exercised at the pre-synaptic terminal (examples being pre-synaptic inhibition and facilitation), (b) the history (pattern) of previous levels of activity across the synapse, and (c) post-synaptic adaptation processes that allow a neuron to self-regulate its activity and responses to inputs. The distribution and effectiveness of synaptic inputs will be discussed, as well as how excitatory inputs interact to depolarise a neurone to threshold.

Readings: Prescribed Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 6



136

WEEK 8 Lecture03/01-P76 - Organisation of spinal cord Theme: III Discipline: Physiology Sub Discipline: Neuroscience CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Helena C. Parkington Department of Physiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating in this session, it is expected that students should have an understanding of the anatomy and clinical applications of the following:

• external coverings of the spinal cord • general arrangement of spinal cord structure • internal structure of the spinal cord white matter & major tracts • blood vessels supplying the spinal cord • internal structure of the spinal cord grey matter, including interneurons • input to the spinal cord • dorsal lamina and input terminations • pathway from the spinal cord to the brain • pathways from the brain to the spinal cord • output to skeletal muscle • pathway of sympathetic outflow • pathway of parasympathetic outflow

Readings: Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 12


137

WEEK 8 Tutorial_04/01-P12 - Vital Signs



Objectives: After participating in this tutorial, students will be able to:

• perform an assessment of pulse, temperature, respiratory rate and blood pressure to a competent basic standard

• describe the normal ranges of these measurements • discuss the pathological and non pathological factors that influence these measurements

Content synopsis: Pulse, blood pressure, temperature and respiratory rate constitute the “vital signs “, also known as “routine observations”. They are chiefly used as an indicator of a patient’s general function, particularly when ill or when recovering after a procedure. After an initial briefing, students will break into smaller groups and practice the correct technique for performing each of the assessments. Students should consider the factors that may influence the findings obtained.

Keywords: vital signs, pulse, blood pressure, temperature, respiratory rate

Readings: Workbook entry for this tutorial Prescribed Cooper D, Buist M, (2008) Vitalness of vital signs, and medical emergency teams. Medical Journal of Australia 188 (11) 630-631 (available electronically via library catalogue from Medical Journal of Australia, search as journal). Cretikos M, Bellomo R, Hillman K, et al. (2008) Respiratory rate: a neglected vital sign. 188 (11) 657-659 (available electronically via library catalogue from Medical Journal of Australia, search as journal). McAlister F. S. Straus. (2001) Measurement of Blood Pressure: an evidence based review. British Medical Journal 322 (7291) 908-911 (available electronically via library catalogue from British Medical Journal, search as journal). Bikley LS, (2009) Bates’ Guide to Physical Examination and History Taking, 10th ed. (Lippincott Williams &Wilkins. Recommended Houlder L, (2000) The accuracy and reliability of tympanic thermometry compared with rectal and axillary sites in young children. Pediatric Nursing May/June 26 (3) 311-314. (Available electronically from Paediatric Nursing via library catalogue, search as journal) Epstein O, Perkin GD, de Bono DP, Cookson J, (2003) Clinical Examination, 3rd ed. (Mosby) pg 47-48, 116-117, 146-151.


138

WEEK 8 Tutorial_03/01-P7 - Tissue biology Theme: III Discipline: Biochemistry Sub Discipline: Histology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Janet Macaulay (Coordinator) Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the basic biology of muscle and nervous tissue • recognise the origin of muscle and nerve cells and interactions between them • use an organ system to understand how cells and tissues maintain normal function • discuss the concept of stem cells • discuss the various development potentials of stem cells • discuss proven vs Theoretical uses of stem cells in medicine

Content synopsis: Use a specialised tissue, for example, the gut, to illustrate how cells maintain coordinated functions:

• Cell-cell communication • Absorption and secretion • Motility • Nerves - extrinsic and intrinsic • Cell renewal



Keywords: stem cells, differentiation

Readings: Prescribed http://stemcells.nih.gov/info/basics/


139

WEEK 8 Lecture03/01-P77 - Spinal reflexes Theme: III Discipline: Physiology Sub Discipline: Neuroscience CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Helena C. Parkington Department of Physiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating successfully in this session and related activities, you should understand that:

• the internal organisation of the spinal cord subserves a number of important reflexes, including the control of movement and the sensation of touch, temperature and noxious stimuli

• these functions are underpinned by complicated internal circuits that can coordinate activity up, down and across the spinal cord, and which generate the basic neural patterns for stereotyped movements and locomotion

• the stretch reflex mediates muscle contraction in response to stretch of muscle spindles • nociceptive information, via small unmyelinated nerves, is conveyed to and integrated in the

spinal cord • the stretch reflex is responsible for maintaining muscle stiffness and posture • this stretch reflex is adaptable and is modified by patterns of sensory input from the body • the monosynaptic stretch reflex circuit mediates the tendon jerk, which is used clinically to

assess the integrity of spinal cord inputs and outputs and to assess the excitability of spinal reflex circuitry, which is increased by upper motoneurone lesions

• the circuitry underlying the flexion reflex • stretch and nociceptive information processing involves interneurons within the spinal cord • a variety of neurotransmitters is involved in the processing of information in the spinal cord

Content synopsis: This lecture will probe the interaction between excitation and inhibition in the spinal cord. As examples, the circuitry involved in pain and stretch reflexes will be discussed. The tendon jerk will be described in detail, how it is elicited and its role in the testing of nerve and spinal cord dysfunction. The coordination of reflex activity in the spinal cord will be detailed. We will also discuss the anatomy and complex neuronal interaction in relation to the processing of noxious stimuli within the spinal cord.

Readings: Prescribed Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 12 Moodle notes on Spinal reflexes Recommended Silverthorn Human Physiology – An Integrated Approach, 3rd ed. Chapter 13, pg 429-438



140

WEEK 8 Lecture03/01-P65 - Cellular and tissue response to injury Theme: III Discipline: Pathology Sub Discipline: Tissue Pathology

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Andrew Ryan Tissuepath Burwood Road Hawthorn

Objectives: • begin to understand the various causes of cell death and the response of the tissue to injury • begin to understand the pathogenesis of cell death • consider the various effects of injury on the body • learn about different tissue types; labile, stable, permanent • learn about the morphology and cause of necrosis, in particular coagulative necrosis • learn about the physiological responses to endogenous and exogenous stimuli • learn and understand the terms; hyperplasia, hypertrophy, atrophy and metaplasia • consider Apoptosis; how does it differ from necrosis, what is its function?

Content synopsis: In the lecture ‘Responses to cellular injury’ the causes of injury to the cell as are the mechanisms of injury at a cell level are given. The response by the body to injury is also discussed and the various factors that relate to the outcome of the injurious agent are given. The two forms of cell death; necrosis and apoptosis are discussed in some detail.

Keywords: cell death, labile, stable and, permanent tissues, necrosis, apoptosis, adaptation, endogenous stimuli, exogenous stimuli

Readings: Prescribed General and Systemic Pathology, JCE Underwood, Chapters 4 and 6



141

WEEK 8 Lecture02/01-P6 - Prevention




Objectives: At the completion of this week you should be able to:

• explain the Rose thesis of prevention • explain the difference between a focus on individuals and a focus on populations in prevention • understand the concepts of an ‘intervention’ and ‘upstream’ and ‘downstream’ perspectives • describe the breadth of public health prevention campaigns and interventions

Content synopsis: These two approaches to aetiology—the individual and the population-based—have their counterparts in prevention. In the first, preventive strategy seeks to identify high-risk susceptible individuals and to offer them some individual protection. In contrast, the 'population strategy' seeks to control the determinants of incidence in the population as a whole (Rose 1992). If our focus is only the treatment of individuals, it is assumed that if all the individuals at risk are ‘treated’ then the population’s health will improve. Yet population health studies have shown that this is not the case. We will explore the difference between a focus on individuals versus the focus on populations. You will be introduced to the work of Geoffrey Rose, one of the pioneers of public health thinking about populations and prevention. For example, in drink-driving and vaccination campaigns, individuals are targeted but the focus is on those most at risk as well as the whole population. Non-communicable diseases of diabetes, cardiovascular disease and obesity are increasingly of interest globally, as efforts are focused on how to reduce the burden of disease associated with NCDs. We will use these two examples as case studies but also discuss what other interventions are effective in reducing morbidity and mortality rates for, and improving the health status of, whole populations.

Keywords: Non-communicable diseases, social context, social gradient, social determinants of health, primary health care

Readings: Cohen J, Newmann P, Weinstein M, Does Preventive Care Save Money? Health Economics and the Presidential Candidates. n engl j med 358;7, 661-663. McGranahan M, (2009). Health and the urban environment: revolutions revisited. International Institute for Environment and Development. Available from http://www.iied.org/pubs/display.php?o=17044IIED Rose G, (1985). Sick Individuals and Sick Populations. International Journal of Epidemiology. vol 14, no 1, pg 32-38. VicHealth (2009). Building on our strengths. A framework to reduce race-based discrimination and support diversity in Victoria. Carlton, Victorian Health Promotion Foundation.

Useful websites: General Assembly of the United Nations, 65th session: High-level Meeting on Non-communicable Diseases http://www.un.org/en/ga/president/65/issues/ncdiseases.shtml Prevention Institute: http://www.preventioninstitute.org/



142

WEEK 8 Practical_03/01-P8 - Neoplasia Theme: III Discipline: Pathology Sub Discipline:


Objectives: • define neoplasia, tumor • understand the important differences between benign and malignant neoplasms • describe the clinical and microscopic features that distinguish benign neoplasms from malignant

neoplasms • consider how malignant neoplasms spread • consider the pathogenesis of neoplasms

Content synopsis: The important features that define a benign from a malignant neoplasm will be reviewed using the bowel as an example.

Students will be expected to have read the workbook entry relating to this practical and to have completed the following prescribed readings:

Readings: Prescribed Underwood JCE, & Cross SS, (Ed.) (2009): General and systematic pathology 5th ed. Edinburgh: Churchill Livingstone Neoplasia - Chapter 11 Underwood Pathology pg 221-258 Colorectal cancer pg 392 – 396 Underwood Pathology Some of the practical will be conducted using virtual slides from an internet website. Please familiarise yourself with this website: http://www.path.uiowa.edu/virtualslidebox/ Students who have laptops with internet access are requested to bring these to the session.


143

WEEK 8 Tutorial_02/01-P8 - Primary and secondary prevention of NCDs Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor In this tutorial we will discuss the primary and secondary prevention of non-communicable (chronic) disease and ask, what does the evidence say? Student-led discussion: select from the following topics:

• the local burden of non-communicable disease • the global burden of non-communicable disease


144

WEEK 8 Lecture03/01-P66 - Stress and Illness Theme: III Discipline: Medicine of the Mind Sub Discipline: Health & Human Behaviour

CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Robert Selzer Alfred Hospital Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: Students should be able to demonstrate an understanding of:

• stress and how it is modified by internal and external factors • the longitudinal course of stress • the impact of personality style on stress and the consequences • the impact of cognitive appraisal on stress and the consequences • how emotions interact with stress and the consequences • coping theory

Content synopsis: The lecture will cover the nature of stress and how it can affect individuals in different ways. How stress can affect different organ systems physiologically and its role in disease will be discussed. A brief overview of differing personality styles and their relationships to stress and illness will be discussed. How thinking (cognition) can affect stress and how one’s emotional state is linked to stress perception and the consequences will also be discussed. Coping theory with clinical anecdotes will be discussed.

Keywords: Stress, personality, coping theory, social support, locus of control, emotion

Readings: Prescribed Morrison V, Bennett P, Butow P, Mullan B, & White K, (2007). An introduction to Health Psychology: An Australian Perspective. Sydney, Australia: Pearson Education Ltd. Chapters 11 and 12.



145

WEEK 8 Lecture03/01-P67 - Neural signalling to skeletal muscles and drugs acting at the

neuromuscular junction Theme: III Discipline: Pharmacology Sub Discipline: N/A




• describe the innervation of skeletal muscle • describe the chain of events that occur after an action potential arrives at the neuromuscular

junction that eventually results in contraction of the skeletal muscle • explain the actions of non-depolarising drugs at the skeletal neuromuscular junction • explain the actions of depolarising drugs at the skeletal neuromuscular junction • describe the symptoms of anticholinesterase poisoning • describe the strategies for treatment of myasthenia gravis

Content synopsis: This lecture will focus on neural control of skeletal muscle and drugs that act at the neuromuscular junction (NMJ) with particular reference to their mode of action.

Keywords: neuromuscular junction, skeletal muscle, synapse, neurotransmission, acetylcholine, depolarising blocker, non-depolarising blocker, acetylcholinesterase

Readings: Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh. Cholinergic transmission: Chapter 13, pg 151-173 Page C, Curtis M, Walker M, & Hoffman B, (2006). Integrated Pharmacology; 3rd ed. Drugs and the nervous system: Chapter 8, pg 207-210



146

WEEK 8 Lecture03/01-P75 - Envenoming and the neuromuscular junction Theme: III Discipline: Pharmacology Sub Discipline: N/A


Professor Iekhsan Othman School of Medicine and Health Sciences Monash University Sunway Malaysia Email: [email protected]


• differentiate between venoms, poisons and toxins • discuss the different roles of venoms and toxins • describe the pathophysiological processes which occur after snake envenoming • describe the mechanism of action of neurotoxins at the neuromuscular junction (NMJ) • explain the role of antivenoms in the treatment of envenoming • identify the appropriate treatment strategies for envenoming

Content synopsis: This lecture will examine the effects of envenoming by terrestrial and marine animals on humans. Particular emphasis will be placed on the effects of venoms/toxins on neurotransmission. The use of antivenoms in the treatment of systemic envenoming will be discussed, as will other first aid strategies.

Keywords: venom, toxin, antivenom, envenoming, neurotoxin, neuromuscular junction, pressure immobilisation

Readings: No readings for this session.


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WEEK 9


By the end of this week it is expected that you will be able to: • apply your knowledge of the different perspectives on social position and health and illness in

order to better comprehend the experiences of those living with asbestos related disease. • outline the basic motivations underlying eating patterns and strategies for improving eating

patterns in order to maintain a healthy weight. • evaluate personal healthy life plans and develop subsequent strategies as appropriate. • discuss the pathology of cancer. • explain the molecular basis of cancer. • distinguish the mechanisms of cell injury and cell death and the body’s acute responses to them

discuss injury, healing and regeneration from the perspective of pathology. • appreciate the relationships between microbes and humans and how they can be managed. • practice giving suitable explanations to a patient that relate to their illness framework. • explain the inputs, processing and outputs of spinal reflexes. • use this week’s CBL to integrate learning during this week.


149

WEEK 9 Lecture03/01-P85 - Principles of diagnosis of infectious diseases Theme: III Discipline: Microbiology Sub Discipline: Laboratory Diagnostics CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the necessity for the detection of pathogens • understand the concepts of appropriate specimen collection • understand the methods used for isolation, culture and identification of microorganisms and

examine alternate methods for detection of microorganisms • understand how the host response may be used to determine infection and/or immunity

Content synopsis: An introduction to some of the methods used in the detection and diagnosis of pathogens, including isolation and identification of the organism and the use of the host response in diagnosis.

• Diagnosis of infection: the necessity for detecting pathogens • Treatable disease • Methods of diagnosis

o Direct Methods for isolation of pathogen Culture and identification Importance of specimen collection

o Indirect Types of specimens needed Markers of infection: using host response to detect infection Antibody detection

o Notifiable diseases Contact tracing

Keywords: culture, serology , ELISA, notifiable disease

Readings: Prescribed Goering et al. Mims Medical Microbiology. 4th ed. Chapter 32



150

WEEK 9 Lecture03/01-P70 - Natural barriers, innate defences Theme: III Discipline: Microbiology Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• describe and discuss the natural barriers of the human body to infection and its innate defence mechanisms

• understand the possible relationships between the human host and microorganisms

Content synopsis: Part 1 - Natural barriers and innate defense mechanisms

• Innate defences • Natural defence mechanisms of the human body

• Anatomical: skin , mucous membranes • Mechanical: mucus and cilia, cough reflex, vomiting • Antimicrobial/Chemical Factors: antibacterial enzymes, cytokines and chemokines,

complement proteins • Cellular defences: Phagocytes (neutrophils and macrophages) • Normal Flora

Part 2 - The host-parasite relationship • Interactions of microorganisms with the human host: the role of normal flora

• Commensalism • Mutualism • Parasitism

• Colonisation, carrier states

Readings: Prescribed Goering et al. Mims Medical Microbiology. 4th ed. Chapters 8, 9, 14.



151

WEEK 9 Lecture03/01-P71 - Healing and repair Theme: III Discipline: Pathology Sub Discipline: Tissue Pathology


Objectives: • begin to understand how tissues repair with an emphasis on labile and stable tissues • begin to understand the outcomes of tissue repair in labile, stable and permanent tissues

Content synopsis: The mechanism of tissue repair in relation to the labile tissues is discussed in detail. The repair of tissues in stable and permanent tissues is also discussed and the differences in clinical outcome are raised.

Keywords: resolution, tissue repair

Readings: Prescribed General and Systemic Pathology, JCE Underwood, Chapter 6 pg 108–115



152

WEEK 9 Lecture01/01-P6 - Nutrition Theme: I Discipline: HEP Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• appreciate the important potential role of food as medicine • understand the many psychological and social factors which impact upon eating patterns • understand the potential risks of widely promoted dieting programs • be aware of some of the simple behavioural and psychological strategies for improving eating

patterns and maintaining a healthy weight

Content synopsis: The food we eat provides the body with all the building blocks it requires to carry out its many and varied functions. When the diet is deficient then that leaves the body lacking in the various elements it needs. The modern diet is commonly nutritionally poor which places a person at significant risk of chronic mental and physical illness. Clinical examples will be provided. Many psychological and social factors affect food choices and knowledge about healthy nutrition often has a small impact upon these food choices. Weight gain is one common manifestation of poor eating patterns and many people adopt oftentimes expensive, ineffective and potentially harmful dieting programs in order to remedy the problem. Understanding the basic motivations behind eating patterns and addressing them has far more potential to be successful in the longer term. Strategies outlined in the program “If Not Dieting, Then What?” can include being able to develop healthy attitudes about food, being aware of non-hungry eating and learning to eat more mindfully.

Keywords: nutrition, dieting, food, attitudes, obesity, weight control

Readings: Prescribed Kausman R, Tips for long-term weight management. AFP 2000; 29 (4): 310-3. Kausman R, A new perspective to long-term weight management. Is there a better way? AFP 2000; 29 (4): 303-7 Recommended Kausman R, If not dieting, then what? 1998, Allen and Unwin, Melbourne.



153

WEEK 9 Lecture03/01-P72 - Interactions between bacteria and the human host Theme: III Discipline: Microbiology Sub Discipline: Bacteriology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the normal flora of the body and its roles • explore and understand the sources, routes of transmission and mechanisms used by bacteria

to invade the human host

Content synopsis: Normal flora: significance of normal flora

• Characteristic Normal Flora of the: • skin • oral cavity • respiratory tract • gastrointestinal tract • genito-urinary tracts

Factors that influence microbial species present • Skin; physical and chemical factors that influence resident flora: Gram positive organisms • Oral cavity: complex habitat, aerobic and anaerobic micro-environments, antibacterial

substances in saliva • Intestinal tracts: acid pH of stomach, flora of small intestine, features of normal flora of large

intestine • Respiratory tract: differences in flora of upper tract, characteristic flora and the lower tract,

normally sterile • Genito-urinary tract: urinary tract normally sterile, characteristic bacterial flora of the vagina and

its importance in protection from infection The breakdown of defenses: causes and consequences of microbial interactions on human host Reservoirs, sources and routes of transmission: how microbial infections may occur Common bacterial diseases of the human body

Readings: Prescribed Goering et al. Mims Medical Microbiology. 4th ed. Chapters 8, 12 &13



154

WEEK 9 Lecture03/01-P63 - Strategies for control of microbes Theme: III Discipline: Microbiology Sub Discipline: Infection Control CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• define and understand the principles of sterilisation and disinfection • gain knowledge in different procedures and agents that are used to sterilise and disinfect • understand how antimicrobial agents work: antimicrobial targets • understand mechanisms of resistance to antimicrobial agents

Content synopsis: Application of cleaning, disinfection and sterilisation in prevention of disease transmission. Principles of sterilisation and disinfection

• Agents for sterilisation • moist and dry heat, ionising radiation, filtration, chemicals • definitions, principles, uses

• Agents for disinfection • heat, ultra-violet radiation, filtration, chemicals • definitions, principles, uses • antiseptics

Antimicrobial agents • antibacterial agents • bacteriostatic and bactericidal action of antimicrobials • action of antimicrobials

• cell wall; cell membrane; synthesis of proteins; synthesis of nucleic acids • concepts of susceptibility and resistance:

• innate • acquired resistance • specific example of resistance: penicillin • impact of resistance to the human host

Readings: Prescribed Goering et al. Mims Medical Microbiology. 4th ed. Chapters 31, 33 & 36



155

WEEK 9 Tutorial_03/01-P10 - Diagnosis and prevention of infections Theme: III Discipline: Microbiology Sub Discipline: Laboratory Diagnostics CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the methods available to diagnose infectious diseases, with particular reference to microscopy, culture, serological and molecular techniques

• identify medically important infectious diseases and some of the ssociated risk and epidemiological factors

• understand methods that can be implemented to prevent infection

Content synopsis: Students will be given a short list of questions and issues to PREPARE PRIOR THE TUTORIAL/SYNDICATE. Individual students will be chosen at random in the tutorial to give a brief exposition of the question and topic to their fellow students, and to lead the discussion of that issue. Refer to entry in workbook for details of preparation required for class – in working document Tutorial 1 hour Syndicate 1 hour

Readings: Prescribed Goering et al. Mims Medical Microbiology 4th ed. pg 335-341 and Chapter 8 Recommended http://www.betterhealth.vic.gov.au/bhcv2/bhcpdf.nsf/ByPDF/Meningitis/$File/Meningitis.PDF http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/

Meningococcal_disease_vaccines?OpenDocument http://www.ncirs.edu.au/immunisation/fact-sheets/meningococcal-vaccines-fact-sheet.pdf http://www.health.vic.gov.au/ideas/bluebook/meningococcal http://www.immunise.health.gov.au/


156

WEEK 9 Tutorial_04/01-P8 - Medical interview - giving explanations


CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer, Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• demonstrate giving explanations that patient’s understand and remember • demonstrate giving explanations that relate to the patient’s illness framework • involve the patient or role player in collaborative planning

Content synopsis: It is essential that students do their pre-reading before attending this tutorial. This tutorial outlines the evidence for giving effective explanations to patients. Patients who are collaboratively involved in planning their care are far more likely to carry out the plans made. On average 50% of patients do not take drugs prescribed by their doctor and about 70% do not adhere to diet advice. Non compliance is often ignored by doctors. Not only is non compliance important in poorer health outcome for patients but it is also enormously expensive in terms of health service usage and wasted medications. Improved communication in giving explanations and making management plans with patients reduces non-compliance and increases patient satisfaction.

Keywords: Collaboration, non-compliance

Readings: Essential tutorial readings in preparation for tutorial Workbook entry for this tutorial National Prescribing Service. (2002). I’ve got a sore throat: Will an antibiotic make me better? Patient Information leaflet, see pdf attached. Murtagh J, (1996) Gastroenteritis in children, in Patient Education. pg 24 McGraw Hill Book Company, New York. Murtagh J, (1996) Pill: the combination pill, in Patient Education. pg 51 McGraw Hill Book Company, New York. A beginners guide to using a stethoscope, see pdf attached Prescribed Silverman J, Kurtz S, Draper J, Skills for communicating with patients. Oxford: Radcliffe Publishing, 2005. pg 147 Using condoms Access information on Family Planning Australia and Health Websites http://www.fpv.org.au/pdfs/Condoms,%20male%20and%20femaleSept06.pdf http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=243&np=292&id=2181#1


157

WEEK 9 Tutorial_HEP_01/01-P2 - Exercise, mindfulness 2 Theme: I Discipline: HEP Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the health benefits of exercise • reflect upon personal exercise patterns • look at goals for behavioural change with relation to exercise • understand the influence of motivational enhancers and inhibitors on exercise patterns • utilise the SMART model to facilitate setting an exercise-related goal • review the experience of practicing mindfulness throughout the week • explore the Stress Release Program task 1: perception and stress

Content synopsis: This tutorial will further explore and discuss topics and principles arising in the lectures and how they apply to the students personally. Experiences and reflections on the previous week’s tutorial and practices will be discussed. Students will be encouraged to reflect on and discuss the role of exercise in their own health and also in healthcare. The second half of the tutorial will review the mindfulness practice and then to introduce the ‘homework’ for the week of exploring the relationship between perception and stress in daily life. Students will be invited to come back to the group next week and report on their experiences and insights. Students will keep a journal of experiences, insights and questions relating to the content of the second tutorial and hand this in at the third tutorial.

Keywords: exercise, goal setting, mindfulness, stress, perception

Readings: Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 62-64, pg 90-104


158

WEEK 9 Lecture03/01-P74 - Necrosis and apoptosis Theme: III Discipline: Pathology Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Anthony Longano Department of Anatomical Pathology Monash Medical Centre Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: To cover the principles of apoptosis and necrosis.

Content synopsis: The various causes of cell injury will be covered. The mechanisms of cell death will be considered including the morphologic changes. The differences between necrosis and apoptosis will be discussed with an emphasis on the relevance to clinical pathology.

Keywords: apoptosis, necrosis

Readings: Prescribed General and Systemic Pathology, JCE Underwood, pg 102-108



159

WEEK 9 Lecture03/01-P86 - Parasites Theme: III Discipline: Microbiology Sub Discipline: Parasitology CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Ross Coppel Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: • understand the general classification of parasites • gain knowledge of the diversity of parasites • acquire an understanding of the routes of transmission of parasitic infections • recognise that parasites can have simple or complex life cycles • describe the different types of diseases caused by parasites • describe the general principles of diagnosis, prevention and control of parasitic diseases

Content synopsis: This lecture will introduce you to parasites as organisms capable of causing disease. The variety of parasites, from protozoan’s to multicellular worms will be defined. Medical important parasites will be discussed.

Keywords: parasites, endoparasites, ectoparasites, protozoa, helminths, intermediate host, vector

Readings: Prescribed Mims Medical Microbiology 4th ed. Chapter 5; Chapter 6; Chapter 19, pg 250-251;Chapter 22, pg 304-311;Chapter 22, pg 320-321;Chapter 24, pg 347-348; Chapter 26, pg 373-374.



160

WEEK 9 Tutorial_02/01-P9 - Prevention of discrimination, stigma, social exclusion Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor This tutorial builds on the content, objectives and readings from Lecture 6. Can theories of prevention be applied to social issues? Our workplaces, local communities and homes all impact on our health and wellbeing and we will focus on the importance of ‘place’ in shaping people’s experience of health. Programs and policies which promote environments for health are central to better health. In this tutorial, topics will be introduced by students who will put forward key ideas for discussion. Students leading discussion may choose to focus on particular population groups who have higher levels of risk. Student-led discussion: select from the following topics:

• prevention of discrimination • prevention of social exclusion – should we focus on people or place?


161

WEEK 9 Practical_03/01-P9 - Normal flora of the human body Theme: III Discipline: Microbiology Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand some of the basic microbiological techniques used to isolate and identify bacteria from clinical specimens

• understand the types of bacteria that are present as normal skin flora • understand the importance of handwashing and disinfection for removal of microorganisms

Content synopsis: Part 1 - Introduction to laboratory based diagnosis and culture media Part 2 - Growth patterns and gram reactions of common medically important bacteria Part 3 - Introduction to normal flora Part 4 - Handwashing Part 5 - Case studies

Case 1 - Young man suffering recurrent boils Case 2 - Food poisoning

Refer to entry in workbook for details of preparation required for class – in working document

Readings: Prescribed Goering et al. Mims Medical Microbiology. 4th ed. Chapters 8 and 32


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WEEK 9 Lecture03/01-P64 - The molecular basis of cancer 1 Theme: III Discipline: Biochemistry Sub Discipline: Cell Biology/Pathology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Caroline Speed Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: After participating successfully in this session and related activities, you should be able to understand the most important causes of cancer, and their relevance to prevention of cancer.

Content synopsis: • cancer is a disease of DNA • genetic errors may be inherited or acquired that predispose to cancer • cancer increases with age correlating with increased DNA errors • cancer results from the accumulation of multiple DNA errors/mutations • genetic predisposition to cancer can be identified • acquired DNA errors can cause cancer such as that induced by mutagens: UV sunlight,

chemical carcinogens, and ionizing radiation and viruses

Keywords: acquired/inherited DNA damage, inherited cancer predisposition

Readings: Recommended Alberts B, et al. Molecular Biology of the Cell 5th ed. Chapter 20



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Objectives: After participating successfully in this session and related activities, you should be able to understand what goes wrong in cancer cells.

Content synopsis: • specific gene products may promote cell growth (oncogenes) • mutation of oncogenes leading to their activation results in uncontrolled cell growth • acquired cancers result from accumulated mutations in oncogenes • genetic changes that immortalise cells or prevent cell death also contribute to cancer

Keywords: proto-oncogene, oncogene, mutation




164

WEEK 9 Lecture03/01-P78 - Culture and health behaviour Theme: III Discipline: Medicine of the Mind Sub Discipline: Health & Human Behaviour

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Azita Moradi School of Psychology and Psychiatry Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• the ability to understand and describe the complex relationship between culture and health behaviour

• an understanding importance of medical practitioner recognition and response to cultural issues • knowledge of cultural issues relevant to health in Australia including those experienced by

refugees • knowledge of the influence of culture on the presentation of mental ill health

Content synopsis: Cultural issues play a major role in the expression of health behaviour. Hence doctors are required to understand and demonstrate cultural competency in order be effective practitioners. Cultural issues relevant to health in an Australian context will be discussed.

Keywords: Culture, Health belief, health behaviour, cultural competence, immigration. refugees

Readings: Prescribed Morrison V, Bennett P, Butow P, Mullan B, & White K, (2007). An introduction to Health Psychology: An Australian Perspective. Sydney, Australia: Pearson Education Ltd. pg 234-5, 245, 414. Recommended American Psychiatric Association. (2000). Appendix 1. Outline for Cultural Formulation and Glossary of Culture Bound Syndromes. In. Diagnostic and statistical manual of mental disorders (4th ed. text rev). Washington, DC: Author. pg 897-903. Culhane KA, (2007). “We are out of balance here”: A Hmong cultural model of diabetes. J. Immigrant Minority Health. 9; 179-190. Betancourt JR, (2004). Cultural competence – Marginal or mainstream. New England Journal of Medicine, 351, 953-955.


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By the end of this week it is expected that you will be able to: • appreciate the importance of multidisciplinary teamwork in patient management. • recognise how local, national and global factors intersect to affect individual and community

health and health care delivery with specific reference to the transmission and management of HIV/AIDS.

• discuss the role of nutrition in healthcare. • discuss the general characteristics of the internal organs. • describe how the body responds to chronic injury. • outline the causes of cell injury and the mechanisms of cell death. • relate the pathology of neoplasms and the pharmacological tools for their control. • discuss injury, healing and regeneration from the perspective of pathology. • consider how the body detects foreign matter and responds to it. • discuss the anatomical principles applying to arteries, veins and capillaries. • discuss the personal and physical implications of tissue injury, management and recovery

(eg. heart attack). • reflect upon the skills used to develop an empathic approach when dealing with colleagues and

patients. • elaborate the pharmacological treatment of cancer. • describe the principles of cancer therapy, common targets of drug action and major drug group

used in management of cancer. • use this week’s CBL to integrate learning during this week.


167

WEEK 10 Lecture03/01-P79 – Principles of vasculature Theme: III Discipline: Anatomy Sub Discipline: Gross Anatomy



• understand the structure, function and classification of arteries and arterial systems • understand the structure, function and classification of veins and venous systems

Content synopsis: This lecture will review the general principles in relation to the structure and function of arteries and veins

Keywords: lumen, intima, media, elastic, muscular, arterioles, end arteries, anastomosis, caval, systemic, portal, venule, emissary, diploic

Readings: Prescribed Anatomy Syllabus, ‘General Anatomy Principles II’ Eizenberg N, et al. (ed.) 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapters 10 & 11



168

WEEK 10 Lecture01/01-P7 - Spirituality and environment

Theme: I Discipline: HEP Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the many ways in which one can look at what environment is • appreciate the positive and negative impacts of environment on many aspects of mental and

physical health • consider the ways in which one can create a healthy environment at home, work or in the community • define and distinguish between meaning, spirituality and religion • appreciate the wide variety of ways in which individuals and cultures explore and express their

spirituality • understand the need for tolerance and respect between different individuals and cultural groups • understand the role of spirituality in building resilience • understand the role of spirituality in health maintenance and healthcare • understand in what sorts of situations spiritual and religious issues may be relevant to or impact

upon healthcare • explore the relevance of these issues in clinical settings including being able to take a ‘spiritual history’

Content synopsis: Environment can be understood in many ways. These include the physical environment like the air we breathe and water we drink, but it also includes the social and cultural environments we make for ourselves. Environment can have many positive and negative impacts upon health some of which we are conscious but many of which we are unconscious. Some of the effects are direct – such as the impact of pollution and climate change – but many are indirect – such as the impact of drought upon economies and mental health. This lecture will explore these issues and give examples to illustrate how environment impacts upon us at home, work and in the wider community. It will also examine the ways in which we can individually and collectively create healthy environments. People search for meaning in various ways. Research suggest that having a spiritual or religious dimension to a person’s life helps them to cope with serious illness and is associated with healthier lifestyle and better mental and physical health. Furthermore, studies suggest that the majority of patients wish to discuss these issues with their doctors, particularly when they are confronting major illnesses. Attention will be drawn to the wide variety of ways in which people and cultures explore and express their spirituality, whether it be through religion or through philosophical inquiry, altruism, environmentalism or by some other means. The importance of being able to explore these issues in a respectful and culturally appropriate way will also be emphasised. The kinds of questions one might use in order to explore these issues with patients will also be explored.

Keywords: environment, soil, air, water, noise, climate change, chemicals, social environment, spirituality, religion, history taking, culture

Readings: Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 82-89, pg 142-157 Recommended Matthews DA, et al. Religious commitment and health status. Arch Fam Med. 1999; 8 (6): 476



169

WEEK 10 Lecture03/01-P80 - Introduction to immune system Theme: III Discipline: Pathology Sub Discipline: Immunology

CMS Lecturer / Tutor MUSC Lecturer / Tutor Emeritus Professor James Goding Department of Physiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: To give a broad overview of the importance of the immune system.

Content synopsis: • major epidemics of infection have played a major role in shaping the evolution of the immune

system, by selecting for individuals who can survive • concept of vaccination; history of its implementation • key concepts of immunity: recognition, specificity, memory • genetics and the immune system: genetic polymorphism, its biological value and immunological

consequences, especially for transplantation • concept of self, nonself and tolerance

Keywords: evolution, immunity, immune system, genetic polymorphism, infection, vaccination, self, nonself, tolerance, transplantation

Readings: Prescribed Kumar & Clarke: Clinical Medicine. Especially Chapter 4 Janeway et al. Immunobiology. Especially Chapter 1 Recommended Sompayrac L, How the Immune System Works. Blackwell Publishing



170

WEEK 10 Lecture03/01-P81 - How does the immune system work? Theme: III Discipline: Pathology Sub Discipline: Immunology CMS Lecturer / Tutor MUSC Lecturer / Tutor Emeritus Professor James Goding Department of Physiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: To gain a broad understanding of how the immune system works.

Content synopsis: • cells of the innate immune system: Macrophages, dendritic cells, polymorphs • cells of the adaptive immune system: T and B lymphocytes, plasma cells • antibody structure and function: Heavy and light chains, Fab and Fc fragments, Fc receptors,

complement, antibody effector functions • interaction of innate and adaptive systems at initiation and effector phases of immune respons • antigen uptake and presentation; Toll receptors • clonal selection theory; commitment of individual clones to particular specificity is determined

by clone-specific rearrangements of antibody and T cell receptor genes • effector mechanisms; especially opsonisation • self and nonself revisited; simplified account of self tolerance by clonal deletion during early

lymphocyte development

Keywords: immune system, immunity, macrophage, dendritic cell, polymorph, phagocytosis, antigen, antibody, complement, innate, adaptive, receptor, opsonisation, Fc receptor, tolerance

Readings: Prescribed Kumar & Clarke: Clinical Medicine. Especially Chapter 4 Janeway et al. Immunobiology. Especially Chapter 1 Recommended Sompayrac L, How the Immune System Works. Blackwell Publishing



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Objectives: After participating in this session, it is expected that students will be able to understand what goes wrong in cancer cells.

Content synopsis: • specific gene products may inhibit cell growth (tumour suppressor genes) • loss of function of tumour suppressor genes leads to uncontrolled cell growth and cancer • inherited cancer syndromes often result from errors in tumour suppressor genes • acquired cancers result from accumulated mutations in tumour suppressor gene • genetic changes that immortalise cells or prevent cell death also contribute to cancer

Keywords: tumour suppressor gene, DNA mismatch repair gene, mutation, inherited cancer syndromes




172

WEEK 10 Lecture03/01-P83 - Anti-cancer drugs 1 Theme: III Discipline: Pharmacology Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Shane Bullock Coordinator, Scientific Basis of Clinical Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• identify general properties of cancer cells • outline the principles of cancer therapy • identify targets for anticancer drugs • describe the mechanism of action of classic cytotoxic drugs • discuss the major adverse effects of anticancer drug therapy

Content synopsis: Anticancer drug therapy is a significant part of the management of cancers. In this lecture we will examine the principles of cancer therapy, the common targets of drug action and the major drug groups used in cancer management. There are two broad types of anticancer drug: the classic cytotoxic drugs and the newer novel agents that are generally thought to be less toxic than the classic drugs. We will also consider the general adverse effects of cancer drug therapy and the strategies used to minimise their effects on patients.

Keywords: selective toxicity, cytotoxic drugs, antimetabolites, alkylating agents, hormones, monoclonal antibodies, immunomodulating agents, adverse drug reactions, cell cycle, drug resistance, tumour cell sanctuaries, drug toxicity

Readings: Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh. Anticancer drugs: Chapter 55, pg 673-688



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WEEK 10 Tutorial_04/01-P9 - Ending the medical interview, motivational interviewing, and

medical history taking from a real patient Theme: IV Discipline: Clinical Skills Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

and

Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the social and ethical complexities with confidentiality in medical environments • have assessed the ethical implications of breaching confidentiality in their medical site visits • demonstrate taking an accurate and empathetic medical history from a patient • employ the principles of motivational interviewing in facilitating healthy lifestyle change • demonstrate communication skills necessary to end a medical interview

Content synopsis: • Take a medical history from a real patient with a chronic illness (one hour) • Ending a medical interview (15 minutes) • Motivational interviewing (45 minutes)

Keywords: Summarizing, contracting, safety net

Readings: Workbook entry for this tutorial Prescribed Silverman J, Kurtz S, Draper J, Skills for communicating with patients. Oxford: Radcliffe Publishing, 2005. pg 141-173 Rollnick S, & Miller WR, (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, 325-334


174

WEEK 10 Tutorial_03/01-P8 - Neoplasia Theme: III Discipline: Pathology/Biochemistry Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Catriona McLean (Tutorial) Department of Medicine Alfred Hospital Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

and

Dr Janet Macaulay (Syndicate) Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: • to introduce the concept of Neoplasia • to understand the mechanisms by which unregulated cell growth may lead to Neoplasia

Content synopsis: The nature of neoplasia and its relationship to normal growth and differentiation.


Keywords: neoplasia, tumours, oncogenes, differentiation

Readings: Workbook entry for this tutorial General and Systemic Pathology, JCE Underwood, Chapter 11, pg 221


175

WEEK 10 Tutorial_HEP_01/01-P3 - Nutrition, mindfulness 3 Theme: I Discipline: HEP Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the main health benefits of healthy nutrition • reflect upon the many factors which affect eating behaviour • reflect upon the lecture content on psychological factors influencing eating patterns and weight

management • identify the barriers to good nutrition and some strategies for dealing with them • understand the various motivational issues related to healthy nutrition • explore the Stress Release Program task 2: letting go and acceptance

Content synopsis: This tutorial will further explore and discuss topics and principles arising in the lectures and how they apply to the students personally. Experiences and reflections on the previous week’s tutorial and practices will be discussed. Students will be encouraged to reflect on and discuss the role of nutrition in their own health and also its role in healthcare. Time will be spent exploring the various personal factors, like mood and attitude, and the environmental factors like advertising and social contexts, which impact upon eating patterns. The strategies discussed in the lecture from the “If not Dieting” program will be explored. The second half of the tutorial will further explore the mindfulness practice and debrief the previous week’s task on perception. Then the ‘homework’ for the following week, of exploring the relationship between letting go, acceptance and stress, will be introduced. Students will be encouraged to explore this in daily life and be prepared to come back to the group the next week and report on their experiences and insights. Students will record these in the journal.

Keywords: nutrition, eating patterns, weight management, behaviour change, motivation, mindful eating, letting go, acceptance, stress

Readings: Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 64-66


176

WEEK 10 SiteVisit_04/01-P3 - Medical contact visit 3 Theme: IV Discipline: Clinical Skills Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]




Readings: Prescribed Levett-Jones T, and Bourgeois S, 2007. The Clinical Placement: An essential guide for nursing students. Chapter 1 Churchill Livingstone. This reading will assist you to understand and manage some of the challenges medical students face in clinical environments.


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WEEK 10 Lecture03/01-P82 - Pain Theme: III Discipline: Medicine of the Mind Sub Discipline: Health & Human Behaviour

CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Stephen Gibson School of Psychology and Psychiatry Faculty of Medicine, Nursing & Health Sciences


• familiarity with the definition and classifications of pain and to understand the sensory, emotional and cognitive aspects of pain

• knowledge of the prevalence of pain • awareness of the major impacts of persistent pain on mood, behaviour, function and quality of

life as well as recognise the important role of psychological factors in mediating these impacts • familiarity with current methods of pain assessment • understanding of the major approaches to the management of persistent pain problems

Content synopsis: This lecture will focus on the phenomenology of persistent pain as a common health problem in its own right, rather than as an inconsequential symptom of disease or injury. The extent to which pain is an issue in Australia and the impacts of persistent pain on the individual and the community will be discussed. An examination of current self-report, questionnaire and behavioural measures of pain as well as discussion of the major psychosocial treatment approaches to pain management will also be undertaken.

Readings: Prescribed Morrison V, Bennett P, Butow P, Mullan B, & White K, (2007). An introduction to Health Psychology: An Australian Perspective. Sydney, Australia: Pearson Education Ltd. Chapter 16, Pain, pg 403-430, 2008. Recommended The high price of pain: the economic impact of persistent pain in Australia. Available at: http://www.mbf.com.au/MBF/About%20MBF/Forms/MBF_Foundation_the_price_of_pain.pdf Psychosocial Aspects of Pain: A handbook for health care providers. Dworkin RH, & Breitbart WS, IASP press, Seattle, 2004.



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WEEK 10 Lecture03/01-P84 - Anti-cancer drugs 2 Theme: III Discipline: Pharmacology Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Shane Bullock Coordinator, Scientific Basis of Clinical Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• briefly review targets for anticancer drugs • describe the mechanism of action novel anticancer drugs • discuss strategies for the management of adverse effects • describe common clinical approaches to drug therapy and the limitations of cancer

chemotherapy

Content synopsis: Anticancer drug therapy is a significant part of the management of cancers. In this lecture we will examine the principles of cancer therapy, the common targets of drug action and the major drug groups used in cancer management. There are two broad types of anticancer drug: the classic cytotoxic drugs and the newer novel agents that are generally thought to be less toxic than the classic drugs. We will also consider the general adverse effects of cancer drug therapy and the strategies used to minimise their effects on patients.

Keywords: selective toxicity, cytotoxic drugs, antimetabolites, alkylating agents, hormones, monoclonal antibodies, immunomodulating agents, adverse drug reactions, cell cycle, drug resistance, tumour cell sanctuaries, drug toxicity

Readings: Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh. Anticancer drugs: Chapter 55, pg 673-688



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WEEK 10 Lecture02/01-P7 - HIV/AIDS across nations





• demonstrate an understanding of the nature of HIV/AIDS as a social process • demonstrate an understanding of the relationship between health risk behaviours and

acquisition of HIV infection • demonstrate an understanding of the relationship between physical and psychological health in

the setting of HIV infection • understand the epidemiological differences across international boundaries • describe the interplay of the biomedical and social models of health in managing HIV-AIDS

across national boundaries

Content synopsis: This lecture examines the global nature of HIV-AIDS as an infectious disease with unprecedented socio-cultural dimensions. From a clinical perspective HIV/AIDS is sometimes presented as a story about a virus and the life threatening diseases that result from it but HIV/AIDS is also a major public health issue. It affects large populations and the social and economic future of whole countries. Treatment options are tied to other economic, social, cultural and political factors that impinge on the provision of adequate health care. It is also a social story which plays out very differently for particular groups and in different countries over time. The social influence of gender relations on infection are examined as well as the health implications of stigma as it is applied in different social contexts. The way in which these approaches influence relationships in clinical settings is outlined.

Keywords: HIV/AIDS as infectious disease and chronic illness, public health, constructions of risk

Readings: Leclerc-Madlala, S, Simbayi, LC, & Cloete, A, (2009) The sociocultural aspects of HIV/AIDS in South Africa. In: Rohleder, P, Swartz, L, Kalichman, SC, & Simbayi, LC, (eds). HIV/AIDS in South Africa 25 years on: psychosocial perspectives. New York: Springer. 13-26. Jewkes R, (2009). HIV and women. In: Rohleder, P, Swartz, L, Kalichman, SC, & Simbayi, LC, (eds). HIV/AIDS in South Africa 25 years on: psychosocial perspectives. New York: Springer. 27-40. McMahon T, Luisi B, (2011). What’s the ‘problem’? Current issues in defining HIV among people from culturally and linguistically diverse (CALD) backgrounds in Australia. HIV Australia, vol 9, no 2, 11-14. Avaialble online at: http://www.afao.org.au/library/hiv-australia

Useful websites: AVERT: http://www.avert.org/ Australian Federation of AIDS organizations http://www.afao.org.au/library/hiv-australia



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WEEK 10 Practical_03/01-P10 - Tissue injury and repair

Theme: III Discipline: Pathology Sub Discipline: Tissue Pathology

CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Catriona McLean Department of Medicine, Alfred Hospital Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: • consider the causes of cell death and injury

• liver • understand the principle of metaplasia

• oesophagus • describe the changes of acute inflammation

• appendix • describe the changes that occur in infarcted tissue

• heart • discuss the consequences of tissue infarction

• heart • describe the changes of chronic injury

• liver • consider the concept of functional reserve • appreciate that death of tissue leads to loss of function • discuss the 3 categories of tissues based on their capacity to divide

Content synopsis: • principles of metaplasia • acute inflammation with reference to acute appendicitis • tissue infarction with reference to the heart • chronic injury with reference to the liver

Keywords: acute inflammation, chronic inflammation, infarction Students are required to read the workbook entry relating to this practical and to have completed the following prescribed reading:

Readings: Prescribed Underwood 5th ed.

Metaplasia - Ch 5, pg 82-83 o Barrett metaplasia in oesophagus - Ch 15 pg 364

Acute Inflammation – Ch 10, pg 200-212 o Acute appendicitis - Ch15 pg 397-398

Chronic inflammation – Ch 10, pg 212-219 o Cirrhosis – Ch 19, pg 420-423

Infarction - Ch8, pg 154-158 o Myocardial – Ch 13, pg 294-299 o Central nervous system – Ch 26, pg 760-762

Some of the practical will be conducted using virtual slides from an internet website. Please familiarise yourself with this website: http://www.path.uiowa.edu/virtualslidebox/ Students who have laptops with internet access are requested to bring these to the session.


181

WEEK 10 Tutorial_02/01-P1 - Local perspectives on HIV-AIDS Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor HIV-AIDS in Australia has its own historical trajectory and set of current issues. A focus has developed on priority population groups where prevention and treatment is targeted. In this tutorial, topics will be introduced by students who will put forward key ideas for discussion. Student-led discussion: select from the following topics:

• social marketing and HIV-AIDS – from the Grim Reaper to today • issues for priority population groups with or at risk of, HIV infection • culturally and Linguistically Diverse (CALD) communities and HIV-AIDS in Australia


182

WEEK 10 Tutorial_03/01-P9 - Tissue injury and repair Theme: III Discipline: Pathology Sub Discipline: Tissue Pathology


Objectives: • to understand the causes of tissue injury • to understand the short-term and longer-term consequences of tissue injury • to understand the basic processes of tissue repair and regeneration

Content synopsis: • common causes of injury • factors that determine outcome of injury • stable, labile and permanent cells


Keywords: injury, stable tissues, labile tissues and permanent tissues

Students will be required to complete the workbook questions prior to attending the tutorial and to have completed the following reading:

Readings: Prescribed General and Systemic Pathology, JCE Underwood, Chapter 6

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By the end of this week it is expected that you will be able to: • reflect on how national and global influences affect the transmission and management of

HIV/AIDS from the perspective of those living with HIV/AIDS. • outline the impact of pain on quality of life. • describe the normal microflora of the body, and the diagnosis and treatment of infections. • enunciate the principles of medical parasitology. • explain the relationship between physical and mental health in a clinical scenario. • discuss the anatomical principles applying to lymph vessels and nodes. • outline medico-legal that may be found in clinical contexts. • reflect upon the skills used to develop an empathic approach when dealing with colleagues and

patients. • identify the components of blood and their origins. • explain the origins and functions of t cells. • discuss the interactions of humans with viruses. • describe the pathology of lobar pneumonia. • explain the nature of fungal infections and their causative organisms. • discuss the factors to consider when deciding the medical importance of infectious diseases. • describe the role of antimicrobials in pharmacological therapy. • use this week’s CBL to integrate learning during this week.


185

WEEK 11 Lecture03/01-P87 - Chronic inflammation Theme: III Discipline: Pathology Sub Discipline: Tissue Pathology

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Anthony Longano Department of Anatomical Pathology Monash Medical Centre Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: Learn the causes and features of chronic inflammation.

Content synopsis: • causes of chronic inflammation • macroscopic appearance of chronic inflammation • cells of chronic inflammation

Keywords: chronic inflammation, lymphocytes, macrophage, granuloma

Readings: Prescribed General and Systemic Pathology, JCE Underwood, Chapter 10 212



186

WEEK 11 Lecture03/01-P72 - 'T' cells Theme: III Discipline: Pathology Sub Discipline: Immunology


Objectives: To gain an understanding of what T cells do, why they are important, how they are activated, and why they are necessary.

Content synopsis: • what do T cells do • T cells are made in the thymus; effect of neonatal thymectomy in mice • helper and cytotoxic (killer) T cells • histocompatibility antigens • antigen uptake, processing and presentation to T cells • two-signal model for activation; co-stimulatory molecules • T cell effector mechanisms: cytokines, help, killing • regulatory T cells (briefly) • viral immunity and transplant rejection are opposite sides of the same coin

Keywords: T cells, helper, cytotoxic, killer, major histocompatibility complex, MHC, HLA, dendritic cells, Treg, virus, transplantation

Readings: Prescribed Kumar & Clarke: Clinical Medicine. Especially Chapter 4 Janeway, et al. Immunobiology. Especially Chapter 1 Recommended Sompayrac L, How the Immune System Works. Blackwell Publishing



187

WEEK 11 Lecture03/01-P89 – Principles of organisation and function of lymph vessels and

nodes Theme: III Discipline: Anatomy Sub Discipline:



• understand the structure, function and classification of lymphatic vessels and how they differ from arteries and veins

• understand the structure and how it relates to the 2 principle functions of the lymphatic channels- lymph drainage and immune surveillance

• how lymph vessels allow the spread of cancer • discuss the arrangement of primary and secondary lymphoid organs and how these relate to

optimising the function of the immune system • understand the basic anatomy of a lymph node and their distribution in the body

Content synopsis: This lecture will review the general principles in relation to the structure and function of the lymphatic vessels and lymphoid organs in relation to normal function and examples of how this can be disturbed.

Keywords: lymph, lymphatic channels, lymphatic ducts, lymph nodes, spleen, thymus, bone marrow, non-encapsulated lymphoid tissues, immune surveillance, lymphoedema

Readings: Prescribed Eizenberg, et al. 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapter 12 Moore, Dalley, Agur pg 43-46 Any good histology text: Kerr, Wheater or Ross etc.



188

WEEK 11 Lecture03/01-P80 - Haematopoietic stem cell biology Theme: III Discipline: Biochemistry Sub Discipline: Haematology CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Harshal Nandurkar Haematology Department St Vincent’s Hospital Melbourne Email: [email protected]

Objectives: This session will introduce the concept of bone marrow stem cells. The development of stem cells from embryo to adults, their microenvironment and the influences that determine lineage commitment will be discussed. The role of growth factors and transcription factors will be described; references will be made to animal models that have helped in the understanding of the differentiation process.

Content synopsis: Blood consists of many cell types that arise from primitive stem cells. These cells retain a high capacity to proliferate and form progenitor cells, which in turn differentiate into the mature cells that are identified in the peripheral blood. Stem cells exist in a hierarchy of capacity to differentiate into various different lineages. This lecture will describe the ‘stem cell niche’, which is the microenvironment that nurtures stem cells within the bone marrow. The ontogeny of stem cells from embryo to adult life and the various in vitro and in vivo assays that are use to define stem cells will be discussed.

Keywords: stem cells, lineage commitment, growth factors, transcription factors

Readings: Prescribed Relevant Chapter in Molecular biology of the cell, by Alberts, et al. (available at the Hargrave library reserve)

Recommended Additional Resources: http://www.hematologyatlas.com/principalpage.htm http://www.hsc.virginia.edu/internet/hematology/hessidb/normal-hematopoietic-cells.cfm This site contains good introduction to normal haematopoiesis.


189

WEEK 11 Lecture03/01-P91 - Immunity to microbes Theme: III Discipline: Pathology Sub Discipline: Immunology


Objectives: To understand how microbes are recognised and destroyed by the immune system.

Content synopsis: • how are immune responses initiated • innate and adaptive immunity • Toll receptors; pathogen-associated molecular patterns (PAMPs) • activation of T cells and B cells; similarities and differences • role of antibodies and T cells in fighting infection • mechanism of immunity after vaccination or recovery from infection • how microbes fight back: concept of Darwinian struggle between microbes and their hosts • factors that influence susceptibility and resistance to infection

Keywords: infection, immunity, phagocytosis, opsonisation, macrophage, polymorph, dendritic cell, antibody, lymphocyte, T cell, B cell, antibody, complement, Fc receptor, Toll receptor, vaccination, evolution, evasion, Darwinian struggle




190

WEEK 11 Lecture03/01-P90 - Interactions between humans and viruses Theme: III Discipline: Microbiology Sub Discipline: Virology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• acquire an understanding of what a virus is • describe what determines the outcome of viral infection • understand viral transmission and invasion and the different types of viral infections • understand how viral infections can be controlled

Content synopsis: Virus structure Viral infections

• Sources and Transmission • transmission: direct contact, respiratory spread, food or water borne • portals of entry • contributing host factors

• Types of infections • acute • persistent: chronic, latent, recurrent, transforming

• Mechanisms of infection • viral receptors, interactions with host cells, immune evasion

• Control of infection • antiviral agents

o mechanisms, use of combination therapy vaccination

Keywords: virus, tropism, acute, persistent, chronic, latent, recurrent, antiviral

Readings: Prescribed Goering, et al. Medical Microbiology. 4th ed. Mosby/Elsevier: Chapter 3; Chapter 21: pg 274-284; Chapter 26: pg 374-384, 36.



191

WEEK 11 Tutorial_04/01-P10 - Medical site visit: legal, ethics and clinical perspectives Theme: IV Discipline: Clinical Skills Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Leanna Darvall Department of Forensic Medicine Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

and

Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the social and ethical complexities with confidentiality in medical environments • have assessed the ethical implications of breaching confidentiality in their medical site visits • understand medico-legal issues that arise from site visits • demonstrate a basic understanding of medico-legal issues in the clinical context • explore medico-legal issues relevant to their assignment

Content synopsis: Ethics tutor debrief (1 hour) Legal tutor debrief (1 hour)

Keywords: Ethics, confidentiality, breach of confidentiality, medico legal, negligence

Readings: Workbook entry for this tutorial


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WEEK 11 Tutorial_HEP_01/01-P4 - Environment, mindfulness 4 Theme: I Discipline: HEP Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the many ways of understanding what constitutes the environment • appreciate why we seek different environments • reflect upon how much control we do and do not have over our environment • reflect upon the role do we play in determining our own environment • explore how to create a healthy environment • explore the Stress Release Program task 3: presence of mind

Content synopsis: This tutorial will further explore and discuss topics and principles arising in the lectures and how they apply to the students personally. Experiences and reflections on the previous week’s tutorial and practices will be discussed. Students will be encouraged to reflect on and discuss the role of environment in their own health and also its role in healthcare. The second half of the tutorial will further explore the mindfulness practice and debrief the previous week’s task on letting-go/acceptance and stress. Then the ‘homework’ for the following week, of exploring the relationship between presence of mind and stress, will be introduced. Students will be encouraged to explore this in daily life and be prepared to come back to the group the next week and report on their experiences and insights. Students will keep a journal of experiences, insights and questions relating to the content of the fourth tutorial and hand this in at the fifth tutorial.

Keywords: environment, mindfulness, presence of mind

Readings: Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 66-67


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WEEK 11 Lecture03/01-P93 - Haematopoietic stem cells and differentiation into red cells, white

cells and platelets Theme: III Discipline: Biochemistry Sub Discipline: Haematology CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Harshal Nandurkar Haematology Department St Vincent’s Hospital Melbourne Email: [email protected]

Objectives: This session will continue to explore the concept of derivation of mature blood cells from the haemopoietic stem cells. It will primarily focus on the the biology of growth factors that cause multiplication of progenitor cells and their ultimate differentiation into mature cells. The clinical applications of growth actors will be discussed.

Content synopsis: Blood consists of many cell types that can be grouped into three compartments: white cells, comprising of granulocytes and lymphocytes, red cells, and platelets. Haematopoietic stem cells retain the capacity to differentiate into the various cell types and thereby serve as an inexhaustible supply of blood components. The decision to differentiate into a particular cell type (lineage commitment) is influenced by “instructions” provided to the haematopoietic stem cells by growth factors and also by the expression within the stem cells of transcription factors that are specific to each lineage. Failure of regulation of stem cell development contributes to the development of blood cancers (leukaemias and lymphomas). Haematopoietic stem cells can be identified by the specific proteins expressed on their surface. Stem cell numbers can be increased by the use of growth factors and these cells can be collected and stored for future use. The above ability forms the basis of bone marrow transplantation.

Keywords: stem cells, lineage commitment, growth factors, transcription factors

Readings: Prescribed Relevant Chapter in Molecular biology of the cell, by Alberts, et al. (available at the Hargrave library reserve)

Recommended Additional Resources: http://www.hematologyatlas.com/principalpage.htm http://www.hsc.virginia.edu/internet/hematology/hessidb/normal-hematopoietic-cells.cfm This site contains good introduction to normal haematopoiesis.


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WEEK 11 Lecture03/01-P94 - Microbial organisms of medical importance Theme: III Discipline: Microbiology Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand the factors involved in determining a microorganism as medically important • understand the causes and control of some nosocomial infections • understand the causes and control of some important community acquired infections • identify the public health responsibilities required for a range of infectious diseases

Content synopsis: Community acquired infections

• Epidemic situations: introduction of a new strain of microorganism into animmunologically naïve population

• Influenza • Outbreak situations: a sudden or unexpected occurrence of a disease in a limited segment of

the population • Meningococcal disease

• Endemic situations: infection or disease occurs regularly at low or moderate frequency • Cholera

• Nosocomial (hospital acquired) infections • Infection control requirements

o Isolation o Barrier nursing

• Preventative measures o Disinfection, single use policy

Public Health measures • Disease control

• Isolation • Vaccination • Prophylaxis • Notifiable diseases: legal requirement for notification of certain diseases

Keywords: epidemic, outbreak, endemic, nosocomial, community acquired

Readings: Prescribed Goering, et al. Medical Microbiology. 4th ed. Mosby, Elsevier: Chapters 31, 36



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WEEK 11 Practical_03/01-P5 - Lobar pneumonia and pathology Theme: III Discipline: Microbiology/Pathology Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing and Health Sciences Email: [email protected] and Professor Catriona McLean Department of Medicine Alfred Hospital Faculty of Medicine, Nursing and Health Sciences Email: [email protected]

PART 1 - INTRODUCTION: The aim of this practical class is to correlate the macroscopic and microscopic features of acute inflammation of the lung with the clinical manifestations.

Aim: The aim of this practical class is to correlate the macroscopic and microscopic features of acute inflammation of the lung with the clinical manifestations.

Overall objective: To begin to understand how our immune system interacts with invading microorganisms.

Learning objectives: At the completion of this class you should be able to:

• Recognize and describe the different types of inflammatory cells that accumulate in inflamed. • Tissues, in particular polymorphonuclear leucocytes, macrophages, lymphocytes and plasma cells. • Describe the microscopic features of acute inflammation in the lung (pneumonia). • Outline the microscopic appearances that correlate with the evolution of the pneumonic process

from the stage of congestion through consolidation to resolution. • Discuss the clinical, laboratory and radiological diagnosis of pneumonia. • Understand some of the causative agents, microscopic and clinical features of pneumonia.

Students are required to read the workbook entry relating to this practical and to have completed the following prescribed reading:

Pre-reading for pathology: Acute inflammation pg 201 Underwood Pathology Cells of the immune system pg 163–177 Underwood Pathology Pneumonia pg 332-324 Underwood Pathology Normal histology of lung – pg 323–326 Underwood Pathology

Pre-reading for microbiology:

Mims et al. Medical Microbiology. Updated 3rd ed. Elsevier Mosby. Section 4: Chapter 19. Pneumonia

Spicer WJ, Clinical Bacteriology, Mycology and Parasitology. An illustrated Colour text. Churchill Livingston. pg 112–115. Some of the practical will be conducted using virtual slides from an internet website. Please familiarise yourself with this website: http://www.path.uiowa.edu/virtualslidebox/ Students who have laptops with internet access are requested to bring these to the session.


196

WEEK 11 Tutorial_02/01-P1 - Global perspectives on HIV-AIDS Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor This week will focus on global dimensions of HIV-AIDS. In this tutorial, you will work in small groups to examine the readings for Lecture 8 and discuss the key ideas put forward. In this tutorial, topics will be introduced by students who will put forward key ideas for discussion. Student-led discussion: select from the following topics:

• TRIPS • Generics vs patents • HIV-AIDS and women


197

WEEK 11 Lecture03/01-P100 - Fungal infections Theme: III Discipline: Microbiology Sub Discipline: Mycology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: • gain knowledge in the diversity of fungi • recognise how fungi are different from other organisms • appreciate how fungal pathogens are classified • acquire an understanding of the major diseases caused by fungal pathogens • describe the general principles of diagnosis, prevention and control of fungal diseases

Content synopsis: This lecture will introduce you to the world of fungi and the major groups of fungi that cause disease. The three types of infection caused by fungi: superficial, subcutaneous and systemic infectious, will be outlined.

Keywords: fungi, mycoses, filamentous, yeast, superficial, subcutaneous, systemic, opportunistic

Readings: Prescribed Goering, et al. Mims Medical Microbiology 4th ed. Chapter 4; Chapter 19, pg 249-250; Chapter 26, pg 368-373; Chapter 30, pg 437-438.



198

WEEK 11 Lecture03/01-P109 - Antibiotics (1) Theme: III Discipline: Pharmacology Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Elizabeth Davis Department of Pharmacology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• describe why selective toxicity is important in chemotherapy • discuss the use, mechanisms of action, clinical uses and adverse effects of examples from each

of the major classes of antibacterial agents

Content synopsis: These lectures will cover the common classes of antibacterial agents that are currently used to treat infections. Explanation will be given as to how these drugs work to relatively selectively affect bacteria and not harm humans. The common side effects that result from using these agents will be covered. The lectures will also cover the important principles which guide choice of a particular antibacterial agent.

Keywords: bacteriocide, bacteriostat, spectrum of activity, resistance, sensitivity, post antibiotic effect

Readings: Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh. Antibacterial drugs: Chapter 50, pg 622-637 Page C, Curtis M, Walker M, & Hoffman B, (2006). Integrated Pharmacology; 3rd ed. Drugs acting on infectious organisms: Chapter 6, pg 87-160



199

WEEK 11 Lecture03/01-P109 - Antibiotics (2) Theme: III Discipline: Pharmacology Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Elizabeth Davis Department of Pharmacology Faculty of Medicine, Nursing and Health Sciences Email: [email protected]

Objectives: • describe why selective toxicity is important in chemotherapy • discuss the use, mechanisms of action, clinical uses and adverse effects of examples from

each of the major classes of antibacterial agents

Content synopsis: These lectures will cover the common classes of antibacterial agents that are currently used to treat infections. Explanation will be given as to how these drugs work to relatively selectively affect bacteria and not harm humans. The common side effects that result from using these agents will be covered. The lectures will also cover the important principles which guide choice of a particular antibacterial agent.

Keywords: bacteriocide, bacteriostat, spectrum of activity, resistance, sensitivity, post antibiotic effect

Readings: Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh. Antibacterial drugs: Chapter 50, pg 622-637 Page C, Curtis M, Walker M, & Hoffman B, (2006). Integrated Pharmacology; 3rd ed. Drugs acting on infectious organisms: Chapter 6, pg 87-160.



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WEEK 12


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WEEK 12 Weekly Learning Objectives By the end of this week it is expected that you will be able to:

• understand the social factors influencing the way in which death, dying and palliative care are viewed in society and how that affects clinical understanding and practice.

• use the sociological imagination to appreciate different factors affecting the use and misuse of antibiotics both nationally and internationally.

• describe the immune response to infection and the role of antimicrobial chemotherapy in its treatment.

• distinguish between active and passive immunity. • discuss the interactions of humans with viruses. • enunciate the pharmacological strategies for combatting inflammation. • explore the impact of culture on health behaviour. • account for the mechanisms of antibiotic resistance and their transmission between organisms. • outline the influence of environment and the impact of personal beliefs on health and wellbeing. • give an account of the clotting mechanism. • understand how the social construction, production and distribution of health and illness

intersect with medicine. • use the sociological imagination to appreciate different factors affecting the use and misuse of

antibiotics both nationally and internationally. • show how the immune system can damage the body and how manipulation of the system can

prevent or treat diseases. • explain the use of antibodies as diagnostic tools. • discuss the means available for the control of viral infections. • use this week’s CBL to integrate learning during this week.


203

WEEK 12 Lecture03/01-P96 - Active and passive immunity; immunodeficiency Theme: III Discipline: Pathology Sub Discipline: Immunology


Objectives: • to understand what is meant by active and passive immunity, and to appreciate their medical

importance • to understand the causes and consequences of the common forms of immune deficiency,

especially (a) congenital (b) acquired due to neoplasia, chemotherapy or immunosuppressive drugs and (c) acquired due to HIV infection

Content synopsis: • definitions and examples of active and passive immunity • active immunity is initiated by antigen. It is slow to develop but results in immunological memory • passive immunity is given by administration of antibodies from outside the body (transplacental,

in milk, and by injection). It acts immediately but only lasts a few months at the most • treatment of snake bite by antivenom; possible complications (serum sickness; anaphylaxis) • use of human monoclonal antibodies for therapy – examples • immune deficiencies: congenital and acquired. Examples and consequences, especially

immune deficiency due to haematological malignancy, chemotherapy, immunosuppressive drugs

• HIV infection; acute infection, long term decline in immune function, HIV replication cycle and its interruption by anti-retroviral drugs

Keywords: active immunity, passive immunity, snake bite, placenta, milk, breast feeding, monoclonal antibody therapy, leukaemia, lymphoma, transplantation, immunosuppressive drugs, chemotherapy, HIV, anti-retroviral drugs




204

WEEK 12 Lecture02/01-P8 - Pharmaceuticals





• discuss the major role played by pharmaceuticals in the effective treatment and management of disease

• demonstrate an understanding of the major challenges of antibiotic resistance and the social factors that underpin its exacerbation

• critique the pharmaceutical industry with respect to its marketing practices and drug pricing policies

• recognise the significance of drug-induced iatrogenesis in society

Content synopsis: In this lecture, we begin with a historical overview of the practice of medicine before and after the introduction of effective pharmaceutical such as the sulfa drugs in the 1930s and antibiotics in the 1940s. We discuss a major challenge that doctors and other healthcare providers are facing today, ie antibiotic resistance, and the social factors that are making this problem worse. We will also cover criticisms aimed at the pharmaceutical industry such as controversial or unethical marketing practices and differential pricing of patented/proprietary drugs in different countries. The significance of drug-induced iatrogenesis (harm to an individual’s health arising directly from medical intervention) as a medical problem will also be covered.

Keywords: Pharmaceuticals, pharmaceutical industry, antibiotic resistance, marketing practices, drug pricing, iatrogenesis

Readings: Alliance for the Prudent Use of Antibiotics. Antibiotic resistance: synthesis of recommendations by expert policy groups. Geneva: World Health Organization, 2001 http://whqlibdoc.who.int/hq/2001/WHO_CDS_CSR_DRS_2001.10.pdf Phua KL, Achike FA, 2007, ‘Vioxx and other pharmaceutical product withdrawals: ethical issues in ensuring the integrity of drug and medical device research, development and commercialisation’ Clinical Ethics 2007; 2 (3): pg 155-162

Useful websites: Public Citizen’s Health Research Group. Misprescribing and overprescribing of drugs. http://www.worstpills.org/public/page.cfm?op_id=3 Drug Money http://www.youtube.com/watch?v=1TwdsYVHjGA



205

WEEK 12 Lecture01/01-P8 - Connectedness Theme: I Discipline: HEP Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• appreciate the relationship between connectedness, social support and health • understand the potential health advantages and disadvantages dependent upon one’s extent

and quality of social support • appreciate that when social supports change there are a number of effects on wellbeing • understand the needs and effects of social support at different stages of life • explore the relevance of these issues in clinical settings

Content synopsis: This lecture will explore the role of social support, relationships and connectedness in health and healthcare. These terms will be defined and described, particularly in relation to how they are used in healthcare and research and some of the evidence-base on the impact of these factors on health will be presented. Connectedness is an often used term for social support. Research suggests that social support has a profound influence upon mental and physical health, independent of other lifestyle factors. It can play a positive or negative role, depending upon the extent and quality of those relationships. Family relationships, such as marriage, and works relationships are particularly influential for health. There are a number of times in one’s life – such as moving from another country or changing from school to university – when significant transitions in one’s level of social support can impact upon wellbeing. This lecture will explore these issues and the impact of social support at different stages in the life cycle.

Keywords: connectedness, social support, social isolation, relationships, marriage, work

Readings: Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 129-141 Recommended Helliwell JF, Putnam RD, The social context of well-being. Philosophical Transactions of the Royal Society of London - Series B: Biological Sciences. 2004; 359 (1449): 1435-46



206

WEEK 12 Lecture03/01-P97 – Antiviral (1) Theme: III Discipline: Pharmacology Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Elizabeth Davis Department of Pharmacology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]



• discuss the general principles of the treatment of viral infections • discuss the use, mechanisms of action, clinical uses and problems associated with the use of

antiviral drugs

Content synopsis: • general characteristics of currently available antiviral drugs • virus specific targets for antiviral drugs • specific examples of antiviral drug drugs

• guanine analogues (eg. aciclovir) • neuraminidase inhibitors (eg. oseltamivir) • interferon alfa • ribavirin

Keywords: virustatic; resistance; DNA polymerase; neuraminidase; M2 ion channel protein; pegylation;

Readings: Recommended Page et al. (2006) Integrated Pharmacology 3rd ed. – Chapter 6 Rang et al. (2012) Pharmacology 7th ed. – Chapter 51 Australian Medicine Handbook (available via the Monash Library website)



207

WEEK 12 Lecture03/01-P98 – Antiviral (2) Theme: III Discipline: Pharmacology Sub Discipline: N/A




• discuss the general principles of the treatment of HIV infections • discuss the use, mechanisms of action, clinical uses and problems associated with the use of

specific anti-retroviral drugs

Content synopsis: • general issues associated with the drug treatment of HIV infections • targets for anti-retroviral drugs • specific examples of antiviral drug drugs

• nucleotide/nucleoside reverse transcriptase inhibitors (eg. zidovudine) • non nucleotide reverse transcriptase inhibitors (eg. nevirapine) • protease inhibitors (eg. ritonavir) • cell entry inhibitors (eg. enfuvirtide) • integrase inhibitors (eg. raltegravir)

Keywords: combination antiretroviral therapy (ART); resistance; reverse transcriptase; gp41

Readings: Recommended Page et al. (2006) Integrated Pharmacology 3rd ed. – Chapter 6 Rang et al. (2012) Pharmacology 7th ed. – Chapter 51 Australian Medicine Handbook (available via the Monash Library website)



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WEEK 12 Lecture03/01-P99 - Antimicrobial resistance and resistance transfer Theme: III Discipline: Microbiology Sub Discipline: Antibiotic Resistance CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• define the meaning of antimicrobial resistance • understand the bacterial targets of antibiotics • gain knowledge in the mechanisms of antibiotic resistance • understand how antibiotic resistance is transferred

Content synopsis:

Antibiotics Targets of antibiotics

• bacterial cell wall or membrane, synthesis of proteins or nucleic acids Concepts of susceptibility and resistance:

• Innate • Acquired resistance

• Plasmids • transposons • mutation

Spread of antibiotic resistance in human pathogens. Impact of resistance on treatment of disease.

Keywords: antimicrobial, antibiotic, antimicrobial resistance, plasmid, transposon, mutation

Readings: Prescribed Goering, et al. Medical Microbiology. 4th ed. Mosby/Elsevier: Chapter 33 pg 479-503.



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WEEK 12 Tutorial_04/01 - OSCE Preparation Theme: IV Discipline: Clinical Skills Sub Discipline: N/A CMS Lecturer / Tutor MUSC Lecturer / Tutor Associate Professor Jan Coles Year 1 & 2 Clinical Skills Coordinator Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected] Dr Nadida Kachkouche Year 1 Clinical Skills Coordinator Lecturer Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand an OSCE examination format • practice communication skills learned in Semester 1 in an OSCE format • receive feedback on their performance from their tutor and peers

Content synopsis: In this session students will discuss what an Objective structured clinical examination involves and prepare for their formative examinations by practising OSCE cases. You will have an opportunity with your peers and tutor to practice using role plays from previous OSCE’s. You will also have marking sheets similar to the ones the examiners used; this gives you some experience in what the examiners were assessing in a particular case.

Keywords: OSCE, objective structured clinical examination, formative and summative assessment

Readings: Workbook entry for this tutorial Prescribed Dornan T, & P O’Neill (2006) Core Clinical Skills for OSCEs in Medicine Introduction pg 1-15. Churchill Livingstone.


210

WEEK 12 Tutorial_03/01-P11 - How the immune system works Theme: III Discipline: Pathology Sub Discipline: Tissue Pathology


Objectives: To understand how our immune system discriminates between self and non-self, how it interacts with invading micro-organisms and how these organisms may evade this process.

Content synopsis: • detection mechanisms in infection • effector mechanisms in infection • T cells • B cells • antibodies • immunisation


Keywords: immunity, T cells, B cells, antibodies

Students are required to read and complete the workbook tutorial questions prior to attending this session.

Readings: Prescribed JCE Underwood, Chapter 9 sections 1-5


211

WEEK 12 Tutorial_03/01-P12 – Can we control viral infections Theme: III Discipline: Microbiology Sub Discipline: Virology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• consider the transmission and infective processes of the following viruses: measles and influenza

• understand what features of viruses allow for their possible eradication or control • understand the situation for each of the viruses listed and what difficulties have been

encountered in efforts in their control

Content synopsis: Students will be given a short list of questions and issues to prepare PRIOR TO THE TUTORIAL/SYNDICATE. Individual students will be chosen at random in the tutorial to give a brief exposition of the question and topic to their fellow students, and to lead the discussion of that issue. Refer to entry in workbook for details of preparation required for class – in working document Tutorial 1 hour Syndicate 1 hour

Readings: Prescribed Goering, et al. Mims Medical Microbiology 4th ed. Chapter 3


212

WEEK 12 Tutorial_HEP_01/01-P5 – Connectedness, spirituality and mindfulness 5

Theme: I Discipline: HEP Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Craig Hassed Department of General Practice Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• appreciate the influence of relationships and social support on health • appreciate the impact of periods of transition on connectedness, coping and wellbeing • be able to apply these principles to the transition to university • understand the relationship between social networks and self image • appreciate a variety of personal sources of coping and inspiration • understand the relationship of these to health, wellbeing and dealing with stress • explore the ways in which individuals search for meaning • consider the relevance of these issues personally and professionally • explore the Stress Release Program task 4: limitations and stress • revise the behaviour change strategies • reflect upon the goals set at the start of the course • reflect upon the medical application of what has been learned • review evaluation and questionnaires

Content synopsis: This tutorial will further explore and discuss topics and principles arising in the lectures and how they apply to the students personally. Experiences and reflections on the previous week’s tutorial and practices will be discussed. Students will be encouraged to reflect on and discuss the ways in which relationships, social support and transition impacts upon wellbeing and coping. The second half of the tutorial will further explore the mindfulness practice and debrief the previous week’s task on presence of mind and stress. Then the ‘homework’ for the following week, of exploring the relationship between limitations and stress, will be introduced. Students will be encouraged to explore this in daily life and be prepared to come back to the group the next week and report on their experiences and insights. Students will not need to hand in a journal in the final tutorial. This tutorial will further explore and discuss topics and principles arising in the lectures and how they apply to the students personally. Experiences and reflections on the previous week’s tutorial and practices will be discussed. Students will be encouraged to reflect on and discuss the ways in which individuals explore and express their spirituality and/or search for meaning and how this impacts upon wellbeing and coping. The second half of the tutorial will further explore the mindfulness practice and debrief the previous week’s task on limitations and stress. The tutorial will culminate in reflecting on what has been learned and how it applies to healthcare and oneself personally. Students will be encouraged to continue to explore the issues covered in the HEP in daily life and especially in periods of high demands and potential stress like exam periods.

Keywords: connectedness, relationships, social support, social isolation, transition, mindfulness, limitations, Lifestyle, ESSENCE, mindfulness, behaviour change, goal setting

Readings: Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 67-69.


213

WEEK 12 Lecture03/01-P100 - Damage to tissues by the immune system Theme: III Discipline: Pathology Sub Discipline: Immunology


Objectives: To understand the common ways in which the defenses of the body can cause harm to the body.

Content synopsis: • classify damage as non-immunological and immunological. Examples. • excessive scarring due to immunological and non-immunological causes; fibrosis and keloid,

generally due to chronic ongoing tissue damage where the stimulus cannot be eliminated (eg. foreign body; cirrhosis of liver; fibrosis is also a common consequence of chronic inflammation due to persisting antigen stimulation or autoimmunity)

Immunological tissue damage: classify as (a) damage to normal tissues (b) damage to abnormal tissues, or (c) damage due to normal immune responses and (d) damage due to abnormal immune responses (eg allergic responses and autoimmunity). These four classifications are not mutually exclusive and indeed they overlap considerably.

Four types of “hypersensitivity” and their mechanisms • allergy and anaphylaxis • incompatible blood transfusion • Rh sensitisation • autoimmune diseases: examples and mechanisms

Keywords: fibrosis, keloid, chronic inflammation, IgE, anaphylaxis, serum sickness, Arthus reaction, complement, haemolysis, blood transfusion, Rh sensitisation, autoimmune disease, diabetes, thyrotoxicosis, myasthenia gravis, lupus




214

WEEK 12 Lecture03/01-P101 - Immune intervention Theme: III Discipline: Pathology Sub Discipline: Immunology


Objectives: To understand the main ways that the immune response can be manipulated to (a) provoke desirable responses and (b) avoid or suppress undesirable responses.

Content synopsis: • antigen-specific activation of immune responses: immunisation • antigen-specific avoidance of immune responses: blood transfusion; tissue matching • antigen-specific suppression of immune responses (only known example is prevention of

Rh sensitisation) • antigen-specific passive immunity (snake bite treatment; therapy with monoclonal antibodies) • nonspecific immunosuppression with immunosuppressive drugs

Keywords: immunisation, vaccination, transfusion, transplantation, Rh antigens, Rh sensitisation, snake bite, anaphylaxis, serum sickness, monoclonal antibodies, gamma globulin, immunosuppressive drugs




215

WEEK 12 Tutorial_02/01-P12 - Global pharmaceutical industry Theme: II Discipline: Health, Knowledge and Society Sub Discipline: N/A

CMS Lecturer / Tutor MUSC Lecturer / Tutor In this tutorial, you will work in small groups to examine the readings for week 11 and discuss the key ideas put forward. Student-led discussion: select from the following topics

• Antibiotics in a global world • Access to affordable essential drugs • Direct to Consumer Marketing – pros and cons • Iatrogenesis

Useful websites: Worst Pills http://www.worstpills.org This website set up by the Health Research Group of consumer advocate Ralph Nader’s Public Citizen organisation deals with the challenge of drugs that have been approved by regulatory authorities such as the Food and Drug Administration of the USA but which may actually pose significant threats to the health of patients.


216

WEEK 12 Practical_03/01-P11 - Serological diagnosis Theme: III Discipline: Microbiology Sub Discipline: Serology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Priscilla Johanesen Department of Microbiology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]


• understand how microorganisms and the infections they cause in the human body may be detected using serological methods

• understand some of the common serological tests used in diagnostic microbiology

Content synopsis: • Introduction to serological testing • Some commonly used serological tests • Case studies employing serological tests

Refer to entry in workbook for details of preparation required for class – in working document

Keywords: serology, antibody, antigen, ELISA, agglutination

Readings: Prescribed Goering, et al. Mims Medical Microbiology, 4th ed. Chapter 32


217

WEEK 12 Lecture03/01-P102 - Anaemia Theme: III Discipline: Biochemistry Sub Discipline: Haematology CMS Lecturer / Tutor MUSC Lecturer / Tutor Professor Harshal Nandurkar Haematology Department St Vincent’s Hospital Melbourne Email: [email protected]

Objectives: After participating successfully in this session and related activities, you should have learnt to:

• be familiar with symptoms and signs of anaemia using a case presentation • understand iron turnover and differentiate between iron deficiency due to blood loss versus poor

dietary intake • appreciate the differential diagnosis of macrocytic anaemia • understand the causes of B12 and folate deficiency and differentiate between causation by poor

diet content, versus malabsorption

Content synopsis: Anaemia is a descriptive term indicating decrease in haemoglobin in the peripheral blood. Symptoms of anaemia are the consequence of the decreased oxygen carrying capacity of the red cells. The reasons for anaemia include blood loss, deficiency of important nutrients, increased destruction of red cells from congenital structural or acquired immune-mediated causes, and bone marrow infiltration preventing normal red cell development. Adequate supply of essential nutrients such as iron, vitamin B12 and folic acid is critical for red cell growth and differentiation. The morphology (size and shape) of red blood cells often reveals clues about the aetiology. Deficiency of iron, B12 or folic acid is a common cause of anaemia. In iron deficiency, examination of blood film reveals microcytic hypochromic red cells. Deficiency of B12 and folic acid results in a macrocytic anaemia resulting from megaloblastic erythropoiesis.

Keywords: anaemia, iron, ferritin, B12, folic acid, microcytic, macrocytic

Glossary of Terms: Microcytes = “small red cells” Macrocytes = “large” red cells Anaemia = reduction in haemoglobin

Formative Assessment: Questions from web sources: http://research.med.umkc.edu/teams/blue2/q3.html The above site contains a good list of MCQs on anaemia.

Readings: Prescribed Wintrobe’s Clinical Haematology, or any other text book of haematology

Recommended Additional Resources: Web for morphology: http://pathy.med.nagoya-u.ac.jp/atlas/doc/ http://www.hematologyatlas.com/principalpage.htm http://www.merck.com/pubs/mmanual/section11/sec11.htm


218

WEEK 12 Lecture03/01-P103 - Mechanisms of haemostasis Theme: III Discipline: Biochemistry Sub Discipline: Haematology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Susan Brown Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing and Health Sciences Email: [email protected]


• describe the basis mechanisms of haemostasis: exposure of the subendothelium, platelet adhesion and activation, activation of blood coagulation proteins leading to formation of a fibrin clot

• understand that bleeding disorders are usually due to either platelet or blood coagulation protein disorders, and describe the differences in the clinical presentation of these two

• be able to identify the key issues in taking a history to assess the bleeding patient or the bleeding risk in a pre-operative patient

• be aware of the basic investigations into bleeding disorders: the platelet count, APPT and PT • discuss the common causes of thrombocytopaenia: increased platelet destruction, decreased

platelet production and platelet sequestration due to splenomegaly • understand the causes of inherited coagulation factor disorders such as von Willebrands

disease and Haemophilia, and the more common acquired disorders due to liver disease, medications such as heparin or vitamin K antagonists

Content synopsis: This lecture describes the basic pathologic mechanisms involved in normal haemstasis, which prevents bleeding from blood vessels. Blood clotting is initiated by damage to the blood vessel wall which exposes the subendothelium, leading to platelet adhesion and aggregation, activation of blood coagulation proteins, leading to fibrin clot formation. The coagulation protein activation cascades are discussed but need not be memorised. Bleeding disorders are usually due to defects in platelets or in blood coagulation proteins. Platelet disorders commonly present with mucocutaneous haemorrhage: petechiae (pin-point skin bleeding), nose bleeds, menorrhagia. Coagulation protein defects more commonly cause deep intramuscular or joint bleeding, or delayed post-operative bleeding. The assessment of the bleeding patient involves a detailed history of previous bleeding events, response to previous challenges such as surgery or tooth extraction, family history of bleeding disorders and current medications. The basis of commonly used investigations the platelet count, APTT and PT are outlined. The common causes of thrombocytopenia- peripheral destruction, decreased production and splenic sequestration are discussed. Common inherited coagulation protein disorders-von Willebrands disease and Hemophilia are explained.

Keywords: haemostasis, subendothelium, platelets, collagen, von Willebrand factor, megakaryocytes, coagaulation proteins, tissue factor, Factor VIII, Thrombin, Fibrin, fibrinolysis, petechiae, bruising, epistaxis, haemophilia, prothrombin time (PT), International normalised ration (INR), activated partial thromboplastin time (APTT), thrombocytopenia, immune thrombocytopenia (ITP), splenic sequestration, disseminated intravascular coagulation

Readings: Recommended Essential Haematology 5th ed. AV Hoffbrand, PAH Moss and JE Petit 2006 Chapters 23 & 24


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WEEK 12 Lecture03/01-P93 - Thrombosis Theme: III Discipline: Biochemistry Sub Discipline: Haematology CMS Lecturer / Tutor MUSC Lecturer / Tutor Dr Susan Brown Department of Biochemistry and Molecular Biology Faculty of Medicine, Nursing & Health Sciences Email: [email protected]

Objectives: • be aware of the importance of arterial and venous thromboembolism as a major cause of

morbidity and mortality • describe the pathogenesis of thrombosis • list the risk factors for venous thrombosis • understand the clinical presentation of venous thromboembolic disease as deep vein

thrombosis and/or pulmonary embolism, and its investigation and management • be aware of the principles of antiplatelet therapy and anticoagulant therapy

Content synopsis: This lecture discusses the clinical importance of thrombosis (inappropriate blood clot formation) in the pathogenesis of arterial and venous thromboembolic disease. The focus of the lecture is on venous thromboembolism: including risk factors, its clinical presentation as deep vein thrombosis and/or pulmonary embolism, initial investigation with ultrasonography of the limbs and CT-pulmonary angiography or Ventilation:Perfusion (V/Q) scanning, and principles of management with the anticoagulants heparin and warfarin.

Keywords: thrombosis, embolism, thromboembolism, thrombophilia, anticoagulants, Factor V Leidin, deep vein thrombosis (DVT), pulmonary embolus (PE), Doppler ultrasound, CT-pulmonary angiography (CTPA), aspirin, heparin, low molecular weight heparin (LMWH), warfarin


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READINGS

MED1011 Study Guide 2012 Readings

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WEEK 1 Lecture03/01-P1 – Introduction to Anatomy

Prescribed Moore, Dalley and Agur 6th ed. 2010. Introduction: pg 1-70 Eizenberg, N, Briggs, C, Adams, C, & Ahern, G, (ed.) 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapters 1 & 2.

Lecture02/01-P1 - What is Health? Huber M, Knottnerus JA, Green L, et al. How should we define health? BMJ 2011;343 Irwin, A. & Scali, E. 2007, ‘Action on the social determinants of health: A historical perspective’, Global Public Health, vol 2, no 3, pg 235–56. Keleher H, & MacDougall C, Concepts of health and primary health care. Chapter 1 in H. Keleher and C. MacDougall (2011). Understanding Health. South Melbourne, Oxford University Press.

Tutorial_BG_02/01 – Beyond Google

No readings listed for this session. Lecture03/01-P3 – Biomolecules of life 1

Prescribed Naish, J, Revest, P, And Syndercombe Court, D, 2009, Medical Sciences, Saunders, Elseveir, Chapters 1 and 2 Sadava, D, Heller, HC, Orians, GH, Purves, WK, & Hillis, DM, 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapters 2 and 3

Lecture03/01-P5 - Biomolecules of life 2

Prescribed Naish, J, Revest, P. And Syndercombe Court, D. 2009, Medical Sciences, Saunders, Elseveir, Chapter 2 Sadava, D, Heller, HC, Orians, GH, Purves, WK, & Hillis, DM. 2008, Life-The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapters 2 and 3

Lecture04/01-P1 - Taking a medical history

Prescribed Silverman, J, Kurtz, S, & Draper, J, 2005, ‘Gathering information’ in Skills for communicating with patients, 2nd ed. Radcliffe Publishing, Oxford, pg 45-64 Silverman J, Kurtz S, Draper J, Skills for communicating with patients. Oxford: Radcliffe Publishing, 2005. pg 77-105

Tutorial_04/01-P1 - The medical interview Prescribed Workbook entry for this tutorial Silverman J, Kurtz S, Draper J. Skills for communicating with patients. Oxford: Radcliffe Publishing, 2005. pg 35-55, 57-86


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Lecture03/01-P2 – Biology of cells 1 Prescribed Alberts B, 1994, Molecular Biology of the Cell, 3rd ed. Garland, New York, pg 17-32. Available from: http://images.lib.monash.edu.au/med1011/04109810-1.pdf http://images.lib.monash.edu.au/med1011/04109810-2.pdf Kerr JB, 2010 Functional Histology, 2nd ed. Mosby, Sydney, Ch 1.

Lecture03/01-P7 – Biology of cells 2

Prescribed Saladin KS, 2007, Anatomy and Physiology: The Unity of Form and Function, 4th ed. McGraw-Hill, New York, pg 90-102. Sadava D, Heller HC, Orians GH, Purves WK, & Hillis DM, 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapters 2 & 3. Kerr JB, Functional Histology, 2nd ed. Mosby, Sydney, Ch 1. Images from 1st ed. available from http://images.lib.monash.edu.au/med1011/04109667.pdf

Lecture02/01-P2 - What is Medicine? Australian and global perspectives

Good BJ, & DelVecchio Good M-J, 1993, ‘Learning medicine: the constructing of medical knowledge at Harvard Medical School’ in Knowledge, Power and Practice: The Anthropology of Medicine and Everyday Life, ed. S. Lindenbaum & M. Lock, University of California Press, Berkeley Irvine, R, McPhee, J, & Kerridge, I, 2002, ‘The challenge of cultural and ethical pluralism to medical practice,’ Medical Journal of Australia, vol.176, pg 174-175 Knight LV, and Mattick K, 2006 ‘When I first came here, I thought medicine was black and white’: making sense of medical students’ ways of knowing’ Social Science and Medicine 63: 1084-1096. R. Horton “What’s Wrong With Doctors” New York Review of Books 54 (9) May 31, 2007 http://www.nybooks.com/articles/20214 R. Shea “The Long View” Johns Hopkins Magazine Winter 2009: 34-39 http://magazine.jhu.edu/2009/12/the-long-view/

Practical_03/01-P1 - How are cells studied?

Introductory chapter to any good Histology textbook. Tutorial_02/01-P1 - Perspectives on the pre-requisites of health and primary health

care No readings listed for this session.

Lecture03/01-P4 - Cellular energetics and the role of enzymes as biological catalysts

Prescribed Naish, J, Revest, P, And Syndercombe Court, D, 2009, Medical Sciences, Saunders, Elseveir, pg 26-30 Sadava, D, Heller, HC, Orians, GH, Purves, WK, & Hillis, DM, 2008, Life – The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapter 8 Computer program “Metabolic challenges” available on Moodle


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Lecture03/01-P6 - Introduction to microbes Prescribed Goering et al. Mims Medical Microbiology-Chapters 1, 2 and 3 Recommended Murray PR, Rosenthal KS, & Pfaller MA, 2005, Medical Microbiology, 5th ed. Elsevier Moby, Pennsylvania, USA – Chapters 3 and 6 Prescott LM, Harley JP, and Klein DA, Microbiology, 6th ed. McGraw Hill – Chapters 3, 4, and 16

Lecture03/01-P6 – Cells and body fluids

Prescribed Naish et al. 2009. Medical Sciences. Saunders: Ch 1, pg 10-13 Sadava D, Heller HC, Orians GH, Purves WK, &. Hillis DM, 2007, Life - The Science of Biology, 8th ed Sinauer, Sunderland, MA, pg 105-108

WEEK 2 Lecture03/01-P9 – Principles of bones

Prescribed Eizenberg, N, Briggs, C, Adams, C. & Ahern, G. (ed.) 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapter 4. Moore, Dalley and Agur 6th ed. 2010. Introduction: pg 1-70

Lecture03/01-P10 – Principles of joints

Prescribed Eizenberg, N, Briggs, C, Adams, C. & Ahern, G. (ed.) 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapter 5. Moore, Dalley and Agur 6th ed. 2010. Introduction: pg 1-70

Lecture03/01-P11 - Fuel molecules – Part 1

Prescribed Sadava, D, Heller, HC, Orians, GH, Purves, WK, & Hillis, DM. 2008, Life-The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapter 9 Naish, J, Revest, P. And Syndercombe Court, D. 2009, Medical Sciences, Saunders, Elseveir, Chapter 3

Lecture03/01-P12 - Fuel molecules - Part 2

Prescribed Sadava, D, Heller, HC, Orians, GH, Purves, WK, & Hillis, DM. 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapter 9 Naish, J, Revest, P. And Syndercombe Court, D. 2009, Medical Sciences, Saunders, Elseveir, Chapter 3

Lecture03/01-P13 - Fuel molecules Part 3

Prescribed Sadava, D, Heller, HC, Orians, GH, Purves, WK, & Hillis, DM. 2008, Life-The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapter 9 Naish, J, Revest, P. And Syndercombe Court, D. 2009, Medical Sciences, Saunders, Elseveir, Chapter 3 Computer program “Metabolic challenges” available on Moodle


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Lecture03/01-P14 - Transport across membranes

Prescribed Sadava, D, Heller, HC, Orians, GH, Purves, WK, & Hillis, DM. 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapter 9 Naish, J, Revest, P. And Syndercombe Court, D. 2009, Medical Sciences, Saunders, Elseveir, Chapter 3 Computer program “Metabolic challenges” available on Moodle

Tutorial_04/01-P2 - Taking a medical history

Prescribed Workbook entry for this tutorial Silverman, J, Kurtz, S, & Draper, J. 2005, ‘Gathering information’ in Skills for communicating with patients, 2nd ed. Radcliffe Publishing, Oxford, pg 45-64 Silverman J, Kurtz S, Draper J. Skills for communicating with patients. Oxford: Radcliffe Publishing, 2005. pg 77-105

Tutorial_03/01-P1 - Body fluid composition, osmolarity and ion balance

Refer to entry in workbook for details of preparation required for class. Tutorial_ETHICS_01/01-P1 - The nature of ethics in everyday life and medicine

Workbook entry for this tutorial Recommended Charlesworth, M (1993) Bioethics In a Liberal Society. Cambridge, Cambridge University Press, pg 10 Frank, Arthur W. The Wounded Storyteller: Body, Illness, and Ethics. University of Chicago Press, 1997 Gillon R. Philosophical medical ethics. Chichester. Wiley, 1986 Komesaroff PA, “From bioethics to microethics: Returning bioethics to the clinic”. In Komesaroff PA ed. Troubled bodies (Melbourne University Press, 1996) Zaner R. Troubled Voices, Pilgrim Press, 1995

Lecture03/01-P16 - Role of the liver in metabolism and detoxification 1

Prescribed Naish, J, Revest, P. and Syndercombe Court, D. (2009) Medical Sciences. Chapter 3 Recommended Other references used will include Baynes, JW & Dominczak, MH (2009) Medical Biochemistry 3rd ed. London/New York: Elsevier/Mosby. Chapters 13 and 29. These chapters cover the content of the lecture in more depth than is required. Nelson, DL and Cox, MM (2008) Lehningers Principles of Biochemistry 5th ed. Computer program: Biochemistry a Metabolic Challenge. http://themedicalbiochemistrypage.org/


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Lecture03/01-P37 - Role of the liver in metabolism and detoxification 2 Prescribed Naish, J, Revest, P. and Syndercombe Court , D. (2009) Medical Sciences. Chapter 3 Recommended Other references used will include Baynes, JW & Dominczak, MH (2009) Medical Biochemistry 3rd ed. London/New York: Elsevier/ Mosby. Chapters 19 and 29. Nelson, DL and Cox, MM (2008) Lehningers Principles of Biochemistry 5th ed. Computer program: Biochemistry a Metabolic Challenge. http://themedicalbiochemistrypage.org/

Lecture02/01-P3 - What determines health?

Halfon N, Larson K, Russ S, (2010). Why Social Determinants? Healthcare Quarterly Vol. 14 Special Issue October, 9-20. Marmot, M. (2001) Economic and social determinants of disease. Bulletin of the World Health Organization, 79 (10), 988-989. Mikkonen, J, & Raphael, D, (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management. Available at http://www.thecanadianfacts.org/ Wilkinson R, Michael M, (2003). Social Determinants of Health: The Solid Facts, 2nd ed. World Health Organization, 2003 http://www.euro.who.int/document/e81384.pdf Useful websites: Commission on the Social Determinants of Health 2005-2008. http://www.who.int/social_determinants/thecommission/en/ 2011 World Conference on Social Determinants of Health http://www.who.int/sdhconference/en/ Harvard Francois-Xavier Bagnoud Centre for Health and Human Rights. http://www.harvardfxbcenter.org/ Human Rights and Equal Opportunity Commission. (n.d.). Close the Gap: Indigenous Health Campaign. Report and other materials available at: http://www.hreoc.gov.au/social_justice/health/index.html

Tutorial_02/01-P2 - The determinants of health at work

No readings listed for this session. Self directed learning exercise: Introduction to diabetes and metabolism This exercise is to be completed before the lecture on Lipid metabolism

Naish J, Revest P, & Syndercombe Court D, (2009) Medical Sciences. 559-564 Baynes JW, & Dominczak MH, (2009) Medical Biochemistry 2nd ed. London/New York: Elsevier/Mosby Chapters 12, 17 & 20. Saladin KS, (2007) Anatomy and Physiology: The Unity of Form and Function. 4th ed. New York: McGraw-Hill. 1020-1022 and 1036-1038. Kumar P, & Clark M, (2005) Clinical Medicine: A Textbook for Medical Students and Doctors 6th ed. Philadelphia: Saunders Ch 19


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Lecture03/01-P18 - Lipid metabolism Prescribed Naish J, Revest P, & Syndercombe Court D, (2009) Medical Sciences. Chapter 3 Recommended Other references used will include Baynes JW, & Dominczak,MH, (2009) Medical Biochemistry 3rd ed. London/New York: Elsevier/Mosby. Chapters 16 and 18. Nelson DL, & Cox MM, (2008) Lehningers Principles of Biochemistry 5th ed. Computer program: Biochemistry a Metabolic Challenge. http://themedicalbiochemistrypage.org/

Lecture03/01-P15 - Structural biology

Prescribed Nelson DL, & Cox MM, (eds) 2005, Lehninger Principles of Biochemistry, 4th ed. W.H. Freeman, New York, pg 78-80, pg 88-89, pg 120-125, pg 132-135, pg 162-164, pg 172-174

Lecture03/01-P105 – Introduction to Acid-Base

Prescribed Chapter 1 Introduction, pg 4-13, Acid-base balance & Fluid Balance, Medical Science, Naish, Revest, Court Recommended Chapter 10 Acid-base Physiology, pg 299-325 Clinical Physiology of Acid-Base and electrolyte disorders, Burton Rose, Post, 5th ed.

Practical_INJECTING_04/01 - Handwashing and injecting

Workbook entry for this tutorial Asepsis Infection Control in the Health Care Setting. The National Health & Medical Research Council http://www.nhmrc.gov.au/publications/synopses/withdrawn/ic6.pdf Once at this URL, choose the link to Full Publication Available Here in PDF (1.41MB). This authoritative document contains much information that exceeds the present objectives, but is a useful resource for future use. This document will be provided in hard copy in the Reserve Section of the Andrew Hargrave Library. Due to copyright issues, this cannot be provided in your Resources Guide but can be downloaded from the web link provided. Prescribed The above document is currently under review, see for handwashing guidelines http://www.asid.net.au/hicsigwiki/index.php?title=NHMRC_infection_control_guideline_review_2008

WEEK 3 Lecture03/01-P19 - Integrative tissue metabolism

Prescribed Naish J, Revest P, & Syndercombe Court D, (2009) Medical Sciences. Chapter 3 Recommended Other references used will include Baynes JW, & Dominczak MH, (2009) Medical Biochemistry 3rd ed. London/New York: Elsevier/ Mosby. Chapter 21. Nelson DL, & Cox MM, (2008) Lehningers Principles of Biochemistry 5th ed. Computer program:Biochemistry a Metabolic Challenge. http://themedicalbiochemistrypage.org/


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Lecture03/01-P20 - Understanding the relevance of genomics to medicine

Purves, WK, Sadava, D, Orians, GH, & Heller, HC 2006, Life-The Science of Biology, 7th ed. Sinauer, Sunderland, MA, Chapter 17, pg 357-361. Powerpoint presentation on WebCT Useful links Human Genetic Society of Australasia: http://www.hgsa.com.au/ Public Health Genetics: http://www.graphint.org/ver2/ Web-based learning resources https://www.hgsa.org.au/website/wp-content/uploads/2009/06/CCResources-KNOWL-for-HGSA.pdf https://www.hgsa.org.au/website/wp-content/uploads/2009/06/CCResources-SKILLS-for-HGSA.pdf

Lecture03/01-P21 - Introduction to health and human behaviour

Prescribed Morrison V, Bennett P, Butow P, Mullan B, & White K, (2007). An Introduction to Health Psychology: An Australian Perspective. Sydney, Australia: Pearson Education Ltd: Chapter 1. What is health?

Lecture03/01-P22 - Behaviour, health and illness

Prescribed Jones, Ken and Creedy, Debra (2008) Health and Human Behaviour. 2nd ed. Oxford University Press: South Melbourne. Chapter 2: Reactions to illness. Recommended Jones, Ken and Creedy, Debra (2008) Health and Human Behaviour. 2nd ed. Oxford University Press: South Melbourne. Chapter 3: Understanding reactions to chronic conditions.

Lecture03/01-P23 - Nucleic acids and the structure and organisation of DNA

Prescribed Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life-The Science of Biology, 9th ed. Sinauer, Sunderland, MA.

Ch.13, pg 267-270, ‘What is the evidence that the gene is DNA?’ Ch.13, pg 272-276, ‘What is the structure of DNA?’ Ch.11, pg 215-216, ‘Prior to mitosis eukaryotic DNA is packed into very compact

chromosomes’ Ch.4, pg 61-64, ‘What are the chemical structures and functions of nucleic acids?’ Ch.14, pg 294-296, ‘How does information flow from genes to proteins?’ Ch.14, pg 300-301, ‘Eukaryotic genes have noncoding sequences’ Ch.14, pg 377-378, ‘Eukaryotes have gene families’

Lecture03/01-P24 - RNA synthesis

Prescribed Sadava D, Hillis DM, Heller HC, & Berenbaum MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Sunderland, MA.

Ch.14, pg 296-300, ‘How is the information content in DNA transcribed to produce RNA?’ Ch.14, pg 302-304, ‘Eukaryotic gene transcripts are processed before translation’ Ch.16, pg 352-356, ‘How is eukaryotic gene transcription regulated?’ Ch.16, pg 360-362, ‘How is eukaryotic gene regulated after transcription?’


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Tutorial_03/01-P2 - How does alcohol disrupt the liver? Refer to entry in workbook for details of preparation required for class.

Tutorial_04/01-P3 - Building the relationship

Prescribed Silverman J, Kurtz S, & Draper J, 2005, Skills for communicating with patients, 2nd ed. Radcliffe Publishing, Oxford: Chapter 5.

Tutorial_LAW_01/01-P1 – Introduction to law and doctor-patient communication:

obtaining patient consent Students are strongly advised to read the comprehensive version of the materials prior to class. The class materials may be accessed on Moodle. Cross references to corresponding sections of the comprehensive version of the Medical Law class materials are included in the workbook outline.

Lecture03/01-P25 - Protein synthesis

Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Sunderland, MA.

Ch.14, pg 304-310, ‘How is RNA translated into proteins?’ Ch.14, pg 310-313, ‘What happens to polypeptides after translation?’

Lecture03/01-P27 - DNA replication

Prescribed Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Sunderland, MA.

Ch. 13, pg 276-284, ‘How is DNA replicated?’ Ch. 13, pg 285-286, ‘How are errors in DNA repaired?’ Ch. 17, pg 366-370, ‘How are genomes sequenced?’

Lecture03/01-P26 – Cell cycle: proliferation, maturation and apoptosis

Prescribed Sadava D, Heller HC, Orians GH, Purves WK, & Hillis DM, 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapter 9. Kerr JB, Functional Histology, 2nd ed. Mosby, Sydney, Ch 1.

Practical_03/01-P2 - The great metabolic race

No readings listed for this session Tutorial_02/01-P3 - Social justice and human rights: what do they mean for health?

No readings listed for this session Lecture03/01-P28 - Principles of muscles

Prescribed Eizenberg N, Briggs C, Adams C, & Ahern G, (ed.) 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapter 6 Moore, Dalley & Agur 6th ed. 2010. Introduction: pg 29-37


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Lecture03/01-P29 - Meiosis and gametogenesis Prescribed Sadava, D, Heller, HC, Orians, GH, Purves, WK, & Hillis, DM, 2008, Life - The Science of Biology, 8th ed. Sinauer, Sunderland, MA, Chapters 9 & 43. Kerr, JB, Functional Histology, 2nd ed. Mosby, Sydney, Ch 1. Langman’s Medical Embryology, TW Sadler, Ch 2, Publ. LWW

Lecture03/01-P30 – Principles of skin

Prescribed Kerr, JB, (1999). Atlas of Functional Histology. London: Mosby. Wheater’s Functional Histology Watch youtube: ‘the persisent hunt’ from ‘The Human Planet’ BBC, ‘Skin deep’ (SBS story featuring Dr Nina Jablonski’s research)

WEEK 4 Lecture03/01-P31 - Chromosome disorders

Prescribed Sadava, D., Hillis, D.M., Heller, H.C. & Berenbaum, M.R. 2011, Life-The Science of Biology, 9th ed. Sinauer, Freeman. Chapter 11, pg 223-229 Recommended Turnpenny and Ellard. Emery’s Elements of Medical Genetics. 13th ed. Elsevier. Chapter 3, pg 30-35, 38-40, 45-54. Chapter 18

Lecture03/01-P32 - Patterns of inheritance: Mendel’s law

Prescribed Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Freeman. Chapter 12, pg 236-250 Recommended Turnpenny and Ellard. Emery’s Elements of Medical Genetics. 13th ed. Elsevier. Chapter 1, pg 4-5. Chapter 7, pg 103-114. Chapter 19, pg 299-302

Lecture03/01-P33 - Mutations and single gene disorders

Prescribed Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Freeman. Chapter 15, pg 299, 316-323, 328 Recommended Turnpenny and Ellard. Emery’s Elements of Medical Genetics. 13th ed. Elsevier. Chapter 2, pg 22-28. Chapter 10, pg 150-157. Chapter 19, pg 291-294


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Lecture02/01-P4 - The individual, society and health Black Report (actual title: Inequalities in Health: Report of a Research Working Group). United Kingdom: DHSS, 1980 http://www.sochealth.co.uk/history/black.htm (complete text available at this website) Chee HL, Barraclough S, (eds.) (2007). Health Care in Malaysia. London: Routledge. Raphael D, Farrell SE, (2002). Beyond medicine and lifestyle: addressing the societal determinants of cardiovascular disease in North America. Leadership in Health Services 15/4, i-v. Centres for Disease Control. (2010) Healthy Youth! Six critical health behaviours, available: http://www.cdc.gov/HealthyYouth/healthtopics/index.htm Noar S, & Zimmerman R, (2005). Health Behavior Theory and cumulative knowledge regarding health behaviors: are we moving in the right direction? Health Education Research, 20 (3), 275-290

Lecture03/01-P34 - Multifactorial inheritance

Prescribed Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life-The Science of Biology, 9th ed. Sinauer, Freeman. Chapter 12, pg 250-253. Chapter 15, pg 330 Recommended Turnpenny and Ellard. Emery’s Elements of Medical Genetics. 13th ed. Elsevier. Chapter 9, pg 136-139. Chapter 15, pg 219-221, 225-227

Tutorial_04/01-P4 - Medical interview skills: building rapport and briefing for medical

contact visits Prescribed Silverman, J, Kurtz, S, & Draper, J, 2005, Skills for communicating with patients, 2nd ed. Radcliffe Publishing, Oxford: Chapter 5.

Tutorial_03/01-P3 - Complementary base pairing/genetic code

Refer to entry in workbook for details of preparation required for class Read the following before attending the tutorial to enhance your understanding of DNA structure: http://www.dnai.org/index.htm then click on Code/Finding the structure/In Putting it together look at Base pairing interactive

Tutorial_ETHICS_01/01-P2 – The nature of the clinical relationship and consent

Workbook entry for this tutorial SiteVisit_04/01-P1 - Medical contact visit

Prescribed Levett-Jones, T, and Bourgeois, S, 2007. The Clinical Placement: An essential guide for nursing students. Chapter 1 Churchill Livingstone. This reading will assist you to understand and manage some of the challenges medical students face in clinical environments.

Lecture03/01-P35 - Genetics counselling

Prescribed Peter S, Harper 5th ed. “Practical Genetic Counselling”, Butterworth-Heinemann (1998) Recommended Human Genetic Society of Australasia (HGSA): Guidelines for the practice of genetic counselling, 1999: http://www.hgsa.com.au/


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Lecture03/01-P33 - Population genetics Prescribed Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Freeman. Chapter 21, pg 440-451, 457-458 Recommended Turnpenny and Ellard. Emery’s Elements of Medical Genetics. 13th ed. Elsevier. Chapter 8, pg 122-130

Tutorial_02/01-P4 – Unnatural causes

No readings listed for this session Practical_03/01-P13 – Integumentary system/skin

Prescribed Kerr, JB, (2010). Functional Histology. Mosby, Chapter 9. Wheater’s ‘Functional Histology’ (4th or 5th ed.) Churchill Livingston, Chapter 9

Lecture03/01-P37 - Origin of cells and tissues

Langman’s ‘Medical Embryology’ TW Sadler LWW, 12th ed. Chapter 3, 4, 5. Lecture03/01-P38 - Primary tissue types - Epithelia, glands and connective tissue

Langman’s ‘Medical Embryology’ TW Sadler LWW, 12th ed. Chapter 6. Lecture03/01-P39 - Primary tissue types - Nerve and muscle

Langman’s ‘Medical Embryology’ TW Sadler LWW, 12th ed, Chapter 6. WEEK 5 Lecture01/01-P1 - Introduction to integrative medicine

No readings listed for this session Lecture03/01-P41 – Cognition, health and illness

Prescribed Jones, Ken and Creedy, Debra (2008) Health and Human Behaviour. 2nd ed. Oxford University Press: South Melbourne. Chapter 6: Cognition and health beliefs. Recommended Morrison, V, Bennett, P, Butow, P, Mullan, B, & White, K, (2007). An introduction to health psychology in Australia. Pearson Education Australia. Chapter 5: Predicting Health Behaviour (pg 104-133), Chapter 10: The Consultation and Beyond (pg 264-275).

Lecture03/01-P35 - Key recombinant DNA techniques impacting on medicine

Sadava D, Hillis DM, Heller HC, & Berenbaum MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Sunderland, MA.

Ch. 18, pg 387-388, ‘What is recombinant DNA?’ Ch. 18, pg 389-392, ‘How are new genes inserted into cells?’ Ch. 18, pg 392-393, ‘What sources of DNA are used in cloning?’ Ch. 18, pg 393-394, ‘Genes can be inactivated by homologous recombination’ Ch. 18, pg 394-395, ‘Complementary RNA can prevent the expression of specific genes’ Ch. 13, pg 286-287, ‘How does the polymerase chain reaction amplify DNA?’


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Lecture03/01-P42 - How cells communicate

Prescribed Purves. WK, Sadava. D, Orians, GH, and Heller. HC, (2001) Life, The Science of Biology, Chapter 15. Alberts, B, (1994) Molecular Biology of the Cell, 3rd ed. (New York, Garland) pg 721–727 Available from: http://images.lib.monash.edu.au/med1011/ Kerr, JB, Functional Histology, 2nd ed. Mosby, Sydney, Ch 1.

Lecture03/01-P43 - Diagnostic DNA tests - technology of mutation detection and

infectious disease diagnosis Prescribed Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Sunderland, MA:

Ch.15, pg 334-337, ‘How is genetic screening used todetect diseases?’ Ch.15, pg 325-326, ’DNA fingerprinting uses restriction analysis and electrophoresis’ Ch.18, pg 395-397, ‘DNA microarrays can reveal RNA expression patterns’

Alcamo, IE, 2001, DNA Technology: The Awesome Skill, 2nd ed. Academic Press, London: Ch. 7, pg 163-164, ‘Diagnosing Infectious Disease. Acquired immune deficiency syndrome’ Ch. 9, pg 208-219, ‘Medical Forensics and DNA Sleuthing’ Available from: http://images.lib.monash.edu.au/med1011/04109047.pdf

Lecture03/01-P44 - Gene and protein engineering in clinical medicine: production of

proteins for use in treatment of disease Prescribed Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Sunderland, MA:

Ch. 18, pg 397-403, ‘What is biotechnology?’ Ch. 42, pg 883-884, ‘Vaccines are an application of immunological memory’ Ch. 18, pg 394-395, ‘Complementary RNA can prevent the expression of specific genes’

Alcamo, IE, 2001, DNA Technology: The Awesome Skill, 2nd ed. Academic Press, London: Ch. 6, pg 125-129, ’Human growth hormone’; pg 141-142, ‘Hepatitis B’ Available from: http://images.lib.monash.edu.au/med1011/04109047.pdf

Tutorial_03/01-P4 - Life cycle of cells

Go to the website: www.thelifewire.com Click on the 8th ed. companion site Click on animated tutorials Work through the Chapter 9 tutorials on Mitosis and Meiosis


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Tutorial_04/01-P5 - Medical interview skills: responding to emotion Prescribed Workbook entry for this tutorial Silverman J, Kurtz S, & Draper J, (1998) Skills for communicating with patients. Building the relationship pg 73-88, 136-141 (Radcliffe Medical Press) Murtagh J, (2007) Chapter 5 Counselling skills “Bereavement” in: General Practice 4th ed. (McGraw Hill) Prigerson H, Jacobs S, Table 2: “Strategies for communication with and caring for bereaved patients”. In: Caring for bereaved patients: ‘All the doctors just suddenly go’ JAMA 286 (11) pg 1326-1376, 2001 Tully J, ‘Grief and loss: I’m not myself anymore’ In Australian Family Physician 32 (9) pg 697-700, 2003. Recommended McCord, R, et al. (2002) Responding to patient anger directed at a physician. Family Medicine Journal 34 (5) 331-336 Sullivan, G, (1998) How to deal with an angry patient. RN 61 (10) 63-4 Wagner, R, et al. (1997) Crying in hospitals: a survey of doctors’, nurses’ and medical students’ experience and attitudes. MJA 166 (1) 13-16 For those interested in qualitative studies Robinson W, Prest L, Susman J, Rouse J, Crabtree B, ‘Technician, friend, detective, and healer: Family physicians’ response to emotional distress’. In The Journal of Family Practice 50 (10) pg 864-870, 2001

Tutorial_LAW_01/01-P2 - Confidentiality in clinical practice: legal aspects

Students are strongly advised to read the comprehensive version of the materials prior to class. The class materials may be accessed on Moodle.

Practical_03/01-P14 - Connective tissues and cartilage

Prescribed Kerr JB, (2010) Functional Histology. Mosby, Chapter 5. Wheater’s ‘Functional Histology’ (4th or 5th ed.) Churchill Livingston.

Lecture03/01-P38 - Gene expression

Prescribed Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Sunderland, MA:

Ch. 16, pg 352-356, ‘How is eukaryotic gene transcription regulated?’ Ch. 16, pg 356-360, ‘How do epigenetic changes regulate gene expression?’

Clark, DP, 2005, Molecular Biology: Understanding the Genetic Revolution, Elsevier, Amsterdam, Ch. 10, pg 262-280, ‘Regulation of Transcription in Eukaryotes’


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Lecture01/01-P3 - Introduction 1 – Behaviour change, lifestyle and motivation Prescribed Britt E, Hudson S, Blampied M, Motivational interviewing in health related settings: a review. Patient Education and Counselling 2004; 53 (2) 147-155 Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 1-14 Hassed C, de Lisle S, Sullivan G, Pier C, Enhancing the health of medical students: outcomes of an integrated mindfulness and lifestyle program. Adv Health Sci Educ Theory Pract. 2008 May 31. [Epub ahead of print] http://dx.doi.org/10.1007/s10459-008-9125-3 Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 161-175 Ornish D, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990; 336 (8708): 129-33 Ornish D, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005; 174 (3) 1065-9

Practical_03/01-P4 - Human karyotype analysis

Refer to entry in workbook for details of preparation required for class Tutorial_02/01-P5 - Concepts of equity, inequity and inequality and the social gradient

No readings listed for this session Lecture03/01-P47 - Introduction to pharmacology

Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7h ed. Churchill Livingstone, Edinburgh. What is pharmacology? Chapter 1, pg 1-5. How drugs act: general principles: Chapter 2, pg 6-19. How drugs act: molecular aspects: Chapter 3, pg 20-48.

Lecture03/01-P48 - Introduction to pharmacodynamics

Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh. How drugs act: general principles: Chapter 2, pg 6-19. How drugs act: molecular aspects: Chapter 3, pg 20-48.

Lecture03/01-P39 - Introduction to gene therapy and therapeutic cloning

Prescribed Sadava, D, Hillis, DM, Heller, HC, & Berenbaum, MR, 2011, Life - The Science of Biology, 9th ed. Sinauer, Sunderland, MA:

Ch. 15, pg 337-339, ‘How are genetic diseases treated?’ Ch. 19, pg 408-412, ‘Is cell differentiation reversible?’

WEEK 6 Lecture03/01-P49 – Structure and function of bone

Prescribed Kerr JB, (2010) Functional Histology Chapter 10. Mosby/Elsevier, Sydney Langman’s ‘Medical Embryology’ TW Sadler LWW, 12th ed. Chapter 9 Wheater et al. ‘Functional Histology’ Chapter 10

http://dx.doi.org/10.1007/s10459-008-9125-3�


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Lecture02/01-P5 – Access to health and social care services Braveman, P, & Gruskin, S, (2003). Poverty, equity, human rights and health. Bulletin of the World Health Organization, 81, 539-545. Chee HL, Barraclough S, ed. (2007). Health Care in Malaysia. London: Routledge. Gulliford M, Morgan M, ed. (2011). Access to Health Care. London: Routledge. National Hospitals and Health Commission Report. (2010). Tackling major access and equity issues that affect health outcomes for people now. Chapter 3, Canberra, Department of Health and Ageing. Turner L, ‘Medical tourism’ and the global marketplace in health services: U.S. patients, international hospitals, and the search for affordable health care. International Journal of Health Services 2010; 40 (3): 443-467.

Lecture03/01-P50 - Introduction to pharmacokinetics

Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7h ed. Churchill Livingstone, Edinburgh. Drug absorption and distribution: Chapter 8. pg 99-114. Drug metabolism and elimination: Chapter 9. pg 115-122.

Tutorial_03/01-P5 - Pedigree construction

Refer to entry in workbook for details of preparation required for class Tutorial_04/01-P6 - Cross cultural communication skills

Prescribed Workbook entry for this tutorial Cole, S, and Bird, J, (2000) Overcoming cultural and language barriers in The Medical Interview: a three function approach, pg 138-150 Eckermann, A, Dowd, T, et al (2006) Binan Goonj Bridging Cultures in Aboriginal Health pg 111-124

Lecture03/01-P51 - Signalling

Recommended Sadava, D, Hillis, DM, Heller, HC, and Berenbaum MR, (2011) Life: The Science of Biology, 9th ed. (WH Freeman & Co). Read Chapter 7, pg 128-45. ‘Cell Signaling and Communication’

Lecture03/01-P52 -Transmitters

Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh:

Chemical mediators and the autonomic nervous system: Chapter 12, pg 139-150; Cholinergic transmission: Chapter 13, pg 151-173; Noradrenergic transmission: Chapter 14, pg 174-193; 5-Hydroxytryptamine and the pharmacology of migraine: Chapter 15, pg 194-203; Purines: Chapter 16, pg 204-207; Local hormones: cytokines, biologically active lipids, amines and peptides. pg 208-220; Nitric oxide: Chapter 20, pg 237-245

Practical_03/01-P3 – Histology - Microstructure bone and normal bone growth

Kerr JB, (2010). Functional Histology. Mosby, Chapter 10. Wheater’s ‘Functional Histology’ (4th or 5th ed.) Churchill Livingston.


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Tutorial_02/01-P6 - Access and equity to health care by Aboriginal and Torres Strait Islander People

No readings listed for this session WEEK 7 Lecture01/01-P3 - Introduction 2 – Stress and mind-body interactions

Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 15-49.

Lecture03/01-P106 - Introduction to cancer

Recommended Alberts, B, et al Molecular Biology of the Cell 5th ed. Chapter 20

Lecture03/01-P50 - What effect does cancer have on the patient

Recommended Alberts, B, et al Molecular Biology of the Cell 5th ed. Chapter 20

Lecture03/01-P54 – Development of the nervous system

Prescribed Sadler “Langman’s Medical Embryology” Lippincott, Williams, Wilkins. This is a simple embryology text that will serve you well for yrs 1-2 and beyond. Chapter 17 deals with the nervous system. Suggested extra reading: For those with a deeper interest in developmental biology in general then try ‘Developmental Biology’ (Gilbert) on line at: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=dbio

Lecture03/01-P55 - Mind and body

Prescribed To be advised.

Lecture01/01-P4 - Mindfulness

Prescribed Krasner MS, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009 Sep 23; 302 (12): 1284-93 Melbourne Academic Mindfulness Interest Group. Mindfulness-based psychotherapies: a review of conceptual foundations, empirical evidence and practical considerations. Aust NZ J Psych 2006; 40: 285-94 Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 53-62 Recommended Books on mindfulness

• Full Catastrophe Living: Jon Kabat-Zinn • Mindfulness-Based CBT: Williams, Segal and Teasdale • The Mindful Way Through Depression • Know Thyself: Craig Hassed




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Tutorial_03/01-P6 - Gene cloning Prescribed Look at the following website: www.dnai.org/manipulation/techniques and www.dnai.org/manipulation/production [pieces of the puzzle and putting it together]

Tutorial_04/01-P7 - Debrief medical contact visits and written communication

Workbook entry for this tutorial Prescribed Medical Protection Society (UK) 2005 A complete guide for students: Keeping medical records, Medical Protection Society, London. Available from: http://www.medicalprotection.org/medical/united_kingdom/publications/booklets/default.aspx

Tutorial_HEP_01/01-P1 - Introduction HEP, ESSENCE, behaviour change, goalsetting,

mindfulness 1 No readings listed for this session.

SiteVisit_04/01-P2 - Medical contact visit

Prescribed Levett-Jones T, & Bourgeois S, 2007. The Clinical Placement: An essential guide for nursing students. Chapter 1 Churchill Livingstone. This reading will assist you to understand and manage some of challenges medical students face in clinical environments.

Practical_03/01-P6 - Amplifying DNA

Prescribed The detailed notes for the practical (available on Moodle) should be read before the session.

Tutorial_02/01-P7 - Access and equity to health care for refugees

No readings listed for this session. Lecture03/01-P107 - How tissues make organs

Prescribed Purves. WK, Sadava. D, Orians, GH, & Heller, HC, (2001) Life, The Science of Biology pg 843-4. Saladin KS, (2001) Anatomy and Physiology: The Unity of Form and Function 2nd ed. (McGraw-Hill). pg 240-242. Kerr JB, 2010 Functional Histology 2nd ed. (Mosby) Due to copyright restrictions, this reading could not be digitised but the book is available from the Hargrave-Andrew library on reserve. Langman’s ‘Medical Embryology’ TW Sadler LWW, 12th ed. Chapter 5 and other ‘systems’ chapters.

Lecture03/01-P57 - Principles of organisation of peripheral spinal nerves

Prescribed Eizenberg N, et al. (ed.) 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapter 9 Moore, Dalley & Agur “Clinically Orientated Anatomy” Intro Ch pg 46-65


239

Lecture03/01-P58 - Resting membrane potential and action potential Prescribed Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 3 HCP notes on Ion Channels

Lecture03/01-P59 - Action potential

Prescribed Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 4 HCP notes on the Action Potential

WEEK 8 Lecture03/01-P60 - Propagating the action potential

Prescribed Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 4

Lecture03/01-P61 - Synaptic transmission

Prescribed Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 5 HCP notes on Synaptic Transmission

Lecture03/01-P62 - Acute inflammation I

Prescribed General and Systemic Pathology, JCE Underwood, Chapter 10 pg 199-209

Lecture01/01-P5 - Exercise

Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 90-104. Recommended Bauman A, Updating the evidence that physical activity is good for health: an epidemiological review 2000-2003. J Science and Medicine in Sport 2004; 7 (1 supp): 6-19

Lecture03/01-P75 - Neural communication and integration

Prescribed Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 6

Lecture03/01-P76 - Organisation of spinal cord

Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 12


240

Tutorial_04/01-P12 - Vital signs Workbook entry for this tutorial Prescribed Cooper D, Buist M, (2008) Vitalness of vital signs, and medical emergency teams. Medical Journal of Australia 188 (11) 630-631 (available electronically via library catalogue from Medical Journal of Australia, search as journal). Cretikos M, Bellomo R, Hillman K, et al. (2008) Respiratory rate: a neglected vital sign. 188 (11) 657-659 (available electronically via library catalogue from Medical Journal of Australia, search as journal). McAlister F. S. Straus. (2001) Measurement of Blood Pressure: an evidence based review. British Medical Journal 322 (7291) 908-911 (available electronically via library catalogue from British Medical Journal, search as journal). Bikley LS, (2009) Bates’ Guide to Physical Examination and History Taking, 10th ed. (Lippincott Williams &Wilkins. Recommended Houlder L, (2000) The accuracy and reliability of tympanic thermometry compared with rectal and axillary sites in young children. Pediatric Nursing May/June 26 (3) 311-314. (Available electronically from Paediatric Nursing via library catalogue, search as journal) Epstein O, Perkin GD, de Bono DP, Cookson J, (2003) Clinical Examination, 3rd ed. (Mosby) pg 47-48, 116-117, 146-151.

Lecture03/01-P77 - Spinal reflexes

Prescribed Bear MF, Connors BW, Paradiso MA, (2007) Neuroscience: exploring the brain Chapter 12 Moodle notes on Spinal reflexes Recommended Silverthorn Human Physiology – An Integrated Approach, 3rd ed. Chapter 13, pg 429-438

Lecture03/01-P65 - Cellular and tissue response to injury

Prescribed General and Systemic Pathology, JCE Underwood, Chapters 4 and 6

Lecture02/01-P6 - Prevention

Cohen, J, Newmann, P, Weinstein, M, Does Preventive Care Save Money? Health Economics and the Presidential Candidates. n engl j med 358;7, 661-663. McGranahan, M, (2009). Health and the urban environment: revolutions revisited. International Institute for Environment and Development. Available from http://www.iied.org/pubs/display.php?o=17044IIED Rose, G, (1985). Sick Individuals and Sick Populations. International Journal of Epidemiology. vol 14, no 1, pg 32-38. VicHealth (2009). Building on our strengths. A framework to reduce race-based discrimination and support diversity in Victoria. Carlton, Victorian Health Promotion Foundation.


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Practical_03/01-P8 - Neoplasia Prescribed Underwood, JCE, and Cross, SS, (Ed.) (2009): General and systematic pathology 5th ed. Edinburgh: Churchill Livingstone Neoplasia - Chapter 11 Underwood Pathology pg 221-258 Colorectal cancer pg 392 – 396 Underwood Pathology Some of the practical will be conducted using virtual slides from an internet website. Please familiarise yourself with this website: http://www.path.uiowa.edu/virtualslidebox/ Students who have laptops with internet access are requested to bring these to the session.

Tutorial_02/01-P8 - Primary and secondary prevention of NCDs

No readings listed for this session. Lecture03/01-P66 - Stress and Illness

Prescribed Morrison V, Bennett P, Butow P, Mullan B, & White K, (2007). An introduction to Health Psychology: An Australian Perspective. Sydney, Australia: Pearson Education Ltd. Chapters 11 and 12.

Lecture03/01-P67 - Neural signalling to skeletal muscles and drugs acting at the

neuromuscular junction Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh. Cholinergic transmission: Chapter 13, pg 151-173 Page C, Curtis M, Walker M, & Hoffman B, (2006). Integrated Pharmacology; 3rd ed. Drugs and the nervous system: Chapter 8, pg 207-210

Lecture03/01-P75 - Envenoming and the neuromuscular junction

No readings for this session. WEEK 9 Lecture03/01-P85 - Principles of diagnosis of infectious diseases

Prescribed Goering et al Mims Medical Microbiology. 4th ed. Chapter 32

Lecture03/01-P70 - Natural barriers, innate defences

Prescribed Goering et al, Mims Medical Microbiology. 4th ed. Chapters 8, 9, 14.

Lecture03/01-P71 - Healing and repair

Prescribed General and Systemic Pathology, JCE Underwood, Chapter 6 pg 108–115


242

Lecture01/01-P6 - Nutrition Prescribed Kausman R, Tips for long-term weight management. AFP 2000; 29 (4): 310-3. Kausman R, A new perspective to long-term weight management. Is there a better way? AFP 2000; 29 (4): 303-7 Recommended Kausman R, If not dieting, then what? 1998, Allen and Unwin, Melbourne.

Lecture03/01-P72 - Interactions between bacteria and the human host

Prescribed Goering et al. Mims Medical Microbiology. 4th ed. Chapters 8, 12 and 13

Lecture03/01-P63 - Strategies for control of microbes

Prescribed Goering et al. Mims Medical Microbiology. 4th ed. Chapters 31, 33 and 36

Tutorial_03/01-P10 - Diagnosis and prevention of infections

Prescribed Goering et al. Mims Medical Microbiology 4th ed. pg 335-341 and Chapter 8 Recommended http://www.betterhealth.vic.gov.au/bhcv2/bhcpdf.nsf/ByPDF/Meningitis/$File/Meningitis.PDF http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/

Meningococcal_disease_vaccines?OpenDocument http://www.ncirs.edu.au/immunisation/fact-sheets/meningococcal-vaccines-fact-sheet.pdf http://www.health.vic.gov.au/ideas/bluebook/meningococcal http://www.immunise.health.gov.au/

Tutorial_04/01-P8 - Medical interview - giving explanations Essential tutorial readings in preparation for tutorial Workbook entry for this tutorial National Prescribing Service. (2002). I’ve got a sore throat: Will an antibiotic make me better? Patient Information leaflet, see pdf attached. Murtagh, J, (1996) Gastroenteritis in children, in Patient Education. pg 24. McGraw Hill Book Company,New York. Murtagh, J, (1996) Pill: the combination pill, in Patient Education. pg 51. McGraw Hill Book Company,New York. A beginners guide to using a stethoscope, see pdf attached Prescribed Silverman J, Kurtz S, Draper J, Skills for communicating with patients. Oxford: Radcliffe Publishing, 2005. pg 147 Using condoms Access information on Family Planning Australia and Health Websites http://www.fpv.org.au/pdfs/Condoms,%20male%20and%20femaleSept06.pdf http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=243&np=292&id=2181#1


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Tutorial_HEP_01/01-P2 - Exercise, mindfulness 2 Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 62-64, pg 90-104

Lecture03/01-P74 - Necrosis and apoptosis

Prescribed General and Systemic Pathology, JCE Underwood, pg 102-108

Lecture03/01-P86 - Parasites

Prescribed Mims Medical Microbiology 4th ed. Chapter 5; Chapter 6; Chapter 19, pg 250-251;Chapter 22, pg 304-311;Chapter 22, pg 320-321;Chapter 24, pg 347-348; Chapter 26, pg 373-374.

Tutorial_02/01-P9 - Prevention of discrimination, stigma, social exclusion

No readings listed for this session. Practical_03/01-P9 - Normal flora of the human body

Prescribed Goering et al. Mims Medical Microbiology. 4th ed. Chapters 8 and 32

Lecture03/01-P64 - The molecular basis of cancer 1

Recommended Alberts B, et al. Molecular Biology of the Cell 5th ed. Chapter 20


Recommended Alberts B, et al. Molecular Biology of the Cell 5th ed. Chapter 20

Lecture03/01-P78 - Culture and health behaviour

Prescribed Morrison V, Bennett P, Butow P, Mullan B, & White K, (2007). An introduction to Health Psychology: An Australian Perspective. Sydney, Australia: Pearson Education Ltd. pg 234-5, 245, 414. Recommended American Psychiatric Association. (2000). Appendix 1. Outline for Cultural Formulation and Glossary of Culture Bound Syndromes. In. Diagnostic and statistical manual of mental disorders (4th ed. text rev). Washington, DC: Author. pg 897-903. Culhane, KA, (2007). “We are out of balance here”: A Hmong cultural model of diabetes. J. Immigrant Minority Health. 9; 179-190. Betancourt, JR, (2004). Cultural competence – Marginal or mainstream. New England Journal of Medicine, 351, 953-955.

WEEK 10 Lecture03/01-P79 – Principles of vasculature

Prescribed Anatomy Syllabus, ‘General Anatomy Principles II’ Eizenberg N, et al. (ed.) 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapters 10 and 11


244

Lecture01/01-P7 - Spirituality and environment Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 82-89, pg 142-157 Recommended Matthews DA, et al Religious commitment and health status. Arch Fam Med. 1999; 8 (6): 476

Lecture03/01-P80 - Introduction to immune system

Prescribed Kumar & Clarke: Clinical Medicine. Especially Chapter 4 Janeway et al. Immunobiology. Especially Chapter 1 Recommended Sompayrac L, How the Immune System Works. Blackwell Publishing

Lecture03/01-P81 - How does the immune system work?



Recommended Alberts B et al. Molecular Biology of the Cell 5th ed. Chapter 20

Lecture03/01-P83 - Anti-cancer drugs 1

Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh. Anticancer drugs: Chapter 55, pg 673-688

Tutorial_04/01-P9 - Ending the medical interview, motivational interviewing, and

medical history taking from a real patient Workbook entry for this tutorial Prescribed Silverman J, Kurtz S, Draper J, Skills for communicating with patients. Oxford: Radcliffe Publishing, 2005. pg 141-173 Rollnick S, & Miller WR, (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, 325-334

Tutorial_03/01-P8 - Neoplasia

Workbook entry for this tutorial General and Systemic Pathology, JCE Underwood, Chapter 11, pg 221

Tutorial_03/01-P7 - Tissue biology

Prescribed http://stemcells.nih.gov/info/basics/


245

Tutorial_HEP_01/01-P3 - Nutrition, mindfulness 3 Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 64-66

SiteVisit_04/01-P3 - Medical contact visit 3

Prescribed Levett-Jones T, & Bourgeois S, 2007. The Clinical Placement: An essential guide for nursing students. Chapter 1 Churchill Livingstone. This reading will assist you to understand and manage some of the challenges medical students face in clinical environments.

Lecture03/01-P82 - Pain

Prescribed Morrison V, Bennett P, Butow P, Mullan B, & White K, (2007). An introduction to Health Psychology: An Australian Perspective. Sydney, Australia: Pearson Education Ltd. Chapter 16, Pain, pg 403-430, 2008. Recommended The high price of pain: the economic impact of persistent pain in Australia. Available at: http://www.mbf.com.au/MBF/About%20MBF/Forms/MBF_Foundation_the_price_of_pain.pdf Psychosocial Aspects of Pain: A handbook for health care providers. Dworkin, RH, & Breitbart, WS, IASP press, Seattle, 2004.

Lecture03/01-P84 - Anti-cancer drugs 2

Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh. Anticancer drugs: Chapter 55, pg 673-688

Lecture02/01-P7 - HIV/AIDS across nations

Leclerc-Madlala, S, Simbayi, LC, & Cloete, A, (2009) The sociocultural aspects of HIV/AIDS in South Africa. In: Rohleder, P, Swartz, L, Kalichman, SC, & Simbayi, LC, (eds). HIV/AIDS in South Africa 25 years on: psychosocial perspectives. New York: Springer. 13-26. Jewkes R, (2009). HIV and women. In: Rohleder, P, Swartz, L, Kalichman, SC, & Simbayi, LC, (eds). HIV/AIDS in South Africa 25 years on: psychosocial perspectives. New York: Springer. 27-40. McMahon T, Luisi B, (2011). What’s the ‘problem’? Current issues in defining HIV among people from culturally and linguistically diverse (CALD) backgrounds in Australia. HIV Australia, vol 9, no 2, 11-14. Avaialble online at: http://www.afao.org.au/library/hiv-australia

Practical_03/01-P10 - Tissue injury and repair Prescribed Underwood 5th ed.

Metaplasia - Ch 5, pg 82-83 o Barrett metaplasia in oesophagus - Ch 15 pg 364

Acute Inflammation – Ch 10, pg 200-212 o Acute appendicitis - Ch15 pg 397-398

Chronic inflammation – Ch 10, pg 212-219 o Cirrhosis – Ch 19, pg 420-423

Infarction - Ch8, pg 154-158 o Myocardial – Ch 13, pg 294-299 o Central nervous system – Ch 26, pg 760-762


246

Tutorial_02/01-P1 - Local perspectives on HIV-AIDS

No readings listed for this session. Tutorial_03/01-P9 - Tissue injury and repair

Prescribed General and Systemic Pathology, JCE Underwood, Chapter 6

WEEK 11 Lecture03/01-P87 - Chronic inflammation

Prescribed General and Systemic Pathology, JCE Underwood, Chapter 10 212

Lecture03/01-P72 - 'T' cells


Lecture03/01-P89 – Principles of organisation and function of lymph vessels and

nodes Prescribed Eizenberg, et al. 2007, General Anatomy - Principles and Applications, Anatomedia, Melbourne, Chapter 12 Moore, Dalley, Agur pg 43-46 Any good histology text: Kerr, Wheater or Ross etc.

Lecture03/01-P80 - Haematopoietic stem cell biology

Prescribed Relevant Chapter in Molecular biology of the cell, by Alberts, et al. (available at the Hargrave library reserve)

Lecture03/01-P91 - Immunity to microbes

Prescribed Kumar & Clarke: Clinical Medicine. Especially Chapter 4 Janeway, et al. Immunobiology. Especially Chapter 1 Recommended Sompayrac L, How the Immune System Works. Blackwell Publishing

Lecture03/01-P90 - Interactions between humans and viruses

Prescribed Goering, et al. Medical Microbiology. 4th ed. Mosby/Elsevier: Chapter 3; Chapter 21: pg 274-284; Chapter 26: pg 374-384, 36.


247

Tutorial_04/01-P10 - Medical site visit: Legal, ethics and clinical perspectives Workbook entry for this tutorial

Tutorial_HEP_01/01-P4 - Environment, mindfulness 4

Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 66-67

Lecture03/01-P93 - Haematopoietic stem cells and differentiation into red cells, white

cells and platelets Prescribed Relevant Chapter in Molecular biology of the cell, by Alberts, et al. (available at the Hargrave library reserve)

Lecture03/01-P94 - Microbial organisms of medical importance

Prescribed Goering, et al. Medical Microbiology. 4th ed. Mosby, Elsevier: Chapters 31, 36

Practical_03/01-P5 - Lobar pneumonia and pathology

Pre-reading for pathology: Acute inflammation pg 201 Underwood Pathology Cells of the immune system pg 163–177 Underwood Pathology Pneumonia pg 332-324 Underwood Pathology Normal histology of lung – pg 323–326 Underwood Pathology Pre-reading for microbiology:

Mims et al. Medical Microbiology. Updated 3rd ed. Elsevier Mosby. Section 4: Chapter 19. Pneumonia

Spicer WJ, Clinical Bacteriology, Mycology and Parasitology. An illustrated Colour text. Churchill Livingston. pg 112–115.

Tutorial_02/01-P1 - Global perspectives on HIV-AIDS

No readings listed for this session. Lecture03/01-P100 - Fungal infections

Prescribed Goering, et al. Mims Medical Microbiology 4th ed. Chapter 4; Chapter 19, pg 249-250; Chapter 26, pg 368-373; Chapter 30, pg 437-438.

Lecture03/01-P109 - Antibiotics (1)

Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh. Antibacterial drugs: Chapter 50, pg 622-637 Page C, Curtis M, Walker M, & Hoffman B, (2006). Integrated Pharmacology; 3rd ed. Drugs acting on infectious organisms: Chapter 6, pg 87-160


248

Lecture03/01-P109 - Antibiotics (2) Recommended Rang HP, Dale MM, Ritter JM, Flower RJ, & Henderson G, (2012) Pharmacology; 7th ed. Churchill Livingstone, Edinburgh. Antibacterial drugs: Chapter 50, pg 622-637 Page C, Curtis M, Walker M, & Hoffman B, (2006). Integrated Pharmacology; 3rd ed. Drugs acting on infectious organisms: Chapter 6, pg 87-160

WEEK 12 Lecture03/01-P96 - Active and passive immunity; immunodeficiency


Lecture02/01-P8 - Pharmaceuticals

Alliance for the Prudent Use of Antibiotics. Antibiotic resistance: synthesis of recommendations by expert policy groups. Geneva: World Health Organization, 2001 http://whqlibdoc.who.int/hq/2001/WHO_CDS_CSR_DRS_2001.10.pdf Phua KL, Achike FA, 2007, ‘Vioxx and other pharmaceutical product withdrawals: ethical issues in ensuring the integrity of drug and medical device research, development and commercialisation’ Clinical Ethics 2007; 2 (3): pg 155-162

Lecture01/01-P8 - Connectedness

Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 129-141 Recommended Helliwell JF, Putnam RD, The social context of well-being. Philosophical Transactions of the Royal Society of London - Series B: Biological Sciences. 2004; 359 (1449): 1435-46

Lecture03/01-P97 – Antiviral (1)

Recommended Page et al. (2006) Integrated Pharmacology 3rd ed. – Chapter 6 Rang et al. (2012) Pharmacology 7th ed. – Chapter 51 Australian Medicine Handbook (available via the Monash Library website)

Lecture03/01-P98 – Antiviral (2)

Recommended Page et al. (2006) Integrated Pharmacology 3rd ed. – Chapter 6 Rang et al. (2012) Pharmacology 7th ed. – Chapter 51 Australian Medicine Handbook (available via the Monash Library website)

Lecture03/01-P99 - Antimicrobial resistance and resistance transfer

Prescribed Goering, et al. Medical Microbiology. 4th ed. Mosby/Elsevier: Chapter 33 pg 479-503


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Tutorial_04/01 - OSCE Preparation Workbook entry for this tutorial Prescribed Dornan T, & P O’Neill (2006) Core Clinical Skills for OSCEs in Medicine Introduction pg 1-15. Churchill Livingstone.

Tutorial_03/01-P11 - How the immune system works

Prescribed JCE Underwood, Chapter 9 sections 1-5

Tutorial_03/01-P12 – Can we control viral infections

Prescribed Goering, et al. Mims Medical Microbiology 4th ed. Chapter 3

Tutorial_HEP_01/01-P5 – Connectedness, spirituality and mindfulness 5 Prescribed Hassed C, (2008) The Essence of Health. Random House, Sydney, pg 67-69

Lecture03/01-P100 - Damage to tissues by the immune system

Prescribed Kumar & Clarke: Clinical Medicine. Especially Chapter 4 Janeway, et al. Immunobiology. Especially Chapter 1 Recommended Sompayrac, L, How the Immune System Works. Blackwell Publishing

Lecture03/01-P101 - Immune intervention


Tutorial_02/01-P12 - Global pharmaceutical industry

No readings listed for this session. Practical_03/01-P11 - Serological diagnosis

Prescribed Goering, et al. Mims Medical Microbiology, 4th ed. Chapter 32

Lecture03/01-P102 - Anaemia

Prescribed Wintrobe’s Clinical Haematology, or any other text book of haematology

Lecture03/01-P103 - Mechanisms of haemostasis

Recommended Essential Haematology 5th ed. AV Hoffbrand, PAH Moss & JE Petit 2006 Chapters 23 & 24


250

Lecture03/01-P93 - Thrombosis No readings listed for this session.

med1011 study guide 2012

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