3/8/11

1
!"#$%&'#$( *&+,-$./0
- assessmeni
!"#$%&'#$( *&+,-$./0
Wlai is being leaini?
i) Conieni
ii) Piocess
Emplasis is on iesiing piocess bui conieni is necessaiily included
1 2+&./ +2 '//$//.$"#
i). In couise assessmeni - :o%
end of yeai gioup pieseniaiion (:o%)
Wiiiien Papei:
:) seen case - (o%
) unseen case - (o%
1 2+&./ +2 '//$//.$"#
i. In couise assessmeni
Gioup woil - designing and pieseniing a case
1 2+&./ +2 '//$//.$"#
i. In couise assessmeni
Eacl M gioup io be 'splii' in lalf and eacl lalf io
design an IP based aiound couise woil iaugli in
Yeai i
Infoimed of gioup immediaiely afiei SSA weel
1 2+&./ +2 '//$//.$"#
i. In couise assessmeni
You will lave been allocaied io Gioup A oi io Gioup B of youi M gioup.
Assessmenis will iale place beiween ioam and midday on:
Tluisday :(
il
Maicl :oii foi Gioups Mi - Mii wiil Gioup A pieseniing
fisi.
Tluisday isi Maicl :oii foi Gioups Mi: - M:: wiil Gioup A pieseniing
fisi.
Noie: ileie is no afieinoon session of IP on ilese daies
3/8/11
2
Tle in couise assessmeni is piimaiily aimed ai
iesiing youi slill ai developing a case and
appieciaiing ile piocess involved in ensuiing ilai a
suiiable numbei of iopics aie coveied.
Ii is noi aimed ai iesiing youi abiliiy io ieseaicl a
iopic]ouicome as ilai las been iesied duiing ile
academic yeai in youi IP sessions.
Wlai you aie being iequesied io do is develop a case and slow
ile iesi of ile gioup and ile assessois, low you developed
ilis, wlai ile main aieas aie ilai ii coveis and wlai leaining
ouicomes ii would geneiaie.
You may wisl io expand ile leaining ouicomes io give moie
deiail aboui ile soii of iopics ilai you migli ieseaicl and give
an indicaiion of ile iefeience souices ilai migli lelp wiil
fnding oui moie on ile ouicome. You aie noi, lowevei,
expecied io give a full accouni of ile fndings ilai you migli
obiain foi ilese ouicomes - ie we do noi expeci an 'IP
afieinoon iype' session.
Please do NOT use Poweipoini as we cannoi guaianiee ilai
ilis will be available in all iooms. Howevei, oveileads and
wliie boaids aie available io use.
Noi all membeis of a ieam need io pieseni and ii is up io
eacl gioup io decide low iley wisl io divide ile laboui.
Slould any gioup lave a paiiiculai concein aboui any
individuals' piofessionalism ilai can be iepoiied io me and
confdeniialiiy will be mainiained.
Tleiefoie, wiilin ile :o-o min pieseniaiion you slould iall aboui eg
- low you ilougli aboui wlai io do,
- low you developed ile case,
- low ile componenis of ile case can be biolen down inio vaiious aieas
of siudy
- wlai ouicomes iley migli geneiaie.
Be quiie cleai aboui youi leaining ouicomes. Tiy io avoid vague ones ilai
do noi give cleai indicaiion of an aiea io be ieseaicled
!" $%&' (&% )**+,-.)&, /%0 &/, *.&1.&)+2 "3)$4 0%+567 81& *,+/)*6 ( &%
)**+,-.)&, &/, 9,-/)$.69 82 0/.-/ *.&1.&)+2 /%+9%$, +,3,)6, .6 +,"13)&,4
82 :,,48)-57 %+ (&% )**+,-.)&, /%0 &/, )$)&%92 %: &/, *.&1.&)+2 "3)$4
4,&,+9.$,6 .&6 :1$-&.%$7;
All sia lave been infoimed aboui wlai is being iequesied
of you and will judge based on ile ciiieiia desciibed
pieviously - iley will lool foi pieseniaiion slills eic as well.
A mail sleei is on WebCT and you will be mailed againsi
ilai foi youi pieseniaiion.
Tle wiiie up is noi an essay bui a wiiiien veision of youi
pieseniaiion and we expeci only one wiiie up pei pieseniing
gioup. Tle pio-foima foi ilis is also on WebCT and
indicaies cleaily wlai you need io do.
MBChB Integrated Problems 1&2 Student Case Presentation Assessment Sheet

M Group number: Assessor name:
Date: Please list all student names for this sub group overleaf

Very poor Poor Average Good Excellent Score
Spoken
(Out of 10)
Inarticulate
Inaudible
Halting
May lack fluency
Jargon
Loose use of English
Avoids jargon
Defines terms
Fluent
Well constructed use of
language
Clear
Precise
Imaginative
Memorable




Visual
(Out of 10)
Irrelevant slides
Illegible
Confusing
Not always clear
Too much data or too little
Inappropriate style type or
use of colours
Neat
Legible
Appropriate to content
Attractive slides
reinforcing the points
being made.
Can be interpreted in
isolation
Exemplary graphics
suitable for teaching or
publication

Content / Background
(Out of 10)
Poorly informed
Erroneous
Shallow understanding

Reasonable
understanding of the
facts / issues involved
Good knowledge of the
facts / issues
Detailed knowledge, and
clear evidence of
understanding


Construction
(Out of 10)
Circuitous
Inconclusive
Disorganised
Has a basic order to the
presentation
Keeps to time
Sets aims and agenda for
the presentation and
delivers on them
Well ordered
presentation with good
balance between the
various components
Outstanding presentation
Overall Teaching
Ability
(Out of 10)
More likely to mislead
than to educate
Transmits information but
lacks sparkle
Holds the attention of
the audience much of
the time
Commands attention
through clarity of
presentation. You are
impressed by the new
information gathered
Excellent transfer of
memorable information.
A revelation

Ability to answer
questions on the case
(Out of 10)
Cannot answer any
questions or is obviously
just making up an
answer
May take a long time to
formulate the answer, not be
sure if it is correct or not
know the answer
Answers most questions
correctly. May have to
rethink some answers or
admit that they do not
know the answer
A answers most
questions correctly and
concisely with
understanding of the
case
Answers all questions
correctly and concisely
demonstrating real
understanding of the
case

Total score % (completed by Module Co-ordinator) Total score
Strengths: Areas for improvement:
Scoring System: Excellent = 8 or more, Good = 6-7, Average = 5, Poor = 4-3, Very poor =2-0

3/8/11
3
1 2+&./ +2 '//$//.$"#
i. In couise assessmeni
Same mail given io all siudenis in eacl lalf M gioup.
io% pieseniaiion (:o-o mins)
io% wiiiien submission
1 2+&./ +2 '//$//.$"#
:. Wiiiien papei
Seen case - given oui ai end of ilis Semesiei
Jakes bike
Jake works on a building site and enjoys mountain biking at the weekends. One weekend,
during a race, he falls from his bicycle and breaks his right humerus. Six weeks later the
bone has healed but he is having problems with moving his right hand. His right arm is
noticeably hot and the skin is dry. He was in some pain, but has found relief through
regular visits to a Chinese acupuncturist that his wife had used previously. His ability to
work is affected and his foreman has said that he may have to lay him off. Jake is worried
about this as he needs the money to support his young family. He sees his GP. Its a
different one that he has never met before, so he has to explain everything again but
really all he wants to know is how long it will be before he can work normally again. The
GP does a neurological assessment and explains to Jake that he has nerve damage and
refers him back to the orthopaedic surgeons for nerve conduction studies. His GP tells
him that there is likely to be a long waiting list. And that he cannot say at this stage when
he will be seen or what his longterm prognosis is. Jake is angry with this and demands to
see his proper GP who he is sure will arrange an immediate appointment.
1 2+&./ +2 '//$//.$"#
:. Wiiiien papei
Seen case: ili
Answei 6 sloii answei quesiions - ilese will be a
mix of BS and MiS iopics. Can include 'iniegiaied
anaiomy' iopics.
!" %: &%*.-6 2%1 6/%134 -%$6.4,+
Neive iegeneiaiion
Anaiomy of aim
Auionomic funciion in slin
Complemeniaiy medicine
Consuliing belavioui
Role of ile locum
3/8/11
4
!"# %&'##& ()'#
! }usi lile cases you've seen in IP
! Asled io pioduce ] ideniify:
! A 'Mindmap'
! Quesiions ilai you would lile io answei
! Mix of Biological Science and Medicine in Socieiy
! Ideniify souices foi ile infoimaiion io answei
quesiions
! ili
!"*&+*&, )-.%/ /"# 01.-2#3
! Be logical
! Go iliougl sysiemaiically
! Lool ai wlai ii says, noi wlai you ilinl migli be belind wlai
ii says
! Read ile case piopeily e.g. in :oio
! Wiiiing aboui diabeies wlicl was noi in ile case
! Tlis is ile neaiesi iling ilai you gei io caiing foi a paiieni in
youi exams - ilinl of ii lile ilai, exeicise ilai caie
! }usi because you can'i see us doesn'i mean we don'i exisi!
45#&678*&, 9%#'6.&'
! Tlinl wlai you'd +,)332 lile io lnow
! Pliase ii in a way ilai is answeiable
! Avoid ilings lile (genuine :oio quesiions):
! "wleie is ile lip locaied?"
! "wlai is siigma?"
! Moie inieiesiing foi all of us if you iiy!
:1*6&, 8.%1 )&';#1
! Lay peison v medical siudeni
! Be suie io ilinl!
! Faciual inaccuiacies fiom :oio
! GMC=Geneial <,4.-)3 Council - dociois noi
paiamedics
! Osieopails don'i do lip ieplacemenis
! Si }oln's Ambulance Seivice is noi ile same as ile
Ambulance Seivice
4< %&'##& =>?>
! Wlai is a noimal blood piessuie?
! <i(o]So
! Wlai was mine?
! -::o]i6o!
@.%1(#'
! Beiween now and ile exam
! If you laven'i, lool ai ile common websiies you migli
wani io quoie, e.g. NICE, GMC, NHS siies
! Tlinl wlicl bools, jouinals, websiies aie good foi
dieieni ilings
! Tlinl aboui wlicl seaicl engines aie good
! Don'i panic aboui excessive deiail, bui lave a !"#$%
idea
3/8/11
5
=>?>
! Lacl of ilougli in suggesiing souices of infoimaiion
! Bools, Medline, PubMed, NICE, GMC
To ,=,+2 >1,6&.%$?
! GP Noiebool "a semi-piofessional souice, so noi
ieliable"...
! "Valid enougl io be used by a GP"
<1.-*/8
! www.caiei.co.ul
! "a websiie foi caieis"
! GMC
! Caieis
! Wlai an alcololic is
! Wlai dociois can do foi siiessed paiienis
! Medicaiion io use and iis dose
! Sysiemaiic ieviews
A.; 8.%1 )&';#1 3)+#' 8.% )00#)1 B;.%25 8.%
;)&/ ) 0)6#&/ /. +&.; /"*' )-.%/ 8.%CD
! "Clinically Oiieniaied ... is a veiy big and leavy bool io caiiy
aiound"
! "Siudies"
! "Wlai we weie iaugli ai medical sclool"
! Tle BM} oi Tle Lancei
! 'Plone a consuliani
! Do a suivey
! "BM} jouinals eic can also be used as iley coniain aiiicles
associaied wiil lealil pioblems" |Clue: Biiiisl <,4.-)3
}ouinalj
! Noi only IPs...
34#4." 5$/6#
Siudenis failing in Summei (<o%) will iesii boil
paiis of ile wiiiien papei. A new 'seen' case will
be seni io you and a new 'unseen' papei sei as
well. Youi ICA mail will noi couni and eacl papei
will coniiibuie o% io ile oveiall mail
plagiaiize
]playjiiz] (also plagiaiise)
veib iale (ile woil oi idea of someone else) and pass ii o as one's own.
DERIVATIVES plagiaiism noun plagiaiisi noun plagiaiizei noun.
ORIGIN fiom Lai.$ *3)".)+ius 'lidnappei', fiom Gie,5 *3)"ion 'a lidnapping'.
The number of people travelling to the high altitude regions, has risen enormously in the past 10 years.1 The areas with the highest mountains are also the areas with the
poorest facilities, especially for medical care.1 Trekkers must therefore understand the effects of altitude on their bodies.1 Why human's performance at altitude is
severely limited The density of air is not the same at all altitudes, i.e. it decreases exponentially ascending from the sea level.2 The Pb of the peak of Mount Everest
measuring 8848 m above the sea level is approximately 255mm Hg, about one third that at sea level, and the ambient PO2 is only 53 mm Hg.2 Here, the PO2 of the
humidified inspired air entering the alveoli is even lower, because of the effects of water vapour.2 The inspired PO2 at altitude is lower, 44 mm Hg compared to 149 mm
Hg at sea level. (Figure 1) Some people who ascend rapidly to altitude develop acute mountain sickness which is caused by cerebral oedema or pulmonary oedema,
which leads to hypoxic vasoconstriction.2 Chronic mountain sickness may also occur after prolonged residence at high altitude. Hypoxia is thus a major problem at the
summit of Mount Everest.2 [pic] BMJ 1998;317(7165):1063 (17 October), doi Figure 1: Relation between altitude and inspired oxygen pressure The uptake of O2 by
the pulmonary blood slows at high altitude, reflecting the smaller O2 gradient from the alveolus to blood.2 As a result, O2 may no longer reach diffusion equilibrium
between alveolar air and pulmonary-capillary blood by the time the blood reaches the end of the capillary.2 Thus, at increasing altitude, not only does alveolar PO2fall,
but the actual arterial PO2 may fall because of a failure of pulmonary capillary blood to equilibrate with alveolar air.2 The reduction in arterial Po2 stimulates the
peripheral chemoreceptors2 located at the carotid bodies andaortic arch.3 This causes an increase in ventilation3 which results in an increase in PaO2 and a decrease in
PaCO2.4 Thus the decrease in lower barometric pressure is partially countered.4 The hyperventilation that drives off CO2 causes respiratory alkalosis.5 The higher the
pH increases O2 affinity via the Bohr effect, and offsetting the effect of 2,3-Diphosphoglycerate5 which normally reduces the affinity of haemoglobin towards oxygen.3
This leads to a similar oxygen affinity and arterio-venous O2 saturation difference as at sea level5. The lowering of the arterial PCO2 to 1.3 kPa results in hypocapnia
cerebral vasoconstriction, causing a reduction of approximately 50% in the blood flow to the brain.6 Avian Respiratory Adaptations Among vertebrates, the avian
respiratory system, the lung/ air sac system, is exceptionally morphologically complex and remarkably efficient.6 Birds occupy a unique position in terms of their
availability to maintain an efficient oxygen supply to the brain during severe hypoxia, an important adaptation contributing to tolerance at extreme altitudes.7 Birds are
characterized by the presence of multiple haemoglobins, i.e adult haemoglobin or HbA(a major component) and embryonic haemoglobin such as HbD (minor
component).7 The advantage for the multiplicity of haemoglobin resides in the differential binding of oxygen and its transport adaptability with respect to environmental
and physiological needs.7 In the haemoglobin component HbD in Tufted duck, the minor haemoglobin seems to possess higher oxygen affinity, loading fully even at
low oxygen tension.7 The lungs of avian are compact and virtually inexpansible.6 In the inexpansible avian lung, surface tension is not a constraining factor to the
ultimate diameter of the terminal gas-exchange components.6 Although avian have relatively smaller lungs per unit body mass than non-flying animals, their rigidity
allows a substantially high respiratory surface area to be generated through intense partitioning of the part of the parabronchial gas-exchange tissue.6 The lungs are
continuously and unidirectional ventilated by synchronised action of the air sac.6 (Figure 2) The unidirectional flow of air through the lungs mean that air moving
through the lungs is 'fresh' air and has a higher oxygen content.8 The birds lung also have relatively thin blood-gas barrier.6 The surface density of the blood-gas barrier,
i.e the surface are per unit volume of parenchyma (a variable that denotes the relative degree of partitioning of the gas-exchange tissue and hence, the relative sizes of
the terminal gas- exchange components), is substantially greater in the avian lung than in the lungs of bats and those of the non-flying mammals.6 [pic] Avian
physiology: Concepts (http://www.csulb.edu/~efernand/ornithol/LECphysiology.pdf) Figure 2: Respiratory System of an Avian Adaptively, during high-altitude flight,
birds hyperventilate without the risk of respiratory alkalosis and cerebral vasoconstriction from hypocapnia.6 In some species, such as pigeons, the blood flow to the
brain increases during hyperventilation hypocapnia.6 By reducing the PO2 gradient between the arterial blood and the inhaled air and by evoking a Bohr effect, which
raises the oxygen content of the blood, the hyperventilatory responses during high-altitude hypoxia enhances the oxygen-carrying capacity of the blood.6 Would this be
beneficial to human? Extrapolating measurements made on human beings at the altitude of Mount Everest, Dejours (1982), West (1983) and Scheid (1985) estimated
that, if the human alveolar lung was replaced with the avianparabronciolar lung, for the same arterial blood gas levels, a human would be able to ascend 780m higher.6
The pulmonary capillary blood volume in birds is 2.5-3 times greater than in the lung of mammal of the equivalent body mass, where only 20% of it is found in the
alveolar blood capillaries.6 Unlike the avian, the air flow in human is bidirectional, i.e. moving back and fourth into and out of the lungs.8 As result, air coming into
human's lungs is mixed with 'old' air, thus delivering less oxygen.8 Thus, in theory, it seems that by adapting the avian lungs to human, it would solve the problem at
altitude. However, in the long term, human adapts to altitude. This includes the increase in the red blood cells, the pulmonary diffusion capacity and the capillary
density.2 Exposure to hypoxia in the long term also promotes the expression of oxidative enzymes in the mitochondria, thereby enhances the tissues ability to extract O2
from the blood.2 The adaptations, both the long term and short term have one aim, i.e. enhancing the oxygen supply to the tissue. Thus, avian adaptations may not be
very beneficial to human.
3/8/11
6
i% maicl (Inieinei fiom i]o]oS)
liip:]]jeb.biologisis.oig
y% maicl (siudeni papeis fiom i]o]oS)
Class: IRM :ooy-:ooS
Assignmeni: ICA :ooy
Papei ID: :i:o(
y% maicl (siudeni papeis fiom i]o]oS)
Class: IRM :ooy-:ooS
Assignmeni: ICA :ooy
Papei ID: :i:oy:

author report paper ID date
Anonymous 100 %
2120365 15-05-08
Anonymous 99 %
2120373 15-05-08
Anonymous 92 %
2126253 16-05-08
Anonymous 89 %
2120719 15-05-08
Anonymous 76 %
2125069 16-05-08
Anonymous 74 %
2120829 15-05-08
Anonymous 56 %
2126922 16-05-08
Anonymous 56 %
2125019 16-05-08
Anonymous 55 %
2126241 16-05-08
Anonymous 55 %
2126923 16-05-08
Anonymous 55 %
2126970 16-05-08
Anonymous 54 %
2126961 16-05-08
Anonymous 52 %
2125076 16-05-08
Anonymous 52 %
2126989 16-05-08
Anonymous 51 %
2125005 16-05-08
Anonymous 51 %
2125000 16-05-08
Anonymous 51 %
2126928 16-05-08
Anonymous 15 %
2125070 16-05-08
Anonymous 15 %
2125211 16-05-08
Anonymous 15 %
2120380 15-05-08
Anonymous 14 %
2125235 16-05-08
Anonymous 14 %
2126978 16-05-08
Anonymous 14 %
2125063 16-05-08
Anonymous 14 %
2125046 16-05-08
Anonymous 14 %
2120714 15-05-08
Anonymous 13 %
2120363 15-05-08
Anonymous 13 %
2125027 16-05-08
Anonymous 12 %
2125067 16-05-08
Anonymous 12 %
2126940 16-05-08
Anonymous 12 %
2120797 15-05-08
Anonymous 12 %
2126256 16-05-08
Anonymous 9 %
2125062 16-05-08
Anonymous 9 %
2120844 15-05-08
Anonymous 9 %
2120394 15-05-08