2. Content
1. How‘s life in clinical years
2. Integrated Block
3. Junior Clerkship
4. Case clerking
5. Book Recommendations
6. Q&A
3. 1. How’s life in clinical years
• Life= WCS + bedsides + clerk case +
tutorials/teaching clinics
• V. different from pre-clinical years takes
time and effort to adapt
• Tiring year but fruitful and amazing
• So don’t be overstressed and enjoy!
4. 2. Integrated Block
• IB = WCS (for formative) +
PE teaching sessions (for future practical
use in block ABC) +
Projects/moliu assignments e.g. TB clerkship, TCM essay
• Formative = MCQ + EMQ
- marks not counted so no worries
- just study the wcs well will do (good to study
the wcs in IB some useful when enter block/
wont be covered again later on)
5. 2. Integrated Block
• PE
- Main focus in IB
- Should take time to study PE well (clin skills
notes + macleod/talley + browse)
- Practice PE well at home & during Clerkship
- Use it when entering blocks
• Human sexuality course
- will also be examined in formative (little)
- one interesting session that worth attending
6. 3. Junior Clerkship
• JC = Block A + B + C (each 2 months)
CCT/exam at the end of each rotation
• Group 1-6 = A B C
Group 7-12 = B C A
Group 13-18 = C A B (congratulations)
7. 3. Junior Clerkship
• Block A = MEDICINE
- CHURest, but most fruitful + meaningful
- (Clerk case + study + chau book) x infinity
- Main focus = 1. Respiratory
2. Cardiology
3. Gastrointestinal
4. Neurology
5. Others less examined
So study the first 4 well!!! Clerk more cases
8. 3. Junior Clerkship
• Block A = MEDICINE
- Study materials: WCS + Red Book +/- Davidson…
- Clerk case is important!
∵= sources of clinical sense, experience,
knowledge and PE skills
But no need rush to clerk case in IB as case clerking would be
much more fruitful when gather more knowledge after
entering blocks and there’s lots of chances
9. 3. Junior Clerkship
• Block A = MEDICINE
Lessons
1. Bedside (Long case)
2. Interactive tutorial (Chau book in small group)
3. Teaching clinic (Chau book in large group)
4. Data interpretation (Chau book in large group again…)
5. Clinical Skills (Go to GH and TWH, learn physical signs)
6. Case clerking, report writing and case checking (every
weekend, homework, depends on different rotation, total
no. case report needed to be done is different)
All fruitful!!
10. 3. Junior Clerkship
• Block A = MEDICINE
CCT: Short case
perform PE, no running commentary
present findings to examiner
Q&A session
Maybe another patient (system)
Exam on Mon (2 systems) + Thurs (2 systems
examed systems will not be examined)
Time is counted
Malignant examiners(E.g: Prof. Kwong, etc)
11. 3. Junior Clerkship
• Block B = SURGERY
- Content: General Surg e.g EGI/CRS/HBP/uro/…
+ ENT
+ Ortho
+ TCM
- Bedside: be prepared to wait/ hv session
cancelled
- Clerk case is also useful
12. 3. Junior Clerkship
• Block B = SURGERY
- General Surgery = Upper GI, Lower GI, HB, Vascular,
Urology, Breast, endocrine surgery, lumps and bumps,
Head and neck/ Plastic surgery
(neurosurgery), (Pediatric surgery)not examined
- Orthopedics and traumatology= Osteosarcoma, Septic
arthritis and TB spondylitis
just need to know these 3 =v=“
just to recite answers for exam which repeat year
after yearreally 100% repeat answers
13. 3. Junior Clerkship
• Block B = SURGERY
-Focus = disease presentation + PE
Investigations in year 4
Operation details not required
-PE: needs running commentary
14. 3. Junior Clerkship
• Block B = SURGERY
Lessons
1. Bedsides (Call surgeon before history taking)
2. Revisit bedside (usu. wont go)
3. Teaching Clinic (much more benign)
4. PBL (Q&A session)
5. Interactive tutorial (grp presentation ==)
6. Emergency surgery (attach to a doctor in A5)
7. Ambulatory surgery (Lipoma and different short surgery, good)
8. ENT teachings (well organized, not commonly appear in long case,
summative?)
9. One lesson on community medicine screening
10.Orthopedics and traumatology teachings
11.Traditional Chinese medicine @@
15. 3. Junior Clerkship
• Block B = SURGERY
- Most surgeons are nice (but still can kill)
- Assessment = Long case
(take place in QMH/TWH: know 1 week before)
about 30 mins history taking ( only you and patient ask diagnosis
Immediately, please)
present to examiner
PE
Q&A session
16. 3. Junior Clerkship
• Block C = Multi-disciplinary
A&E, O&G, Pediatrics, Community medicine,
Microbiology, Clinical oncology, Chemical
Pathology, Family medicine, ophthalmology,
Diagnostic radiology
17. 3. Junior Clerkship
• Block C = Multi-disciplinary
- not much case clerking can be done
- CCT: OSCA in CSL
Live: Ophthalm, Fammed, A&E (New)
Others dead
Paedi: got a video, watch and ans abt
physical signs observed
18. 3. Junior Clerkship
• Block C = Multi-disciplinary
- A&E (Lectures and clinical skills important because useful
and name of maneuver, learn how to perform those ‘PE’
during CSL sessions as it will be examined)
- Chemical Pathology (hypo-/hyper-Na = exam focus,
remember the diagnostic pathway)
- Clinical oncology (1 lecture + Q&A, 1 OPD, 1 bedside,
medicine and surgery revisit/introduction)
- Community medicine (3 seminars and HAP)
19. 3. Junior Clerkship
• Block C = Multi-disciplinary
- Diagnostic radiology (Several lectures, gd)
- Family medicine (go to Ap Lei Chau GOPC, attach GP)
- Microbiology (bedside + teaching clinic)
- O&G (One week, PBL, case clerking for later presentation,
organized, good preparation is needed)
- Ophthalmology
- Pediatrics (Physical examination, lecture, Q&A, bedside
on CVS, RS, NS, MSS & GI, good teaching)
20. 4. Case Clerking
• Don’t just focus on signs, learn to take a good
history from patients
• Be good to the patients, plz don’t clerk larn
cases
• Joyea said golden case clerk time = EARLY
morning ie. 7-7:15am arrive
21. 4. Case Clerking
• Block A = MEDICINE
B1- Admission ward (female)
A2- Admission ward (male)
B2- Admission ward (female)
E3- Male GI+ HBS+ general ward
B6- respiratory (male, female)
D6- Male hematology+ general ward
E6- Female (and male) endocrinology ward
B7- Male and female neurology ward
K19- Male and female cardiology ward
22. 4. Case Clerking
• Block B = SURGERY
A3- Male HBS
B3- Female HBS
A5- Colorectal surgery
B5- Admission ward
A7- Neurosurgery ward
K14- Vascular surgery
K 15- Paedi surgery (seldom go)
K 16- endocrine, head and neck/ plastic surgery
K 17- Urology and Upper GI
K 18- Transplant ward
24. • 1 - Kocher's Incision Biliary surgery eg. Cholecystectomy Hepatic
surgery (may also require a larger transverse incision for wider
access: eg. Liver Transplant)
• 2 - Upper Midline laparotomy Nissens fundoplication observe:
associated with Gastrostomy tube? Upper GI surgery 2a - Lower /
Long Midline Laparotomy Scars Any major abdominal surgery
• 3 - Transverse Upper Abdominal Incision Repair of congenital
diaphragmatic hernia Splenic surgery
• 4 - Ramstedt's Pyloromyotomy Scar Ramstedt's Pyloromyotomy
Scar - treatment of Pyloric Stenosis
• 5 - Grid-Iron Incisions at McBurney's Poiint Appendicectomy A
non-inflamed appendix should always be removed once this scar
has been made so that clinicians are not mislead in the future.
Called the 'Grid-Iron' incision due to the way the muscle layers are
divided at operation. McBurney's Point: the junction of the distal
third and proximal two thirds of the line between the umbilicus
and the anterior superior iliac crest.
• 6 - Umbilical / Sub-umbilical Scars Hernia repairs Gastroschisis
repair Exomphalos
• 7 - Point incision marks Laparoscopy port sites Drain sites Also
consider abdominal wound sites for Ventriculo-Peritoneal shunts
• 8 - Inguinal Incisions Inguinal hernia repairs Vascular access scars
• 9 - Lateral Thoracolumbar Incision Renal Surgery - eg.
Nephrectomy
• 10 - 'Hockey-Stick' scar Examine for orthotopic renal transplant
25. 5. Bedside Tips
• Lines, Tubes and Drains
• - Central venous line
-peripheral inserted central catheter
- Nasal cannula
- IV fluid/antibiotics
- IV access
- Nasogastric tube
- Foeley’s catheter
- Chest drain
26. 5. Bedside Tips
• Drug chart (Oral, Parenteral)
• Temperature chart
• I/O chart
• Nursing station
• Patient record
• X-ray/CT/MRI/PETs/
36. CLINICAL
RESPIRATORY MEDICINE
Third Edition
Edited by
James CM Ho
Bing Lam
Mary SM Ip
WK Lam
Division of Respiratory Medicine
Department of Medicine
The University of Hong Kong
Hong Kong 2007
M 616.2 C64
Clinical Respiratory Medicine (HKU)
