FACULTY OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF MEDICINE
YEAR 3 MEDICINE MDP 30209
2022/2023

ROTATION 2

DATE: 2ND JANUARY 2023 – 19TH MARCH 2023

GUIDE BOOK

POSTING COORDINATOR: DR AFFIZAL BIN SAMSUDIN

DEPUTY COORDINATOR: -

HEAD OF DEPARTMENT: AP DR CHAI CHEE SHEE

Version 3.3 (2022-2023)

1
 CONTENTS

Page No.
Mission Statement, PEO, PLO, CLO 3
Posting Objectives 4
Teaching faculty 4-5
Introduction, How to get the best out of the posting, Points to note 6-7
Responsibilities of class leader and group leaders 7
Mentor- Mentee, Key Trainers 8
Assessment plan 8
Eligibility to sit EOP exam 8
Passing criteria 8
Promotion to year 4 criteria 9
Curriculum for Year 3 Medicine 10-20
Recommended reference books 21
Detailed Learning Needs 22-27
Student groups A, B, C, D 28-29
Week 1 30
Week 2 30
Week 3 31
Week 4 31
Week 5 32
Week 6 32
Week 7 and 8 33
EOPE Timetable 34
Points to ponder 35
The Batch of Students 36

2
 UNIMAS
Faculty of Medicine and Health Sciences
MISSION STATEMENT

The Faculty of Medicine and Health Sciences UNIMAS is committed to be an exemplary educational centre,
which will train men and women who will care for the health needs of the individual and the community and
which will inspire them to do this with dedication and compassion and imbue them with a spirit of inquiry,
integrity, creativity and courage.

Program Educational Objectives (PEO):

This program shall produce graduates who are able to:

PEO 1 Apply current knowledge and skills fundamental to the practice of medicine
PEO 2 Demonstrate good management and leadership skills, and the ability to solve problems and apply critical thinking in
order to become a safe and competent doctor
PEO 3 Practice lifelong learning by continually improving one’s knowledge and skills
PEO 4 Conduct professionally and ethically in various medical practices

Program Learning Objectives (PLO):

Upon graduating from this program, the students shall be able to: MQF Learning Domain Learning Domain

PLO 1 apply and integrate basic medical sciences with clinical knowledge Knowledge Cognitive
acquired for the diagnosis and management of common health
problems of an individual and the community

PLO 2 perform the skills of history-taking, physical examination and basic Practical skills Psychomotor
laboratory and clinical procedures in patient care and healthcare
promotion

PLO 3 appreciate the influence of socio-cultural, religious and environmental Social skills and Affective
factors affecting individual and community healthcare delivery when responsibilities
discharging one’s professional responsibilities

PLO 4 demonstrate high moral, professional and ethical values to be adaptable Values, attitudes and Affective
to work in various healthcare settings professionalism

PLO 5 demonstrate competent leadership and communication skills with Communication, Affective
patients and team members leadership and team
skills
PLO 6 critically analyse individual and community healthcare problems and Problem solving and Cognitive
formulate plans to resolve these problems scientific skills

PLO 7 integrate the various knowledge learned to pursue further self-directed Information Affective/cognitive
lifelong learning activities management and
lifelong learning skills

PLO 8 demonstrate basic management skills in the areas of human resources, Managerial and Affective/cognitive
materials and information related to healthcare delivery entrepreneurial skills

3
 MDP30209: COURSE LEARNING OUTCOMES

CLO 1 Perform comprehensive assessment (history-taking, physical examination and investigation) of

patients applying basic medical knowledge to identify normal as well as common medical conditions
in order to make a provisional diagnosis and relevant differential diagnoses
CLO 2 Formulate a reasonable management plan based on the patient's provisional diagnosis
CLO 3 Demonstrate leadership, moral and ethical values, communication skills while interacting with
patients, colleagues and superiors
CLO 4 Demonstrate self-directed learning skills, discussion and presentation skills, and ability to handle
digital technologies

YEAR 3 MEDICINE POSTING OBJECTIVES

By the end of this posting the student should be able to:

1. Demonstrate basic core knowledge in medicine

2. Demonstrate basic skills in history-taking and documentation of the same.
3. Perform complete physical examination and document the same.
4. Present the case succinctly (briefly and clearly), correlate symptoms and signs, and coin the probable
diagnosis / differential diagnoses.
5. Identify common clinical problems.
6. Interpret investigation results of urine, blood, stool, sputum and CSF.
7. Recognize normal anatomical structures and gross abnormalities in common radiographs, especially that
of the chest.
8. Record an electrocardiogram and identify normal and common ECG abnormalities.
9. Describe basic principles of airway management, oxygen therapy, fluid therapy, and vascular access.
10. State the principles of management of common medical conditions.
11. State the role of allied health facilities in patient management.
12. Show professionalism, ethical behaviour, care and concern for the patients.
13. Communicate effectively with patients, their relatives, teachers and hospital staff.

TEACHING FACULTY UNIMAS

Prof Dr Asri B Said (AS) 0138021143 sasri@unimas.my
Assoc. Prof Dr Chai Chee Shee (CHAI) 0198188265 cschai@unimas.my
Prof Dr Kuan Jew Win (KJW) 0198593011 wkjew@unimas.my
Prof Dr Henry Gudum (HG) 0198895047 gudum@unimas.my
Assoc. Prof Dr Loh Huai Heng (LHH) 0122010765 hhloh@unimas.my
Dr Affizal B Samsudin (AF) 0176631789 saffizal@unimas.my
Dr Myint Aung (MA) 0146824712 amyint@unimas.my
Dr Htwe Htwe Chit (HHC) 0128871964 hchtwe@unimas.my
Dr Diana Ng Leh Ching (DNG) 0198198265 nlcdiana@unimas.my
Dr Ling Hwei Sung (LHS) 0128939596 hsling@unimas.my
Dr Yeoh Cheng Wooi (YEOH) 0182628290 cwyeoh@unimas.my
Dr Sim Chun Yang (SCY) 0138273338 cysim@unimas.my
4
Dr Chow Han Bing (CHB) 0192712889 hbchow@unimas.my
Dr Chan En Ze (CEZ) 0105054955 ezchan@unimas.my
Dr Chai Chau Chung (CCC) 0168682338 ccchai@unimas.my

TEACHING FACULTY SARAWAK GENERAL HOSPITAL/ADJUNCT

Prof Datuk Dr Chew Peng Hong (CPH) 0198867259

Prof Dr P T Thomas (PT) 0168890430
Dr Wong See Yin (WSY – Consultant Physician 0138021162
Dr Frederick De Rozario (FRED- HOD Medicine SGH) – Consultant Physician 0168678252
Dr Kalwinder Singh Khaira (KSK) – Consultant Physician 0138107646
Dr Joshua Chung Bui Khiong – Physician 0168963966
Dr Pang Ing Xiang -Physician 0138168091
Dr Francis Shu Eng Pbeng 0109687130
Dr Rachel Chin Wei Ven 0129551212
Dr Wendy Lee Wan Hui 0168087746
Dr Liew Chee How 0128824123
Dr Chiang Kit Hou 0129794735

INTRODUCTION

Welcome to Year 3 Medicine Posting MDP30209. All students need to read thru this highly informative
student guidebook. Indeed, the knowledge and skills required for students to obtain by the end of Year 3
Medicine posting is vast. During this Pandemic COVID-19 we had to undergo multiple revision in our
technique of teaching and assessment.

All our lecturers are highly skilled and motivated to guide and teach you. We expect our students to
demonstrate excellent level of communication skills whilst communicating with patients, colleagues and
lecturers as part of our course learning outcome. We encouraged our students to engage with their assigned
Mentor during posting. You will gain a lot from the Mentor-Mentee session if you actively participate in the
system, but you will also gain nothing if you become passive.

In MDP30209 posting, you need to incorporate what you have learnt in basic sciences in Phase 1 and during
the ICC 1. You will acquire new knowledge and skills during this posting that you must be able to relate to
your previous courses that you have completed. This is a nine-week posting whereby you will have 8 weeks
of teaching and continuous assessment, and another week is allocated for your final assessment. You will
only have 8 weeks to gain the vast amount of knowledge and to develop the necessary skills required at this
level. Hence, time is of the essence here. I would strongly advise you to start planning and prepare early.
Never leave it to the last minute. Many students have complained and addressed similar issue in the past
about how limited time is provided in MDP30209. My advice, you are given 24 hours in a day, manage it
well. Time is the most undervalued assets by people due to poor management of time. Manage your time
properly, start planning and act now.

I would advise all of you to read back on the material provided and to incorporate it into clinical practise.
During these 8 weeks of teaching, you will have lectures and seminars delivered via synchronous online
learning (SOL) or asynchronous online (ASOL). The clinical aspect of the teaching consists of Bedside
teaching-learning (BST), Case Discussion (CD) and Case Simulation (CS). The first week of your ICC 2 is

5
 mainly to focus on the basic of clinical examination that you have to grasp. This core skills and knowledge
would be the tool for you to progress further. BST is one of the core teaching and learning that you must be
actively involved. BST Presentation is not being assessed but merely as a guidance for the students.

Your assessment consists of continuous assessment (30%) and end of posting assessment (70%). The
breakdown of the assessment is provided in this guidebook. I would strongly advise you to go thru it in detail.
Pay attention to details.

Your ultimate goal is to become a safe and competent doctor, hence start preparing and act now. Not
tomorrow or the day after tomorrow. The resources for clinical materials are endless. Medicine CANNOT
be learned from textbook alone and indeed that is the recipe for failure. Learn from your patient. Set a goal
of how many patients you want to clerk and perform physical examination (At least one patient daily). Take
history, perfecting your physical examination, applying your basic medical knowledge to come out with your
diagnosis and differential diagnosis. Think about appropriate investigation and management relevant to the
case. You need to exhibit good leadership skill, whilst practising good moral and ethical values throughout.
Be a ‘detective’ while clerking patients and a ‘lawyer’ while presenting them. Do constantly ask the question
“Why” and always remember to be able to provide “Justification”. Practice makes perfect.

We will continue to update you if for any changes on your teaching, learning and assessment. Currently, in
MDP30209, we will not be conducting any Post-call rounds (PCR) and student are not required to attend
Emergency and Trauma department until further notice.

The eLEAP is our e-learning platform. It serves as both teaching and assessment platform. We expect you to
fully utilize this platform as part of your self-directed learning skills, having discussion and to embrace such
digital technologies. Involvement in eLEAP is compulsory for all students.
Success is to labour

All the best.

Dr Affizal Samsudin
Posting Coordinator MDP30209
11th November 2021

HOW TO GET THE BEST OUT OF THE POSTING!

1. None of the patients in the wards should be left out. It is up to the facilitator to choose which patient is used for
teaching. The student should practice how to do a detailed presentation during BST as well as a brief
presentation during rounds. Learn how to present a case effectively – precise, to the point with relevant
information. Please refer to students conduct and guidance whilst in hospital. This can be found in eLEAP.
2. Students must dress decently, put on white coats and ID tags. Must know the ward rules and routines and follow
them diligently. Introduce yourself and ask permission from the patient before examining. NOTE: male
students are not supposed to examine female patients in private - need a female relative or companion
(chaperon) while examining a female patient. It is also true for female students examining male patients. This
is a must and should be strictly followed. Show respect, be kind and mindful of the patient’s privacy and
confidentiality, at the same time safeguard your dignity.
3. Observe and learn from the activities of Medical Officers and Nursing Staff. Ask questions. Read about cases
you see. Be cordial to all.
4. Interact effectively with your mentor during the weekly mentor-mentee sessions (MMS). Discuss what you
learned, your doubts and acquire clear concepts.
5. COMMENTARIES: Submit 2 commentaries/case write up (CWU) on eLEAP as Word document in the
provided template. Upload them at eLEAP website on specified dates. Plagiarism is a serious offence and
disciplinary action will be taken. Discuss with your assigned lecturers on the topics and seek specific
6
 requirement for the commentary. You may refer to the examples of good and bad commentaries uploaded on
eLEAP. Nevertheless, the format and requirement for the commentaries may differ between assigned lecturers.
Assign a representative to discuss further.
6. LOG BOOK is a check book and proof, showing how much the student is learning from the wards. Record the
procedures you observe/assist/do and get the signature. Tick in the list the conditions you see every day. Submit
log book for checking whenever required and in the 8th week to determine your eligibility to sit the EOPE.
Satisfactory completion of log book is a prerequisite for sitting the EOPE. Ensure you tick the cases that you
have learnt as listed in the logbook.
7. Be mature adult learners. Be earnest in exploiting the clinical materials in the hospital and facilities at FMHS.
Gain the best possible benefits, knowledge and skills from this posting.
8. Cooperate and collaborate with colleagues. Share good cases. Work as a team.
9. Uphold the ethical principal, be professional, prevent transmission of infections and become a good doctor.

POINTS TO NOTE
Bedside teaching BST: The lecturer would discuss the clinical cases found in the ward with the
students. You are expected to learn the basic clinical examination during the first week and to
continue practising. By the time you have the BST session, the focus would be more to correct any
flaws in your technique and to focus on identifying the positive physical signs. You may not get the
opportunity to find these physical signs during other times, thus make full use of the slots provided.
Practise makes perfect. You should practise all the basic physical examination and including specific
ones on a daily basis. Only then, you will be able to perform them well.

Seminar will no longer be ‘copy and paste’ presentations from books. It will be based on real case
scenarios or triggers/ problems provided by the lecturer. All students should read and prepare for the
seminars, not only those presenting. Relevant topics can be added on. Assigned students should
consult the facilitator in charge well in advance regarding the format of the session. Remember to
document these seminars that you have presented in the Student’s Logbook for record.

The mentor mentee session: The group to decide the time, venue and frequency. Students are
encouraged to keep a diary or clinical journal to note down their doubts, problems and difficult to
understand concepts and discuss with the mentors.

Gain maximum benefit from the commentaries. When you get the comments from the lecturer
discuss further with the lecturer. Lots more clarifications can be made when you meet the lecturer
and discuss. Remember none of the case will be straight forward and exactly like the textbook
description. All cases would generate many issues worth discussing. This is how medicine study will
progress.

RESPONSIBILITIES OF CLASS LEADER (CL) & GROUP LEADERS (GL)

1. CL should make arrangement for teaching venues, audio-visual aids & attendance of common
sessions. Get copies of attendance sheet from eLeap.

7
2. The GL/CL should get the attendance signed at all T/L sessions including, seminars, lecture, Case
Discussion and BST. Mark clearly those who are absent.
3. GL should make sure their group members upload commentaries using template provided as per
schedule at eLEAP.
4. Submit attendance books and completed logbooks to coordinator on week 8 Friday pm.

MENTORS – MENTEES
MENTORS GROUPS
Dr Chow Han Bing A
Dr Yeoh Cheng Wooi B
Dr Ling Hwei Sung C
Dr Chan En Ze D

The group, in consultation with the mentor, can decide the frequency and time of their meeting

ASSESSMENT
CONTINOUS ASSESSMENT END OF POSTING (EOP)
CASE WRITE UP- 2/COMMENTARIES 2 8 20 MCQ + 15 BAQ 17.5
QUIZ 1: 30 MCQ 6 2HR MEQ/SAQ 17.5
QUIZ 2: 30 BAQ 9
MID-POSTING CLINICAL ASSESSMENT 10 OSCE 10.5
(MPCA) 7 1 LONG CASE/SBCE 14
2 SHORT CASES 10.5
TOTAL 30% TOTAL 70%

ELIGIBILITY TO TAKE THE EOP EXAM

• 90% Attendance. (Any absence must be with valid reason). Candidate with <90% attendance will be referred
to the Student Academic Discipline Committee. Any appeal has to be submitted to the dean.
• Commentaries - 2 on time
• Satisfactory completion of log book activities and submission of logbook
• Fill up details of Commentaries
• BST & Case simulation record
• Case Discussion record
• Seminar presentation (Minimum 1)
• *PCR and ETD posting not applicable at this point of time
• Students must record the procedures observed, assist and performed.
• Free from serious disciplinary actions:
• Active participation in eLEAP activities - expected

PASSING CRITERIA FOR THE POSTING

1. ≥50% marks in total of long case plus short cases

2. ≥50% marks in total clinical component (LC+SC+OSCE)
3. ≥50% in grand total marks (CA + Theory + Clinical)

8
PROMOTION TO YEAR 4 - CRITERIA

9
 CURRICULUM FOR YEAR 3 MEDICINE

1. CARDIOVASCULAR SYSTEM- Prof Dr Asri Said, Dr Ling HS,

MUST KNOW GOOD TO KNOW
1. History taking of CV diseases: grading effort intolerance, shortness of breath, orthopnoea, 1. Diagnosis of sec HTN
PND, chest pain, palpitations, syncopal attacks, pedal oedema, IVDU, past history of Antihypertensive drugs
rheumatic fever, risk factors of coronary artery disease and IE
2. Drug treatment of heart
2. Physical examination: Hands: clubbing, cyanosis, stigmata of IE, pulse, BP, JVP, pallor, failure
jaundice, corneal arcus, oral hygiene, precordial bulging, pulsations, apex beat, parasternal
heave, thrills, palpable heart sounds, auscultation: heart sounds, murmurs, pericardial rub,
3. Investigations: stress test,
coronary angiography,
bi-basal crepitations, peripheral pulses
echocardiography
3. Hypertension: Definitions, Target organ changes, Investigations, Complications, Causes of
secondary hypertension
4. CHADVASC score,
ABCD2,Duke’s criteria
4. Ischaemic heart disease (coronary artery disease) presentations, Acute coronary syndrome, 5. ECG: LV Hypertrophy,
Investigations, Outline of management
hypokalaemia, SVT, VT,
VF
5. Basic ECG diagnosis: Atrial fibrillation, , Myocardial infarction, Hyperkalaemia
6. Primary and secondary
6. Rheumatic heart disease: aetiology and presentations of rheumatic fever, valve lesions of
pulmonary hypertension,
chronic rheumatic heart disease, complications, secondary prevention
cor-pulmonale
7. Valve lesions: MR, MS, AR, AS, TR, VSD
7. Cardiac tamponade:
8. Heart failure: acute and chronic, heart failure with preserved ejection fraction, Congestive mechanism, presentation
heart failure: causes, clinical features and outline of management
8. Cardiac resuscitation:
9. Infective endocarditis: pathogens, clinical manifestations, complications, diagnosis, outline steps and technique
of management, Duke’s criteria

2. RESPIRATORY SYSTEM: AP Dr Chai Chee Shee

MUST KNOW GOOD TO KNOW
Bronchial asthma (BA)
1. How to diagnose BA. 1. Assessment of BA severity.
2. Differential diagnosis of BA. 2. Drug used in BA control.
3. Assessment of BA control. 3. Devices in BA treatment – MDI and Aero-chamber.
4. Approach to poor control BA.
5. Approach to acute exacerbation of BA.
Chronic obstructive pulmonary disease (COPD)
1. How to diagnose COPD. 1. MMRC classification.
2. Physical findings of COPD. 2. Drug used in acute COPD attack.
3. Quantify smoking history. 3. Drug used in COPD control.
4. Differential diagnosis of COPD.
5. Approach to poor control COPD.
6. Chest X-ray in COPD.
Interstitial lung disease (ILD)
10
1. How to diagnose ILD. 1. Chest X-ray in ILD.
2. Physical findings of ILD.
3. Causes of ILD.
4. Differential diagnosis of ILD.
Bronchiectasis
1. How to diagnose bronchiectasis. 1. Drugs used in bronchiectasis. 2. Non-pharmacology management of
2. Physical findings of bronchiectasis. bronchiectasis.
3. Causes of bronchiectasis.
4. Differential diagnosis of bronchiectasis.
5. Chest X-ray in bronchiectasis.

Pneumonia

1. Types of pneumonia. 1. Treatment for different type of pneumonia.

2. CURB-65 score.
4. Complications of pneumonia.
5. Chest X-ray of pneumonia.
Pleural effusion
1. Types of pleural effusion. 1. Lights criteria.
2. Physical findings in pleural effusion. 2. Pleural fluid aspiration.
3. Chest X-ray in pleural effusion.

Pneumothorax
1. Types of pneumothorax. 2. Chest tube in pneumothorax.
2. Causes of pneumothorax.
3. Chest X-ray of pneumothorax.
Arterial blood gases (ABG)
ABG versus VBG.
Respiratory failure.
Respiratory or metabolic acidosis/alkalosis

Spirometry
1. Obstructive lung disease.
2. Restrictive lung disease.
Other respiratory medicine procedure
1. Chest tube/cook catheter 2. Bronchoscopy.

3. RENAL SYSTEM – Dr Yeoh Cheng Wooi

MUST KNOW GOOD TO KNOW
Clinical assessment: renal patient history; Physical examination; Diagnostic imaging
Urine dipstick, Urinalysis; Assessment of renal function

Glomerular diseases: clinical presentation of nephrotic & nephritic syndrome; Diagnosis and outline of management of
primary glomerular diseases: Minimal change nephropathy; glomerular diseases
Membranoproliferative GN; Focal glomerulosclerosis (FGS); Membranous Renal biopsy: Indications,
nephropathy; IgA Nephropathy; Post infectious GN Complications
Secondary glomerular diseases due to Systemic Lupus Erythematosus

11
Acute kidney injury (AKI): prerenal, intrinsic renal and obstructive renal; AKI: Drug causing, Management; fluid and
urinary osmolality and electrolyte indices, urine microscopy, imaging studies electrolyte balance; Timing and initiation of
especially ultrasonography dialysis;
Chronic kidney disease (CKD); causes; Pathophysiology of anaemia, Preparation of patients for RRT Drug dosing in
bone disease, CVS and lipid disorders, hypertension. Laboratory and CKD; access for dialysis; Management of anaemia,
imaging investigations in CKD bone disease and CVD risk factors

Diabetic nephropathy (DN): Natural history, microalbuminuria, factors Assessment of patient for RRT; vascular and
promoting progression; use of ACE inhibitors and ARB in DN peritoneal access sites and timing of initiation,
blood pressure control

CYSTIC AND INHERITED DISEASES OF THE KIDNEY Genetics of Management of ADPKD Genetic counselling;
ADPKD: presentations, diagnosis, Natural history and extra renal Transplant in ADPKD, Alport’s syndrome
manifestations of ADPKD
Urinary Tract Infection (UTI) Bacterial UTI pathogenesis, routes and clinical Management of Acute and
course of infection investigations in Urinary tract infection Chronic pyelonephritis, lower tract infections
Management of asymptomatic bacteriuria
Investigation and management of
Recurrent UT1

ACID BASE DISORDERS Metabolic acidosis; Metabolic alkalosis; Renal

tubular acidosis; Lactic acidosis; Anion gap
Fluid and Electrolyte Disorders Diuretics: indications and complications. The Management of hyponatraemia & hypernatremia
pathophysiology, causes, clinical features, diagnosis of hyponatraemia & Management of hypokalemia & hyperkalemia
hypernatremia. The pathophysiology, causes, clinical features, diagnosis of
hypokalemia & hyperkalemia

Renal replacement therapy: Advantages and disadvantages of Haemodialysis,

CAPD and renal transplant

4. INFECTIOUS DISEASE: Dr Chow HB

MUST KNOW GOOD TO KNOW
Pyrexia of unknown origin (PUO) and approach to patient with fever
Definition of PUO Investigations
Causes General: FBC (clinical application of abnormal results),
Infections CRP Imaging:
Malignancy X-rays, USS, Echo, CT, MRI
Connective Tissue Diseases Microbiological
miscellaneous (e.g. drugs) Diagnosis - Microscopy
History: - Culture
Fever pattern - Immunodiagnostic tests
System review
Clues to the cause
(travel, occupation, contact, risk behaviours,
immunodeficiency) Physical examination. Thorough examination
covering all systems (including skin, genitals as necessary)
Malaria

12
Plasmodium spp. Treatment: choice of drugs
Mode of transmission, vector. Endemic regions Side effects of anti-
malarials (Chloroquine and quinine)
Clinical features and course in relation to life cycle
Risk conditions for severe malaria
Complications: severe anaemia, cerebral malaria, AKI ARDS
Investigations: for Dx and assessment of patient condition

Leptospirosis
Causal organism Treatment: Choice of antibiotics
Mode of transmission and risk conditions
Common sites of infection Clinical features:
4 main clinical syndromes and Investigations

Dengue fever
Causal organism Epidemiology Management (supportive)
Mode of transmission, vector risk conditions, Endemic regions - Monitor Hct
Role of dengue virus serotypes in pathogenesis - correct dehydration
Patho-physiology of fluid loss to 3rd space
Clinical features in 3 phases: Warning signs Tourniquet test
Definition of:
Dengue fever (DF)
Dengue hemorrhagic fever (DHF)
Dengue shock syndrome (DSS) Investigations:
Dengue serology
Hct, FBC, LFT, BUSE

Melioidosis
Causal organism Treatment:
Mode of infection: Innoculation, inhalation Risk condition. Endemic choice of antibiotics
regions Duration of treatment.
Pathogenesis: widespread suppurative lesions commonly
involving lungs, liver, spleen
Clinical features; Diagnosis: culture, serology

Human immunodeficiency virus (HIV)

HIV virology: Complications due to opportunistic infection:
retrovirus, reverse transcriptase Epidemiology: Respiratory: TB, PCP
mode of transmission, risk factors global and local prevalence, incidence GI: candidiasis, chronic diarrhea
Clinical presentation (of different stages: Seroconversion, PGL, Eye: CMV retinitis
AIDS-related complex, AIDS) Neuro: Toxoplasmosis, Cryptococcal meningitis.
Haemato: Mycobacterium intracellular complex Skin:
Herpes zoster, HSV Complications due to AIDS.
Investigations:
HIV-Ab, p24 antigen, HIV RNA (PCR)

Septicaemia
Definitions Investigations:
Causes - For causal organism
Pathophysiology: - For source of infection
Pro-inflammatory cytokines, widespread endothelial damage, - To assess patient’s condition
microvascular thrombosis, impaired tissue oxygenation, multiorgan
dysfunction Management principles:
Clinical features/complications: - Treat infection (antibiotics, removal of source of
systemic manifestations, septic shock, multiorgan failure, DIC infection)
- Supportive care
(IV fluids, ventilator, dialysis, nutrition)

13
 5. GIT AND LIVER – Dr Myint Aung
MUST KNOW GOOD TO KNOW
• History taking in abdominal pain, jaundice, abdominal Alcoholic hepatitis: Features,
distension, diarrhoea, constipation Complications
• PE of Abdomen Alpha-1-antitrypsin Deficiency:
Manifestations
• General examination: stigmata of chronic liver disease
Primary biliary cirrhosis: Clinical features
• Liver function tests Wilson’s disease: Pathophysiology,
• Cirrhosis of liver: Definition, Causes, Complications
Pathophysiology, Clinical features, Complications Haemochromatosis: Causes,
• Portal hypertension: Causes, Features, Complications Pathophysiology, Complications
• Ascites: Causes, how to differentiate exudate from Chronic hepatitis B and C: Transmission,
transudate Complications
Chronic diarrhoea: Causes, Manifestations
• Portosystemic encephalopathy, Clinical features Malabsorption: Causes, Manifestations
• Acute liver failure, Causes, Features Inflammatory bowel disease: Definition,
• Acute viral hepatitis A, B, C: Transmission, Clinical Pathophysiology, Manifestations
course, Complications
Acute diarrhoea: Causes, Clinical features of
dehydration, Complications

6. NEUROLOGY – Dr Chan En Ze & Prof Dr PT Thomas

MUST KNOW GOOD TO KNOW
Neuroanatomy, functions of the nervous system; history taking of Brain CT appearances
neurological disorders and physical examination of the nervous system CT brain, MRI brain and spinal cord, carotid Doppler,
Glasgow coma scale EEG, electromyography

14
Stroke Definition; Classification according to pathology, BAMFORD Causes of young stroke: antiphospholipid
classification; small vessel strokes and large vessel strokes; risk factors of syndrome, Vasculitis, hypercoagulable states, watershed
stroke (modifiable and non-modifiable): factors increasing atherosclerosis; infarcts
causes of embolization: atrial fibrillation, past myocardial infarction,
infective endocarditis; risk factors for haemorrhagic stroke: Thrombolytic therapy: indications and contraindications,
Intraparenchymal haemorrhage due to microaneurysms rupture; window period, drugs used, complications
subarchnoid haemorrhage: berry aneurysms, presentation of SAH . Clinical Thrombectomy
presentations of strokes, the 5 neurological deficits of TACS
Brainstem syndromes, locked-in syndrome, persistent
Blood supply of brain: Circle of Willis formation and branches; deep vegetative state, brain death
penetrating branches - lacunar infarcts; presentations of stroke: features of
internal capsule lesions, occipital lobe lesions, brainstem lesions – crossed How cerebellar lesions cause death
paralysis, cerebellar lesions; optic tract and optic radiation lesions, Loss Supranuclear and nuclear gaze palsy, vestibulo-occular
of consciousness in stroke, Gaze palsy, Importance of pupil size and reflex, doll’s eye phenomenon
reactions. Cranial nerve involvement in cerebral and brainstem strokes.
Todd’s paralysis
Speech problems in stroke: fluent and non-fluent aphasia,
Types of dysarthria, Dysphonia Syringomyelia
Sensory disorders, dissociated sensory loss
BP management in stroke,
Life-threatening complications of stroke; features of increased intracranial
pressure, herniation of brain causing cardiorespiratory arrest, transtentorial Anticoagulation therapy, drugs
and foramen magnum herniations

Investigations in stroke: CT brain, explore risk factors

Principles of thrombolytic therapy – timing, indications and
contraindications.

Managing blood pressure in stroke, Primary and secondary prevention of

stroke, CHA2DS2VASc scoring, antithrombotic therapy

Seizures and Epilepsy Definitions, classification of seizure, how to Investigations: EEG

differentiate focal and generalised seizures Distinguishing seizure from Antiepileptic drugs: how to choose, side effects of drugs,
syncope duration of therapy

Parkinson’s disease Cardinal features, clinical presentations, pathology, Choice of drugs, deep brain stimulation, atypical
diagnosis, investigations, asymmetry of features, demonstrating clinical parkinsonism - Parkinson Plus syndromes
signs of PD, gait, differentiating rigidity from spasticity, outline of
management, prognosis

Myasthenia gravis Aetiology, pathology, cardinal feature, presentations, Drugs therapy; Thymectomy,
clinical features, demonstrating cranial muscle weakness, proximal Immunosuppression therapy,
myopathy, demonstrating fatigability Investigations, antibodies, repeated IVIG and plasmapheresis in MG
nerve stimulation test; myasthenic crisis, precipitating factors, outline of
management.
Guillain Barré Syndrome AIDP, AMAN, AMSAN, clinical presentation, CIDP, Miller Fischer syndrome Electromyography, GBS
clinical features, pathology, diagnostic investigations, aetiological factors crisis, prognosis, recovery, IVIG and
like infections, vaccination, surgery; cranial nerve involvement, CSF Plasmapheresis, LMWH
findings, oligoclonal bands
Autonomic dysfunctions; Differentiating GBS from transverse myelitis

15
CNS Infections Viral meningitis and encephalitis: clinical presentation Pathogens
Bacterial meningitis and tuberculous meningitis, pathogens, presentation Investigations and diagnosis, CSF findings in viral,
and clinical features bacterial and tuberculous meningitis LP: procedure,
Lumbar puncture: indications and contraindications complications
Antimicrobials of choice

Multiple sclerosis Definition, clinical presentation Aetiology, pathology, clinical manifestations,

investigations, MRI findings and management

Degenerative conditions of the CNS Presentation Amyotrophic Lateral Sclerosis, Alzheimer’s disease,
dementias

7 ENDOCRINOLOGY: AP Dr Loh Huai Heng

Must Know Good to Know
Diabetes mellitus and metabolic disorders
2. Diagnosis of Diabetes mellitus 1. Autoantibodies of type 1 diabetes
- Types of DM and differentiating type 1 vs type 2 2. Autonomic neuropathy
DM 3. Groups of oral antidiabetic agents and their
- OGTT interpretation mechanisms of actions
- Cut off for diagnosis using FBS, HbA1C, RBS 4. Types of insulin 5. Obesity
3. Acute DM complications - Possible consequences
- DKA, HHS and their pathophysiology
- Hypoglycemia
4. Chronic DM complications
- Microvascular, macrovascular
5. The must-do examination of patients with diabetes
6. Brief overview of DM management
- Lifestyle modification
- Types of treatment: oral anti-diabetic agents, injectable
therapy
- Monitoring of control (glucometer targets, HbA1C targets)
7. Obesity - Calculation of BMI

Hypothalamic-pituitary disorders

16
 1. Acromegaly 1. Acromegaly
- Clinical features - Management
- Screening investigations options
- Confirmatory tests 2. Cushing’s syndrome
- Localization investigation - Management
options
- Complications Prolactinoma
2. Cushing’s syndrome 3.
- Management and treatment side effects
- Clinical features
- Screening investigations
- Confirmatory tests
- Localization investigation
- Complications
3. Prolactinoma
- Differential diagnoses of hyperprolactinemia
- Clinical features & Complications
-
Adrenal disorders

1. Primary aldosteronism 1. Primary aldosteronism

- Clinical features - Treatment options
- Types of primary aldosteronism 2. Pheochromocytoma
- Screening investigations - Peri-operative management
- Confirmatory tests Hypoadrenalism
- Localization investigation 3. - Common causes
- Complications - Clinical features
2. Pheochromocytoma - Bio investigation interpretation
- Clinical features - Imaging findings
- Laboratory investigations - Treatment
- Localization investigation
- Complications

Thyroid disorders

17
 1. Hyperthyroidism 1. Hyperthyroidism
- Causes of hyperthyroidism - Multinodular
- Clinical features of hyperthyroidism goiter, toxic
- Specific features of Grave’s disease adenoma
- Interpretation of thyroid function tests - Thyroid storm
- Antibody specific to Grave’s disease - Anti-thyroid drugs and their potential side
effects
- Brief overview of management Thyroid nodule
- Complications of untreated hyperthyroidism - Clinical features of thyroid malignancy
2. Hypothyroidism 2.
- Approach to thyroid nodule
- Causes of hypothyroidism
- Clinical features of hypothyroidism
- Interpretation of thyroid function tests
- Antibody specific to Hashimoto’s thyroiditis
- Brief overview of management

8. Haematology - Prof. Dr Kuan Jew Win

Must know Good to know
Thalassaemia
• Symptoms & signs
• Differences between Hb analysis and DNA analysis
• Complication of iron overload
• Iron chelation therapy
• Genetic counselling
Haemophilia
• Symptoms & signs Recognize congenital haemophilia with inhibitor
• Types and severity of haemophilia
• Factor replacement – type & calculation
• Genetic counselling
Dissemianted Intravascular coagulopathy (DIC)
• Symptoms & signs
• Causes
• General management of DIC
Thrombotic thrombocytopaenic purpura (TTP) - Haematological disease emergency!
• Symptoms & signs
• Pathophysiology
• Investigations
• General management of TTP
• Differentiate from HUS & DIC
Acute Leukaemias
• Symptoms & signs
• Investigations to diagnose & prognosticate
• Principles of treatment
Acute Promyelocytic Leukaemia (APML)- Haematological disease emergency!
• Symptoms & signs
• Investigations to diagnose
• Principles of treatment - ATRA
Lymphomas

18
• Symptoms & signs Hodgkin’s lymphoma versus Non-Hodgkin’s
• Investigations to diagnose lymphoma
• Ann Arbor staging
• Principles of treatment
Multiple myeloma
• The spectrum of plasma cell neoplasms
• Symptoms & signs
• Investigations to diagnose
• Principles of treatment
Aplastic anaemia (AA)
• Definition of severe and very severe AA
• Symptoms & signs
• Investigations to diagnose
• Principles of treatment
Others
• Concept of WHO classification Bone marrow failure
• Myeloproliferative neoplasms (CML, ET, PV, PMF) - symptoms &
signs, investigations to diagnose
• Myelodysplastic syndrome - symptoms & signs, spectrum of disease

9. RHEUMATOLOGY: Dr Htwe Htwe Chit

Approach to arthritis
Clinical
- Sociodemographic factors
- Background medical Hx
- Onset
- Joints involved
- Number of joints involved
- Symmetry
- Pain character, morning stiffness, systemic manifestations
- Extent of disability
- Triggers
Investigations
- FBC, ESR, CRP; Autoantibodies
- Joint aspiration; Radiological imaging
Rheumatoid arthritis Less common presentations: - Acute Monoarthritis
Epidemiology - systemic manifestations Early X-ray or MRI changes
Pathophysiology Management:
Typical presentation: Chronic symmetrical - NSAIDs, DMARDs
polyarthritis Diagnostic criteria Investigations: - Role of corticosteroids and monoclonal antibody
- multi-disciplinary
Complications of treatment
Seronegative RA
General knowledge on anti-cytokine therapy; Role of surgery
Osteoarthritis Other features: joint instability, stiffness
Pathological hallmark: Treatment
- cartilage loss followed by periarticular bone response - Pain relief
- Physiotherapy (walking aids, footwear, exercise)
Epidemiology - Surgery (joint replacement)
Clinical features Factors predisposing to OA
Imaging findings: Secondary OA
- loss of joint space, subchondral sclerosis, cysts

19
Crystal arthopathies: gout and pseudogout Pseudogout
Gout - More common in elderly women
Epidemiology - Due to calcium pyrophosphate
Pathogenesis: due to urate crystal deposits in the joint deposits in the cartilage and joint
Causes of hyperuricaemia - Usually affects the knee or wrist
Clinical presentations - Investigations
- Acute
- Chronic tophaceous gout Use of steroids in gout

Triggers of acute gout

Complications
Differential Diagnosis
Investigation Management:
- pain relief, dietary advice, Urate-lowering agents

Spondyloarthropathies: Ankylosing spondylitis, enteropathic

spondyloarthropathies, psoriatic arthropathies, reactive arthritis - Clinical features of each entity
Common features shared within the group - Diagnosis
- Associated with HLA-B27; Seronegative; Sacroiliitis - Investigations
- Asymmetrical oligoarthritis; Marked enthesitis - Management
- Extraarticular (conjunctivitis, uveitis, etc)
SLE Treatment outline of SLE
Epidemiology Monitoring disease activity
Aetiology and Pathophysiology Antiphospholipid syndrome
Clinical Features Drug-induced lupus
Triggers of SLE flares SLICC diagnostic criteria
Revised ACR diagnostic criteria; Investigations Course of disease during pregnancy
Systemic sclerosis Investigations
Epidemiology, Types, Pathophysiology, Characteristic features Management
Septic arthritis
Risk factors; Common organisms; Presenting features, Treatment of acute septic arthritis
Investigations
Investigations Joint aspiration and synovial fluid analysis
Useful blood tests Radiological imaging
Serum autoantibodies

20
 RECOMMENDED REFERENCE BOOKS – SITES

1. Current Medical Diagnosis and Treatment latest ed.

2. The Little Book of Causes – Hua Huat Soo, CE Publishing

3. Hutchison’s Clinical Methods, W. B. Saunders, latest ed.

4. Use on-line books and journals available free at CAIS Website: Access Medicine, etc.

5. Macleod’s Clinical Examination;

Churchill Livingstone, latest ed.

6. Clinical Examination by Nicholas J Talley. Simon O'Connor latest ed.

7. Aids To Clinical Examination

UNIMAS Publication - buy online from UNIMAS publications

8. Essential Explanations to Clinical Examination, Ed 2

UNIMAS Publication – P T Thomas – buy online from UNIMAS publications

9. Davidson’s Principles and Practice of Medicine; Churchill Livingstone, latest ed.

10. Kumar and Clark Clinical Medicine; W B Saunders, latest ed.

11. Harrison's Principles of Internal Medicine; Mc Graw-Hill, latest ed.

12. Access Medicine – CAIS online login: student@unimas.my

21
 DETAILED LEARNING NEEDS IN MEDICINE: CLINICAL

GENERAL
• Take complete history, document it and present it. Know all symptoms pertaining to all systems,
their mechanism, relevance and importance
• Know all the physical findings on examination of a normal adult male and female
• Know all abnormal physical signs in all the systems and how to elicit and interpret them
• Observe the patient: gait, posture, attitude, props, equipment and therapies provided

RESPIRATORY SYSTEM
• Count respiratory rate, note breathing pattern, features of respiratory distress
• Any cough, quality of cough, dry or productive, type of sputum & quantity, Usage of accessory
muscles respiration, pursed lip breathing. Is the JVP raised? Is it pulsating or not?
• Examine hands for finger clubbing, cyanosis, warmth
• Flapping tremor, any hand tremor or increased sympathomimetic activity
• Muscle wasting suggestive of brachial plexus compression, radiating pain
• Hypertrophic pulmonary osteoarthropathy – tender swelling at wrists and ankles
• Examination of lymph nodes, especially supraclavicular, cervical
• Upper respiratory passages: stridor, audible wheezes, odour of breath
• Any tracheal deviation, estimate cricosternal distance and tracheal tug
• Surface anatomy of the chest: dividing and specifying areas of the chest
• Shape of the chest: any barrel chest, deformities (scoliosis, kyphosis), surgical scars, pleural
aspiration scars, dilated veins
• Chest movements, up and down and chest expansion (quantity and symmetry)
• Vocal fremitus: (normal, decreased, absent or increased). Is it symmetrical?
• Chest percussion: normal resonance, dull, stony dull or hyper-resonant. Is it symmetrical?
• Breath sounds: vesicular (normal, decreased intensity, prolonged expiratory phase, or bronchial
– all areas of the chest
• Adventitious sounds: crackles (crepitations), wheezes (rhonchi), pleural rub, transmitted sounds.
Does it increase or disappear after coughing?
• Vocal resonance: normal, increased, decreased or absent – area-wise. Is it symmetrical?
• Whispering pectoriloquy – test when vocal resonance is increased
• Any evidence of right heart failure secondary to pulmonary hypertension (Cor-pulmonale)
• Any evidence of superior vena cava obstruction? Pemberton’s sign, absent neck vein pulsation
• Any evidence of Horner’s syndrome, compression of sympathetic fibres by apical lung tumor?
• Physical signs of consolidation (pneumonia), lobe/lung collapse, lung fibrosis, lung tumour,
bronchiectasis, lung abscess, pleural effusion, pneumothorax, tension pneumothorax,
emphysema, chronic bronchitis, bronchial asthma
• Features and types of respiratory failure
• Sputum AFB, smear and culture examination
• Peak flowmetry, lung function tests - spirometry
• Arterial blood gas analysis
• Aetiology, clinical features, diagnosis and principles of management of all common pulmonary
diseases.

CARDIOVASCULAR SYSTEM
• Any syndromic facies: Marfan syndrome, Down syndrome, Turner syndrome
22
• Central or peripheral cyanosis
• Hands: finger clubbing, cyanosis, stigmata of infective endocarditis
• Examination of radial pulse: rate, rhythm, volume, character and condition of the arterial wall,
dancing brachialis
• How to elicit collapsing pulse, slow-rising pulse, radio-radial delay, radio-femoral delay, causes
of absent peripheral pulses
• Palpate brachial pulse, carotid pulse; any cord-like thickening of brachialis?
• Pallor of conjunctivae, oral mucosa and tongue
• Oral hygiene: condition of teeth and gums, halitosis, any high arching palate of Marfan syndrome
• Neck pulsations: how to differentiate jugular venous pulse from carotid pulse
• Measuring jugular venous pressure
• Why external jugular vein is not reliable to assess central venous pressure?
• What is Corrigan’s sign, common causes?
• Examine other peripheral pulses like dorsalis pedis, posterior tibial, popliteal.
• Elicit pedal oedema, up to what level on the legs, is it pitting or non-pitting? What is the
significance of pitting / non-pitting, unilateral/bilateral oedema?
• Examine precordium: inspection from the foot-end of the bed, surgical scars
• Any bulging of the precordium or pulsations
• Locate apex beat, four types of apex beat and their clinical significance
• Any palpable thrill, its timing – systolic or diastolic
• Left parasternal pulsations or heave, what is its significance?
• Any palpable heart sounds?
• Elicit cardiac dullness by percussion, is it normal, increased or decreased, significance? What
causes these?
• Auscultation: First and second heart sounds: are they normal, soft or loud, split?
• Any third or fourth heart sound? What do they indicate? Any gallop rhythm?
• Any cardiac murmur heard: how to describe the murmur?
• Auscultate: mitral, tricuspid, pulmonary, aortic, second aortic areas and the carotid arteries
• Auscultate mitral area in the left lateral position with bell and second aortic area in the sitting
position with diaphragm.
• Effect respiratory phase on cardiac murmurs? Effect of posture on murmurs. Location, timing,
quality, grade, change with respiratory phase of the murmur. Pericardial rub, any change with
posture?
• Signs of congestive heart failure
• Auscultate lung bases for crackles
• Elicit enlargement of liver and spleen, is there any liver pulsations?
• Fundoscopy for changes of hypertension, diabetes, Roth spots of infective endocarditis
• How to read chest X-ray, features of cardiomegaly, pulmonary oedema
• How to record and read ECG, common ECG abnormalities, cardiac monitoring
• Common CVS disorders: primary and secondary hypertension, Non-modifiable and modifiable
risk factors of atherosclerosis (coronary artery disease), valvular heart disease, common
congenital heart diseases, cardiomyopathy, infective endocarditis, stable angina, unstable angina,
acute myocardial infarction, right heart failure, left heart failure, congestive heart failure, causes
and differential diagnosis of acute dyspnoea, principles of management of acute and chronic heart
failure.

GIT AND EXAMIANTION OF ABDOMEN

• Level of consciousness, alertness, orientation in time, person and place
• Hands: palmar erythema, clubbing, Dupuytren’s contracture, flapping tremor

23
 • Jaundice: sclera, sublingual area, skin and mucosae
• Bilateral parotid hypertrophy
• Subconjunctival haemorrhage, bleeding tendency
• Stigmata of chronic liver disease
• Gynaecomastia, spider naevi, loss of axillary/pubic hair, testicular atrophy
• Inspect the abdomen: size and shape, asymmetry, umbilicus, movement, dilated veins, surgical
scars
• Superficial palpation of the abdomen: rigidity, tenderness, large mass, general feel
• Deep palpation of abdomen: any tenderness, masses, palpable organs
• Palpate for the liver: lower edge and surface: tenderness, consistency, nodularity, palpable bruit
• Percuss for the upper border of the liver, measure the liver span at the right midclavicular line
• Palpate for the spleen, its lower pole, notch: mild, moderate, massive splenomegaly
• Palpate for the kidneys: bimanual palpation and ballotable
• How to differentiate liver from enlarged right kidney and spleen from enlarged left kidney?
• Percussion of abdomen: resonant or dull, any shifting dullness, fluid thrill
• Auscultate the abdomen: bowel sounds, renal bruit, hepatic bruit, splenic rub
• Elicit lymph node enlargement, supraclavicular, inguinal

LIVER DISEASES: signs of chronic liver disease, how to elicit them, their aetiology,
pathophysiology, liver function tests interpretation, imaging, principles of management. Differential
diagnosis of jaundice, viral hepatitis, portal hypertension, hepatic encephalopathy, precipitating
factors of liver failure, carcinoma liver, principles of management of liver failure.

GIT DISORDERS: acute diarrhoea, chronic diarrhoea, malabsorption syndrome, acute

gastroenteritis, bacillary dysentery, irritable bowel syndrome, inflammatory bowel disease (ulcerative
colitis and Crohn’s disease), peptic ulcer disease, gastro-oesophageal reflux disease, carcinoma
stomach, Helicobacter pylori infection

RENAL DISEASES: acute and chronic glomerular disease, tubulointerstitial disease, acute kidney
injury (AKI) and chronic kidney disease and its staging, nephritic syndrome, nephrotic syndrome,
diabetic nephropathy, proteinuria, haematuria, urinalysis, all about end stage renal failure, polycystic
kidney disease, kidney and hypertension. Urine dipstick test, urinalysis, ACR, PCR

INFECTIOUS DISEASES: tuberculosis, dengue fever, dengue haemorrhagic syndrome, malaria,

leptospirosis, typhoid fever, chikungunya fever, septicaemic shock, diagnostic tests for infections,
HIV/AIDS, meningitis, encephalitis, meningococcaemia, H1N1 influenza. AFB, blood culture,
serology

CENTRAL NERVOUS SYSTEM

• Level of consciousness, Glasgow Coma Scale, alertness, cooperation
• Behaviour, emotional status, orientation in time, person and place, memory- short and long-term.
Dyspraxia and language disorders
• Speech/dysphasia: expressive/non-fluent and receptive/fluent, dysarthria and dysphonia
• How to differentiate dysarthria from dysphasia (both can be combined)
• Neck stiffness, Kernig’s sign, Brudzinski’s sign – how to elicit them
• Is the patient able to walk? How is the gait, any abnormality?
• Abnormal gaits: high stepping, stomping, hemiparetic, shuffling, festinant, ataxic, antalgic
• Examination of the 12 cranial nerves
• Examination of smell, anosmia, parosmia

24
• Examination of acuity of vision, visual field (confrontation test), colour vision, funduscopy, how is
perimetry done
• Homonymous hemianopia: congruous and non-congruous, bitemporal hemianopia
• Elicit pupillary reflexes: direct and consensual light reflex, accommodation reflex
• Examine eye movements, diplopia in any direction of eye movement, conjugate deviation of eyes;
nystagmus: horizontal, vertical and torsional
• Examine muscles of mastication (masseter, temporalis, medial pterygoid and lateral pterygoid) any
jaw deviation on opening mouth against resistance.
• Examine sensations in the three divisions of the cranial nerve V, elicit jaw jerk, corneal reflex
• Examine muscles of facial expression, any asymmetry, drooping, drooling of saliva lifting of
eyebrows, frowning, eye closure, grin, tight mouth closure to puff cheeks, platysma, sense of taste,
hyper-accusis in Bell’s palsy, Ramsay-Hunt syndrome
• Differentiate UMN lesion from LMN lesion of facial nerve
• Why lower face is usually affected with limb weakness in stroke? Why upper face is spared in cerebral
stroke? Crossed paralysis in brainstem stroke
• Examine acuity of hearing in both ears, using tuning fork 512 or 256 Hz – Rinne’s and Weber’s test
• How to differentiate conductive deafness from sensorineural deafness?
• Examine integrity of cranial nerves IX and X: nasal voice, nasal regurgitation, palatal arching, any
asymmetry, gag reflex to check IX and X, bovine cough
• Examine muscles innervated by cranial nerves XI: neck rotation, palpate sternomastoid muscles,
upper part of trapezius
• Examine cranial nerve XII: inspect tongue while it is resting - fasciculation or wasting; protrusion,
any deviation, side to side movement and push against cheeks

MOTOR SYSTEM OF UPPER LIMBS AND LOWER LIMBS

• Posture of the limb, any muscle wasting, fasciculation. How to elicit fasciculation?
• Pronator drift of outstretched arms with eyes closed – screening test
• Muscle tone: normal, rigidity, spasticity, hypotonia and the mechanism of each How to differentiate
spasticity from rigidity? What is cogwheel rigidity?
• Muscle power: test at least two movements of each joint, grading power (0 to 5)
• Elicit tendon reflexes: triceps, biceps, knee, ankle, grading tendon reflexes Hoffman’s sign, delayed
relaxation of tendon reflex; patellar & ankle clonus
• Reinforcement of tendon reflexes, Jendrassik manoeuvre
• Superficial reflexes: abdominal, cremasteric (optional) and plantar reflex – Babinski sign and
different methods of eliciting plantar reflex, interpretation of each
• Elicit coordination of movements in upper limbs and lower limbs
• Elicit signs of cerebellar dysfunction: nystagmus, dysmetria, dysdiadochokinesis, rebound, check
reflex, hypotonia, pendular knee jerk, wide-based gait, trunk ataxia
• How to elicit bradykinesia? Hypomimia, hypophonia
• Differentiate between upper motor neurone lesion and lower motor neurone lesion, causes of each

SENSORY SYSTEM
• Elicit sensations served by spinothalamic tract: pain, temperature, pressure touch
• Elicit sensations served by dorsal/posterior column: fine/discriminatory touch, sense of vibration,
proprioception, stereognosis, graphesthesia, two-point discrimination, sensory inattention / extinction
• Know the dermatomes and distribution of areas of peripheral nerves

25
• Pattern of sensory loss in peripheral neuropathy, spinal cord lesions, brainstem lesion, thalamic lesion,
cortical lesion. What is dissociated sensory loss? Cape-like distribution (hung-up) of sensory loss,
astereognosis, agraphesthesia

COMMON NEUROLOGICAL DISORDERS: migraine and other headaches, stroke,

transient ischaemic attack, multiple sclerosis, seizure (types), differentiate seizure from syncope, risk
factors of cerebrovascular disease and stroke, CNS aneurysms and their presentation, subarachnoid
haemorrhage, space occupying lesions in brain, features of brain herniation, what causes loss of
consciousness, metabolic causes of coma, infections of the CNS, presentation of cerebellar disorders;
degenerative brain disorders: Parkinson’s disease, Alzheimer's disease; peripheral nerve disorders like
Guillain Barrѐ syndrome, peripheral neuropathy, proximal myopathy, mononeuropathy; neuromuscular
disorder like myasthenia gravis

ENDOCRINE SYSTEM
THYROID DISORDERS
Types of goitre, examination of thyroid gland, features of compression, retrosternal goitre, Pemberton’s
sign, clinical features of thyrotoxicosis and hypothyroidism, eye signs of thyrotoxicosis, eye signs of
Graves’ disease, proximal myopathy, hyperactive tendon reflexes, hung-up jerk, possible evidence heart
failure and arrhythmias, features of thyroiditis, thyroid storm, diagnostic tests in thyroid disorders and
principles of management

CUSHING’S SYNDROME: Causes, classification, clinical features, proximal muscle weakness of

shoulder and hips, IGT, DM, osteoporosis, diagnostic tests, principles of management.

PRIMARY HYPERALDOSTERONISM: Conn’s syndrome, bilateral adrenal cortical hypertrophy,

clinical features, diagnostic tests and principles of management.

ADDISON’S DISEASE: Causes, clinical features, differentiation from secondary hypoadrenalism,

diagnostic tests and principles of management.

ADDISONIAN CRISIS: Causes, clinical presentation, diagnostic tests and principles of management

PHAEOCHROMOCYTOMA: Adrenal tumour and paraganglioma, rule of TEN, clinical features,

diagnostic tests and principles of management

ACROMEGALY: Aetiology, facial and other features, increased sweating, voice changes (hollow
voice), evidence of carpal tunnel syndrome, kyphosis, osteoarthritis, obstructive sleep apnoea,
hypertension, IGT, DM, diagnosis, principles of management

HYPOPITUITARISM: Causes of panhypopituitarism, clinical features, diagnostic tests and principles

of management.

DIABETES INSIPIDUS: Types, aetiology, clinical features, diagnostic tests, principles of management

RHEUMATOLOGICAL EXAMINATION OF HANDS

• Distribution of joint involvement, hand deformities, muscle wasting, palmar erythema, is the disease
active?
• Signs of inflammation of joints, range of movements of joints, functional status of the use of hands
for activities of daily living, evidence of nerve compression like carpal tunnel syndrome.
• Rheumatoid nodules in the forearm

26
• Features of psoriasis
• Features of gouty arthritis, presence of tophi
• Involvement of other joints in the limbs and axial skeleton
• Features of scleroderma and sicca syndrome

HAEMATOLOGICAL SYSTEM
• Clinical features and types of anaemia, polycythaemia, leukaemia, lymphoma
• Thalassaemia, types, features, facies, haemochromatosis
• Regional and generalized lymphadenopathy – differential diagnosis
• Gum hypertrophy, bleeding from gums
• Haemolytic anaemia, causes and diagnosis
• Splenomegaly, hypersplenism, hyposplenism, splenectomy
• Platelet disorders, immune thrombocytopenic purpura
• Koilonychia, brittle nails
• Features of hyperdynamic circulation in severe anaemia
• Features of bleeding tendency: gum bleeding, petechiae, purpura, ecchymosis
o Evidence of bleeding into joints and muscles, joint contractures
o Full blood count, blood film examination, bone marrow examination.

27
 GROUP A BST OR CASE SIMULATION DATE
S. NO MATRIC NO STUDENT NAME
1 2019-72654 ROXANNE ANAK RICHI
5 2020-73548 MELVIN JINAP ANAK PETER
9 2020-73613 MUHAMMAD FIRDAUS
13 2020-73834 SITI NUR 'AISYAH
16 2020-74116 ANGEL WONG YI WEN
22 2020-75333 KRISNA RAAJ A/L KUMARARAJA
24 2020-75397 LEE ZHI WEI
28 2020-76962 TAY HUI YIN

GROUP B BST OR CASE SIMULATION DATE

S. NO MATRIC NO STUDENT NAME
6 2020-73550 MICHELLE AK ALICE @ ELLAY
2 2020-73325 ALIF ROHAIMI BIN JOHNNY
10 2020-73679 NUR AISHAH BINTI FIRDAUS
14 2020-73838 SITI UMAIRAH BINTI ZULKEFLI
17 2020-74258 AZYAN HANNANY BINTI ASERI
20 2020-75185 JOANNA LAW YIH TING
29 2020-76971 TEE YAN XUAN
32 2020-77241 YVONNE HO KAR KIAT

28
 GROUP C BST OR CASE SIMULATION DATE
S. NO MATRIC NO STUDENT NAME
3 2020-73457 FATIN NURZAFIRAH
7 2020-73554 MOHAMAD HARITH
11 2020-73698 NUR BATRISYIA BINTI HOSSEN
15 2020-73851 SYARAFANA BINTI RAHMAN
18 2020-74409 CHEONG ZHEN YE
23 2020-75341 KUAN SHI MIN
25 2020-75981 NATASHA ANAK JOHNATTAN
27 2020-76611 RAJA SARAH NATASHA

GROUP D BST OR CASE SIMULATION DATE

S. NO MATRIC NO STUDENT NAME
4 2020-73537 MAGDELLEN ANAK DREAM
8 2020-73588 MUHAMAD IZZAT AKMAL
12 2020-73737 NUR SYAZANA BINTI ZAMZURY
19 2020-74709 ENG ZHI JIAN
21 2020-75309 KHOR ZHI WEN
26 2020-76159 NUR ARDIANA BINTI HAZLAN
30 2020-77021 TING SING YIE
31 2020-77099 VIMAL A/L GENGATHARAN
33 2020-77266 FATHIN ATHIRAH BINTI ISMAIL

29
 Year 3 - Rotation 2 MDP30209 - 2022/2023
Teaching: 2ND JANUARY 2023 – 19TH MARCH 2023
EOP: 13TH MARCH 2023 – 19TH MARCH 2023
WEEK 1 (INTRODUCTION TO CLINICAL EXAM)

TIME
CITY CAMPUS: BASIC INTRODUCTORY TO CLININCAL EXAMINATION
SLOTS
2/1/2023 0800-0900
Monday PUBLIC HOLIDAY (NEW YEAR REPLACEMENT HOLIDAY)
1000-1200
0800-1000 LHH 1 ENDOCRINOLOGY INTRODUCTION CLINICAL EXAM (SOL)
3/1/2023 1000-1100 LHH 2 ENDOCRINOLOGY INTRODUCTION CLINICAL EXAM (SOL)
Tuesday 1130 – 1300 BRIEFING BY DR AFFIZAL SAMSUDIN
1130 - 1300 AF 1 GASTROENTEROLOGY INTRODUCTON
PM CHB 1 CARDIOVASCULAR INTRODUCTION CLINICAL EXAM (SOL)
4/1/2023 0800-1000 CHAI 1 RESPIRATORY INTRODUCTION CLINICAL EXAM (ASOL)
Wednesday 1000-1200
5/1/2023 0800-1000 A YEOH 1 LOT 77 C AF2 SAMARAHAN FPSK
Thursday 1000-1200 B YEOH 2 LOT 77 D AF3 SAMARAHAN FPSK
PM
6/1/2023
0800-1000 CEZ 1 NEUROLOGY: INTRODUCTION AND CLINICAL EXAM
Friday
F2F: Face to face teaching. CS: Case Simulation CD: Case Discussion
ASOL: Asynchronous online learning: Group leader to liaise with respective lecturers on their available time
CITY CAMPUS: Case Discussion please liaise with respective lecturers on timing and method used (F2F/SOL)

SUPPLEMENTARY FINAL PROFESSIONAL EXAM WEEK (YEAR 5)

TIME
BST (SGH) BST (SGH) BST (PJS) BST (PJS) CASE DISCUSSION
SLOTS
9/1/2023 0800-
Monday 1000
10/1/2023 0800-
Tuesday 1000
11/1/2023 0800-
Wednesday 1000 SUPPLEMENTARY FINAL
12/1/2023 0800-
Thursday 1000 PROFESSIONAL EXAM (YEAR 5)
13/1/2023 0800-
Friday 1000

30
 WEEK 2 (LU: CARDIOLOGY AND RESPIRATORY)
TIME SLOTS BST (SGH) BST (SGH) BST (PJS) BST (PJS) CASE DISCUSSION

16/1/2023 0800-1000 C LHH 3 AB CCC 1

Monday 1000-1200 D LHH 4
PM A KJW 1 D CHIANG 1
17/1/2023 0800-1000 C CHIANG 2 B KJW 2 A LHS 1
Tuesday 1000-1200
PM CHB 2 CARDIOLOGY LECTURE
18/1/2023 0800-1000 A CHIANG 3 B LHS 2 CD CCC 2
Wednesday 1000-1200
PM CHB 3 CARDIOLOGY SEMINAR
19/1/2023 0800-1000 B CHIANG 4 CD DNG 1
Thursday 1000-1200
PM CHAI 2 RESPIRATORY LECTURE
20/1/2023 0800-1000 C CPH 1 D LHS 3 AB DNG 2
Friday 1000-1200
PM CHAI 3 RESPIRATORY SEMINAR

TIME SLOTS BST (SGH) BST (BST) BST (PJS) BST (PJS) CASE DISCUSSION
23/1/2023 0800-1000
Monday 1000-1200
PM
24/1/2023 0800-1000
Tuesday 1000-1200
PM
PM
25/1/2023 0800-1000
Wednesday 1000-1200 CHINESE NEW YEAR BREAK
PM
26/1/2023 0800-1000
Thursday 1000-1200
PM
27/1/2023 0800-1000
Friday 1000-1200
PM

31
 WEEK 3 (LU: GASTROENTEROLOGY & INFECTIOUS DISEASE)
CASE
TIME SLOTS BST (SGH) BST (BST) BST (PJS) BST (PJS)
DISCUSSION
30/1/2023 0800-1000 A AF 4 CD CEZ 2
Monday 1000-1200
PM C KJW 3 AB CEZ 3
31/1/2023 0800-1000 A WSY 1 (0900) D KJW 4 B JOSHUA 1
Tuesday 1000-1200 C KHAIRA 1
PM DNG 3 INFECTIOUS DISEASE LECTURE
1/2/2023 0800-1000 A JOSHUA 2 CD LHS 4
Wednesday 1000-1200
PM AF 5 GASTROENTEROLOGY LECTURE
2/2/2023 0800-1000 B WSY 2 (0900) C JOSHUA 3
Thursday 1000-1200 D KHAIRA 2
PM AF 6 GASTROENTEROLOGY SEMINAR
3/2/2023 0800-1000 D JOSHUA 4 AB LHS 5
Friday 1000-1200
PM DNG 4 INFECTIOUS DISEASE SEMINAR

WEEK 4 - MID SEMESTER QUIZ (HAEMATOLOGY)

TIME SLOTS BST (SGH) BST (SGH) BST (PJS) BST (PJS) CASE DISCUSSION

6/2/2023 0800-1000 A HG 1 D PT 1 AB LHH 8

Monday 1000-1200
PM HAEMATOLOGY LECTURE KJW 5
7/2/2023 0800-1000 A KHAIRA 3 B HG 2 CD CEZ 4
Tuesday 1000-1200
PM HAEMATOLOGY SEMINAR KJW 6
8/2/2023 0800-1000 C HG 3 B YEOH 3
Wednesday 1000-1200
PM C PT 2 D HG 4
9/2/2023 0800-1000 FORMAL QUIZ MDP30209 R2
Thursday 1000-1200 (MAKMAL KOMPUTER FPSK KOTA SAMARAHAN)
PM AB CEZ 5
10/2/2023 0800-1000 CD CHB 4
Friday 1000-1200
PM

32
 WEEK 5 (LU: ENDCRINOLOGY)
TIME SLOTS BST (SGH) BST (SGH) BST (PJS) BST (PJS) CASE DISCUSSION

13/2/2023 0800-1200 ENDOCRINOLOGY LECTURE LHH 6

Monday AM
PM C DNG 5 D CHAI 4 AB KJW 7
14/2/2023 0800-1000 ENDOCRINOLOGY SEMINAR LHH 7
Tuesday 1000-1200
PM B DNG 6 CD KJW 8
15/2/2023 0800-1000 A PT 3 D YEOH 4
Wednesday 1000-1200
PM CD LING 6
16/2/2023 0800-1000 C YEOH 5 B PT 4
Thursday 1000-1200
PM AB LING 7
17/2/2023 0800-1200 A CHAI 5
Friday PM
PM

WEEK 6 - CASE WRITE UP 2 & MPCA (LU: NEPHROLOGY)

TIME SLOTS BST (SGH) BST (SGH) BST (PJS) BST (PJS) CASE DISCUSSION

20/2/2023 0800-1000 CD LHH 9

Monday 1000-1200
PM A KJW 9
21/2/2023 0800-1000 B AF 7 CD CHB 5
Tuesday 1000-1200
PM NEPHROLOGY LECTURE YEOH 6
22/2/2023 0800-1000 A LHS 8 B CPH 2
Wednesday 1000-1200
PM AB CHB 6
23/2/2023 0800-1000 C YEOH 7 D DNG 7 AB AF 8
Thursday 1000-1200
PM
24/2/2023 0800-1000 C LHS 9 D CPH 3
Friday 1000-1200
PM NEPRHOLOGY SEMINAR YEOH 8

33
 Week 7 MPCA (LU: NEUROLOGY)

TIME SLOTS BST (SGH) BST (SGH) BST (PJS) BST (PJS) CASE DISCUSSION

27/2/2023 0800-1000 A LHH 10

Monday 1000-1200 B LHH 5
PM CEZ 6 NEUROOGY LECTURE
28/2/2023 0800-1000 C YEOH 9 B CHAI 6 D CHB 8
Tuesday 1000-1200 A CHB 7
PM CD KJW 10
1/3/2023 0800-1000 D YEOH 10 B CHB 9 C CEZ 7
Wednesday 1000-1200
PM AB LHS 10
2/3/2023 0800-1000 AB CHB 10
Thursday 1000-1200
PM CEZ 8 NEUROLOGY SEMINAR
3/3/2023 0800-1000 CD CHAI 7
Friday 1000-1200
PM

Week 8 (LU: RHEUMATOLOGY)

TIME SLOTS BST (SGH) BST (SGH) BST (PJS) BST (PJS) CASE DISCUSSION

6/3/2023 0800-1000 B LHH 11 A CPH 4 C LHS 11

Monday 1000-1200
PM DNG 8 RHEUMATOLOGY LECTURE
7/3/2023 0800-1000 C CHAI 8 D YEOH 11 AB AS 1
Tuesday 1000-1200
PM DNG 9 RHEUMATOLOGY SEMINAR
8/3/2023 0800-1000 A DNG 10 CD AF 9
Wednesday 1000-1200
PM
9/3/2023 0800-1000 B CEZ 9 CD AS 2
Thursday 1000-1200
PM
10/3/2023 0800-1000 D CEZ 10 AB CHB 11
Friday 1000-1200
PM

34
 WEEK 9 END OF POSTING EXAMINATION
TIME
SLOTS
0830-0920 OSCE (10 QUESTIONS)
13/3/2023 0930-1010 SAQ (4 QUESTIONS)
MAKMAL KOMPUTER GROUND FLOOR
Monday 1030-1210 MEQ (5 QUESTIONS)
UNIMAS MAIN CAMPUS
1400-1440 MCQ (20 QUESTIONS)
1450-1540 BAQ (20 QUESTIONS
14/3/2023 0800-1000
Tuesday 1000-1200
PM
15/3/2023
Wednesday 0800-1200 CLINICAL SBCE CSL/PBL UNIMAS CITY CAMPUS

16/3/2023
Thursday 0800-1200 CLINICAL SC CSL/PBL UNIMAS CITY CAMPUS

17/3/202 0800-0900
Friday 1000-1200
PM

35
 POINTS TO PONDER

“Medicine is learned at the bedside and not in the classroom”. (Sir William Osler)

“More mistakes are from want of a proper examination than for any other reason”.
(Russel John Howard)
Even though sophisticated investigative methods are available today, it will not – should not
– replace clinical skills and bedside medicine. (Hutchison’s Clinical Methods) “The greatest
mistake you can make in life is continually to be fearing you will make one”.
(Elbert Hubbard)
“Love is a fruit in season at all times, and within the reach of every hand”. (Mother Theresa) “You are not
mature until you expect the unexpected”.
(Oliver Wendell Holmes Sr)
Writing down your thoughts is the best way to clarify them. PT

Be a doctor not a reporter, explore further the details of patient’s history. PT

If you aspire to be an efficient and competent doctor, start behaving like one. PT

Disclaimer

Your learning in this posting will largely depend on the number of patient you clerk and study.
Clerking cases only for BST is a sure recipe for failure. Do not expect a systematic teaching in this
posting, learning in bits and pieces is the rule.

Posting Coordinator

36
 MDP30209 ROTATION 2
MATRIC
S. NO. STUDENT NAME
NO.
1 2019-72654 ROXANNE ANAK RICHI
2 2020-73325 ALIF ROHAIMI BIN JOHNNY
3 2020-73457 FATIN NURZAFIRAH BINTI MOHAMAD SALIM
4 2020-73537 MAGDELLEN ANAK DREAM
5 2020-73548 MELVIN JINAP ANAK PETER
6 2020-73550 MICHELLE AK ALICE @ ELLAY
7 2020-73554 MOHAMAD HARITH BIN MOHAMAD HASROMIA
8 2020-73588 MUHAMAD IZZAT AKMAL BIN ZULSUFANAN
9 2020-73613 MUHAMMAD FIRDAUS BIN RAFANDI
10 2020-73679 NUR AISHAH BINTI FIRDAUS
11 2020-73698 NUR BATRISYIA BINTI HOSSEN
12 2020-73737 NUR SYAZANA BINTI ZAMZURY
13 2020-73834 SITI NUR 'AISYAH BINTI MUHAMAD SUHAIMI
14 2020-73838 SITI UMAIRAH BINTI ZULKEFLI
15 2020-73851 SYARAFANA BINTI RAHMAN
16 2020-74116 ANGEL WONG YI WEN
17 2020-74258 AZYAN HANNANY BINTI ASERI
18 2020-74409 CHEONG ZHEN YE
19 2020-74709 ENG ZHI JIAN
20 2020-75185 JOANNA LAW YIH TING
21 2020-75309 KHOR ZHI WEN
22 2020-75333 KRISNA RAAJ A/L KUMARARAJA
23 2020-75341 KUAN SHI MIN
24 2020-75397 LEE ZHI WEI
25 2020-75981 NATASHA ANAK JOHNATTAN
26 2020-76159 NUR ARDIANA BINTI HAZLAN
27 2020-76611 RAJA SARAH NATASHA BINTI RAJA PUTRA
28 2020-76962 TAY HUI YIN
29 2020-76971 TEE YAN XUAN
30 2020-77021 TING SING YIE
31 2020-77099 VIMAL A/L GENGATHARAN
32 2020-77241 YVONNE HO KAR KIAT
33 2020-77266 FATHIN ATHIRAH BINTI ISMAIL
34
35
36
37
38
39
40

37
Faculty of Medicine and Health Sciences
Department of Medicine

https://eleap.unimas.my/

38