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Medicine: Portfolio Tasks Essay

Portfolio Task: Module 1
“Effective study skills are the sole foundation of a sound education”.

Study skills or study strategies are approaches applied to learning. They are generally critical to success in school, considered essential for acquiring good grades, and useful for learning throughout one’s life.

Study skills are fundamental to academic competence. Effective study skills are associated with positive outcomes across multiple academic content areas and for diverse learners. Study skills improve the competences associated with acquiring recording, organizing, remembering and using information. These skills also contribute to success in both employment and non – academic settings. Studying is often an individual activity and what works for one student with regards to study may not work for someone else. Self regulation is an important aspect of study skills. Having the ability to goal set, work towards deadlines and have persistence in the subject the student is studying will help achieve success. In effect good studiers are good strategy users, they know how to use a variety of goal specific tactics, to execute them in a planned requence and monitor their use.

A sufficient amount of time needs to be dedicated to studying to achieve the best outcome. Effective study skills may also help with issues such as confidence and organisational skills which are used in every day activities some students take notes whilst they are reading to help them understand what they are reading. Others students may wish to “think about” as it helps students to understand and retain information. Many students find that by repeating information they retain it. There is little doubt that no two people study the same way, and it is a near certainty that what works for one person may not work for another. The results of poor study skills are wasted time, frustration, and low or failing grades. It’s your life, your time, and your future. Effective study skills must be practiced in order for you to improve. It is not enough to simply “think about” studying; you have to actually do it, and in the process use information from what you do to get better.

http://psychcentral.com/lib/top-10-most-effective-study-habits/000599 http://www.adprima.com/studyout.htm
http://www.palgrave.com/skills4study/studyskills/learning/effective.asp http://en.wikipedia.org/wiki/Study_skills

Portfolio Task: Module 2
“Briefly describe the importance of the interaction between the respiratory and cardiovascular systems in maintaining the body s internal balance”.

When you breathe in air through your mouth and nose it travels to your lungs. Oxygen from the air is absorbed into your bloodstream through your lungs. Your heart then pumps oxygen-rich (oxygenated) blood through a network of blood vessels (arteries) to tissues including your organs, muscles and nerves, all around your body. When blood reaches the capillaries in your tissues it releases oxygen, which cells use to function. Cells release waste products, such as carbon dioxide and water, which your blood absorbs and carries away. The used (deoxygenated) blood then travels through your veins and back towards your heart. Your heart pumps the deoxygenated blood back to your lungs, where it absorbs fresh oxygen, releases the carbon dioxide and the cycle starts again. The primary function of the respiratory system is to supply the blood with oxygen in order for the blood to deliver oxygen to all parts of the body. The respiratory system does this through breathing. When we breathe, we inhale oxygen and exhale carbon dioxide.

This exchange of gases is the respiratory system’s means of getting oxygen to the blood. Respiration is achieved through the mouth, nose, trachea, lungs, and diaphragm. Oxygen enters the respiratory system through the mouth and the nose. The oxygen then passes through the larynx (where speech sounds are produced) and the trachea which is a tube that enters the chest cavity. In the chest cavity, the trachea splits into two smaller tubes called the bronchi. Each bronchus then divides again forming the bronchial tubes. The bronchial tubes lead directly into the lungs where they divide into many smaller tubes which connect to tiny sacs called alveoli. The average adult’s lungs contain about 600 million of these spongy, air-filled sacs that are surrounded by capillaries. The inhaled oxygen passes into the alveoli and then diffuses through the capillaries into the arterial blood. Meanwhile, the waste-rich blood from the veins releases its carbon dioxide into the alveoli. The carbon dioxide follows the same path out of the lungs when you exhale. The diaphragm’s job is to help pump the carbon dioxide out of the lungs and pull the oxygen into the lungs.

The diaphragm is a sheet of muscles that lies across the bottom of the chest cavity. As the diaphragm contracts and relaxes, breathing takes place. When the diaphragm contracts, oxygen is pulled into the lungs. When the diaphragm relaxes, carbon dioxide is pumped out of the lungs. The cardiovascular system is part of the larger circulatory system, which circulates fluids throughout the body. The circulatory system includes both the cardiovascular system and the lymphatic system. The cardiovascular system moves blood throughout the body, and the lymphatic system moves lymph, which is a clear fluid that’s similar to the plasma in blood. Blood contains nutrients from the foods you eat and oxygen from the air you breathe. It also contains hormones and cells that fight infection. The blood also transports waste products to various places that then promptly remove the waste from the body. The parts of the cardiovascular system include the heart, which is the organ that pumps the blood, and a network of blood vessels:

Arteries: The blood vessels that take blood away from the heart Veins: Blood vessels that return blood to the heart

Capillaries: Very small vessels that lie between the arteries and veins The portal vein and its tributaries carry blood from parts of the digestive system to the liver before reaching the heart. The heart is a muscular pump with four chambers inside: the right and left atria and the right and left ventricles.

Those four chambers allow the heart to pump blood through the following two circulatory pathways:

Systemic circulation: Takes oxygen-rich blood to the tissues and organs of the body Pulmonary circulation: Takes oxygen-depleted blood to the lungs and oxygen-rich blood back to the heart again.

1. The left ventricle of the heart receives oxygenated blood from the left atrium.

2. Blood is ejected from the left ventricle into the aorta, a large artery. The ascending aorta sends blood to the upper thorax, upper extremities, neck, and head. The descending aorta sends blood to the lower thorax, the abdomen, the pelvis, and the lower extremities.

3. The blood leaves the ascending and descending parts of the aorta and enters a network of systemic arteries that run to all places of the body.

4. Blood passes from the smallest arteries (called arterioles) into the capillary beds. In the capillary beds, blood exchanges oxygen, nutrients, and waste products with the tissues.

5. The oxygen-poor blood leaves the capillary beds via small veins (called venules) and drains into a network of systemic veins that eventually lead to the venae cavae (either of the two large veins leading into the heart). The superior vena cava receives blood from the upper thorax, head, neck, and upper extremities. The inferior vena cava receives blood from the lower thorax, the abdomen, the pelvis, and the lower extremities.

6. The venae cavae empty the oxygen-poor blood into the right atrium of the heart. After systemic circulation, the blood in the right atrium is depleted of oxygen, so it needs to go to the lungs to exchange carbon dioxide for oxygen.

The pathway from the heart to the lungs and back to the heart is called pulmonary circulation, and it takes the following path:

1. The right ventricle receives the oxygen-depleted blood from the right atrium.

2. The blood leaves the right ventricle and enters the pulmonary trunk, which splits into two pulmonary arteries.

3. The pulmonary arteries lead to the lungs, where exchange of gases takes place. Carbon dioxide is removed from the blood, and oxygen enters the blood.

4. Blood leaves the lungs via the pulmonary veins. The pulmonary veins carry freshly oxygenated blood to the heart while the systemic veins carry oxygen-poor blood to the heart.

5. The oxygenated blood enters the left atrium of the heart. The blood in the left atrium moves into the left ventricle and enters the systemic circulation.


Portfolio Task: Module 3
“When you ask a patient to plantar flex a foot, what changes occur within the muscles involved?”

Plantar flexion is the movement which increases the approximate 90 degree angle between the front part of the foot and the skin, as when depressing an automobile pedal or standing on the tip toes. The movement in the opposite direction is dorsifexion, where the dorsal part (top) of the foot is moved in a manner towards the tibia. It ocurs at the ankle. The range of motion for planter flexion is usually indicated in the lterature as 30 to 40 degree, but sometimes also 50 degree. The nerves are primarily from the sacral spinal cord roots S1 and S2. Compression of S1 roots may result in weakness in plantar flexion. These nerves run from the lower back to the bottom of the foot. Plantar flexion is the movement of the foot away from the body by bending the ankle.

The joints in the ankle are highly involved in plantar flexion. Ankle movement is made possible by the meeting of three bones: tibia (shinbone or leg), fibula (the small bone in leg) and the talus (a large bone in foot). The end of tibiaconstitutes the inner postion of the ankle, wheareas the outer portoon of the ankle is formed by fibula. The ony bulges on either side of toe ankle are called malleoli which aid is stability of the ankle, joints while standing or walking.

Primary muscles for plantar flexion are:

Posterior compartment of leg
Plantaris (only weak participation)
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior
Lateral compartment of leg (only weak participation)
Fibularis longus
Fibularis brevis


Portfolio Task: Module 4
“A patient comes in with a hot inflamed toe, how does the circulatory system contribute to this process?”

When inflammation occurs in the toes it can be caused by a number of conditions, such as gout, rheumatoid arthritis, bunions, bursitis, or ingrown toenails. Toe inflammation is typically a protective measure that the body takes in reaction to injury or the presence of bacteria. This is generally a normal occurrence and it is a part of the natural way that the body heals. It may also be incorrectly triggered by certain conditions or diseases. Gout, which is a type of arthritic condition, is one of the more common causes of toeinflammation. Symptoms of gout often affect the big toe, in which case it may be referred to as podagra. The inflammation is a result of excess uric acid building up in the toe joint. Inflammation that is caused by gout is often seen in people who are overweight, diabetic, havekidney disease, or that are taking certain medications. Toe inflammation may also be caused by the autoimmune disease known as rheumatoid arthritis.

For people with this condition, their body’s immune system attacks tissue that is healthy as opposed to responding to injury or bacteria. When this occurs at the toe joints, the result is inflammation. Eventually this will cause other toe problems that can lead to changes that affect a person’s ability to walk and wear most types of shoes. Inflammation is at the root of the most serious complications that occur after infection and injury. But while the course of molecular events leading to microbial infection of the inflammatory condition called sepsis is fairly well understood, is much less clear how and why physical injury can result in an inflammatory response similar dangerous. The process of acute inflammation is initiated by cells already present in all tissues, mainly resident macrophages, dendritic cells, histiocytes, Kupffer cells and mast cells.

At the onset of infection, burns or other injury, these cells are activated and release inflammatory mediators responsible for clinical signs of inflammation. Vasodilation and increased blood flow resulting causes redness (rubor) and heat gain (heat), increased permeability of blood vessels produce an exudation (output) of plasma proteins and fluid in the tissues (edema), which manifests as a swelling (tumor). Some of the released mediators such as bradykinin increased pain sensitivity (hyperalgesia, pain). Mediator molecules also alters the blood vessels to allow migration of leukocytes, primarily neutrophils, outside the blood vessels (extravasation) in the tissue. Neutrophils migrate along a chemotactic gradient created by local cells to reach the site of injury. The loss of function (functio Laesa) is probably the result of a neurological reflex in response to pain. In addition to cell-derived mediators, several acellular biochemical cascade systems is preformed plasma proteins act in parallel to initiate and propagate the inflammatory response. These include the complement system activated by the bacteria, and the systems of coagulation and fibrinolysis activated by necrosis, such as a burn or trauma.

Human tissues respond to trauma by a complex series of events that have yet to be fully understood. This trauma may be mechanical, thermal, photo or chemical, or brought about through allergic or autoimmune events. If blood vessels have been injured, damaged platelets will activate the clotting cascade. Damaged tissues will release chemical messengers, which start the inflammatory process. In health, sequential phases of proliferation, maturation and repair of the damaged tissue follow inflammation. Blood cells and platlets, the immune system and nerves, chemical transmitters, and tissue cells such as macrophages are among the tissues and systems involved in inflammation. The molecular and cellular events during inflammation flow into and overlap with one with the other. Initially, neutrophils arrive, followed by macrophages, lymphocites and then fibroblasts, which lay down collagen. Epithelial cells migrate on from wound edges over the newly laid down dermis and healing is complete. Healing by first intention will close over 2 – 5 days; a wound healing by second intention will take longer, the time taken depending on the tissue area that needs to be filled in and covered. The predominance and sequence of mediator release will allow different types of inflammatory response to occur.

The classic and clinical features of inflammation are redness, heat, swelling and pain; loss of function is sometimes included in this list. These features are brought about through chemical/inflammatory mediators released from damaged tissues. The main effects of these mediators are on the blood supply, causing vasodilation (redness and heat) and increased blood vessel permeability that allow plasma proteins and immunoglobulins to pass easily into the tissues. Pressure or nerve endings from the interstitial fluid and the effect of some inflammatory mediators such as substance P and prostaglandins cause pain.

Hot inflamed toe it is might be acute or chronic inflammation. Acute inflammation is the initial response of the body to harmful stimuli and is by the increaced movement of plasma and leukocytes from the blood into the injured tissues. A coscade of biochemical events propagates and matures the inflammatory response, involving the local vascular system, the immune system, and various cells within the injured tissue.

Chronic inflammation leads to a progressive shift in the type of cells present at the site of inflammation and is characterized by simultaneous destruction and healing of the tissue from the inflammatory process.

The respiratory system gets the oxygen it needs and the circulatory system bring the oxygen along with many other products in the blood to the toe. The digestive system helps obtain nutrients for the toe which the blood brings as part of the circulatory system.

http://lyceum.algonquincollege.com/lts/AandPResources/videos/2-4_Inflammatory.html http://en.wikipedia.org/wiki/Inflammation

http://www.researchomatic.com/essay/Role-Of-Circulatory-System-Inflammatory-Response-56305.aspx http://www.wisegeek.com/what-causes-toe-inflammation.htm

Portfolio task: Module 5
“Discuss the possible presenting symptoms after a hard knock on the leg in the area behind the knee”.

A hard knock on the leg to the area behind the knee would certainly be painful. A hard knock to the posterior of the knee could cause many symptoms, depending on the severity of the hit and how long ago it occured. The knee could be swollen or bruiced. Range of motion may be less, or painful. The person may limp or be unable to fear weight. The kneecap could be displaced. The patient will likely complain of moderate to severe pain. Because the knee is not meant to be hyper-extended, the person should go to an ER for X-ray or other imaging. Might be the inability to properly bend or straighten the knee. Elevate the leg. Alternate between warm moist heat and ice. To help keep the swelling is check, use an ace bandage to supportthe knee. Dont wrap so tightly that it causes indentantion in the skin.

Area behind the knee called the popliteal forsa. The nerves most important nerve travelling throught this area is the popliteal nerve that travels to the lower leg and foot and allowing both sensation and motor strength. Injury to the popliteal nerve can cause numbness, tingling, pain, and weakness in the lower leg, ankle and foot.

Vascular injury could cause a bleed from either popliteal artery or vein causing a hematoma or blood pool that could causesignificant pain in the area. The main types of injury could include soft tissue, muscle, nerve and artery/vein , ligaments and menesci. A skin and soft tissue injury could include a mild contusion with some redness or brusing. Serathes may occur. If there is a deeper penetration and not appropriate would care, an infection could form causing a skin and soft tissue infection known as a cellulitis.

Injury to the muscle could include a tear of the plantaris muscle which travels throught the area of the popliteal fossa. tear of this muscle will not result in too much deformity or motor deficits, but can cause significant pain.

The hamstrings insert near the region of the popliteal fossa and could be affected as well causing pain, but unlikely deformity or decreased range of motion. Damage to the ligaments can result in severe pain and disability. The posterior cruciate ligament and the lateral ligaments: the medial collateral ligament and the lateral collateral ligament commonly occur with injury during sports and can cause severe disabling pain and motor dysfunction. These are the main ligaments that allow for smooth motion during knee flexion and extension and a tear which occurs commonly often requires invasive surgical repair.

Finally the menisci which are cartilaginous structures found inside the knee joint that allow for smooth movement of the bones in the leg. A meniscal tear can occur in a sports accident as above with the ligamentous injuries and cause significant pain and decreased range of motion at the knee. This may likewise require surgical evaluation and correction to restore function and eliminate pain. Because the knee is a complicated region and the back of it has many important structures including veins, arteries, nerves, and muscle components, a hard knock to the knee can be extremely debilitating and should be avoided whenever possible. Protection of the knee with appropriate gear is critical when dangerous activities are being attempted.



Portfolio Task: Module 6
Write a proparly referenced essay on the treatment and management of a patient with corns

When we walk or stand or body weigh is carried first on the heel and then on the ball of the foot where the skin is thicker to withstand the pressure. When this pressure becomes intense, growth in the form of corns and callus may appear. Corns always occur over a bony prominence, such as a joint.

A corn is a small areas of hard skin, roughly round in shape, which press into the skin. They are often found over high-pressure areas of the foot. There are five different types of corns. The two most common are hard and soft corns. Hard corns the most common and appears as small, concentrated areas of hard skin up to the size of a small pea, usually within a wider area of thickened skin or callous, and can be symptoms of feet or toes not functioning properly.

Soft corns develop in a similar way to hard corns. They are whitish and rubbery in texture, and appear between toes, where the skin is moist fromsweat or from inadequate drying. A podiatrist will be able to reduce the bulk of the corns and apply antringents to cut down on sweat retentionbetween the toes.

If a corn is left untreated it will become painful. A corn will not get better on its own unless the pressure that originally caused the corn is removed. If the cause is not removed then the skin will continue to thicken and become more painful.

After some time the body may treat the corn as a foreign body and an ulcer or abscess could develop. These can be serious, especially if they become infected. Infection is a very serious complication for individuals with diabetes, poor circulation and peripheral neuropathy. There are many over the counter corn remedies and plasters that are readily available. These, however, do not treat the cause of the corn and can be risky in many individuals such as those with diabetes, poor circulation, frail skin etc.

Podiatric management of corns at Podiatry includes:

a thorough assessment to determine the cause of the corn
implementation of a management / treatment plan
Management plans for the treatment of corns commonly consist of: maintenance appointments to keep the corn reduced
use of padding to prevent the pressure
footwear fitting advice
provision of foot orthotics or supports to relieve the pressure under the foot surgical correction of the bony prominence that may be causing the high pressure area

Most corns and calleures gradually disappear when the friction or preassure stops, although doctor (cheropodist) may shave the top of a calleus to reduce the thickners. Properly positionece moleskin pads can help relieve pressure on a corn. There are also special corn and callus removal liquids and plasters, usually containing saliaytic acid, but there are not suitable everyone. Oral antibiotics generally clear up infected corns, but pus may have to be drained through a small incision.

Moisturising creams may help the skin and remove cracked callures. Apply the misturiing cream to the callus and cover the area for 30-60 minutes with a plastic bag or a rock. Than gently rub off as much of the callus as you can with a worm towel or soft brush. Using the pumice stone first to rub off a dead skin from a callus after a bath or shower and talk applying moisturaising cream can also be effective.

There are also stronger creams containing urea that might be more effective, but do not use these unless recommended by doctor or cheropodist. May consider surgery to remove a planter callus, but there are no guarantees that the callus will not come back. A conservative approach is best initially. Keep your feet dry and friction – free. Wear proparly fitted shoes and cotton socks, rather then wool or synthetic fibres that might irritate the skin. If a podiatrist thinks your corn or callus i caused by abnormal foot structure your walking motion or hip rotation, orthopaedic shoe inserts or surgery to correct foot deformitie may help correct the problem. When complete reduction of the corn is achievied than 25% or 50% silver nitrate solution may be applied.

Example of products that can be used to treat corns and callus include:

special rehydratation creams for thickened skin;
protective corn plasters;
customosed soft padding or foam insoles;
small foam wedges that are placed between the toes to help relieve soft corns;

special silicone wedges that change the position of your toes or redistribute pressure.


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