PBL CASE OUTLINE AND FACILITATOR GUIDE

Case Name: Stress

Year, Semester,
Case:
Y2, S3, C1
S3c1
Links to previous Y1, S1, C12: Depression, neuronal drug action, pharmacodynamics,
cases: pharmacokinetics
Y1, S1, C9: Endocrine system
Y1, S1, C11: Cardiovascular system
Y1, S2, C7: Sleep physiology
Context:
The case revolves around a junior doctor experiencing work-related stress. In the SS
theme, the main focus is on the neuro-endocrine response to stress and the
autonomic nervous system and the endocrine system. Much of the HAP content
for the case overlaps with the SS focus on the stress response and is focussed on
what aspects of social environment generally produce increased cortisol levels,
the rising incidence of stress as a health risk factor in advanced industrialised
nations and behavioural interventions for stress management. The Practitioner
theme content for the case is related to consultations involving mental health and
testing and diagnosis of undifferentiated complaints.

Learning outcomes: At the end of this case, Learning activity and resources
students should be able to:
Scientist and Scholar LOs 1-6, HAP LOs 1-5
1. Describe the major endocrine glands, 3hr Workshop: The physiologic response to stress
identifying their anatomical locations and (Gary Hamlin)
nerve and blood supply (PBL case, LGRS, • Station-based session; half cohort split
Workshop) • Role of hypothalamus
2. Describe the key structures and functions • HPA axis and cortisol
of the autonomic nervous system (PBL
case, LGRS, Workshop) LO 2
3. Explain the role of the endocrine and 1.5hr LGRS: Introduction to key structures and
nervous system in the regulation and functions of the autonomic nervous system
coordination of organ system function (PBL (Athanasios Raikos)
case, LGRS, Workshop) • Divisions of ANS
4. Explain the role of the hypothalamus in the • Anatomy of the ANS
coordination of output from the nervous • Sympathetic vs Parasympathetic
system and the pituitary glands (PBL case, • Sympathetic pathways
LGRS, Workshop) • Referred pain
5. Explain the general neuroendocrine
response to stressors (PBL case, LGRS, LOs 3-7
Workshop) 90min LGRS: The cortisol-mediated stress
6. Describe the role of the adrenal gland in response and its significance (David Waynforth)
response to stress (PBL case, LGRS, • Diurnal variation in cortisol
Workshop)
• Work-related stress and cortisol
7. Explain the pattern of secretion of cortisol
• Relationships between cortisol and blood
and adrenaline in response to acute and
pressure
chronic stress (PBL case, LGRS, Workshop)
8. Explain how pharmacological modulation
LO 8
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Case and Facilitator Guide: S3c1 | 2018 15/01/2018 1:29:00 PM
 of the ANS drives functional change (LGRS,
Workshop)
9. Review the physiology of sleep (Y1S2C7)
ADJUSTMENTS FOR 2018
COMMONWEALTH GAMES
1. Describe the structure and the function of the
thyroid gland and the actions of thyroid
hormones (PBL case, Self-study)
2. Interpret thyroid function tests and outline
strategies for managing hypo- or hyper-
thyroid diseases (PBL case, Skills)
3. Discuss the concept of BMR (basic metabolic
rate) as a physiological indicator (PBL case,
Workshop)
4. Describe common pathological conditions of
the thyroid and parathyroid gland
5. Describe the pharmacology of drugs for
managing hypo- and hyperthyroidism
Case and Facilitator Guide: S3c1 | 2018
50min LGRS: Introduction to drug action in the
autonomic nervous system (David Pache)
• Adrenergic system
• Drugs and the SNS
• Receptors and subtypes
• Alpha-antagonists
• Beta-adrenergic receptors and agonists
• Muscarinic receptors and agonists
• Beta-adrenergic receptors
LOs 1,2,8
3hr Workshop: Exploring key structures and
functions of the autonomic nervous system and
identifying pharmacological targets of the ANS to
drive functional change (Athanasios Raikos/Allan
Stirling/David Pache/Russ Chess-Williams)
• Half cohort split
LOs 1,2
Self-study: Structure and function of the
endocrine organs (Athanasios Raikos)
• Anatomy/physiology/histology
• Hypothalamus; Pineal gland; Pituitary
gland; Thyroid gland; Parathyroid gland;
Heart; Thymus; Kidney; Adrenal glands;
Adipose tissue; Digestive tract; Pancreatic
islets; Gonads
Self-study websites:
• http://www.beyondblue.org.au/
• https://labtestsonline.org/
ADJUSTMENTS FOR 2018
COMMONWEALTH GAMES
LO 1
50 min LGRS: Thyroid gland and thyroid hormones
(Gary Hamlin)
LO 1
Self-study (Vodcast): Anatomy of the thyroid and
parathyroid glands (Allan Stirling)
LO 1, 5
90 min/hr Workshop: Exploring thyroid hormone
(Gary Hamlin)
LO 4, 6
90 min Tutorial: Common pathological conditions
of thyroid and parathyroid gland (Gordon Wright)
LO 7
Self-study (VOPP): Pharmacology of drugs for
hypo- and hyperthyroidism (Treasure McGuire)
Worksheet and practice MCQs
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Practitioner
nil
Health Advocate and Professional
1. Consider the direct and indirect effects of
social support upon health outcomes
(LGRS)
2. Recognise the need for personal wellness
as a doctor (PBL case, LGRS, S2C6 LGRS)
3. Recognise the duty to seek professional
help and not self-treat medical or mental
health problems (LGRS; S2C6 LGRSs)
4. Identify support services for medical
students and physicians, as well as barriers
to seeking support services (PBL case,
LGRS)
Program sessions
Please note that the ‘links to cases’ section of this document is for guidance only and may not be complete.
You may want to review this section within your PBL group or as part of your self-study.
Case and Facilitator Guide: S3c1 | 2018
LO 4
Reading: Thyroid function tests
Mortimer RH. Thyroids function tests. Australian
Prescriber 2011;3 4:12-5
Self-study: Introduction to history-taking in
semester 3 (Julie Danesi)
Self-study: Revise history checklists and consider
reviewing Year 1 practitioner podcasts
LOs 1-4
50min LGRS: Physician wellness (Margaret Kay)
• Identify common problems relating to
medical student and physician mental
health
• Identify support services for medical
students and physicians, as well as barriers
(including stigma) to seeking support
services
• Continue to build self-management skills to
decrease worry and burnout and increase
resilience and work-life balance
2hr LGRS: Welcome to Year 2 (Athanasios
Raikos/Neelam Doshi/Christian Moro/Anne
Spooner/David Waynforth/Richard
Matthews/Michelle McLean)
90min LGRS: Placement orientation (Christine
Sly/Kelly Jenkings/Odette Smith/Patricia Green)
*Compulsory session
2hr: Compulsory practice exam 1 (includes End of
semester assessment review) (Athanasios
Raikos/Carmel Tepper/Neelam Doshi)
*Compulsory session
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