Unusual cause of resistant hypertension in a 33-year-old woman with a palpable parathyroid nodule.

A 33-year-old woman presented for investigation for a secondary cause of her long-standing treatment-resistant hypertension. Physical examination revealed a palpable thyroid nodule with subsequent ultrasound and CT scan indicating the nodule was of parathyroid origin. A palpable parathyroid nodule is known to be highly suspicious for a parathyroid carcinoma, and it remains a differential until proven otherwise. Histopathology following surgical excision confirmed a parathyroid adenoma, and during subsequent follow-up visits with her general practitioner, her antihypertensive was successfully weaned. We report a case of a large palpable parathyroid adenoma being the secondary cause of treatment-resistant hypertension.

Reflecting on exchange students' learning: Structure, objectives and supervision.

Background and aim: The increasing opportunities for medical students to participate in international electives may improve students' professionalism and cultural competence. However, the students' overall experiences may be unpredictable, unstructured and lack supervision. There is scant evidence with respect to their learning outcomes. These reflections demonstrate that short-term supervised elective can provide students with structured learning experiences to achieve specific learning objectives.Methods: We carried out daily debriefs and a weekly summary with seven Curtin Medical School students from Perth, Australia during an 18-days supervised elective in the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. The daily debriefs and the weekly summary in different disciplines become the content of the reflections discussed in this article.Results: The main themes identified in the feedback were as follows: Skills in history taking and physical examination; clinical reasoning; diagnosis and management of diseases rarely seen in Australia; awareness of clinical ethics; merits and demerits of different systems of healthcare; sensitivity to issues in doctor-patient relationships; work ethics; enhancement of cultural competence; and personal development.Conclusions: These reflections provide insight into how overseas electives may be structured to improve students' clinical reasoning skills in this hospital. These students achieved their learning outcomes under joint supervision from both institutions. The clinical skills learned from these experiences enhanced the students' professionalism and cultural competence, giving students the opportunities to appreciate the multitude healthcare model of bio-psycho-social-political-economical-spiritual dimensions.