Clival chordoma is a rare malignant tumor of the brain that typically occurs in older adults. It has a high local recurrence rate and is hence associated with poor prognosis. Here, we report a case of an adolescent who presented with a 1-month history of worsening headache and blurring of vision, as well as a 6-month history of left-sided facial and body numbness. Clinical findings were consistent with left upper motor neuron lesion of the seventh cranial nerve with involvement of the fifth cranial nerve. He was also found to have a sixth cranial nerve palsy demonstrated by diplopia upon lateral gaze with no evidence of papilledema. Magnetic resonance imaging of the brain suggested clival chordoma. He was subsequently referred to the neurosurgical team, and he successfully underwent an endoscopic trans-sphenoidal surgery to excise the lesion. He recovered well, continued his follow-ups with the neurosurgical team, and showed good progress. He also attended regular follow-ups with his primary care physician to ensure ongoing psychosocial support and monitoring of his overall health status. This case demonstrates the importance of prompt identification and treatment of clival chordoma in an adolescent. Long-term follow-ups and shared care between primary and secondary care physicians are essential to monitor recurrence of tumor and to provide psychosocial support.

Superior vena cava (SVC) syndrome can be fatal if not discovered early. Most SVC syndrome presentations are related to malignancies; lung cancer in particular. The presentations may vary, depending on severity of SVC obstruction. We report a case of mild SVC syndrome of a 70-year-old gentleman who presented with a one-month history of intermittent plethora and facial puffiness. Computed tomography scan of the chest revealed superior mediastinal mass which may represent matted lymph nodes obstructing SVC with bilateral pleural and pericardial effusion. Biopsy of the mass was done, and non-small cell lung carcinoma was diagnosed. Clinical presentation, differential diagnoses and issues relating to SVC syndrome were discussed with the emphasis on early recognition of mild symptoms and prompt management.

Introduction: The COVID-19 pandemic has significantly changed the learning environment for medical students and affected their academic achievement. This study aims to determine the student’s clinical competency, learning environment, and its associated factors during the primary care medicine posting amid the COVID-19 pandemic. Methods: This is a cross-sectional study among medical students who had completed primary care medicine posting during the COVID-19 pandemic. Data on socio-demographic, posting characteristics, and students’ learning environment using the Dundee Ready Educational Environment Measure (DREEM) questionnaire and their objective structured clinical examination (OSCE) marks were collected. Independent t-test was used to compare DREEM scores between face-to-face and online groups. Multivariate analysis was used to determine factors associated with clinical competency and DREEM scores with p <0.05 considered significant. Results: A total of 205 students were recruited. Only 9.8% failed OSCE. Face-to-face teaching delivery (OR=3.61, 95 CI =1.03,11.30), face-to-face precept method (OR=1.24, 95 CI =1.12,12.51) and integrated curriculum (OR=5.23, 95 CI =1.03,26.47) were associated with good clinical competency. The total mean DREEM score was 72.94 (SD 28.8), with 89.3% having poor DREEM scores. Students who received face-to-face teaching scored higher in the Student’s Perceptions of Teacher domain compared to online teaching (p =0.036). Conclusion: Face-to-face teaching is preferred for good clinical competence and a learning environment. The impact of experiential learning was huge in our study, and it cannot be replaced by online learning. Furthermore, retraining teachers will improve the online learning experience for the students.