Clerkship Study Guide
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Clerkship Study Guide |
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TABLE OF CONTENTS
OVERVIEW 2
DIAGNOSIS RETURN SHEET 10 STUDY QUESTIONS FOR MEDICAL STUDENTS 11 _______________________________________________________ OVERVIEW 1. At general orientation:
*Page 8 of the Study Guide **Page 10 of the Study Guide
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INTRODUCTION The establishment of this senior experience in Otolaryngology-Head and Neck Surgery will allow the undergraduate medical trainee to improve his/her clinical acumen with regards to disease processes of the ears, nose and throat. An emphasis on teaching the pathophysiology, diagnosis and treatment of emergent and non-emergent disorders common to this discipline will be made._______________________________________________________
GOALS AND OBJECTIVES 1. Take an adequate otolaryngology history 2. Demonstrate and appropriate level of competency in the following clinical skills: a. otoscopy and pneumatic otoscopy b. examination of the oral cavity c. indirect laryngoscopy d. observe rhinolaryngoscopy 3. Examine the neck including bimanual palpation: a. observe fiberoptic rhinolaryngology b. anterior and fiberoptic rhinoscopy 4. Be conversant about the pathophysiology of common otolaryngologic processes: a. otitis media b. sinusitis c. upper aerodigestive tract neoplasms d. tonsillitis e. disorders of the vestibular system f. hearing loss g. hoarseness 5. Diagnose and treat the following disorders: a. otitis media in children and adults b. sinusitis c. chronic tonsillitis d. neoplasms of the upper aerodigestive tract e. hearing loss f. vestibular dysfunction g. facial paralysis 6. Basically understand audiograms and tympanograms 7. Demonstrate the ability to evaluate cervical masses 8. Appreciate the scope of otolaryngology as a specialty _______________________________________________________
METHOD OF INSTRUCTION It is anticipated that the student will be able to satisfy these goals and objectives by utilizing the following modalities:
NOTE: Otherwise, call your assigned resident for instructions regarding remainder of the day’s activities.
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CLERKSHIP ORGANIZATION Orientation Students will gather on the first day of their rotation at 8:00 a.m. as instructed by Becky Adams in Orthopaedic Surgery, for orientation for the clerkships in orthopedics, ophthalmology, and otolaryngology. Otolaryngology’s portion of this session is intended to acquaint the students with the following:
Be prepared to stay for Monday’s lecture (if it is your rotation), if orientation is on a Monday. Faculty and Resident Lectures Medical students will be expected to attend regularly scheduled resident lectures. Monday, 9:00 a.m. – 12:00 p.m. Lecture by Dr. Francisco Vieira, Coleman Building, Conference Room B227. Tuesday, 1:30 p.m. – 3:30 p.m. Lecture by Dr. Francisco Vieira, Coleman Building, Conference Room B227. Tuesday, 4:00 p.m. – 7:00 p.m. Lecture by Dr. Larry E. Duberstein, Coleman Building, Conference Room B227 Wednesday, 3:00 p.m. – 5:00 p.m. Activities with assigned resident Thursday, 2:00 p.m. – 3:00 p.m. Head and Neck Infections and Tumors, Coleman Building, Conference Room B227, given by PGY 6 assigned to Med/Bowld Thursday, 3:00 p.m. – 4:00 p.m. M&M Conference, Patient Care Rounds, or Research Conference, U. T. Cancer Institute, 1331 Union Ave. 10th Floor Training Room Thursday, 4:00 p.m. – 5:00 p.m., Treatment Planning Conference (TPC), U. T. Cancer Institute, 1331 Union Ave. 10th Floor Training Room Friday, 7:30 a.m. – 8:30 a.m. Grand Rounds, Coleman Building, Conference Room B227
Clinics Students will be assigned to clinic rotations at one of the following sites:
All of the above sites have active clinical services and should provide a wealth of experience for the rotating medical student. The placement of no more than two students per clinical site will allow for the most favorable resident/staff to student ratio. Development of basic otolaryngologic skills and comprehension of basic disease processes will be emphasized. Clinical Skills Check-off List Each student will receive a clinical skills check-off list as part of the orientation package. This list is for you as a guideline as to what you should have done on the rotation in the Department of Otolaryngology-Head and Neck Surgery. Required skills are listed below:
Night Call Students will be required to accompany their resident on at least one night of call.
Evaluations The standard form, "Forms for Evaluation Students in Clerkships and Elective," will be used to document the students’ performance on the rotation. Final grades will be determined by attendance in clinic, lectures in Otolaryngology and final test grade. A written examination will be given each month on the last day of the Specialty clerkship. The ENT written exam is for your personal evaluation of what you have learned and will contribute to your grade. This will be a 50-question computer generated examination to include 25 orthopedic questions, 13 otolaryngology questions and 12 ophthalmology questions. Students will be given a numerical grade as follows: A 100 - 85 B 84 - 70 C 69 - 50 Unsatisfactory – 49 or below Student final clinical evaluation numerical grade will be determined as follows: Orthopaedic Surgery 50% Otolaryngology-Head & Neck Surgery 25% Ophthalmology 25% Written examination numerical grade and overall clinic evaluation numerical grade will be averaged to arrive at clerkship final grade. A 90 – 100 B 80 – 89 C 70 – 79 Unsatisfactory – 69 or below The written examination grade, clinical performance grade and overall course grade will be completed by the Clerkship Administrative Coordinator on the original University evaluation form for each student and forwarded to the Dean’s office. A student’s final grade will be changed only by agreement of three faculty representatives. _______________________________________________________
OTOLARYNGOLOGY-HEAD AND NECK SURGERY COURSE EVALUATION
Please select a resident from the list below for the MEDICAL STUDENTS’ "RESIDENT TEACHING AWARD"
PLACE NUMBER HERE ______________ Please select a faculty member from the list below for the MEDICAL STUDENTS’ "FACULTY TEACHING AWARD"
PLACE NUMBER HERE ______________ Return the completed form to Claudia Achkar in room B216, Coleman Building. Please feel free to include additional comments, negative and positive, on the back of this form. OTOLARYNGOLOGY Clinical Skills Check-off List (for the student to keep)
DIAGNOSIS RETURN SHEET List all diagnoses without the patients name (a requirement for LCME accreditation of the medical school) Medical students’ name __________________________________________________ Diagnosis (i.e., Otitis Media) Please return the completed form to Claudia Achkar in room B216, Coleman Building. _______________________________________________________ OTOLARYNGOLOGY STUDY QUESTIONS FOR MEDICAL STUDENTS 1. Indications for adenoidectomy include: a. Nasal airway obstruction b. Chronic sinusitis with nasal airway obstruction c. Chronic serous otitis with nasal airway obstruction d. All of the above 2. Indications for tonsillectomy include all of the following except: a. Peritonsillar abscess b. Recurrent pharyngitis/tonsillitis causing significant missed days from work or school c. Large tonsils d. Oropharyngeal airway obstruction 3. The following is true about Malignant Otitis Externa except: a. Is a fulminate pseudomonas infection of the soft tissues b. Can occur in immunocompromised hosts such as diabetics c. Can be fatal d. Can be diagnosed by CT alone 4. Indications for PE tubes include: a. Chronic serous otitis media greater than 3 months b. Recurrent otitis media with failure of prophylaxis c. Persistent otitis media despite multiple antibiotics d. All of the above 5. Which of the following are commonly seen in patients with peritonsillar abscess: a. Trismus b. Deviation of the uvula c lpsilateral otaigia e. All of the above 6. The most common organism(s) causing external otitis are: a. Pseudomonas b. Hemophilus c. Bacteroides d. All of the above 7. The Rinne Test evaluates: a. Air conduction b. Bone conduction c. Both d. Neither 8. Which of the following are recognized complications of otitis media: a. Sigmoid and cavernous sinus thrombosis b. Subdural and brain abscesses c. Meningitis d. Facial nerve paralysis e. All of the above 9. Sinuses which drain into middle turbinate are: a. Anterior ethmoid & maxillary b. Posterior ethmoid & sphenoid c. Posterior ethmoid & maxillary d. Anterior ethmoid & sphenoid 10. Which of the following commonly results in a "hot potato" voice? a. Squamous cell carcinoma of the oropharynx b. Peritonsillar abscess c. Streptococcal pharyngitis d. Viral pharyngitis 11. The most common cause of hearing loss in children is: a. Noise exposure b. Congenital anomalies of the head c. Otitis media d. Meningitis e. Congenital TORCH infection 12. Which of the following is not a common etiologic organism of otitis media in children: a. Hemophilus influenza b. Streptococcus pneumonia c. Streptococcus pyrogenes d. Pseudomonas Sp. 13. In a patient in which a tympanic membrane perforation cannot be excluded, the best ear drops for treatment of otitis externa is: a. Cortisporin otitis solution b. Boric acid/Acid ETOH drops c. Cortisporin otic suspension d. Garamycin drops e. ETOH/Acetic Acid drops 14. Salivary gland tumors occur most often in which gland: a. Parotid gland b. Submandibular gland c. Sublingual gland d. Minor salivary glands 15. Risk factors for head and neck cancer include: a. Alcohol b. Cigarettes c. Both d. Neither 16. Which is the least effective treatment for head and neck cancers? a. Surgery b. Chemotherapy c. Radiation d. All are equally effective 17. Most common anatomical obstruction of the nasal cavity: a. Tumor b. Septal deviation c. Hematoma d. Abscess 18. Cholesteatomas: a. Most commonly form from tympanic membrane retraction pockets b. Are treated with IV antibiotics c. Does not progressively destroy the middle ear and temporal bone d. Are malignant tumors 19. Acute Epiglottitis, though rare now, because of the vaccine: a. Is almost never caused by H. influenza in children b. Can safely be initially managed with epinephrine, to temporize c. Should be initially managed in the operating room d. Is usually associated with cough, hoarseness and expiratory stridor 20. Patients with Downs' Syndrome: a. Are at relatively high risk for atlantoaxial joint subluxation during adenotonsillectomy b. Often have airway obstruction which is not related to the adenoids or tonsils c, Are at relatively high risk for hypernasality following adenoidectomy d. All of the above
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