ENT Activities in UGME McMaster 2023

Grid focus:Activities
Tagged with: Laryngeal Diseases [C08.360] (MeSH)
Otorhinolaryngologic Diseases [C09] (MeSH)
Laryngeal Diseases [C09.400] (MeSH)
Thyroid Diseases [C19.874] (MeSH)
Voice Disorders [C10.597.975] (MeSH)
Voice Disorders [C23.888.592.979] (MeSH)
Pharyngeal Diseases [C09.775] (MeSH)
Neck Pain [C10.597.617.576] (MeSH)
Neck Pain [C23.888.592.612.553] (MeSH)
Neck Pain [C23.888.646.501] (MeSH)
Neck [A01.598] (MeSH)
Thyroid Gland [A06.407.900] (MeSH)
Ear Diseases [C09.218] (MeSH)
Hearing Disorders [C10.597.751.418] (MeSH)
Hearing Loss [C10.597.751.418.341] (MeSH)
Hearing Disorders [C23.888.592.763.393] (MeSH)
Hearing Loss [C23.888.592.763.393.341] (MeSH)
Parathyroid Diseases [C19.642] (MeSH)
Parathyroid Hormone [D12.644.548.587] (MeSH)
Pharyngeal Diseases [C07.550] (MeSH)
Nose [A01.456.505.733] (MeSH)
Nose [A04.531] (MeSH)
Nose [A09.531] (MeSH)
Earache [C23.888.646.386] (MeSH)
Nose Diseases [C08.460] (MeSH)
Nose Diseases [C09.603] (MeSH)
Rhinitis, Allergic, Seasonal [C20.543.480.680.795] (MeSH)
Rhinitis, Allergic, Perennial [C20.543.480.680.791] (MeSH)
Dizziness, Vertigo (MCC Presentations)
Ear Pain (MCC Presentations)
Hearing Loss (MCC Presentations)
Language and Speech Disorders (MCC Presentations)
Lymphadenopathy (MCC Presentations)
Neck Mass, Goiter, Thyroid Disease (MCC Presentations)
Sore Throat and/or Rhinorrhea (MCC Presentations)
Tinnitus (MCC Presentations)
Hypothyroidism [C19.874.482] (MeSH)
Hyperthyroidism [C19.874.397] (MeSH)
Antithyroid Agents [D06.347.100] (MeSH)
Parathyroid Glands [A06.407.560] (MeSH)
Thyroidectomy [E04.270.856] (MeSH)
Thyroid Neoplasms [C04.588.322.894] (MeSH)
Thyroid Nodule [C04.588.322.894.800] (MeSH)
Otitis [C09.218.705] (MeSH)
Otitis Media [C09.218.705.663] (MeSH)
Hyperparathyroidism [C19.642.355] (MeSH)
Nasopharynx [A04.623.557] (MeSH)
Laryngitis [C08.730.368] (MeSH)
Laryngitis [C08.360.535] (MeSH)
Croup [C08.360.535.365] (MeSH)
Head and Neck Examination (AFMC National Clinical Skills)
Vertigo [C10.597.951] (MeSH)
Vestibular Function Tests [E01.370.382.900] (MeSH)
Hearing Loss, Sensorineural [C10.597.751.418.341.887] (MeSH)
Hearing Tests [E01.370.382.375] (MeSH)
Hearing [G11.561.600.810.263] (MeSH)
Neck Pain (MCC Presentations)
Head and Neck Neoplasms [C04.588.443] (MeSH)
Otorhinolaryngologic Surgical Procedures [E04.580] (MeSH)
Thyroiditis [C19.874.871] (MeSH)
Hearing Disorders [C09.218.458] (MeSH)
Tinnitus [C09.218.458.670] (MeSH)
Vocal Cords [A04.329.364.737] (MeSH)
Thyroid Function Tests [E01.370.374.750] (MeSH)
Tag method: Match any
Exclusions: Archived (Archived)
= most relevant
Displaying 61 records
Activities Linked ObjectivesCurriculum BlockMCC Presentations

Clinical Skills Practice Sessions: Respiratory Exam

Part 1, Medical Foundation 1

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

Part 1
Medical Foundation 1
Blood in Sputum (Hemoptysis)
Chest Pain
Cough
Cyanosis, Hypoxia
Dyspnea
Language and Speech Disorders

Anatomy Demonstrations: Orientation and upper airway

Part 1, Medical Foundation 1, Respirology, Week 1

Nasal skull. The Pharynx and larynx.

Part 1
Medical Foundation 1
Respirology
Week 1

Anatomy Lectures: Respiratory System Anatomy

Part 1, Medical Foundation 1, Respirology, Week 3

Control of breathing. Chest wall, diaphragm. The airway.

General Objectives
Describe the nose (its walls , nasal septum, nasal lining, concha and meatus) , describe and identify paranasal sinuses (frontal, maxillary, ethmoidal and sphenoidal) , describe the nasoapharynx its walls and lymphoid tissues in the region.
Describe and identify lobes of the lung, bronchopulmonary segments, fissures and surface anatomy of the lung and the fissure
Describe surface anatomy and structure of the thoracic wall (ribs, costal cartilages, joints), intercostal spaces and muscles of breathing (intercostal muscles, diaphragm). Describe blood supply and innervations (intercostal neurovascular bundle) of the thoracic wall.
Describe the larynx its landmark and cartilages (thyroid, cricoid, arytenoid and epiglottis) , divisions (supra glotic, ventricle and infra glotic {subglotic}) , identify the vocal cords (true and false vocal cords), describe the innervation of the larynx (reccurent laryngeal nerve, superior laryngeal nerve)
Identify and describe the pleura, pleural cavity, visceral & parietal pleura, innervation of both layers (intercostal , phrenic, and visceral nerves), surface anatomy of the pleura, Identify Costodiaphragmatic (costophrenic) and costomediastinal recesses and suprapleural membrane
Describe and understand mechanics of respiration: inspiration (quiet inspiration, vertical diameter, AP diameter, transverse diameter, forced inspiration, expiration (quiet expiration, forced expiration) and lung changes on inspiration and expiration.
Describe the trachea, its anatomic relations and surface markings, bifurcation and carina
Understand and describe the blood supply (bronchial artery and vein, pulmonary artery and vein), lymph drainage and nerve supply of the lungs
Describe the principal bronchi (superior, middle and inferior lobar bronchus), bronchial tree
Understand the intrapleural pressure and normal mechanics of lung inflation and deflation.
Understand how haemothorax, pneumothorax, pleural effusion, tension pneumothorax can occur.
Part 1
Medical Foundation 1
Respirology
Week 3

Tutorial: Wael M. MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 1

Wael M. is a 78-year-old man who is brought to the emergency room after collapsing at the casino. The last thing he recalls before losing consciousness is drawing an ace while sitting at the blackjack table. His past medical history is unremarkable and he is on no medications. On arrival to the ER, his heart rate is 30 bpm with a blood pressure of 80/50 mmHg. He is alert and oriented, but feels lightheaded. His JVP is not elevated, but cannon a-waves are occasionally seen. There are no carotid bruits. The remainder of the physical examination, including a neurological examination, is normal. In the ER, a temporary transvenous pacemaker is inserted via the right internal jugular vein and positioned into the right ventricular apex. The pacemaker is turned on and set to pace at 60 bpm. At this rate, Wael M.'s BP increases to 100/70 mmHg and his light-headedness resolves. The next morning, Wael M. has a dual chamber permanent pacemaker inserted. His 12-lead EKG post implant shows paced ventricular beats with a left bundle branch block pattern.

General Objectives
Explain electrical impulse generation in cardiac pacemaker cells and how it is propagated through myocardial cells.
Describe the key electrophysiologic principles behind the genesis of the electrocardiogram (EKG) and the electrocardiographic changes that can occur in selected cardiac disorders.
Describe and understand innervation of the heart, conduction system and cardiac pacemaker
Global Objectives
Upon completion of this problem, students should be able to explain cardiac electrical impulse conduction.
Part 1
Medical Foundation 1
Cardiology
Week 1
Dizziness, Vertigo
Syncope and Pre-Syncope

Clinical Skills Sessions: Head and Neck Exam: Practice Case - Hearing Loss

Part 1, Medical Foundation 1, Cardiology, Week 3

Discuss and to practice the Head and Neck history and physical exam, with a focus on the ear and nose exam. Note: The ENT exam includes the Ear, Nose and Throat. We will not focus on the Thyroid exam as it is covered in MF3, nor the Lymph Node exam as it is explored in MF2.

Part 1
Medical Foundation 1
Cardiology
Week 3
Neck Pain
Dizziness, Vertigo
Ear Pain
Hearing Loss

Clinical Skills Sessions: Head and Neck Exam: Practice Case - Sore Throat

Part 1, Medical Foundation 1, Cardiology, Week 4

Objective: To discuss and to practice the Head and Neck history and physical exam, with a focus on the oropharyngeal exam. Pro-Comp Connection: Poverty - the disproportionate burden of Rheumatic Heart Disease on marginalized populations.

Part 1
Medical Foundation 1
Cardiology
Week 4
Neck Pain
Neck Mass, Goiter, Thyroid Disease
Sore Throat and/or Rhinorrhea

Tutorial: Rana Osman MF1 Respirology

Part 1, Medical Foundation 1, Introduction to Medicine, Week 2

Rana Osman is a 2-year-old girl who has been previously well. She has had a barky, seal-like cough for 2 days but tonight has become acutely worse. In the emergency room, she is found to be sitting "bolt upright", with pronounced stridor on inspiration. Her inspiratory phase is prolonged. She has intercostal indrawing and suprasternal indrawing.

General Objectives
Describe the factors that determine airway calibre (upper and lower), including autonomic control and chemical mediators of inflammation.
Explain the normal mechanics of lung inflation and deflation, including the role of intrapleural pressure in inflation of the lung and the role of tissue elasticity and surface tension in elastic recoil of the lung.
Demonstrate the ability to participate in a group discussion, both by contributing to the discussion and by actively listening to the contributions of colleagues.
Explain the basic pathophysiology of the diseases which result in airway obstruction (upper and lower airway).
Explain a concept effectively in a group setting.
Explain the effects of airflow obstruction on the respiratory tract, lung mechanics and gas exchange. Use this knowledge to explain the symptoms and signs with which the patient with lower or upper airway obstruction presents.
Global Objectives
Demonstrate the ability to participate in a group discussion, both by contributing to the discussion and by actively listening to the contributions of colleagues.
Explain a concept effectively in a group setting.
Give and receive simple feedback between colleagues appropriately.
Explain the difference between extra-thoracic and intra-thoracic airway obstruction.
Part 1
Medical Foundation 1
Introduction to Medicine
Week 2
Pediatric Respiratory Distress

Tutorial: Nabil Assad MF1 Respirology

Part 1, Medical Foundation 1, Introduction to Medicine, Week 2

Salim takes Nabil, his 7-year-old son, to see Dr. Lockwood, his family doctor, because both of them have a sore throat. Nabil’s younger brother had a sore throat and runny nose a week ago, but he improved quickly. Salim is concerned about Nabil because he seems to be taking longer to improve. Dr. Lockwood asks more details and learns that both Nabil and Salim are mostly having swallowing difficulties but feel otherwise quite well. Salim has a mild cough, but Nabil does not. There have been no rigors, just slight chills last night.

General Objectives
Describe the acute response of the respiratory system to inhaled material.
Identify and utilize effective strategies for retaining and retrieving new information, while minimizing time spent on strategies that are less effective.
Demonstrate the ability to reflect upon the strengths and weakness of their own communication skills.
Global Objectives
Identify and utilize effective strategies for retaining and retrieving new information, while minimizing time spent on strategies that are less effective
Demonstrate the ability to reflect upon the strengths and weakness of their own communication skills.
Recognize and describe viral versus bacterial infection of the upper respiratory tract.
Part 1
Medical Foundation 1
Introduction to Medicine
Week 2
Sore Throat and/or Rhinorrhea

Tutorial: Ron Chen MF1 Respirology

Part 1, Medical Foundation 1, Introduction to Medicine, Week 3

Ron Chen is a 25 year old computer sciences post-graduate student who had been previously well. Three weeks ago he suffered a viral gastroenteritis from which he has recovered. Over the past week, he has noticed increasing weakness of his limbs, starting with his legs, and progressing to involve his arms. He reports he has experienced patchy areas of sensory loss, symmetrically. He has also noticed occasional clumsy speech and facial weakness.

General Objectives
Explain the normal mechanics of lung inflation and deflation, including the role of intrapleural pressure in inflation of the lung and the role of tissue elasticity and surface tension in elastic recoil of the lung.
Explain the pathophysiology of some of the common disease processes affecting the respiratory pump (upper airway, neuromusculature, lower airways and lung parenchyma).
Describe how the mechanics of breathing are disturbed in examples of obstructive and non-obstructive (“restrictive”) diseases.
Explain the assessment of respiratory pump failure using diagnostic tests.
Develop a mechanism-based approach to management of respiratory pump failure.
Global Objectives
Upon completion of this problem, students should be able to explain the role of the neuromusculature in respiratory pump function.
Part 1
Medical Foundation 1
Introduction to Medicine
Week 3
Dyspnea
Language and Speech Disorders
Weakness (not caused by Cerebrovascular Accident)

Anatomy Lectures: Lymphatic System

Part 2, Medical Foundation 2, Hematology, Week 2

The lymphatic system consists of lymphatic tissues (Thymus, Lymph nodes, Spleen) and lymphatic vessels (vessels which assist in returning tissue fluid to the blood). Thymus Gland. Type of cells in a lymph node. Lymph node and lymphatic vessel. Popliteal lymph nodes and vessels. Femoral and external iliac lymph nodes and vessels. Female and male pelvic lymph nodes.

General Objectives
Describe the classification of the types of white blood cells.
Describe the roles of neutrophils, monocytes, and lymphocytes.
Describe the pathophysiology that leads to white cell malignancies.
Explain how the immune system responds to infection.
Part 2
Medical Foundation 2
Hematology
Week 2
Lymphadenopathy

Clinical Skills Sessions: Introduction and Overview of the Lymph Node Examination

Part 2, Medical Foundation 2, Hematology, Week 2

To discuss and to practice the components of the Lymph Node history and physical examination.

General Objectives
Lymph Node survey/location (cervical, mental/submental/submandibular, tonsil/adenoid, supraclavicular, axillary, epitrochlear, inguinal, popliteal).
Description of lymph nodes.
Part 2
Medical Foundation 2
Hematology
Week 2
Lymphadenopathy
Neck Mass, Goiter, Thyroid Disease

Clinical Skills Sessions: Lymph Node Exam: Practice Case – Lymphadenopathy

Part 2, Medical Foundation 2, Hematology, Week 3

To practice the Lymph Node history and physical examination.

Part 2
Medical Foundation 2
Hematology
Week 3
Lymphadenopathy

Tutorial: Charlotte Bouchard MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 4

Charlotte Bouchard is a 31 year old female who has presented to the ER with new onset shortness of breath. She is previously healthy with no history of medical problems and is not on any medications. She tells you her chest pain and shortness of breath started roughly six weeks prior and have gotten worse to the point she can barely take a few steps without having to stop. She’s also lost about 15 lbs in this time and has noted night sweats such that she has had to change her pajamas during the night. On exam, her pulse is 105, BP 115/87, SpO2 97% on R/A, Temp 37.2. She is not visibly distressed. Respiratory exam reveals decreased air entry on the left and you are able to palpate lymph nodes along her bilateral cervical chains and supraclavicular regions. You also appreciate enlarged lymph nodes in her bilateral axillae and inguinal regions. Her spleen is palpable 5 cm below the costal margin. Chest x-ray performed in the ER reveals a left-sided pleural effusion and is suspicious for a mediastinal mass. You order a follow up CT and this confirms a 15.3 cm mediastinal mass as well as diffuse hilar and axillary adenopathy.

General Objectives
Describe the differentiation and development of white blood cells.
Describe the classification of the types of white blood cells.
Describe the roles of neutrophils, monocytes, and lymphocytes.
Describe the pathophysiology that leads to white cell malignancies.
Recognize the most common types of white cell malignancies.
Global Objectives
Upon completion of this problem, students will be able to describe the role of the lymphocyte in the immune system, develop an introductory approach to the manifestations, diagnosis, and complications of lymphoma, and will be able to describe a palliative approach to care.
Part 2
Medical Foundation 2
Hematology
Week 4
Abdominal masses and pelvic masses
Lymphadenopathy
Mediastinal Mass

Clinical Skills Practice Sessions: Breast and Lymph Node Examination

Part 3, Medical Foundation 3, Reproduction and Pregnancy

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

General Objectives
Breast examination
Inspection: draping, position, proper lighting. Inspecting breast and axilla using a model.
Lymph Node survey/location (cervical, mental/submental/submandibular, tonsil/adenoid, supraclavicular, axillary, epitrochlear, inguinal, popliteal).
Lymph node examination
Palpation: breast and axilla (for mass and lymph nodes) using a model.
Description of lymph nodes.
Part 3
Medical Foundation 3
Reproduction and Pregnancy
Lymphadenopathy
Breast Masses and Enlargement

Active Large Group Session: Autoimmunity

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 2

Activity Objectives
Discuss the concept of autoimmunity, the role of the thymus in its development and its role in various disease states.
List the cells that mediate autoimmune conditions.
Describe the roles of the innate and adaptive immune systems as well as the mucosal immune system in the pathogenesis of Celiac disease.
Explain the roles of B- and T-cells in the development of Hashimoto’s thyroiditis and the different theories regarding mechanisms of thyroid injury in this context.
List the autoantigens associated with T1DM.
Outline the contribution of the cellular immune system in the pathogenesis of T1DM.
List autoimmune diseases commonly associated with T1DM.
Part 3
Medical Foundation 3
Gastroenterology and Nutrition
Week 2
Diabetes Mellitus

Clinical Skills Sessions: Thyroid Exam Practice Case - Thyroid disease

Part 3, Medical Foundation 3, Endocrinology, Week 2

Goiter (hypothyroidism and hyperthyroidism). Observations of a student(s) examining a patient with hyper or hypothyroidism. Discussions of examination of the thyroid by the preceptor. Example: the gland itself, lid lag, tremor. Observation of a student(s) examining a patient with thyroid disorder.

General Objectives
Thyroid examination: inspection of the neck for masses (thyroid enlargement), palpation of the neck, auscultation for bruits.
Part 3
Medical Foundation 3
Endocrinology
Week 2
Neck Mass, Goiter, Thyroid Disease

Tutorial: Adam Pajek MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 2

A 40-year old man, Adam Pajek, was seen in a walk-in clinic complaining of palpitations, heat intolerance (felt hot when others were comfortable or cold), sweating, anxiety, weight loss, fatigue, and sleeplessness for two months. He reports that his sister has a hypothyroid problem for which she takes Eltroxin pills.

General Objectives
Recognize the pituitary as the central control gland of the body.
Outline the synthesis and secretion of thyroid hormones, the types of thyroid hormone and the feedback loops governing interactions between the pituitary gland and the thyroid gland.
Explain the physiological function of thyroid hormone, including its effects on basal metabolic rate.
Explain the laboratory abnormalities and clinical manifestations seen in thyroid dysfunction.
Describe the treatment of thyroid disease.
Global Objectives
Upon completion of this problem, students will describe the role of thyroid hormones in energy metabolism.
Part 3
Medical Foundation 3
Endocrinology
Week 2
Fatigue
Neck Mass, Goiter, Thyroid Disease
Palpitations
Anxiety
Sleep-Wake Disorders
Weight Loss / Eating Disorders / Anorexia

Tutorial: Pia Meta MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 2

Pia Meta is a 21-year-old female university student with paroxysmal attacks of palpitations, dizziness, blurring of vision and headache over the past 6 months. Each attack persists for a few minutes to half an hour. They occur irregularly with essentially no warning. She reports that during one of her attacks, she went to the emergency department and was found to have a blood pressure of 210/140 mmHg. She was told that she was having a panic attack. She was previously well and has no significant family history. Pia occasionally consumes alcohol on weekends only. She denies the use of any medications or recreational drugs, particularly methamphetamines or other sympathomimetics. She has one cup of coffee per day unless she is studying for exams, in which case she drinks 2-3 cups per day at most. She lives with roommates with whom she attends McMaster University. She has been performing well at school and has an active social life. On examination in the clinic, she has no abnormal physical findings.

General Objectives
Outline the structure and function of the adrenal gland.
Describe the control of each of the hormones produced by the adrenal gland.
Summarize the clinical manifestations of excess or inadequate production of adrenal hormones, especially with respect to glucocorticoids and catecholamines.
Global Objectives
Upon completion of this problem, students will be able to describe the anatomy and physiology of the adrenal gland. Students will be able to summarize the physiological role of catecholamines and the consequences of catecholamine excess.
Part 3
Medical Foundation 3
Endocrinology
Week 2
Dizziness, Vertigo
Headache
Palpitations

Clinical Skills Sessions: Adrenal Exam Practice Case - Adrenocortical disorders

Part 3, Medical Foundation 3, Endocrinology, Week 3

Examples: Cushing’s syndrome, Addison’s disease. Observations of a student(s) taking a history from a patient with adrenocortical disorder. Demonstration by preceptor of examination of a patient with adrenal disorder. Example: blood pressure, skin assessment, pigmentation, weight loss/gain, face and neck assessment. Observation of a student(s) examining a patient with adrenal disorder.

General Objectives
Examination of a patient with cortisol excess.
Altered skin texture.
Abnormal hair growth.
Part 3
Medical Foundation 3
Endocrinology
Week 3
Abdominal masses and pelvic masses
Skin and Integument Conditions
Neck Mass, Goiter, Thyroid Disease
Stature Abnormal (Tall Stature / Short Stature)
Weight Gain, Obesity

Tutorial: Julian Knight MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 3

Mr. Knight is a 65-year-old obese male of African descent who works as a miner in Yellowknife, NWT. He smokes one pack of cigarettes per day. Outside of work he is generally sedentary and tends not to leave his home unless it is really necessary. He has a past medical history of type 2 diabetes mellitus, chronic kidney disease and COPD. His medications include metformin, sitagliptin and the inhalers ipratropium and fluticasone. He recently completed a course of prednisone for a COPD exacerbation, which he has a few times per year. He presented to the local Emergency Department after a fall at work. He tripped over a drill bit and fell on his outstretched hand. He felt a snap, followed by severe pain in the left wrist with noticeable swelling and bruising.

General Objectives
Describe the anatomy and physiology of the parathyroid glands.
Identify the role of vitamin D in calcium homeostasis.
Explain the interplay among the major systems involved in maintaining calcium homeostasis including the parathyroid glands, the kidneys, the digestive system and the bony skeleton.
Define osteoporosis and list secondary causes for this condition.
Describe the histology of bone and the hormonal regulation of its cellular components.
Global Objectives
Upon completion of this problem, students will outline the key hormones and organs or tissues involved in calcium homeostasis, as well as the causes and consequences of hypercalcemia. Students will also be able to describe the histological structure of bone, the physiology of bone formation and remodeling and the pathophysiology of osteoporosis.
Part 3
Medical Foundation 3
Endocrinology
Week 3
Black Health
Bone or Joint Injury

Tutorial: Brenda Farnett MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 1

Brenda Farnett, an 82-year-old right-handed woman, was reviewed in the stroke prevention clinic for a possible TIA. Her past medical history included hypertension, treated hypothyroidism, and diet-controlled type II diabetes. Her medications included ASA, HCTZ, and eltroxin. She was initially referred from her family physician's office for evaluation of an episode of right-sided weakness and numbness, mostly involving the arm, lasting about 15 minutes. Her examination in the clinic showed her to be mildly hypertensive at 150/90, and with a regular pulse at 76. Her neurological examination was normal. Her EKG done that day was normal (sinus rhythm). An urgent carotid ultrasound was arranged and she was started on clopidogrel 75 mg OD, ramipril 2.5 mg OD, and atorvastatin 10 mg OD. On the following morning she awoke with mild right-sided weakness and an inability to speak. Her husband immediately called 911. She was taken to the nearest hospital.

General Objectives
Describe the structure of the neuron, axon, synapse.
Review the basic organization of the cerebral hemispheres.
Recognize major cerebral blood vessels.
Discuss the mechanisms and consequences of cerebral ischemia.
Identify the clinical symptoms of stroke.
Global Objectives
Upon completion of this problem, students should be able to discuss the cortical organization of language.
Part 4
Medical Foundation 4
Neuroscience
Week 1
Cerebrovascular Accident and Transient Ischemic Attack (Stroke)
Language and Speech Disorders
Numbness / Tingling / Altered Sensation
Weakness (not caused by Cerebrovascular Accident)

Tutorial: Neil Wartson (Part 1) MF4 Neuro

Part 4, Medical Foundation 4, Neuroscience, Week 1

Neil Wartson is a 4-year-old boy who is being seen by his family doctor for right-sided hearing loss. According to his mother, his hearing was fine at birth (based on the initial screening tests performed), but seems to have slowly worsened on the left over time. He began complaining of “ringing” in his right ear approximately 6 months ago. It was initially intermittent, but seems to have become more constant over time. He is also reported to have difficulty responding when spoken to on the right side. He is otherwise well and developmentally normal. There is a family history of bilateral hearing impairment in Neil’s father. This has not previously been investigated. On examination, Neil is found to have reduced hearing to whispered words on the right. Rinne and Weber’s tests support sensorineural hearing loss on the right. The family doctor orders formal audiology testing and a sedated MRI. She also suggests that it might be helpful for Neil’s father to be assessed for his hearing loss.

General Objectives
Discuss the anatomy and physiology of the ear and auditory system.
Differentiate between central and peripheral hearing loss.
Global Objectives
Upon completion of this problem, students should be able to describe the anatomy and physiology of the auditory system.
Part 4
Medical Foundation 4
Neuroscience
Week 1
Genetic Concerns
Hearing Loss
Tinnitus

Small Group Session: Neuro Team based learning session #2

Part 4, Medical Foundation 4, Neuroscience, Week 2

Dizziness, meningitis, stroke, headache

Activity Objectives
Recognize the signs and symptoms of stroke
Appreciate the initial management of stroke
Differentiate between the different meanings of the term “dizziness” (e.g., vertigo vs. presyncope vs. unsteadiness).
Differentiate central vs peripheral causes of vertigo.
Appreciate the role of the brainstem as it pertains to “dizziness”, vertigo, syncope, unsteadiness.
Discuss your approach to a patient with dizziness.
Identify clinical and laboratory features that suggest meningitis.
Interpret the CSF analysis of patients presenting with a differential diagnosis that includes meningitis.
Discuss your approach to the initial management of meningitis.
List the red flags that suggest a worrisome cause of headache.
List the different types of headache commonly encountered.
Provide a basic strategy for managing simple migraine headaches
Part 4
Medical Foundation 4
Neuroscience
Week 2
Dizziness, Vertigo
Headache
Cerebrovascular Accident and Transient Ischemic Attack (Stroke)
Fever and Hyperthermia

Tutorial: Andrea Holmes MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 2

Andrea, an 84-year-old woman, is accompanied by her niece to her family physician's office. Andrea has been living on her own ever since her husband died 10 years ago. Her niece Bev would occasionally pick up some groceries for her aunt. Andrea was always proud to be independent. As she got older, Bev noted that her aunt was a bit forgetful, but put that down to simply getting older. Last month her aunt's neighbour called Bev to tell her that her aunt's hydro was disconnected. Bev was surprised. Her aunt hadn't called her that there was any trouble. Bev noted that her aunt hadn't really called her much over the last few months. Bev went over to her aunt's house. Her aunt greeted her at the door. Her aunt was surprised to see her, even though Bev had called her that day to tell her that she was coming to visit. Bev was surprised to see that her aunt had lost a fair amount of weight. She was even more surprised about the unkempt nature of her aunt's house. This was a woman who prided herself on organization and cleanliness. After much discussion and arguing, Andrea agreed to see her family physician for a routine checkup. She hadn't been to the doctor's for some time.

General Objectives
Explain the pathophysiology and clinical presentation of dementia.
Describe the basic anatomical substrate of memory.
Global Objectives
Upon completion of this problem, students should be able to discuss the concept of dementia.
Part 4
Medical Foundation 4
Neuroscience
Week 2
Delirium
Frailty in the Elderly
Major/Mild Neurocognitive Disorders (Dementia)
Weight Loss / Eating Disorders / Anorexia

Tutorial: Ivan Nettar MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 2

Ivan is a 68 year old man who has enjoyed excellent health in the past. His only medication is hydrochlorothiazide for mild hypertension. For the past few weeks he noticed that by the end of the day he had difficulty focusing his eyes and keeping them open. He decided to see his family physician when the other day his vision became double. On the day of the visit, Ivan was feeling even worse. His double vision was present shortly after lunch and he felt generally weak. On observation, it was clear that Ivan had a right-sided ptosis. He kept closing one eye and then the other, complaining that otherwise his vision was double. His voice seemed mildly hoarse. Blood pressure was normal at 135/80. General physical examination of the heart, lungs, and abdomen was normal. Neurological examination showed that the pupils were equal and reactive. A prominent ptosis was present on the right. The extra ocular movements were abnormal with dysconjugate gaze present intermittently and not consistently on lateral, upward, and downward gaze. The other cranial nerves were normal. Tone was normal in the limbs. He had some difficulty holding up his arms in the air for more than a couple of minutes. He had some difficulty doing more that 5 deep knee bends. Sensation was normal and the reflexes were all present and symmetric. The plantar responses were down going. You ask Ivan to close his eyes and rest them for a few minutes while you make some notes. You ask him then to open his eyes and temporarily the double vision is much better and the ptosis is almost gone! A referral is made to the neurologist on call. She asks that you send Ivan to the emergency room so that she can perform a tensilon test to confirm the diagnosis.

General Objectives
Identify the anatomy and describe the physiology of the neuromuscular junction.
Global Objectives
Upon completion of this problem, students should be able to describe the normal function of the neuromuscular junction.
Part 4
Medical Foundation 4
Neuroscience
Week 2
Diplopia
Language and Speech Disorders
Weakness (not caused by Cerebrovascular Accident)

Clinical Skills Sessions: Neurology Exam: Practice Cases – Vertigo, Headache

Part 4, Medical Foundation 4, Neuroscience, Week 2

Discuss and practice the components of the history and physical exam for a patient presenting with vertigo. Discuss and practice the components of the history and physical exam for a patient presenting with headache.

Part 4
Medical Foundation 4
Neuroscience
Week 2
Dizziness, Vertigo
Headache
Strabismus and/or Amblyopia

Tutorial: Carmen Shellinger MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 3

Carmen Shellinger is a 32-year-old office manager at a local law firm. Her regular office duties include transcription for the senior partner. Over the past few weeks she has noticed pain in the right wrist at the end of the day. On some occasions she has been awakened at night by pain, tingling and numbness in the right hand. After shaking the hand, the symptoms seem to settle down and she has been able to fall asleep. Her symptoms have become more persistent and she decides to seek her doctor's help. Carmen is otherwise healthy and general inquiry identifies only occasional neck and shoulder pain. The results from the neurological examination are normal. Phalen's manoeuvre reproduces her symptoms in the right hand that she has experienced at night. Tinel's sign provokes numbness into the lateral 3 fingers of the right hand.

General Objectives
Identify the anatomy and describe the physiology of the neuromuscular junction.
Recognize the presentation and articulate the management of neuromuscular junction disorders.
Explain the consequences of nerve trauma.
Describe how to perform an appropriate examination of sensation.
Global Objectives
Upon completion of this problem, students should be able to describe the microscopic anatomy and physiology of a peripheral nerve.
Part 4
Medical Foundation 4
Neuroscience
Week 3
Central / Peripheral Neuropathic Pain
Numbness / Tingling / Altered Sensation
Work-Related Health Issues

Tutorial: Petter Khant MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 3

Petter Khant, a 6-year-old boy, is brought to his family doctor by his mother because of concerns that he is not learning in school. He is described as a "high energy child", always on the go. He has a very short attention span. His teacher sent along a note explaining that Petter is well behind the expectations for this age. His classmates are learning the sounds that go with different letters, but Petter does not yet even have a concept of letters or numbers. His vocabulary seems very limited, both receptive and expressive. His mother recalls no concerns about his early development. She remembers him as a generally healthy baby. He started to crawl at 9 months and could walk on his own by 13 months. He only began to use a few single words at 2 years of age. A hearing test done at that time was normal.

General Objectives
Recall major normal neurodevelopmental milestones in child development.
Define “developmental delay”.
Review the genetic concept of trinucleotide repeats and anticipation.
Global Objectives
Upon completion of this problem, students should be able to discuss and identify normal and delayed neurodevelopment in childhood.
Part 4
Medical Foundation 4
Neuroscience
Week 3
Developmental Delay
Language and Speech Disorders
Congenital Anomalies, Dysmorphic Features

Anatomy Lectures: Sensory Systems

Part 4, Medical Foundation 4, Neuroscience, Week 3

Sensory pathways of the somatosensory system. Reflexes. Cross extensor reflex and central pattern generators. Parts of the Central Nervous system: cerebral cortex, diencephalon, brainstem, cerebellum, spinal cord. Peripheral nerves. Skin. Cutaneous nerve receptors. Testing the 5 sensory modalities (pain, temperature, pressure, touch, vibration). Cutaneous receptors. Deep receptors. Sensory Homunculus. Dorsal columns quantitative sensations (touch, pressure and proprioception (position)). Spino-thalamic tract qualitative sensations (pain and temperature). Gate control of pain. Reflex descending control of pain. Role of enkephalins and endorphins. Neuropathic pain. Romberg Test. Olfactory pathways.

Part 4
Medical Foundation 4
Neuroscience
Week 3
Central / Peripheral Neuropathic Pain
Dizziness, Vertigo
Ataxia (Gait)
Hearing Loss
Numbness / Tingling / Altered Sensation

Large Group Session: Aphasia

Part 4, Medical Foundation 4, Neuroscience, Week 4

Connections between Wernicke's and Broca's areas, mediating expression of language utterances in speech. Broca's area and the primary motor area. Primary auditory perception and Wernicke's area. Connection between vision and Wernicke's area, mediating reading ability. Somatosensory perception (tactile, pain, cold/hot, position sense) and Wernicke's area. Key aspects to aphasia: Lesion, insult in the dominant hemisphere; Impaired naming; Is repetition impaired? Is comprehension impaired? Is reading and writing impaired?

Part 4
Medical Foundation 4
Neuroscience
Week 4
Cerebrovascular Accident and Transient Ischemic Attack (Stroke)
Language and Speech Disorders

Active Large Group Session: Antibiotic Prescribing

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 1

Activity Objectives
Recognize important factors in choosing between various antibiotics.
Describe basic mechanisms of action for antimicrobials.
Define and describe commonly used terminology and principles of antimicrobial use.
Identify some common antibiotic classes and describe their spectrum of antimicrobial activity.
Apply principles of antibiotic stewardship using case examples.
Part 5
Integration Foundation
Host Defense and Neoplasia
Week 1
Sore Throat and/or Rhinorrhea
Dysuria, Urinary Frequency and Urgency, and/or Pyuria

Tutorial: P.J. Peters (Part 2) IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 2

When you see Mr. Peters next, you learn that he had continued to take his HAART faithfully an additional 6 months after he last saw you. He had been feeling physically well and figured his virus was under control (as he recalled it had last been "non-detectable") and so began questioning the need to continue his medications. He was concerned about long-term side effects of therapy and figured he could diminish his risk by reducing his exposure to HAART. Moreover he had started a new job around that time and did not want anyone to inadvertently find out about his diagnosis of HIV. He therefore elected to stop taking his anti-retrovirals. Mr. Peters was reluctant to tell his physicians about his decision and so he had not come back for his follow ups. He returns today complaining of a new painful rash on his chest that appeared 2 days prior. Additionally he notes a 3-month history of increasing fatigue as well as intermittent fevers, night sweats and a 20 lb weight loss. On examination his temperature is 37.2º C, blood pressure 135/80, pulse 79. There are 2 cm nodes palpable in the cervical and axillary areas bilaterally. His throat is clear. When you examine his chest you notice a vesicular rash over the right side of his chest extending from the midline towards his right axilla at the level of his nipple. Examination of his respiratory and cardiovascular system are unremarkable. His abdomen is soft with no palpable masses or organomegaly. Examination of his extremities is unremarkable.

General Objectives
Explain the overall structure of the immune system.
Recognize how an interdisciplinary team can help manage a patient with complex chronic disease.
Identify a patient centered approach to care for individuals with chronic illnesses.
Global Objectives
Upon completion of this problem, students should be able to describe how long-term immunosuppression can result in opportunistic infection and increase the risk of developing malignancy.
Part 5
Integration Foundation
Host Defense and Neoplasia
Week 2
Fatigue
Skin and Integument Conditions
Lymphadenopathy
Fever in the Immune Compromised Host / Recurrent Fever
Weight Loss / Eating Disorders / Anorexia

Clinical Skills Sessions: New Lymphadenopathy and STBBI assessment

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4

Review and to practice an approach to history and exam for lymphadenopathy and STBBI (sexually transmitted and blood-borne infection) assessment. A 27yo F presents with new lymphadenopathy and concern for STBBI to Emergency room.

Part 5
Integration Foundation
Host Defense and Neoplasia
Week 4
Lymphadenopathy
Vaginal Discharge / Vulvar Pruritis / STI

e-Learning Module: Integration Foundation Rapid Fire Cases: Medical decision making in the acute care setting

Part 5, Integration Foundation, Maternal Health Risks/Aging-Related Care, Week 4

12-15 cases of rapid action required or immediate clinical decision making. Content of these modules: Internal Medicine, Surgery, Obstetrics, Paediatrics, Geriatrics and Radiology.

General Objectives
Review common scenarios involving urgent decision making processes encountered in the acute care setting.
Demonstrate application of subjective and objective patient information to support decision making and critical thinking in urgent care situations.
Modify treatment plans and clinical decision making skills when required with review of rationale for each scenario encountered.
Demonstrate synthesis of clinical knowledge gained throughout the Pre-Clerkship Curriculum in Rapid Fire Cases
Evaluate and identify any learning challenges or learning needs in Rapid Fire case scenarios following review of rationale for clinical actions and completion of modules.
Part 5
Integration Foundation
Maternal Health Risks/Aging-Related Care
Week 4
Abdominal Distension
Chest Pain
Dizziness, Vertigo
The Dying Patient
Dyspnea
Headache
Jaundice
Palpitations
Vomiting and/or Nausea
Acute Abdominal Pain
Acute Diarrhea
Delirium
Hyperkalemia
Hypotension/Shock
Polyuria and/or Polydipsia
Pediatric Respiratory Distress
Fever and Hyperthermia

Clinical Skills Sessions: Headache and Cough in a Pregnant Patient x 3 days

Transition to Clerkship, Week 2

You are working with a community family physician who works in their clinic and the emergency department at an academic centre in St. Catharines. You are early in your clerkship and haven’t completed your Obstetrics/Gynecology core rotation yet. The clinic is able to do in-house ECGs and Urine dipsticks. They can send a requisition for bloodwork and chest x-ray, completed offsite. Your first patient is Vanessa, a 35 year-old G2P0 patient who is 28 weeks pregnant with exercise-induced asthma and normal prenatal course to date, last seen for prenatal care at 24-weeks where she was sent for a gestational diabetes screen that was normal. She is taking a prenatal vitamin with 1mg folic acid daily. Your clinic is following her for prenatal care within a shared care model for her pregnancy, with an obstetrician in St. Catharines following her with a plan to deliver at Niagara Health St. Catharines hospital. You were due to see her in follow-up later this week (for her 28-week visit) but she has been scheduled as an urgent visit today for headache and cough x 3 days.

Activity Objectives
Learn and practice the SBAR (Situation, Background, Assessment, Recommendation) tool for verbal handover of patient care.
Learn and to practice the SOAP (Subjective, Objective, Assessment, Plan) tool for written handover of patient care.
Practice holding a goals of care discussion with a capable patient using the Serious Illness Conversation Guide framework.
Practice communicating serious illness news to a substitute decision maker over the phone.
Review routine prenatal care visits, including questions to ask at each visit in the 3rd trimester.
Practice a focused history and exam for a patient presenting with abnormal vital signs, with a focus on infection.
Review intermittent auscultation as an in-office assessment of fetal well-being, including normal vs. abnormal findings.
To discuss initial in-office management for a patient who is clinically unstable, including transfer to acute care.
Transition to Clerkship
Week 2
Allergic Reactions and Atopy
Cough
Headache
Prenatal Care

Clinical Exposure: EM Medical Expert (presenting problems)

Clerkship, Emergency Medicine Rotation

Demonstrate an approach to patients presenting to the ED with the following problems listed below (including basic differential diagnosis, initial investigations, and initial treatments)

Clerkship Objectives
Chest pain
Shortness of breath
Altered level of consciousness - including the recognition and management of acute stroke
Anaphylaxis / severe allergic reaction
Abdominal pain
Loss of consciousness (syncope)
Shock - Recognize shock and predict underlying etiology (distributive, cardiogenic, hypovolemic, obstructive).
Seizure
Cardiorespiratory arrest
Headache
Minor trauma / MSK injuries (including fracture / dislocation/ sprain). Explain the ABCDE approach to major and minor trauma, identify resuscitative priorities and recognize injuries which require acute management.
Abnormal behavior (psychosis, delirium, intoxication, violence).
Head injury - minor
Fever
Dizziness / vertigo
Cardiac dysrhythmias. Synthesize ACLS (Advanced Cardiovascular Life Support) algorithms, recognize unstable ACLS states and use ACLS algorithms to guide treatment.
Vaginal bleeding - pregnant
Poisoning
Burns - minor / major
Urinary symptoms
Neck and back pain
Eye pain (including red eye)
Clerkship
Emergency Medicine Rotation
Lower urinary tract symptoms
Allergic Reactions and Atopy
Back Pain and Related Symptoms (e.g., Sciatica)
Neck Pain
Burns
Cardiac Arrest
Chest Pain
Dizziness, Vertigo
Dyspnea
Eye Redness
Headache
Poisoning
Early Pregnancy Loss / Spontaneous Abortion
Psychosis
Seizures / Epilepsy
Syncope and Pre-Syncope
Trauma
Vaginal Bleeding, Excessive/Irregular/Abnormal
Abnormal Heart Sounds and Murmurs
Acute Abdominal Pain
Delirium
Dysuria, Urinary Frequency and Urgency, and/or Pyuria
Fever in the Immune Compromised Host / Recurrent Fever
Hypotension/Shock
Abdominal Pain (Children)
Bone or Joint Injury
Chronic Abdominal Pain
Fever and Hyperthermia
Head Trauma / Brain Death / Transplant Donations

Tutorial: ENT presentations

Clerkship, Family Medicine Rotation

Clerkship Objectives
Earache
Nasal congestion
Sore throat
Clerkship
Family Medicine Rotation
Ear Pain
Sore Throat and/or Rhinorrhea
Clerkship Objectives
Asthma
Chronic pain
COPD
End of Life Management
Hypertension
Ischemic Heart disease
Type 2 Diabetes Mellitus
Clerkship
Family Medicine Rotation
Chest Pain
Abnormal, Serum Lipids
Neck Mass, Goiter, Thyroid Disease
Diabetes Mellitus
Hypertension

Clinical Exposure: ENT

Clerkship, Family Medicine Rotation

Clerkship Objectives
Earache
Nasal congestion
Sore throat
Clerkship
Family Medicine Rotation
Ear Pain
Oral Conditions
Neck Mass, Goiter, Thyroid Disease

Tutorial: Neurology

Clerkship, Family Medicine Rotation

Clerkship Objectives
Dizziness
Headache
Numbness
Clerkship
Family Medicine Rotation
Dizziness, Vertigo
Headache

Clinical Exposure: Musculoskeletal Presentations

Clerkship, Family Medicine Rotation

Clerkship Objectives
Back pain - Acute
Soft tissue injury
Back pain - Chronic
Joint pain
Clerkship
Family Medicine Rotation
Back Pain and Related Symptoms (e.g., Sciatica)
Neck Pain
Oligoarthralgia (Pain in One to Four Joints)
Polyarthralgia (Pain in More Than Four Joints)
Non-Articular Musculoskeletal Pain

Clinical Exposure: Neurology

Clerkship, Family Medicine Rotation

Clerkship Objectives
Dizziness
Headache
Numbness
Clerkship
Family Medicine Rotation
Dizziness, Vertigo
Headache
Numbness / Tingling / Altered Sensation

Tutorial: Musculoskeletal presentations

Clerkship, Family Medicine Rotation

Clerkship Objectives
Back pain - Acute
Soft tissue injury
Back pain - Chronic
Joint pain
Clerkship
Family Medicine Rotation
Back Pain and Related Symptoms (e.g., Sciatica)
Neck Pain
Oligoarthralgia (Pain in One to Four Joints)
Polyarthralgia (Pain in More Than Four Joints)
Non-Articular Musculoskeletal Pain

Essential Clinical Experience: Dizziness

Clerkship, Family Medicine Rotation

Essential Clinical Experience
Dizziness
Clerkship
Family Medicine Rotation
Dizziness, Vertigo

Essential Clinical Experience: Stroke

Internal Medicine Rotation

Essential Clinical Experience
Stroke
Internal Medicine Rotation
Cerebrovascular Accident and Transient Ischemic Attack (Stroke)
Language and Speech Disorders
Numbness / Tingling / Altered Sensation

Clinical Exposure: Parkinson's disease

Clerkship, Internal Medicine Rotation

Clerkship Objectives
Parkinson's disease
Clerkship
Internal Medicine Rotation
Language and Speech Disorders
Movement Disorders, Involuntary / Tic Disorders

Clinical Exposure: Hypo/hyperthyroidism

Clerkship, Internal Medicine Rotation

Clerkship Objectives
Hypo/hyperthyroidism
Clerkship
Internal Medicine Rotation
Fatigue
Abnormal, Serum Lipids
Neck Mass, Goiter, Thyroid Disease
Weight Gain, Obesity
Weight Loss / Eating Disorders / Anorexia
Clerkship Objectives
Sore Ear: Otitis externa, Otitis media
Sore Throat / Sore Mouth: Dental disease, Oral thrush, Peritonsillar abscess, Pharyngitis, Retropharyngeal abscess / cellulitis, Stomatitis
Essential Clinical Experience
Otitis/Pharyngitis
Pediatrics Rotation
Hearing Loss
Sore Throat and/or Rhinorrhea
Clerkship Objectives
Perform otoscopy
Essential Clinical Experience
Otoscopy
Pediatrics Rotation
Ear Pain

e-Learning Module: CLIPP Cases: Common Pediatric Conditions

Clerkship, Pediatrics Rotation

Computer simulated pediatric cases will be used to supplement direct patient encounters. A series of 31 e-learning modules is made available to each student. Students are required to complete 15 cases by the end of the rotation.

Clerkship Objectives
Diarrhea: Celiac disease, Cow’s milk protein allergy, Gastroenteritis, Hemolytic uremic syndrome, Inflammatory bowel disease, Toddler’s diarrhea
Fever: Different age groups (<1mo, 1-3 mo, >3 mo), Kawasaki disease, Meningitis, Occult bacteremia /sepsis, Urinary tract infection, Viral
Genito-urinary Complaints (hematuria, dysuria, polyuria, frequency, pain): Balanitis, Enuresis, Phimosis, Testicular torsion, Vesicoureteral reflux, Vulvo-vaginitis
Limp / Extremity Pain: Bone tumor, Growing pains, Juvenile idiopathic arthritis, Legg Calve Perthes disease, Osgood Schlatter disease, Osteomyelitis, Post-infectious, Reactive arthritis, Rheumatic fever, Septic arthritis, Slipped capital femoral epiphysis, Transient synovitis, Trauma / injury
Neonatal Jaundice: Biliary atresia, Breast feeding jaundice, Breast milk jaundice, Hemolytic anemia, Kernicterus, Physiologic
Rash: Acne, Cellulitis, Diaper rashes, Drug eruption, Eczema, Henoch Scholein purpura, Impetigo, Scabies, Scarlet fever, Seborrhea dermatitis, Urticaria, Viral exanthems
Respiratory distress / Cough: Anaphylaxis, Asthma, Bronchiolitis, Congestive heart failure, Croup, Cystic fibrosis, Epiglottitis, Foreign body, Pertussis, Pneumonia, Status asthmaticus, Tracheitis
Sore Ear: Otitis externa, Otitis media
Sore Throat / Sore Mouth: Dental disease, Oral thrush, Peritonsillar abscess, Pharyngitis, Retropharyngeal abscess / cellulitis, Stomatitis
Clerkship
Pediatrics Rotation
Cough
Ear Pain
Skin and Integument Conditions
Seizures / Epilepsy
Sore Throat and/or Rhinorrhea
Syncope and Pre-Syncope
Vomiting and/or Nausea
Abnormal Heart Sounds and Murmurs
Dysuria, Urinary Frequency and Urgency, and/or Pyuria
Abdominal Pain (Children)
Pediatric Diarrhea
Pediatric Respiratory Distress
Fever and Hyperthermia

Tutorial: Pediatrics Peer to Peer teaching session

Clerkship, Pediatrics Rotation

At the end of the third week of your rotation, you are asked to present a brief overview of one of these key topics: Fever (differential, focus on UTI); Headache in children/teens; Neonatal jaundice; Approach to Lymphadenopathy; Abdominal pain (differential, focus on constipation); Growth problems in children

Clerkship Objectives
Abdominal Pain & Abdominal Mass: Appendicitis, Constipation, Functional, Neuroblastoma, Ovarian torsion, Pregnancy, Wilm’s tumor
Demonstrate effective teaching/learning strategies and content that facilitate the learning of others (peers, patients, families, allied health professionals).
Fever: Different age groups (<1mo, 1-3 mo, >3 mo), Kawasaki disease, Meningitis, Occult bacteremia /sepsis, Urinary tract infection, Viral
Genito-urinary Complaints (hematuria, dysuria, polyuria, frequency, pain): Balanitis, Enuresis, Phimosis, Testicular torsion, Vesicoureteral reflux, Vulvo-vaginitis
Growth Problems: Constitutional delay, Failure to thrive, Familial short stature, Obesity, Turner syndrome
Headache: Brain tumor, Concussion, Increased intracranial pressure, Migraine
Lymphadenopathy: Cervical adenitis, Lymphoma, Mononucleosis, Reactive
Neonatal Jaundice: Biliary atresia, Breast feeding jaundice, Breast milk jaundice, Hemolytic anemia, Kernicterus, Physiologic
Clerkship
Pediatrics Rotation
Headache
Lymphadenopathy
Dysuria, Urinary Frequency and Urgency, and/or Pyuria
Neonatal Jaundice
Pediatric Constipation
Abdominal Pain (Children)
Fever and Hyperthermia

Large Group Session: Pediatric Surgery

Clerkship, Surgery Rotation

Pediatric IV Fluid requirements. Appendicitis. Intussusception. Hernia. Hydrocele. Pyloric stenosis. Umbilical hernia. Neonatal congenital anomalies. Bowel obstruction in newborn. Hirschsprung’s Disease. Congenital neck masses.

Clerkship Objectives
Hernias/Hydroceles
Neck Masses
Bowel obstruction: Adhesions, hernias, intussusception, Meckel's diverticulum, Volvulus, Hirschprung's disease.
Volvulus
Clerkship
Surgery Rotation
Abdominal Distension
Neck Mass, Goiter, Thyroid Disease
Vomiting and/or Nausea
Acute Abdominal Pain
Congenital Anomalies, Dysmorphic Features
Pediatric Constipation
Abdominal Pain (Children)
Hernia (Abdominal Wall and Groin)
Pediatric Diarrhea
Pediatric Respiratory Distress

e-Learning Module: Thyroid nodule

Clerkship, Surgery Rotation

In this module, you will learn about the presentation, diagnosis, and management of thyroid nodules and specifically of thyroid cancer.

Clerkship Objectives
Discuss the evaluation and differential diagnosis of a patient with a thyroid nodule.
Discuss the common thyroid malignancies, their cell of origin and their management. Which has the best prognosis? The worst?
Which (common thyroid malignancies) are associated with MEN syndrome?
Discuss the relationship of radiation exposure to thyroid malignancy.
Which malignancies frequently metastasize to the neck?
Discuss the common non-neoplastic thyroid diseases that could present as a mass.
Discuss the symptoms associated with hyperthyroidism and discuss treatment options.
Discuss diagnosis and management of thyroiditis.
Clerkship
Surgery Rotation
Neck Mass, Goiter, Thyroid Disease
Clerkship Objectives
Hernias/Hydroceles
Neck Masses
Bowel obstruction: Adhesions, hernias, intussusception, Meckel's diverticulum, Volvulus, Hirschprung's disease.
Volvulus
Clerkship
Surgery Rotation
Neck Mass, Goiter, Thyroid Disease
Abdominal Pain (Children)
Hernia (Abdominal Wall and Groin)
Clerkship Objectives
Discuss the differential diagnosis of ear pain (otalgia). Consider infection, trauma, neoplasm, inflammation, vascular contrast etiologies in children versus adults.
Discuss the diagnosis, treatment and complications of acute and chronic otitis media. Include indications for myringotomy tube placement.
Outline the evaluation of a patient presenting with hearing loss; differentiate between conductive and sensorineural hearing loss. Identify treatable causes.
Outline the evaluation of a patient presenting with tinnitus. Describe the potential etiologies and management.
Describe the risk factors, diagnosis and management of epistaxis. Describe the indications and techniques for nasal packing.
Discuss the causes and mechanisms of chronic rhinitis/rhinorrhea. Outline the evaluation and management of chronic rhinitis.
Describe the indications for tonsillectomy.
Outline the evaluation of a patient with a salivary gland mass. Describe the potential etiologies. Describe the common tumors of the salivary gland and their management.
Clerkship
Surgery Rotation
Ear Pain
Hearing Loss
Tinnitus
Bleeding, Bruising

Large Group Session: Head and Neck

Clerkship, Surgery Rotation

Introduction to Head and Neck Surgery: basic clinical exam; relevant anatomy. Review common clinical scenarios in head and neck surgery. Neck Mass. Thyroid Nodules.

Clerkship Objectives
Discuss the embryologic origin of these lesions (neck mass) and the anatomic implications to consider when resecting them.
Describe the signs, symptoms & etiologies of inflammatory neck masses.
Discuss Ludwig's angina and why it may be life-threatening.
What is appropriate treatment for cervical adenitis?
Describe the most common neoplastic neck masses and their origin.
Discuss the role of fine-needle cytology, open biopsy, CT scan, MRI, thyroid scan, and nasopharyngeal endoscopy in the diagnostic work up of a neck mass.
Discuss the evaluation and differential diagnosis of a patient with a thyroid nodule.
Discuss the common thyroid malignancies, their cell of origin and their management. Which has the best prognosis? The worst?
Which (common thyroid malignancies) are associated with MEN syndrome?
Discuss the relationship of radiation exposure to thyroid malignancy.
Which malignancies frequently metastasize to the neck?
Discuss the common non-neoplastic thyroid diseases that could present as a mass.
Discuss the symptoms associated with hyperthyroidism and discuss treatment options.
Discuss diagnosis and management of thyroiditis.
Clerkship
Surgery Rotation
Neck Pain
Ear Pain
Neck Mass, Goiter, Thyroid Disease

Large Group Session: Ear, Nose and Throat

Clerkship, Surgery Rotation

How to evaluate a patient with a sore throat, hearing loss or with nasal obstruction. Acute Tonsillitis. Epiglottitis. Rinne and Weber Tests. Tympanometry.

Clerkship Objectives
Discuss the differential diagnosis of ear pain (otalgia). Consider infection, trauma, neoplasm, inflammation, vascular contrast etiologies in children versus adults.
Discuss the diagnosis, treatment and complications of acute and chronic otitis media. Include indications for myringotomy tube placement.
Outline the evaluation of a patient presenting with hearing loss; differentiate between conductive and sensorineural hearing loss. Identify treatable causes.
Outline the evaluation of a patient presenting with tinnitus. Describe the potential etiologies and management.
Describe the risk factors, diagnosis and management of epistaxis. Describe the indications and techniques for nasal packing.
Discuss the causes and mechanisms of chronic rhinitis/rhinorrhea. Outline the evaluation and management of chronic rhinitis.
Describe the indications for tonsillectomy.
Outline the evaluation of a patient with a salivary gland mass. Describe the potential etiologies. Describe the common tumors of the salivary gland and their management.
Clerkship
Surgery Rotation
Ear Pain
Hearing Loss
Sore Throat and/or Rhinorrhea
Bleeding, Bruising
Pediatric Respiratory Distress

Essential Clinical Experience: Neck/Back Pain (Incl. Disease)

Clerkship, Emergency Medicine Rotation, Family Medicine Rotation, Orthopedic Surgery Rotation

Essential Clinical Experience
Neck/Back Pain (Incl. Disease)
Clerkship
Emergency Medicine Rotation
Family Medicine Rotation
Orthopedic Surgery Rotation
Back Pain and Related Symptoms (e.g., Sciatica)
Neck Pain

Concept Integration and Review: Microbiology and Infectious Disease

Post-clerkship, Concept Integration and Review

Infectious diseases. Transmission. Gram Stain. Microbiology. Infections head to toe.

Post-clerkship
Concept Integration and Review
Blood in Sputum (Hemoptysis)
Cough
Dyspnea
Ear Pain
Eye Redness
Pleural Effusion
Sore Throat and/or Rhinorrhea
Vaginal Discharge / Vulvar Pruritis / STI
Vomiting and/or Nausea
Dysuria, Urinary Frequency and Urgency, and/or Pyuria
Localized Edema
Abdominal Pain (Children)
Fever and Hyperthermia

Concept Integration and Review: Pediatric Communicable Diseases

Post-clerkship, Concept Integration and Review

How do you decide what antibiotics to use? Is there an infection? Where is the infection? What pathogens are probably causing the infection? Are there antibiotics that can get to where the pathogens are? kill the pathogens?

Post-clerkship
Concept Integration and Review
Cough
Limp in Children
Dyspnea
Ear Pain
Skin and Integument Conditions
Sore Throat and/or Rhinorrhea
Abdominal Pain (Children)
Pediatric Diarrhea
Pediatric Respiratory Distress
Fever and Hyperthermia

Concept Integration and Review: Endocrinology

Post-clerkship, Concept Integration and Review, Week 4

Thyroid disorders: Hypothyroidism; Thyrotoxicosis (Graves, toxic nodule, thyroiditis); Thyroid Nodules. Pituitary Disorders: Pituitary disorder manifests clinically in 3 ways: Hyperfunction: too much hormones; Hypofunction: too little hormones; Local mass effects; Acromegalia. Posterior Pituitary dysfunction: ADH. Adrenal Disorders.

Post-clerkship
Concept Integration and Review
Week 4
Diplopia
Abnormal, Serum Lipids
Neck Mass, Goiter, Thyroid Disease
Stature Abnormal (Tall Stature / Short Stature)
Diabetes Mellitus
Hyperkalemia
Chronic Visual Disturbance/Loss
Hyponatremia
Calcium disorders