Duration …… 8weeks,
Every Wednesday from 8:00am to 10:00
am
·
Clerkship
Overview
·
Organization
and Delivery strategies
·
Objectives
·
Themes and
scenarios
·
Assessment
and feedback
Clerkship Overview
ENT
diseases form a major component of patients presenting to the family physician
clinic.
Main
aim of ENT clerkship is to
· Enable the student to
diagnose common ENT diseases.
· Identify diseases that need
urgent referral to specialist
· Generate interest about the
ENT specialty which might help students in choosing their career in future.
THEMES
- Patient with sore throat
- Patient with nasal obstruction and nasal discharge
- Patient with hearing loss
- Patient with ear discharge/earache
- Patient with dysphagia
- Common ENT emergencies
CLINICAL
SKILLS
- Light focusing
- Anterior rhinoscopy
- Throat examination with tongue depressor
- Otoscopy
- Tuning fork tests
- Identification of IDL mirror
- Identification of posterior rhinoscopy mirror
- Neck node examination
THEME 1:
Patient with sore throat
A 16
year old girl presented to OPD with complaints of sore throat, high grade fever
and odynophagia for the last 4 days. She was unable to take anything orally for
one day. There is also history of recurrent sorethroats for the last 4 years. On
examination of throat there is generalized congestion, grade 3 tonsillar
hypertrophy and pus coming out of crypts. Her temperature is 102 degree Fahrenheit.
Neck examination revealed bilateral tender jugulodigastric lymadenopathy.
OBJECTIVES
- Formulate the differential diagnosis of sore throat based on history and examination.
- EXAMINE throat of the patient and look for clinical signs in order to differentiate between different forms of acute tonsillitis, chronic tonsillitis, membranous tonsillitis
Applied anatomy of oral cavity and pharynx including
tonsils
Infective conditions of oropharynx including the
pathophysiology, symptoms and signs
- Acute tonsillitis and its different forms
- Chronic tonsillitis
- Membranous tonsillitis
- Acute membranous tonsillitis
- Diphtheria
- Acute and chronic pharyngitis
THEME 2:
PATIENT WITH NASAL OBSTRUCTION
AND NASAL DISCHARGE
A 35 year old male presented to OPD
with complaints of nasal obstruction, nasal discharge and high grade fever for
the last 3 days. There is also history of sneezing and rhinorrhea on exposure
to dust. On anterior rhinoscopy the nasal mucosa is congested and there is
mucopurulent discharge.
Endoscopic view of nasal cavity
A: nasal septum
B: middle turbinate
C: mucopurulent discharge in middle
meatus
OBJECTIVES:
· Formulate the differential diagnosis of nasal obstruction with and
without nasal discharge based on history and examination
· Examine the nose of the patient for Identification of normal
structures within the nasal cavity
Look
for clinical signs on anterior rhinoscopy examination
· Background knowledge
Applied
anatomy of nose and paranasal sinuses
Pathophysiology,
symptoms and signs related to
1.
Acute rhinitis and sinusitis
2.
Chronic sinusitis
3.
Fungal sinusitis
4.
Allergic rhinitis
5.
Foreign body nose, rhinolith
THEME 3:
PATIENT WITH HEARING LOSS
A 65 year old male presented to OPD with complaints of
bilateral decreased hearing for the last 3 years. Otoscopic examination
revealed bilateral impacted wax.
OBJECTIVES
· Formulate the differential diagnosis of conductive and sensorineural
hearing loss
· Perform otoscopic examination and tuning fork tests (Rinne and Weber)
and interpretation of tuning fork tests
· Background knowledge
Pathway of air conduction and
related causes of conductive hearing loss
Pathway of bone conduction and
related causes of sensorineural hearing loss
THEME 4:
PATIENT WITH EAR DISCHARGE
A 35 year old male presented to ENT OPD
with complaints of left ear discharge for the last 6 years. The discharge is
mucopurulent, copious, non-blood stained and odorless. There is no history of
fever.Otoscopic examination of left ear revealed large central perforation of
tympanic membrane.
Otoscopic Examination
OBJECTIVES:
·
Formulate differential diagnosis for ear
discharge based on history and examination
·
Perform otoscopic examination and tuning fork
tests
·
Identify normal tympanic membrane and tympanic
membrane perforation on otoscopy
·
Background Knowledge:
Pathophysiology, symptoms and signs of
1. Otitis externa
Localized
Diffused
2.
Acute otitis media
3.
Chronic otitis media and its types
Tubotympanic
Attico-antral
THEME 5:
PATIENT WITH HOARSENESS OF
VOICE
A 45 year old school teacher presented
to OPD with complaints of hoarseness of voice for the last 8 months. On
indirect laryngoscopy there are bilateral smooth surface round swellings at
junction of anterior one third with posterior two third of both vocal cords.
OBJECTIVES:
·
Formulate differential diagnosis for hoarseness
of voice based on the history and examination
·
How is larynx examined and what structures are seen on IDL
examination?
· Background Knowledge:
1.
Applied anatomy of larynx including its
subsites and nerve supply
2.
Functions of larynx in relation to airway,
speech and swallowing
3.
Benign
causes of hoarseness (Acute and chronic laryngitis, Vocal cord nodules, vocal
cord polyps, juvenile respiratory papillomatosis) risk factors, symptoms and
signs
4.
Malignant
cause of hoarseness (squamous cell carcinoma) risk factors, symptoms and signs
THEME 6:
Patient with dysphagia
A 40 year old female presented to OPD with
complaints of relative dysphagia for solids for the last 6 months. On
examination she is markedly pale. There is angular stomatitis and her nails are
spoon shaped. IDL examination was unremarkable.
Upper GI endoscopy view
X ray barium swallow
OBJECTIVES:
Formulate the
differential diagnosis of dysphagia based on history and clinical examination.
How is hypopharynx examined and
structures seen on IDL examination?
Background
Knowledge:
Phases
of swallowing and different causes related to dysphagia
Pathophysiology,
symptoms and signs related to:
1. Plummer Vinson syndrome, cardia achalasia
2. Pharyngeal pouch
3. Foreign body in digestive tract
4. Hypopharyngeal carcinoma
THEME 7:
COMMON ENT EMERGENCIES
OBJECTIVES:
-Epistaxis
A 25 year old male while playing
cricket with his friends got hit with the ball on his nose. He presented to
emergency with complaints of bleeding from inside of his nose for the last 1 hour.
Bleeding could not be controlled with conservative measures.
- Formulate the differential diagnosis of patient with epistaxis based on history and examination.
- Perform nasal examination (anterior rhinoscopy)
-Stridor
Scenario 1
A 5 year old girl was brought to emergency
with complaints of breathing difficulty for the last 5 hours. They also give
history of sore throat and high grade fever for the last 2 days. On examination
she is in stridor.
Scenario 2
A 60 year old male presented to
emergency with complaints of severe breathing difficulty for the last 5 days. There
is also history of hoarseness of voice for the last 6 months. Patient is a
smoker and smokes 10 packs per day for the past 30 years. Indirect laryngoscopy
revealed exophytic growth involving true vocal cords and airway is narrow.
Direct Laryngoscopy View
- Formulate a Differential diagnosis for hoarseness and stridor, in children and adults, based on history and clinical examination.
- Identify IDL mirror
- Background knowledge: pathophysiology, symptoms and signs
- Infective conditions of larynx (Epiglottitis, Laryngotracheobronchitis, Laryngeal diphtheria, Odema of larynx)
- Foreign body in airway
- Juvenile Respiratory papilloma
- Malignant tumours of larynx
-Foreign body in food passages and foreign
body in air passages
Scenario 1
A 5 year old boy was brought to
emergency by his parents with complaints of absolute dysphagia after ingestion
of a five rupee coin.
X-Ray Chest
Endoscopic view of upper esophageal
sphincter
Scenario 2
A 3 year old boy while playing with his
brothers experienced choking, coughing and became blue. On examination patient
has mild cough and chest auscultation revealed both inspiratory and expiratory
wheeze.
Background knowledge
X ray chest
· Types of foreign bodies
· Pathophysiology
· History and examination
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