Goals & Objectives
Objectives for Dermatology
The material provided in this handout is not meant to limit your study and knowledge in the field of dermatology. Throughout your training in medicine you will be exposed to a vast amount of material that will complement these learning objectives. Additional material and clinical skills obtain through courseware, PBL, PSD, clinical and research electives should be integrated in your conceptualization of dermatology and doctor-patient interaction. Through this integration we believe that you will be able to have a clear conceptualization of the skin as well as an overview of common diseases.
Review from Previous Blocks
- Bacterial Infection (Infection and Host Response)
- Viral Infection (Infection and Host Response)
- Immune System (Haematology and Neoplasia; Infection and Host Response)
- Herpes (D & H, Infection and Host Response)
- EBV, CMV, HHV-8 (Infection and Host Response)
- STDs (Infection and Host Response, Reproduction)
- Mycoses (Infection and Host Response)
- Rheumatology (MSK)
Specific Learning Objectives for Dermatology Section of Special Senses
Knowledge
Anatomy & Histology
- List the functions of the skin
- List the layers of the skin.
- List and describe the four cell types of the epidermis.
- Describe the histological presentation of the dermoepidermal junction.
- List the parts of the dermis and state the cells that comprise this area.
- Describe the histological presentation of the subcutis.
- Describe the vasculature of the skin and state it ’s functions.
- Describe the innervation of the skin.
- Describe the role of the lymphatic system in the skin.
- Describe the dispersion of hair on the body.
- Describe the cycling period of hair.
- Describe the function of pilosebaceous units.
- List the components of pilosebaceous units.
- Describe the function and simulation of sebaceous glands.
- Name the muscles responsible for hair erection.
- Describe the production of nails.
- Describe the distribution and function of eccrine and apocrine glands.
- Define the following terms: acanthosis, hyperkeratosis, exocytosis, spongiosis, hypogranulosis.
Bacterial Infections of the Skin
- Define resident and transient bacteria.
- Describe the etiology, symptoms, differential diagnosis, complications and management of: punctuate keratolysis, erythrasma, proprionibacteria acnes, impetigo, bullous impetigo, ecthyma, staphylococcal scalded skin syndrome, erysipelas, cellulitis, scarlet fever, follicutus, furuncles and carbuncles and secondary cutaneous infections.
Cutaneous Viral Infections
Describe the clinical diagnosis, infectious agent and clinical and morphological presentation of: rubella, hand, foot and mouth disease, roseola, rubeolla, fifth disease, various viral herpes infection, varicella zoster, moluscum contagiosum, warts, pityriasis rosea and Karposi’s sarcoma.
Mycoses
- State examples of superficial, intermediate and deep mycoses.
- Define: fungus, dermatophytes, dermatophytosis, zoophilic fungi, anthropophilic fungi, geophilic fungi, Tinea capitis, Tinea barbae, Tinea corporis, Tinea cruris, Tinea manis and pedis, Tinea unguium, KOH test.
- Describe the growth and structure of mycoses.
- Describe the pathophysiology of mycotic infection in skin, hair and nails.
- Describe the etiology, distribution, appearance, diagnosis and differential diagnosis of tinea versicolour, tinea capitis, tinea barbae, tinea corporis, tinea cruris, tinea pedis (and manis), tinea unguum (onychomycosis).
- Describe the appearance (gross and microscopically), laboratory identification, etiology, predisposing factors, diagnosis, association (comorbidity) and differential diagnosis of candida albicans.
- Describe the treatment for: tinea versicolour, tinea capitis, tinea barbae, tinea corporis, tinea cruris, tinea pedis (and manis), tinea unguium (onychomycosis) and candida albicans.
Psoriasis
- Describe and classify the lesions found in psoriasis.
- Describe the pathological factors leading to the clinical appearance of psoriasis.
- State the differential diagnosis of papulosquamous lesions.
- Describe the clinical features of the different types of psoriasis, mail changes in psoriasis, and the
- Koebner phenomenon.
- List the factors that are known to exacerbate psoriasis.
- Explain the role of heredity in psoriasis.
- Identify the histological features of psoriasis.
- Describe the pathogenesis of psoriasis.
- Describe the treatment of psoriasis and explain it’s rational.
Atopic Dermatitis
- Describe and classify the lesions found in atopic dermatitis.
- Describe the pathological factors leading to the clinical appearance in atopic dermatitis.
- Classify causes of eczema into exogenous and endogenous.
- Explain the concept of atopy and atopic dermatitis.
- Identify the clinical features of atopic dermatitis.
- List the major/minor diagnostic criteria for the diagnosis of atopic dermatitis.
- Describe the roles of foods, irritants, infection, stress, dryness, genetics and aeroallergens in atopic dermatitis.
- Recognize the histopathology and mediators of inflammation involved in atopic dermatitis.
- Explain the immunological abnormalities associated with atopic dermatitis.
- Describe the therapy of atopic dermatitis.
Acne
- Describe and classify the lesions found in acne.
- Describe the pathological factors leading to the clinical appearance in acne.
- Describe the sebaceous gland and its distribution.
- Explain the physiology of the sebaceous gland and changes that occur with age and sex.
- Describe the pathogenesis of acne.
- Describe the different types of clinical lesions seen in acne.
- Describe the effect of severe acne on the emotional well being and interpersonal relationship of patients.
- List current therapies and explain the rationale for their usage in the treatment of acne.
- List those conditions which should be differentiated from acne and describe the differentiating features.
Skin Cancer
- Classify skin malignancies, including melanomas.
- Identify the cells of origin and the major histological features of the three most common forms of skin cancer (squamous cell carcinoma, basal cell carcinoma and melanoma), as seen under the light microscope
- Define the word ‘naevus’ and give clinical and histological descriptions of common acquired melanocytic naevi.
- State the risk factors for the development of skin cancer.
- Identify the major prognostic factors in assessing a patient with melanoma.
- List precursor lesions of skin cancer. What is the difference between a precursor lesion and a marker lesion with respect to skin cancer?
- What signs do essentially all in-situ skin cancers have in common? Name some in-situ skin cancers.
- Outline therapeutic alternatives for the prevention and treatment of skin cancer.
- The ABCD’s of mules and melanoma
Skills
- Take a proper dermatological history.
- Use proper techniques to examine the skin.
- Give a logical and complete report on what can be seen in a patient with skin disease.
- Apply, understand and define the basic dermatological terms.
- Describe the anatomy of the external ear.
- Be familiar with the various morphologic presentations of dermatitis herpetiformis, lichen planus, discoid lupus erythematosus, pemphigus vulgaris, scabies, neurofibromatosis, verucae.
Objectives for Otolaryngology
Nose:
Anatomy
- Name the functions of the nose.
- Name the two parts of the nasal septum.
- Name the turbinates.
- Describe the function of nasal turbinates.
- Name the meati found on the lateral wall of the nose.
- Describe the blood supply to the nose.
- Explain Little’s Area or Kiesselbach’s plexus
- Explain the function of the nasal mucosa.
- Explain the function of the olfactory nerve.
- Specify where the olfactory nerve enters the nasal cavity.
Pathology
- Define anterior and posterior epistaxis.
- List the risk factors for epistaxis.
- Describe the management of epistaxis.
- List 3 types of rhinitis.
- Explain how the nasal mucosa affected by allergies and URTI, Otrivin©/Dristan©, Nasal steroids.
- Identify the risk factors for sinonasal carcinoma.
- List the common causes of hyposmia and anosmia.
- List the differential diagnosis of unilateral nasal obstruction.
Sinus
Anatomy
- Name and describe the location of the paranasal sinuses.
Pathology:
- Identify the common pathogens in acute sinusitis.
- Identify the risk factors for chronic sinusitis.
- Define nasal polyp.
- Describe the treatment of acute sinusitis.
- Describe the treatment options available for chronic sinusitis with or without nasal polyposis.
- List the possible complications (orbital and intracranial) of acute sinusitis.
Oral Cavity and Oropharynx:
Anatomy
- Identify and describe the three parts of the pharynx.
- Describe the location of the adenoids, palatine tonsils and lingual tonsils.
- Explain the function of the adenoids, palatine tonsils and lingual tonsils.
- Define Waldeyer’s Ring.
- Identify the nerves responsible for the gag reflex.
- List the muscles of mastication and their nerve supply.
- Describe the sensory innervation of the tongue (both taste and sensation).
- Identify the motor supply to the tongue.
Pathology
- Define tonsillitis, peritonsillar cellulitis and peritonsillar abscess.
- Describe the management of tonsillitis, peritonsillar cellulitis and peritonsillar abscess.
- List the differential diagnosis of pharyngitis.
- Define leukoplakia, cheilitis and macrochelia.
- List disorders that are related to pigmented patches and plaques in the mouth.
Larynx/Hypopharynx
Anatomy:
- Indicate the positionof the true vocal cords during phonation and respiration.
- List the cartilages of the larynx.
- Name the nerves responsible for the motor function of the larynx.
- Name the nerve responsible for the sensation of the larynx.
Pathology:
- List the symptoms and signs of pharyngeal or laryngeal disorders.
- Define epiglottitis.
- Understand that epiglottitis and supraglottitis are found in both children and adults and that since the introduction of the HiB vaccine, the pathogens and epidemiology are changing.
- Describe the progression of symptoms involved in epiglottitis.
- State the diagnostic criteria for the diagnosis of epiglottitis.
- Describe the treatment of epiglottitis.
- Differentiate between epiglottitis and suprglottitis.
- List the factors associated with laryngeal/hypopharyngeal carcinoma.
- Define dysphagia.
- List the differential diagnosis for dysphagia.
- Define stridor.
- List the differential diagnosis for stridor.
Ear:
Anatomy
- Explain the function of the three parts of the ear (external ear, middle ear, inner ear).
- Identify the sensory innervation to the external ear.
- Identify the landmarks present on the tympanic membrane.
- Describe the functions of the tympanic membrane and the middle ear ossicles.
- Name the middle ear ossicles.
- Describe the location and functions of the eustachian (auditory) tube.
- Describe the structure of the cochlea.
- Discuss how sound travels from the source to the temporal lobe (i.e. understand the mechanism of hearing).
- Be able to distinguish between conductive and sensorineural hearing loss on an audiogram and with tuning forks.
- Describe the structure and function of the labyrinth.
- Identify the systems required for equilibrium.
Pathology
- Define otalgia.
- List the differential diagnosis of otalgia.
- List the causes of referred otalgia.
- Describe how other types of pain can be related to otalgia (orofacial, temporomandibular joint disorder, pharynx and tonsil, aerodigestive, cervical spine, neuralgias, infratemporal tumors).
- Define otorrhea, otitis, chondritis, and perichondritis.
- Name the most common pathogens for otitis externa.
- Define malignant otitis externa.
- Understand that otorrhea can be present because of a pathological process in the external ear and/or the middle ear.
- List the differential diagnosis of otorrhea.
- Define acute otitis media, serous otitis media, cholesteatoma and tympanic membrane perforation.
- Be able to identify acute otitis media, serous otitis media, tympanic membrane perforation and cholesteatoma.
- Identify the most common pathogens in acute otitis media.
- Discuss treatment options available for acute otitis media, serous otitis media, tympanic membrane perforation and cholesteatoma.
- Describe the complications of a cholesteatoma.
- List the differential diagnosis of a unilateral serous otitis media.
- Define vertigo, dizziness, disequilibrium and lightheadedness.
- Be able to perform and adequate history and physical exam on a patient presenting with vertigo.
- List and describe the exams and tests used in the diagnosis of vertigo.
- List and describe the 7 most common vestibular causes of vertigo.
- Define Benign Positional Vertigo and give the classic symptoms and signs of the disease.
- Define Meniere’s Disease and give the classic symptoms and signs of the disease.
- Define Vestibular Labyrinthitis/Vestibular Neuronitis and give the classic symptoms and signs of the disease.
- Recognize the clinical symptoms and signs of hearing loss in both children and adults.
- Perform targeted history and physical exam of a patient complaining of hearing loss.
- Differentiate between sensorineural hearing loss and conductive hearing loss.
- List the differential diagnosis of sensorineural hearing loss.
- List the differential diagnosis of conductive hearing loss.
- Define otosclerosis.
- Define noise induced hearing loss.
- List the differential diagnosis for sudden sensorineural hearing loss.
- List treatment strategies for sudden sensorineural hearing loss.
- Understand an audiogram, OAEs and ABR.
- List risk factors for hearing loss in the pediatric population.
- Compare and contrast hearing aids and cochlear implants.
Facial Nerve:
Anatomy
- Describe the course of the facial nerve.
- Identify the external branches of the facial nerve.
- Indicate the functions of the facial nerve.
Pathology
- Differentiate between facial nerve paralysis and Bell’s palsy.
- List the differential diagnosis of facial nerve paralysis.
- List investigations that may be used when a patient presents with facial nerve paralysis.
- Describe the treatment options available for a patient presenting with idiopathic facial nerve paralysis.
Tinnitus:
Anatomy
- Define tinnitus.
Pathology
- Differentiate between subjective and objective tinnitus.
- List the differential diagnosis of subjective tinnitus
- List the differential diagnosis of objective tinnitus.
- Understand the importance in differentiating between pulsatile and non-pulsatile tinnitus.
- Be able to carry out an appropriate history and physical exam of a patient who presents with tinnitus.
- List investigations that might be used in a patient presenting with tinnitus (both pulsatile and non-pulsatile).
- Identify worrisome characteristics of tinnitus which should spark further investigation.
- List various treatment modalities used for tinnitus.
Skull:
- List the three cranial fossa and the bones that form them.
- List the layers of the scalp.
Neck and Salivary Glands:
Anatomy
- Describe the locations and functions of the parotid glands, the submandibular glands and the sublingual glands.
- List the fascia of the neck.
- List the spaces of the neck.
- List the anatomical triangles of the neck.
- List the major arteries that feed the face and the neck.
Pathology
- Identify the most common organism involved with parotitis.
- Identify the risk factors for parotitis.
- Define Ludwig’s angina.
- Define sialolithiasis.
- Indicate the symptoms and sings of a parapharyngeal space infection.
- Indicate the symptoms and signs of a retropharyngeal space infection.
- List the differential diagnosis of a lateral neck mass.
- List the differential diagnosis of a midline neck mass.
Head and Neck Oncology:
- State the prevalence of squamous cell carcinoma.
- List risk factors associated with the development of squamous cell carcinoma.
- Describe the clinical presentations of squamous cell carcinoma in the oral cavity, oropharynx, larynx and hypopharynx.
- Describe, in general, various treatment modalities available for the treatment of squamous cell carcinoma of the head and neck.
Cleft lip and palate
- Have an understanding of the embryology of cleft lip and palate
- Have an understanding of the treatment goals in patients with a cleft lip and/or palate.
- Understand the multidisciplinary approach to patients with a cleft lip and/or palate
- Understand the timing of different treatments and surgeries for patients with cleft lip and/or palate
- Be able to describe feature of Pierre Robin sequence and velo-cardio-facial syndrome
Objectives for Ophthalmology
The material provided in this handout is not meant to limit your study and knowledge in the field of ophthalmology. Throughout your training in medicine you will be exposed to a vast amount of material that will complement these learning objectives. Additional material and clinical skills obtain through courseware, PBL, PSD, clinical and research electives should be integrated in your conceptualization of ophthalmology and doctor-patient interaction. Through this integration we believe that you will be able to have a clear conceptualization of the eyes as well as an overview of common diseases.
Review from Previous Blocks
- Giant Cell Arthritis (MSK)
- Hypertension (Cardiovasular)
- SLE (Haematology)
- Diabetes Mellitus (Endocrine)
- Sarcoidosis (Respiratory)
- MS (MSK)
- Carcinoma (Haematology and Neoplasia)
- Emboli (Haematology and Neoplasia)
Specific Learning Objectives for Ophthalmology Section of Special Senses
Anatomy
- Describe blood circulation in the eye.
- State the cranial nerve associated with the cornea.
- State the composition of the uveal tract.
- Describe the function of the lens.
- Describe the physical characteristics of the lens.
- Identify the various regions of the lens (cortex, anterior capsule, lens epithelium, nucleus and posterior capsule).
- Describe the morphology and function of the anterior chamber angle.
- Name and describe the cells found in the retina.
- Compare and contrast the function of rods and cones.
- Describe the differential placement of the cones and rods in the retina.
- Describe the pathology of retinal detachment.
- Describe the blood supply to the retina.
- Compare and contrast vitreous and aqueous humour.
- Describe the function and position of the extra ocular muscles (recti and obliques).
- Name and describe the action of the nerves that stimulate the extra ocular muscles.
- List and describe the function of eyelids and lacrimal apparatus.
- Describe the structure and function of the optic nerve.
- Describe the function and location of the optic chiasm and the retrochiasmatic pathways.
Histology
- Locate the diencephalon and the optic cup.
- Recognize immature retina, lens and iris.
- Recognize the three coats of the eyeball.
- Recognize rods and cones.
- Recognize the cornea as a continuation of the sclera.
- Recognize the lens as a biconcave disk located just behind the iris and attached to the ciliary processes of the ciliary body.
Embryology
State the embryological origin of the lens.
Vison Testing
- State questions necessary in taking a complete history.
- List methods to test visual acuity.
- Describe the use and function of a Snellen Chart
- Describe the method and use of a pinhole test.
- Describe the method for administering eye drops and name two types of dialating drops.
- Define the term legal blindness.
- Describe the methods used to determine intra ocular pressure.
Pathology
- Describe pathological reasons for sudden painless loss of vision.
- List examples of diseases affecting the eye and vision (related to congenital disease, traumatic disease, vascular disease, neoplastic disease, autoimmune disease, idiopathic disorders).
- Define cataract.
- Describe the morphological and the etiological classification of cataracts.
- Describe the pathological basis and complications of macular degeneration.
- Describe the clinical characteristics, patho physiology, signs and symptoms, and complications of primary open angle glaucoma.
- Describe the treatment for primary open angle glaucoma.
- Define amblyopia.
- Describe the patho physiological basis and treatment of amblyopia.
- Explain the relationship between amblyopia and cortical plasticity.
- Define strabismus (constant/intermittent, non-alternating/alternating, comitant or incomitant)
- Describe the types of strabismus (pseudoesotropia, congenital esotropia, accommodative esotropia, intermittent exotropia).
- State the prevalence and complications of retinoblastoma.
- Identify and explain congenital variations of the optic nerve.
- Describe the appearance of optic nerve hypoplasia.
- State the characteristics of papilledema.
- State the characteristics of pseudopapilledema.
- Define papillitis (optic neuritis).
- Describe the etiology of papillitis (optic neuritis).
Refractive Errors
- Define the following terms: emmetropia, ametropia, hyperopia, myopia, astigmatism, presbyopia, aphakia and pseudophakia.
Imaging
- Identify the orbit and the eye on X-Ray, MRI and CT scan.
- Identify the muscles of the eye and the optic nerve.