Objectives: EAGO

 

ENT

1)Become familiar with the Ear, Nose, and Throat Physical Exam which includes the location of normal landmarks. (Patient care, Medical Knowledge, Interpersonal Skills,Professionalism)

 

 

2)Become familiar with the approach to common outpatient ENT problems:vertigo, epistaxis,chronic sinus disease,tonsillitis,hoarseness,tinnitus, and chronic hearing loss. (Patient care, Medical Knowledge)

 

3)Become aware of problems that require immediate ENT evaluation:chronic otorrhea,sudden hearing loss,severe epistaxis, head/neck masses,stridor.(Patient Care, Medical Knowledge)

 

4)Become familiar with the common equipment/imaging used to evaluate many ENT problems: audiometry, vestibular testing, use of MRI vs. CT for certain diagnoses, laryngoscopy (Patient Care, Medical Knowledge, Interpersonal Skills, Practice Based Learning)

 

5)Become familiar with the various resources (subspecialty consultants, audiology, office management, etc)  necessary to provide optimal care for the ambulatory ENT patient (Practice Based Learning, Systems Based Practice)

 

6)Demonstrate the application of evidence-based cost effective strategies to the prevention, diagnosis and management of ENT disease in the ambulatory setting (Systems Based Practice)

 

 

 

ALLERGY

(Objectives highlighted in bold would be considered to be the minimum necessary.)

ASTHMA (Patient Care, Medical Knowledge)

1.      List the major pathologic factors responsible for airway obstruction in asthma and differentiate asthma from emphysema

2. Explain the pathophysiology of asthma regarding the:
   1. IgE mechanisms
   2. airway remodeling
   3. genetics
3.  Discuss precipitating factors including:
   1. infection
   2. irritants
   3. exercise
   4. allergens
   5. medications
   6. intrinsic factors including gastroesophageal reflux disease
4. Describe the clinical findings typical of asthma
5. Discuss the role of spirometry in the diagnosis and management of asthma.
6. Describe the typical spirometric and flow volume loop findings in patients with asthma, COPD, and laryngeal obstruction
7. Discuss etiologic evaluation of asthma by:
   1. history
   2. allergy testing
8. Explain environmental control measures.
9. Discuss classifying asthma severity in patients based on day and night time symptoms & lung function-mild intermittent, mild persistent, moderate persistent, severe persistent. (NHLBI guidelines)
10. Discuss the different classes of drugs used in the medical management of asthma and their side effects and their use in step therapy based on asthma severity:
    1. beta2 agonists
    2. theophylline (methylxanthenes)
    3. cromolyn and nedocromil
    4. steroids, inhaled and systemic
    5. atropine, ipratropium bromide
    6. leukotriene modifiers
    7. antihistamines
    8. omalizumab
11. Demonstrate proficiency in the proper use of the meter dosed inhaler, spacer devices, dry power inhalers and how to instruct patients in their use. (also Interpersonal Skills,Professionalism)
12. Explain goals and precautions of immunotherapy in patients with asthma (also Interpersonal Skills, Professionalism)
13. Discuss use of peak flow meters in the clinical management of asthma and develop an asthma action plan based on levels of peak flow measurements (also Interpersonal Skills, Professionalism)
14. Describe a basic program of outpatient management for: (also Interpersonal Skills, Professionalism)
    1. an adolescent or young adult female who has asthma with a febrile viral respiratory tract infection
    2. an adolescent or young adult male with seasonal asthma each April.
    3. a 15-year-old adolescent with exercise-induced bronchospasm
15. Define and explain the management of status asthmaticus (Patient Care, Medical Knowledge)
16. Discuss quality of life issues regarding patients with chronic asthma (also Interpersonal Skills, Professionalism, Systems Based Practice)
17. Recognize emotional/behavioral aspects of caring for patients with asthma (also Interpersonal Skills, Professionalism)
18. List indications for referral to an allergy/immunologist (also Interpersonal Skills, Professionalism, Systems Based Practice)

 

PULMONARY FUNCTION TESTING (Patient Care, Medical Knowledge)

1. Label the lung capacities and lung volumes in a line drawing.
2. Describe methods by which standard pulmonary function values have been obtained.
3. List the most common pulmonary function values that are obtained in an office setting (peak flow measurement, spirometry, flow volume loop) (also Practice Based learning )
4. Describe the typical spirometric and flow volume loop findings in patients with asthma, COPD, and laryngeal obstruction (also Practice Based Learning)
5. Explain the measurement of non-specific bronchial hyperactivity by methacholine or histamine inhalation challenge
6. Explain exercise challenge testing including methods and interpretation of results

 

RHINITIS (Patient Care, Medical Knowledge)

1. Classify rhinitis in the categories of seasonal allergic rhinitis, perennial allergic rhinitis, perennial nonallergic rhinitis, (vasomotor/chronic) rhinitis, and other causes
2. Describe the signs and symptoms of allergic rhinitis and contrast them with those of vasomotor/chronic rhinitis
3. Summarize the natural history of allergic rhinitis and contrast it with that of vasomotor/chronic rhinitis
4. Explain the pathophysiology of allergic rhinitis
5. Identify precipitating factors for rhinitis
   1. outdoor allergens (with knowledge of seasons, trees, grasses, weeds, and molds)
   2. indoor allergens (dust mites, animal dander, cockroach feces, etc.)
   3. irritants
   4. physical factors
   5. endocrine factors
   6. other causes
6. Explain the roles of nasal smears and allergy testing in the differential diagnosis of rhinitis
7. Describe methods to manage allergic rhinitis,
   1. environmental control: home, school, work
   2. antihistamines (oral, topical) including contraindications, (e.g.,benign prostatic hypertrophy) and use in patients with concomitant asthma
   3. decongestants
   4. sympathomimetics (oral, topical)
   5. cromolyn sodium and nedocromil
   6. topical steroids
   7. leukotriene antagonists
   8. immunotherapy
8. List the complications of untreated allergic rhinitis (including sinusitis, orthodontic problems, otitis media)
9. Describe quality of life issues in patients with allergic rhinitis (also Interpersonal Skills, Professionalism, Systems Based Practice)
10. Discuss allergic conjunctivitis including differential diagnosis and treatment
11. Describe indications for referral to an allergy/immunologist (also Practice Based Learning, Systems Based Practice)

 

SINUSITIS (Patient Care, Medical Knowledge)

1. Classify sinusitis based on duration of symptoms into (a) acute, (b) subacute, (c) chronic.
2. Describe signs and symptoms of acute versus chronic sinusitis.
3. Differentiate the microbiological causes of acute versus chronic sinusitis in children versus adults.
4. Discuss the pathophysiology of sinus disease and how underlying factors can be contributory including (a) allergic rhinitis, (b) nasal polyposis, (c) anatomic/structural abnormalities, (d) viral URI.
5. Discuss tests used in the diagnosis of sinusitis including nasal smear, nasal culture and sensitivity, and imaging studies. (also Practice Based Learning)
6. Review paranasal sinus anatomy and development.
7. Discuss the radiographic findings of sinus x-ray/CT scan in patients with acute viral URI and allergic rhinitis versus sinusitis. (also Practice Based Learning)
8. Discuss the incidence of aspirin sensitivity in patients with sinusitis.
9. Describe the different potential therapeutic modalities used in the treatment of sinusitis: (a) antibiotics, (b) decongestants (oral, topical), (c) antihistamines, (d) corticosteroids, topical and systemic, (e) duration of therapy, (f) nasal saline.
10. Discuss surgical therapy for sinusitis. (also Practice Based Learning)
11. Describe complications of sinusitis.
12. Describe effects of sinusitis on asthma.

 

ANAPHYLAXIS (Patient Care, Medical Knowledge)

1. List the allergic emergencies including anaphylaxis, allergic asthma, and laryngeal edema. Define anaphylaxis and differentiate from anaphylactoid reactions
2. List the causes of anaphylactic/-oid reactions including foods, medication, latex, inset stings, endogenous histamine releasers, idiopathic, exercise
3. List the common and less common symptoms and signs of an anaphylactic/-oid reaction
4. List the differential diagnoses for anaphylaxis
5. Explain the long term prophylactic management of anaphylaxis including: (also Interpersonal Skills, Practice Based Learning, Professionalism)
   1. prevention of occurrence through avoidance
   2. Medic-alert identification
6. Be able to describe or demonstrate the proper use of an Epi-pen, Ana-Kit, or other device.  (also Interpersonal Skills, Practice Based Learning, Professionalism)

 

ALLERGY TESTING (Patient Care, Medical Knowledge)

1. Describe the techniques of allergy skin testing (also Practice Based Learning)
   1. puncture (prick)
   2. intradermal
2. List the advantages and disadvantages of each method and of skin testing vs. in vitro testing.
3. List contra-indications for skin testing
4. Explain the significance of a delayed skin reaction
5. List medications that interfere with allergy skin testing
6. List 10 common antigens available for allergy skin testing
7. Describe clinical indications for performing allergy skin testing:
   1. to make a diagnosis
   2. to assist in environmental control
   3. to predict the timing of a patient's allergy season
   4. to determine the composition of extracts used for immunotherapy

 

 

IMMUNOLOGY (Medical Knowledge)

1. List functions of Th1, Th2, and B cells
2. Describe briefly the interaction between T cells, B cells and macrophages
3. Describe the various classes of immunoglobulins and their functions
4. Discuss the use of functional antibody assays in the diagnosis of humoral immune deficiency
5. List the components of the complement system and disorders associated with deficiency of C1INH, early classical pathway components, late classical pathway components
6. List two diseases with phagocytic dysfunction
7. Classify immunodeficiency diseases including:
   1. B cell immunodeficiency diseases
   2. T cell immunodeficiency diseases
   3. combined B cell and T cell immunodeficiency diseases
8. For the immunodeficiency states above describe: (also Patient Care)
   1. common presenting signs and symptoms
   2. common physical findings
   3. types of organisms typically causing infection in these patients
   4. differential diagnoses of
      1. recurrent respiratory tract infections, including cystic fibrosis, IgE-mediated processes, air pollution exposure, anatomic abnormalities, etc.
      2. recurrent sepsis and/or meningitis
      3. recurrent soft-tissue, bone, and joint bacterial infections
9. List laboratory methods to identify deficiency of antibody-mediated immunity
10. List methods for screening for cell-mediated immunity
11. List laboratory test methods for screening for phagocytic deficiency
12. List laboratory tests for screening of complement deficiency

 

ALLERGIC SKIN DISORDERS (Patient Care, Medical Knowledge)

1. Define the terms "atopic dermatitis" and "eczema"
2. Identify the characteristic age at onset of atopic dermatitis and the typical distribution of skin involvement by age of the patient.
3. Discuss the triggers of exacerbations of atopic dermatitis including:
   1. allergens including foods & airborne allergens
   2. infections including staphylococcal, fungal
   3. irritants such as soaps
4. Discuss the natural history of atopic dermatitis
5. List the complications of atopic dermatitis
6. Describe typical laboratory findings in patients with atopic dermatitis
7. Outline a management for a patient with atopic dermatitis including:
   1. environmental control
   2. topical humidification & lubrication
   3. topical steroids and topical immune modulators
   4. dietary factors
   5. control of pruritis
   6. treatment of complications
   7. when to refer to an allergist/immunologist
8. Describe the etiology of this Type IV, cellular immunity type reaction
9. Describe typical distribution of contact dermatitis caused by different common contactants
10. Describe patch tests and their role in the diagnosis of contact dermatitis
11. Outline a program of management for a patient with contact dermatitis including:
    1. avoidance
    2. oral steroids
    3. topical steroids
    4. soothing skin soaks
    5. antipruritic drugs

 

URTICARIA AND ANGIOEDEMA (Patient Care, Medical Knowledge)

1. Define urticaria
2. Describe the natural history of: urticaria and angioedema
3. Describe the pathophysiology of urticaria/angioedema, including IgE, autoimmune, immune complex, and nonimmune mechanisms, including direct histamine release; and modifying factors including hormonal agents and medications such as aspirin.
4. Outline logical attempts to identify etiologic factors contributing to urticaria/angioedema including:
   1. history
   2. physical exam
   3. appropriate laboratory investigation
5. Outline a management program for a patient with acute and for a patient with chronic urticaria/angioedema. (also Interpersonal Skills, Practice Based Learning, Professionalism)
6. Describe hereditary angioedema including:
   1. clinical presentation
   2. laboratory findings
   3. management-acquired versus congenital form

 

STINGING INSECT ALLERGY (Patient Care, Medical Knowledge)

1. List the insects that are members of the order Hymenoptera
2. Identify where in the natural habitat one could typically find a honey bee, wasp, yellow jacket, hornet, and fire ant
3. Differentiate the reactions that can occur after insect stings including:
   1. normal reactions
   2. large local reactions
   3. systemic reactions
   4. delayed reactions
4. Explain the role of venom skin testing and in vitro serum IgE allergen specific assays in the diagnosis of stinging insect hypersensitivity
5. Outline an emergency treatment for a patient with:
   1. local reaction to insect sting
   2. large local reactions to insect sting
   3. systemic reactions to insect sting
6. Explain long-term management of patient with insect sting reaction (also Interpersonal Skills, Professionalism)
7. List indications for venom immunotherapy in the prophylaxis of stinging insect hypersensitivity

 

DRUG ALLERGY (Patient Care, Medical Knowledge)

1. Classify adverse drug reactions and give examples, including:
   1. toxicity
   2. intolerance
   3. side effects
   4. idiosyncrasy
   5. drug allergy
   6. drug interactions
2. Explain the pathophysiology of drug allergy
   1. Type I, immediate hypersensitivity (IgE-mediated) drug reaction with several examples
   2. Type II, cytotoxic-type drug reactions with examples
   3. Type III, serum sickness: Arthus-type drug reaction with examples
   4. Type IV, cellular hypersensitivity-type drug reaction with examples
3. Explain the roles of clinical history, physical examination, and laboratory testing in the evaluation of adverse drug reactions
4. Discuss the role of skin testing for drug allergy and adverse reactions.
5. Describe reactions to local anesthetics and use of graduated dose therapeutic trial
6. Identify several drugs that have been implicated in anaphylactic reactions

 

FOOD ALLERGY AND ADVERSE REACTIONS (Patient Care, Medical Knowledge)

1. Classify adverse reactions to foods and give examples of:
   1. genetic enzymatic reactions
   2. reactions of intolerance
   3. toxic reactions
   4. reactions to food additives, metabisulfites, tartrazine
   5. allergic reactions
2. List foods commonly implicated in Type I, IgE-mediated, hypersensitivity anaphylactic reactions
3. Describe common and less common manifestations of IgE-mediated disease caused by foods (oral allergy syndrome).
4. Explain methods to diagnose IgE-mediated hypersensitivity food reactions
5. Identify when to refer to an allergy/immunologist. (also Systems Based Practice)

 

 

GYN

1) Become familiar with normal pelvic anatomy and the approach to a bimanual pelvic exam in the GYN patient. (Patient care, Medical Knowledge, Interpersonal Skills,Professionalism)

 

 

2) To perform pelvic exams under supervision (includes sending cultures for GC, chlamydia, performing a KOH and wet prep and to perform pap smears) (Patient care, Medical Knowledge, Practice Based Learning, Interpersonal Skills,Professionalism)

 

 

3) Become familiar with the common outpatient conditions for which an internist would consult a gynecologist (general well woman visit, pelvic pain, vaginal discharge, dysfunctional uterine bleeding, abnormal pap smear, dyspareunia, menorrhagia, premenstrual dysphoric syndrome,etc) and to understand the approach to each of these. (Patient care, Medical Knowledge, Interpersonal Skills, Systems Based Practice, Professionalism)

 

 

4) Understand the approach to and discussion of contraception from the point of view of the gynecologist and the methods selected for particular patients. (Patient care, Medical Knowledge, Interpersonal Skills,Professionalism)

 

5) Understand problems that require immediate GYN evaluation: DUB, abnormal pap smears, emergency contraception. (Patient care, Medical Knowledge, Interpersonal Skills,Professionalism, Systems Based Practice)

 

 

6)Become familiar with the various resources (subspecialty consultants, etc)  necessary to provide optimal care for the ambulatory GYN patient (Systems Based Practice)

 

7)Demonstrate the application of evidence-based cost effective strategies to the prevention, diagnosis and management of GYN disease in the ambulatory setting (Systems Based Practice)

 

 

 

 

Ophthalmology

1) Become familiar with the external eye evaluation and eyelid problems including blepharitis, chalazion, ptosis, ectropion and entropion, dacryocystitis, ptosis, and eyelid lesions that might be malignant (Patient care, Medical Knowledge, Interpersonal Skills,Professionalism)

 

2) Become familiar with the evaluation of the Red Eye including the distinction between iritis, iridocyclitis, conjunctivitis, trauma, subconjunctival hemorrhage, episcleritis, etc. (Patient care, Medical Knowledge, Interpersonal Skills,Professionalism)

 

3) Become familiar with the causes of acute vision loss, transient vision loss, and chronic vision loss. (Patient care, Medical Knowledge, Interpersonal Skills,Professionalism)

 

4) Become familiar with the distinction between emergency, acute, and subacute reasons for referral: (Patient care, Medical Knowledge, Interpersonal Skills,Professionalism)

Emergent-chemical burns, acute decrease visual acuity, pain, orbital cellulites, trauma

Acute-corneal abrasion, preseptal cellulites, foreign body, hyphema, acute visual field

          loss, floaters

Subacute-painless red eye, etc.

 

5) Recognize ophthalmic manifestations of systemic disease.(Patient care, Medical Knowledge, Interpersonal Skills,Professionalism)

 

6) Recognize and become familiar with the basic equipment used by ophthalmologists to evaluate eye problems. (Patient care, Medical Knowledge, Practice Based Learning)

 

7)Demonstrate the application of evidence-based cost effective strategies to the prevention, diagnosis and management of ophthalmological disease in the ambulatory setting (Systems Based Practice)