SURG 403 - SURGERY SUBSPECIALTIES SENIOR CLERKSHIP CORE
Core Teaching Sessions with Learning Outcomes
Urology
Hematuria
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Differentiate red or brown urine from hematuria, transient from persistent, and glomerular
from extraglomerular hematuria.
Determine whether the patient has true hematuria.
Diagnose the presence of urinary tract infections.
Differentiate between glomerular and extraglomerular hematuria by examination of urine
sediment.
Interpret reported urinalysis findings.
Outline significance of patient's age, gender, and life style on diagnostic possibilities.
Outline the selection of treatment for patients with urinary tract infections appropriate for
gender, lower, and upper urinary tract.
Outline a plan for investigation of patients with recurrent nephrolithiasis.
Formulate a management plan (non-pharmacological) for prevention of recurrent
nephrolithiasis.
Discuss possible strategies for the detection and prevention of urinary tract tumors.
Prostate diseases
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Define the clinical presentation, workup and management of a patient with benign prostatic
hypertrophy.
Demonstrate an understanding of the use of ultrasound and prostatic biopsy in diagnosing
prostate cancer.
Consider these Medical Council of Canada (MCC) Objectives related to "Prostate"
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IMPOTENCE/ERECTILE DYSFUNCTION 48
URINARY TRACT INJURIES 109-14
DYSURIA AND/OR PYURIA 110-1
URINARY OBSTRUCTION/HESITANCY/PROSTATIC CANCER 111
INCONTINENCE, URINE 47-2
LOCAL PAIN, SPINE/LOW BACK PAIN 67-1-2-6
SCROTAL MASS 90
SCROTAL PAIN 91
Urinary obstruction/renal stones
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Determine whether a patient has an acute obstruction any time the complaint is complete
anuria or unexplained renal insufficiency (other causes of anuria or renal insufficiency such as
shock, Rapidly Progressive Glumerulonephritis (RPGN) and Hemolytic Uremic Syndrom (HUS)
are relatively rare).
Determine whether the obstruction is acute or chronic, duration, complete or partial, and
unilateral or bilateral, and site.
Ask whether pain is present, site of pain (e.g., suprapubic for bladder distention, flank for renal
capsule), whether it is colicky and radiates to ipsilateral testicle or labia (renal or ureteral colic),
or occurs after a fluid load that increases urine output (e.g., beer drinking).
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Examine for tenderness, hydronephrosis, hypertension, and palpable bladder.
Select ultrasonography as the diagnostic imaging tool to diagnose obstruction.
List indications for other types of diagnostic imaging.
Select and interpret tests of renal function; outline indications for prostate cancer screening.
Perform catheterization of the bladder for both therapeutic and diagnostic reasons.
Discuss how to select patients for referral to specialized care.
Orthopedic Surgery
Arthritis/deformities
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Outline the diagnostic workup for a patient with a suspected primary and secondary malignant
of bone.
List and discuss the laboratory and radiological techniques used in making the diagnosis of
rheumatoid arthritis and osteoarthritis.
List and discuss the nonsurgical and surgical treatment options of degenerative joint disease of
the hip, knee, and spine.
Outline the diagnostic workup for a patient with lumbar or cervical disc hernia.
Consider these MCC Objectives related to Arthritis/deformities:
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JOINT PAIN, MONO-ARTICULAR (ACUTE, CHRONIC) 50-1
LOCAL PAIN, SHOULDER/ELBOW/WRIST/HAND 67-1-2-2
JOINT PAIN, POLY-ARTICULAR (ACUTE, CHRONIC) 50-2
DEFORMITY/LIMP/PAIN IN LOWER EXTREMITY, CHILD 20
DIASTOLIC MURMUR 62-1
LOCAL PAIN, SPINAL COMPRESSION/OSTEOPOROSIS 67-1-2-4
LOCAL PAIN, SPINE/NECK/THORACIC 67-1-2-5
LUMP/MASS, MUSCULOSKELETAL 53
GAIT DISTURBANCES/ATAXIA 35
PERIARTICULAR PAIN/SOFT TISSUE RHEUMATIC DISORDERS 50-3
FEVER OF UNKNOWN ORIGIN 107-2
LOCAL PAIN, SPINE/LOW BACK PAIN 67-1-2-6
LOCAL PAIN, HIP/KNEE/ANKLE/FOOT 67-1-2-3
FATIGUE 33
FALLS 32
CHRONIC RENAL FAILURE 89-2
Orthopedic trauma/soft tissue injuries
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List and discuss principles of physical rehabilitation of an extremity following immobilization
for fracture healing.
Outline the management priorities in treating fractures.
List the complications of cast immobilization of acute extremity injuries.
Describe the management of dislocations and subluxations.
Discuss the treatment of a compartment syndrome.
Discuss common fractures and joint injuries; identify specific problems with their diagnoses
and management.
List and discuss the diagnostic workup used in making a definitive diagnosis of bone or joint
infection.
Consider these MCC objectives related to "Orthopedic trauma"
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FRACTURES/DISLOCATIONS 34
Plastic Surgery
Burns
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Diagnose burns according to depth and percentage total body surface area (TBSA) involved.
Outline the initial management of major thermal trauma patients according to Advanced
Trauma Life Support protocol
Determine the depth and TBSA affected by 2nd and 3rd degree burns.
Determine the risk of associated inhalation injury.
Determine whether there are other associated clinical problems or other trauma.
Determine patient's tetanus immunization status.
Order CBC, electrolytes, urea, arterial blood gases, and chest x-ray in patients with major
burns.
Order carboxyhemoglobin to diagnose carbon monoxide poisoning.
Order bronchoscopy if inhalation injury is suspected.
Identify patients requiring special care:
o 2nd and 3rd degree burns>10% body surface area;
o 2nd and 3rd degree burns on face, hands, and perineum;
o Circumferential or splash burns;
o Electrical burns (including lightning);
o Chemical burns; and
o Pediatric burns suspicious for neglect or abuse.
Outline the outpatient management of minor cutaneous burns.
Stabilize the burn patient requiring referral to burn treatment center including stopping
further burn injury, covering of burn area, protecting airway, resuscitate (oxygen, intravenous
fluids), and provide physiologic monitoring and pain control.
Cardiac Surgery
Coronary artery disease
Consider these MCC Objectives related to "Coronary artery disease"
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CHEST DISCOMFORT/PAIN/ANGINA PECTORIS 14
LIPIDS ABNORMAL, SERUM 51
PLEURAL EFFUSION/PLEURAL ABNORMALITIES 76
SLEEP AND CIRCADIAN RHYTHM DISORDERS/SLEEP APNEA SYNDROME/INSOMNIA 98
CARDIAC ARREST 13
Valvular diseases/Congenital heart diseases
Consider these MCC Objectives related to "Congenital heart diseases"
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NON-REASSURING FETAL STATUS (FETAL DISTRESS) 65
LIVER FUNCTION TESTS ABNORMAL, SERUM 52
CHRONIC RENAL FAILURE 89-2
Thoracic Surgery
Lung neoplasia
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Compare and contrast the management and prognosis of metastatic versus primary lung
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malignancies.
Describe the surgical approach to lung cancer as dictated by location of the lesion.
Discuss the etiology and management of lung abscess and empyema.
Vascular Surgery
Peripheral vascular diseases/Aneurysms
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List the diagnostic and management plans for a patient with a rupturing abdominal aortic
aneurysm.
Discuss the indications, contraindications, and risk factors for surgery in chronic asymptomatic
abdominal aneurysms.
Define and discuss the prevention of the common complications following aneurysms surgery.
Compare thoracic, abdominal, femoral and popliteal aneurysms with respect to treatment.
Describe the diagnostic approach and medical management of arterial occlusive disease;
include a discussion of the roles of the commonly used non-invasive procedures.
List criteria to help differentiate venous, arterial, diabetic, and infectious leg ulcers.
Describe the operative treatment choices available for chronic occlusive disease of the distal
aorta and iliac arteries, superficial femoral/popliteal arteries, and tibial and peroneal arterial.
Describe the diagnostic workup and surgical indications for chronic renal artery occlusion.
List six signs and symptoms of acute arterial occlusion and outline its management (e.g.,
indications for medical versus surgical treatment).
Neurosurgery
Neurotrauma
Intracranial Disease
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Recognize and manage transtentorial herniation.
List the features that distinguish focal mass, cerebral swelling, and hydrocephalus as causes of
increased intracranial pressure. Understand the methods for monitoring and treating each of
them.
Describe the management of scalp lacerations and penetrating injuries.
List the types of skull fracture; describe the steps in their management and their complications.
List the indications for carotid surgery.
Describe the diagnosis and management of intraparenchymal bleeding and subarachnoid
hemorrhage.
On the basis of the history and physical examination, choose and interpret the diagnostic tests
needed to establish the site and nature of brain tumors.
List the indications for sterotaxic biopsy, open surgical excision, radiation, and chemotherapy
of brain tumors.
Intraspinal Disease
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List the important evaluation and management steps in the case of acute spinal cord
injury. Consider (a) bodily injuries, (b) spinal instability, and (c) spinal cord damage.
Describe the indications for external immobilization and for internal decompression and fusion
of the spine. Include consideration of anterior and posterior approaches.
Describe the clinical manifestations, diagnostic workup, conservative management, and
surgical indications for a patient with (a) cervical disc herniation and (b) lumbar disc herniation.
List the common spinal infections, their symptoms and treatment.
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List the common intramedullary, intradural extramedullary, and extradural tumors and
compare their modes of presentation.
List the three most common origins of spinal metastases.
Functional Neurosurgery
List the indications for surgical relief of pain and the surgical options available.
List the indications for epilepsy.
Describe the symptoms of normal pressure hydrocephalus.
Cerebrovascular accidents
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Outline diagnostic methods as sell as medical and surgical management of a patient with
symptomatic carotid artery disease.
Outline a management and treatment plan for patients with TIA.
ENT
Heck & Neck Cancers
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List the risk factors, workup, and three major treatment modalities of laryngeal cancer.
Describe the evaluation, and management of congenital, inflammatory, and neoplastic neck
masses of the oral cavity and pharynx.
List the causes and describe the workup of hoarseness.
Head & Neck Emergencies (Foreign bodies, Airway obstruction, Deep neck infection & Apistaxis)
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Discuss the differential diagnosis and management approach to a patient with penetrating
neck trauma and blunt neck trauma.
Outline the principles of investigation and management of patients with a neck mass
(infection, congenital or neoplastic).
For Integrated Clerkship: Weekly learning sessions will cover the same material as above.
Patient Encounter / Procedure Log Checklist
Minimum number of
cases
Setting
Consultation to ER
2
Emergency
room
Pre op care
2
Ward
OR
2
OR
Specialty specific clinic patients
2
Outpatient
clinic
Post op care
2
Ward
Skin closure
1
OR
Surgery Subspecialties Clinical Encounters/Procedures