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24 Νοε 2013 (πριν από 3 χρόνια και 8 μήνες)

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HMS 601 Surgical Anatomy
Thorax. Development. Heart and great vessels, foetal circulation, oesophagus, diaphragm.
Thoracic wall. Mechanics of breathing. Thoracic cavity and viscera; superior and inferior
mediastinum, heart and pericardium, lungs, pleurae. Surface and imaging anatomy; heart,
heart valves, auscultation sites, lungs and pleurae, plane of sternal angle, dermatomes, chest
drains, incisions, chest xray, CT/MRI.
Abdomen, Pelvis, Perineum. Development; foregut, midgut, hindgut. Gut rotation. Anal canal.
Kidneys and ureters. Bladder and urethra. Testis. Abdomen and pelvis; Anterior abdominal wall
(inguinal canal, spermatic cord, inguinal hernia), posterior abdominal wall, pelvic floor and wall,
lumbar plexus and sacral plexus. Peritoneal cavity. intra-abdominal spaces. Abdominal viscera.
Oesophagus and stomach, small and large intestine, appendix. Liver, gall bladder, bile ducts,
pancreas, spleen, kidney, ureter, suprarenal gland. Pelvic viscera. Rectum, bladder, prostate,
seminal vescicles, uterus, uterine tubes, ovaries, vagina. Perineum. Anal triangle, anal canal,
ischiorectal fossa, male urogenital triangle, scrotum, testis, epididymis, penis, urethra, female
urogenital triangle, vulva. Surface and imaging anatomy. Quadrants/nine regions, Planes
(subcostal, transpyloric, transtubercular), dermatomes, abdominal incisions, rectal and vaginal
examinations, imaging appearances of abdomen, gastrointestinal, biliary and urinary tracts,
arteriography, ultrasound, CT/MRI. Upper limb and Breast. Pectoral girdle, breast, axilla,
brachial plexus, scapular region, arm, cubital fossa, forearm, hand including carpal tunnel,
shoulder joint, elbow joint, radio-ulnar joints, wrist joint, hand joints. Surface and imaging
anatomy. Cubital fossa, wrist structures, thumb movements, arteries and pulses, superficial
veins and lymphatics, nerves (axillary, radial, musculocutaneous, ulnar, median), dermatomes
and tendon reflexes, arteriography and venography. Lower limb. Gluteal region, thigh, femoral
triangle, femoral sheath and canal, femoral hernia, adductor canal, popliteal fossa, leg
compartments, foot arches, hip joint, knee joint, ankle joint, foot joints. Surface and imaging
anatomy. Femoral triangle, popliteal fossa, arteries and pulses, superficial veins and
lymphatics, nerves (femoral, sciatic, tibial, common peroneal), dermatomes and tendon reflexes,
arteriography, venography. Head, neck and spine. Development. Branchial arches, face, palate,
thyroid gland, parathyroid glands, spine. Head. Face, scalp, cranial cavity, dural venous sinuses,
pituitary gland, orbit, eyeball, ear, parotid gland, temporomandibular joint, nose and paranasal air
sinuses, mouth, tongue, submandibular and sublingual glands. Neck. Anterior triangle and
contents ( thyroid and parathyroid glands, larynx and trachea, pharynx and oesophagus, carotid
sheath), posterior triangle and its contents ( spinal accessory nerve, cervical plexus), root of neck
and thoracic duct. Spine. Vertebral column, vertebral canal. Surface and imaging anatomy.
Middle meningeal aretery, neck blood vessels, central venous catheterisation, laryngeal
structures, airway access, skull and cervical spine, arteriography, CT/MRI. Nervous system.
Central nervous system. Cerebral hemispheres, ventricles, cerebellum, brain stem, spinal cord,
meninges. Peripheral nervous system. Cranial nerves, spinal nerves, peripheral nerves.
Autonomic nervous system. Surface and imaging anatomy. Arteriography, CT/MRI.
Microscopic structure of tissues and organs of surgical relevance e.g. skin, thyroid gland,
appendix, etc.
Applied surgical embryology. Developmental basis of surgically treatable common congenital
abnormalities e.g. congenital heart disease and malrotation of gut.
Course and distribution of major blood vessels and nerves, including dermatome patterns and
pathways of lymphatic drainage particularly those of important structures e.g. the breast.
Principal attachments, actions, and nerve supply of important muscles.
Knowledge of bones of the skeleton including the hand and foot.
General physiological principles. Homeostasis, thermoregulation, metabolic pathways, sepsis
and septic shock, fluid balance and fluid replacement therapy, causes of metabolic
acidosis/alkalosis, colloid and crystalloid solutions, coagulation and bleeding. Respiratory
systems. Central nervous control of ventilation, normal ventilatory cycle, intermittent positive
pressure ventilation (IPPV), normal and abnormal blood gases, causes of post operative
respiratory failure. Acute adult respiratory distress syndrome (ARDS). Cardiovascular system.
Cardiac pressure cycle, control of cardiac output, haemorrhagic shock, blood pressure and its
control mechanisms. Gastrointestinal systems. Gastric emptying, Gut hormones, pancreatic
function, peristalsis and ileus. Renal/Genitourinary system. Function of the nephron,, renal
autoregulation, renin-angiotensin system, causes of a poor urine output, types of renal failure.
Endocrine system. Function of the pituitary gland, function of the adrenal gland, calcium
metabolism, erythropoetin. Central nervous system. Causes of postoperative confusion,
physiology of space occupying lesions, cerebral autoregulation, Thyroid and parathyroid.
Thyroid hormones, hypothyroidism, hyperthyroidism, parathyroid hormones, disorders of
parathyroid hormones and calcium homeostasis. Glucose homeostasis and diabetes.
General Pathology; Inflammation. Classification. Acute inflammation with an infective
organism as the primary agent, microscopic and macroscopic features including microscopic
appearances. Chronic inflammation with an infective organism as the primary agent, non-
specific and specific (classified by the infective organism or the host reaction), microscopic and
macroscopic features, mechanisms and effects (local and systemic). Abscess, sinus, fistula
formation (definitions, complications). Cellular injury other than by infection; chemical injury
(chemical burns, poisoning, chemotherapy), physical injury (direct destructive trauma), radiation
injury, injury as a consequence of genetic abnormalities. Wounds and wound healing:
classification of wounds, ulcer and erosion (resolution and repair), first and second intention
healing, scar formation, healing in the central nervous system, fractures and pathological
fractures. Vascular disorders. Thrombosis and clot formation. Hypercoagulable states, embolus
formation (aetiology, complications), atheroma, ischaemia and infarction, aneurysms and
varicosities, oedema, ascites, transudate , exudates, coagulation deficits (classification, tests,
complications). Disorders of growth, differentiation and morphogenesis. Failure of growth or
maintenance of growth (agenesis, aplasia, hypoplasia, atrophy, apoptosis, necrosis). Overgrowth
with normal cell differention (hyperplasia, hypertrophy, metaplasia, harmatoma formation).
Growth and overgrowth with abnormal cell differentiation (giant cells, dysplasia).
Accumulations and depositions (amyloid, haemosiderosis, haemochromatosis, calcification,
calculi). Neoplasia. Classification of tumours (carcinoma, sarcoma, blastoma, teratoma, etc),
Diagnosis (cytology, biopsy, frozen section). Benign neoplasms. Carcinogenesis (normal and
disordered cell replication, behaviour of cancer cells). Molecular biology of cancer (cell cycle
and the human genome, mechanisms of tumour genesis, tumour markers, mechanisms of
invasion and routes of metastasis). Typing grading and staging of cancer. Teratoma (definition,
sites, behaviour). Paraneoplastic syndromes. Epidemiology of common cancers and cancer
registration. Principles of screening. Surgical immunology. Hypersensitivity reactions.
Complement cascade functions. Immunoglobulins and their functions. Chemotaxis and
cytokines. Diseases mediated by immunological mechanisms (Graves disease, pernicious
anaemia, rheumatoid arthritis). Immunodeficiency. Transplantation (graft Vs host reactions).
System Specific Pathology: Nervous system. Head injuries. Raised intracranial pressure.
Meningitis. Brain abscess. Neoplasms. Spinal cord and peripheral nerve injuries. Muskulo-
skeletal system. Bone and joint infection. Osteomyelitis. Septic arthritis. Pathophysiology of
fractures and healing. Complications of fractures. Pathological fractures. Traumatic oedema and
compartment syndromes. Osteoarthritis. Tumours of the musculoskeletal system. Metabolic bone
diseases. Rheumatoid arthritis. Respiratory system. Carcinoma of the bronchus and lung.
Pneumothorax. Pneumonia. Empyema. Bronchiectasis. Breast disorders. Benign and malignant
tumours. Brest cancer (screening principles, asssesmenr classificccation, staging systems).
Infections. Gynaecomastia. Cardiovasccular system. Artherosclerosis. Ischaemic heart disease.
Aneurysms. Peripheral vascular disease. Varicose veins. Deep venous thrombosis. Endocrine
systems. Hyperthyroidism and hypothyroidism. Thyroid cancers. Hyperparathyroidism.
Addisons disease. Neoplasms of adrenal medulla. Piiitutary adenomas. Carcinoid syndrome.
Multiple endocrine adenopathy. Genitourinary system. Gynaecological causes of acute
abdominal pain. Pelvic inflammatory disease. Ovarian disease. Ectopic pregnancy.
Endometriosis. Urinary stone disease. Tumours o0f the kidney, bladder, penis, testis and
scrotum. Urinary tract infections. Haematuria. Gastrointestinal systems.
Intestinal fistulas. Colonic polyps. Colonic carcinoma (classification, aetiology, genetics, staging
systems, complications). Oesophageal carcinoma. Peptic ulceration. Gastric carcinoma. Gall
stones and obstructive jaundice. Pancreatitis. Dermatological diseases. Burns. Skin cancer.
Melanoma. Lymphoreticular system. Spleen. Lymphoma.
Surgical pathology of common tropical conditions. Sickle cell anaemia. Burkitts tumour.
Kaposis sarcomaa. Tropical ulcer (including Buruli ulcer). Mycetoma. Phycomycosis.
Histoplasmosis. Schistosomiasis. Onchocerciasis. Dracunculosis. Helminthoma. Pyomyositis
(Tropical pyomyositis). Cancrum oris. Leprosy.
Microbiology & Parasitology. Surgically important microorganisms and parasites.
(Ascariasis, Typhoid fever, Tuberculosis, Amoebiasis, Hydatid disease,Toxoplasmosis,
Cysticercosis, Schistosomiasis, Paragonimiasis, Trichinosis, Actinomycosis, Aspergilosis,
Blastomycosis, Candidiasis, Cladosporiosis, Coccidiomycosis, Cryptococcosis,
Histoplasmosis, NorcadiosisPhycomycosss, Sarcoidosis) Exotoxins and endotoxins.
Pathophysiology of sepsis. Disinfection and sterilisation. Immunisation. Commensals.
Nosocomial infections. Sources of surgical infection. Prevention of infection (principles of
asepsis and antisepsis). Modern antibiotic usage (commonly used antibiotics, selecting the
right antibiotic, antibiotic resistance). Surgery in Hepatitis and HIV carriers (blood-borne
viruses, universal precautions, surgical precautions, immunisation, management of sharps
Cell physiology; normal cellular molecular physiology and molecular physiology of cancer cells.
The human genome. DNA replication. Messenger RNA. Regulatory elements and enhancers.
Transcription and translation. Mitochondrial genome Screening; Potential of knowledge of
molecular and genetic function to identify patients at risk to develop cancer or to experience
recurrence after curative resection. Recombinant DNA techniques. Cloning. Polymerase chain
reaction. Southern blot analysis. Northern and Western blot analysis. Gene therapy. Role in
development of specific anti-neoplastic therapies.Role of molecular biology in understanding
certain diseases (Wilms tumour, neuroblastoma, Hirschsprung disease, polyposis syndromes
and multiple endocrine neoplasias). Growth Factors (platelet derived growth factor, Epidermal
Growth Factor, Transforming Growth Factor a, Transforming Growth Factor B, Fibroblast
Growth Factor, Insulin-like Growth Factor 1 & II, Bombesin, Growth Factor Receptors. Signal
Transduction, Phosphotidyl linositol system, Protein Kinase-C, G-(ras) proteins, Oncogenes;
dominant oncogenes (membrane oncogenes, growth factor like oncogenes, signal transduction
oncogenes, nuclear oncogenes), the role of dominant oncogenes in surgical oncology. Ras
Oncogenes, myc oncogenes, HER-2/neugenes (and their predictive value in surgical oncology).
Suppressor /Recessive oncogenes and their role in carcinogenesis. Role of molecular biology
in understanding certain cancers (retinoblastoma, Wilms tumour, Lung cancer, Colon
Cancer). The theory of multiple carcinogenesis and cancer progression.
Principles of biostatistics and research design; commonly used statistical tests and
terminology. Principles of biostatistics and epidemiology; as applicable to the use of
diagnostic tests, screening and disease and prevention programs, patterns of disease (e.g. trauma,
cancer), risk assessment, scoring systems (e.g. physiologic and anatomic scoring of trauma,
neurologic function), prediction of outcome.
Identify the meaning of appropriate usage of commonly used terms including sensitivity,
specificity, positive predictive value, negative predictive value, false positive, false negative,
confidence limits, standard deviation, standard error of the mean (SEM), retrospective,
prospective, intention to treat, power, randomised trial, control, blind, double-blind.
Identify types 1 and 2 statistical errors and factors influencing them.
Identify requirements for the appropriate usage of common statistical comparisons including t
test, chi-square, analysis of variance (ANOVA), correlation, regression, non-parametric testing.
Evidence based surgical practice (decision making, statistics, principles of research and
clinical trials, critical evaluations of surgical innovations).
PERIOPERATIVE CARE. Assessment of fitness for surgery. Preoperative assessment and
risk scoring systems. Laboratory testing and imaging. Management of associated medical
conditions. Organ specific diseases. Issues related to medications. General factors. Preparation
for surgery. Informed consent. Pre-medication. Risk management. Principles of anaesthesia.
General anaesthesia. Local anaesthesia. Regional anaesthesia. Monitoring of the anaesthetised
patient. Non-invasive and Invasive monitoring. Care of the patient under anaesthesia.
Positioning of the patient and avoidance of nerve injuries. Implications to surgery of the
physiologic changes of; aging, pregnancy and paediatric group. POSTOPERATIVE
MANAGEMENT AND CRITICAL CARE. Anaesthetic management. Postoperative
monitoring. Ventilatory support. Pain control. Intravenous drug delivery. Metabolic and
Nutritional support. Fluid and electrolyte management. Nutrition in the surgical patient.
Postoperative complications. General surgical complications. Respiratory failure. Acute renal
failure. Systemic inflammatory response syndrome-SIRS. Multiple organ dysfunction syndrome-
Classificatiom, principles of wound management, pathophysiology of wound healing, scars and
contractures. Surgical Technique. Principles of safe surgery. Incisions and wound closure.
Diathermy and laser. Sutures and lagature materials. Basic surgical instruments. Surgical
Procedures. Minor surgical procedures. Day care surgery. Principles of anastomosis.
Endoscopic surgery and laparascopy. Tourniquets in the operating theatre. Indications.
Evidence based surgical practice. Decision making. Statistics. Principles of research and
clinical trials. Critical evaluations of surgical innovations. Management Aspects of Surgical
Practice Clinical audit. Clinical governance. Medico-legal aspects of surgery. Communication
skills. Psychological effects of surgery. Communication skills in medicine and surgery. Working
in teams. Breaking bad news. Dealing with conflict. Management of crises. Medical litigation.
Avoidance and management of errors, Ethics and medical negligence. Ethical and legal
principles relating to confidentiality and access to health records. Record-keeping, Informed
consent. Obtaining permission for autopsy. Withholding resuscitative measures. Organ donation.
Brain death. Professional misconduct. Mental sequel of trauma. EMERGENCY MEDICINE
AND MANAGEMENT OF TRAUMA. Pathophysiology of trauma shock and
cardiovascular physiology, metabolic response to injury, adult respiratory distress syndrome-
ARDS. Initial assessment of the trauma patient airway management and tracheostomy,
principles of pre-hospital care, major incident triage, clinical assessment and scoring systems,
resuscitation after trauma. Neurological trauma and management of the unconscious patient
Head injury. Intracranial haemorrhage-subarachnoid, intracerebral, subdural, extradural,
intraventricular. Brain injuries. Spinal cord injuries. Assessment and resuscitation of the
comatose patient. Paralytic disorders. Peripheral nerve injuries. Brain stem death (diagnosis,
principles of organ donation). Abdominal trauma. Penetrating abdominal trauma. Blunt
abdominal trauma. Assessment and management of abdominal trauma. Specific organ injuries.
Urological trauma. Renal. Ureteric, bladder, urethral, penile and scrotal trauma. Vascular
trauma. Effects of blunt and penetrating injuries to arteries and veins. Assessment of vascular
injury. Iatrogenic injuries. Traumatic wounds principles of management, gunshot and blast
injuries, stab wounds, human and animal bites. Thoracic trauma. Pathophysiology of thoracic
trauma. Presentation, assessment and management. Specific thoracic injuries. Pneumothorax.
Chest drainage and pericardiocentesis. Indications and preparation for thoracotomy. Skeletal
fractures. Pathophysiology of fracture healing. Classification of fractures. Principles of
management of fractures. Management of joint injuries. Common fractures and joint injuries of
upper limb, lower limb, trunk, pelvis and vertebral column. Soft tissuer injuries and disorders.
Nature and mechanism of soft tissue injury. Management of soft tissue injuries. Management of
skin loss The wound, skin graft, skin flaps. Traumatic oedema and compartment syndrome
Pathogenesis and physiology, diagnosis and treatment. Burns. Classification and
pathophysiology. Initial assessment and management. Treatment including secondary surgery.
Burns of special areas (face, eyes, hands, perineum). PRINCIPLES OF SURGICAL
ONCOLOGY. Epidemiology of common cancers Epidemiology studies and cancer
registration Common cancers. Screening programmes Screening of breast, cervical, prostate,
skin and colorectal cancers. Clinicopathological staging of cancer Staging and grading cancer.
Clinical staging. Pathological staging. Principles of cancer treatment The role of surgery
(block dissection). Radiootherpy. Chemotherapy. Hormone therapy. Immunotherapy. Palliative
care. Palliative care team. Pain and other symptoms.
CARDIOTHORACIC SURGERY. Haemodynamic control. Haemodynamic principles.
Cardiovascular homeostasis. Pharmacological haemodynamic control. Cardiac surgery Surgical
disorders of the heart vessels and valves. Cardio-pulmonary bypass. Thoracic trauma.
Pathophysiology of thoracic trauma. Presentation, assessment and management. Specific thoracic
injuries. Thoracotomy and chest drainage. Assessment and preparation. Indications for
thoracotomy. Chest drainage and pericardiocentesis. Surgical disorders of the lung. Lung
cancer. Other indications for lung resection. Complications of thoracic operations. General and
specific. Pneumothorax and empyema thoracis. THE ABDOMEN. Abdominal trauma.
Penetrating abdominal trauma. Blunt abdominal trauma, Assessment and management of
abdominal trauma. Specific organ injuries. Common abdominal problems. Abdominal pain.
Abdominal masses. The acute abdomen. Abdominal emergencies-intestinal obstruction,
peritonitis, abdominal and pelvic abscess, gastrointestinal haemorrhage. Abdominal hernia.
Inguinal. Femoral. Incisional and rare hernias. Intestinal fistulas. Classification, assessment and
management. Gastrointestinal stomas. Gastrostomy. Ileostomy. Colostomy. Surgery of the
spleen. Treatment of splenic disease and injury. Post splenectomy sepsis. Oesophageal
disorders. Gastro-oesophageal reflux. Motility disorders. Carcinoma. Diverticulum. Foreign
body. Peptic ulcer disease. Carcinoma of the stomach. Hepatobiliary and pancreatic
surgery Jaundice. Gallstones and gall bladder. Acute pancreatitis. Chronic pancreatitis.
Carcinoma of the pancreas. Benign and malignant biliary strictures. Portal hypertension. Ascites.
Colorectal surgery. Clinical presentation of colorectal and anal disease. Surgical disorders of
the colon and rectum (ulcerative colitis and crohn s disease, colorectal cancer, diverticular
disease, faecal incontinence, rectal prolapse). Surgical disorders of the anus and perineum.
Pruritus ani. Fissure in-ano. Haemorrhoids. Fistu la-in-ano. Anorectal abscess. Carcinoma of
the anus. Pilonidal sinus and abscess. BREAST AND ENDOCRINE SURGERY Common
breast disorders. Pain. Lump. Cysts. Nipple discharge. Gynaecomastia. Breast carcinoma.
Risk factors. Pathology. Diagnosis. Treatment. Breast reconstruction. Surgery of the thyroid
gland. Indications for surgery. Thyroid cancer. Complications of Thyroidectomy. Parathyroid
disorders. Calcium metabolism. Clinical presentation of hypercalcaemia. Investigation and
management of hyperparathyroidism. Adrenal disorders and secondary hypertension. Causes
of hypertension. Conns syndrome. Phaechromocytoma. Endocrine disorders of the pancreas.
Insulinoma. Gastrinoma. Neuroendocrine tumours. Other rare endocrine tumours. VASCULAR
SURGERY. Arterial surgery. Peripheral vascular disease and limb ischaemia. Arterial
embolism and acute limb ischaemia. Arterial aneurysms. Carotid disease. Renovascular disease.
Arterial trauma. Venous disorders of the lower limb. Venous insufficiency and varicose veins,
Venous ulceration. Deep venous thrombosis. Pulmonary embolism. Lymphoedema. ORGAN
TRANSPLANTATION. Basic principles of transplant immunology. Clinical organ
transplantation. Organ donation and procurement. Immunosuppression and prevention of
rejection. ORAL AND MAXILLOFACIAL SURGERY. Maxillofacial Trauma
Classification of facial fractures. Presentation of maxillofacial fractures. Assessment,
investigation and treatment of facial fractures. Common conditions of the face mouth and
jaws. Principles of soft tissue repair of mouth, face, head and neck. NEUROSURGERY.
Neurological Trauma. Head injuries. Spinal cord injuries. Paralytic disorders. Nerve disorders.
Surgical disorders of the Brain. Clinical presentation of the intracranial mass. Tumours of the
nervous system. Epilepsy. Congenital and developmental problems. Intracranial haemorrhage-
subarachnoid, intracerebral, subbdural, extradural and intraventricular. Brain Stem Death.
Diagnosis and testing for brain stem death. Principles of organ donation. Surgical aspects of
meningitis. Rehabilitation. OTOLARYNGOLOGY. Inflammatory disorders. Foreign bodies.
Common neck swellings Ccongenital. Inflammatory. Neoplastic. Salivary Gland Disorders.
Infections and inflammations. Tumours. Calculi. EYE SURGERY. Trauma. Common
infections. PAEDIATRIC SURGERY Principles of Neonatal and Paediatric Surgery.
History and physical examination of the neonate and child. Maintenance of body temperature.
Assessment of respiratory and cardiovascular function. Metabolic status. Fluids, electrolytes and
the metabolic response. Vascular access. Correctable Congenital Abnormalities
Gastrointestinal tract. Congenital heart disease. Abdominal wall defects. Diaphragmatic hernia.
Neural tube defects. Urological abnormalities. Common Paediatric Surgical Disorders. Pyloric
stenosis. Intussusception. Inguinal hernia and hydrocele. Undescended testes. Torsion of the
testes. Orthopaedic disorders of infancy and childhood. Gait disorders. Hip problems. Knee
disorders. Foot disorders. PLASTIC AND RECONSTRUCTIVE SURGERY. Burns.
Classification and pathophysiology. Initial assessment and management. Treatment and
secondary surgery. Burns of special areas-face, eyes, hands, perineum. Soft tissue infections.
Principles of hand trauma Tendon, nerve, nail bed. Hand disorders. Dupytrens disease,
carpal tunnel syndrome. Benign skin lesions. Malignant skin lesions Basal cell carcinoma.
Squamous cell carcinoma. Malignant melanoma. Principlles of skin cover. Split skin grafts.
Full thickness skin grafts. Local flaps. Distant flaps. Free transfer flaps. Principles of
Microvascular Surgery. Wound Healing. TRAUMA AND ORTHOPAEDIC SURGERY.
Skeletal fractures Pathophysiology of fracture healing. Classification of fractures. Principles of
management of fractures. Complications of fractures. Management of joint injuries. Common
fractures and joint injuries of upper and lower limb. Clavicle fractures. Dislocated shoulder.
Humeral, radial and ulnar shaft fractures. Fractures of neck of humerus. Internal fixation of
olecranon fracture. Management of supracondylar fracture of elbow. Aspiration of elbow.
Scaphoid fractures. Phalangeal fractures. Femoral, tibial and fibula shaft fractures. Dislocated
hip. Fractures of neck of femur. Tibial plateau fractures. Aspiration of knee. Common
fractures and joint injuries of trunk, pelvis and vertebral column. Soft tissue injuries and
disorders. Nature and mechanism of soft tissue injury. Management of soft tissue injuries
including compartment syndrome. Common disorders of the extremities. Disorders of the hand
(trigger finger, ganglion, carpal tunnel syndrome, Dupytrens disease). Disorders of the foot.
Degenerative and Rheumatoid arthritis. Osteoarthritis. Rheumatoid arthritis. Other
inflammatory conditions. Surgical treatment of joint diseases. Infections of Bones and Joints.
Osteomyelitis. Other bone infections. Locomotor pain. Low back pain and sciatica. Pain in the
neck and upper limbs. Bone tumours and amputations. Primary bone tumours. Metastatic
bone tumours. Amputations. Imaging techniques. MRI. CT. Bone scan. Ultrasound.
Neurophysiological investigations. UROLOGY Urological Trauma Renal. Ureteric. Bladder.
Urethral. PenileS scrotal. Urinary tract infections and calculi. Haematuria Classification,
aetiology and assessment. Tumours of the kidney, bladder, prostate and testis. Urinary
Tract Obstruction. Urinary retention. Disorders of the prostate. Pain and swelling in the
scrotum. Scrotal skin conditions. Non-malignant testicular swellings. Inflammatory conditions.
Testicular torsion. Testicular tumours. Chronic renal failure. Dialysis. Principles of
transplantation. Aspects of pelvic surgery. Gynaecological causes of acute abdominal pain
(ovarian cyst, ectopic pregnancy, carcinoma. Pelvic inflammatory disease). Disorders of
urinary incontinence. EMERGENCY MEDICINE AND CRITICAL CARE. Advanced
Trauma Life Support (ATLS). Mass accidents and principles of accidents organization.
Resuscitation principles and practice. Shock management, fluid electrolytes; plasma
expanders drug treatment. Care of the multiple injured patient. Organization and
administration of the casualty unit. Intubation (indications and technique). Assisted
ventilation (indications and application). Inotropic and other haemodynamic suport.
Central venous access and usage (pressure monitoring, drug and fluid administration). Arterial
blood gas analysis and interpretation for patient management. Fluid and electrolyte balance.
Weaning off assisted ventilation. Paediatric resuscitation. Tracheostomy.
Chronological record of all practical procedures and surgical operations done during part one
course as categorized in the logbook.
HMOTO 701. Principles and Practice of Otolaryngology
Clinical Otolaryngologic anatomy and physiology

Special functional anatomy of the ear and its relations. Anatomic peculiarities of the external
auditory meatus and their impact on external ear disease, anatomical basis of the transformer and
amplifier system of the tympanic membrane, and ossicles, the hydraulic system of the tympanic
membrane and oval window, baffle effect of the round window, functional anatomy of the
Eustachian tube and its relations, vestibular components and its relations, bony and membranous
ducts of the inner ear the internal auditory meatus, contents and its special relations with the
cerebellopontine angle, basis of various cochlear coils and the anatomical relevance to frequency
distribution, vascularity and sheering forces, anatomical variations, compartmentalisation,
components and of the facial nerve. Facial nerve landmarks and relations to CPA structures,
labyrinth, middle ear and cervicofacial region. Central nervous tracts and connections of the
facial cochlear and vestibular nerves. Nerve supply to inner outer and middle ear and their
relevance to referred pain pheneomenon. Physical attributes of sound: sound sources, media in
sound transmission, sound waves, dimensions of sound energy, propagation of sound waves,
sounds at electronic techniques, perception of sound frequency, intensity and binaural hearing
effects, external ear acoustic properties, middle ear amplification, lever and hydraulic actions,
acoustic separation of round window from oval window, ossicular frequency response,
Eustachian tube function, acoustic neural pathways, acoustics and damping mechanisms
intratympanic muscles. Cochlear mechanisms of function in hearing, chemistry of the cochlear
fluids, origin, circulation absorption of the perilymph and endolymph, oxygen distribution and
utilisation in the cochlear hydro - dynamics, theories of hearing, physiology of the hair cells
cochlear transduction responses and significance in auditory nerves, efferent cochlear system.
Recruitment, decay, masking and sound distortion. Otoacoustic emissions. Central process of
hearing, cochlear pathways and the volley principle, methods and mechanisms used in
assessment of auditory function.
Mechanism of the vestibular sensory organs: Labyrinthine fluids. Vestibular nerve action
potentials. Intergrated applied activity of the peripheral and central vestibular system. Cerebellar,
proprioceptive and ocular contributions, methods of investigating vestibular function
Special functional Anatomy and physiology of the nose and the paranasal sinuses. Structure
of cavities of nasal cavities paranasal sinuses, their partitions and vital relations, microscopic
anatomy of the cavities surface including mucus membrane and cilia, the olfactory epithelium.
Functions of the nose: Respiratory channel, olfaction, psychophysics of smell, theories of
olfaction, olfaction as a contributor to taste sensation, vocal resonance and role of the nose in air
conditioning and speech, nasal reflexes vasomotor responses and their role in causing rhinitis
ciliary function and methods of assessment, factors affecting nasal blood flow including drugs,
air conditioners and ambient temperatures, reflexes initiated from the nose, nasal rhythm and
cycle functions of the paranasal sinuses, patterns of pain from the sinunasal tract response of
nasal cavities, sinunasal barotrauma, air space and sea sickness, assessment of olfaction and
nasal airway patency.
Special functional anatomy and physiology of the mouth, pharynx, salivary glands and
oesophagus. Salivary glands: Surgical anatomy and relations of salivary glands and vital
relations, acinar structure, duct system, histochemistry and composition of saliva, process of
secretion, pathological factors influencing salivary secretion including radiation, sjogrens
syndrome, functions of saliva, normal control of salivary secretion. Drugs affecting salivary
secretion. tongue anatomy embryological derivation Mouth surgical divisions of the oral cavity,
tongue, floor of mouth, buccal cavity alveolus, palate, distribution of taste receptors, structure of
taste buds, distribution of primary taste sensations normal pathways for taste and pathological
and surgical complications impacting on his function, interaction of taste and olfaction to
produce flavour. Pharynx: Musculo-facsial planes of the pharynx and oesophagus and their
relevance to neoplastic and infection spread. Anaomical communications with the pharyngeal
and oesophageal structures. Functions of the lymphoid tissue and lymph nodes. Motor activity of
the pharynx. Oesophagus: Motor activity of the oesophagus, mechanisms involved in
deglutition. Pharyngeal and oesophageal sensations. Manometry in oesophageal disorders.
Surgical Anatomy and Physiology of the larynx and the tracheobronchial tree.
Functional structure of the larynx and tracheobronchial tree. Mechanisms of function of the
larynx as an airway, phonatory organ and protective valvular mechanism, neural regulation,
laryngeal lubrication, airflow, secretion, mucociliary mechanism in the tracheobronchial tree,
maturational lag in the laryngotracheobronchial tree, mechanisms of speech generation,
mechanisms of phonation, speech articulation, acoustic output in speech volume control, speech
reception, linguistic and processing of speech.
Surgical Anatomy and Physiology of Soft Tissues of the cervicofacial area. Surgical anatomy
of the tissue planes and neurovascular bundles of the cervicofacial region functional zoning of
the lymphatic system as regards neoplastic and infective pathology. Physiology of cervicofacial
musculo-aponeurosis and galea capitits
Otolaryngologic and Head and Neck Pathology. Histologic features of metaplasia, dysplasia,
carcinoma in situ, invasive carcinoma, topographic classification of head and neck neoplasms,
Characteristic histologic features of various head and neck tumours including oral,
oropharyngeal, hypopharyngeal, oesophageal, laryngeal, salivary gland, sinunasal, cervicofacial
skin, chemical, viral and physical carcinogenesis, of head and neck cancers, metastatic head and
neck cancer and significance of in transit cancer cells, grading and staging of cancer, cancer
prevention, metaststic patterns. Inflammatory conditions in otolaryngology: histologic
correlates of acute and chronic infective and inflammatory otolaryngologic diseases.
Pathogenesis and methods of spread of middle ear inflammatory conditions, cholesteatoma
Otolaryngologic pharmacology. Use, mechanisms of action and interactions of drugs
commonly used in otolaryngology including antihistamines, decongestants, vestibular sedatives,
vasodilators mucolytics, H2-blockers, anticonvulsants, mast cell stabilisers, antibiotic ear drops,
steroids local anaesthetics. Use and mechanism of action of drugs that cause otolaryngologic
complications: including antihypertensives, tricyclic antidepressants, steroids, ototoxic agents,
anticancer agents and anticoagulants.
Paediatric Otolaryngology. Congenital malformations presenting in paediatric period.
Congenital malformations of the ear and their modes of evolution. Congenital malformations and
cysts of larynx, oral cavity, sinunasal tract and cervicofacial area including
laryngotracheomalacia, laryngeal webs, subglottic stenosis, choanal atresia, cystic hygroma,
branchial, dermoid and thyroglossal cysts, head and neck haemangiomas, juvenile multiple
laryngeal papillomatosis. Tonsils and adenoids: Palatine, lingual, and nasopharyngeal tonsillitis
(adenoiditis), obstructive upper airway manifestations, tonsillectomy and adenoidectomy.
Logbook entries: Adenotonsillectomy, surgery of branchial cysts, thyroglossal cysts and
masses, myringoplasty and insertion of tympanostomy tubes, ariarytenoidotomy for
laryngolmalacia, paediatric tracheostomy.
Deaf Child. The early identification and screening of deafness in infancy, implications of
deafness in a child, fitting of hearing aids, cochlear implants, brainstem implants in children,
education of hearing impaired children sign language, communication. Causes of childhood
deafness: teratogenicity, intrauterine infections and genetic inheritance.
Pain management. Pain syndromes. Trigeminal, Glossopharyngeal neuralgia, peripheral nerve
stimulation, microvascular decompression. Treatment plans for simple pain syndromes,
electrodiagnostic and topognostic studies in peripheral nerve injury.
Logbook entry: division of Glossopharyngeal nerve.
Diseases of the ear. Physical and applied examination of the ear: relevant history taking,
inspection for specific clinical signs for various otological disorders, and eliciting hearing loss,
deafness, distortion, decay and recruitment by using whisper and voice tests, tuning fork tests,
audiometric investigations and electrophysiological tests, practical knowledge and technique of
using pure tone audiometer, impedance audiometer, and translating the results. Physical and
applied examination of the vestibular system, examination for nystagmus. Examination of the
cranial nerves, tests of body posture, equilibrium and gait. Caloric tests. Radiological techniques
of ear assessment: techniques views and projections used in plain radiography. Computerised
Tomographic scans, Magnetic Resonance Imaging, angiography, and digital subtraction
tinnitus Objective and subjective. Assessment and management, facial nerve disorders, causes,
features, assessment techniques.
Affections of the external ear. Congenital malformations of the pinna, congenital fistula,
congenital tumours, trauma, infections and dermatological conditions of the auricle, tumours of
the auricle, plastic surgery of the pinna. External Auditory Meatus, Atresia, Cerumen impaction,
Trauma. Keratosis obturans, foreign bodies, inflammatory lesions, dermatoses, tumours, Plastic
surgery for the congenital abnormalities of the external meatus.
Affections of the middle ear. Congenital Anomalies: middle ear atresia, ossicular malformations,
perilymph gusher, vascular abnormalities. Acute inflammations of the middle ear cleft: Acute
otitis media, acute mastoiditis, acute pertrositis. Myringitis bullosa heamorrhagica, Chronic non
suppurative otitis media(CNSOM): otitis media with effusion. Middle ear atelectasis. Adhesive
otitis media. Tympanosclerosis.
chronic otitis media morbidity,complications and management of CSOM and its complications,
tuberculosis of the middle ear cleft, middle ear manifestations of acquired immunodeficiency
syndrome. Management of CSOM, CNSOM and Complications: antibiotic therapy and its
microbiologic basis, atticotomy, tympanomastoidectomy (radical mastoidectomy),
atticoantrotomy (modified radical mastoidectomy), combined approach mastoidectomy (canal up
and canal down mastoidectomy), tympanoplasties, myringotomy, insertion of grommets,
tympanotomy, exploration of facial nerve, drainage of mastoid and lateral sinus abscesses, role
of endoscopy in middle ear surgery, autologous, homologous artificial implants and prosthesis
used in otologic reconstructive surgery. Tumours of the middle ear cleft and the temporal bone
Classification and pathology. Osseous disorders of the temporal bone. Diseases of the otic
capsule, Otosclerosis, pathology. Genetic factors and natural history. Clinical features and
treatment. Osteogenesis imperfecta, Osteitis deformans, Osteitis fibrosa cystica, fibrous
dysplasia, early and late syphilis, autoimmune ear disease, plasmacytoma. Deafness in adults.
Clinical audiological features of all types of hearing loss in adults, economic and social
consequences of deafness, rehabilitation of adults with acquired hearing loss, auditory training,
combined lip reading and auditory training, insertion of hearing aids, bone implants, cochlear
implants, brainstem implants
Hearing Aids: Types and mechanism of function of all hearing aids, indications and techniques
of fitting of hearing aids, cochlear implants, problems associated with use of hearing aids.
Noise and the ear: Effects of sound stimulation. Noise induced hearing loss. Changes in electrical
potentials. Specific noise induced industrial hazards. Effects of infrasound, vibration and
ultrasound. Non auditory effects of noise. Hearing conservation programmes. Medico-legal and
social implications. Inflammatory lesions of the labyrinth and the auditory nerve, viral infections.
bacterial infections,. balance and hearing disorders due to ageing, acoustic neuroma, ototoxicity,
presbycusis. Vascular lesions of the inner ear: Autonomic control of the inner ear. Control of
cochlear blood flow. Pathophysiology of vascular occlusion. Microcirculatory pathology, general
circulatory disturbances. Sudden and flactuant hearing loss, Menieres disease, neurological
aspects of vertigo, Congenital diseases of the ears and their chromosomal, genetic, and
teratogenic basis.
Log book entries: Pinnaplasty meatoplasty, plastic repair stenosed ear canal, foreign body
removals, tympanotomy, myringoplasty, tymanomastoidectomy, cortical Mastoidectomy,
ossiculoplasty, facial nerve decompression, facial nerve repair techniques, tympanic neurectomy,
stapedectomy, excision of glomus jugulare/ tympanicum.
Diseases of the mouth, pharynx, salivary glands, larynx and head and neck.
Examination of the mouth pharynx and larynx, congenital and developmental anomalies,
stomatitis, Oral manifestation of blood disorders, cysts of the mouth. Disorders of the temporal -
mandibular joints, fibro-osseous diseases of the jaws and facial bones, tumours of the jaw and
the oral cavity. Disorders of the salivary glands. Retention cysts, salivary calculi, infections,
neoplasms, autoimmune phenemenon, Diseases of the pharynx: Pharyngitis, Ludwigs angina,
infectious fevers, Chronic pharyngitis, atrophic pharyngitis, syphilis, lupus vulgaris,
Tuberculosis, Pharyngeal stenosis, Virus infections of the pharynx. Pharyngeal lesions associated
with general disease, anaemia, haemorrhagic states, agranulacytic angina, leukaemia, glandular
fever, Behcets disease and pharyngeal lesions due to nerve dysfunction keratosis pharynges
benign and malignant neoplasms of the oro-, hypo- and nasopharynx. Benign and malignant
neoplasms screening diagnosis and management with special emphasis on naso- pharyngeal
Affections of the cervical oesophagus of relevance to otolaryngology: Dysphagia, diverticuli,
gastro-oesophageal reflux disease infective oesophageal conditions, congenital abnormalities of
the oesophagus, chemical and physical injuries of the oesophagus, foreign bodies of the
oesophagus and neoplasms of tumours of the oesophagus. Larynx and tracheobronchial tree.
Examination, investigative and imaging methods. Structural and applied differences between the
adult and the infant larynx both structural and applied, signs and symptoms of laryngeal diseases
of the newborn, management of the newborn child with laryngeal obstruction. Open wounds,
closed injuries, burns and scalds, foreign bodies and laryngeal stenosis.
Laryngeal infections Acute laryngeal infections of the new-born and children, acute
laryngotracheo-bronchitis, acute laryngitis in adults. oedema of the larynx, acute perichondritis
of the larynx, abscesses of the larynx, chronic laryngitis, tuberculosis, lupus vulgaris, syphilis,
mycoses, scleroma, chronic non-specific laryngitis, atrophic laryngitis, laryngeal nodules,
fibromas, laryngoceles, polyps and cysts, vocal cord paralysis and management, angiomas,
chondromatosis, amyloidosis, adenomas, myoblastoma, and malignant tumours, Speech
rehabilitation after laryngectomy. Neurological disorders of the larynx, psychogenic disorders of
the larynx, occupational disorders of the larynx, vocal disabilities tracheobronchial, foreign
bodies. Thyroid gland. Endocrinologic, inflammatory, immune and neoplastic disorders of the
thyroid gland and their medical and surgical management.
Log book entries: salivary glands surgery, glossectomies, mandibulectomies, palatoplasty,
tracheostomy, microlaryngoscopy, lateralisation of the vocal cords, laryngotracheal repair,
laryngectomy, excisions of the mandibular oral, oropharyngeal, hypopharyngeal and
nasopharyngeal pathologies, salivary gland surgery. Thyroid gland surgery.
Diseases of the nose and the paranasal sinuses. Examination investigations and imaging of the
nose and paranasal sinuses. Congenital malformations: Cleft palate, high palatal arch conditions,
atresia of the nasal cavity and paranasal sinus cavities. Affection of the external nose and nasal
cavities. Nasal trauma, nasal foreign bodies, injuries of the facial skeleton. septal haematoma,
deviated nasal septum, septal perforations, epistaxis. infections including lupus vulgaris, syphilis,
leprosy. Acquired immunedeficiency manifestations in the nose. Inflammatory affections of the
nose: Common cold, specific rhinitis, hypertrophic rhinitis, atrophic rhinitis, lupus vulgaris and
tuberculosis, scleroma, leprosy, yaws, mycoses, Wegeners and Lethal midline granuloma, septal
Neoplasms of the nose and upper airway, vasomotor instability, nasal polypi.
Infections of the paranasal sinuses: microbiology, pathology, surgical and medical management
of acute and chronic sinusitis. Complications of acute and chronic sinusitis and their
management. Tumours of the nose and the paranasal sinuses. Neurophysiology of facial pain.
Transphenoidal hypophysectomy.
Logbook entries: Antral washouts, cautery, nasal polypectomy, cautery of the nose, intranasal
antrostomies, submucosal diathermy, intranasal endoscopic and external
ethmoidectomy/drainage of periorbital abscess, endoscopic and external drainage of the frontal
sinuses, sphenoidotomy, septoplasty, rhinoplasty, repair septal perforation, closed and open
reduction nasal fracture, perforation of choanal atresia, turbinate reduction surgeries, ligation of
sphenopalatine artery, septoplasty, rhinoplasty, repair septal perforations, lacrimal duct surgery,
craniofacial resection.
Head and Neck Benign and Malignant Cancers. The concept of neoplasia as a multistep
cumulative mutational process occurring over a period of time, basic steps and mechanisms of
regulatory proteins involved in the cell cycle, molecular mechanisms of carcinogenesis of upper
aerodigestive tract and soft tissues of the head and neck, field carcinogenesis, synchronous and
metachronous primary, mechanism of action of chemical, viral and radiational carcinogens on
the cell cycle, genetics and sequence. The concept and patterns of local, locoregional and distant
metastatic disease. Application of the above concepts in evolution of all benign and malignant
head and neck neoplasms including angiofibroma, glomus tumours, neuromas, nasopharyngeal
carcinoma, oral cancer, salivary gland tumours, laryngeal cancer, cancer of the lip,
hypopharyngeal cancer, upper oesophageal cancer, sinunasal tract cancer. Current concepts in
management of benign tumours and cancers of the head, frozen sections, excission margins.
Principles of molecular diagnosis of head and neck neoplasms. Principles of molecular diagnosis
of head and neck neoplasms. Principles of radio-oncology and chemotherapy in head and neck
cancer, prevention of head and neck cancer rehabilitation in speech, deglutition and oral
continence after radical head and neck cancer. Prosthesis use in closure, organ replacement,
closure of defects following head and neck ablative surgery
Otolaryngologic and cervicofacial trauma: facial bone structures trauma, consequences and
management. Mechanisms of nasal fractures and management, deep penetrating cervical wounds
and management, mechanisms of temporal bone fractures and its affections affections of the ear:
tympanic membrane rupture, ossicular dislocation/fracture/damage, implosion / explosion
injuries, perilymphatic and CSF leak.
Complications and management, laryngotracheal trauma, complications and management,
pharyngooesophageal trauma complications and management.
PLASTIC AND RECONSTRUCTIVE SURGERY. Skin grafting. Release of post-burn
contractures (including ectropion). Revise scars utilizing plastic surgical principles and
techniques. Close small skin defects (wounds) using local rotational flaps. Repair a unilateral
cleft lip. Management of keloids, hypertrophic scars and contractures. Management of cleft lip
and palate, pressure sores/decubitus ulcers. Different types of flaps and their use in plastic
surgery. Microsurgery techniques.
NEUROSURGERY. Management of craniofacial malformations. Management of head injury.
Management of CNS infections. Management of skull base tumours
ORAL AND MAXILLOFACIAL SURGERY. Principles of management of maxillofacial
injuries, mandibulotomies and mandibulectomies.
Log book entries: Excision of all head and neck cancers, (lip, oral, oropharyngeal,
nasopharyngeal, hypopharyngeal, salivary glands, larynx, hypopharynx, cervical oesophagus,
sinunasal tract, cervical soft tissues, cervicofacial and scalp skin), various cervical node block
dissections, skin grafting and plastic/reconstructive techniques in radical head and neck surgery,
insertion of tracheo-oesophageal speech valve.
Laser: Basic principles in laser surgery in Otolaryngology.
Imaging in otolaryngology and head and neck surgery, Techniques of imaging including
plain in x-rays ultrasound computed tomographic scans, magnetic resonance and contrast media.
Medicolegal issues relevant to practice of otolaryngology. Common medicolegal pitfalls in
Otolaryngologic practice, doctor/patient confidentiality and its legal limits, patient counselling
before surgery, patients overall rights in preoperative procedures and concept of informed
consent to surgery, doctors intraoperative discret ion in decision making, patient records
documentation, security and back ups, indemnity, relationship between doctor and medical
insurance organisations.
Temporal bone dissection. All the practical aspects of the course to be done by the student on a
suitably prepared cadaveric temporal bones.
Description of the drilling and microsurgical otological equipment, surgical anatomy, overview
of surgical anatomy of external, middle and inner ear, facial nerve, middle cranial fossa and
cerebellopontine angle, review of central connections of nerve 7and 8 and their orientation at the
fundus of internal auditory meatus, normal and congenital variants of otological structures,
incisions and surgical access employed in all variants of ear surgery, landmarks employed in
access to microanatomy of the ear, special precautions in all aspects of external, middle inner ear
and cerebellopontine angle surgery, evolving current concepts in surgical procedures in the ear.
Functional endoscopic sinus surgery. Overview of old open surgical techniques as opposed to
current endoscopic techniques, endoscopic and microsurgical equipment used in functional
endoscopic sinus surgery (FESS), gross and endoscopic aspects of sinunasal and skull base
anatomy, Endoscopic surgical access to anatomic elements of the sinunasal tract, skull base,
orbit, landmarks for safe identification and access to vital structures of the sinunasal tract and
skull base, basic endoscopic surgical manouvres used in managing sinunasal tract infective
disease, orbital decompression, closure of cerebrospinal fluid leaks, management of epistaxis,
All the practical aspects of the course to be done by the candidate on a suitably prepared
cadaveric specimen. Plastic and reconstructive surgery of the head and neck. Overview of
ablative and other surgical manouvres requiring plastic and reconstructive intervention, surgical
equipment used in reconstructive surgery, descriptive anatomy of the chest wall, facial muscles,
radial muscles, ileum, colon and their blood supply in relevance to their use for reconstruction,
methods of reconstruction using direct closure of wounds, local rotational/transposition flaps,
axial flaps, free microvascular flaps, compound flaps, ileum, colon and prosthesis, Basics of face
lift. Suitably prepared cadavers shall be used for hands on practical demonstrations.
Rhinoplasty. Overview of the ethnic and racial variations of the nose, applied anatomy of the
nasal components relevant to rhinoplasty, nasal cosmetic disorders necessitating rhinoplastic
intervention, techniques of rhinoplasty for various deformities, functional disorders in patients
needing rhinoplasty, functional results in rhinoplasty, common nasal deformities in rhinoplasty.
HMOTO 702. Otolaryngology Logbook
Chronological record of all practical procedures and surgical operations done during part II
course as categorized in the prescribed logbook.
HMOTO 901. Dissertation.
Research on a topic within the field of Otolaryngology, Head and Neck Surgery.