MEDEX Seattle 37 Slit Lamp Examination Workshop Required Readings: Bates, Chap.

5 Goal: Be able to perform a basic slit lamp examination. Objectives: 1. Be familiar with patient education needed in regards to the slit lamp examination. 2. Be able to name and explain the use of various components of the slit lamp. 3. Given an eye mannequin, be able to describe normal and abnormal findings. Abdominal X-Ray Interpretation Required Readings: Squire, Chaps. 11,12,14 Goal: Be able to perform a basic interpretation of an abdominal x-ray series. Objectives: 1. Identify which views are included in an acute abdominal series and what each one detects. 2. Identify the patient in whom plain films are needed. 3. In the abdominal series, describe and recognize a. abnormal gas collections b. gas patterns c. calcifications Interpretation of Orthopedic Radiographs: Upper and Lower Extremities Required Readings: Squire, Chap 15 Tinntinelli, Chap 259 Goal: Learn the basic fundamentals of describing and interpreting plain x-rays of extremity trauma and other orthopedic pathology. Objectives: 1. Know the minimum number of x-rays views needed for adequate interpretation of extremity trauma. 2. Be able to list views other than the AP and

MEDEX Seattle 36 Slit Lamp Examination Workshop Required Reading: Swartz, Chap. 9 Goal: Be able to perform a basic slit lamp examination. Objectives: 1. Be familiar with patient education needed in regards to the slit lamp examination. 2. Be able to name and explain the use of various components of the slit lamp. 3. Given an eye mannequin, be able to describe normal and abnormal findings. Radiology Workshop: Abdominal X-Ray Interpretation Required Reading: Squire, Chaps. 11,12,14 Goal: Be able to perform a basic interpretation of an abdominal x-ray series. Objectives: 1. Identify which views are included in an acute abdominal series and what each one detects. 2. Identify the patient in whom plain films are needed. 3. In the abdominal series, describe and recognize a. abnormal gas collections b. gas patterns c. calcifications Interpretation of Orthopedic Radiographs: Upper and Lower Extremities Required Reading: Squire, Chap 15 Goal: Learn the basic fundamentals of describing and interpreting plain x-rays of extremity trauma and other orthopedic pathology. Objectives: 1. Know the minimum number of x-rays views needed for adequate interpretation of extremity trauma. 2. Be able to list other views appropriate for

lateral that are appropriate for the following:: a. ankle-mortise view b. knee- notch and sunrise views c. hand navicular/scaphoid views d. shoulder-axillary view or Y view (tangential lateral) 3. Given an x-ray, be able to describe a fracture using these criteria: a. anatomic location b. orientation c. degree of displacement/ separation d. shortening e. angulation f. rotational deformity 4. Given a diagram or x-ray of a pediatric fracture, be able to describe the pattern of injury according to the Salter-Harris classification system. Electrocardiogram I Required Readings: Dehn, Chap 10 Dubin Chaps 5 Goal: Be able to identify basic rhythm disturbances. Objectives: If given an ECG, be able to: 1. Identify the following sinus rhythms: a. Normal sinus rhythm b. Sinus Bradycardia c. Sinus Tachycardia d. Sinus Arrhythmia 2. Differentiate atrial flutter and fibrillation. 3. Identify supraventricular tachycardias. Electrocardiogram II Required Readings: Dubin Chaps 5 & 6 Goal: Be able to identify more complex dysrhythmias. Objectives: If given an ECG, be able to: 1. Identify junctional dysrhythmias. 2. Differentiate premature ventricular contractions (PVCs), ventricular tachycardia, and ventricular fibrillation. 3. Identify the characteristics distinct to first,

the following anatomic areas: a. ankle-mortise view b. knee- notch and sunrise views c. hand navicular/scaphoid views d. shoulder-axillary view or Y view (tangential lateral) 3. Given an x-ray, be able to describe a fracture using these criteria: a. anatomic location b. orientation c. degree of displacement/ separation d. shortening e. angulation f. rotational deformity 4. Given a diagram or x-ray of a pediatric fracture, be able to describe the pattern of injury according to the Salter-Harris classification system. Electrocardiogram I Required Reading: Dehn, Chap 10 Aehlert Chaps 3,4 Goal: Be able to identify basic rhythm disturbances. Objectives: If given an ECG, be able to: 1. Identify the following sinus rhythms: a. Normal sinus rhythm b. Sinus Bradycardia c. Sinus Tachycardia d. Sinus Arrhythmia 2. Differentiate atrial flutter and fibrillation. 3. Identify supraventricular tachycardias. Electrocardiograms II Required Reading: Aehlert Chaps 5,6,7, Goal: Be able to identify more complex dysrhythmias. Objectives: If given an ECG, be able to: 1. Identify junctional dysrhythmias. 2. Differentiate premature ventricular contractions (PVCs), ventricular tachycardia, and ventricular fibrillation. 3. Identify the characteristics distinct to

second and third degree atrioventricular (AV) blocks . Splinting and Casting Workshop Required Readings: Dehn, Chap 21 Tintinelli, Chap 259 Goal: Exposure to and practice the rudimentary skills in applying and removing casts and splints to upper and lower extremities. Although the workshops will use fiberglass, you should be aware that many emergency and orthopedic physicians and physician assistants prefer to use plaster, especially for splinting. Although it is messy and requires more time to use and to harden, it is superior for customizing and molding a precise fit. Objectives: 1. Describe the rational for casting or splinting an extremity. 2. Be able to explain why the joint above and below a fracture site should be immobilized.

first, second and third degree atrioventricular (AV) blocks . Splinting and Casting Workshop Required Reading: Dehn, Chap 21 Tintinelli, Chap 259 Goal: Exposure to and practice the rudimentary skills in applying and removing casts and splints to upper and lower extremities. Although the workshops will use fiberglass, you should be aware that many emergency and orthopedic physicians and physician assistants prefer to use plaster, especially for splinting. Although it is messy and requires more time to use and to harden, it is superior for customizing and molding a precise fit. Objectives:

1. Describe the rational for casting or splinting an extremity. 2. Be able to explain why the joint above and below a fracture site should be immobilized. 3. Describe a potential complication of casting 3. Describe a potential complication of an acutely injured extremity casting an acutely injured extremity 4. Describe iatrogenic conditions that can be 4. Describeiatrogenicconditionsthat caused by casting. canbecausedbycasting. 5. Explain how long the splint should be for 5. Explain how long the splint should be the following injured areas: for the following injured areas: a. elbow a. elbow b. ankle b. ankle c. mid-shaft of the radius/ulna c. mid-shaft of the radius/ulna d. mid-shaft of the tibia/fibula d. mid-shaft of the tibia/fibula 6. Review the various splints shown in 6. Review the various splints shown in Tintinalli on pages 1748-51, as you will be Tintinalli on pages 1748-51, as you will be required to fabricate some of them in the required to fabricate some of them in the workshops using fiberglass. workshops using fiberglass. 7. List the similarities and differences between 7. List the similarities and differences plaster of paris and fiberglass casting materials. between plaster of paris and fiberglass casting materials. 8. Explain or demonstrate splinting techniques 8. Explain or demonstrate splinting for the: techniques for the: a. elbow a. elbow b. forearm b. forearm c. ankle c. ankle

d. mid-shaft tibia/fibula e. hand (include; the intrinsic plus position or position of function splinting) 9. Apply and remove at least one upper and lower extremity cast and splint. Examination of the Hand / Wrist Required Readings: Green, Chap 204 Optional Readings: Reider Chap 4 Downloadable Items: Focus Sheet: Hand and Wrist Musculoskeletal Branching Exam Checklist Hand and Wrist Goal: To be able to perform a focused hand exam. Objectives: 1. Identify normal and abnormal findings on a hand exam. 2. Demonstrate competency by being able to perform a hand exam as taught in class. 3. Demonstrate competency by being able to perform tests specific to pathologic conditions found in the hand. Examination of the Shoulder Required Readings: Bates, Chap 15 Downloadable Items: Focus Sheet: Shoulder Musculoskeletal Branching Exam Checklist Shoulder Goals: To be able to perform a focus shoulder examination Objectives: 1. Know the four rotator cuff muscles and their attachment on the proximal humerus 2. Be able to describe the technique and identify the significance of : axial compression test acromioclavicular stress test impingment signs drop arm test 3. Be able to describe the testing utilized to evaluate: rotator cuff tears bicipital tendonitis

d. mid-shaft tibia/fibula e. hand (include; the intrinsic plus position or position of function splinting) 9. Apply and remove at least one upper and lower extremity cast and splint Examination of the Hand / Wrist Required Reading: Green, Chap 204 Optional Reading: Reider Chap 4 Goal: To be able to perform a focused hand exam. Objective:

1. Identify normal and abnormal findings on a hand exam. 2. Demonstrate competency by being able to perform a hand exam as taught in class. 3. Demonstrate competency by being able to perform tests specific to pathologic conditions found in the hand. Fall36

shoulder instability 4. Be able to discuss the causes of referred pain to the shoulder and other esstential systems to be evaluated. Examination of the Knee Required Readings: Bates, Chap 15 Downloadable Items: Focus Sheet: Knee Musculoskeletal Branching Exam Checklist Knee Goals: To be able to perform a focus knee examination Objectives: 1. Distinguish between genu varum and genu valgum. 2. Describe typical findings associated with effusion of the knee, including bulge sign and ballottement. 3. Describe the findings and typical age of the patient in Osgood-Schlatter disease. 4. Be able to describe the technique and identify the significance of: ligament laxity of the knee patellar apprehension test anterior & posterior drawer signs Lachman test Examination of the Foot and Ankle Required Readings: Bates, Chap 15 Downloadable Items: Focus Sheet: Foot and Ankle Musculoskeletal Branching Exam Checklist Foot and Ankle Goals: To be able to perform a focused foot and ankle examination Objectives: 1. Be able to identify the lateral and medial ligaments of the ankle. 2. Know the most common ligaments sprained in the ankle 3. Be able to describe the technique and identify the significance of the anteror drawer and talar tilt tests of the ankle Fall36

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Introduction to Microscopy and Peripheral Blood Smear Workshop Required Readings: Pagana, Chap 7, p.671 Goal: To become familiar with the optical microscope. Objectives:

Introduction to Microscopy and Peripheral Blood Smear, KOH & Wet Prep Workshop Required Reading: Pagana, Chap 7, p.671 Goal: To become familiar with the optical microscope. Objectives: 1. Be able to demonstrate the process needed to 1. Be able to demonstrate the process make a peripheral blood smear. needed to make a peripheral blood smear. 2. Be able to describe white and red cell 2. Be able to describe white and red cell morphology. morphology. 3. If given a peripheral blood smear, be able to 3. If given a peripheral blood smear, be perform basic interpretation of white and red able to perform basic interpretation of white cell morphology. and red cell morphology. 4. Be able to describe the process needed to make a KOH or Wet Preparation. 5. Given a KOH or wet prep, be able to identify associated pathological conditions. Newborn Examination Downloadable Items: Focus Sheet: Newborn Exam Newborn Exam Write Up Objectives: 1. Observe a complete newborn exam. 2. Perform a complete newborn exam 3. Attempt to assess gestational age, using criteria from the Ballard scoring system. 4. Observe physician/parent interaction and teaching. 5. Observe parent/infant interactions. 6. Write up the physical exam you performed. You may use the SOAP note format and include delivery history and pertinent information about the mother in the subjective area if you have access to that information. See the example of a newborn write-up that was presented in class. Write-ups are due the Monday following your visit unless otherwise cleared by the course coordinator. Additional information for students: 1. Ask what the protocols are for scrubbing/hand washing, gloves, etc. 2. Bring your stethoscope and clean it prior to using it on the infant.

3. Review notes from the Newborn lecture and reading assignments in your Peds text and physical exam text. 4. Wear your lab coat and nametag. Well Child Examination Required Readings: Bates, chapter 17 Downloadable Items: Focus Sheet: Well Child Basic Screening Exam Well Child Exam Write Ups Goal:To be able to perform a complete wellchild examination. Objectives: 1. Compare and contrast the differing approaches used when performing a physical exam on an infant, (2-6 months), during early childhood, (2-4 years of age), and during late childhood, (10-12 years of age). 2. Describe the techniques used to measure height, weight, and head circumference in infants and children. 3. Describe the methods for assessing visual acuity in infancy, early childhood, and late childhood. 4. Describe the methods used to test for stabismus. List the physical exam finding that may indicate ocular muscle weakness or diminished visual acuity. 5. Describe the clinical features of a patient with an intestinal obstruction and the procedure usually used for diagnosis. Venipuncture Required Reading: Dehn Chap 5 Pagana, Chap 7, p.671 Goal: Obtain a venous sample of blood while observing standard precautions and with minimal risk to the patient. Objectives: 1. Be able to describe the appropriate anatomy and physiology associated with a venipuncture. Describe the indications, contraindications and rationale for performing a venipuncture. Demonstrate competency in obtaining a venous blood specimen.