The third European ORLBoard Examination oral part II

The third European ORL-Board Examination (oral part II, ) 1. 9. 2010 during the ELS 2010 Vienna, University of Music and Arts 1

University of Music and Art Vienna, Anton von Webern Platz 1, 1030 Wien Part II Oral Examination EBE-ORL-HNS 2010 September 1: 7. 00 -18. 00 Internet Entrance Porter Buffet Registration Post-exam Waiting Room 1 rst floor Courtyard Supervisors from the Austrian Medical Academy Ways of the Candidates Toiletts Buffet for examiners Chairmen room Preexam Waiting Room Examroom II Examroom I 2

Time Activity 6. 00 Arrival staff 6. 30 Arrival candidates 1 7. 00 Cand. 1 preexam. + Info question+arrival examiners 7. 30 9. 00 Exam 1. round 9. 00 9. 15 Break, coffee, 9. 15 10. 45 Exam. 2. round 10. 45 11. 00 Break, coffee, 11. 00 12. 30 Exam. 3. round 12. 30 13. 15 Lunch 13. 15 14. 45 Exam. 4. round 14. 45 15. 00 Break, coffee, 9. 00 Postexam room Cand. 1 8. 15 Arrival Cand. 2 8. 45 preexam. Cand. 2 10. 00 Arrival Cand. 3 10. 30 preexam. Cand. 3 12. 15 Arrival Cand. 4 12. 45 preexam. Cand. 4 14. 00 Arrival Cand. 5 14. 30 preexam. Cand 5 10. 45 Postexam room Cand. 2 Exit 14. 45 Postexam room Cand. 4 Exit 15. 00 16. 30 Exam. 5. round 16. 30 17. 00 Break, Coffee 17. 00 18. 30 Call over, Preparation of the letters 18. 30 19. 00 Farewell-Ceremony, Toast with some wine, proseccho, jiuce, water, snacks……. 19. 00 Departure for Heurigen Wolff 3

Countries of the Candidates I Bahrain 1 Serbia 1 Czech Republic 1 Slovenia 1 France 1 Thailand 1 Kuwait 1 New Zealand 1 Venezuela 1 Romania 1 Countries of the Candidates II First Part II Oral Exam Vienna, Sept. 1 2010 Number of Candidates n=78 4

Part II Oral Exam Vienna Number of Candidates n=78 Not passed n=8, Passed n=70 Results 5

The third European ORL-Board Examination (first oral part II, ) 1. 9. 2010 during the ELS congress 2010 Vienna, University of Music and Arts 38 Examiners, 4 Supervisors, 6 Guides 6

Distribution of the 38 Examiners and Supervisors From 13 European Countries for the Oral Exam in Vienna September 1 2010 7

For the Candidate Case Report: A mother comes with her 14 months daughter to the ENT-Specialist. The baby presents with left retro-auricular redness and fever (39. 2 C) of 24 hours duration. She has had an upper airway respiratory infection one week ago. There was no ear drainage, however, she has had purulent nasal drainage. Otoscopic Picture Question 1: a) What do you see on the pictures? b) What is your first diagnosis? c) Do you have further questions? d) What is your next step? Patients Foto of the retroauricular region 8

For the Examiner Blue Print: Diagnosis, Bacteria, possible complications and treatment of acute otitis media with early mastoiditis. By Ari Sismanis (Athens) Background Information for the examiners Intracranial complications I. Most common is meningitis S. pneumoniae H. Influenzae 2. Cerebral abscess (temporal lobe > cerebellum) 3. Sigmoid (lateral) sinus thrombosis Cannonball chest infiltrates on chest x-ray (CXR) edema and tenderness over the mastoid cortex and is associated with thrombosis of the mastoid emissary vein as a result of lateral sinus thrombosis (Griesinger sign) 4. Jacksonian epilepsy, hemiplegia, and OM indicates a 9 subdural abscess, until proven otherwise

For the Examiner Blue Print: Diagnosis, Bacteria, possible complications and treatment of acute otitis media with early mastoiditis. By Ari Sismanis (Athens) a. Most common complication is mastoiditis, which may progress to Subperiosteal abscess 1. Bezold abscess—abscess in digastric groove of SCM b. Petrous apicitis 1, Gradenigo syndrome--otorrhea, retro-orbital pain, and lateral rectus palsy secondary to irritation of CN VI within Dorello canal c. Facial Nerve paralysis: perform myringotomy, culture, and administer antibiotics Residual middle ear effusion after treatment a. 70% of patients at 2 weeks b. 20% after 2 months c. 10% after 3 months d. 90% of middle ear effusions persistent after an episode of treated AOM resolve within 90 days 10

Question 1: 20% a) What do you see on the pictures? b) What is your first diagnosis? c) Do you have further questions? d) What is your next step? Diagnosis: Acute otitis media with early mastoiditis Question 2: Are further diagnostic procedures necessary? Question 3: Which complications of acute otitis media do you know? 50% ? ? Question 4: What Therapy would you consider? Question 5: 30% What are the main causative organisms of AOM? Further Diagnostic procedures necessary? Plain-X-ray? CT of the temporal bones ? It was immediately done: in this case it showed cloudiness of the left mastoid without any destruction of the air cells Acute otitis media (AOM) Causative organisms Streptococcus pneumoniae (40%) Haemophilus influenzae (30%) 11 Moraxella catarrhalis (20%)

SITUATION ON THE WEBSITE AS PER 06/10/2010 What will be the future of the European Exam ORLHNS? NUMBERS REGISTRATIONS ON WEB SITE WITH INCOMPLETE REGISTRATION. IN PROCESS OF SENDING REQUIRED DOCUMENTATION 120 CANDIDATES THAT HAVE ALREADY BEEN VALIDATED (DOCUMENTS SENT AND CORRECT). WAITING TO REGISTER FOR NEXT EXAM 31 CANDIDATES THAT HAVE PAST THE WRITTEN PART EITHER IN MANNHEIM OR PAMPLONA AND HAVE EITHER FAILED OR NOT DONE THE ORAL EXAM YET. POTENTIAL CANDIDATES FOR NEXT ORAL EXAM 42 FELLOWS OF THE EUROPEAN BOARD EXAM. CANDIDATES THAT HAVE PASSED BOTH PARTS (I AND II) 70 12

We are convinced, that the introduction of the EBE ORL-HNS is a big step forward in the harmonisation process and quality 13 improvement of our speciality in Europe!