Bullet Points in ENT: Postgraduate and Exit Exam Preparation

Review by L Flood, V Veer
Middlesborough, UK / Newcastle upon Tyne, UK

This is a paperback (but a bit large for a pocketbook) that is, as intended, ideally suited to help in preparation for the Diploma in Otolaryngology Head and Neck Surgery or the Intercollegiate Fellow of The Royal College of Surgeons FRCS (ORL-HNS) exit exam. It could be equally applicable further afield, but perhaps lacks the depth of facioplastics knowledge required across the Pond. There is, of course, more to examination preparation than learning a large number of facts, but that knowledge cannot hurt. The art is to learn how to put this information into clinical practice, assess a series of patients whose clinical signs may well be obscure and, finally, demonstrate across a table that one has reached that required standard. As an examiner for 12 years, and subsequently a lecturer and demonstrator on examination preparation courses, I quickly saw how valuable the book could be (and all at a very reasonable price indeed).

It is a book of bullet points and not text. You get facts and not discussion or explanation (by this stage that should be unnecessary). There are nice colour diagrams and reproductions of imaging scans, especially notable in the head and neck/laryngology section. Piriform fossa and post cricoid tumours are rarely this well shown.

The real value comes with the most exam-orientated features, of course. The editors recall only too well, from personal experience, what have been hot topics. In otology, we read of the Belfast rule of thumband the Glasgow Benefit Plot. In temporal bone drilling, they set (and answer) classical questions as to how to proceed if things go wrong in mastoid surgery. There is what may seem excessively long coverage of auditory processing disorder/auditory neuropathy, but that is another favourite topic (at least until the panel read this book!). Learn sections 19.1 and 19.1.1 off by heart. The anatomy of the facial nerve and its course will crop up in every examination, whether in the otology, the head and neck, or the clin- ical assessments.

The section on rhinology taught this otologist a great deal. I now know the four Messerklinger landmarks, and am updated on vasculitides such as Wegener’s granulomatosis and Churg–Strauss syndrome (neither eponyms are now acceptable of course). A chapter on the European Position Paper on Rhinosinusitis and Polyps is a great discussion topic for any viva. For endoscopic sinus surgery, the bullet point approach really works and the algorithms are again invaluable in that rhinology confrontation. Facioplastics is confined to local flaps and the excision of skin lesions, which is entirely appropriate in the UK and Ireland setting. Algorithms, again, are good revision aids in subjects such as paediatric lymph node management.

Finally, another clever feature comes at the very end, under the heading Miscellaneous; this section covers the basic medical sciences, but focuses on statistics, governance and audit, and, above all, classifications. The latter are represented by lists of all those stages, types, classes and levels beloved of the flagging examiner. Tell me about the classification of frontal sinus mucoceles, types IVb. My favourite was Chandlers classification for orbital sepsis, which almost everyone used to get wrong, describing group 3; these authors did not. I will forgive them for 

labelling an image of the vestibule as the labyrinthas that is even commoner an error. The latter is the whole thing of course, cochlea and all.

That is the former examiners view. This could be a very important standard textbook for ENT training, and, frankly, I wish I had had it as an examiner. Let us see what a future exam victim makes of it (without reading my review!).

 

I was knee deep in a multitude of reference texts trying to revise for my Fellowship of the Royal College of Surgeonsexam (84 days to go), when heaven sent me Mr Flood, adorned with this revision book. In summary, its fantastic, and perfect for my current predicament. It is in note form, similar to the Pocket Pashaseries, but just in more detail (and in British English rather than American English). The authors do well to provide the information in digestible

chunks, and organise it in a form that would be useful when formulating an answer in a viva situation. Even anatomy, embryology, and pathology and physiology are covered to an acceptable level for each topic, and should help with part one of the exam. There are also chapters on microbiology, anaesthetics, pharmacology and so on.

The images, scans and diagrams are clear. These are frequently used to describe classifications, which greatly improve memory retention of the more obscure lists we need to quote.

This is a fabulous revision book for the Fellowship of the Royal College of Surgeonsexam, and I thoroughly recommend it for anyone considering the quiz. I only hope this review is released after my exam date, so that my competition isnt given a similar advantage. 


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