Clinic @5

EXAMINATION...
How?

Conventional OPD Examination setup encompasses 

1) Bull's Eye Lamp

2) Head Mirror

This setup ensures 

a) CONSISTENT and CONCENTRATED illumination.

b) BINOCULAR vision.

Binocular vision is EXTREMELY MANDATORY for perception of DEPTH OF FIELD, the significance of which can't be underestimated after per viewing the following images...

Clinic @4

HISTORY TAKING..
Why..???
1) To come to a diagnosis...e.g. CSOM safe/unsafe
2) To know the etiology...e.g. Tonsilloadenoiditis Rhinosinusitis...as a cause for CSOM
3) To ascertain the severity of the condition...e.g. Mild/Moderate/Severe hearing loss...conductive/sensorineural
4) To identify any ( Impending) complication/s...e.g. Facial palsy, Gradenigo's Syndrome,Otogenic Meningitis
5) To know any co morbidities...e.g. DM, HT,IHD.

LEADING QUESTION.. a question which is framed in such a manner the answer to can be ONLY YES or NO...

Clinic @3

HISTORY TAKING...
The time alloted for history taking and examination for a long case in the MUHS University is 30 minutes.
It is expected of the candidate to present the history in a definite sequence...
1) Particulars of the Patient
2) Chief Complaint/s...to be ENUMERATED in the patients words verbatim in CHRONOLOGICAL order.
3) Onset,duration and progress
4) Past history
5) Personal history
6) Family history
7) \Drug history
8) H/o Allergy
9) Immunization history
10) History of Surgery in the past
11) GENERAL EXAMINATION
12) Local Examination..
       Ears
       Nose
       Throat
       Neck
13) Tuning Fork Tests...for ear case.

Would like to humbly urge all as I have often quoted to follow the example of this marvelous feat of human engineering...THE PYRAMID...let the base of my history taking be so exhaustive that the pinnacle of my diagnosis will NEVER topple over....

Clinic @ 2

Dear All,
THE MARKING SYSTEM..
1) Long case...20 marks
2) Short case...10 marks
3) Table...Viva Voce...10 marks
                 Instruments...03
                 Specimen...03
                 X Rays...02
                 Audiograms...02

LONG CASE..
Usually it is a Ear Case.. a case of CSOM safe
History taking..05 marks.
Examination..05 marks.
Diagnosis..05 marks.
Treatment..05 marks. (*)      

(*) Treatment basically implies investigations and treatment.

Clinic @1

Dear All,
In pursuance of the clinical case discussion we had the other day, would like to share certain things,


THE UNWRITTEN PROTOCOL...
1) During the final MUHS practical examination, be appropriately dressed for the occasion.
2) After entering the examination hall, wish the examiner/s .
3) Be seated ONLY after being asked to do so.
4) AVOID use of short forms (acronyms) e.g. CSOM, ESR etc.
5) When the candidate is asked to explain any examination e.g. indirect laryngoscopy or any test e.g. tuning fork test, it is appropriate to preface the answer by saying " I WILL EXPLAIN THE PROCEDURE/TEST TO THE PATIENT IN A LANGUAGE WHICH HE OR SHE UNDERSTANDS".....creates a good impression on the examiner..

TUNING FORK TESTS

Tuning fork tests are an integral part of ear examination which help us assess the FUNCTION of the ear....HEARING.
There are many Tuning fork tests but the commonly performed are 3
1) Rinne's Test
2) Weber's Test
3) Absolute Bone Conduction Test
The tests essentially tell us whether the hearing loss is....
a) CONDUCTIVE...the pathology is in the EXTERNAL EAR +/- MIDDLE EAR.....Treatment is Medical +/- Surgical.
b) SENSORI NEURAL...the pathology is in the INNER EAR or beyond....Providing a commensurate hearing aid is the only treatment.
c) MIXED
So the competence to perform these tests properly is mandatory .
The tests need to be discussed under the following headings
Principle
Procedure
Observstion/s
Inference
Exception/s 

RINNE'S TEST

                                             
WEBER'S TEST

                                            

ABSOLUTE BONE CONDUCTION TEST

Dear All,
Posting a few images of ears for clinical discussion.

Image No. 1) 

Image No. 2)

Points to notice -
1) Both the images are of the RIGHT ear as is our protocol ( for matters of convenience).
2) Image No. 1 shows a big DEFECT in the Tympanic Membrane.
3) Image No. 2 shows multiple discrete chalky flakes on the Tympanic Membrane....these are typical TYMPANOSCLEROTIC patches which suggest old affection of the Middle Ear (probably an old c/o Otitis Media)...this is an extension of our discussion yesterday in the theory class on Otosclerosis.....this condition can mimic Otosclerosis (Differential diagnosis) in the sense that here too patient may complain of hard of hearing WITHOUT any h/o earache, otorrhoea ....the ONLY thing that will distinguish it from Otosclerosis is the ABNORMAL appearance of TM.

Points to ponder -
1) Which type of perforation does the Image No. 1 denote?
2) What is the type of CSOM here?
3) What are the Synonyms for this type of CSOM?
4) Waht is the Management of this condition?