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Osce ent


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Osce ent

  1. 1. Osce ear nose n telinga. ;p*throat!- from siti zarina. Muehehe-
  2. 11. <ul><li>otoscopy should includes inspection of the external ear and pinna INSPECT THE EXTERNAL MEATUS --discharge,blood or pus -masses -on insertion of speculum inspect the canal -skin -discharge -swelling -wax OTOSCOPY POSITION pt should be positioned e the head flexed laterally away from the examiner the external auditory canal has a bend which normally restricts the examiner,s view the pinna of the ear to be examined is held firmly and gently pulled upwards and backwards to straighten the canal using the hand not holding the otoscope HOLDING THE INSTRUMENT otoscope is held in the same hand as the ear being examined the speculum should be as wide as possible to comforttably fit into the ear canal holding the otoscope (like a pen) horizontally provides a secure cradle for the instrument the curled fingers can rest against the cheek and the handle will not catch the shoulder (as it may if held vertically) in addition this position will help protect against accidently pushing too deeply into the outer ear TYMPANIC MEMBRANE inspect the tympanic membrane identify the normal structure any insignificant variation in normal appearance report ur findings to examiner </li></ul>
  3. 14. 1. Name the syndrome Ramsay Hunt syndrome 2. Name the causative organism Varizella zoster virus 3. Name the other areas where rashes can be seen in this syndrome Anterior 2/3 of tongue, soft palate, external auditory canal, and pinna
  4. 15. <ul><li>Name the various eye care procedures which should be followed in treating the patient at the previous station </li></ul><ul><li>1. Wearing of eye glasses to prevent corneal damage </li></ul><ul><li>2. Instilling moisturizing eye drops to prevent exposure keratitis </li></ul>
  5. 16. <ul><li>Name the instrument </li></ul><ul><li>Siegle's pneumatic aural speculum </li></ul><ul><li>Name it uses </li></ul><ul><li>1. Examination of ear drum </li></ul><ul><li>2. Testing the mobility of the ear drum </li></ul><ul><li>Write down its magnification factor </li></ul><ul><li>2.5 times </li></ul>
  6. 17. <ul><li>Examine the right ear of this patient </li></ul><ul><li>1. Describe the lesion </li></ul><ul><li>Cotton wool like mass seen occluding the external auditory canal. Black spots are also seen </li></ul><ul><li>2. What could be the probable diagnosis ? </li></ul><ul><li>Otomycosis </li></ul><ul><li>3. What could be the causative organisms? </li></ul><ul><li>Aspergillus Niger - black spots </li></ul><ul><li>Candida - Cotton wool like mass </li></ul>
  7. 18. <ul><li>Comment on the ear drum </li></ul><ul><li>1. Loss of light reflex </li></ul><ul><li>2. Prominence of handle of malleus </li></ul><ul><li>3. Loss of mobility of ear drum </li></ul><ul><li>4. Retracted ear drum </li></ul>
  8. 19. <ul><li>Name the structures numbered </li></ul><ul><li>1. Round window </li></ul><ul><li>2. Stapedial tendon </li></ul><ul><li>3. Pyramid </li></ul><ul><li>4. Long process of incus </li></ul>
  9. 20. <ul><li>Write down the possible causes of bilateral retracted ear drum </li></ul><ul><li>1. Nasopharyngeal carcinoma </li></ul><ul><li>2. Following adenotonsillectomy (Iatrogenic) </li></ul><ul><li>3. Cleft palate </li></ul>
  10. 21. <ul><li>Comment on ear discharge of this patient </li></ul><ul><li>What could be the possible diagnosis ? </li></ul><ul><li>1. Scanty </li></ul><ul><li>2. Foul smelling </li></ul><ul><li>3. Blood tinged (sometimes) </li></ul><ul><li>4. CSOM with attic cholesteatoma </li></ul>
  11. 22. <ul><li>Name this condition seen on the ear drum </li></ul><ul><li>Enumerate 3 causes for it </li></ul><ul><li>1. Tympanosclerosis </li></ul><ul><li>2. Due to resolved otitis media </li></ul><ul><li>3. Trauma </li></ul><ul><li>4. Grommet insertion (Iatrogenic) </li></ul>
  12. 23. <ul><li>65 years old man </li></ul><ul><li>Known diabetic for 15 years on poor glycemic control </li></ul><ul><li>c/o pain left ear - 1 month </li></ul><ul><li>Blood stained discharge from left ear - 1 month </li></ul><ul><li>Tragal tenderness left side - 15 days </li></ul><ul><li>Inability to close left eye - 10 days </li></ul><ul><li>Otoscopic finding: </li></ul><ul><li>1. What could be the possible diagnosis ? </li></ul><ul><li>2. Name the probable causative organism </li></ul><ul><li>3. Name the choice of antibiotic </li></ul><ul><li>Malignant otitis externa </li></ul><ul><li>Psuedomonas aeruginosa is the probable causative organism </li></ul><ul><li>Carbenicillin / IV generation cephalosporins </li></ul>
  13. 24. <ul><li>Enumerate Levenson's criteria for malignant otitis externa </li></ul><ul><li>1. Refractory otitis externa </li></ul><ul><li>2. Severe nocturnal otalgia </li></ul><ul><li>3. Purulent otorrhoea </li></ul><ul><li>4. Granulation tissue in external canal </li></ul><ul><li>5. Growth of pseudomonas aeruginosa in specimen cultured from external canal </li></ul><ul><li>6. Presence of diabetes mellitus / other immunocompromised states </li></ul>
  14. 25. <ul><li>5 years old child </li></ul><ul><li>c/o excrutiating pain in right ear - 6 hours </li></ul><ul><li>H/O URI - 2 days </li></ul><ul><li>Otoscopy showed: </li></ul><ul><li>Name the diagnosis </li></ul><ul><li>Name the various stages of this disorder </li></ul><ul><li>Acute otitis media </li></ul><ul><li>Stages of acute otitis media: </li></ul><ul><li>1. Stage of hyperemia </li></ul><ul><li>2. Stage of exudation </li></ul><ul><li>3. Stage of suppuration </li></ul><ul><li>4. Stage of resolution </li></ul>
  15. 26. <ul><li>Name the surgery performed in AOM </li></ul><ul><li>Indication for surgery in AOM </li></ul><ul><li>Myringotomy </li></ul><ul><li>AOM which does not respond to adequate medical managment within 48 hours </li></ul>
  16. 27. <ul><li>Post surgical otoscopic finding of a patient with AOM </li></ul><ul><li>Name the instrument used for this surgical procedure </li></ul><ul><li>Name the possible surgical complications of myringotomy </li></ul><ul><li>Myringotomy knife </li></ul><ul><li>Complications include: </li></ul><ul><li>1. Dislocation of incudostapedial </li></ul><ul><li>joint </li></ul><ul><li>2. Injury to corda tympani nerve </li></ul><ul><li>3. Persistent perforation </li></ul>
  17. 28. <ul><li>Differential diagnosis of this lesion: </li></ul><ul><li>This is a red drum </li></ul><ul><li>Could be due to: </li></ul><ul><li>1. AOM - associated with otalgia </li></ul><ul><li>2. High jugular bulb - Normal variant. CT scan shows intact jugular foramen </li></ul><ul><li>3. Glomus jugulare - associated with pulsatile tinnitus, conductive deafness, positive Brown's sign. CT scan shows eorsion of jugular foramen. </li></ul>
  18. 29. <ul><li>40 years old male patient </li></ul><ul><li>C/O swelling behind left ear - 7 d </li></ul><ul><li>Pain in left ear - 4 days </li></ul><ul><li>H/O ear discharge - 8 years </li></ul><ul><li>What differential diagnosis you can offer ? </li></ul><ul><li>1. Subperiosteal abscess </li></ul><ul><li>2. Suppurated retroauricular lymph node </li></ul>
  19. 30. <ul><li>Perform three finger test on this patient </li></ul><ul><li>Greet the patient first </li></ul><ul><li>Explain the procedure </li></ul><ul><li>Reassure the patient </li></ul><ul><li>Three fingers are used to perform this test. </li></ul><ul><li>Middle finger is used to apply pressure over the well of the concha - Tenderness in this area indicates tenderness over the antral area </li></ul><ul><li>Index finger is used to apply pressure over mastoid process - Tenderness indicates mastoiditis </li></ul><ul><li>Thumb is used to apply pressure over mastoid tip - Tenderness indicates mastoid emissary vein thrombophlebitis </li></ul>
  20. 31. <ul><li>30 years old male patient came with c/o </li></ul><ul><li>Pain right ear - 1 week </li></ul><ul><li>Blocking sensation right ear - 10 days </li></ul><ul><li>Mild discharge from right ear - 1 week </li></ul><ul><li>Otoscopy shows: </li></ul><ul><li>Enumerate otoscopic findings </li></ul><ul><li>Mention the possible diagnosis </li></ul><ul><li>Mention in brief the pathophysiology of this disorder </li></ul><ul><li>Whitish mass admixed with wax can be seen in the external canal </li></ul><ul><li>The external canal appears widened </li></ul><ul><li>Probable diagnosis - Keratosis obturans </li></ul><ul><li>Kertosis obturans occur due to faulty epithelial migration of external canal skin. This movement occurs in a reverse direction in these patients (i.e. towards the ear drum) </li></ul>
  21. 32. <ul><li>Name the type of pinna seen here </li></ul><ul><li>Name some drugs which when ingested during pregnancy would cause this condition </li></ul><ul><li>Microtia </li></ul><ul><li>Warfarin, Folic acid antagonists like methotrexate and aminopterin </li></ul>
  22. 33. <ul><li>22 year male patient came with c/o swelling over right pinna - 4 days </li></ul><ul><li>Mild pain ++ </li></ul><ul><li>No h/o fever </li></ul><ul><li>Name the possible pathology </li></ul><ul><li>How will you manage this condition ? </li></ul><ul><li>Aural seroma </li></ul><ul><li>Needle aspiration with application of compression dressing to prevent reaccumulation. </li></ul>
  23. 34. <ul><li>Why is this external auditory canal narrow ? </li></ul><ul><li>What could be the cause ? </li></ul><ul><li>What could be the clinical problems faced by the patient ? </li></ul><ul><li>What surgery should be performed in this patient ? </li></ul><ul><li>Exostosis of external auditory canal. </li></ul><ul><li>It is common in swimmers. </li></ul><ul><li>These patients have conductive deafness, cerumen impaction. </li></ul><ul><li>Cerumen impaction is caused by abnormal self cleansing mechanism of the skin lining external canal in these patients. </li></ul><ul><li>Canalplasty </li></ul>
  24. 35. <ul><li>30 years old female patient came to the OPD </li></ul><ul><li>with c/o: </li></ul><ul><li>Hard of hearing both sides – 4 years Tinnitus on and off left ear – 6 months </li></ul><ul><li>O/e: </li></ul><ul><li>Ear drum on both sides appeared normal. They also showed normal mobility on siegalization. </li></ul><ul><li>Given below is the audiogram of the patient: </li></ul><ul><li>What could be the probable diagnosis? What do you see in the audiogram? </li></ul><ul><li>This patient is probably suffering from otosclerosis. </li></ul><ul><li>The audiogram shows carharts notch. It is classically seen in bone conduction audiogram of patients as a dip centered around 2000Hz. </li></ul>