Plain C.T. scan and M.R.I. are useful imaging modalities for evaluating sinusitis and its complications. C.T. scan is most reliable for delineating the extent of disease and defining anatomical variants. M.R.I. helps assess intracranial extension and orbital complications.
Eustachian tube is commonly overlooked even by many physicians as effect of chronic otitis media rather than a cause. this is a humble attempt to explain the role eustachian tube dysfunction and interventions to reduce the same
Eustachian tube is commonly overlooked even by many physicians as effect of chronic otitis media rather than a cause. this is a humble attempt to explain the role eustachian tube dysfunction and interventions to reduce the same
Sinus tymapni shape and depth can influence surgical approach in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; while in the case of a deeper ST, a retrofacial approach is usually preferred.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Rhino-sinusitis: inflammation of lining mucosa of nose & paranasal sinuses
Acute: infection lasting < 4 weeks
Sub acute: infection lasting 4 to 12 weeks
Chronic: infection lasting > 12 weeks
Recurrent acute (RARS): > 4 episodes in a year, each episode lasting for 7-10 days, without persistent symptoms in between
Etiology:
Rhinogenic: commonest (85%), following any form of rhinitis
Dental: root abscess, dental procedures (maxillary sinusitis)
Trauma:
Accidental: R.T.A., swimming, diving, F.B., barotrauma
Iatrogenic: nasal packing, septal surgery
Hematogenous : rare
Symptoms
Nasal discharge : mucoid / purulent / blood-stained
Nasal obstruction with hyposmia / anosmia
Headache and facial pain
Cheek / eyelid congestion and swelling
Hawking, sore throat, dry irritating cough
Earache: associated Eustachian tube dysfunction
Constitutional: fever, malaise, body ache
Rhinosinusitis Task Force Criteria (RI 2004)
Location of facial pain in sinusitis
Maxillary sinusitis
Cheek, upper jaw, forehead that increases on bending forward
Frontal sinusitis
Pain over the forehead that increases during morning and decreases by late afternoon (office headache)
Anterior Ethmoid : nasal bridge and peri-orbital, more on eye movement
Posterior Ethmoid : deep seated retro-orbital
Sphenoid : vertex, occipital, retro-orbital pain
Palpation to elicit paranasal sinus tenderness
Maxillary: over the canine fossa
Anterior ethmoid: medial to medial canthus
Frontal: Floor of sinus at the superomedial aspect of the orbit or tap over its anterior wall on the forehead
Postural tests for rhinosinusitis
Performed in acute sinusitis (active nasal discharge)
Pus cleaned in supine position & patient sits upright
Pus appears : frontal or ethmoid sinusitis
Pus appears on stooping forwards: sphenoid sinusitis
No discharge patient lies in lateral position with affected side up
Pus appears: maxillary sinusitis
Plain x ray of Paranasal Sinuses
Water’s view (Occipito -mental) maxillary sinus
Caldwell’s view (Occipito -frontal) and lateral view frontal
Rhese’s view (lateral oblique) and laterai view ethmoids
Base skull view (Submento - vertical) and Pierre’s view (Occipito -mental with mouth open) sphenoid
Air-fluid level seen in acute sinusitis
Mucosal thickening seen in chronic sinusitis
CT scan of nose and PNS
Most reliable imaging modality for sinusitis at present
Plain axial, coronal and sagittal cuts of 3 mm (contrast for suspected vascular, neoplastic, inflammatory lesions)
Helps to delineate the extent of disease, define anatomical variants and study the relationship of sinuses with surrounding structures
Indications:
Recurrent acute/chronic sinusitis not responding to medical treatment
Before endoscopic sinus surgery
Impending complications of sinusitis
Sinus tymapni shape and depth can influence surgical approach in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; while in the case of a deeper ST, a retrofacial approach is usually preferred.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Rhino-sinusitis: inflammation of lining mucosa of nose & paranasal sinuses
Acute: infection lasting < 4 weeks
Sub acute: infection lasting 4 to 12 weeks
Chronic: infection lasting > 12 weeks
Recurrent acute (RARS): > 4 episodes in a year, each episode lasting for 7-10 days, without persistent symptoms in between
Etiology:
Rhinogenic: commonest (85%), following any form of rhinitis
Dental: root abscess, dental procedures (maxillary sinusitis)
Trauma:
Accidental: R.T.A., swimming, diving, F.B., barotrauma
Iatrogenic: nasal packing, septal surgery
Hematogenous : rare
Symptoms
Nasal discharge : mucoid / purulent / blood-stained
Nasal obstruction with hyposmia / anosmia
Headache and facial pain
Cheek / eyelid congestion and swelling
Hawking, sore throat, dry irritating cough
Earache: associated Eustachian tube dysfunction
Constitutional: fever, malaise, body ache
Rhinosinusitis Task Force Criteria (RI 2004)
Location of facial pain in sinusitis
Maxillary sinusitis
Cheek, upper jaw, forehead that increases on bending forward
Frontal sinusitis
Pain over the forehead that increases during morning and decreases by late afternoon (office headache)
Anterior Ethmoid : nasal bridge and peri-orbital, more on eye movement
Posterior Ethmoid : deep seated retro-orbital
Sphenoid : vertex, occipital, retro-orbital pain
Palpation to elicit paranasal sinus tenderness
Maxillary: over the canine fossa
Anterior ethmoid: medial to medial canthus
Frontal: Floor of sinus at the superomedial aspect of the orbit or tap over its anterior wall on the forehead
Postural tests for rhinosinusitis
Performed in acute sinusitis (active nasal discharge)
Pus cleaned in supine position & patient sits upright
Pus appears : frontal or ethmoid sinusitis
Pus appears on stooping forwards: sphenoid sinusitis
No discharge patient lies in lateral position with affected side up
Pus appears: maxillary sinusitis
Plain x ray of Paranasal Sinuses
Water’s view (Occipito -mental) maxillary sinus
Caldwell’s view (Occipito -frontal) and lateral view frontal
Rhese’s view (lateral oblique) and laterai view ethmoids
Base skull view (Submento - vertical) and Pierre’s view (Occipito -mental with mouth open) sphenoid
Air-fluid level seen in acute sinusitis
Mucosal thickening seen in chronic sinusitis
CT scan of nose and PNS
Most reliable imaging modality for sinusitis at present
Plain axial, coronal and sagittal cuts of 3 mm (contrast for suspected vascular, neoplastic, inflammatory lesions)
Helps to delineate the extent of disease, define anatomical variants and study the relationship of sinuses with surrounding structures
Indications:
Recurrent acute/chronic sinusitis not responding to medical treatment
Before endoscopic sinus surgery
Impending complications of sinusitis
Nasal Polyps are defined as pale, polypoidal, pedunculated , prolapsed sinus mucosa into the nose.
They cause nasal obstruction. Nasal allergy and infecions are proposed to be the most common etiological factors for nasal polyps.
This presentation explains in detail about every aspect of nasal polyps.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Acute suppurative otitis media and and cortical mastoidectomykrishnakoirala4
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students.
This presentation gives a lucid idea about different neoplasms of nose like inverted papilloma, ca maxilla, ethmoid and so on.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students.
Epistaxis is one of the commonly encountered problem in day to day life by the otolaryngologists. Most of the times, it is mild , but sometimes, it is very difficult to manage and there may be mortality, too.
This presentation gives a lucid idea of causes of epistaxis, emergency treatment options and operative treatment of epistaxis, too.
Deviated nasal septum and other septal conditionskrishnakoirala4
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides were prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. • Rhino-sinusitis: inflammation of lining mucosa of nose & paranasal sinuses
• Acute: infection lasting < 4 weeks
• Sub acute: infection lasting 4 to 12 weeks
• Chronic: infection lasting > 12 weeks
• Recurrent acute (RARS): > 3 episodes of rhinosinusitis in 6 months or > 4
episodes in a year, each episode lasting for 7-10 days, without persistent
symptoms in between
Definitions
3. Types of sinusitis
• Acute / sub acute / chronic / recurrent
• Open / Closed (depending on its drainage)
• Unilateral / bilateral
• Maxillary / frontal / ethmoidal / sphenoidal
• Single / multi / pan-sinusitis
• Anterior / posterior group
• Suppurative / hypertrophic
• Bacterial / fungal / allergic / occupational
4. Etiology
• Rhinogenic: commonest (85%), following any form of rhinitis
• Dental: maxillary sinusitis, root abscess, dental procedures
• Trauma:
– R.T.A., swimming, diving, F.B., barotrauma
– Iatrogenic: nasal packing, septal surgery
• Hematogenous : rare
10. Progress
• Severity and resolution depends on
– Open / closed
– Virulence of the organism
– Host resistance
– Treatment received
11. • Ostio-meatal complex is key
area for causation of infection
in anterior group of sinuses
• Pathological variants of ostio -
meatal complex play a major
role in causation of sinusitis
due to reduced ventilation and
drainage of sinuses
12. Clinical features of Rhinosinusitis
• Symptoms
− Nasal discharge : mucoid / purulent / blood-stained
− Nasal obstruction with hyposmia / anosmia
− Headache and facial pain
− Cheek / eyelid congestion and swelling
− Hawking, sore throat, dry irritating cough
− Earache: associated Eustachian tube dysfunction
− Constitutional: fever, malaise, body ache
13. Location of facial pain in Rhinosinusitis
• Maxillary sinusitis
− Cheek, upper jaw, forehead that increases on bending forward
• Frontal sinusitis
− Forehead that increases during morning and decreases by late
afternoon (office headache)
• Anterior Ethmoid: nasal bridge and peri-orbital, more on eye movement
• Posterior Ethmoid : deep seated retro-orbital
• Sphenoid : vertex, occipital, retro-orbital pain
14. Signs of Rhinosinusitis
• Congested and edematous nasal mucosa
• Nasal discharge (anterior and posterior rhinoscopy)
−Middle meatus: frontal, maxillary, anterior ethmoid
−Superior meatus: posterior ethmoid, sphenoid
• Tenderness over the paranasal sinuses
• Postnasal drip, granular pharyngitis
• Cheek swelling in maxillary sinusitis
• Lid edema in ethmoid & frontal sinusitis
15. Palpation to elicit paranasal sinus tenderness
• Maxillary: over the canine fossa
• Anterior ethmoid: medial to medial canthus
• Frontal: Floor of sinus at the superomedial
aspect of the orbit or tap over its anterior
wall on the forehead
16.
17. Transillumination test for sinuses
• Performed in a dark room.
• High-intensity light source placed inside patient’s mouth or
against the cheek (for maxillary sinus) & under medial
aspect of supra-orbital ridge (for frontal sinus)
• Trans-illumination normal : no sinusitis
• Trans-illumination absent : sinus filled with pus
• Trans-illumination dull : equivocal result
18. Postural tests for sinusitis
• Performed in acute sinusitis (active nasal discharge)
• Pus cleaned in supine position & pt sits upright
• Pus appears = frontal or ethmoid sinusitis
• Pus appears on stooping forwards = sphenoid sinusitis
• No discharge pt lies in lateral position with affected side up
• Pus appears = maxillary sinusitis
19. Rhinosinusitis Task Force Criteria
Major Minor
1. Facial pain / pressure 1. Headache
2. Nasal obstruction 2. Fever (non-acute sinusitis)
3. Nasal discharge or 3. Halitosis
discolored postnasal drip 4. Fatigue
4. Hyposmia / anosmia 5. Dental pain
5. Purulence on exam 6. Cough
6. Fever (acute sinusitis) 7. Ear pain / pressure / fullness
Presence of 2 major factors or 1 major + 2 minor factors = sinusitis
20. Investigations
1. Diagnostic nasal endoscopy (D.N.E.)
2. Maxillary Sinoscopy
3. X-ray of P.N.S.
4. U.S.G. of maxillary sinus (Rhinoscan)
5. C.T. scan of P.N.S.
6. M.R.I. of P.N.S.: rarely done
7. Allergic tests
8. Proof puncture (antral wash): for maxillary sinus
9. Endoscopic microswab for culture & sensitivity
10. Fungal culture: of cheesy nasal discharge
22. • Patients not responding to medical therapy
• Anatomic factor preventing adequate
examination by anterior rhinoscopy
• Collection of pus from hiatus semilunaris
for culture & sensitivity
• Objective monitoring of patients
• Peri-operative nasal inspection & cleaning
Indications for D.N.E.
Pus seen in middle meatus
on doing D.N.E.
23. Maxillary sinoscopy
• Anterior sinus wall perforated directly through
canine fossa between roots of 3rd & 4th teeth
with maxillary sinus trocar & cannula
• Trocar removed and sinoscope introduced
through cannula to see inside the maxillary
sinus
24. Plain X- ray of Paranasal sinuses
• Water’s view (Occipito -mental) maxillary sinus
• Caldwell’s view (Occipito -frontal) and lateral view
frontal
• Rhese’s view (lateral oblique) and lateral view
ethmoids
• Base skull view (Submento -vertical) and Pierre’s view
(Occipito -mental with mouth open) sphenoid
− Air-fluid level seen in acute sinusitis
− Mucosal thickening seen in chronic sinusitis
25. Para-nasal sinus sonography
• Bony anterior wall is seen as hyper-echoic line
• Maxillary cavity filled with air appears as hyper-
echoic hence posterior sinus margin not seen
• Fluid in sinus, cyst & mucosal thickening are
hypoechoic, so posterior sinus margin is visible
• B mode sonogram differentiates between fluid
in sinus, cyst & mucosal thickening
26. C.T. scan of Nose and PNS
• Most reliable imaging modality for sinusitis at present
• Plain axial, coronal and sagittal cuts of 3 mm
• Contrast for suspected vascular, neoplastic, inflammatory lesions
• Helps to delineate the extent of disease, define anatomical
variants and study the relationship of sinuses with
surrounding structures
• Indications:
• Recurrent acute/chronic sinusitis not responding to medical treatment
• Before endoscopic sinus surgery
• Impending complications of sinusitis
27. Plain C.T. scan Nose and PNS: Maxillary and ethmoid sinusitis
30. M.R.I. of P.N.S.
• Indications
−To assess the intracranial extension of
sinonasal disease, brain abscess due to
sinusitis and meningocele or encephalocele
−Malignant neoplasms of sinonasal tract
−To evaluate the orbital complications of
sinusitis