An otoplasty, also known as ear reshaping or ear pinning, is a cosmetic procedure that improves the appearance of abnormally large, protruding or uneven ears, which can occur naturally or as a result of the injury. During an otoplasty, the ears are reshaped to be more symmetrical, reduced in size or pinned back to lie closer to the head.
Introduction
Functions
Development
Structure
Nasal cavity
Nasal septum
Lateral wall
Applied anatomy and pathology –
- danger area of nose
- nose bleeding
- foreign body in nose
- developmental nasal deformities
- nasal polyps
- mouth breathing
- rhinitis
An otoplasty, also known as ear reshaping or ear pinning, is a cosmetic procedure that improves the appearance of abnormally large, protruding or uneven ears, which can occur naturally or as a result of the injury. During an otoplasty, the ears are reshaped to be more symmetrical, reduced in size or pinned back to lie closer to the head.
Introduction
Functions
Development
Structure
Nasal cavity
Nasal septum
Lateral wall
Applied anatomy and pathology –
- danger area of nose
- nose bleeding
- foreign body in nose
- developmental nasal deformities
- nasal polyps
- mouth breathing
- rhinitis
Google drive:-https://www.youtube.com/redirect?q=https%3A%2F%2Fdrive.google.com%2Fopen%3Fid%3D1ZET4JzZalyUfM1KWXemKZsQQXMzrYpcJ&v=WHOggpW5Ee8&event=video_description&redir_token=77oOekaJs8_u0RLfrUH8z68tJFt8MTU2MDY1Njc4N0AxNTYwNTcwMzg3
Youtube:-https://www.youtube.com/watch?v=WHOggpW5Ee8
Google drive:-https://www.youtube.com/redirect?q=https%3A%2F%2Fdrive.google.com%2Fopen%3Fid%3D1ZET4JzZalyUfM1KWXemKZsQQXMzrYpcJ&v=WHOggpW5Ee8&event=video_description&redir_token=77oOekaJs8_u0RLfrUH8z68tJFt8MTU2MDY1Njc4N0AxNTYwNTcwMzg3
Youtube:-https://www.youtube.com/watch?v=WHOggpW5Ee8
Approach to a patient with CNS diseaseAhsan Sajjad
Approach and management of a patient showing signs and symptoms of CNS disease. Although its an extensive Presentation but it contains all the relevant knowledge which was possible by me to Gather.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
3. MAIN PRESENTING COMPLAINTS
OF CNS
Headache, backache or neck pain
Facial pain
Fits ,faints or funny turns
Dizziness or vertigo
Disturbance of vision, hearing or smell
Disturbance of memory, sphincter control,
sleep, speech, language or gait
7. Where is the lesion?
1) Is the lesion :
Single,multiple or is it a diffuse process
Restricted to CNS or part of systemic illness
2) Do the findings combine to form a
recognizable clinical syndrome eg parkinsonism
9. HISTORY
Onset of illness & its course
Comorbation of history by attendants
Premorbid condition
Family history
Medical history
Drug use, abuse & toxin exposure
Formulating an impression of the patient
Precipitating factors
Associated symptoms
11. SYSTEMIC EXAMINATION
CENTRAL NERVOUS SYSTEM
CARDIOVACULAR EXAMINATION
HEART MURMUR
GASTROINTESTINAL EXAMINATION
KIDNEYS, SPLEEN
RESPIRATORY SYSTEM
PULMONARY INFECTION
PULMONARY EDEMA
12. CENTRAL NERVOUS SYSTEM
GCS
PUPILS
HIGHER MENTAL FUCTION
E4V5M6
Time- knows month or year
Place- has general knowledge of where they are
Person- knows own name, able to name relatives or friend
Memory- capability for early and recent recall
CRANIAL NERVES
21. Tin-pot dictators have ravaged Asia, Latin America &
Africa. They are the worst tyrants of post-colonial period.
They have destroyed time-honored institutions & treated
their people like animals. They have caused internal
divisions &external confusion. The dictator is one animal
who needs to be caged. He betrays his profession & his
constitution. Not a single one of them has made a
moments contribution to history.
24.
Case scenario
A 45yrs old lady is brought to ER with c/o sudden weakness of
right half of body. O/E
Patient drowsy
BP = 180/110 mmHg
Pulse = 68/min
CNS: GCS 7/15
Power decreased on right
Tone increased on right
Right plantar upgoing
Right facial nerve palsy (UMN type)
Explain the nature of lesion.
25. CASE SCENARIO
A 56yrs old gentleman with h/o uncontrolled
hypertension presents in ER with sudden onset
of weakness of left arm.
Where is the lesion in brain?
26.
27.
28.
29. CEREBRAL DOMINANCE
Two cerebral hemispheres
All the right handed persons and most of left
handed persons have left hemisphere as the
dominant one.
Dominant hemisphere controls the speech.
42.
Spinal cord begins at the end of medulla oblongata and
extends upto lumbar vertebra 2 or 3 in adults.
Lower tapering part is called conus medularis and the
lowermost bundle of nerve fibres is called cauda equina.
It contains all the ascending and descending fibres.
Lesion here can cause hemiplegia, paraplegia or
quadriplegia.
46. Main arteries are:
Internal carotid arteries
Basilar arteries
Vertebral arteries
Anterior cerebral arteries
Middle cerebral arteries
Posterior cerebral arteries
These form a circle called CIRCLE OF WILLIS
47.
48.
49.
50. Areas of supply
MCA supplies lateral surface of frontal, parietal
& temporal lobe ie most of the motor & sensory
cortex except which lies on medial side and
controls legs.
ACA supplies medial side of brain.
PCA supplies the occipital lobe.
53. CORTICOSPINAL PATHWAY
Neurons in precentral gyrus
Corona radiata
Posterior limb of internal capsule
Cerebral peduncle in pons
Midbrain
Medulla oblongata
Decussation of fibres occur in pyramids of MO
and then descend as lateral corticospinal tracts.
57. APPROACH TO WEAKNESS
First determine whether its:
Generalised weakness
Weakness of all 4 limbs
Hemiplegia
Paraplegia
Monoplegia
Patchy weakness
58. Weakness all 4
limbs
yes
Upper motor
Neuron pattern
Cervical spinal cord
Or bilateral brainstem
Or hemisphere
no
no
proximal>distal
no
Neuropathy
Distal sensory loss
yes
Myopathy
No sensory loss
no
Weakness in both
legs
no
yes
Upper motor neuron
pattern
Yes
Spinal cord, thoracic spine or above
59. Unilateral arm
And leg
yes
Lesion in brainstem
Or hemisphere
no
Single limb
Single root
no
yes
Radiculopathy
no
no
Patchy weakness
Single named nerve yes
yes
Multiple named nerves yes
Mononeuropathy
Mononeuritis
multiplex
no
Variable weakness
yes
Fatigues
yes
Myesthenia
gravis
60. Case scenario
A 50yrs old male suddenly develops weakness of
left half of body. O/E there is weak left arm &
leg with increased tone & upgoing plantar. There
is sensory loss also.3 days later patient starts
complaining of agonizing pain down the left leg.
Patient says that he feels like as his flesh is being
torn away from bones.
What is the lesion and where is the lesion?
61. Case scenario
A 46yrs old male is brought to OPD with
c/o sudden inability to walk & to hold the
objects. O/E pt is having right nystagmus.
There is dysarthria & past pointing on right.
When asked to walk, patient sways to right.
Where is the lesion in CNS?
69. Dorsal Column
It is concerned with joint position sense,
vibration and touch
Axons proceed in the posterior column to dorsal
column nuclei in medulla
Second order neurons decussate and ascend in
medial lemniscus to thalamus
From thalamus fibres relay in parietal sensory
cortex
70. Lateral spinothalamic tract
It is concerned with pain and temperature
Fibres synapse in posterior horns and decussate
in the center of cord
Later they pass in lateral column as
spinothalamic tract and join medial leminiscus to
reach thalamus
71.
72.
73. Symptoms of Sensory disturbances
Complaints like:
Being unable to feel feet on the floor
Unable to judge temperature of bath water
Pins and needle sensations
Sensory ataxia
Paraesthesias and pain in nerve root region of
supply
74. Patterns of Sensory loss
Single nerve lesion e.g., median n. lesion
Root lesion
as in cervical or lumbar disc protrusion
Peripheral nerve lesion
e.g., neuralgias, glove and stocking sensory loss
Brain stem lesions:
loss of pain and temperature on ipsilateral half of face
and opposite half of body (e.g. lateral medullary
syndrome)
75. Patterns of Sensory loss
(continued-----)
Thalamic lesion:
hemisensory loss of all modalities and severe
deep seated burning pain
(Dejerine roussy syndrome )
Cortical lesion (parietal lobe )
Hemisensory loss of all modalities
Spinal cord lesions
77. CASE SCENARIOS
Gulzar bibi, 65 yr old lady presented via opd
with c/o gradual weakness of both the legs for
last 2months associated with urinary and fecal
incontinence. There is also a c/o tingling and
burning sensation in the legs.
78. O/E
An old lady lying in bed, conscious.
No abnormality on inspection
Power 0/5 in both the legs
Tone decreased in both the legs
Reflexes diminished
Plantars bilaterally upgoing
Spine normal
Sensory level at T6
what is the investigation of choice?
79. MRI spine showed degenerative spondylitis at
mid and lower thoracic spine,most evident at
T8 & T9 causing cord compression.
80. Case 2
Mr Fazal kareem, an 80yr old gentleman
presented in ER with c/o weakness of legs,
constipation & urinary retention. Patient
referred to surgical unit as a case of intestinal
obstruction and urinary retention. Later no
surgical abnormality detected. Medical
consultation taken.
82. CASE 3
Miss maryam, 16 yr old presented in OPD with
c/o progressively increasing difficulty in
walking. O/E
POWER
3/5 in both legs
TONE
increased
REFLEXES hyperreflexia
Plantars upgoing
Ankle & knee clonus positive
Sensory level
T6
83. Patient had pulmonary TB 3yrs back, took
ATT for 2months.
MRI spine showed two soft tissue density
masses in thoracic spine causing cord
compression.
Histopathology of the mass showed
features consistent with the diagnosis of
-------?
84. CASE 4
A 30 yrs man is brought to ER after an RTA causing
injury to spine. O/E:
Vitals stable
Power 0/5 in the legs
Reflexes absent
Tone decreased in both legs
Plantars non-specific
Complete absence of all sensations below the umbilicus
86. CASE 5
A 40 yrs old male, victim of earthquake with spinal injury
is admitted in the ward. Examination of legs shows:
Power 0/5 in left leg
Tone increased in left leg
Left plantar upgoing
Reflexes brisk on left side
Absent joint position & vibration sense on left
Absent pain & temperature sensation on right
What is the pathology?
87. CASE 6
A 57 yrs old man is brought to ER with c/o sudden
inability to walk. O/E power reduced in both legs with
upgoing plantars. There is loss of pain & temperature
sensation in both legs but joint position sense is intact.
What is your diagnosis?
88. CASE 7
A 48 yrs old male is brought to ER with c/o weakness
of all the four limbs over a period of 1year. However
there is no incontinence. Thre is also dysphagia.
Examination reveals UMN quadriplegia with visible
fasciculations over the tongue. Uvula deviates to left
when 10th nerve is examined.
Where is the lesion & what is the pathology?
89. CASE 8
A 42 yrs old lady comes in OPD with c/o numbness of
both the hands and difficulty in holding the objects.
O/E there is absent pain & temperature sensation over
the hands and forearms. Sensory loss is dissociated.
Sense of vibration and joint position sense is intact.
There is weakness of small muscles of hands.
What is your impression?
90. CASE 9
A 65 yrs old gentleman is brought to OPD with c/o progressively
increasing generalised weakness, anorexia, SOB & easy
bruisability. There is previous h/o partial gastrectomy due to
unknown reason. O/E:
An elderly gentleman with marked pallor, bilateral pitttting edema
feet & bruises over the arms and legs.
Vitals stable
GIT:
no abnormality
91. LABS
Hb = 5.7 g/dl
MCV =
116 Fl
Serum albumin = 2.7 g/dl
PT
= 22sec/ 14 sec
What is your diagnosis & management plan?
106. Midbrain
Involvement of:
Third and fourth cranial nerves
Descending corticospinal and corticobulbar
tracts
Reticular formation
Red nucleus
107. Clinical syndromes associated with
lesion
Weber´s syndrome: Contralateral hemiplegia and
ipsilateral third nerve lesion
Benedikt´s syndrome: third nerve palsy with
involuntary movements of opposite limbs (red
nucleus involvement)
Akinetic mutism:
Involvement of reticular formation; patient makes
no voluntary movements except that of eyes
109. Lesions in pons
It contains 5th, 6th,7th & 8th cranial nerve nuclei.
Lateralized lesion in pons causes ipsilateral CN
involvement with crossed paralysis or sensory loss as in
Millard Gubler syndrome. (6th and 7th nerve palsy)
Central pontine lesion may cause coma, hyperthermia
& pinpoint pupils.
Locked in syndrome: only eye movement is possible. Pt
is able to communicate via eye signals.
110. Lesions in medulla
Medial medullary syndrome:
Weakness and loss of postural sense in limbs on
side oposite to lesion with ipsilateral paralysis of
tongue.
113. Unilateral
Cranial nerve
abnormalities
Contralateral
Hemiplegia or
tetraplegia
Multiple Cranial nerve abnormalities
No
yes
IIIrd nerve palsy yes
No
VI and/ or VII
No
XII ± IX and XI
yes
Combined V
VII and VIII
yes
No
Cerebellopontine
lesion
Midbrain lesion
Combined III, VIth yes
And V
No
Cavernous sinus
Pontine lesion
lesion
Combined IX,
X and XI
Medullary lesion
Jugular foramen
syndrome
114.
115.
116. Middle cerebral artery
It constitutes 2/3 of all cerebral infarcts
Contralateral hemiparesis and sensory loss, arm
and face most affected
Expressive aphasia(dominant hemisphere)
Anosogonosia and spatial disorientation (nondominant)
Contralateral inferior quadrantanopia
117. Anterior cerebral artery
It constitutes two percent of all infarcts
Contralateral hemiparesis and sensory loss,
worse in leg
Incontinence of urine
Loss of verbal fluency but preserved ability to
repeat
118. Posterior cerebral artery
As it supplies occipital lobe, so lesion causes
visual field defects, contralateral homonymous
hemianopia