NBE CME programme for DNB consultants - National Board Of ...

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NBE CME programme for DNB consultantsdisease; Sickle cell disease SLE; Radiation retinopathyNon Surgical Management General Management - Diabetic control and its effect onretinopathy(Diabetic control and complications trial study; Primary and secondary prevention ofretinopathy), Antiplatelet Therapy(Use ofNSAlD as cyclo-oxygenase inhibitors), Use of HypoLipidemic Agents like Lovastatin and Prevastatin and their effect on retinopathy.Photocoagulation - PRP - Indications ( High risk characteristics (HRC) ) ; Focal treatment / Maculargrid- Indications; Criteria for CSME according to ETDRS; ETDRS Guidelines for follow up treatmentafter initial PRP; Factors for additional photocoagulation; Technique of additional laserphotocoagulation; Size and duration of spots in photocoagulation; Areas to be avoided duringphotocoagulation; Complications of laserCryoablation - Indications; Method and areas where cryo spots are to be applied.Surgical Management - Vltrectomy - Indications of Vitrectomy in diabetic eye disease; Surgicalobjectives and techniques; Risk of removal of lens with vitrectomy - Progression of Rubeosislridis; How to stop bleeding while doing vitrectomy(Raising bottle height, Bipolar diathermy,Endolaser; Fluid gas exchange; Silicone oil temponade its indications, technique, complications,removal methodology; Indications for fluid gas exchange.PtosisHistory - H/O Diabetics, ENT Problem, Fever, Trauma, Parotid surgery Etc.Clinical Examination - Upper Motor Neurone/L.M.N Difference; Bells Pheromone +/-, 6 th NerveinvolvementInvestigations - ENT check up/CT/Rule out diabetesDifferential Diagnosis - UMN/LMN involvement to be ruled out.Non – Surgical Management - Ocular Lubricants/ oral steroids.Surgical Management - Tarsoraphy /Jascial N DecompresssionAny Other - Prognosis – invariably bad.MEDICINECerebro-vascular diseaseHistory - Detailed history relating to the event onset, progress, neurological deficit(s); Assessmentof risk factors for CVA; If young patient, to evaluate for ‘Stroke in young’; Medication/TreatmenthistoryClinical examination - Vital Signs-pulse, BP, RR, Temp., Eval. Of carotids; Detailed Neurologicalexam including (Cranial N Plasies – Speech;Pupillary Signs;Motor System Examination); Exam ofHeart/CNS; To evaluate for causes of stroke in young;Should be able to identify the VascularTerritory involved Fundus Exam.Investigations-All invest but specifically-ECG;NCCT(Head);Role of CECT(Head);MRI(Brain);CarotidDoppler; Role of ECHO.Differential diagnosis-CVA (Conbouc, Haemorrhagic,Thrombotic); In young patients(Aneurysm,AVM); Other Causes (Vasculitis;SOL; Causes of stroke in young)Management - Immediate M/M; Supportive Care; Specific — Role of Thrombolysis in ThromboticEvents/Infarcts— When , How; M/M of HT in setting of Stroke—How 10w to bring down BP, Any other- Should discuss causes/Risk factors for CVA in elderly patients; Should discuss causes/Riskfactors for stroke in young patients; Should be able to identify Vascular territory; Discussion onposterior circulation stroke should be thereMulti-valvular heart diseaseHistory-Detailed history of symptoms– Palpitations, Dyspnoes, PND, Orthopndea, EDEMA,Hospitalizations, Embousations; History suggestive of RHD, other connective tissue disease, IE;120
NBE CME programme for DNB consultantsShould be able to identify-RT V/s LT sided Valve Lesions, Stenotic V/s Regurgitant LesionsClinical examination- Detailed ESP, GPE-Pulse(especially for)- BP, Signs of IE, Evidence of RF, Ifsuspected AR-Look for features of MARFAN’S, Syndrome,JVP, EDEMA; CVS – Detailed, thoroughexam of CVS-all areas; Abdomen; Fundus Exam; CNSInvestigations– ECG, Discuss Findings; CXR—Discuss Findings; ECHO—What all can be seenIf IE – Blood c/s— How many/when; RF – ASLO/CRP, other anti strept AbDifferential diagnosis- To give diagnosis as Which all valves are involved list in order of severity;Etiology (?Rheumatic ?MARFANS etc.); Presence/Absence of-Pulmonary A hypertension,Congestive cardiac failure, Arrythmias/Normal Sinus Rhythm, Rheumatic Aaivety, Infective EndoCarditis.Management - Discuss M/m in relation of; Valve involvement- Conservative, Surgical, Others ofBMV; CHF; IE; RF; Emborisation; AF; Special Simulation eg. In Pregnancy discuss prognosis andoutcomeAny other – Discuss-Prophylaxis for RF; IE Prophylaxis; Anticoagulation; Digoxcin-Role andToxicity; M/m of Embolisation in setting of IE; Fungal EndocarditisCerebellar diseaseHistory- Detailed History of Onsent, Progression of complaints; Family History – should traceinvolvement in family for inherited forms of cerebellar disease; Drugs/Toxics – History especially of; Other Neoplasms – Paraneoplastic involvementClinical examination - Detailed neurological exam Especially of – CNS and also spine; Othersystems-To be able to identify cause of cerebellar involvement.Investigations - Role of MR/CT; Discuss findingsDifferential diagnosis-Acuteonset-Chroniconset;Symmetrical - Symmetrical;Asymmetrical –Asymmetrical.To discuss D/D according to individual situations.Management -To identify the involvement as; Degenerative; Inherited; Drug/Toxin related; Infective;Vascular involvement; Paraneoplastic; M/m of individual situationAny other -To discuss D/D appropriate IE clinical situation eg. Age.Congenital Heart DiseaseHistory - Onset of Symptoms – childhood, adolescence, adults; Discuss the symptoms; Cynosis– if yes cyanotic spells feeding; Growth and milestones in children; Respiratory infectionClinical examination-Any compiler eg. Stroke, etc.,Detailed Cardiovascular- Exam, GPE – Sxanosis,Cuilbbing, JVP, EDEMA; Evaluate for other inherited/congenital malformation/disorders.Investigations – ECG; CXR; ECHO; Polycythemia/Hci; ABGDifferential diagnosis - To reach diagnosis as congenital HD. Cyanotic, Acynotic and then furtherdiscuss the individual differential thesis according to the case in hand; Eisenmenger – to discussin detail.Management - ISSUEO regarding; M/m of cyanotic spells(in children); M/m of CHF; M/m relating to;Operability; Surgery; Prognosis and OutcomeShort CaseMyopathy - Disease of Muscle/NerveHistory-History of symptoms,weakness especially, Onset, Progress, Prox V/s Distae, Severity,Fasciculations, Atrosphy, MSI Fatigue; To identify cause if possible on history; ParaneoplasticinvolvementClinical examination - Complete physical exam including; Detailed neurological examination;Focus on demonstration of (focus on LMN signs); Refrences-Planter response, Atrophy of MSIS;Skin Exam; Spine Exam121
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