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

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NBE CME programme for DNB consultants(LMMH); Morphine; Nitroglycerine; Beta blockers; ACE Inhibitor; Calcium Channel Blocker;Statins; Thrombolysis (streptokinase, Urokinase, tenecteplase and reteplase) ; GP nb/liJ,ainhibitor; Glycemia control (insulin)Surgical - CABG (Coronary artery bypass Grafting)Others - Diet; Exercise/activity; Bowel (constipation) ; Sedation;Macrovascular ComplicationsCerebrovascular accidents - (Occlusive stroke and transient ischemic attacks)History - Sudden onset of loss of sensation (one side of body); Sudden onset weakness (one sideof body) ; Change in vision; Gait disturbance; Inability to speak/understand; Sudden, severeheadache; Seizure; Fever/sepsis; Risk factors (hypertension, cigarette, smoking, alcohol, familyhistory etc)Examination - High motor function; Cranial nerves; Motor examination; Sensory tests; Gait;Coordination; Carotid bruitDifferential Diagnosis-Intracranial hemorrhage; Subarachnoid hemorrhage; Migrane; Meningitis;Metabolic Encephalopathy; Cerebal Venous thrombosis; Subdural Hematoma, Neoplasm; HeadInjury; Todd’s paralysis; Multiple Scletosis; Vestibular disorder; HysteriaInvestigation - Complete haemogram with platlet count; ESR; Bleeding time, clotting time andprothrombin time; Sickle cell test; Anticardioplipin antibodies; C-reactive protein; Lipid profile;Uric acid and electrolytes; Serum protein C and S level; Homocystein level in blood; Chest x Rays;ECG, Hotler monitoring; 2D Echocardiography; CSF; VDRL of blood and CSF; Fluorescenttreponemal antibody absorption test (FTA- ABS) ; HIV; Computed tomography; Carotid Doppler;MRI of Brain; MRA or digital subtraction angiography; SPECT of brainManagement-Medical; Maintenance of vitals ;Temperature; Pulse; Respiration (ventilation); Bloodpressure;Fluid and electrolytes;Prevention of complications like pulmonary aspiration, seizures,thromboplebitis and bedsores; Glycemic control; Mannitol, Dexamethasone; Aspirin; Clopidogreal;Heparin / low molecular weight heparin (LMWH); Thrombolytic therapy (RT -P A- Recombinanttissue plasminogen activator); Neuroprotective agentsSurgical - Carotid endarterectomy; Extracranial to intracranial bypass surgery; Angioplasty andstentingOthers - Diet; Exercise! activity; Stroke prevention (modification of risk factors)JaundiceHistory-Alcohol intake ( quantity and duration) ; Length of history of liver disease (P/H Hepatitis,Jaundice including contact, H/o during addiction (i/V), Tatoos, transfusions. H/o drug intake,overseas travel, H/o fever) ;H/o D.M, Cardiac failure, arthropathy; Treatment history; Historysuggestive of complication, (e.g.) any P/H encephalopathy, G.I. bleeding, abdominal pain, distentionof abdomen secondary to ascites; P/H any operations; H/o travel to endemic areas ( for malaria,leptospirosisLook for signs of )Examination- Note the patient’s racial origin (for Hepatitis B and Hepatitis c) ; chronic liver disease(Spider Neave, Gynaecomasia, Palmar erythema, petichae, etc.) ; Look for signs of Liver failure,flapping , breath, confusion , stupor; Small of alcohol; Anaemia/ WT loss/Tatoos/ body piercing,needle pricks/scratch marks/oedema xanthelesma/ K.F. rings/ Duputren’s contractures/ lymphodelubbing; Examination of the Abdomen; Exclude severe Rt. Heart failure, Tricuspid Regurgitation,Constrictive Pericarditis;Rectal Examination.Investigations-The following list covers all the causes for Jaundice. One could narrow it downto the selected one’s depending on the provisional diagnosis made — Full Haemogram includingperipherial smear and reticulocyte count; L.F.T. including P.T/INR; Auto immune workup;Ascitic Tap; Abdomino-Pelvic U/S Scan; Hepatitis-B and Hepatitis-C; Abdominal DopplerStudies- Arterial; CT scan Abdomen; Barium Series; Endoscopy; Alpha Feto Protein; FNACand Liver biopsy if indicated; ERCP/MRCP (Diagnostic and Thearapetic) ; Serum Ammonia134
NBE CME programme for DNB consultantslevels and copper levels ; Serum ElectrolyteDifferential Diagnosis (Few Of them) - Haemolytic Disease; Hepatitis/ Cirrhosis of Liver; G.I .Malignancy with Metastastasis; Primary biliary cirohosis; Wilson’s disease; Obstructive Jaundice;Hemolysis due to infectionNon Surgical Management-Depends on the diagnosis made-Diuretics; Salt restriction;Removal ofprecipitating causes; Treatment of infections;Treatment of Haemolysis;Treatment of chronic Hepatocellular failure; Treatment of G.I. Bleeding;Steroids in specific auto immune hepatitis;i/v Octreoatide,Beta BlockersSurgical Treatment -Sclerotherapy; Esophageal banding (Superior to Sclerotherapy); Peritonealshunts; Various specific surgical procedures for obstructive jaundice; Splenectomy.Diabetes MellitusDefinition-The national diabetes data group &WHO have issued diagnostic Criteria for D.M.Symptoms of Diabetes plus random blood glucose concentration > 126mg/dL during on oralglucose tolerance test.History-Polyuria, Polydipsia, Polyphagia, weight loss; Blurred vision, lower extremity paresthesias,yeast infection, particularly Voluovaginitis in women, balanitis in men; Obese patients; Patientfirst degree relative with type 2 diabetes mellitus; Patients with hypertension; Patients with hightriglyceride or HDL- Cholesterol men. Place- endemic area for goiter. Any history ofswelling in neck - When was the swelling 1 st sighted?, Has the size of swelling remained same/gradually increasing?, Any pain at the sight of swelling?(In Hasimoto’s thyroiditis there will besome discomfort in the neck) ; Any history of painful enlargement of thyroid gland with fever?Thyroiditis)- Initially there will be thyrotoxic state-> Hypothyroid state ;History of symptoms S/oHypothyroidism - History of tiredness, weakness, History of loss of appetite with weight gain,History of cold intolerance, Recent excessive loss of hair, History of any change in voice(hoarsenessof voice), History of parasthesia suggested by tingling numbness in limb, any loss of sensationssuggested by inability to feel foot wear (this complication/symptom is very rare/late), Any history ofdysponea on exertion and effort angina, History s/o constipationPersonal History - Decrease in appetite, History of constipation, History of loss of libidoMenstrual history/ Obstetric history-Complete obstetric history- GPL status, Ask specifically forhistory of any congenital Hypothyroidism in baby. Suggested by - Prolonged jaundice, Feedingproblem, Flaccidity, Macroglossia, Delayed bone maturation, Umbilical hernia, Permanentneurological deficits in the child.Menstrual history - History of increase flow (menorrhagia) followed by decrease flow,(oligomenorrhea) and then amenorrhoea; History of recurrent abortions.Drug/ Treatment history - H/o recent thyroid surgery or treatment with radio iodine in recent past. B]135
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