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

NBE CME programme for DNB consultants(Meningitis, encephalitis, TBM),Demyelintng- Acute Desseminated Encephalo Myelitis(ADEM),Todd’s paralysis also may be considered,ifhemiplegia follows a prolonged seizure, Spaceoccupying lesionsNon-surgical management - Depends on etiology. Measures to reduce cerebral edema, correctionof fluid and electrlytes imbalance, if any has to be done. Long term management like physiotherapy,speech therapy, and rehabilitative measures may be required in some cases. Referral to a childdevelopment center (CDC) is advisable for selective .patients.Surgical management - Surgical management will be required in space occupying lesions .andselective cases of spastic cerebral palsy.Any other - Site of the lesion,(Localisation) must be discussed before considering the differentialdiagnosis..Ear DischargeHistory - Name, Age, Sex, Address, Occupation, Brought by, Reliability , Presenting Complaints-Ear - Ear discharge- duration, Insidious,sudden, Progressive,stable, Intermittent,continuous,Color of discharge, Amount – copious, scanty, Smell - foul smell ,not, Aggravating,relieving factor,H/o FB ears; b. Earache-Site, duration, Sudden,insidious,character, Association withotorrhoea,vomiting,giddiness, Radiation, Periodicity, Aggravating, relieving factors; Hearing Loss– Side,duration, Insidious,sudden, trauma, exposure to sound,H/o drug, ingestion (Ototoxic) ,Progressive,stable, Associated giddiness;itching in ear- -Side / duration, Association withdischarge, HOH, Aggraveting relieving factor; Vertigo- Duration, Periodicity, Associated withnausea,vomiting, Frequency of attack , Aggravated by change in posture, Associated with discharge’HOH;Tinnitus—Side, High pitched,Low pitched;Fever-Associated with headache & chill, Periodicity,With nausea,vomiting;Hyperacusis, Aautophony, Dip!acusis;Diplopia;Facial weakness; Swelling behind ear; H/o trauma;H/o swimming, diving;Nose-Nasal discharge, Side - duration (Intermittent,continuous,Stable,progressive), Nature – watery, mucoid, purulent,blood stained, FouL smelling / or not ,Aggravating, relieving factor; Nasal obstruction- Side, duration, Birth, acquired, Intermittent,persistent, paradoxical- Associated with sneezing, Progressive or not - Aggravating, relievingfactors, Mouth breathing,snoring; Headache-Side, duration(Time of onset, Periodicity), Blurring ofvision, vomiting ( Character – throbbing, piercing, cutting ), Aggravating, relieving factor, Associatedwith ear discharge,bleeding;Anosmia- - Side, duration, Intermittent, Permanent, Associated withsneezing or loss of taste. Sneezing- Duration, With mouth breathing, With rhinorrhea, nasal block,anosmia; Post nasal drip- -Duration, Amount; Allergy- Specific,seasonal ;Throat -Sore Throat-Duration, Recurrent ,not , With fever and dysphagia;Past History - Any prolonged medication forTB, Ototoxic Drugs, Prolonged use of ear drops, nasal drops, Hlo HIV, HIO recurrent URTinfection, Hlo measles, whopping cough, Surgical history- Tonsillectomy, adenoidectomy, DNSsurgery, myringotomy, myringoplasty, Medical History- Use of antibiotics, analgesics,eardrops,antihistamines, H/o native treatment;Family History - Similar Complaints, Deafness,Overcrowding;Contact History - H/o Contact with known case of TB ;Immunization History - DPT,OPV, BCG, Measles, HIB, Pneumococcal, conjugated, polysaccharide;Dietic history - Totalcalories expected, Calories deficit, Protein deficitExamination - General Examination - General Condition WT, HT, Head Circumference, Anemia,BP ,Pulse, Temperature, Nutritional status, Febrile, Cyanosis, Generalized lymph adenopathy,Clubbing, Systemic ExaminationEar - Pinna, Pre auricular and post auricular region, External auditory canal (without speculum,with speculum) , Tympanic membrane (Position, Color, Surface, Mobility) , Middle ear, Mastoid, 3-finger test, Eustation tube, Tragus sign, Fistula test , Tuning fork test (rinne test , weber test,absolute bone conduction) , Ear examination under microscopeNose - External nose, Vestibule, Anterior rhinoscopy(nasal passage, septum, floor, roof, lateral158