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

NBE CME programme for DNB consultantsInvestigations-ECG, X-ray chest, ECHO; Renal function tests; Blood glucose, lipid profile;Investigations for secondary hypertension depending upon history and clinical examination.Management-To bring the patient to normotensive level, antihypertensive drugs; AnaestheticManagement - Techniques of choice, Deciding factors; Regional – spinal /epidural, Local, GeneralAnaesthesia, TIVADiscussion of case -Classification of Hypertension; Classification of antihypertensive drugs, dosagesindications / contraindications; Pathophysiology of Hypertension; Pathogenesis and regulation ofblood pressure; Pathogenesis of target organ damage.Coronary Artery DiseasesHistory-Pertaining to angina, myocardial infarction, current activity level (Functional capacity interms of METS); Any intervention/drug therapy pertaining to IHD, hypertension, diabetes, renaldiseases etc.; History of congenital hyperplipidemic states.Clinical signs-Cardiovascular system in details as describes in Hutchison’s methodsInvestigations-Haematological, renal function, blood sugar and their implications; ECG- to be ableto discuss features of related to ischaemia and relationship between various lead and myocardiallocations; Invasive/non-invasive stress tests and their implications.Management-ACC/AHA guidelines for risk stritifiaction; Preoperative optimization – Goals andinterventions (pharmacological/non-pharmacological); Anticoagulants/ statins (pharmacology/implications on anaesthetic techniques); Perioperative haemodynamic goals and how to achievethem; Perioperative monitoring – ECG, CVP, invasive blood pressure, TEE; Post-operative painmanagement.Bronchial AsthmaHistory-History of breathlessness, duration and frequency, precipitating factors; History of hospitaladmission, ICU admission, ventilator management; History of medications, steroids.Clinical signs-Wheezing, respiratory system examination; Differential diagnosis-Aspirated foreignbodies, Viral tracheobronchitis, Restrictive pulmonary diseases (Sarcoidosis), Rheumatoid arthritisand associated bronchiolitis, Extrinsic compression like mediastinal neoplasm, thoracic aneurysm,Intrinsic compression like croup, epiglottitis, Recent history of trauma, surgery or tracheal intubation,Congestive heart failure, Pulmonary embolism, Gastroesophageal reflux and aspiration.Investigations-Breath holding and pulmonary function tests; X-ray chest, blood count, ABGManagement-Bronchodiltors; Corticosteroids; Cromolyns; Anticholinergic; Chest physiotherapy,systemic hydration, appropriate antibiotics and bronchodilator therapy during the preoperativeperiod improves reversible components of asthma; Technique of anaesthesia- Regionalanaesthesia by avoiding upper airway instrumentation is an attractive proposition. However,accidental high levels of sensory block, spontaneous and uncontrollable coughing, inability to lieflat for a long time can all prove problematic. General anaesthesiaAny other-Intraoperative bronchospasm- Diagnosis and treatment; Pregnancy and asthmaChronic Obstructive Pulmonary Disease (COPD)History-Candidate should be able to bring out typical history of chronic bronchitis or emphysema;History of recent exacerbations, hospitalization, therapy, activity level; History of any domiciliaryoxygen therapy should be brought out.Clinical signs-Examination of respiratory system as described in Hutichison’s Hunter; Simplebedside pulmonary function tests; Signs of respiratory failureDifferential diagnosis-To be able to discuss the differences between reactive airway disease andCOPD56