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

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NBE CME programme for DNB consultantsDifferential Diagnosis-Important because many of the signs and symptoms may be found in otherdiseases also. This will complete the probable provisional diagnosis and the candidates clinicalknowledge will be known.Non Surgical Management- Knowledge about the optimization of the patient. Anaestheticmanagement includes ASA grading, premedication, choice of anaesthesia technique and why theproposed technique was chosen. Monitoring and post operative management regarding pain ,anyspecial orders to the Post operative nurse. Oxygen, any post op. mechanical elective ventilation oflungs.Any other- Candidates may be asked to tell about the technique and the various drugs available forthe specific case in the institution where they got trained. In the anaesthetic management thecandidate must be able to say why he/she is managing the case particular way and the justificationfor doing so.Pregnancy - Normal & related diseaseHistory- Pertaining to the pregnancy i.e., weeks of amenorrhoea, nausea, vomiting, gastritis, etc.;Pertaining to associated co-morbidities if anyClinical signs-Emphasis on eliciting anemia; Features pertaining to pregnancy inducedhypertension; Airway examination; Fundal height and fetal heart soundDifferential diagnosis-Hydatidform mole, Ovarian cystInvestigations- Implications of various physiological changes of pregnancyManagement-To be able to discuss the various physiologic changes in pregnancy and theirimplications on anaesthesia; Labour analgesia- method and modalities; Failed intubation drillShort casesCyanotic Heart Disease ( TOF, ASD, VSD, PDA)History-To bring out the onset of cyanosis (congenital cyanotic vs Eisenmenger syndrome); Toelicit history of cyanotic spells; To elicit history of chest infections/failure to thrive/cardiac failure/anyinterventions in the past.Clinical examination- To bring out the physical/developmental milestones in case of pediatric agegroup; To recognize cyanosis and other signs of chronic hypoxemia; To identify features ofassociated congenital anomalies.Investigations-Typical ECG, X-ray, echocardiography, cardiac catheterization, blood gas findings.Differential Diagnosis-To be able to enumerate other congenital cyanotic heart diseases/ to discussEisenmenger syndrome.Management-To be able to discuss the rationale of anesthetic management based on the pathophysiology(To discuss various induction/volatile agents/opioids and their effects on PVR, SVR andheart rate)Buerger’s diseaseHistory-History of smoking, hypertension, cough, pain in calf muscle or Foot, intermittentclaudication.Clinical signs -Check for pulses- peripheral, low volume; Skin colour, blackish to brownish; BP maybe raised if uncontrolled; Local examination, specially lower limbsInvestigations-Haemoglobulin; X-ray Chest; Doppler; ECGManagement-Abstain from smoking; Vasodilator; Amputation; Neuraxial block for sympathectomyand Anaesthetic Management; Antiplatelets or anticoagulants; Calcium channel blockersCleft lip and cleft palateHistory-History of feeding; Voice change60
NBE CME programme for DNB consultantsClinical signs -Cardiovascular for associated anomalies; Other congenital anomalies; LocalexaminationInvestigations-Haemoglobulin; Investigations for associated disordersManagement- Surgery; Induction- Ideal Method; Intubation- types of endotracheal tube; AnaestheticManagement; Pain-relief- Infraorbital nerve blockMeningocele or Meningo-myeloceleHistory-History of trauma; Any history of neurological deficitClinical signs- Local Examination; Other associated congenital anomalies; Full neurologicalexaminationDifferential diagnosis-LipomaInvestigations-CT scan; MRI; Associated congenital annomaliesManagement-Surgical excision; Prone position; Care during induction- Position of head; Choice ofendotracheal tube; Post-operative neurological assessmentAny other-Development problemHydrocephalusHistory-H/o vomiting; History of neurological problems; History of tuberculosisClinical signs- Signs of raised intracranial pressure (Bulging of Anterior fontenalle); Pulse rate;Cushing triad; Sun setting sign; Neurological examinationDifferential diagnosis-MacrocephalyInvestigations-CT head; Fundoscopy; Serum electrolytesManagement-Medical; Surgical- Shunts, types of shunt; Anaesthesia problems- Induction;Developmental problems; Causes of hydrocephalus; Peri-operative problemsTracheostomyHistory-Questions pertaining to indications of tracheostomy; History of respiratory problems; Historyof change of voice; History of loss of weight or appetite; History of trauma; History of prolongedventilationClinical signs-Vitals- Pulse, blood pressure; CVS examination; Respiratory system examination;Associated injury in trauma patientDifferential diagnosis-Ca larynx; Ca thyroidInvestigations-Pertaining to primary cause; X-ray Chest, neckManagement-Types of tracheostomy; Percutaneous tracheostomy (PCT); Steps of PCT;Complications of tracheostomy; Indications of tracheostomyBurn ContractureHistory-Type of burns-flame burns, steam burns, chemical or electric burns; History suggestive ofinhalational smoke injury as it could cause respiratory impairment; Period elapsed since the injury,as it would dictate choice of muscle relaxants; Associated comorbid conditionsClinical signs-General physical and systemic examination; Examination of the contracture;Contractures of the face, head and neck—can result in a difficult airway ; Chest contractures canlead to a restrictive pulmonary disorder; Contractures involving major joints can produce difficulty inpositioning & placement of monitoring modalities as well as IV accessExam of the airway is specially important- Patency of the nares ( may be obliterated by contractures);Mouth opening-at least 2 finger breaths between the incisors is desirable in adults (maybe reduceddue to contractures) ; Teeth- prominent upper incisors, loose teeth ; TM Joint- Movement (mayberestricted in facial contractures); Submental space- hyometal/thromental distance should be > 6cm (reduced in neck contractures); Neck movements- may be reduced in neck contractures;61
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