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

NBE CME programme for DNB consultantsHistory of – Sleep apnoea, Postural Hypotension, Regurgitaion, vomiting, diarrhea; CVS involvement– History of HTN, IHD and patient may complaints of chest pain and dyspnoea; Management ofdiabetes; Past History. History of hospitalization in the past; Drug history and ingestion of toxicmetabolites, history of infection in the childhood like mumps, Food habits; Family History of Diabetes.Clinical signs-Examination from head to toe- Nourishment, Built – Thin, Obese; Vitals- PR – RestingTachycardia , Beat to beat Variation – absent with deep breath valsalva maneuver. Arrhythmias- BP–Monitoring of blood pressure- Including testing for orthostatic changes- RR -Altered regulation ofbreathing; Temperature – increased during infection; Local Examination; Systemic examination ;Respiratory System – Look for respiratory infection; Assess the air way ( mobility of A-O joint); PerAbdomen – NAD; CNS – Superficial and deep tendon reflexesDifferential diagnosis-Traumatic, Ischaemic, venous, trophic, Tropical, TuberculousInvestigations-Blood sugar, glycosylated (HbA1C), depending upon the organ involvementManagement-Medical Management - TREATMENT OF DIABETES; Surgical and anaestheticManagementSquintHistory-History of deviation of eyes; History of long sightedness; History of measles, viral fever,meningitis etc.; History of muscle weakness elsewhere (squint can be manifestation of underlyingmyopathy); History of any surgery under general anaesthesia - Complications like convulsionsrigidity, hyperthermia to rule out malignant hyperthermiaClinical signs-Detailed general and systemic examination to rule out associated systemic diseases,congenital abnormalities and muscle dystrophies; Airway Assessment - Patient with squint mayhave associated congenital syndromes which affect airway ( Downs syndrome, Marfan’s syndrome)Investigations-Routine investigations like Hb, TLC, DLC, Urine - examination are needed in mostof the patients as per history and examinationManagement-Anaesthetic Management of Strabismus or squint surgery is guided by age &. cooperationof the patients. Strabismus surgery in adult can be performed under local anaesthesiawith or without sedation; Adult Un-coperative patient can be managed with total intravenousanaesthetic technique with sedative and narcotic drugs; Children will always require generalanaesthesia for corrective surgery. Strabismus is the commonest eye operation in children; Beforediscussing the anaesthetic management, the special anaesthetic problems associated withStrabismus surgery are to be considered; Oculocardiac reflex; Strabismus & Malignant hyperthermia;Antiemetic prophylaxis can be provided with Ondansetron 0.1 mg/kg IV to prevent postoperativevomiting.SpotsElectrocardiogram-The candidates should be able to diagnose the following ECGs- ECG –Arrhythmia’s (Atrial Fibrillation,Ventricular Fibrillation,,Atrial flutter, Ventricular Tachycardia,Supravntricular tachycardia, Junction rhythm); Pacemaker; Coronary Artery Disease with MyocardialIschaemia and infarction; Left Ventricular Hypertrophy and Right Ventricular Hypertrophy; RightBundle Branch Block; Left Bundle Branch BlockX-ray Chest-Description of the x-ray; Whether AP or PA? How will you differentiate? What are thecharacteristics or findings of the following conditions- Pneumothorax, Malignancy, Pleural Effusion,Bronchietasis, Emphysema, Hydropneumothorax, Consolidation, Collapse of lung, Pericardialeffusion, Cardiomegaly, Mitral Stenosis, Plethoric lung field (PDA), Pulmonary Edema, AdultRespiratory Distress Syndrome, Oligaemic lung field, Fractured ribs, Foreign Body in Bronchus,Foreign Body Oesophagus, Pulmonary Koch’s Miliary TB, Inter costal drain, Pacemaker,Diaphragmatic hernia, Eventration of diaphragm, Lung Cyst-Congenital & adult, Hydatid cyst; What63