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

NBE CME programme for DNB consultants(confirmed by Fluid thrill and shifting dullness ) or abdominal lump ( detailed evaluation of abdominallump); Dipping method to be employed for palpation if huge ascitis; Differentiation between Spleenand left renal lump; And Liver and right renal lump; Liver span MUST be mentioned if liver isenlarged; Per Rectal examination ( colour of fingerstall ); Systemic exam – Respiratory; CVS andCNS.Investigations - Complete hemogram; Peripheral blood film; Bone marrow aspiration/biopsy; Asciticfluid examination – biochemical and cytology; Liver functions; X-ray Chest; ECG; USG evaluation ofabdomen and if any equivocality , CECT; Upper GI endoscopy; Diagnostic laparoscopy.Differential Diagnosis - ( Single pathology which can explain both hepatosplenomegaly ; Otherwiseincidental mild splenomegaly may be associated with even Secodaries liver ); Malaria , Kala Azar;Lymphoma; Chronic hemolytic anemias; Portal Hypertension; Other rare causes at the endNon- surgical treatment - Antimalarial for malaria. Pentamidine for kalaazar; Antitubercular treatmentfor TB; Supportive measures like blood transfusion etc.Surgical Management - Splenectomy ( in ITP, Heriditary spherocytosis ); Splenectomy may beuseful in hypersplenism; Splenectomy done sometimes for relieving pain and mass effect.;Splenectomy for staging in stage I & II; For Portal hypertension(Endoscopic therapy; Decompressiveshunts and TIPS; Devascularisation procedures; Liver transpalnatation for end stage liver diasease;Any Other -Child classification slould be known.Peripheral vascular disease – History(Pain – Intermittent claudication / Rest pain; Uni or bilateral;Mode of onset; Paraesthesia; Attacks of fainting, Black out , chest pain , weakness , abdominal painimpotence etc.; Past history of IHD, Diabetes; Excessive smoking.Clinical Examination - Gen physical exam – Routine with emphasis on peripheral pulses; Localexam; Gangrene – extent , line of demarcation and type ( Dry or wet ); Pre-gangrene; Evidence ofchronic ischemia – thin shiny skin with scanty hair, atrophic limbs , Brttle nails; Any previous surgeryscar viz Lum.sympecthectomy / Amputations; Burger’s test , Capillary filling time; Raynaud’sphenomena; Adson test, Elevated arm stress test , Allen test for Thoracic outlet syndrome; Systemicexam; CVS particularly.Investigations - Complete blood evaluation; B Sugar/ S Cholesterol; Angiography; DSA; Doppler;Ultrasound; Duplex scan; Plethysmography.Differential Diagnosis - Burger’s Disease; Atherosclerosis; Raynaud’s; Other rare cause at the endNon – Surgical treatment - Apart from supportive treatment for pain; Burger’s exercise; Stop smoking;Obesity reduction; Avoid injuries; Vasodilators; Chemical sympethectomy; Surgical Management;Lumbar sympecthectomy ( Contraindicated in Intermittent caludication stage ); Omento pexy ( &other revasularisation procedures ); Amputation; By pass grafts ( for Atherosclerosis ); Aorto-ilealendarterectomy; Baloon angioplasty;Breast noduleHistory-Patient’s Name; Age; Duration of lump; H/o – Pain – Nature, Severity, whether associatedwith menstruation; Fever; Increase in size; Cough, expectoration; Whether received any treatment.Family history – H/o – Such nodule in mother or sister, treatment received.Past history – H/o – Previous operation.Personal history – Menstrual history.Clinical examination - General examination - Pallor(Jaundice), Local - Location – quadrant of thebreast( Size; Overbuying skin; Prominent veins; Tethering; Peau de arange; Uleration; Nodule onthe skin; Nipple(wheter retracted, Whether recent retraction, Areola); Surface of the lump(Smooth;Irregular; Local temp; Tenderness; Consistency); Fixity to - Overbuying skin and Underlyingmuscle; Lymph nodes – Ipsilateral - Axillary, Supraclaviulan, Contrateral - Axillary; Examination ofother breast93