Dental and anesthesia procedures and equipment

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Dental:
1. X-ray (skull)
1. 2. 3. 4. Which view 3 uses Dx.: # of mandible Le-forte classification
2. OPG dentigerous cyst

1. View 2. Findings 1. Unerrupted 3rd molar in maxillary teeth. 2. Multiloculated lesion on the left side on the mandibular body (radiolucency) extending from 4th, 6th to sigmoid nthc?? 3. Normal condylar and coronoid process 3. d/d 3.
Mouth gag- Acralic, se

1. Identify 2. Uses
4. Dental floss
1. Identify 2. Uses 3. types INTRA-ORAL PERIAPICAL RADIOGRAPH (IOPAR) 1. Molars 2. Radiolucency suggesting carries OCCLUSAL RADIOGRAPH 1. Radiolucency line suggesting 2. # of maxilla 3. # of incisor teeth Impacted Tooth: 1. Occlusal radiograph showing Radiopaque shadows showing bone plating in # of mandible or maxilla. Chisel Malleate Periosteal Elevator (WOODLANDS) Forceps MANDIBLE MAXILLARY LOCAL ANAESTHETIC SOLUTION 2% xylocaine with adrenaline 1: 2 Lac
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13. OPG
Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition
Page |2 Indications Dental cysts Abnormality in x ray - # mandible 14. Dental cast of maxilla A/c to FDI, name the teeth present What may be the D/D for the defect? 15. Toothbrush Types A/c to bristle, hard, medium, soft A/c to handle, fixed & flexible Manual & electric Ultrasonic When to replace & why? 16. Removable partial denture Teeth present Upper left and right central incisors (11, 21) Composition Poly Methyl Methacrylate Dental tumours
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Anesthesia
1. Aqmour? Shesel? Metallic tube
1) 2) 3) 4) Advantage: can be bent in any direction There is a stainless steel spring inside Latex tube, Silico latex, Slicon Disadv: - becomes soft with autoclaving - low vol, high pressure cuff - may get disloged 5) Use: - Risk of kinking tube? - Oral surgery - Head surgery 6) Cannot be kept for a long time 7) Spring valve in PVC | Not in Flexometallic. 1) Patient on ventilator for more than 2 weeks D/t changes of Failed ventilation/ 2) Cuff 3) Radiopaque line 4) Mass in oral cavity?
6. LMA BRAIN MASK

1) 2) 3) 4) 5) Oral cuff (silicon) Airway tube (PVC) Airway bars prevent epiglottis Herniation into airway tube Indications 1. As an alternative to intubation where difficult intubations anticipated. 2. Securing airway in emergency where intubation and mask ventilation is not possible. 3. As a elective method for minor surgeries where anaesthetist wants to avoid intubation. 4. As a conduit for bronchoscope, small size tubes gum elastic bougies. 5. Tip goes to oesophagus 6. Aperture pass at vocal cords. 6) What are the contraindications? 1. Full stomach patient 2. Hiatus hernia, pregnancy 3. Oropharyngeal abscess or mass 4. Patient who are vulnerable to go in bronchospasm. 7) What are the advantages? 1. It is easy to perform 2. Does not require any laryngoscope and muscle relaxant
2. Red Rubber tube

1) Type of cuff: High Pressure variety 2) Disavd.:
Eliminates toxic gases on autoclaving
To test toxicity place tube in muscles of rabbit, inflammation seen microscopically. 3) asdfa
3. PREFORMED tube
1) RAE tubes 2) Oral and head and neck surgery
4. Double lumen tube:

1) 1 tube with 2 tubes inside 2) Thoracic surgery lobectomy, pneumectomy Separating the lungs in cases of hemorrhage and infection 3) 2 inflating lumens 4) C/I: Pts in whom you cannot change tubes.
5. Tracheostomy tube:
Page |4 3. Does not require any specific position of cervical spine so can be used in cervical injuries. What are the disadvantages? 1. Does not prevent aspiration so should not be used in full stomach patients. 2. High incidence of laryngospasm and bronchospasm. Types: 1) Classic LMA 2) Intubating LMA 3) Proseal LMA 4) Short Handle LMA How to select LMA? Decided upon the body wt of pt. 1. 1 - 5-10 kg 2. 2 10-15 kg 3. 2 - 15 -20 kg 4. 3 20-30 kg 5. 4 30-50 kg 6. 5 50-70 kg How much air to inflate the cuff in fixed in an LMA? Not used for lung surgeries Black line should face incubator? Complications: 1. Dental trauma 2. Mucosa, lips 3. Sore throat.
8. 9. Endotracheal Tube:
1. What are the types? Mainly 2 types Red rubber and PVC 2. Secure airway 3. PVC quality: Non-toxic, on autoclaving does not eliminate toxic gases or become soft. 4. Write down the Parts. a. Two ends patients end machine end b. Patient end is BEVELLED (45o in case of oral and 30o in case of nasal) c. Murphy eye serves as an alternate coat for ventilation and sucking out secretion even when main lumen is blocked. d. Cuffi. Pedeatric non cuffed ii. Help in ventilation iii. Prevent leak of gas iv. Preventing aspiration v. CO2 monitoring. e. Pilot balloon f. Inflating tube g. Tube connector 5. Black mark at level of vocal cord 6. Standard 15 mm 7. How to decide the size of ETT? Ascertaining DIAMETER Age Size Premature 2.5 mm ID 0-6 months 3- 3.5 mm 6-1 year 3.5 4 mm 1-6 years > 6 years Healthy male Healthy female 9 mm 8 mm
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11) 12) 13) 14)
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7. I.V cannula:
1) Sizes: 1. Or 14 2. Br 16 3. Gr 18 4. Pn 20 5. B 22 6. Y 24 7. W 26 2) I.V cannula
Page |5 ID = internal diameter Ascertainign LENGTH Male = 23 cm Females = 21 cm Children = Age in years/2 + 12 cm. For NASAL intubation, add 3 cm is added to oral length. 8. How do ascertain that the tube has reached its position? 1. Auscultation of chest for air entry 2. Characteristic feel of bag 3. Chest inflation on positive pressure 4. X-ray radiopaque line in PVC 5. CAPNOGRAPHY. 9. What are the complications of intubation? 1. Reflex disturbances 2. May go into oesophagus 3. Ischemia, edema and necrosis by cuff. 4. Aspiration 5. Bronchial intubation and collapse of other lung 6. Sore throat most common postop complication 7. Laryngeal aodema 8. Palsies 9. Infections 10. Vocal cord granuloma. 11. 10. What are the reflex that can be caused and how to handle them? Reflex reactions 1. Laryngospasm 2. Bronchospasm 3. Severe hypertension 4. Tachycardia 5. Cardia arrhythmias. How to manage? 1. Adequate depth of anesthesia 2. Opiodis (SULFENTANIL) is DOC 3. i.v xylocard 2% 1mg/kg 2-3 minutes before intubation 4. local xylocaine spray 5. -blocker (ESMOLOL) 6. CCB How long ETTC can be kept? 1. Max is 7 days. How much pressure should be thre to prevent ischemia? < 30 cm of H2O Prefer non-cuffed in children <5 years. How much air to required to fill the cuff? - 4 to 8 mL How to intubate? 1. Patient should lie supine. 2. There should be extension at atlanto-occipital joint and flexion at cervical spine. 3. This position can be achieved by putting 6-8 cm thick pillow under occiput. 4. The laryngoscope blade should be inserted from right side of mouth and advanced slowly displacing the tongue to left until epiglottis is visualized. 5. Once epiglottis is visualized, it is lifted anteriorly to visualize glottis. 6. Once the glottis is seen the ETT is passed between the cords. 7. Cuff is inflated and the cuff should be well below the vocal cords. 8. Position confirmed by capnography and auscultation over chest. What should be level of cuff? 2 to 2.5 cm below vocal cords. What is the relation with Dead space and intubation?
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Page |6 Reduced dead space by 70 mL as 1. Nasal passage is bypassed and 2. Lumen of ETT is less than that of airway. 17. When and how to extubate? 18. Diff between Red rubber and PVC ETT? Red rubber PVC 1. Costelier Cheap 2. Reusable Disposable 3. Cuff type: High pressure, Low pressure and low volume high volume 4. Tracheal Less and so can be injuries chance safely for prolonged high so no to surgeries prolong surgeries 5. Radiolucent Radioapque line can be visualized in x-ray 6. NonTransparent, so transparent secretions can be visualized 7. No Murphy eye Present present 8. Slightly more Easily conforms to rigid and so anatomy of airways does not conform to anatomy of airways 9. Less incidence Increased due to of sore throat large cuff 10. Has no preservative LEAD 19. What are the conditions contraindicationg to both oral and nasal intubation? 1. Laryngeal odema 2. Epiglottis 3. Laryngotracheaobronchitis. 20. What are the indications of Nasal intubation? Obstructive mass in oral cavity Oral surgery Fracture mandible Inadequate mouth opening due to TMJ dysfunction 5. Neck injury 6. For awake intubation, it is preferred. 21. Contraindications for nasal intubation? 1. Basal cell fractures and CSF rhinorrhoea 2. Bleeding disorders 3. Nasal polyp, abscess, foreign body. 4. Previous nasal surgery 5. Adenoids 6. And that applying to both. 22. 23. 1. 2. 3. 4.
10. LMA:
1. Types flexometallic, intubating, standard, prosseal 2. Use/indications 1. To protect the airway without the anesthesist hands to support a mask 2. To avoid the use of tracheal intubation 3. In cases of difficult intubation 4. In case of short surgeries 3. C/I 1. Pt is on full stomach 2. When regurgitation is likely 3. When surgical access is impeded by the cuff of the LMA 4. 4. Disavd. 1. Aspiration 2. Aerophagia 3. Laryngospasm 4. Injury 5. Parts tube, eye, cuff, pilot, connector.
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11. Intubating LMA (Fastrach)

1. 3, 4, 5 sizes 2. Diff- preformed, rigid, stainless steel airway tube 3. Used a. alternate for laryngoscopy to intubate b. Controlled ventilation c. Easy to use (paramedical staff) 4. Stabilizaer of ILMA 5. Disavd a. More airway damage than LMA b. Dental trauma c. Sore throat d. Cannot be kept for long term 6.
e. Significant air can go into oesophagus and thus increases intragastric pressure (>28 cm H2O) leading to aspiration. 6. Why Black? Antistatic 7. Childred dead space of 200-300 mL 8. REINDEL BAKER MASK a. low dead space b. for neonates All masks: Causes damage to skin, mucosa, small nerves for long time
13.
Simple Face Mask
12. Masks: 1. Anatomical mask

2. Fixed to anatomy of tissue Cuff, body, connector hook What are the parts? 1. Connector 2. Hook 3. Filling tube 4. Body 5. Air filled cuff (has soft cushioning effect) 3. The pyramidal area that the face mask can occupy air equivalent to DEAD space so increased dead space. 4. What is the main indications? 1. To maintain airway 2. And oxygenation 5. What are the Disadv a. It is very tiring. b. Cannot prevent regurgitation and vomiting c. Cannot secure airway d. Uncomfortable for tissue
1. Nose is clipped so that mask is in place 2. Istoles For air entrapment 3. Used to supplement O2 (this is the only use) 14. Nasal Cannula 1. Low flow oxygen delivery device 2. No high flow O2 (upto 4L) 3. FiO2 (4%)
15.
Venturi Mask:
1. Based on BERNOULLis LAW or VENTURI PRINCIPLE. when a fluid or gas passed through a tube of varying diameter, the pressure exerted by fluid (lateral pressure) is minimum where velocity is maximum (pressure energy drops where kinetic energy increase; BERNOULLISs law). 2. What is the advantage? By increasing flow rate (velocity), through narrow constriction, we can create subatmoshpheric pressure. 3. What are the uses? 1. Venture mask 2. Jet ventilation 3. Suction apparatus.
Page |8 4. What do you mean by Venturi mask is FIXEED PERFORMANCE oxygen delivering devices? Meaning that performance not affected by changes in patients tidal volume and respiratory rate. 5. What is the maximum oxygen that can be achieved by venture mask? 60% 6. What can kind of delivery system is it? it is a high flow oxygen system - 3 to 4 times Minute volume. 7. What are other low flow oxygen delivery systems? Also called VARIABLE performance device. 1. Nasal cannula 2. Simple mask 3. Oxygen tents 4. Non-rebreathing mask 5. Rebreathing mask 6. polymask 8. - Achieve 80% FiO2 - Venturi yellow, blue, red (depending upon % of O2) - 35% - 8L of O2 - ICU use In Epidural, Lig. Of Flavum is not pierced. 8.
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Epidural Needle (TOUHYs)

1. 16-18G 2. Puncture chances more if pierced in subarachanoid, 3. Loss of resitance technique 4. Air/saline can be used for technique 5. Normal depth of epidural 4-6 cm 6. Catheter epidural threaded 7. 8-9 at skin length 8. Needle 10 cm 9. Cutting of epidural needle stability, direction of hub 10. The dye used here is plain and not heavy 11. Walking epidurals only analgesia, no motor block, pt can walk without pain 12. Bupivacaine 13. Lignocaine. 14. Indications 15. Contraindications
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1. 2. 3. 4. 5. 6.
Spinal needle (18-32 G)

In BPKIHS, 25G is used Cutting/Non-cutting Opening at distal tip Cut an angle Length 10 cm needle + 5% bupivacaine heavy It is made heavy by adding 25% dextrose 7. Parts pierced: Skin, s.c tissue, supraspinous lig., interspinous lig., lig. Of flavum,
Epidural set: 1. Components: 1. Epidural catheter 2. Loss of resistance syringe 3. Microfilter 4. Touchy needle 2. Indications 1. Surgery below waist 2. Post-op analgesia 3. Cancer pain relief 4. Administration of corticosteroid 5. Caeseraian section
Page |9 3. 2 methods to know you have reached the epidural space? 1. On piercing the ligamentum flavum, there is loss of reistance 2. Hanging drop method: a drop of water placed on the needle tip of epidural needle is soaked in. 3. Disadv: tend to slip
23.
1. 2. 3. 4.
Bupivacaine:
20 mL vials Max dose 2-3 mL/kg Cardiotoxic 4 mL ampoules for spinal
24.
Thiopentone
1. How do you recognize? Yellow hygroscopic powder. 2. Indications: 1. i.v induction 3. 1 week of self-life after making into solution 4. What is its half life? 5. What is its pH? - 10.5-10.8 6. Why pH is important?
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Guedels Airway:
1. 3 parts: 1. Curved part 2. Bite guard 3. flange 2. 2 uses/Indications 1. To prevent backward displacement of tongue 2. To prevent biting of tongue 3. Assisted ventilation 4. Oropharyngeal suction 5. Maintenance of airway 3. 2 disadvantages 1. Cannot prevent aspiration 2. Cannot be used in tenesmus 4.
25.
Propofol
1. Color: Milky white in color (only white) 2. Contents: Egg phosphate, neuroprotection 3. TIVA: Total Intravenous sedation?
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CVP catheter:
1. Identify 2. Indications 3. Route of admission Route of admission
26. 27.
Adrenaline Midazolam
1. Dose: 0.01mg/kg 2. Uses: 1. uasdf 3. Asdf 4. asdf
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B.T packs:
1. Filter for micro particles, wider pore
21. Burete I.V. set 22. McGills Foreceps:

1. 2. Endotracheal intubation (Guiding) in cases of Nasal intubation Throat packing Insertion of NG tube Adv: does not have a hinge no trauma
28.VECURONIUM/ITRACURONIUM 29.SUXAMETHONIUM
1. What precaution to keep in children? Give atropine 1st in paedeatric d/t bradycardia 2.
30.Fluids
1.
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OtoRhinoLaryngology:
1. X-ray mastoid 1. View 2. Identify A dural plant B Lat sinus plate C sinodural angle D mastoid air cells 3. 6 other views 4. 6 indications of cortical mastoidectomy 2. LAWs view (lateral oblique view) 1. Findings 3. Indirect Laryngoscopy mirror 1. Identify 7. 4. Arterial supply of tonsil Audiogram SNHL 1. Type of hearing loss 2. Average threshold 3. Pre-requisities 4. Causes of mixed H/L metabolic, noise trauma, otosclerosis, drugs 5. Principles of Gelles test. Tympanogram: 1. Name of graph 2. Type of curve 3. Provisional dx. 4. ET tube: adult vs. padiatric PTA: Karharts notch Tracheostomy: 1. Steps 2. Complications 3. Indications 4. Tracheal dilator
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9. 10.
2. How to use before patient and why 3. Structures seen with diagram 4. Adult larynx vs child larynx 4. X-ray of neck 1. View 2. Finding 3. Management 4. complication 5. Foreign body neck 1. Identify 2. Normal length of oesophagus 3. Narrow constriction of oesophagus 4. What FB? 6. Peritonsilar abscess foreceps 1. Identify 2. Use 3. Waldeyers ring?
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12. Jaegers B type graph of OME 1. Signs 2. Symptoms 3. Management 13. 14. Hartmans Foreceps: 1. Identify 2. 2 uses 3. Nerve supply of pinna 4. Predisposing factors of wax formation 1. Genetic secrete more ceruminous gland
P a g e | 12 2. Narrow and torturous canal 3. Stiff hair 4. Obstruction in canal e.g., exostosis. 5. What are the contents of wax? 1. Secretions of sebaceous gland 2. Ceruminous gland 3. Hair 4. Desquamated epithelial debris 5. Kerain 6. dirt 6. what are the ceruminolytics? 1. 5% HCO3 in equal volume of glycerine and H2O 2. H2O2 3. Olive oil 4. Liquid paraffin 5. Paradichlobenzene 2% 7. 15. St. Clair Thompson adenoid curette 1. Identify 2. Parts: 1. Curette: shaves off the adenoid mass 2. Guard holds the tissue and prevent the slipping. 3. Operations where used 4. Contraindications: 1. Cleft palate and submucous palate 2. Hemorrhagic diasthesis 3. Acute infection 5. Syndrome associated with operation 6. c/f of the syndrome 16. Photo of tracheostomy tubes 1. PVC cuffed 2. Flexometallic 2. 3 adv & 1 disadv of 1 over 2 3. Which of these is used immediately postop. 4. Diameter of adult and infant trachea 5. Adductors of vocal cord 6. Nerve supply to post. Cricoarytenoid. 17. asf 18. Identify the view Occipitomental (Waters) view Findings Haziness in the maxillary sinuses B/L Mucosal thickness How would you treat? Decongestants Antibiotics Mastoidectomy !!
19. Identify the instrument Trachial dilator Advantages of this? 4 most important indications of Tracheostomy 4 postop complications of tracheostomy.
20. Pure tone audiogram SensoriNeural Hearing Loss Causes 21. Pure tone AudiogramTympanogram B-type graph (flat curve) Probable diagnosis-
22. X-ray soft tissue neck and chest lateral view
P a g e | 13 Abnormality Radio-opaque shadow in C5, 6, 7 levels Probable diagnosis FB in Oesophagus T/tRemoval of FB with Rigid esophagoscope under GA 24. Identify Posterior rhinoscopy mirror How do you use it? Write method. Draw a labeled diagram of PR view. If posterior third is depressed, what will happen? Which part of the tongue will you depress ? 23. Identify Tongue depressor Uses
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OPTHALMOLOGY:
1. IOL 1. Identify 2. Draw parts 3. 2 contraindications 2. Atropine 1. MOA 2. 4 uses 3. 2 contraindications 3. Photo corneal ulcer staining 1. Staining techniques 2. Finding 3. Management 4. Photo Graves opthalmopathy 1. Findings 2. 2 ocular signs 3. 2 investigations 5. CT Scan rt. Eye proptosis 1. Findings 2. Dx. 3. Mng. 6. Perimetry 1. Defect 2. Other Ix. 3. Mx. 7. PinHole: 1. Identify 2. M-O.A 3. Uses 8. Lacrimal syringe and punctuate dilator 1. Identify 2. indications 9. Leukocoria photo 1. Identify 2. d/d 3. dx 4. t/t modalities
P a g e | 15 10. Pilocarpine eye drops 1. M.O.A 2. 3 indications 3. ADR 11. Hertels exompthamoter 1. Identify 2. Indications 3. Normal value 12. Maddox rod 1. Identify 2. Used 3. Why macular function not in cataract 13. Photo: Congenital glaucoma 1. Identify 2. Common problems as seen in photo 3. Mx 4. 4 causes of epiphora in child 14. Severe ptosis 1. Identify 2. hx 3. Inv. 15. Convex lens: 1. Identify convex lens 2. How will you recognize? 3. Conditions 4. disadvantages 16. Spectacle with concave lens 1. Identify 2. Uses in correction of myopia 3. 5 other modalities of treatment 1. Contact lens 2. Radial keratotomy 3. Photorefractive keratomy 4. LASIK 5. Extraction of lens 4. 3 complications of this condition 1. Complicated cataract 2. Retinal detachment 3. Vitreous hemorrhage 4. Choroidal hemorrhage 5. Clinical varieties of myopia
P a g e | 16 1. 2. 3. 4. Congenital Developmental Pathological Acquired
17. CT scan 1. Proptosis of left eye 2. Describe lesion 1. Forward protrusion of left eyeball 2. Mass behind the left eye ball 3. Name the view: Axial view 4. Causes: 1. Orbital abscess/cellulitis 2. Tumours of the orbit 3. Cysts of orbit 4. 5. Management: 18. 19. RAF rule 1. RAF rule 2. Uses to examine convergence of the eye 3. 20. Malignant melanoma 1. Identify malignant melanoma of upper lid 2. Management surgical excision with reconstruction of lid 3. d/d Naevus, pigmented basal call ca. 21. Schiotz tonometer: 1. Identify schiotz tonometer 2. Principle plunger will indent a soft eye more than hard eye (INDENTATIOn tonomtery) 3. Parts with diagram 4. Falls readings high/low 22. FMN gel 1. Group steroid 2. Other drugs prednisolone, dexamethasone, betamethasone, hydrocortisone 3. M.O.A anti-inflammatory, anto-allergic, anti-fribrotic, decreases inflammation by 1. Maintain cellular membrane integrity 2. Decreases lymphocytes 3. Decreases lysosomal release 4. Decreases tissue swelling. 4. ADR complication 1. Glaucoma
P a g e | 17 2. 3. 4. 5. 6. 23. Cataract Activation of infection Delayed wound healing Dry eye ptosis
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5. Corneal ulcer: 1. Identify 2. Investigations 1. Ocular examination 2. Lab investigation Routine Microbiology 3. Treatment: 1. Local antibiotics topical, subconjunctival 2. Systemic antibiotis 3. Cycloplegics 4. Analgesics 5. Hot formentation 6. Pad and bandage 4. Advice: 1. Rest 2. Do not strain. 5. Na-Flourescein stain 1. Identify Na Flourescin stain stripes 2. Principle 3. Conditions of use 1. corneal ulcer 2. tear film test (break up time) 3. applanation tonometry 4. Jones test 5. Floursecin dye displacement test Kelman McPhersons forceps 1. Identify 2. Use 1. To tear off the anterior capsular flap 2. Sutures 3. IOL implantation 3. Chalazion clamp:
P a g e | 18 1. Use: to fix the chalazion and achieve hemostasis during incision and curettage 2. Describe the process 27. Mebomian cell ca: 1. Dx.: Meibomian cell ca 2. Lesion: reddish, irregular, solid mass on inner aspect of upper lid 3. Management 28. Foreign body in eye eye is red and watery examination 29. A
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Family Medicine
1. Anaphylactic shock: Management 2. Diabetic Ketoacidosis: findings given, discuss on them 3. X-ray Pleural effusion (Mng. Of Dx) 1. Nursing care 2. Investigation 3. Emergency treatment 4. Discharge plan 4. Consult on 1. Anxiety 2. Depression, 3. Consult on dry cough 4. Stroke 5. Post MI 5. H/O crushing chest pain X-ray (?) Pulmonary odema clinical co-relation with condition 6. Advice for 24/F on contraception 7. Abstract and its questions 8. Write LFT readings for Hep.A 9. Primary survey of RTA (Demon on model) 10. Shoulder examination and exerceise 11. Fluid charting: 1) 50/F for cholecystectomy, NPO-12 hrs 2) 4/M, 15 kg NPO 12 hrs 12. ECG reporting, Ant. Wall MI 13. MI counseling 14. Headache counseling 15. Migraine counseling 16. CAGE questions Alcohol counseling 17. HEADS questions Adolescent Health 18. PV discharge 19. Counsel on : pregnancy, STDs, LBP, Infertility, child with seizure and fever, gout, tubal ligation, 20. Adrenaline + saline dilution 21. TRIAGE 22. OP poisoining 23. Measuring visual acquity 24. How to use PEFR 25. How to use MDI + spacer? 26. IMCI
P a g e | 20 27. Broncial asthma
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Orthopaedics:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Instruments Periosteum Elevator Bone Lever Bone Nibbler Bone Cutter Osteotome Bone Chisel Mallet Bone Curette Bone Gouge Bone Awl Bone Holding Forceps Plate Holding Forceps
6) BOHLER STIRRUP 7) K-WIRESTIRRUP WITH TENSIONER 8) SKULL TRACTION TONGS IMPLANTS 1) KUNTSCHERS NAIL
Traction Instruments 1) KIRSHNER WIRE 2) GUIDE WIRE
3) SANZ PIN ???
2) SMITH-PETERSEN NAIL 3) V NAIL 4) INTERLOCKING NAIL
4) Used in external fixation (for open #) Femur 4.5 mm Upper limb 6 mm Hip 6mm Hand 2.5 mm 5) STEINMANN PIN
5) TALWALKAR NAIL 6) RUSH NAIL 7) ENDERS NAIL PLATES AND SCREWS
P a g e | 22 1. Heavy duty Plate 2. Cortical screw
6. 3. Malleolar Screw 4. Cancellous Screw PROSTHESES 1. 2. 3. 4. AUSTIN MOORE PROSTHESIS THOMPOSN PROSTHESIS CHARNLEYs TOTAL HIP PROSTHESIS MULLERS TOTAL HIP PROSTEHESIS.
SPLINTS and Tractions 1. Crammer-wire splint 2. Thomas Splint 3. Bohler-Braun Splint 4.
5. HARTSHILL RECTANGLE
1) KUNTSCHNERs CLOVERLEAF INTRAMEDULLARY NAIL 1. Common use: Intramedullary nail for fixation of femoral fractures. 2. What are the parts: 1. Hollow tube 2. Slot on one side 3. Eye on both the ends. 3. What is the principle of fixation? Based on three point fixation i.e. when a straight rod passes through curved medullary cavity o f the femur, it fixes the bone at three points at either ends and at the isthmus. 4. Why is there eye on its either end?
Hook of extractor goes there while removing the nail. 5. How do you estimate the size of K-nail for a particular case? - Length is found by tip of greater trochanter to the lateral joint line of the knee and subtracting 2 cm from it. - Diameter is determined by X-ray, from width of the medullary cavity at the ISTHMUS. 6. What are the techniques of insertion? 1. Inserted from fracture-site and hammered proximally till it comes out of the trochanter. The # is reduced and nail driven back into the distal fragment. Called Retrograde Nailing.
P a g e | 23 2. Other is introduced from greater trochanter over a guide wide passed from the fracture-site. Once the nail comes upto the fracture-site, the guide wire is removed, the fracture reduced under the vision, and the nail driven home. About 2 cm is left protruding at the trochanter to facilitate removal. 7. When is it removed? Usually 2 years after the operation. 8. What are the complications? 1. Nail getting stuck 2. Splintering of the cortex while hammering the nail 3. Proximal migration of the nail leading to bursitis over its protruding end 4. Distal migration of the nail leading to stiffness of the knee 5. Infection. 9. Ulnar nerve injury and deformities Colles fracture, Dx and complications Supracondylar # - dx. And 3 complications What are the objectives of tractions? 1. Reduction of # and their maintenance. 2. For immobilizing a painful, inflamed joint 3. For the prevention of deformity by counteracting the muscle spasm with painful joint conditions 4. For the correction of soft-tissue contractures by pulling them out. 5. How to care for patient in traction? 1. The traction should be comfortable as possible 2. Proper functioning of the traction-unit must be ensured. 3. Traction weight should not touching the ground. 4. Ropes should be in groove. 5. The foot of the patient or the end of traction device should be touching the pulley. 6. Terminal part of limb in traction must be warm and of normal color, sensations should be normal. 7. Any new arise of swelling may point tight bandage. 8. A pin-tract infection must be noted. 9. The proper position of the # should be ensured bytaking x-rays in traction. 10. A watch must be kept on general complications bed sores, chest congestion, UTI, constipation. 11. Physiotherapy of the limb in traction should be continued to minimize muscle wasting. 7) Contradict SKIN and SKELETON traction. SKIN Mildmoderate force Children Adhesive plaster On skin Below knee Upto 3-4 kg Short duration SKELETON Moderatesevere force Adults Pin, K-wire Through bone Upper tibial pin traction Upto 20 kg Long duration.
2) 3) 4) 5)
Required for
Age used for Applied with Applied Common site Weight permitted Used for
6)
8) How to prepare for SKIN Traction? 1. Logic is to provide traction in skin that is transmitted from through deep fascia and intermuscular septae to the bone.
P a g e | 24 2. Prepare the skin by plucking hair, washing and drying the area. 3. Avoid placing adhesive straps over bony prominences. 4. If bony prominences are in way, cover them well with cast padding. 5. Make the adhesive straps. 6. Place longitudinally on opposite sites with the skin left between the straps to prevent tourniquet effect. 7. Attach the free ends of these straps to the spreader bar. 8. Hold the straps in place by encircling them with adhesive tapes. 9. Now apply the traction rope to spreader bar. 10. Support the leg in traction with pillows . 9) How to prepare for SKELETAL Traction? 1. Establish thestatus of NEUROVASCULAR structures before proceeding. 2. General rule: always start from the place where vital structures are situated. This gives more control and better avoidance. E.g. start from medial side for olecranon pin to avoid ulnar nerve. 3. Prepare skin. It should be free from active infection. 4. Giving anesthesia: Inject 1% xylocaine in skin, s.c tissue and go down to periosteum. 1st do for that side from where drilling with start. Once the drilling reaches middle or cavity, give anesthesia from other side. 5. SKIN INCISION 6. Pins and wires better inserted with Hand drill than power tool. 7. Best placed in metaphysic 8. Avoid epiphyseal plate damage, muscles and tendons piercing. 9. Do not violate fracture hematoma. 10. Do not penetrate joints 10) 11) KIRSCHNER WIRE: 1. What are the uses? 1. For internal fixation of small bones 2. For giving traction e.g., for applying traction through the olecranon 3. For fixing fractures in children 4. For Ilizarovs fixating system. 2. 12) Steinmanns pin Identify and 2 uses 1. For skeletal traction 1. Upper end of tibia 2. Supracondylar region of the femur 3. calcaneum 2. Places for insertion: a. Metacarpals. Place the wire through the metaphyseal diaphysed junction of the index and middle metacarpals. To facilitate insertion, push the first dorsal interosseous muscle in a volar direction and palpate the subcutaneous portion of the bone. Angle the wire to pass through the index and middle metacarpals and to come out the dorsum of the hand, so as to preserve the natural arch. b. Distal radius and ulna. Usually place the wire or pin through both the radius and the ulna. This site is rarely used. c. Olecranon. Take care to avoid an open epiphysis. Do not place the pin too far distally because this causes elbow extension, and it is more comfortable to pull through a flexed elbow than an extended elbow. Use a moderate-sized wire or pin and insert from the medial side to avoid the ulnar nerve. Use a very small traction bow.
P a g e | 25 d. Distal femur. Start on the medial side, anterior enough to avoid the neurovascular structures. This insertion is best accomplished by placing the pin 1 in. inferior to the abductor tubercle. If the pin will be used for traction on a fracture table for delayed intramedullary nailing, make sure it is placed far anterior, off the coronal midline to avoid incarceration by the intramedullary nail. Fluoroscopy should be used to help the surgeon avoid an open physis. e. Proximal tibia. Place the wire or pin 1 in. inferior and 1/2 in. posterior to the tibial tubercle, starting on the lateral side to avoid the peroneal nerve. Take extreme care to avoid an open epiphysis; if the anterior portion of the proximal tibial epiphyseal plate is violated, genu recurvatum can occur. f. Distal tibia and fibula. Start the pin 1 to 1 1/2 fingerbreadths above the most prominent portion of the lateral malleolus to avoid the ankle mortise. Insert it parallel to the ankle joint and angulate it slightly anteriorly. The surgeon should feel the pin pass through the two fibular cortices and then the two tibial cortices. Pass the pin through both bones to avoid the tendons and neurovascular structures. If the pin is placed too far proximally, the foot rests on the bow, and a pressure sore may occur. g. Calcaneus. Generally select a large diamond-point pin. The preferred insertion site is 1 in. inferior and posterior from the lateral malleolus or 1 3/4 in. inferior and 1 1/2 in. posterior from the medial malleolus. Because of the position of the tibial nerve, the medial starting site is preferred. If the pin is placed too far posteriorly, it causes a calcaneal position of the foot. If the pin is placed too far inferiorly, it may cut out of the bone. If the pin is placed too far superiorly, it can enter the subtalar joint and also spear the flexor tendons or tibial nerve and/or artery. Infections that are difficult to treat often occur when the calcaneus is used for long-term traction.
3. What are the complications? 1. Infection (treat by removing, Abs) 2. Distraction of bone fragments 3. Heavy traction may lead to nerve palsy 4. Pin breakage 4. 13) Crammer wire splint identify and 2 uses 1. What is its use? For temporary splintage of fractures during transportation. 2. What is the advantage? It can be bent into different shapes in order to immobise different parts of the body. 3. 14) Thomas Splint: 1. What is it? Thomas Knee-Bed Splint 2. What are its uses? 1. Immobilsation 2. Definite treatment for fracture femur 3. What are its parts? 1. Ring 2. Two side bars joined distally 3. Ring has angle of 120o 4. Outer bar has a curvature near its junction with the ring to accommodate the greater trochanter. 4. How to measure its size?
P a g e | 26 1. Ring size: thigh circumference at the highest point of groin + 2 inches. 2. Length: highest point on the medial side of the groin upto heel + 6 inches 5. What are its disadvantage? 1. Ring is discomfort. 6. 15) BOHLER-BRAWN Splint: 1. What is its use? Fracture-femur 2. What are its parts? Multiple pulleys (1-3) 3. What is disadvantage and advantage over Thomas splint? Adv. More convenient than Thomas splint as has no ring. Disadv: No Inbuilt system for counter-traction, so not suitable for transportation. 4. 16) How do you care for a patient in a splint? 1. The splint should be properly applied, well-padded at BONY PROMINENCE and at the fracture site. 2. The bandage of the splint should not be too tight as it may produce sores; or too loose it be ineffective. 3. The patient should be encouraged to actively exercise muscle and joints inside the splint as much as permitted. 4. Any compression of nerve or vessel s usually due to too tight bandage, should be detected early and managed accordingly. 5. Daily checking and adjustments, if requirement should be made. 17) Femur parts and attachments (Lesser trochanter) 18) Tibia parts shown and attachment (Tibial tuberosity) 19) POP setting time, use, complication of tight cast. 20) Posterior dislocation of Hip 21) CTEV photo 22) Fixed Flexion deformity 23) DCP 1. What is this? Dynamic Hip Screw 2. Why is it called Dynamic 3. What the use? For fixation of trochanteric fractures. 4. What are the parts? 1. Lag screw 2. Barrel 5. 24) Ankylosing spondylitis X-ray: 25) Austin Moore Prosthesis:
1. What is this? Austin Moore prostehsis. 2. What it it use? - Replacement of femoral head in case of fracture neck of femur in elderly persons. 3. What are its part? 1. Head 2. Small neck with a hole 3. 2 fenestration 4. Stem 4. What are its sizes? - 35 mm to 59 mm (ODD sizes) 5. Why there is small hole at the top of stem?
P a g e | 27 6. 7. 8. For the hook of extractor used while removing the prosthesis Why fenestration in midline? Through which bone supposedly grows and helps in fixation of prosthesis. Can cement be used? No as use of cement make its removal if required, difficult. What are other advantageous Prothesis for # neck of femur than Austin MOORE? THOMPSONs PROSTHESIS: Advantages; 1. In older fracturs of femoral head where neck of femur is absorbed. 2. It can be used with or without cement. 3. 1. CHARNLEYS TOTAL HIP PROSTHESIS: 2. MULLERS TOTAL HIP PROSTHESIS. For replacement of both Acetabulum and Head of femur. 2) Massive swelling (may increase so before definitive treatment) 3) Supracondylar # 2. Cast What are the basic principle before apply? 1. 2 joints 2. Immobilize the joints in functional position (collaterals are maximally stressed after physiotherapy, so length and activity easily achieved) 3. Physiotherapy of all the joints that are not incorporated in the cast 4. Adequately padded 5. (distal to proximal as venous return distal to proximal so swelling subsides early) Advantages: 1. Cheap 2. Easily available 3. Easy to apply 4. Not allergic 5. Moulds to the shape of limp Disadvantages: 1. Doesnt protect from water 2. Hold for longer time till setting 3. Heavy What is setting time? What is its clinical importance? Time taken from conversion of Amorphous form to Crystalline from. 2-7 min. One has to hold the limb in position for this time. What is Drying time? What is its clinical importance? Change of crystalline from into anhydrous form. It is 24-72 hours Ask the patient to avoid weight bearing till this time.
4.
5.
6. 9. 26) PLASTER OF PARIS? 1. What is the chemical formula? [CaSO4)2H2O 2. What is the reaction? (CaSO4)2H2O + 3H2O Anhydrous calcium sulfate: plaster of paris 2(CaSO4 2H2O) + heat Hydrated calcium sulfate: Gypsum. 3. Forms: 1. Slab Only 2/3rd of the circumference covered Remaining by cotton and bandage Indications: 1) Soft-tissue injury
7. 8. -
P a g e | 28 9. How to decrease the setting time? 1. Warm the H2O 2. Salt 3. Boric acid 4. resin 10. How to increase? 1. Cold H2O 2. Mobilization of joints. 11. What are the after care instructions? 12. Complications? 1. 5Ps pain in passive movement, parasthesia, p 2. Compartment syndrome. 3. Pressure sores 4. stiffness 13. How to cut the plaster? - Manual saw - Electrically powered oscillating (Anteropostero-movement) 14. Recent advancements: 1. Synthetic cast Beni Cast, Articast 1. Light 2. H2O resistant 3. Strong 4. Radiolucent 2. Disadv: Allergy and costly. 15. Special casts: 1. PTB cast patella tendon bearing cast e.g. # both bone of legs 2. SPICA involves the part of trunk and limbs. e.g., # of femur 3. THUMB SPICA for scapoid # 16. What will be the extent of plaster of paris in case of colles #? 17. What should be the extent of PoP cast for lower tibial #? 27)
P a g e | 29
Lab Medicine:
DM Draw unctonrolled DM graph Serum C-peptide Tests for insulin Wintrobe tube: 1. Uses: 1. PCV 2. ESR 2. Normal values: Male Female s s PC 4037-47% Increases: V 54% 1. Polycythemia vera 2. High altitude Decreases: 1. Aplastic anemia 2. Thalasemia ESR 0-10 0-20 Increases: (at mm mm 1. TB the 2. Rheumatoid en arthritis d Decreases: of 1. Polycythemia 1st vera hr) 2. Leukemia 1. 2. 4. What can be done to increase HDL: 1. Exercise 2. Moderate alcohol intake 5. 4. Calculate creatinine clearance:
U is the urinary concentration of substance x, V is the rate of urine formation (mL/min) P is the plasma concentration of substance x. (Note: 24 hr urine volume divided by 24 x 60) Inference: obtained value 1. If C.C is <75% normal, serves as sensitive indicator of a decreased GFR, due to renal damage. 2. Early detection of impairment in kidney function, often before the clinical manifestations are seen. Normal = 105-125 mL/min 1. Why creatinine clearance most reliable? 1. Creatinine is neither secreted nor reabsorbed by tubules (cf. Urea which is partially reabsorbed by renal tubules hence urea clearance is <GFR) 2. Creatinine level unaffected by diet. (cf. urea) 3. This is the first to decrease in renal pathology 2. What are Renal Function
3. 3. Calculate VLDL 1. 2. LDL = Total Cholesterol VLDL HDL 3. Normal values HDL >30 VLDL >30 LDL <160 Total Cholesterol <200 TG <160
tests?
P a g e | 30 1. Glomerular Function tests: Clearance tests (Urea, inulin, creatinine) 2. Tubular function test: 1. Urine concentration or dilution test 2. Urine acidification test 3. Analysis of blood/serum: 1. Estimation of blood urea 2. Serum creatinine 3. Protein and electrolyte 4. Urine examination: 1. Volume 2. pH 3. specific gravity: 1.020 in the early morning 4. abnormal contents (proteins, blood, glucose) 3. Formula for Urea: Process Formula Normal value If V is >2 75 mL/min mL/min Maximum Urea Clearance If 54 V<2mL/min mL/min Standard Urea Clearance 4. Which one is better indicator of GFR, creatinine clearance or serum creatinine levels? It is observed that the GFR must fall to about 50% of its normal value before a significant increase in serum creatinine occurs. Therefore, a normal serum creatinine level does not necessarily mean that all is well with the kidney. 5. 5.
Blood Urea:
1. Blood urea concentration(NonProtein Nitrogen) is 60 mg. Calculate Blood Urea Nitrogen (BUN). BUN = NPN
NPN = 2 BUN 2. What is the normal value = 10-40 mg/dL. 3. Write the conditions where Blood Urea is increased. Pre-renal Renal Post-renal Increased Renal Obstruction protein disorders in urinary breakdown tract 1. Surge 1. AGN 1. Tum ry 2. Chroni ors 2. Fever c 2. Ston 3. Diabe nephri es tic tis 3. Enlar coma 3. Nephr gem 4. Thyro osclero ent toxico sis of sis 4. Polycy prost 5. Leuke stic rate mia kidney 6. Bleedi ng 4. How do you differenetiate Renal and Pre-renal ARF? Pre-renal <20 >1.5 Renal >40 <1.1
1. Urine Na+ mmol/L 2. Urine/ Plasma osmolality 3. Urine urea /plasma urea 4. Urea and creatinine
>10 Disproportio nate rise in urea
<5 Tend to rise together
P a g e | 31 5. Protein in urine Uncommon Present on dipstick testing
5. How do you measure the Blood Urea? Urease method Diacetyl Monoaxime (DAM) method 6. What is Azotemia? Condition in which elevation in blood urea/or other nitrogen metabolites which may or may not be associated with renal diseases. 7. What is Uremia? Indicate increased blood urea levels due to renal failure 8. 9. Asd 10. Asdf 11.
P a g e | 32 7. Precautions: 1. Draw blood before starting antibiotics 2. Send sample immediately 3. Aseptic precautions. 10. How to collect Sputum sample? Take deep breath Regurgitate >25 epithelial cells or >10 pus cells rejected 11. 12. 13. 14. 15. 16. 17. Asdf Asdf Asdf BHI:
6. Jaundice
7. SAHLIs Haemoglobinometer 1. What is the principle? Blood -> add 0.1 nomrla HCL acid Hematin (brown in color) Dilute with distilled water Compare in sunglight 2. 2 savles g/dL and % concentration 3. Precautions 1. Thick prick as free flow of blood is needed 2. Wipe 1st 2-3 drops of blood to decrease tissue fluid interference 3. Wipe the pipette before putting the blood into the tube. 4. 8. Rubella H/o given
9. BHI:
1. Brain Heart Infusion 2. Principle: Enrichment media Bacterial Growth is inhibited by many chemicals in the blood. By dilution and enriching the media with blood, bacteria growth can be made to proliferate. 3. Constituents: Beef Heart, Calf Brain, Peptone Water, Phosphate buffer, Glucose 4. Use: IE 5. What is the ratio of blood to broth? 1:10 6. What is the anticoagunt used? Sulpho-Polyethamol-sulphate (0.02%) ??
CML AML 1. Features of slide: 1. Blast cells 2. Increased WBC 3. NC/ 4. Anemia 5. Thrombocytopenia 2. Dx AML 3. Other investigation: 1. Hb, TLC, DLC 2. Bone marrow aspirate 3. CXR 4. ECG 5. Serum URATE 6. RFT, LFT 4. 18. LD Bodies 19. Widal test 1) Antigen present O and H 2) Name of test (type) widal (Tube agglutionation test) 3) For which disease duodenal aspirate typhoid 4) Name of organism:
P a g e | 33 S. typhi, S. paratyphi A 5) Vaccination: TAB vaccination 6) What is the significant value? 7) Anamestic reaction Low rise: 8) 20. N. Gonorrhoea: 1. Name of the stain: Gram stain 2. What are the features? 1. Gram negative diplococci 2. Present both intracellular and extracellularly 3. Kidney-shaped in shape 4. Polymorphs present. 3. Draw diagram 4. Culture medium: 1. Non selective chocolate agar 2. Selective Thayer martin, Chacko-Nair medium 5. d/t that organ can cause Gonorrhoea 6. Name of another organism of same genre N. Meningitis 7. Any specific test: Oxidase test 8. What are the specimen that can be used? Sites Male URETHRA, Littres and cowpers glands, prostrate, seminal vesicles and epididymis Females Urethra, Bartholins and skenes glands Extragenital sites Rectum and pharynx So SPECIMEN taken from: 1. Urethral discharge 2. Endocervical discharge 3. Pharyngeal 4. And Rectal Swabs 9. What are the presenting symptoms in male and females? Males Females 1. Painful micturition 1. Often 2. Urethral discharge ASYMPTOMATIC. which is purulent, 2. Primary site is profuse, thick and ENDOCERVICAL creamy CANAL. 3. Redness and 3. Vaginal discharge edema of urethral which be scanty or meatus profuse 4. The infection may 4. Dysuria, frequency spread to and urgency of posterior urethra micturition. 10. What can be the complications in male and female? Males Acute 1. Infection of glands (tysonitis, littritis) 2. Ascending infections (Prostatitis, Cystitis, Epididymitis) 3. Infection of adjoining structures (periurethral abscess and infection of median raphe) Chronic 1. Urethral stricture 2. Infertility Females 1. 2. 3. 4. Bartholinitis Skenitis Proctitis PID
1. Ectopic pregnancy 2. Tubal factor infertility.
11. How do you treat? 1. Sexual abstinence 2. Treatment of sexual partners 3. Avoidance of heavy work
P a g e | 34 4. Avoidance of alcohol intake 5. Uncomplicated: 1. Azithromycin 2g single oral dose. or CEFTRIAXONE 250 mg i.m single dose 6. COMPLICATED: 1. CEFTRIAXONE 1g i.m o.d. x 7 days. 7. 12. 21. ELISA 22. Stain: SUPRAVITAL STAIN 1) Other name: METHYL CRESYL BLUE 2) Staining for: reticulocyte 3) Increased in: 4) Its counterpart cell in peripheral smear: RBC as parasite/QBC field >100 parasite /QBC field
4|
4. What investigation is this? Thick smear: chances of finding is high as small place, more density Thin smear: structure and morphology more well visualized. 5. What is an ideal smear? 1. From head to tail, RBC decrease in number 2. Newspaper can be read through the smear thickness 3. Tongue shaped 2 cm 4. 30 times more concentrated blood in thick than in thin smear 5. Blood not angi-coagulated, clotted. 6.
23.P. Falciparum
1. Describe the findings. RBC size similar - smaller (cf. p vivax reticulocyte etc.) Two chromatin dots can be seen Multiple rings 2. How to report? 1-10 parasites /100 + oil immersion field 11-100/100 field ++ 1-10/ field +++ >10 /field ++++
24.WUCHERIA BRANCROFTI:
1. What is this? Microfilariae larvae 2. Describe morphology. 1. Large, measuring 275-300 x 810 m 2. Body curves are few, nuclei are distinct 3. Sheath stains pink with giemsa and palely with Hematoxylin 4. Tail: no nuclei in the tip 3. When to test: Test night blood 16-18 h PACIFIC Strain 4. What disease it causes? Lymphatic filariasis 5. What are the d/d? 1. Brugia and L.Loa 2. Mansonella. 6. 25. Amastigotes: LD bodies
3. QBC Quantification: <1 parasite/QBC field 1-10 parasite/QBC field 11-100 = 11-100
+ ++ +++
P a g e | 35 1. Describe findings: 1. Small, round to oval bodies measuring 2-4 m 2. Can be seen in group inside blood macrophages, in aspirates or skin smears or lying free between cells. 3. Nucleus and rod shaped kinetoplast in each amastigote stain dark reddish curve 4. Cytoplasm stains palely. 2. How to grade? 6+ 5+ 4+ 3+ 2+ 1+
>1000 /hpf 100-1000/field 10-100/field 1-10/10 field 1-10/10 field 1-10/100 field
3. What is the disease caused? 4. What is the vector? 26.
P a g e | 36
Radiology:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. Consolidation Collapse COPD (emphysema) Pleural effusion Pneumothorax Mitral stenosis Rickets Scurvy Osteochondroma GCT Osteosarcoma Ewings Osteoarthritis R.A Cholelithiasias IVU IVP: dx hydronephrosis; horse-shoe kidney Stone in urinary bladder Horse-shoe kidney Hysterosalphingography Ulcerative colitis
1. Horse Shoe Kidney a) What is the investigation b) Radiological features? 2. Pneumothorax a) Radiological feature b) Dx. c) cause 3. Osteochondroma a) Feature b) Dx c) Disability/complication 4. Ulcerative colltiis a) Type of x-ray b) Radiological feature c) Dx 5. Mitral stenosis
P a g e | 37 1) Feature 2) Cause 3) Further investigation. 6.
P a g e | 38
Psychiatry:
1) 2) 3) 4) 5) 6) Drugs: Antipsychotics Antidepressants Mood Stabilizing drugs Anti-Anxiety and Hypnosedatives Anti-Epileptics Alcohol and drugs of dependence 5) NDRIS NOREPINEPHRINE DOPAMINE REUPTAKE INHIBITORS 6) SARIs SEROTONIN ANTAGONISTS AND REUPTAKE INHIBITORS 7) NARIs- NORADRENERGIC REUPTAKE INHIBITORS 8) MAOI Monoamine Oxidase Inhibtors.
2. Mania 1. Classification of AntiDepressants

1. Cyclic antidepress ants 1. Imipramine 2. Amitrytptiline 3. Clomipramine 4. Nortryptiline 5. Amoxapine 6. Mianserin SSRIs 1. Fluoxetine 2. Paroxetine 3. Fluvoxamine 4. Sertraline 5. Cialopram SNRIs Venlafxaine NSREs Tianeptin NaSSA Mirtazapine NDRIs Bupropion SARIs Trazodone Nefazonone NARIs Reboxetine MAOIs Selegelline MAOI-A Moclobemide SSRIs Selective Serotonin Reuptake Inhibitors SNRIs- SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITOR NSREs NOREPINEPHRINE SEROTONIN REUPTAKE INHIBITOR NaSSA NORADERENERGIC AND SPECIFIC SEROTONERGIC ANTIDEPRESSANTs 1) Treatment 2) Distractibility 3) Euphoria
3. Fluoxetine
1. Category : SSRI 2. Uses: 1. Depression 2. Panic attack 3. 3. Side effects Refer to Amitryptiline, Less side effects and CVs effects. 4. Dosage: 10-60 mg/day 5. 4. Verbigeration 5. Catatonia 1. Features: 1) Mutism 2) Negativisim 3) Rigidity 4) Posturing 5) Stupor 6) Echolalia 7) Echopraxia 8) 2. T/t 3. Conditions in which catatonia occurs
2.
3. 4. 5. 6. 7. 8. 9. 10. 1) 2) 3) 4)
P a g e | 39 6. Depression: Photo; Depressed old woman photo 1. Describe appearance: Low mood2. Lack of interest of surroundings 3. Loss of sleep 4. D/d 5. 5 types of drugs for T/t. 7. Q: Where do you live? A: Live, Live Live 1. What is the disorder ECHOLALIA 2. Condition 3. What if action is repeated ECHOPRAXIA 8. Hey doctor, I have come from KTM. Im a contractor, I will soon be PM. 1. Comment on MSE a) Behavior b) Thought c) Speech d) Affect e) Insignt 2. 9. Alcohol: 1. Amount increase ->tolerance 2. Control not possible 3. Physiological dependence 4. T/t- Alcohol dependence syndrome. 1. Neurological TREMOR, muscular weakness, seizures, neurotoxicity (seizure, celebellar signs, coma) 2. Renal: Polyuria, Polydipsia, tubular changes, Nephrotic syndrome. 3. CVS: hypokalemia like changes. 4. Endocrine: Goitre, Hypothyroidism 5. Gastro-intestinal: - nausea, vomiting, diarrhea 6. Dermatological: acneiform eruptions, popular eruptions. So all tests are to be done before starting the dose Generally for ACUTE MANIA initial starting dose 900-2100 mg/day 5. What is its effect on pregnancy? 1. Teratogenic 2. Increased incidence of Ebsteins anomaly (distortion and downward displacement of tricuspid valve in right ventricle) when taken in 1st trimester. 3. Secreted in milk can cause toxicity in infant. 6. What are other mood-stabilizing drugs that can be given? 1. VALPROATE 2. CARBAMAZEPINE 3. 7. What are the INDICATIONS of Lithium? 1. Treatment of acute mania 2. Prophylaxis of bipolar mood disorder 3. Treatment of shizo-affective disorder 4. Prophylaxis of unipolar mood disorder 5. Treatment of Cyclothymia 6. Treatmentof acute depression.
10.Lithium carbonate
1. Drug category 2. Use 3. What are the different levels? Level Value Therapeutic 0.8 1.2 mEq/L Prophylactic 0.6 1.2 mEq/L For relapse prevention in bipolar disorder Toxic lithium levels >2.0 mEq/L
4. What are the side effects?
P a g e | 40 7. Treatment of medical disorders. cluster headace, Huntingtons chorea. 8. 2. Tremor 3. 4. Cardiac side effects 1. Tachycardia 2. ECKG changes 7) 12. ANTIPSYCHOTIC DRUGS: 1. Asdf 2. Side effects: A. Autonomic Side effects B. Extra-pyramidal side effects C. Other CNS effects D. Metabolic and Endrocrine effects E. Allergic side effects F. Cardiac side effects G. Ocular side effects H. Dermatological side effects. 3. Autonomic dry mouth, constipation, cyclopegia, mydriasis, urinary retiontion, orthostatic hypotension, impotence, impaired ejaculation 4. Extra-pyramidal Parkinsoniian syndrome, Akathasia (motor restlessness), Acute Dystonia, Rabbit Syndrome (Peri-oral syndrome), Tardive Dyskinesia (Late onset Oro-facial dyskinesia), Neuroepileptic malignant Syndrome (Fever, EPS, High CPK), 5. Other CNS seizures, sedation, depresseion or pseudo-depression 6. Metabolic wt gain, diabetes, galactorrhea 7. Allergic Cholestatic jaundice 8. Cardiac EKG changes 9. Write the names of TYPICAL ANTIPSYCOTICS. 1. CHLORPORMINE 2. THIORIDAZINE 3. HALOPERIDONE 4. PIMOZIDE 5. LOXAPINE
11.Amitryptilline
1) Generic name: 2) Category belongs: ANTIDEPRESSANT Drugs 3) What is the mechanism of action? Tricyclic antidepressants are also called MARIs Mono-Amine reuptake Inhibitors 1. Blocking the reuptake of norepinephrine (NE), Serotonin (5HT) and or Dopamine (DA) at the nerve terminals, thus increasing the NE, 5HT, or DA levels at receptor site 2. Down-regulation of the -adrenergic receptors. 4) Indication 1. Depression 2. Child Psychiatric disorders 3. Other psychiatric disorders 4. Medical disorders 5) Contraindications: 6) ADR: 1. Autonomic side effects 1) Dry mouth 2) Constipation 3) Cyclopegia 4) Mydriasis 5) Urinary retension 6) Delirium 7) Aggravation of glaucoma 8) Orthostatic hypotension 2. Sexual-side effects: 1. Impotence 2. Impoaired/retarded ejaculation. 3. CNS effects 1. Sedation
P a g e | 41 6. PROCHLORPERAZINE. 10. Write the names of ATYPICAL ANTIPSYCHOTICS. 1. Clozapine 2. Risperidone 3. Olanzepine 4. QUETIAPINE 5. SULPIRIDE 6. 11. What is the mechanism of action? Anti-Dopaminergic activity? 12. What are the indications? 1. Organic psychiatric disorders 2. Non-organic psychotic disorders 3. Child Psychiatric Disroders 4. Neurotic and Other psychiatric disorders 5. Medical disorders 13. ORGANIC (D4) 1. 2. 3. 4. Delirium Dementia Delirium tremens Drug induced psychosis 13. 14. Non-Organic 1. Schizophrenia 2. Schizo-affective disorder 3. Acute Psychoses 4. Mania 5. Major depression 6. Delusional disorder 15. CHILD-PSYCHIATRIC DISORDERS 1. Attention Deficit disorder with hyperactivity 2. Infantile autism 3. Conduct disorders in Children. 16. NEUROTIC and other PSYCHIATRIC DISORDERS 1. Severe intractable and disabling anxiety 2. Treatment refractory OCD 3. Anorexia Nervosa 17. Medical Disorders 1. HUNTINGTONs CHOREA 2. INTRACTABLE HICCUPS 18.
P a g e | 42
Dermatology:
1. G. auricular nerve thickening 1) Dx 2) Bed side test 3) Lab test 4) Treatment 2. TB chancre
6. 7. 8. 9.
3. PSORIASIS: 1. What is your dx? Psoriasis 2. Describe the lesion 1. Well defined 2. Erythematous 3. Have large, silvery, loose scales 3. What are the histological changes seen? 1. Epidermal: 1) Increased epidermal cell proliferation. Why? Increased growth fraction 100% of basal cells are multiplying Shortened epidermal turnover time 45 days to 70 days. 2) Retention of nuclei in stratum corneum parakeratosis 2. Dermal: 1) Dilated and torturous capillary loops 2) Proliferation of fibroblasts. 4. What are the bed side tests you can do? 1. Grattage test 2. Auspitz sign 5. What is the basic pathogenesis of psoriasis?
What are the sites of Predilection? What are the morphological variants? What are the investigations? How do you treat? 1. 10. What are d/d? 1. Seborrhoeic dermatitis 2. Discoid eczema 3. Hyperkeratotic hand eczema 4. Pityriasis rosea 5. Candida intertrigo 11.
4.
5. Chancroid:
1. Causative organism: H. Ducrei 2. d/d: 1. herpes group of infection 2. 3. Ulcer: 1. Bleeding on manipulation 2. Friable and soft 3. Can pick granulation tissue from Base LN: 1. Inguinal unilateral lymphadenopathy 2. May show groove sign (if inguinal and femoral LN) 4. Ix: 1. Gram staining 2. Culture 3. PCR 4. School of fish/Railtrack sign 5. T.t 1. Erythromycin 500 mg q.i.d x 7 days
P a g e | 43 2. Ciprox 500 mg b.d. x 3-7 days 3. Azithromycin 4. Ceftroaxone. 6.
7. Urticaria:
1. Triple response of 1. Erythema 2. Wheel 3. Flare 2. Clinical types: Acute: less than 6 wks, disappear within 24 hrs Evanescent type: s Idiopathic: should not be there at particular site within 72 hrs of appearance of lesion 3. d/d: 1. Urticaria vasculatiis (>72 hrs) 2. Eosinophilic vasculitis (mimic urticaria) No skin changes or pigmentation left in urticaria but secondary changes in vasculitis. 4.
6. BHC:
1) Generic name: Lindane 2) Mechanism of action: By invading chitimous layer and affects CNS of lice 3) Concentration used 1% 4) Contraindication: 1. Pregnant lady or breastfeeding mother 2. Young children 3. History of convulsion 4. Body weight <50 kg 5) Uses: Scabies, Pediculosis 6) Instruction to patient Pediculosis (Pediculosis humanus capitis) 1. Applied for 24 hrs 2. Avoid eye contact 3. Wash off 4. Egg cases (nits) can be removed by soft-fine tooth comb 5. Repeat once after 7 days 6. All the clothes and bed linens wash in hot water. Scabies (Sarcoptes Scabei) 1. 7) ADR: 1) Irritation 2) CNS stimulation 3) Vertigo 4) Convulsion 5) Arrythmias 6) 8) Pediculosis
8. T. Capitis (Tinea of Scalp)

1. Common group: Epidemic in school children 2. What are the patterns in hair? 1. Non-inflammatory tinea capitis 1) Caused by ANTHROPHILIC 2) Gray patch (multiple, erythematous patches, mild scaling, patchy, parital alopecia) 3) Block dot ( hair broken at the surface, mild erythema and scales) 4) Seborrhoic dermatitis like lesion 5) Alopecia areata like lesion (tinea complete patchy loss of lesion) 2. Inflammatory tinea capitis (KERION)
P a g e | 44 (caused by ZOOPHILIC, Painful, boggy swelling with pustulations Reactive occipital Lymphadenopathy) 3. AGMINATE folliculitis: well defined, dull red plaques, follicular pustules. 4. FAVUS: T. Schoenleinii (presence of foul-smelling, yellowish cup-shaped, cicatrical alopecia) 3. Antifungal used: 1) Griseofulvin 10 mg/kg daily after food, 4-6 weeks Minimum 6 wks in T. capitis 2) TERBINAFINE 250 mg daily x 2 weeks 4. 1. Trichophyton rubrum (commonest) 2. Epidemophyton floccosum bedside test: KOH of nail clippings fungal hyphae WOOD LAMPS examination. confirmatory test: culture in SDA dx/ t/t 1. Finger nails: Griseofuvin x 6 months Terbinafine x 6 weeks Itraconazole pulse therapy (3-5 mg/kg daily for 1 week every 4 week) 2. Toe nails: Griseofulvin x 9 months Terbinafine x 12 weeks Itraconazole pulse therapy
4.
5. 6. 7.
8.
9. T. Unguium:
1. Describe the lesion 1) Assymetrical nail infected (cf. psoriasis) 2) Yellowish brown discoloration and crumbling of the nail plate 3) TUNNELING of the nail plate. (cf. psoriasis, no crumbling, as debris is firm) 4) Nail plate thickened 5) No pitting (cf. psoriasis) 6) Collection of friable debris under the nail SUBUNGUAL HYPERKERATOSIS. 7) Separation of nail plate from nail bed ONYCHOLYSIS. 2. d/d 1. psoriasis of nail 2. yeast and mould infections of nails. 3. Causative organism?
10.Leprosy?
1. Lupus vulgaris: d/d of BT 2. Investigation: 1. Go for FNA before biopsy 2. Only sensory fibre providing nerve is biopsied not motor fibre proving nerve 3. Sural nerve: purely sensory nerve, Area supplied by sural nerve? 4. Biopsy features: 1. Tuberculoid (epitheloid) type of granuloma 2. Few lymphocytes along with Langhans giant cell- horse shoe shaped 3. Compact type of granuloma 4. Foamy macrophages 5. Spongios (inter-cellular oedema) in tuberculoid pole 6. No differentiation between dermis and epidermis
P a g e | 45 4. Stricture of anus 5. PID 6. Ritters dz: Arthritis, Urethretis, Uveitis Delayed complication 5. Treatment: Ceftriaxone: 125 mg i.m Azithro: 2 g stat Cipro 500 mg stat Doxy 100 mg (if not treated) 6.
5. Type I reaction 6. Type ii reaction 3. 11. Satellite lesion 2-5 mm from main lesion 12. Bubo Formation (Primary syphilis/LGV)?? 1. Groove Sign 2. D/D 3. Dx. 4. Serological test 5. treatment
13.LGV:
1. Causative organism: Chlamydia trachomatis (organism) 2. Site: 1. Glans, prepuce 2. Post. Wall, vulva 3. Other: Eye, lip, Rectum, anal mucosa 3. What are the clinical features? 1. Primary 1) Small papule after 3-4 days enlarge and ulcerate Painless ulcer, base covered with white solugh 2. Inguinal syndrome: 1) 30-40 days later 2) Inguinal lymphadenopathy 3) True Bubo (Multinodular, soft) 4) Groove sign +ve 3. Lymphatic obstruction 1) Anogenital rectal syndrome 2) Proctocolitis (Female) 3) Tenesemus, Low abdominal pain. 4. 4. Complications: 1. Ram Rod Penis, Saxophone penis 2. Chronic induration of vulva 3. Vaginal fistula
14.Molluscum contagiosum
1. Describe the lesion: 1) Pearly white, dome-shaped papules which are umbilicated. Cheesey material oozes out when pierced through umbilication. 2) Pseudo-Isomorphic phenomenon: due to autoinoculation can give rise to lesions arranged linearly along line of trauma. 2. Complication: Secondary infection. 3. t/t: 1. children: few lesions may resolve spontaneously several lesions WART PAINT, MECHANICAL REMOVAL after using EMLA 2. Adult Few lesions Mechanical expression followed by chemical cautery Several lesions Cryotherapy , WART PAINT. 4. 2 conditions in adult where it is seen 1. Anogenital region: Sexually transmitted MC 2. In HIV patients. 5. Investigation:
P a g e | 46 1. Cytology shows large eosinophilic cytoplasmic inclusion bodies. 6. Causative organism: pox virus 7. 14. TB (Cutaneous) 1. D/d 1. Sclofuroderma 2. Orofacial TB 3. TB gumma 4. Lupus vulgaris 5. TB chancre 2. Lesion: undermined edges on unclear base 3. Investigation 4. T/t: 15. Asfasfas
P a g e | 47
OSCE Final
13th July 06, Thursday Opthal, ENT, Anaes, Oral
Opthalmology 1. Do Confrontation test in the pt. 2. Name the procedure - Indirect ophthalmoscopys 2 advantages & 2 disadvantages. Adv large area of retina can be examined Can examine even in hazy media Disadv less magnification Mastered only after hours of practice 3. Desxribe the lesion Black pigmented mass in the upper lid of left eye Irregular border, no ulceration, bleeding Lower lid is also involved D/D Malignant melanoma Pigmented basal cell carcinoma T/t Exenteration Chemotherapy, Laser therapy 4. Name the operation. Exenteration Indications for the above operation Malignant melanoma Perforated injury to eyeball
P a g e | 48 Retinoblastoma 5. Write the condition Facial nerve palsy Surgical and non surgical methods Tarsorraphy Tear drops Eye padding Importance of Bells phenomenon.??? 6. signs in the given photo Lid retraction Staring gaze Other 6 signs seen in this condition. 7. write 4 causes of epiphora in child Congenital glaucoma Atresia of lacrimal draining system
Signs in this patient Blue sclera Strabismus Treatment for congenital glaucoma Goniotomy Trabecuectomy 8. diagnosis of the photo Membranous keratitis Signs Conjunctival chemosis, congestion Keratitis
P a g e | 49 Complications Perforation Iris prolapse
ENT
1. Identify Mollisons self retaining haemostatic mastoid retractor Used in Mastoidectomy Types of mastoidectomy Cortical, Radical, Modified radical 2. Identify Boyle-Davis mouth gag Used in Tonsillectomy, Adenoidectomy 4 Indications of tonsillectomy Recurrent tonsillitis, chronic tonsillitis, enlarged tonsils, tonsillitis refractory to medical therapy C/I of tonsillitis Active tonsillitis 3. Name the graph Pure tone audiogram Abnormality Conductive hearing loss 4 causes of CHL wax , FB in EAM,
P a g e | 50 4. Abnormality in PTA High frequency hearing loss in air bone conduction Diagnosis Presbycusis
5. Name the type of curve B type Probable diag. Serous OM Mgt Myringotomy with Grommet insertion Decongestants T/t of throat infections 6. Name the view Laws view of mastoids Abnormalities in xray haziness in the mastoid air cells Irregular outline of air cells Normal appearance of mastoid in xray, draw a diagram.
7. view Waters view of maxillary, sphenoid, frontal sinuses with open mouth Abnormalities Diagnosis Chronic maxillary sinusitis Mgt. 8.
Anaesthesia 1. drug Thiopentone sodium 2 indications Induction & maintenance of anaesthesia
P a g e | 51 In Status epilepticus Major ADRs 2. Identify Guedels airway Draw and label the parts. Uses Complications 3. LMA 2 Uses 2 advantages & 2 disadvantages 4. Tuohys needle how to know it has gone to accurate place? Uses
Oral 1. OPG Indications orthodontic diagnosis, impacted third molar, Mandibular fracture, unerupted/impacted tooth. Dental cysts : Dentegerous, OKC, Radicular, eruption cyst. Dental tumours : Adenomatoid odontogenic tumor, ameloblastoma, Calcifing odontogenic tumor, Abnormality in x ray - # mandible 2. Dental cast of maxilla A/c to FDI, name the teeth present What may be the D/D for the defect? 3. Toothbrush Types A/c to bristle, hard, medium, soft
P a g e | 52 A/c to handle, fixed & flexible Manual & electric Ultrasonic When to replace & why? 4. Removable partial denture Teeth present Upper left and right central incisors (11, 21) Composition Poly Methyl Methacrylate 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. Station 1: Asthma patient. 80% PEFR! Criteria? Management? Station 2: ECG.. report..! MI? Station 3: Acute sob in 55/m diabetes, hypertension. jvp raised. no edema. immediate resusitation? d/d? inv? St. 4: X-ray Gas under diaphragm. Management St. 5: Haloperidol. from the CIMS. St. 6: Primary Survey in Head trauma St 7: Spacer and Meter dose in haler. how to use? st. 8: IMCI of pneumonia. management? st.9 : Hypertension councelling. st.10: Shoulder Examination st.11: Severe dehydration and fluid management acc. to iMCI. st.12: Councelling in depression. st.13: 17/M. RBS: 433 and ketoneurea with UTI. further investigations? st.14: st.15: anterior d/l shoulder.which nerve injury? reduction technique. names? x-ray st.16: POP. colles' cast till where? fracture tibia cast till where? st.17: Steinmann's pin. uses in detail!! st.18: supracondylar fracture. what type? deformity? st.19: pneumatic torniquet. advantage? disadvantage? st.20: K-nail: where eye? principle? use? st.21: 70/F with external rotation, adduction and swelling of the lower limb. shortening. inter-trochanteric fracture? management? (Russell traction, DCP screw!!) st.22: deformity at hip with fixed flexion deformity. apparent lengething/shortening? adduction deformity? abduction deformity? examination of hip.
P a g e | 53 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. st.23: principle of management of open fracture. x-ray photo st.24: lateral mastoid view(??): features? d/d? diag? mc. evans triangle? st.25: water's view? structure passing thru infra-orbital foramen.? AC polyp vs. ethmoidal. st.26: Boyle Davis mouth gag. other instrument? commonest operation? indication? contraindication? causes of reactive bleeding?? st.27: Posterior rhinoscopy mirror. diagram? importance of rossenmuller fossa? st.28: 3/M unable to speak since birth, most likely diagnosis? risk factors prenatal? objective test? management? st.29: h/o 2 years ear discharge. now with fever, neck rigidity, facial deformity. d/d?? difference between supra nuclear and infra nuclear lesions. parts of facial nerve and topographical test for intratemporal lesion. st.30: myringotome. used for? serous otitis media predisposing factors and complications? st.31: conductive hearing loss b/l in PTA. causes? st.32: B type impedence tympanograph. other types? causes of B type. st.33: maddox rod. uses? principle for any one use. st.34: schiotz tonometer. parts and principle. advantage and disadvantage. st.35: convex lens. uses. disadvantages. st.36: snellen's chart. angle at nodal point? alternative for children. st.37: pin hole. principle and condition in which VA worsens? st.38: perimetry. bitemporal hemi anopia. lesion where? investigations? machine used? st.39: fluorescin dye. 2 uses? principles. st.40: pilocarpine. what class of drug? principle. ADR? Use? st.41: Photo of exopthalmos. systemic condition associated? investigation to confirm? other signs in eyes.
P a g e | 54 OSCE 2008: Orthopaedics and GP: GP 1. Get the history from a person suffering from enlargement of thyroid. 2. A person otherwise fine. Get history on drug and Alcohol and advice him on safe limits. 3. Draw adrenaline for paediatric dose. (Dont forget to throw, dont inject again into via if you have taken in excess). 4. Dr. J is new Resident in Emergency. Advice him on preventing transmission of infection to and from him. 1. Follow universal precaution 2. Hand washing 3. Wearing gloves, aprons, spectacles 4. Proper disposal 5. Needle prick injury, prevent, authority, prophylaxis HepB, HIV 6. Get prophylaxis of most common diseases 7. Treat your infectious disease, avoid contact to patient during so 5. A newborn baby 7 days old, diagnose HIRSCHPRUNGs disease. Discuss with his father who is also a Resident, about care to be done in EMERGENCY medicine. Hypothermia, Hypoglycaemia, NG, electrolytes, fluids 6. Burn in hand and face, How to manage? Fluids 7. Do snake bite bandaging along with patient explanation. 8. Sinus bradycarida, Rhythm discussion, causes and symptoms. 9. TB spondylitis: describe, causes, late complications. 10. IMCI, what to look for in Pneumonia, danger signs, severe pneumonia signs. 11. Vertigo: causes and treatment. 12. An alcoholic with fever, pain abdomen, distended, peritoneal lavage was done with serous fluid high TLC count, neutrophils more, - dx and treatment bacterial peritonitis. 13. Breast Lump question: what could be the causes, what test you do 14. GCS write 15. Intubation: what all you require Ortho: 1. 2. 3. 4. GCT: on the foot, what you write # neck of femur: dx, treatment Dynamic compression plates # intertrochanteric ?: A 70 year old lady suddenly falls, not able to move her leg. Picture shows swelling on hip joint and adduction and external rotation is more than 90 degree and shortening also seen. 5. Fibula and tibia both #, and a wound: Picture: Dx and treatment
P a g e | 55 6. Compartment syndrome history: dx and treatment. 7. STEINMAN pin 8. Four-POST-COLLAR Brace DGPLR Dermatology 1. Herpes Zooster Opthalmicus a. Diagnosis b. Treatment c. Complications 2. Condyloma Accuminata a. Diagnosis b. What are the other forms? c. Treatment d. How do you apply the dryg? 3. Psoriasis a. Diagnosis b. Other variety c. 2 systemic and 2 topical 4. Pediculosis a. Diagnosis b. Treatment c. Other forms in body 5. Triamcenolone a. Strengths available b. Uses c. How to apply? 6. Fasdfa General Medicine 7. Counsel Febrile seizures What kind of child is susceptible? Is it life threatening? Chance of recurrence in future? Any motor or sensory deficit in future? 8. Primary survey 9. Neck muscle exercises 10. X-ray: Cervical spine damage: management 11. Pneumothorax ? S. Emphysema 12. Elbow dislocated. Till refer, how to treat
P a g e | 56 13. Depression: counsel 14.

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Page |1

2. OPG dentigerous cyst

Mouth gag- Acralic, se

7. 8. 9. 10. 11. 12.

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

6. LMA BRAIN MASK

2. Red Rubber tube

Eliminates toxic gases on autoclaving

4. Double lumen tube:

11) 12) 13) 14)

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

11. Intubating LMA (Fastrach)

Simple Face Mask

12. Masks: 1. Anatomical mask

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Epidural Needle (TOUHYs)

Spinal needle (18-32 G)

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

21. Burete I.V. set 22. McGills Foreceps:

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

22. X-ray soft tissue neck and chest lateral view

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

P a g e | 16 1. 2. 3. 4. Congenital Developmental Pathological Acquired

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

P a g e | 20 27. Broncial asthma

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Traction Instruments 1) KIRSHNER WIRE 2) GUIDE WIRE

3) SANZ PIN ???

2) SMITH-PETERSEN NAIL 3) V NAIL 4) INTERLOCKING NAIL

5) TALWALKAR NAIL 6) RUSH NAIL 7) ENDERS NAIL PLATES AND SCREWS

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

P a g e | 22 1. Heavy duty Plate 2. Cortical screw

SPLINTS and Tractions 1. Crammer-wire splint 2. Thomas Splint 3. Bohler-Braun Splint 4.

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

>10 Disproportio nate rise in urea

<5 Tend to rise together

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

P a g e | 31 5. Protein in urine Uncommon Present on dipstick testing

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

1. Ectopic pregnancy 2. Tubal factor infertility.

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

3. What is the disease caused? 4. What is the vector? 26.