Membrane over tonsil (Differential diagnoses)

Mnenomics
Membrane Above A Tonsils Can Vary from MILd To Dangerous.

Membranes
Above        Apthous Ulcer
A               Agranulocytosis
Tonsil       membranous Tonsillitis
Can          Candiasis
Vary         Vincents Angina
MILd       Malignancy
                 Infectious Mononucleosis
                 Leukemia
To            Trauma
Dangerous Diptheria

Do you know how your examiner wants to hear the examination of oral cavity during your OSCE and Clinical Skills. Follow link.

Paradise Criteria for Tonsillectomy 

Know the difference between membranous tonsillitis and diptheria.

Difference between adenoid and Tonsils.

Examination of Ear: How to describe

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The following is the complete examination of ear from pinna up to the tympanic membrane to  be described after the complete ear examination .

PINNA

On examination of external ear (both medially and laterally), the ear looks normal in shape (funnel shaped), size (equal to dorsum of nose) and position (The Frankfurt line divides the ear in upper one third) with normal contour (formed by helix, antihelix, conchae, cymbaconchae, tragus, antitragus and lobule) There is no gross deformity, no swelling or redness. The pre auricuar area looks normal with no sinus, no pits, redness,  swelling or any other mass or skin tags. The post auricular area looks normal. The postauricular area looks normal with no ironed out appearance, and no obliteration of retroauricular groove.   

On palpation there is no local rise in temperature and or tenderness both on the pinna and the mastoid. There is no thickening of tissue. Circumduction can be performed.

EXTERNAL AUDITORY CANAL

On examination of the external auditory canal without speculum, the size of the meatus is adequate 

(normal 8-9mm, stenosed if <4mm) containing wax and debris. The content is (Profuse/scanty in amount)(Foul smelling)(Blood mixed). There is no swelling or any mass.

On examination with otoscope or speculum, there is no furuncles, swelling or mass on the wall of the external auditory canal and contains().

TYMPANIC MEMBRANE

The tympanic membrane on examination under speculum/otoscope looks semitransparent glistening and pearly white in color with visible cone of light and handle of malleus. There is no perforation or bulging of tympanic membrane. There is no perforation, vesicles on the surface of tympanic membrane, the mobility of tympanic membrane is not assessed.

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Sideeffect of anticancer cytotoxic drugs

@ABCDEFGHI

A- Alopecia
B- Bone marrow suppression
       (aplastic anaemia, thrombocytopenia, agranulocytosis)
C- Secondary Carcinogenecity
       (lymphoma, leukemia)
D- Dermatitis
E- Enteric disorders
     (nausea, vomiting, hemorrhage, xerostomia, stomatitis)
F- Fetal
     (death, abortion, teratogenecity)
G- Gonads
      (sterlity, oligozoospermia, amennorhaea, mutagenesis)
H- Hyperurecaemia
      (gout, urate stone)
I- Immunosupression
      (opportunistic infection)

Examination of Nose and PNS: How to describe.

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EXTERNAL NOSE

On examination of osteocartilagenous framework and the skin of the nose, it looks normal in shape and size (Mid face). No gross deformity like hump nose, depressed or deviated nose visible on examination from lateral profile. There is no widening of nasal dorsum. No swelling or lump in the area adjacent to the nose. No scars, sinus, change in color of skin and any ulceration

On palpation of nose, there is no local rise in temperature or tenderness. No fixity of skin, no thickening of soft tissue and No crepitation.

Spatula Test

On performing the spatula test, mist formation is equally present bilaterally suggestive of bilateral nasal patency.

Cotton Wool Test

There is equal movement of cotton on performing cotton wool test.

NASAL VESTIBULE

There is no furuncle, fissure, crusting, and there is no caudal dislocation of nasal septum. No grossly visible pathology with in nasal cavity.

ANTERIOR RHINOSCOPY

The opening of nasal cavity is wide/narrow or adequate. The mucosa looks normal pink and moist. There is no discharge or any other mass. On examination of nasal septum there is no deviation, no perforation, no septal bulging and no any ulceration or growth.

The Mucosa of the nasal turbinate looks pink and moist. The turbinates are not hypertrophied/ atrophied. There is no discharge from the middle meatus.

POSTERIOR RHINOSCOPY

On performing posterior rhinoscopy, the normal structures like opening of ET tube, Choana, posterior end of the septum and turbinates can be visualized. There is no mass on anterior side. There is no post nasal discharge.

PARANASAL SINUS

The area over the soft tissue of cheek, lip, lower eyelid, Upper eyelid, forehead, root of nose, orbital margin and its content look normal. There is no swelling or redness. There is no proptosis.

On palpation over the canine fossa, medial aspect of the root of the orbit and deep to medial canthus, there is no tenderness.

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Drugs/Poisons resisting Putrefaction

Drugs/Poisons resisting Putrefaction

Organophosphorus

Edrin

Strychnine

Antimony

Arsenic

Nicotine

Dhatura

Yellow Oleander

@ OE SANDY

Difference between True bruise and Artificial Bruise

The concept of malingering has made it important to identify whether any bluish discoloration in the body is true bruise or bruise induced with use of various plant products. It is useful in forensic science to identify whether any assault / physical violence is true or the victim is fortifying the evidence to setup any guiltless.

True bruises can be present anywhere in the body and is generally associated with blister and itching. It changes color following the blunt trauma unlike false bruise which are stained by plant products and hence don’t change their color.

Click to know how is a respired lungs different from the unrespired lungs of a newborn.

Character	Artificial Bruise	True Bruise
Cause	Chemical Agent like plumbago, semicarpus, madar juice	Blunt Trauma
Location	Accessible part of body mostly	Anywhere
Blister	Present around the bruise	Not present
Itching	Present	Not Present
Color Changes	Absent	Characteristic
Fingers	Marks of scratching	Not so
Content	Acrid Serum	Extravagated blood
Chemical Analysis	Chemical detected	Not so

Difference between Chili and Dhatura

Character	Chilli	Dhatura
Size	Small	Large
Color	Yellow	Brown to black
Smell	Pungent	Odorless
Taste	Pungent	Bitter
Appearance	Round & Smooth	Reniform with pitted surface
Border	Convex Single edge	Concave with double edge
Section	Embryo curved inward	Embryo curved outward

Difference between respired and unrespired lungs (Live birth vs Dead Birth)

The knowledge whether a dead fetus was a still birth or died after coming into the environment (Live Birth) is very important in Forensic Science. This is important specially in countries where killing of neonate in the name of black magic is prevalent. Similarly, killing of female fetus/ newborn is also common in some part of the world. Killing a newborn is Crime in most part of the world and differentiation between the two can be made based upon the study of the lungs in the postmortem. 

Postmortem finding of a respired and unrespired lungs have many differences. The unrespired lungs is parenchymatous like a liver occupying lesser volume. Being condensed and no air particle inside it tends to sink in the water with density higher than that of water. 

Respired lungs on the other hand have spongy elastic appearance with lesser density and hence floats in water. It is expanded covering the heart and with respiration the cardiac circulation changes and the patency of the vessels is maintained making it ooze with frothy blood when cut into pieces.

The following are the characters based upon which the differentiation can be made between the two.

Character	Unrespired Lungs	Respired Lungs
Weight in relation to body weight	1/70	1/35
Volume	Small	Large and covers the heart
Consistency	Liver Like: Dense firm non crepitant	Soft, spongy, elastic, Crepitant
Extension	Up to the level of 4th and 5th rib	Up to the level of 6th and 7th rib
Specific gravity	1.04	0.94
Margin	Sharp	Rounded
Color	Uniform reddish	Mottled/ marbled appearance
Air vesicle	Not inflated	Inflated
Section	Little froth less blood exudates on pressure	Abundant frothy blood exudates
Breslow life test	Whole or part sinks	Expanded
Microscopy	Cuboidal lining	Squamous Epithelium
Blood vessel	Less patent	More Patent

Difference between Rigor Mortis and Cadaveric Spasm

Though rigor mortis and cadaveric spasm both occur both following death but they are totally different things. Cadaveric spasm is a localized contraction of muscle that was occurring during the time of death and perisisted then after unlike Rigor mortis which developed through out the body including visceral muscle. There is a period of flaccidity before rigor mortis  develops. The following points helps us differentiate between the cadaveric spam and rigor mortis.

Know the physiology behind rigor mortis 

Character	Rigor Mortis	Cadaveric Spasm
Time Of Onset	Within 1-2 hours of death	At the time of Death
Occurrence	Occurs in all death except burn	Predisposed by sudden violent death
Muscle	Both Voluntary and involuntary Muscle Heart is the first to be involved Small muscle of digits develop it last	Local Voluntary Muscle eg. Hand with knife in suicide
Muscle Stiffening	Moderate force required to break it	Great Force required to break
Primary flaccidity	Occurs	Does not occur
Mechanism of Production	Known	Still Obscure
Response of Electrical Stimuli	Absent	Present
Medico Legal Importance	Gives idea about Time since death	Gives idea about Mode of Death

Oral Cavity Examination : How to describe.

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Complete description of oral cavity examination. 

LIP

The mucosa of lips on examination is pink in color, shiny and lustrous. The vermilion border looks normal. There is no angular stomatitis, No swelling, no vesicles, ulcers scars or cleft lip.

BUCCAL CAVITY

On examination of mouth and oral cavity, there is no restriction in opening of mouth, the buccal mucosa looks normal with no abnormal change in color and surface epithelium. Opening of parotid gland opposite the upper second molar looks normal and patent without any redness swelling or pus.( If inflamed-On applying pressure over the parotid gland there is no discharge.)

No halitosis present.

TEETH AND GUMS

On examination of gums and teeth, there is no redness or swelling over the gingival. There is no extraction of teeth. Dental caries are present on xyz teeth / No dental caries or abnormal dental pattern noted. Gingiolabial sulcus, gingiobuccal sulcus and Retromolar trigone looks normal. 

HARD PALATE AND SOFT PALATE

The mucosa overlying the hard and soft palate looks pink, moist and normal. The uvula is placed centrally and on asking the patient to say AHH there is symmetrical movement of palate and no deviation of uvula is noted

There is no cleft palate, oronasal fistula, No high arched palate, no bulge. No midline bony growth, mass or ulcer.  

TONGUE and FLOOR OF ORAL CAVITY

On examination of tongue, the tongue is normal in shape, size and tone and bulk. No restricted motility on outward protusion, sideways movement and upward movement. There is no fasciculation and deviation of tongue on outward protusion. There is no coating, ulcer or fissure over the surface of the tongue. No ulcers on the lateral margin of tongue.

Opening of submandibular gland on either side of the frenulum on the undersurface of tongue is visible. There are no swelling or redness or pus. There is no scar, ulcer or swelling on the undersurface of tongue.

On bimanual palpation of submandibular salivary gland, there is no swelling or hard masses (stones).                         

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Differntial Diagnoses in Nose

Nasal Polyp	Nasal mass
Antrochonal Polyp	Blob of mucous
Juvenile Nasal Angiofibroma	Rhinosporiodosis
Glioma	Antrochonal Polyp
Hemangioma	Rhinoscleroma
Encephaloceles	Rhinolith
Papilloma	Hypertrophied turbinates
	Malignancy
	Septal Hematoma

Learn describing the Nose and PNS during the OSCE and  Clinical Skill  examination.

Crust in Nose

Atrophic Rhinitis

Rhinoscleroma

Rhinitis Sicca

TB

Syphillis

Septal Perforation

Rhinosporiodosis

Any granulomatos disease of nose

Differential diagnoses of various types of Nasal discharge.

Membrane over nose

Bacterial Rhinitis

Diptheria

Aspergillosis

Causes of altered sensation of Smell

Itching  over nose

Myiasis

Allergic Rhinitis

Differential diagnosis of Nasal discharge

Unilateral Foul Smelling Nasal Discharge	Bilateral Foul Smelling Nasal Discharge
Atrophic Rhinitis	Nasal foreign Body
Rhinoscleroma	Rhinolith
Syphilis	Nasal diphtheria
Leprosy	Nasal Myasis
	Acute Unilateral sinusitis
	Chronic Unilateral Sinusitis

Purulent Nasal Discharge	Watery Nasal Discharge
Rhinitis Caseosa	CSF Rhinitis
Wegeners Granulomatosis	Allergic Rhinitis
Chronic sinusitis	Vasomotor Rhinitis
	Acute Rhinitis

Blood Tinged nasal discharge

Rhinosporiodosis

Wegeners granulomatosis

Foreign Body

Rhinolith

Myiasis

Differential Diagnoses in Ear

Differential Diagnoses in Ear

Polyp In EAR	Character
CSOM TT	Pale
CSOM AA	Red Fleshy
Glomus Tumor
Perforating TB

Purulent Ear Discharge

Diffuse otitis Externa

Primary Cholesteatoma of External Ear Canal

Acute Coalascent Mastoiditis

ASOM (Reservior Sign)

Petrositis

Infected Glomus tumor

 

Itching in Ear

Diffuse Otitis Externa

Eczematous Otitis Externa

Otomycosis

Seborrhagic Otitis Externa

Neurodermatitis

Blood Stained discharge from ear

Otitis Externa Hemorrhagica

Middle Ear Carcinoma

CSOM AA

Trauma to External Ear

ASOM in the stage of Resolution temporal Bone fracture

Foul smelling discharge from Ear

CSOM AA

Otomycosis

TB

Carcinoma Middle Ear

Carcinoma Mastoid

Crust in Ear

Eczematous Otitis Externa

CSOM AA

Chronic Diffuse Otitis Externa

Fluctuating Hearing loss

Meniere's Disease

Perilymph Fistula

Autoimmune

Syphillis

Malingering

Minor Ear Disorders

Satyr Ear

Darwin Tubercle

Stahl's ear

Absent Tragus