Search This Blog

Friday, September 19, 2014

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 




Examination of Ear: How to describe



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.


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)

Thursday, September 18, 2014

Examination of Nose and PNS: How to describe.

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.


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

Tuesday, September 16, 2014

Oral Cavity Examination : How to describe.


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).                         

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
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