Causes of altered sensation of Smell

Learn how to examine the sense of smell.

Anosmia (No smell)

Atrophic rhinitis

Peripheral neuritis

Degenerative Disease of Nose

Injury to factory nerve

Injury to olfactory bulb

Anterior Cranial fossa fracture

Intracranial abscess

Intracranial tumors

Meningitis

Causes of various types of Nasal discharge.

Parosmia (Perversion of smell)

Recovery Phase of post influenza anosmia

Intracranial tumor

Clinical Examination of Nose and PNS

Hyposmia (Decreased Smell)

Nasal Polyp

Enlarged Turbinate

Edema of Mucosal Membrane

Common cold

Vasomotor Rhinitis

Allergic Rhinitis

Pupillary Reaction to Various Drugs and Substances

PUPIL REACTION TO SUBSTANCE/DRUGS

Pupil of human eye constrict and dilate depending upon the need of the eye to focus on near object/far object, dim light/bright light and whether it is under stress/not. This response is solely dependent upon the muscles inside the eyes in the iris. The pupillae constrictor muscle respond to cholinergic agents and cause pupillary constriction while the dilator pupillae muscle is acted upon by sympathetic system and causes pupillary dilation.

Beside these natural response, the substances we come in contact with can also alter the pupillary size. Drugs such as Adrenaline, antidepresssants, antihistaminics, can cause pupillary dilatation. Pethidine being an exception is the only opoid to cause pupillary dilation. Herbal products such as belladona, strychinine, calotropis and Chemicals such as alcohol, formic acid, cyanide Carbon monoxide also have dilatatory effect based upon the dosing.

Phenols, Organophosphate, carbamates, Carbolic acid, cause pupillary cosntriction. Drugs such as Opoids, barbiturates, Benzodiaepines, methyl dopa and plant product such as Nicotine, caffiene and opium causes the dilatation of pupil. 

Know how to assess the pupillary reaction or light reflex.

DILATORS		CONSTRICTORS
A6 C5 (Big1 Co Ca Cola Can)		O2 B2 C5 ( Car Car Caf )
Formic Acid			Phenol (Carbolic Acid)
Pethidine2 (only exception in Opoid)		O	All Opoids2  (Except severe Acidosis/hypoxia/ respiratory depression)
Adrenaline*/ Ephidrine/Sympathetomimetics	A		Parasympathetomimetics*
Atropine*/ Belladona/ Dhatura	A	O	Organophosphate*
Amphetamine	A	B	Barbiturates
Alcohol3	A	B	Benzodiazepines
Antidepressants	A
Antihistaminics	A
Cocaine Crack	Co	Car	Carbamate
Carbon Monoxide/ CO	Ca/CO	Car	Carbolic Acid
Calotropis	Cola	Caf	Caffeine
Cannabis	Can		Coma of Alcohol3
Cyanide			Clonidine
Hypothermia*			Heat Stroke*
Strychnine			Nicotine4
			Methyl Dopa

HIPPUS: Alternating dilatation and constriction is done by ACONITE

Note: All A’s constrict the pupil. All B’s and O’s dilate the pupil.

¹ Big is not a part of drug rather means dilatation.

² Only opoid to cause pupillary dilatation is Pethidine.

³ Toxic Effect of alcohol causes pupillary constriction as patient develops coma.

⁴ Delayed effect of Nicotine is dilatation of pupil.

* The drugs/substances in row with different color across the table are physiological Counterparts

  

Types of Wound: Superificial Abrsaion and Lacerated Wound

OSTEOCHONDRITIS

osteochondritis 

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

Learn How to describe other systems and pathological conditions.

| Abdominal | Respiratory | Cardiovascular | Nose and PNS | Oral Cavity | Ear | Digital Rectal Examination | Ulcer | 

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.

Learn How to describe other systems and pathological conditions.

| Abdominal | Respiratory | Cardiovascular | Nose and PNS | Oral Cavity | Ear | Digital Rectal Examination | Ulcer | 

Examination of Nose and PNS: How to describe.

Learn How to describe other systems and pathological conditions.

| Abdominal | Respiratory | Cardiovascular | Nose and PNS | Oral Cavity | Ear | Digital Rectal Examination | Ulcer | 

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.

Learn How to describe other systems and pathological conditions.

| Abdominal | Respiratory | Cardiovascular | Nose and PNS | Oral Cavity | Ear | Digital Rectal Examination | Ulcer | 

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