Saturday, March 5, 2011

ENT : End Posting Part 1 and 2

Just to be brief :(yelah tue..)

My end posting for 6th semester is divided into two.

I sat down and wait for the Dr to finish the inspection on patient in small cramped OPD by 11 am.

Part one ( Instruments ,X-rays and Viva)

me alone

Dr: *smiling* How do you ask the patient whether he/she have an ear Kannada?
Me: Dumb stucked! Errmmmmmmmmmmm.............*blink-blink*
Dr: How to ask "do you have ear pain?" in Kannada? Again and again...
Me: Half geleng-geleng...Ermm Sir,i forgot sir..

A patient came to OPD. He went to check her.
I to think very hard....and.....

A moment later,

Dr: So?
Me: Ermm... Aunty, Illi (sambil tunjuk telinga) novu untha?
Dr: hahahah.....Okayh, but the right word for this(telinga) is Kivi = ear in Kannada.
     So, it is like this, "Kivi novu untha?"
Me: sengeh...


Dr: what is this?
Me: It is a laryngoscope.
Dr: mention it uses..
Me: for direct laryngoscopy in emergency cases in airway obstruction or difficulty in deglution.
Dr: Okay, Any other uses?
Me : It is also used in biopsy and sleep apnea emergencies.

Dr: Tell me what is this and mention other types of this instrument.
Me: it is a tracheostomy tube. There are other type too.For example, metal and plastic tube. The metal tube have two type.One is Jackson`s tracheostomy tube and the other one is Fuller's tube. The plastic tube are also called as Portex tracheostomy tube.
Dr: Tell me the disadvantages of this plastic tube.
Me: well, it has only one tube which makes cleaning the tube to be more difficult.In case of airway block or obstruction to the tube, it is hard to remove it.
Dr: Any other disadvantages?
Me: *blink-blink*
Dr: Well, what happen if there is massive pressure by the tracheostomy tube?
Me: it will stimulate the baroreceptor causing hypotension?*grin*
Dr: Yes, but it also can cause something else.
Me: *Blink-blink*
Dr: Well, it can also cause oesophageal mucosa necrosis due to massive pressure for  very long time.
Me: BUt, sir it wont be that hard right? ( Nada tak puas hati )
Dr: Yeah, for a period of time, high pressure on the neck can cause mucocal necrosis.
Me: Setuju ajelah..

Dr: Okay, tell me what is that?
Me: Its a plain x ray, lateral oblique view, showing the mastoid, the cervical vertebrae and the mandible.It also shows the external auditory canal.
Dr: Now, what do you see?
Me: The x-ray shows the pneumatised air cells surrounding the meatus.
Dr: Good, so how many types of of pneumatisation of the air cells.
Me: Cellular,accellular and diploic.(Diploic = both sclerosing and honeyconb air cells)

Dr: Good...Thats all, roll number?
Me: 63 sir. Saying it joyfully....

Part 2 ( presentation of case history)
Me,Miss R,Mr S

Dr: Well,present the case.
Me: A patient came to the hospital by the name Bhavya....bla..bla...
Dr: Okay,(cutting me midway)..tell me positive findings..
Me: There is mucoid discharge and small perforation in the tympanic membrane sir.The mucosa is congested.
Dr: Tell me what is he having.
Me: An ear infection.Probably chronic infection.... (Baru teringat , patutnya cakap Otitis media with effusion, OME..Cess!!!)
Dr: So, tell me what is inactive written is your report here..
Me: means no discharge.
Dr: Yup, but is there any particular duration for dry ear with perforation?
Me: (alamak...ape nih? Ade ker dry  ear...tak pernah baca pun????)
Dr: Okay, it is in inactive stage.Tell me other stages.
Me: Huh? *blink-blink*seyes tak tahu...
Dr: Ms R, Mr. there any particular duration for dry ear?
Miss R and Mr S : We dunno Sir..
                            Sambil geleng-geleng..Owh, mereka pun tak tahu.Selamat aku...(-__-)''
Me: Sengeh...dan sengeh.... atas kepala nampak bintang-bintang
Dr:  This is baddddd....How come you dont know?
Me: Ishhh..sir, tulah..mane tau mende tue...kan belajar maser 7th term..sape suruh buat maser 5th term? *blink-blink*
Dr : Tell me the management for this case.
Me: Give a local and systemic antibiotics..culture of the pus and audiogram to assess either it is a conductive type deafness or a sensorineural deafness.
Dr: Okayh, go..!! Roll number?
Me: 63, sir...Saying it reluctantly...

Arghhhhh...dah ler last posting ENT... Slack pulakkk lerr time hujung sekali..Viva and instruments dah lepas. Sekali, ini tak lepas pulak...Adoiiiiyaii....

Moral of the story, read the WHOLE text book next time. (Soryy, this is sarcastically mentioned)

Yang penting:
-semua nama instruments,uses and how to handle it.
-advantages and disadvantages.
-SOM (Suppurative Otitis Media)
-CSOM(Chronis Suppurative Otitis Media)
-OME ( Otitis Media with Effusion)
- All major surgeries like tonsillectomy,adenoidectomy,mastoidectomy,laryngoscopy..


Inactive Chronic otitis media: In this condition the middle ear mucosa is relatively healthy. The mastoid cavity also appear healthy. These patients may slip into active phase rather easily because of the existing pathology. Inactive chronic otitis media can further be subdivided into Inactive mucosal chronic otitis media and Active squamous chronic otitis media.

Inactive mucosal chronic otitis media: This condition is always associated with dry perforation of the ear drum. There is permanent perforation of the pars tensa, but the middle ear and mastoid mucosa are not inflammed. The drum remnant around the perforation is always healthy. The rim of the perforation is thickened due to proliferation of fibrous tissue. Squamous epithelial cells from the external auditory canal does not migrate into the middle ear cavity in this stage because the annulus of the ear drum is intact and it prevents this migration. These patients benefit from myringoplasty.

Inactive squamous epithelial chronic otitis media: These include retraction pockets, atelectasis and epidermization. Negative middle ear pressure can cause retraction of tympanic membrane. A retraction pocket consists of an invagination into the middle ear space of part of the ear drum. These retraction pockets may be fixed when it is adherent to structures in the middle ear or free when it can move freely medially or laterally depending on the state of inflation of the middle ear. "Epidermization" is a more advanced type of retraction and it refers to replacement of middle ear mucosa by keratinizing squamous epithelium without retention of keratin debris. The area of epidermization may involve part or all of the middle ear cavity. Epidermization often remain quiescent and does not progress to cholesteatoma or active suppuration. So epidermization per se is not an indication for surgical intervention.


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