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(K)OSCE 2014new.pptx dnb practical examination
- 1. Identify the pathology? Radioopaque Foreign Body Cricopharynx Describe the symptoms with which the patient will present? Dysphagia, Odynophagia, Drooling of Saliva Name 2 s clinical signs? Boca’s Sign and Jacksons sign What is the procedure of choice? Hypopharyngoscopy /Dlscopy What are the complications if treatment is not done in time? Oesophageal Perforation, Abscess Station 1
- 2. Identify and interpretthe radiological investigation? Barium Swallow showing Lax lower esophageal sphincter/ Achalasia Cardia Name the weak areas of the upper digestive tract? Laimer Hackerman area, Killian Jamieson Area, Killian’s Dehiscence Classify Pharyngeal Diverticulum? Lateral Congenital Acquired a. normal bulges b. traumatic c. raised intrapharyngeal pressure Posterior Congenital Acquired a. traumatic B. raised intrapharyngeal pressure c.posterior pharyngeal pulsion diverticulum (Zenker’s diverticulum) Name the types of Tracheo-esophageal fistula? Types 1,2,3,4,5 Station 2
- 3. Identify the deviceand mention its use? Calf muscle Compression Device , Deep Vein Thrombosis What is the pressure set for its use? 50mm Hg, 60 mm Hg Name two drugs which will help to prevent this complication of major surgery? Heparin, Warfarin, Low Molecular Weight Heparin, Dicoumarol Station 3
- 4. These pictures showexplantation of a cochlear implant due to flap necrosis and wound infection. Answer the following questions; What are Biofilms? Name two common micro-organisms which form Biofilms Name two investigations to confirm Biofilms Mention two antibiotics which have proved effective in controlling Biofilms Station 4
- 5. What are Biofilms? ABiofilm is an accumulation of microorganisms embedded in a polysaccharide matrix and adherent to the any solid biologic or non biologic surface. 2. Name two common microorganisms causing biofilms Staph Aureus, Staph Epidermidis, E.Coli, Klebsiella Pnueumoniae Name two investigations to confirm Biofilms Scanning Electron Microscopy Polymerase Chain Reaction Mention two antibiotics which have proved effective in controlling biofilms Tetracycline Rifampicin Imipenem Ciprofloxacin Tobramycin Lactoferrin Station 4
- 6. Identify the patternof inheritance from this pedigree chart, which is noted in a child with Syndromic Deafness 2. The following genetic mutations are noted in non- syndromic deafness; Please “MATCH THE FOLLOWING” genes to the intra-cochlear pathology they induce appropriately; 1. GJB2 A. Instability of Stereocilia 2. Myosin VI B. Degradation of Outer Hair Cells 3. PMCA2 C. Hinders Gap Junction construction 4. KCNQ4 D. Reduction of Tunnel of Corti Station 5
- 7. AUTOSOMAL RECESSIVE INHERITANCE 1= C ; 2 = A ; 3 = D ; 4 = B Station 5
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- 9. This person isthe parent of a 3 year old child born with normal hearing, but subsequent to an attack of bacterial meningitis four weeks ago, this child has now developed bilateral severe to profound hearing loss. The Pediatrician has immediately referred this patient to you for further management. Kindly counsel this parent about the nature of the child’s hearing loss, the necessary intervention which is required and consequences of the treatment. Station 6
- 10. 1. INVESTIGATIONS TOBE DONE (AUDIOLOGICAL / CT & MRI SCANS) 2. NEED FOR URGENT COCHLEAR IMPLANTATION DUE TO RISK OF COMPLETE OSSIFICATION OF COCHLEA 3. GUARDED OUTCOMES AND NEED FOR INTENSIVE AUDITORY VERBAL HABILITATION WITH EMPHASIS ON PARENT MOTIVATION AND COOPERATION 4. FINANCIAL & SOCIAL IMPLICATIONS OF CI 5. CHANCE OF FAILURE OF CI IN CASE OF COMPLETE OSSIFICATION AND SO AN OPTION OF ABI Station 6
- 11. Audiological Screening Test Results Diagnosis Diseased NotDiseased Total Positives Negatives True Positive (a) = 106 False Negative (c) = 16 False Positive (b) = 10 True Negative (d) = 68 a + b = 116 c + d = 84 Total a + c = 122 b + d = 78 a + b + c + d = 200 The following table shows the results of an audiological screening test conducted among 200 infants at a maternity & child health Institute From this table how would you calculate the following ; •Sensitivity •Specificity •Positive Predictive Value •Negative Predictive Value •Overall Inference from these Tests Station 7
- 12. Sensitivity = TP/ TP + FN = a / a + c = 106 / 122 = 0.868 Specificity = TN / TN+ FP = b / b + d = 10 / 78 = 0.128 Positive Predictive Value = TP / TP + FP = a / a + b = 106 / 116 = 0.913 Negative Predictive Value = TN / TN + FN = d / d + c = 68 / 84 = 0.80 Overall Inference : The Audiological tests have good sensitivity and positive predictive value and hence can be used as effective screening tools. Station 7
- 13. 1. Identify themode of auditory stimulation shown in this diagram 2. Describe the audiological candidacy for using this type of implant 3. Name two clinical scenarios where it is indicated 4. Name two commercially available Devices which work on this principle Station 8
- 14. Bone Conduction BasedImplantable Hearing Device Audiological Candidacy Criteria: a) Patients suffering from either Conductive or Mixed hearing loss as indicated by audiometric testing with bone conduction thresholds better than or equal to 45dB HL at 500Hz, 1kHz, 2kHz and 3kHz b) Single-sided severe to profound Deafness, other ear with normal hearing (air conduction should be equal to or better than 20 dB HL measured at 500Hz, 1kHz, 2kHz and 3kHz) Clinical Scenarios: External auditory canal atresia / stenosis; chronic discharging ears; Extensive recurring tympanosclerosis un-aided by conventional H.Aids; Sudden deafness or acoustic neuroma which cause unilateral severe to profound SNHL Implants Available: a) Cochlear – BAHA / BAHA Attract b) MedEl – BONEBRIDGE c) Oticon Medical – PONTO d) SOPHONO Station 8 Negative marks for wrong ans
- 15. Interpret the salientfindings in the above chart Mention 4 phenomenons which provided added benefits to the above bilateral cochlear implantees when they used both implants simultaneously Station 9 This group of Bilateral Cochlear Implantees when tested for Speech Discrimination Scores in a quiet environment performed significantly better by 15%, while using both the implants simultaneously, rather than with one implant switched-off. a) Head-Shadow Effect is overcome b) Improved Sound Localization Binaural Squelch Phenomenon Binaural Summation & Redundancy
- 16. What is theblood supply of the facial nerve? Describe Sunderland’s classification of facial nerve injury. Name the topodiagnostic tests of the facial nerve. Describe four intratemporal surgical landmarks of the facial nerve. Station 10
- 17. Anterior inferior cerebellarartery Petrosal branch of the middle meningeal artery Stylomastoid branch of postauricular artery . (1 mark) Sunderland’s classification 1st degree - Compression of the nerve 2nd degree - Interruption of axoplasm and myelin 3rd degree - Disruption of endoneurium 4th degree - Disruption of endoneurium and perineurium 5th degree - Transection of the nerve . (1 mark) Topognostic tests reveal the site of the lesion Schirmer`s test Stapedius reflex test Submandibular flow tests- sialometry Tests for altered taste- electrogustometry (1 mark) Intratemporal surgical landmarks Processus cochleariformis Oval window Lateral semicircular canal, fossa incudis Pyramidal eminence - the nerve takes a retropyramidal course Tympanomastoid suture line - just anterior to the facial nerve Digastric ridge - points to the facial nerve at the stylomastoid foramen (2 marks) Station 10
- 18. Identify the organism Whatis the stain used and interpret the type of organism Name the ENT manifestations What are the indications of vaccination in ENT Station 11
- 19. 1. Streptococcus pneumonia. 2.Grams stain , Gram-positive cocci in chains, alpha-hemolytic 3. ENT manifestations include acute sinusitis, otitis media, meningitis, bacteraemia, pneumonia, sepsis and brain abscess. 4. Before Cochlear implantation, Neurosurgical procedures Station 11
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- 21. Balloon Sinuplasty Station 13 •Identifyand describe the procedure •Name 2 indications for this surgery •Mention 2 merits & 2 de-merits of this technique
- 22. Balloon Sinuplasty Station 13 BalloonSinuplasty of Left Frontal Sinus using the Relieva SPIN Balloon Dilatational System Indications: Chronic Frontal Sinusitis, Empyema Frontal Sinus, Frontal Mucocoele, Fungal Granuloma, frontal recess polyps (expanded indications as in BA-FESS) Merits: Advanced technology, Minimally Invasive, Less Morbid & Painless, ‘Day-Care’ Surgery, can be done under LA, No nasal packing required, useful in pts unfit for GA De-Merits: Expensive, Chance of recurrence if not strictly followed-up, Failure in cases where sinus ostium may not be dilatable due to previous scarring / fibrosis / neo- osteogenesis
- 23. What is thedose of this drug? What is the mechanism of action? What are the adverse effects of this drug? What are the applications of this drug? Station 14 B
- 24. Dose - Intravenousinfusion of dexmedetomidine is commonly initiated with a 1 µg/kg loading dose, administered over 10 minutes, followed by a maintenance infusion of 0.2–1.0 µg/kg/hour Mechanism of action - Major sedative and antinociceptive effects of dexmedetomidine are attributable to its stimulation of the α2 adrenoceptors in the locus coeruleus. It also stimulates α2 receptors directly in the spinal cord, thus inhibiting the firing of nociceptive neurons. Adverse effects - hypotension and bradycardia, Applications in ENT - Its applications as a premedication, as an anesthetic adjunct for general and regional anesthesia, and as a postoperative sedative and analgesic are similar to those of the benzodiazepines, for intractable pain, agitation or delirium, treating cancer patients, for DISE Station 14 B
- 25. Name four usesof this drug? 1. Spasmodic Dysphonia 2. Blepharospasm 3. Face lift 4. Strabismus 5. Achalasia 6. Tic Dolourex Give one contraindication to its use? Hypersensitivity What is the mechanism of action? By inhibiting acetylcholine release Station 14 A
- 26. Secondary Endolymphatic HydropsLeft ear Station 15
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- 28. Clinical Examination ofthe Nose Station 17
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- 31. A. McFee Incision 1.Adv – Post irradiated Neck 2. Disadv – Bleeding from the undersurface of the flap - Inadequate exposure B. Conley Incision 1. Adv – smaller posterior triangle flap 2. Disadv – 3 point junction over the great vessels C. Schobinger Incision 1. Adv – 3 point junction is posterior to great vessels 2. Disadv – scar contracture can occur in the vertical incision ½ mark each for naming the incision ½ mark each for Adv and Dis Adv Station 19 Negative marks for wrong ans
- 32. Chimeric superficial temporalartery based skin and temporal fascia flap plus temporalis muscle flap The temporalis muscle flap may be used for reconstruction of oral (floor of mouth, tongue, buccal, retromolar trigone, and palate), oropharyngeal, nasopharyngeal, orbital, maxillectomy and facial soft tissue defects An alternative to free flap for suprastructure maxillectomy with external skin defect Station 19 2 mark
- 33. •Identify the structures A,B, C, D. •Name the structures crossing the carotid sheath. •How is the External & Internal jugular vein formed? Station 20
- 34. A. Posterior Bellyof Digastric Muscle B. Common Facial vein C. Hypoglossal Nerve D. Superior Thyroid Artery Station 20 Each ½ marks, total 2 mark Negative marks for wrong ans
- 35. •Name the structurescrossing the carotid sheath. A. Common facial vein B. Ansa Cervicalis C. Hypoglossal Nerve D. Omohyoid muscle A. EJV • Posterior division of Retromandibular vein • Posterior auricular vein B. IJV • Inferior petrosal sinus • Sigmoid sinus Station 20 Each 1 mark, total 2 mark Total 1 mark Negative marks for wrong ans
- 36. Identify the scansand the procedure done? What is Lothrop & modified Lothrop procedure? Station 21
- 37. Identify the scansand the procedure done? Postoperative CT Paranasal Sinus Coronal section • Scan 1 - showing widening of frontal recess keeping the nasal spine & vertical lamina intact without uncinate process suggestive of procedure Draf 2a • Scan 2 - showing widening of frontal recess without the nasal spine & vertical lamina, intersinus septum and superior part of nasal septum suggestive of procedure Draf 3 Station 21 Each 1 ½ mark, total 3 marks
- 38. What is Lothrop& modified Lothrop procedure? • Lothrop is an external approach to frontal sinus and replaced by modified Lothrop which is an endoscopic procedure otherwise known as draf-3. • widening of frontal recess by removing intersinus septa, floor and superior part of septum (horse shoe shape) • Draf1 is simply anterior ethmoidectomy and clearance of frontal sinus. • Draf2a- frontal sinus opened between lamina papyracea and vertical lamina of Middle Turbinate • Draf2b is between vertical lamina and septum resecting the nasal septum anterior to ventral margin of olfactory fossa. Station 21 Each 1 mark, total 2 mark
- 39. •Spot the diagnosis? •Whatis the commonest cause? •How will you manage? Station 22
- 40. 1. Spot thediagnosis? – Oroantral Fistula 2. What is the commonest cause? – Dental Extraction 3. How will you manage? – Spontaneous closure will not happen in most cases. Immediate closure of an oroantral fistula with a rotating Gingivovestibular Flap is done, which consists of a modification of a vestibular flap. Station 22 1 mark 2 marks 2 marks Negative marks for wrong ans
- 41. •Match the rightanswer, to which coloured box you will be disposing the hospital waste? •How will you manage needle stick injury during surgery? Station 23
- 42. • Match theright answer, to which coloured box you will be disposing the hospital waste? • 1 – C • 2 – D • 3 – A • 4 - B Station 23 ½ mark each right answer Total 2 marks Negative marks for wrong ans
- 43. • How willyou manage needle stick injury during surgery? • The affected area should be rinsed and washed thoroughly with soap and water • Lab tests of the recipient are obtained for baseline studies: HIV, acute hepatitis panel (HAV IgM, HBsAg, HB core IgM, HCV • the infectious status of the source needs to be determined by checking for HBsAG, anti-HCV, and HIV antibody Station 23
- 44. • How willyou manage needle stick injury during surgery? • HIV post-exposure prophylaxis (PEP) should be initiated, ideally within one hour of the injury • follow-up of exposed individuals includes counseling and HIV testing by enzyme immunoassay to monitor for a possible seroconversion for at least 6 months after exposure. Such tests are done at baseline, 6 weeks, 12 weeks, and 6 months, and longer in specific circumstances, such as co-infection with HCV. Station 23 1 Mark for each points Total 3 marks
- 45. 1. Pharyngeal branch 2.Zygomatic branch 3. Zygomaticotemporal 4. Zygomaticofacial 5. Infraorbital nerve 6. Superior labial nerve 7. Anterior superior alveolar nerve 8. Middle superior alveolar nerve 9. Posterior superior alveolar nerve 10. Greater palatine nerve Station 24 Each ½ mark, total 5 marks Negative marks for wrong ans
- 46. A 45 yearold patient is suffering from hard of hearing and tinnitus, 1. Identify the condition 2. What are the types of cells ? 3. Describe the histopathology 4. What are the different methods of treatment of this condition? Station 25
- 47. 1. Acoustic neuroma- 1 2. Antoni A and Antoni B - 1 3. The tumour is composed cells of different cellular -2 densities. More cellular areas (Antoni A,) are composed of a haphazard arrangement of bland cells with spindled and oval nuclei. Loose, less cellular areas (Antoni B,) are composed of a loose oedematous and mucinous stroma with fibrillar collagen. Characteristic Verocay bodies may be seen. These consist of parallel columns of elongated nuclei on either side of a homogeneous acellular material. 4. Conservative, Surgery , Steriotactic radiosurgery - 1 Station 25 Negative marks for wrong ans
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