BIOS222 TUTORIAL ACTIVITY SESSION 1

Transcription

1 BIOS222 TUTORIAL ACTIVITY SESSION 1 Instructions: The Tutorial activities are designed to help you practice the concepts learned in the lecture. Read the following case studies and answer the questions below. You may need to read other text books and websites to find some of these answers. It is important that you follow the clinical management pentagon for the case analysis. Think of a facet that incorporates to each of the question of the case study. Research, analyse and answer the questions to meet the criteria of the identified facet. You may sometimes find that not all the facets could be applied to a tutorial case study all the time. Try and identify as many relevant facets as you can and answer the questions accordingly. Facets of clinical management pentagon: A. Observe and ask: Define and specify the problem B. Find and generate: Gather information/data and generate knowledge C. Analyse and Interpret: Analyse the information/data collected and create your interpretations. D. Investigate and reflect: Critically evaluate the information and reflect on the evidences E. Synthesize and apply: Decide what information and which sources to rely on, synthesize the evaluated information and apply the gained knowledge to achieve the desired outcome. F. Organize, manage and communicate: Effectively convey your proposals/opinions/options/actions/results/ recommendations etc. to others Key concept covered: Understanding the pathophysiology of common disorders affecting ears, nose and throat Case Study 1 5 year Old Nick presented with right ear pain for 2 days. He previously had rhinorrhea, nasal congestion, and cough, for 1 week which resolved 4 days ago. There was no temperature previously but yesterday he had a temperature of 39 C. Mum gave him Panadol for fever and pain. Nick feels more tired than usual. He is taking additional naps during the afternoon and waking up at night in pain. He had been unable to attend school due to the pain and fever. He is not eating well as he feels nauseous while eating. Additionally, Nick had been feeling dizzy occasionally while playing outside with his 3 years old brother. His mother also mentioned she has to speak louder than usual for Nick to hear when she is reading a book to him for the last 2 days. Past history: Acute Otitis Media twice in the past three years. Treated with a course of antibiotics. History of recurrent upper respiratory infections. No overnight hospitalizations or surgeries. No other major disease conditions in past. Clinical examinations: Vital signs Result Normal range(for this age group) Temperature 39.2 C C (axillary) Last updated on 1-Mar-17 Page 1 of 10

2 Pulse rate 84 beats per minute, Regular beats per minute Respiratory rate 18 breath per minute breaths per minute Questions: 1. Discuss the key diagnostic features this patient is presented with. What further questions would you like to ask to identify the likely condition? 2. Based on clinical presentation suggest the type of otitis media this patient may be suffering from. 3. Discuss the pathological mechanism of your suggested diagnosis. Relate the pathophysiology to the clinical presentation of this patient. 4. Discuss further examination and investigations you would like to perform to confirm your suggested diagnosis. 5. Discuss how otoscopic examination of tympanic membrane is helpful in diagnosis of various types of otitis media. What would you expect to see on an otoscopic examination in this patient considering the presenting complaints? 6. Discuss clinical management options for this patient s condition. 7. Discuss the complications of your suggested diagnosis for this patient if left untreated. Activity1: Go through the disease charts of the below disease conditions on lecture notes and identify key points of the disease conditions. Meniere s disease Influenza Try developing a similar disease chart for Allergic rhinitis. Activity 2: Observe the appearance of tympanic membrane below to identify different types of Otitis media. Note: The Images and description below are taken from: You can review more images by visiting this website. 1. Acute Suppurative Otitis Media Description: The earliest visible otoscopic change in acute suppurative otitis media consists of redness, edema, and bulging of the pars flaccida. This is the stage of Eustachian tube obstruction Last updated on 1-Mar-17 Page 2 of 10

3 2. Acute Otitis Media Description: Shortly after, a creamy white purulent effusion can be seen collecting in the middle ear. This is the early stage: stage of redness. 3. Perforated Otitis Media - Description: This adult who has a long-standing perforation in the right tympanic membrane developed an acute otitis media following a severe viral upper respiratory infection. A mixture of creamy white purulent material and clear mucus can be seen draining into the external canal through the large antero-inferior perforation. Last updated on 1-Mar-17 Page 3 of 10

4 4. Acute Otitis Media Description: This is the stage of resolution. The stage of resolution may be modified by antibiotic therapy. Note the air fluid level, and collection of white and presumably sterile exudate in the inferior third of the middle ear. 5. Acute Otitis Media Description: the infection in the middle ear has extended through the bulging tympanic membrane. Note the swollen keratin patches on the lateral surface of the tympanic membrane Last updated on 1-Mar-17 Page 4 of 10

5 6. Acute Otitis Media Description: This patient presented with an acute otitis media in the stage of suppuration. Note the redness and bulging of the pars flaccida and the accumulation of a creamy white purulent exudate in the middle ear. There is a moderate outward bulging of the eardrum. 7. Early Acute Otitis Media Description: The middle ear then becomes completely filled with the purulent exudate the pressure of which causes the tympanic membrane to bulge laterally. This is the stage of suppuration Last updated on 1-Mar-17 Page 5 of 10

6 8. Advanced Suppurative Otitis Media Description: The infection in the middle ear may extend into the tympanic membrane causing infection and necrosis with rupture of the radial vessels. Note the central area of interstitial hemorrhage. 9. Severe Acute Otitis Media Description: The infection in the middle ear may spread into the fibrous middle layer of the tympanic membrane causing necrosis of a portion of the fibrous middle layer. The small herniation of the seen in the center of this right tympanic membrane just posterior to the mid portion of the malleus represents such a necrotic area. The tympanic membrane has lost its strength in the area Last updated on 1-Mar-17 Page 6 of 10

7 of necrosis and the pressure of the purulent effusion within the middle ear has caused the epithelium to bulge laterally. This is the area through which a perforation will shortly develop. 10. Mucoid otitis media Description: The otoscopic appearance of mucoid otitis media is quite variable and depends upon the degree of inflammation present and the amount of exudate remaining in the middle ear. At first glance, this tympanic membrane appears to be normal; however, on careful inspection it is apparent that the middle ear is filled with a Grey fluid. Note how opalescence of the fluid prevents the examiner from seeing 'into" the middle ear 11. Mucoid Otitis Media Description: The middle ear is filled with typical opalescent thick glue like fluid which prevents the examiner from viewing the medial wall of the middle ear. Last updated on 1-Mar-17 Page 7 of 10

8 12. Serous Otitis Media Description: Serous otitis media is characterized by the presence of a thin straw colored clear transudate in the middle ear. The tympanic membrane shows an orange discoloration from the fluid which fills the middle ear cleft. The clear nature of the fluid allows the examiner to look into the depths of the middle ear. Last updated on 1-Mar-17 Page 8 of 10

9 13. Serous Otitis Media Description: characterized by the presence of a thin straw colored clear transudate in the middle ear. 14. Chronic suppurative otitis media: with mucopurulent discharge Last updated on 1-Mar-17 Page 9 of 10

10 15. Chronic suppurative otitis media: with perforated ear drum Last updated on 1-Mar-17 Page 10 of 10