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By: I. Hamil, M.B.A., M.D.
Deputy Director, Touro College of Osteopathic Medicine
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Mastoid segment: It turns as 2 genu and runs vertically downwards behind the tympanic cavity, giving nerve to stapedius and chorda tympani nerve. Extracranial course: the nerve leaves the skull through the stylomastoid foramen, passes between the superficial and deep lobes of the parotid gland and divides into its terminal branches that innervate the face muscles. The greater superficial petrosal nerve: it contains secretomotor fibers to the lacrimal glands and nasal mucosa. Chorda tympani nerve: arises in the vertical part, it contains: Secretomotor fibers to the submandibular and sublingual salivary glands and afferent taste fibers from the anterior 2/3 of the tongue. Muscular branches: After the nerve comes out from the stylomastoid foramen, it gives nerves to muscles of expression, muscles of the auricle, occipitofrontalis, stylohyoid and posterior belly of digastric. Only the lower 1/2 of the face is paralysed Upper and lower halves of the face are (upper half being supplied from both paralysed. Loss of both voluntary and involuntary Loss of only voluntary with intact (emotional) movements. Tympanic segment above the nerve to stapedius: Loss of stapedial reflex and Hyperacusis. Mastoid segment above the chorda tympani: Loss of taste on the anterior 2/3 of the tongue. Mastoid segment below the chorda tympani (at the stylomastoid foramen): Lacrimation, stapedial reflex, taste and salivation are intact. Extra cranial part: Lacrimation, stapedial reflex, taste and salivation are intact. Examination of the ear: may show manifestations of acute or chronic suppurative otitis media, Herpes zoster oticus, malignant otitis externa, glomus tumour or carcinoma. Then the length of the moistened segment of paper is measured on the paralysed and normal sides. It is significant when the difference between the lacrimal flow on both sides exceeds 30% of the total bilateral lacrimation, indicating a lesion at or proximal to the geniculate ganglion. Stapedial reflex (for stapedius muscle): Lost in any lesion proximal to the nerve to stapedius. Qualitative: compare taste of salt, sugar, sour and bitter applied to lateral edge of the anterior 2/3 of the tongue b. Salivary flow rate test: compares the amount of saliva by cannulation of submandibular ducts in both sides. Determine the minimal electric current in milliamperes required to produce just visible contraction and compare both sides. Record the evoked action potential of the muscles when stimulated by maximal stimulation of the nerve and compare both sides. Care of the eye: the eye is at risk due to lack of blinking, incomplete closure, decreased lacrimation and corneal exposure.
Syndromes
- Amount swallowed
- Alport syndrome
- Keep you from starting to use tobacco again.
- Collapse
- Large jaw (prognathism) and tongue
- Blood clot
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Adopt a compassionate attitude toward towards the patients (and their families) under his/ her charge. Critically evaluate and initiate investigation for solving problems relating to skin, venereal diseases and leprosy. Evaluate and manage the common diseases in dermatology and have a broad idea how to approach an uncommon diseases. To achieve adequate skills for tests done in side laboratory in day-to-day practice and be familiar with other sophisticated investigations. During postings 2nd and 3rd year residents or senior residents will give cover to first year residents and have active involvement in the diagnosis, investigations and treatment of the admitted patients. Internal assessment this will be carried out every three monthly be means of written test and practical with viva examination every six months. Thesis Each student is expected to write thesis under the guidance of one ore more faculty members as per the institute rules. The protocol to be submitted within 6 months of joining and thesis submission within 2 ½ years of joining the 3 year course. Weekly by senior resident an consultant for regularity, patient care, records and library search. Title of the paper Paper I : Basic sciences, anatomy, physiology, biochemistry, pathology etc. Practical and/or clinical examination will be held on 1-2 days Semi-Long case 4 Dermatology – 2 Venereology – 1 Leprology – 1 Spots:10-12 Spot same for each candidate 2. Fundamental • History taking and examination of dermatological patient • Type of skin lesions • Distribution patterns • Aids in diagnosis of skin diseases etc. Biochemistry and Physiology of epidermis and its appendages including • Melanin synthesis • Keratinization • Pathophysiologic reactions of skin • Basic immunology Skin Diseases 1. Disorders effecting skin appendages, hair, nail, sebaceous glands, sweat glands and apocrine glands etc. Dermatitis: exogenous – contact dermatitis, patch testing, endogenous – atopic acquired endogenous nummular 7. Disorders of hair, nail sweat glands, sebaceous glands, apocrine glands, mastocytosis etc. Disorders due to chemical agents – reactions to chemicals, occupational dermatosis 14. Dermatology in relation to internal medicine Nutritional diseases – protein and vitamin deficiencies Metabolic disorders 1. Dermatosurgery the course would consist of lesions in basic techniques of dermatosurgery or various diseases and laser. For Vitiligo • Punch grafting • Split skin grafting • Dermabrasion and suction blister grafting • Tattooing For Acne • Dermabrasion Course and Curriculum of M D Dermatology and Venereology 65 • Scar revision • Chemical peeling For Melasma • Chemical face peels with glycolic ad trichloroacetic acid For Nevi and Keloid etc. Practical – They would be subjected to questions on various dermatosurgical procedures and instruments related to these procedures during their viva voce examination. Teaching Methods for Dermatopathology • 10 ttheory lectures in form of seminar, journal club • Dermatopathology discussion every week.
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A randomized controlled paring patients with major depressive disorder treated trial by Croft et al. A meta-analysis of six studies efficacy to fluoxetine with a significantly lower burden of (1027) found mirtazapine to have comparable efficacy to side effects (1017. Lower rates of sexual dysfunction have amitriptyline over 6?8 weeks, with both drugs showing also been found with bupropion compared with sertraline superiority to placebo. In both studies, the treatments had taking mirtazapine had about a 50% reduction in relapse equal efficacy at study endpoint, but mirtazapine demon rates. Another trial ran more weight than those taking placebo across the 9 months domly assigned elderly depressed patients (at least age of continuation phase therapy. Nefazodone and trazodone pine showed a greater benefit at day 14, had less attrition the efficacy of nefazodone has been established in pla for side effects, and was significantly more effective in im cebo-controlled trials, with efficacy comparable to both proving sleep. In a review of 18 studies from 1980 observed when mirtazapine was compared with citalopram through 2003, Mendelson (173) found that trazodone, when (N=270) in an 8-week trial (1036) and when an oral disin compared with various control groups, did improve sleep. In an 8-week trial, Since the first trial in which a tricyclic compound (imi Guelfi et al. Mirtazapine controlled trials have demonstrated the efficacy of this an and venlafaxine did not differ significantly in depression tidepressant class as a treatment for major depressive dis outcomes, although sleep was better with mirtazapine, order (105. The efficacy of individual agents and subclasses of mirtazapine showed greater benefit during the first 15 days tricyclics (e. There were no significant differences in any randomized controlled trials of amitriptyline, generally of outcome measure, and the medications were comparably 6?8 weeks? duration, in inpatient and outpatient settings. Selective serotonin reuptake inhibitors were Mirtazapine has been shown to decrease rates of re better tolerated. Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition 87 ized controlled trials conducted between 1979 and 1991, ing subgroups of patients with major depressive disorder with a combined sample size of 1,555 men and 2,331 women. Interpersonal psy cated in two subsequent studies by Amsterdam (124) chotherapy alone. Clinical experience sug in all measures in preventing relapse than the 15 patients gests that some patients who fail to benefit from one of randomly assigned to receive placebo. Re a 3-week period in a randomized double-blind trial of mission occurred in only about one-third to one-half of 92 patients and found no difference in response rates be the sample, and two-thirds of those with remission expe tween the two electrode placements. In terms of the time to recover reorien ies overall have yielded heterogeneous results. However, for active treatment and for sham treat with more prominent effects on cognition at follow-up as ment, remission occurred in fewer than 10% of subjects sessments (253, 1081. Studies with placement produced prolonged anterograde amnesia stimulation intensities below 90% of motor threshold ap (1076.
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Diagnosis the major clinical features therefore include hypopigmented anaesthetic macula or nodular and erythematous skin lesions and nerve thickening. General information: all three names, sex, year of birth, full address form home to clinic, ioccupation? Main complaints, including date of onset, site of first lesions, subsequent changes and development received. Physical examination should always be carried out with adequate light available and with enough privacy for the person to feel at ease. To ensure that no important sign is missed, a patient must be examined systematically. A well tried system is to examine the patient as follows: o Start with examination of the skin, first head, then neck, shoulders, arms, trunk, buttocks and legs o Then palpation of the nerves; starting with the head and gradually going to the feet o Then the examination of other organs o Examination of the skin smear o Finally the examination of eyes, hands and feet for disabilities. Complications due to nerve damage Patients should be examined for the following complications which result from nerve damage:? Mark and draw also wounds, clawing and absorption levels on the maps using the appropriate marks. Leprosy is classified into two groups depending on the number of bacilli present in the body. Classification is also important as it may indicate the degree of infectiouness and the possible problems of leprosy reactions and further complications. The presence of bacilli in the skin smear Skin smear is recommended for all new doubtful leprosy suspects and relapse or return to control cases. This certainly applies to patients who have been treated in the past and of who insufficient information is available on the treatment previous used. Treatment of leprosy with only one drug monotherapy will result in development of drug resistance, therefore it should be avoided. Patient having multibacillary leprosy are given a combination of Rifampicin, Dapsone and clofezimine while those having paucibacillary leprsosy are given a combination of Rifampicin and Dapsone. For the following 27 days, the patient takes the medicines at home under observation of treatment supporter. When collecting the 6th dose the patient should be released from treatment (treatment Completed)? The management, including treatment reactions, does not require any modifications. Leprosy Reactions and Relapse Leprosy reaction is sudden appearance of acute inflammation in the lesions (skinpatches, nerves, other organs) of a patient with leprosy. Sometimes patients report for first time to a health facility because of leprosy reaction. SevereErythema Nodosum Leprosum: Refer the patient to the nearest hospital for appropriate examinations and treatment. For health facilities without laboratory services, one must treat on clinical grounds i. In syndromic approach clinical syndromes are identified followed by syndrome specific treatment targeting all causative agents which can cause the syndrome.
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