Brown John Robinson Sandra Young Margaret

Case Study 1: Cleft Lip, Cleft Palate HISTORY Informant: Mother, reliable • 10 month old male child with history of nasal regurgitation while feeding and recurrent ear infection. • Child had frequent episodes of upper respiratory tract infection; was given antibiotics and nebulization for the same, never hospitalized. FAMILY HISTORY: No relevant family history BIRTH HISTORY: • Mother had no history of any drug intake or infection during pregnancy. • full term, LSCS; birth wt: 2.8kg • Passed urine and meconium within 24 hrs • No other congenital anomalies FEEDING HISTORY: • Child was given breast milk since birth and weaning started at 6 months. • He has difficulty in sucking and nasal regurgitation of milk and weaning food. Child is fed with palada. IMMUNIZATION HISTORY: • Child immunized for age DEVELOPMENTAL MILESTONES: • Stands with support • Immature pincer grasp • Waves bye-bye • Utters mama GENERAL PHYSICAL EXAMINATION: • Child playful, afebrile • Length: 75cm, Wt: 8kg, Head circumference: 42cm • No pallor, no cyanosis, no edema • HR-110/min; SpO2-100%; BP-80/50 mmHg; RR-28/min AIRWAY EXAMINATION: • Left unilateral cleft in soft palate approx. 2cm seen in the roof of oral cavity ALL SYSTEMS-WNL INVESTIGATIONS: • Hb- 10.9 g/dl • Hct- 32.8 • TLC- 9100 • DLC- 51/33/1/15 • Platelets- 3,84,000 • Urea- 36 • Creat- 0.5 • Sodium- 141 meq/L • Potassium- 4.2 meq/L Echo: normal study Coagulation profile: • Bleeding time: 2 min 34 sec • Clotting time: 5 min 50 sec • PT/INR: 1.22 SUMMARY AND DIAGNOSIS: • 10 month old term baby born by LSCS, with birth weight 2.8kg, no history of ICU admission or other congenital anomaly, presented with unilateral cleft palate, with nasal regurgitation and recurrent ear infection, with no history of developmental delay/LRTI requiring hospital admission; immunised for age with weight of 8kg, O/E: Left unilateral cleft in soft palate approx. 2cm seen in the roof of oral cavity, admitted to hospital for palatoplasty DIAGNOSIS: Left unilateral cleft palate with normal milestones, no other congenital anomalies.

Case 2: Anemia in Pregnancy PATIENT DETAILS • Name: Ponni • Age: 24 yrs • Address: Attapady • Occupation: Home maker • Education: 6th std • G4P3L2A1 • Gestational age: 36 weeks • W/O Raghu, 30 yr old manual labourer PRESENTING COMPLAINTS • Easy fatiguability x 2 months • Palpitation x 2 months • Swelling on both legs x 2 months HISTORY OF PRESENTING ILLNESS • 24 year old, G4P3L2A1, c/o Easy fatiguability since 2 months, progressively increasing in intensity, relieving with rest. • Palpitation(+) increasingly felt with exertion, Relieved with rest/sleep • Bilateral pedal edema(+), progressive, aggravated on prolonged standing. Decreased with rest/foot end elevation. • No h/o Syncope/chest pain/PND • No h/o generalised swelling/headache/Blurring of vision • No h/o cough with expectoration/ Hemoptysis/evening rise of temperature • No h/o bleeding PV/ leaking PV • No h/o of passing worms in stools • No h/o bleeding PR/malena/hemetemesis • No h/o fever with chills/hematuria/burning miturition • No h/o yellowish discolouration of skin or sclera HISTORY OF PRESENT PREGNANCY FIRST TRIMESTER • UPT +ve on 26/12/2020, 2 wks after missing periods • Regular antenatal checkups from nearby PHC • Hospital admission for hyperemesis gravidarum(+) • 2 doses of TT was taken • Folic acid tablets were not taken regularly • No h/o bleeding PV/abdominal pain/fever with rash/UTI/radiation exposure/drug intake • USG @11 wks : Normal SECOND TRIMESTER • Quickening felt at 4 and half months • Anomaly scan @ 20 wks: Normal • 75 g GTT: Normal • Irregular intake of Iron, Folic acid & Calcium tablets • No h/o GDM/GHTN/bleeding PV/leaking PV THIRD TRIMESTER • Patient appreciates adequate fetal movements • No h/o GDM/GHTN/bleeding PV/leaking PV/abdominal pain. • USG done during present admission reported that fetal growth did not correspond to gestational age. PAST OBSTETRIC HISTORY • G4P3L2A1 • First and Third pregnancy FTNVD • Second pregnancy - Spontaneous abortion at 2 months • H/o anaemia in the Third pregnancy requiring 1 unit blood transfusion (37 weeks of gestation) • Second child was born with Low birth weight(2.3 kgs). MENSTRUAL HISTORY • LMP - 11-11-2020 • Menarche at 14 yrs • Regular 28-30 day cycles with 6 days of menstrual flow • No h/o dysmenorrhea/menorrhagia MARITAL HISTORY • Non consanguineous marriage at the age of 17 yrs • No h/o contraceptive use PAST HISTORY • No H/o DM/HTN/CAD/CVA/BA/PTB/Jaundice/Seizures/Measles/Mumps/Chickenpox • No H/O previous surgery/Drug / Food allergy • No H/O Covid 19/ Recent RTI FAMILY HISTORY • No H/o DM/HTN/Heart disease/BA/Malignancy/Abortions/Congenital anomalies in the family PERSONAL HISTORY • Sleep - Normal • Non vegetarian • Appetite - Normal • Bowel & Bladder habits- Normal • Addictions - Nil SOCIOECONOMIC STATUS • BPL family • GENERAL EXAMINATION • Patient conscious, oriented in time, place and person • Moderately built, Poorly nourished • Ht- 150 cm, Wt- 52 kg, BMI-23 • Pre pregnant wt - 45kg, wt gain-7 kg • Pallor(+), bilateral pitting pedal edema (+) • No Icterus, Cyanosis, Clubbing, Lymphadenopathy • Skin- Pale, Nails -vertical ridges(+) • Head to foot examination - normal • Spine - No Tenderness VITALS • PR- 96 /min, Regular rhythm, Normal Volume and Character, no Radio - Radial delay/ Radio - Femoral delay, All peripheral pulses felt equally , bilaterally • BP -108/76 mm Hg Rt Upper limb in sitting position • Afebrile • RR- 24/min,Regular AIRWAY EXAMINATION • MO >3F, TMD>3F, TMJ 1F, MMPC 2 • No loose tooth, artificial tooth, buck tooth • Neck movements - WNL. OBSTETRIC EXAMINATION INSPECTION • Abdomen is longitudinally distended • Flanks not full • Umbilicus everted • Stria gravidarum and linea nigra seen • Hernial orifice normal • No engorged veins PALPATION (LEGS SEMIFLEXED) • Fundal height correspond to 32 weeks • Symphysio-Fundal height 33 cm • Abdominal girth- 97 cm FUNDAL GRIP • Broad, soft, irregular, non ballotable mass suggestive of Breech is palpable UMBILICAL GRIP • Firm, uniform resistance felt over left side s/o Back of baby • Multiple nodules s/o Limbs on the Right side FIRST PELVIC GRIP • Hard, round, freely mobile, ballotable mass ; head → cepahlic presentation SECOND PELVIC GRIP • Occiput is at a lower level than Sinciput → flexed head / not engaged Auscultation • FHS- 142/min obtained over the left side inferior of umbilicus CVS • PR - 96 bpm, regular, normal volume and character, no Radio-Radial / Radio-Femoral delay, all peripheral pulse felt equally and bilaterally, vessel wall not palpable • BP - 108/76 mm Hg in Right Upper Limb in sitting position • JVP - Not elevated INSPECTION • Shape of precordium - normal, no precordial bulge/chest deformities • Apical impulse not seen • No other visible pulsation, engorged veins or pigmentation • No Scars, Sinuses or Accessory nipple PALPATION • Apex beat felt in 4 th Left ICS lateral to MCL • No palpable P2/ Left Parasternal Heave • No thrill or other palpable pulsations PERCUSSION • Liver Dullness 4th Right ICS • Right Heart border corresponds to Right border of Sternum • Left Heart border corresponds to Apex • 2nd Left ICS Dullness - Normally felt AUSCULTATION • 1st and 2nd heart sound normal • Ejection systolic murmur of grade 3/6 heard in the aortic area, no radiation • No adventitious sounds (clicks, Rub) • GASTROINTESTINAL TRACT WNL • RESPIRATORY SYSTEM WNL • CENTRAL NERVOUS SYSTEM WNL SUMMARY • 24 year old female, G4P3L2A1, Gestational Age 36 weeks hailing from socioeconomically backward family • C/O Easy fatiguability, dyspnea on exertion, and palpitation for past 2 months. • H/O Irregular intake of iron and folic acid tablets. • Third trimester USG scan shows fetal growth restriction. • Multiple closely spaced pregnancies at an early age. SUMMARY cont'd O • H/o Anaemia requiring blood transfusion in the Third pregnancy • Low birth weight baby(2.3kgs) in the previous pregnancy. • On examination she is poorly nourished, has Pallor,vertical ridges in the nails, and Ejection systolic murmur in the aortic area. • Poor weight gain during present pregnancy and size of Uterus doesn't correspond to gestational age.. PROVISIONAL DIAGNOSIS • 24 YEAR OLD,G4P3L2A1,GESTATIONAL AGE 36 WEEKS, WITH ANAEMIA COMPLICATING PREGNANCY PROBABLY DUE TO IRON DEFICIENCY.

Nice answers by the students.. ALMS unnecessary🙏🙏 Gurudutt sir should've finished till the end..

Cost is very important factor for its implementation.

Can't thank you enough for this amazing class ma'am

Thank you madam. Helped me a lot. Vaporiser was a bit difficult for me to understand😢

Excellent class by josheph sir on airway USG !!!!❤

😮

Excellent teaching sir

❤

Great class mam. Tq.

Seems more like exam viva rather than presentation . The PG is stressed out.

Very good discussion

Very informative sir

Good lecture on segmental anaesthesia

Airway USG 54:00

Thank you sir

Very good quick review

Too much interruption by one professor here

Thank you sir.... kindly tell the name of the modification of smith test...genny s??sir.

SIR THERE ARE MANY CONTRAINDICATIONS FOR TONSILLECTOMY SIR

Very boring lecture. Just reading out the ppts. This is how we used to take classes in 1st year😂

Thank you sir

Kindly Provide link for next session

This looks like an exam viva rather than a case discussion

Thank you Very much Sir. Very much informative. ❤

Sir we have only hyperbaric bupivacaine 0.5% how to make isobaric bupicacaine out of it ?!

Nice lecture … thanks

Thank you😊

So much of thanks sir, loved your teaching

Thanks

very very awesome sir. thank u so much sir !

Choukouria

Sir is making the girl go crazy,,, and girl is not answering to the point she is giving sir chances to ask more and more question by saying other stuffs 🙏

Wonderful session sir

excellent presentation, sir

Mam I am a fan of your Great teaching,if we get your more lectures on all topics of anesthesiology ,it will be a Blessing for all students..If possible plz consider my request..

Very Good lecture Although the classification of breathing systems is confusing and need re updating

Thankyou so much Ma'am

Thank you so much maam

Nice qt round

Wonderful discussion 😊

Fantastic.❤ thank you

Thank you

Well done doctors you really exhausted anemia

The background music is disturbing a lot wt the hell is that,,,,,, the case discussion is amazing gurudatt sir ❤

Thanks sir,, very good class

Loud S1 due to stiff but mobile Mitral valve leaflets closure as elevated left atrial pressure keeps them relatively wide apart. Loud S1 is heard in mild to moderate MV stenosis . In severe MV stenosis , S1 is soft.

With all due respect, I would like to request to encourage pgs rather than making them feel terrorised of questions ! Pls make pgs feel comfortable, so that they become confident anaesthesiologists in future !