PCAT hx and case - Summary of said topic PDF

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PCAT script hello, my name is …. I am a second year medical student. Your GP has asked me to come and talk to you today is that ok? Pt: yes, that is ok : may I confirm your name and date of birth please Pt: *name and DOB given* perfect, thank you! How can I help you today? Pt: well I’ve not been feeling too great lately, my nose is all blocked and my throat feels very sore. *perhaps open up the opportunity for differential diagnosis/ ask group what other things need to be asked* That doesn't sound great, could you tell me how long this has been going on for? Pt: well to be honest, I thought it was just a normal cold; my daughter had been sick for a few days but had gotten better so I thought I had caught it from her. It’s been a week now and it doesn’t feel like my condition has improved all. : so you feel like it hasn’t gotten any better? Has the pain gotten worse? Pt: well, I feel like the pain has actually spread. My throat and nose are sore, but it feels like below my ears are painful too and its started traveling down to my chest. So the patient has developed nasal symptoms can anyone tell me about the nasal anatomy (using skulls) Major features of the wall of nasal cavity That must be really horrible, do you have any other symptoms developing? Pt: I have been having these awful headaches which I try and sleep off. It also feels like I am starting to get toothache too. : Can anyone tell me why the patient maybe having headaches and toothache ?.... The patients sinuses are probably infected, since they haven’t gone away for a while prescribing antibiotics may be an option. Sinusitis is also really clear on imaging, as you can see in these … Finally we have a quick kahoot to cover what we have gone through today... Could we talk about coryzal symptoms link and tx? Open question to all group -

What could the pt have What further questions need to be asked How would you treat the pt ( not sure if this is applicable just yet)

Kahoot review : link to Kahoot will be inserted here.

Make not that folder with all resources is available

(1) 1. Talk about the different bones – get the group to point them out on the skull 2. Talk about the location of the different paranasal sinuses – how this links to headaches & toothaches 3. Talk about the drainage through the lateral wall

Major bones of Nasal cavity

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Gather around anatomage table talk through the sinuses – link to clinical anatomy  

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Can anyone name a sinus and point it out on … Frontal: o Variable in size as shown between ect. o This drains into the Middle meatus via the frontonsal duct o Innervated by the supra-orbital nerve from the ophthamic nerve Ethmodial: o Formed by a variable number of individual chambers – divided into anterior, middle and posterior ethmdial cells

Anterior drain --> frontonasal duct – which other Sinuse drains into this? Middle – open into the ethmodial bulla, or onto lateral wall Posterior ethmodial cells open onto the lateral wall of the superior nasal meatus Innervated by anterior and posterior ethmoidal branches of the ophthalmic nerve and maxillary nerve via orbiatl branches Maxillary o Largest o Anterolateral surface is related to the roots of the upper molar and premolar teeth which is toothache cause o Drains semilunar hiatus near the middle nasal meatus o Innervated by maxillary nerve Sphenoidal sinuses o Drains into the superior meatus o Posterior wall of the spheno-ethmoidal recess o Thin shelves of bone separate the sphenoidal sinuses from the nasal cavities below and hypophyseal fossa above – Why is this important : as it means the pituitary gland can be surgical approached through the roof of nasal cavities by going through sphenoid bone and then into the sphenoidal sinuses then through into the hypophyeal fossa o Opthalmic nerve and maxillary nerve o o o o

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Pain and headaches come when these get mucosal membranes become infected so swell and get blocked with mucus which lead to an increased pressure and headache Worried about frontal sinus – lead to ostemoyitis – brain absecc or meningitis Worried about ethmodial sinus – break the delicate eye socket – infection in eye - blindness...