OSPE Instruments
Dr. Mahmudur Rahman Siddiqui
MBBS, FCPS (Medicine), FACP FCCP
Associate Professor of Medicine
Lumber Puncture Needle
Q. Identify the instrument.
• Lumber puncture needle
Q. Mention its parts.
• Trocker & Cannula.
Q. Write down the clinical
use / indications of LP.
Use of LP
• Diagnostic:
– Infection (meningitis, encephalitis),
– Subarachnoid haemorrhage,
– Inflammatory condition (GBS, MS, sarcoidosis),
– Measurement of CSF pressure (BIH),
– Neurological malignancy (lymphoma, leukaemia,
carcinomatous meningitis)
– Part of Myelography,
• Therapeutic:
– To administer drugs:
• Intrathecal injection of Methotrexate (MTX) in ALL,
• Spinal anaesthesia (CS)
– To lower CSF pressure (Benign intracranial hypertension
BIH / IIH)
Contraindications of LP
• Raised intracranial pressure (ICP) in
suspected intracranial space occupied
lesion (ICSOL),
• Local infection,
• Thrombocytopenia or DIC and
• in those on warfarin or heparin therapy,
• What are the site of LP?
– Between L3 & L4 (at the level of hight point of iliac
crest),
– Cisternal puncture in children.
• Write down the procedure of LP?
– Informed written consent.
– Aseptic precaution (wash with povidon iodine,
spirit),
– Left lateral position,
– Local anaesthesia,???
– Needle is inserted be………..& the stylet is
withdrawn.)
– CSF is collected in 3 sterile vial & sent to
laboratory.
• Clinical signs of raised ICP?
– Bradycardia,
– Hypertension,
– Depressed consciousness,
– Bilateral papilloedema,
– 6th Cranial nerve palsy, false localizing sign.
• Complication of LP if done in ICSOL pt.
– Coning of medulla (shift of intracerebral
contents downwards, towards and into the
spinal canal)
complications of LP
• Post lumber puncture headache (30%),
• Transient radicular pain, pain over lumber
region,
• Local infection, bleeding,
• Introduction of infection into meninges
(rare),
• Coning of medulla,
• Para vertebral venous plexus injury,
Bone marrow aspiration needle
Q. Identify the inst.?
• Bone marrow
aspiration needle,
Q. Mention its parts?
• Trocker (stylet),
• Cannula,
• Adjustable Guard,
What are the sites of BM puncture?
• Adult:
– Posterior iliac crest,
– Maubrium Sterni or body of sternum,
• Children (<2 yrs):
– Upper part of the tibia (Medial part).
Procedure of BM puncture
• Informed written consent,
• Patient with supine position,
• Asedptic precaution,
• Local anaesthesia (lignocaine 2%),
• Gird fixation,
• Boring with the needle with 90o vertically,
• Suction,
Indications of BM puncture
• Diagnostic:
– Hematological malignancies (Leukaemia,
multiple myeloma, staging of Lymphoma)
– Aplastic anaemia, ITP
– Megaloblastic anaemia,
– Infection : KalaAzar, PUO, TB,
– Secondaries in marrow,
– Unexplained anaemia, splenomegaly,
lymphadenopathy, hepatomegaly)
• Prognostic:
– Acute Leukaemia
Complications of BM puncture
• Bleeding,
• Local infection,
• Local pain,
• Injury to underlying structure; Aorta
Contraindications
• Local infection,
• Blood dyscracias; haemophilia,
• Anticoagulation,
• Non-cooperative patient,
IV Cannula
Metallic Tongue Depressor
• Identify the spacimen,
• Mention its parts?
– Broad part (to depress
tongue),
– Holding part,
Use of tongue depressor
• Examination of the oral cavity:
– Tonsilitis,
– Diphtheria,
– Oral ulcer,
– Oral thrush,
– Measles Koplic spot,
• Removal of foreign body from the pharynx
Airway Tube/Oropharyngeal tube
Airway Tube/Oropharyngeal tube
• Identify the specimen?
– Airway Tube/Oropharyngeal tube,
• Write down the uses of it?
– To prevent tongue fall back in unconscious
patient,
– Maintain clear airway,
– Oropharyngeal suction.
Ryles Tube / Nasogastric Tube
• Identify the specimen.
• What are the marking?
– From the incisor teeth:
– 40cm- cardiac end,
– 50cm- body of stomach,
– 60cm- pylorus,
– 68cm- 2nd part of
duodenum,
• How to confirm the position of tube in
stomach?
– Aspiration of stomach content,
– Auscultation of the abdomen after providing
air through tube,
– X-ray chest,
• How can you suspect that the tube in
lung?
– Patient cough violently,
– On emersion of tube in water, bubble appears
in water.
– X-ray chest,
Indications of NG tube
• Therapeutic:
– Feeding & drug administration in unconscious,
– Feeding in pt. with bulbar palsy to prevent aspiration e.g.
MND,
– NG suction in pt with acute abdomen, e.g. intestinal obst,
perforation, gastric outlet obst,
• Diagnostic:
– Gastric juice analysis for PUD, achlorohydria,
– 24 hrs oesphageal PH monitoring in GERD,
– Stomach aspirate to detect infection e.g. Tuberculosis,
– Toxicological analysis of gastric juice in poisoning,
Complications of Ryle’s tube
• Entrance of tube in respiratory tract,
• Aspiration pneumonia,
• Haemorrhage,
• Infection,
ESR tube
• Identify the instrument
• What are the methods
of ESR estimation?
– Weatergren method,
– Wintrobe method,
• Mention the marking of Westergren tube?
– Westergren tube: mark 0-200mm, length
300mm, breath 2.5mm,
• Normal ESR
– Male: 0-8mm in 1st hour,
– Female: 0-12mm in 1st hour,
• Clinical importance of ESR?
What are the causes of raised ESR
• Chronic infection: TB, Kala-azar,
• Malignancy,
• Acute inflammatory disease: Acute rheumatic
fever, systemic vasculitis,
• Collagen disease: SLE, Sjogren’s syndrome,
• Haematological malignancy: Multiple
Myeloma,
• Pregnancy, old age,
Very low ESR
• Polycythemia,
• Hereditary spherocytosis,
• Sickle cell anaemia,
• Hypoproteinaemia,
Spacer / Respochamber
• What is the device?
• What is the use?
– Inhalation of drugs in
children / elderly,
• What are the
advantages of it?
– More efficacy,
– Less oropharyngeal
deposition,
Peak flow meter
• What is the use?
– To measure diurnal
variation of PEF in
bronchial asthma,
– To asses severity of
asthma,
Metered Dose Inhaler
Accuhaler
• For inhalation of Salmeterol, Fluticason,
Nebulizer
Nebulisation with salbutamol, ipratropium bromide, budisonite
• Thank you