ENT :

1. Perform ear syringing ( Foreign body, impacted wax) ( careful not to stimulate vagal syncope on the
mannequin- hence the upward holding technique)
2. Otoscopy ( ASOM/CSOM/Foreign body/fungal inf/perforated TM)

Opthal :
1. Fundoscopy ( stages of diabetic retinopathy, stages of hypertensive retinopathy)
For the ear syringing mannequin, there r a total of 11 ear sets there : normal, bigger ext aud canal, som, mom, csom, asom,
cholesteatoma, tympanosclerosis, traumatic perforations, cerumen block,


list of counselling 4 commed
1.Needle stick injury
2.Family planning
(contraceptive and etc)
3.HiV
4.Quit smoking
5.Occupational asthma
6.vaccination schedule and how to give injection




List of counselling for paeds
1.Breast feeding/ 'mother comes with complains of child not feeding properly'
2.Down syndrome/Thalasemia/Cerebral palsy
3.Nutrition
4.Child with failure to thrive and/or developmental delay.
5.Asthma and inhaler technique.



Breast counseling


Counseling is different from theoretical knowledge. It is what you will actually tell a mother when she will come to you for such
advice, in exactly the same way, in her language (i.e. in layman's language)

READ THE QUESTION CAREFULLY - a lot of you forgot all the points you were supposed to elaborate on -(i) assess if the baby is
getting enough milk; (ii) counsel the mother on how, (iii) when (iv) how long she should breast feed the baby.

Some of you started very well, but some of you thought (and said so!) you had to teach the patient. Talk to her as an equal,do not
"talk down"to her.Some even said "I am here to teach you".

Begin by asking her what her problems are (even if that is written on the note, she may be having more problems), how she is
feeding the baby, and praise the mother for what she is doing.

How do u assess if the baby is getting enough milk? By ASKING the mother how long does he sleep after a feed? how many times
does he pass uirne? etc

No mother (or even your lecturer) is interested in "the 4 positions" of breast feeding - the bottom line is the baby and mother should
be comfortable, baby's head should be higher than his bottom (some of you actually held the baby the other way - NO ONE CAN
SWALLOW ANYTHING LIKE THAT).

SUPPORT the HEAD of the baby (even if it's only a mannequin )

No 5 days old baby can bring his hands in mid-line to suck his fingers - even when hungry. So learn your developmental milestones
well.

Mother should always empty one breast and then shift the baby to the other side. In engorged breasts she SHOULD continuing
FEEDING from that side - it is engorged because of excess milk; hence has to be emptied.

Why some of u wanted the mother to pat the baby every 5 minutes during each feed, I do not know. And babies should be burped at
the end of the feeding session IN AN UPRIGHT POSITION.

Duration of each feed after lactation has been established, is about 10 minutes, not 45.

Some of u did not demonstrate the correct technique of breast feeding and latching.

At the end of it all, I have to commend u all for knowing so much (I thought no one thinks it's an exam question!)

Finally, I do agree that 5 minutes is too short a time for all this counseling, but I have no control over that.



From dr.usha