ELIXIRS

T H I R D Y E A R P R A C T I C A L M AT E R I A L

- KAUSHIK M
OPHTHALMOLOGY
1) Diabetic retinopathy

2) Micro aneurysms, Dot & Blot haemorrhages,

Flame shaped haemorrhages, Hard exudates

3) Non Proliferative DR, Proliferative DR, Diabetic

Maculopathy

4) Laser photocoagulation
1) Papilloedema

2) Headache, Amaurosis fugax, Diplopia, Projectile

vomiting

3) Early, Established, Chronic, Atropic

4) Pseudo papilloedema, Papillitis, Pseudoneuritis,

Ischaemic optic neuropathy, Drüsen of optic disk
1) Plane mirror

2) Retinoscope, Refraction

3) 1 meter

4) Opposite movement - Myopia, Same movement -

Hypermetropia
1) Keratoconus

2) Munson’s sign, Vogt’s line, Fleisher ring, Oil

droplet on D/O, Scissor reflex on retinoscopy

3) Rigid contact lenses / Penetrating keratoplasty

4) Marfan syndrome, Down’s syndrome

1) Surface ectoderm

2) 1.39

3) Cataract

4) Intraocular lens (IOL)

1) Exophthalmos (thyroid ophthalmopathy)

2) Dalrymple’s sign (lid retraction) , Von Graefe’s sign

(upper lid lag on down gaze), Rosenbach’s sign

3) Reduced ocular motility, Optic neuropathy, Dry

eye, Exposure keratitis

4) Medical treatment - topical eyedrops (lubricants),

systemic steroids & Surgical treatment
1) Varicella - Zoster virus

2) Trigeminal ganglion

3) When the tip of the nose is involved, the eye is

also involved due to nerve supply

4) Nasociliary nerve, a branch of trigeminal nerve

1) Flexner-Wintersteiner rosette

2) Retinoblastoma

3) Childhood (0-6 years)

4) Quiescent stage, Glaucomatous stage, Stage of

Extraocular extension, Stage of Metastasis
1) Chalazion

2) Meibomian gland

3) Warm fomentation, Lid massage, Antibiotic

ointment
Incision & Curettage

4) Zeis gland
1) Intra ocular lens

2) Optic and Haptics

3) Posterior chamber IOl, Anterior chamber IOl & Iris

supported IOL

4) PMMA - Polymethyl Methacrylate

1) Direct ophthalmoscope

2) 15x

3) Erect, Virtual

4) Easy procedure, Better magnification, Can see

with small pupil, Patient feels comfortable
1) Punctum, Canaliculi, Lacrimal sac, Nasolacrimal
duct

2) Inferior meatus

3) Valve of Hasner

4) Dacryocystorhinostomy (DCR)
Dacryocystectomy (DCT)
1) Ophthalmia neonatorum

2) Gonocoocus, Chlamydia

3) Antibiotic eye ointments

4) Crede’s method (1% Silver Nitrate), 1%

Tetracycline, 0.5% Erythromycin
1) Antifungal (topical eyedrops)

2) Amphotericin B, Nystatin

3) Fungal corneal ulcer

4) Satellite lesion, Feathery border, Yellow ring

1) Epithelium, Bowman’s membrane, Stroma,
Descemet’s membrane & Endothelium

2) 3000 cells/mm2

3) Pachymeter

4) Specular microscope
1) Phaco machine or Simcoe’s phacoprobe

2) Phaco probe/Hand piece or 1mm titanium needle

3) Emulsify the nucleus

4) Smaller incision - quicker healing and recovery, No

limbus scar, No astigmatism
1) Snellen chart

2) Distance at which the patient is able to read

3) Distance at which normal person will be able to

read

4) 6 metres
1) Flurescein strip

2) 2% solution - 1 drop

3) To diagnose corneal ulcer, corneal abrasions

4) Rose bengal dye, Lissamine green dye

1) Keratometer

2) 43D

3) Horizontal and Vertical meridians

4) For IOL power calculation, fitting contact lenses

1) Biocmicroscopic examination of structures in angle
of anterior chamber

2) Schwalbe’s line, Trabecular meshwork, Scleral

spur, Ciliary body band, Root of iris

3) Direct and Indirect gonio lens

4) Direct - Koeppe, Barkan & Indirect - Goldmann

single mirror, Sussman four mirror
1) Glaucoma (open angle)

2) 0.3:1

3) Asymmetry of cup disc ration > 0.2, localised

notch or thinning of neuroretinal rim, pallor of
neuroretinal rim, superficial disc haemorrhage \
1) Anticholinergic

2) Mydriasis and impair accommodation leading to

Cycloplegia

3) 1%

4) Refraction and funds examination in children,

Pealization therapy in ambylopia
1) 3%

2) Antiviral (inhibit viral DNA polymerase)

3) Idoxuridine

4) Viral keratitis caused by HSV and HZV

1) Herpes simplex

2) Medusa like pattern (Dendritic)

3) Satellite lesion in fungal keratitis

4) Antiviral (Acyclovir 3%)

1) Central Retinal Artery Occlusion

2) Cherry red spot

3) Painless unilateral sudden loss of vision

4) Embolus from carotid artery, Haemorrhage and

Atherosclerotic plaque, Dissecting aneurysm
1) Fundus fluorescein angiography

2) Fluorescein dye, 5ml 10% solution

3) Diabetic retinopathy, Age related macular

degeneration, CRVO

4) Central serous retinopathy

1) Ishihara’s/Pseudo isochromatic test

2) Holmgren’s wool test, Farnsworth-Munsell 100

Hue test, Edridge Lantern test

3) Retinitis pigmentosa, Cone Rod dystrophy &

Vitamin A deficiency

4) Opsins present on L and M cones

1) Indirect ophthalmoscope

2) Inverted and Real

3) 20D

4) 3x
1) Glaucoma, Hyperosmotic agent

2) Decreases H20 content of vitreous - reduction in

volume of eye - lowering the IOP (by increasing
plasma tonicity)

3) 1-2 gm/kg

4) IV route
1) White pupil

2) Retinoblastoma

3) Rosettes (Flexner-Wintersteiner rosettes, Homer

Wright) & Fleurettes

4) Enucleation
SURGICAL INSTRUMENTS
DR RAMYA CHELLIAH
 CATARACT INSTRUMENTS

Dastoor superior rectus holding forceps

UNIVERSAL WIRE SPECULUM
COLUBRI
CONJUNCTIVAL SCISSORS
CASTROVEIJO CORNEAL SCISSORS
VANNAS SCISSORS
ANGLED VANNAS
CURVED VANNAS
BLADES

Crescent / tunnel Entry keratome

Side port
VECTIS
LENS HOOK
SINSKEY HOOK
SIMCOE IRRIGATION ASPIRATION CANNULA
MC PERSON FORCEPS
STRAIGHT SUTURE TYING
LENS HOLDING FORCEPS
BARRAQUER NEEDLE HOLDER
GRAEFE’S TISSUE HOLDING FORCEPS
IRIS REPOSITOR
BARD PARKER HANDLE
CHALAZION CLAMP
CURETTE
KELLY’S TRABECULECTOMY PUNCH
MEULLER’S HAEMOSTATIC SELF RETAINING
RETRACTOR
NETTLESHIP PUNCTUM DILATOR
LACRIMAL PROBE
KERRISON’S RONJEUR / BONE PUNCH
EVISCERATION SCOOP
ENUCLEATION SPOON
DESMARRES LID RETRACTOR
EPILATION FORCEPS
ENT
1)  Identify 1, 2, 3, & 4
1
      1- tectorial membrane

      2- outer hair cells 2

      3- tunnel of corti

3
      4- basilar membrane 4
2)  Name 2 ototoxic drugs

        Streptomycin, quinine, furosemide, salicylates

Findings on ear examination in a patient with
itching and pain

1)  What could be the probable diagnosis ?

       Otomycosis

2)  Name 2 causative organism 

        Aspergillus Niger & fumigatus, Candida

albicans
1)  Name of the procedure

         Anterior nasal packing

2)  Indication

         Epistaxis

3)  2 materials used for this

         Ribbon gauze, Liquid paraffin/gel foam, Tilley’s dressing forceps

1)  Probable diagnosis

          Peritonsillar abscess (Quinsy)

2)  What is the treatment?

          Incision & drainage of abscess

          Hot tonsillectomy

1)  Most probable diagnosis

        Vocal cord carcinoma

2)  Identity the side of the lesion

        Left side

3)  2 treatment options

        Chemotherapy

        Radiotherapy
1) What procedure has been done for this patient?

          Permanent tracheostomy

2)  Give 2 indications for this procedure

       Laryngeal stenosis (or) bilateral abductor paralysis

         Laryngectomy (or) laryngopharyngectomy

1)What is the probable diagnosis?

        Tongue rannula 

2)  What is the treatment ?

        Small - surgical excision

        Large – marsupialization

1)  Name the starred structure

         Hypertrophied adenoid

2)  Name 2 expected consequences

       Adenoid facies features, obstruction of eustachian tube,

ASOM

3)  Treatment

      Adenoidectomy
1) 2 differential diagnosis with 2 clinical features to support
them

    DD- Rhinospordiosis, haemangioma

    Clinical feature- nasal obstruction, bleeding

1)  Probable diagnosis

         Bleeding polyp

2)  Treatment

        Polypectomy
1)Identify the side of the tympanic membrane

        Right side

2)  Name the numbered structures 1

       1- pars flaccida

4
2
       2- handle of malleus

       3- cone of light

3
       4- incudostapedial joint
1)  Name of the incision

         Post aural incision 

2)  2 surgeries where it is used

          Radical mastoidectomy

          Modified radical mastoidectomy

1)  Name of the incision

         End aural incision 

2)  2 surgeries where it is used

          Radical mastoidectomy

          Modified radical mastoidectomy

1)  Diagnosis

        Pre auricular sinus (or) pit

2)  Complications

        Infection, abscess

3)  Treatment

        Surgical excision of the track

1) Name the area enclosed by 1, 2 & 3

        MacEwen’s triangle

2) Surgical importance

        To expose the mastoid antrum in mastoid surgery

1)  What is the diagnosis?

         Attic perforation

2)  List four possible symptoms

        Ear discharge, conductive hearing

loss, bleeding, pain, fever
1)  List four possible symptoms

     Whistling, crust formation, nasal obstruction, epistaxis

2)  List two possible treatment options available

     Plastic flap, silastic button

1) Describe three key steps in managing this patient

    External presser, cauterisation, anterior nasal packing 

2)  List three specific causes /precipitants for this complaint

   Trauma, foreign body, neoplasms, hypertension, infections

1)  Identify the numbered structures

      1- frontal sinus

      2- maxillary sinus

      3- sphenoid sinus

      4- orbit

2) What is the most likely diagnosis ?

       Maxillary sinusitis

1)List four causative agents for this condition

       Haemolytic streptococcus, H. influenzae, staphylococci , pneumococci

2)  List four indications for tonsillectomy

       Recurrent throat infection, Peritonsillar abscess, tonsillitis,

hypertrophy of tonsil, suspicion malignancy
1)How will you manage this situation ?

      Insect should be killed by oil/water if alive

      Removed by using syringe, suction ,forceps

2)  List two possible complications for the procedure which had selected earlier

       Tympanic membrane perforation, Vertigo

1) Identify the test being performed

      Hallpike manouvre

2) Why is this test performed? What is canal which is being tested?

    To diagnose the positional vertigo

    To differentiate central & peripheral lesion

    Posterior semicircular canal

1)Identify the numbered structures

      1- lobule

      2- tragus

      3- antihelix

      4- antitragus

2)  List three graft materials which can be harvested from the pinna

       Skin, fat, cartilage, perichondrium

1)Identify the test being performed

      Fistula test

2)What are the four possible interpretations of this test

   Negative —> no nystagmus, no fistula

   Positive —> nystagmus,fistla (cholesteatoma, surgically created window)

   False  +ve —> nystagmus, no fistula (congenital syphilis, meniere’s disease)

   False –ve —> no nystagmus, fistula (cholesteatoma covers the site of fistula)

1)  Identify the condition

     Rhinophyma (potato tumor)

2)  What is the cause?

    Hypertrophy of the sebaceous glands of tip of the nose

    Long standing acne rosacea

1)List four causes of nasal obstructions in children

    Foreign body, DNS, antrochoanal polyp, rhinitis

2)  How will you interpret the findings of this test ?

      Patency of both nasal cavity is determined by

comparing
1) What is the probable diagnosis? Identify the numbered structures.

   Foreign body in glottic region

     1- vocal cord

     2- foreign body

     3- ventricular fold

     4- arytenoid cartilage

2)  How will you manage such a situation ?

      Removal of foreign body by using rigid bronchoscopy 

1) What is the probable diagnosis? Which side is affected?

     Bell’s palsy, Left side

2) Name any four infectious conditions which can cause this

disorder.

     ASOM, CSOM, herpes zoster oticus, malignant otitis externa

1)Name two investigations which will help us to clinch the
diagnosis.

     Beta transferrin ,beta trace protein

2)  List four causes for this condition.

      Trauma, neoplasm, fungal infection, meningocele

1)What is the probable diagnosis?

        Septal  haematoma

2)  How will you manage this patient?

        Incision & drainage, antibiotics

1)  Identify the marked object

      Grommet tube

2)  List four complications associated with the usage of this device

    Displacement,

    Expulsion,

    Permanent perforation,

    Secondary acquired cholesteatoma

6 year old child with a history of (L) ear discharge for 2 months comes with
complaints of double vision, profuse ear discharge & severe pain behind the
(L) ear.

1)  Interpret the picture

    6th CN paralysis (abducens nerve)

2)  What is the probable diagnosis? How will you confirm the diagnosis?

    Gradenigo syndrome

    CT scan & MRI scan

1)  Identify the test, whose possible results are shown above ?

    Impedance audiometry

2)  State one condition each will produce (B), (C),  (As) & (Ad) curves

B-   fluid in middle ear

C-  Eustachian tube obstruction

As- otosclerosis

Ad- ossicular discontinuity

1)Identify the type of hearing loss in figures (A) & (B)

    A - sensorineural hearing loss

    B - conductive hearing loss

2)  How will you manage the patient with figure (A) type of
hearing loss

    Hearing aid

1) Mention two important aspects in the post operative care of this
patient

      Constant supervision, suction, preventing the crusting & infection

2) Mention two conditions where long time tracheostomy is required

Laryngeal stenosis (or) bilateral abductor paralysis

    Laryngectomy (or) laryngopharyngectomy

1)Identify the surgical procedure pictured above

     Caldwell - Luc operation

2)  Mention two indications for this procedure

      Oroantral fistula, Chronic maxillary sinusitis

3)  Mention one complication for this procedure

      Osteomyelitis, Sublabial fistula

35 year old female patient comes with H/O foul smelling nasal discharge,
nasal block for 2 years duration. Endoscopic picture is shown above

1)  Identify the probable cause

         Endocrine disorder, Nutritional deficiency, infective

2)  Mention two treatment options

          Medical – nasal irrigation , removal of crust, antibiotics

          Surgical – young’s operation, modified young’s operation 

3 year old child presents with severe ear pain since last 2 hours. H/O of acute
respiratory tract infection present.

1)  What is the diagnosis ?

       Acute suppurative otitis media

2)  What is the stage ?

      Stage of pre-suppuration

3)  Describe the findings

       Congestion in pars tensa

37 year old man presents with rapidly developing swelling in the
neck and floor of the mouth. He gives H/O caries in the lower
molar teeth.

1)What is the probable diagnosis ?

     Ludwig’s angina

2)  Why has tracheostomy been performed ?

     Airway is endangered

Picture of 28 year old man showing
the external nose in profile. He gives
H/O  sub mucosal resection of nasal
septum 2 years ago.

1)  What is the diagnosis ?

         Saddle nose deformity

2)  Name two disease will can lead to

this condition

       Atrophic rhinitis, Tuberculosis,

Syphilis
A leading politician presents with gradual hoarseness of voice

1)What is the probable diagnosis ?

         Vocal nodules

2)  What is the method of management ?

       Conservative – proper use of voice

       Surgical – excision with cold instrument (or) laser

1)  Identify A, B & C

     A-incus ,

      B- stapes ,

      C-malleus

2)  Name one disease each which affect  A & B

      Chronic otitis media, Tubercular & syphilitic otitis media, Otosclerosis

  
4% Xylocaine
Savlon
 SKULL BASE

•Sphenoid sinus
•Foramen ovale
•Stylomastoid foramen
•Pterygopalatine fossa
•Styloid process
 TEMPORAL BONE

•Cortical mastoidectomy
•MRM
INSTRUMENTS
COMMUNITY MEDICINE