ENT LUMINAIRE

EAR
1. Normal tympanic membrane (draw both sides rt,lt)
2. Middle ear cleft.
3. Medial wall of middle ear.
4. Membranous labyrinth.
5. Section through cochlea.
6. Structure of organ of corti.
7. Central auditory pathway.
8. Types of post aural incision.
9. Ear ossicles.
10. Normal pure tone audiogram
11. Nerve supply of external ear.
12. Audiogram of Conductive deafness &senorineural deafness
13. Various curves of tympanogram
14. Pure tone audiogram in Otosclerosis(Carhart’s notch)-13.2
15. Type of tympanic membrane perforations(of rt& Lt ear)-11.7
16. Audiogram showing Mixed deafness
17. Internal acoustic meatus(pg 124)
NOSE
1. Structure of lateral wall of nose.
2. Nerve supply of lateral wall of nose.
3. Anatomy of nasal septum.
4. Blood supply of nasal septum.
5. Blood supply of lateral wall of nose.

ORAL CAVITY, PHARYNX, LARYNX& ESOPHAGUS

1. Arterial supply of tonsil.
2. Spaces in relation to pharynx where abscesses can form.
3. Laryngeal web.
4. Vocal nodules.
5. Structures seen on posterior rhinoscopy.
6. Structure seen on indirect laryngoscopy.
7. Position of vocal cord.
8. Oesophagus showing various constrictions.
9. Oral cavity.
10.Tonsillar bed.
11.Waldeyer’s ring.
ANATOMY OF EAR
SHORT NOTES(Include nerve/blood supply,diagram,development wherever required)
1. External Acoustic Canal (pg 4)
2. Fissures Of Santorini( DO Study Definition,Clinical Significance) (pg 4)
3. Tympanic Membrane ( pg 4)
4. Korner’s septum- importance-pg8
5. McEwans Triangle ( pg 7)
6. Medial Wall Of Middle Ear ( pg 6)
7. Mastoid Antrum( pg 7)
8. Mastoid Air Cell System ( pg 8)
9. Ossicles Of Middle Ear(pg 8)
10.Intra Tympanic Muscles (Origin,Insertion,NerveSupply,Action)(pg 9)
11.Tympanic Plexus (Formation,Supply)(pg 10)
12.Chorda Tympani (pg 10)
13.Inner Ear Fluids ( pg 12)
14.Bony And Membranous Labyrinth (pg 11)
15.Organ Of Corti-Fig V Imp ( pg 16)
16.Hair Cells (pg 16)
17.Auditory Pathways (pg 17)
18.Impedence Matching, Phase Differential B/W Oval And Round Window(pg 18)
19.Electrical Potentials Of Cochlea And 8th Nerve ( pg 19)
20.Structure OfCrista.Macula (pg 20)
21.Vestibular Pathway (pg 20)
22.Vertigo-At Least 4 Central And 4 Peripheral Causes Of Vertigo With Treatment
23.Sensation level pg 24
24.Masking (pg 24)
25.Tuning Fork Tests(pg 26-27)
26.Pure Tone Audiometry-Uses ( pg 27)
27.Tympanometry-Curves,Dig Also (pg 29)
28.Acoustic Reflex And Significance (pg 30)
29.Recruitment And Other Special Test (pg 31)
30.Tone decay test – pg 31
31.Oto Acoustic Emission ( pg32)
32.Conductive Hearing Loss-PTA Finding Diagram Also ( pg 37, 38)
33.Ototoxicity ( pg 39)
34.Sudden Hearing Loss-Causes (pg-41)
35.Presbyacusis (pg 41)
 36.Non Organic Hearing Loss (pg 42)

ASSESSMENT OF HEARING

DIAGRAM
1. Types of tympanogram
2. Pg34-symbols used in audiogram charting: PTA in various pathologies can be asked
to draw
SHORT NOTES
1. Tuning fork test, interpretation [26]
2. Uses of PTA [pg27][Code: ALARMS-Audiogram uses:-Hearing Loss measurement.
Hearing Aid prescription, Records for future reference, Medico legal
importance, Speech reception threshold prediction]
3. Tympanometry [pg29], Types of tympanogram-also known as curve of impedance
audiometry: diagrams and egs [pg30]
4. Threshold tone decay test: more than 25db acoustic neuroma, less than 20db
Meniere’s d/s [pg 31]
5. BERA [pg32}
6. Oto-acoustic emission OAE/welch allynOAE[pg33]
7. Recruitment (for viva)[pg31]
8. Roll over phenomenon (for viva)[pg28]
9. SISI test[pg 31]

DISORDERS OF VESTIBLAR SYSTEM

1. Peripheral vestibular disorders and central vestibular disorders (table 7.1 pg 51)
2. Epleys manoeuvre (pg 51)
3. Vestibular neuronitis(pg 52)
4. Vestibulotoxicdrugs(pg 52)
5. Wallenberg syndrome (pg 52)

DISEASES OF EXTERNAL EAR

1. Pre-auricular pit or sinus (pg 54)
2. Cauiflowerear(pg 55)
3. Keloid of auricle(pg 56)
4. Perichondritis(pg 56)
5. Furuncle (pg 56)
6. Diffuse otitis externa (pg 57-58)
 7. Otomycosis (pg 58)
8. Herpes zoster oticus (pg 58,62)
9. Malignant otitis externa (pg 58)
10.Impacted wax or cerumen (pg 59-60)
11.Foreign bodies of ear(pg 60)
12.Keratosis obturans(pg 61)
13.Traumatic perforation – pg 62 (imp, causes, treatment)
14.Retracted tympanic membrane – pg61
15.Tympanosclerosis –pg62
16.Perforations of tympanic membrane – pg89
17.Aural syringing-pg60

ASSESSMENT OF VESTUBULAR FUNCTION

1. Fistula Test (pg 47)
2. Caloric Test (pg 48)
3. Hall Pike Manvoure(Pg 47)

EUSTACHIAN TUBE AND ITS DISORDERS

1. Functions of Eustachian tube(pg 64)
2. Valsalvatest(pg 65)
3. Politzer test (pg 65)
4. Eustachian tube catheterisation(pg 65)
5. Toynbees test (pg 65)
6. Patulous Eustachian tube (pg 67)
DISORDERS OF MIDDLE EAR
1. Serous otitis media (glue ear)(pg 71-73) (ESSAY)
2. Aero otitis media (otitic barotrauma)(pg 74)
3. Differences between ASOM and AOM
4. Cholesteatoma (pg 75-77)(imp)
5. Differences between tubo tympanic and atticoantraldisease(table 11.1 pg 77 )
6. Classification (pg 85)
7. Acute mastoiditis (pg 85-87)
8. Abscesses in relation to mastoid-Bezold abscess, Citelli’s abscess imp (pg 87)
9. Masked mastoiditis (pg 88-89)
10.Petrositis and Gardenigo’s syndrome (pg 89)
11.Lateral sinus thrombophlebitis- pg 95 (essay)
12.Paracusis willisi-pg98
 13.Medical treatment of otosclerosis-pg99(imp)

OTOSCLEROSIS
Schwartz sign-(pg 98)
Stapedectomy-steps,contraindications(pg 100)

FACIAL NERVE AND ITS DISORDERS

1. Bellspalsy(pg 105)
2. Melkersson’s syndrome (106 )
3. Herpes zoster oticus (pg 107)
4. Complications of facial;nerve paralysis (pg 109)
5. Topognosis of facial palsy(pg 109)

MENIERE’S DISEASE
1. Variants of Meniere’s disease (pg 113)
2. Tullio phenomenon-pg112

TUMORS OF EXTERNAL EAR

1. Tumours of auricle (pg 117)
2. Tumours of external auditory canal (pg 118)

3. Glomus tumour-pathology,clinicalfeatures,diagnosis,treatment

ACOUSTIC NEUROMA
Acoustic neuroma (pg 124) imp
DDs-table 18.1
THE DEAF CHILD
1. Aetiology (pg 127)
2. Waardenburg’s syndrome (pg 129)
3. Syndromes associated with hearing loss (pg 129)
4. Assessment of hearing in infants and children (pg 131)

REHABILITATION OF HEARING IMPAIRED

1. Hearing aids (pg 134)
2. Cochlear implants(pg 138)
3. Bone anchored hearing aids-BAHA (pg 136)
OTALGIA-causes(pg 143)

TINNITUS-types,causes,treatment (pg 145)

CHAPTER 23
Lateral wall of nasal cavity – Blood supply, contents, nerve supply) (151)

CHAPTER 24
1. Olfactory pathway, anosmia, parosmia (157)
2. Functions of nose
3. Air conditioning of inspired air
4. Protection of lower airway
CHAPTER 25
1. Saddle nose (158)
2. Rhinophyma (160)
3. Furuncle (160)
4. Vestibulitis (161) Acute and chronic forms

CHAPTER 26
1. Jarjaway and chevallet fracture of nasal septum (163)
2. Little’sArea (162)
3. Septal -hematoma,Abscess,Perforation-causes

CHAPTER 27
1. Coryza-common cold(168)
2. Atrophic rhinitis(170)
3. Rhinitis sicca and Caseosa(171)

CHAPTER 28
1. Rhinoscleroma-Stages and diagnosis(172)
2. Rhinosporiodosis(174)
3. WegenersGranulomatosis(174)

CHAPTER 29
1. Foreign bodies (176)
 2. Rhinolith(176)
3. Nasal myiasis(176)
4. Choanal Atresia (177)
5. CSF rhinorrhoea (178)
6. Diff b/w CSF & nasal secretions (179)

CHAPTER 30
Allergic Rhinitis(180)

CHAPTER 31
1. Rhinitis Medicamentosa (184)
2. Vasomotor rhinitis (183)

CHAPTER 32
Ethmoidalpolyp(185)
Antrochoanalpolyp(186)
Treatement of ethmoidalpolyp(186)
D/d Nasal polyp(188)
Treatment of recurrent antrochoanal polyp
CHAPTER 33
Little’s Area(190)
Anterior and posterior nasal packing (191)

CHAPTER 34
1. Fracture nasal Bone (!95)
2. Fracture of zygoma, orbital floor (197)
3. Types of fracture maxilla(198)
4. Oroantral fistula (200)

CHAPTER 35
1. Development and functions of paranasal sinuses (202)

CHAPTER 36, 37
2. Acute sinusitis(204) (etiopathology, maxillary, frontal imp.)
3. Chronic sinusitis (208)

CHAPTER 38
 1. Mucocoele of PNS(211)
2. Complication of PNS(211.Table 38.1)
3. Orbital complication of sinusitis

CHAPTER 39
1. Inverted papilloma or ringertz tumour or transitional cell papilloma(216)
2. Intranasal meningoencephalocele (217)

CHAPTER 40
1. Carcinoma of maxillary sinus(221)
2. Osteomeatal Complex
3. Ohngren’s line –pg221 (extends from medial canthus of eye to angle of mandible)

CHAPTER 41
1. Lymphatic drainage of oral cavity

CHAPTER42
2. Vincent’s infection(229)
3. Aphthous ulcers (230)
4. Behcet’ssyndrome(236)
5. Fordyce’s spots(233)
6. Geographical tongue(232)

CHAPTER 43
1. Squamous papilloma(236)
2. Torus(237)
3. Mucocele(237)
4. Leukoplakia(238)
5. Kaposi‘s sarcoma

CHAPTER 44
1. Sjogren’s syndrome(Sicca syndrome)(245)

CHAPTER 45-54
1. Pleomorphic adenoma(247)
2. Frey’s syndrome or gustatory sweating(249)
3. Ludwig’s Angina….277
 4. Waldeyer’s ring….254
5. Nasopharynx….254
6. Killian’s dehiscence…259
7. Pyriform fossa….257
8. Adenoid facies….259
9. Keratosis pharyngitis….270
10.Crypta magna….271
11.Blood supply of tonsil….274
12.DD of membrane over tonsil Code:-[VIMALA Took My CD ie. Vincent’s agna,IMN,
Malignancy
tonsil,Aphthousulcer,Leukemia,Agranulocytosis,Traumaticulcer,
Membraneoustonsillitis,Candidiasis,Diphtheria]
13.Faucial diphtheria….274
14.Tonsilllolith…276
15.Peritonsilarabcess(quinsy)….278
16.Retropharyngeal &parapharyngeal abscess….280,281
17.Stylalgia(Eagle’s syndrome)….287
18.Pharyngeal pouch….289
19.Malignant tumour of oropharynx…284
20.Sleep apnoea…292

CHAPTER 55
1. Laryngeal cartilages [299]
2. Laryngeal abductors[300]

CHAPTER 57
1. Acute epiglottitis [307]
2. Laryngeal diphtheria [308]
3. Reinke’s oedema/polypiod degeneration of vocal cords or B/L diffuse polyposis
[311,323][UQ]
4. Contact ulcer[311,323]
5. Tuberculosis larynx[312]
6. Atrophic laryngitis / laryngitis sicca [312]

CHAPTER 58
1. Laryngomalacia/congenital Laryngeal stridor [314][UQ]
 2. Laryngeal web[314]
3. Laryngocoele; types, symptoms, diagnosis , treatment [324][UQ 2009]
4. Stridor ;aetiology, management, laryngeal causes in children [315][UQ]

CHAPTER 59
1. Bilateral recurrent l Laryngeal nerve palsy [318]
2. Benign tumors of larynx [tab 60.1,pg 322]

CHAPTER 60
1. Vocal nodules/singer’s nodes/screamer’s nodes [322][UQ 2011]
2. Vocal polyp;aetiology,symptoms,treatment[323]
3. Leukoplakia/keratosis [323]
4. Squamous papilloma; juvenile&adult onset [324]
5. Left vocal cord paralysis [321][UQ]
6. Premalignant conditions in larynx[UQ]

CHAPTERS 61-64
1. Causes of hoarseness[333]
2. Ventricular dysphonia [334]
3. Tracheostomy [UQ] function, indicators, types, complications
4. Laryngeal foreign body [343]
5. Heimlich manouvre[344]
6. Direct laryngoscopy [432]

CHAPTERS 65-68
1. Esophageal proliferation[349]
2. Benign structures of esophagus[350]
3. Cardiac achalasia [352]
4. Dysphagia – Oesophageal causes [354]
5. Dysphagia Lusoria[354, 458]
6. Foreign body Oesophagus [356]
7. Oesophagoscopy -indications [436]

RECENT ADVANCES
1. Types of lasers [ch69,pg361]
2. ENT manifestations of AIDS [ch73, pg374]
3. Use of lasers in ENT
 4. Occult primaries in ENT

Section 7: Operative Surgery ( Chapter 76-92)

1. Endaural approach [410]
2. Cortical mastoidectomy /Schwartz operation-indications [411]
3. Radical mastoidectomy –complications [414]
4. Modified Radical mastoidectomy [415]
5. Myringoplasty-graft materials, types, specific complications [416-417]
6. Antral wash-indications, complications [418]
7. Antral puncture
8. Caldwell Luc operation- indications, complications [421]
9. Sub mucous resection [423]
10. Septoplasty [425]
11. FESS (functional endoscopic sinus surgery)[429]
12. Rigid bronchoscopy [434]
13. Oesophagoscopy [436]
14. Tonsillectomy- indications, contraindications, complications [438]
15. Adenoidectomy- indications, contraindications, complications [442]

CLINICAL QUESTION : (10 marks) EAR

1. Secretory Otitis Media
2. Chronic Suppurative Otitis Media (Also Difference b/w canal wall up & canal wall
down procedures)
3. Otosclerosis
4. Meniere’s disease
5. Acute Mastoiditis
6. ASOM-(Treatment of asom-6A”s…. AURAL TOILET, ANTIBIOTICS,
ANTIFLAMATORY, ANALGESICS, WATER AWAY,
AMPROLITE(MUCOLYTICS)
CLINICAL QUESTIONS (10 Marks) NOSE
1. Deviated nasal septum (aetiology, types, clinical features ,treatment)(pg 163)
2. Atrophic Rhinitis (types, etiology)[Aetiology of primary-code HERNIA-Hereditary
Endocrinal disturbances, Racial, Nutritional deficiencies, Infective,
Autoimmune](pg 163)
3. Nasal polypi(types ,difference b/w ethmoidal & antrochonal, DD’s ) (185)
 4. Epistaxis (causes, site , management, difference between anterior and posterior
epistaxis) (Pg. 190)
5. Frontal sinusitis (aetiology, clinical features, treatment ,complications) (206)
6. Chronic maxillary sinusitis (209)
7. CSF rhinorrhoea (aetiology, Differentiating from running nose, diagnosis &
treatment)

CLINICAL QUESTIONS .THROAT, ORAL CAVITY.PHARYNX

1. Submucous fibrosis
2. Mumps
3. Carcinoma Oral Cavity
4. Acute tonsillitis(272)
5. Retropharyngeal abscess(280)

ESSAY(always mention which ear-rt/lt)

1. A 20 year old lady presented in OP department with history of bilateral progressive
hearing loss and tinnitus. Examination revealed a normal tympanic membrane and
conductive hearing loss.
a) Most probable diagnosis (Otosclerosis)
b) Two Differential Diagnosis
c) What will you look for during Otoscopy?
d) How will you investigate this patient?
e) What is the medical management of this condition?
f) What is the surgical management of this condition?
2. A 65 year old man presented with change of voice for three months. On Indirect
Laryngoscopy, there was a proliferating swelling on the right vocal cord and the vocal
cord is not mobile
a) Diagnosis (Ca Larynx)
b) Etiological factors of the above condition
c) Clinical features of the above condition
d) Investigations for the above condition
e) Treatment for the above condition
3. A 25 year old lady presented with pain and scanty foul smelling discharge from the ear
for the last two years. On observation, there was perforation in the pars flaccida
a) Diagnosis (Atticoantal disease)
 b) Etiological factors and theories of the above condition
c) Clinical features of the above condition
d) Treatment of the above condition
e) Complications of the above condition
4. A 60 year old male patient is brought to the casualty with profuse bleeding from the
nose bilaterally
a) Describe emergency management
b) Enumerate various local causes of epistaxis
c) Define Little’s area and state its clinical importance
5. A 40 year old patient who is a known diabetic came with history of pain and ear
discharge of 3 days duration
a) Diagnosis
b) What are the tympanic membrane findings in ASOM?
c) Aetiological factors of ASOM
d) Complications of ASOM
e) Describe the different stages of ASOM
f) DD”s –otitis externa, myringitis..
6. A 25 year old female came with history of nasal obstruction, headache, loss of smell
sensation and thick greenish secretion from her nose
a) What is your diagnosis?
b) Etiological factors in Atrophic Rhinitis?
c) Clinical features of Atrophic Rhinitis
d) Differential Diagnosis of Atrophic Rhinitis
e) Treatment of Atrophic Rhinitis
7. A 6 year old child presented with defective speech, mouth breathing and snoring.
Clinical examination reveals a dull, opaque tympanic membrane on both sides.
Tuningfork tests show Rinne’s Test negative bilaterally, Weber central, ABC normal
a) Diagnosis
b) Typical Otoscopic findings that you get in this condition
c) What are the relevant investigations to be done?
d) What is the treatment of the above case?
e) What are the sequelae of the ear condition if left untreated?

8. A 30 year old male with history of foul smelling discharge from right ear for 6 years
came to the casualty with high grade fever with chills and rigor and headache. On
observation it showed papilloedema and tenderness over right side of neck.
a) Diagnosis (Lateral Sinus Thrombophlebitis)
 b) Pathology
c) Describe two clinical tests that help in the diagnosis
d) What are the relevant investigations?
e) How will you manage this case?

9. A 65 yr old smoker for many years present to the ENT OP with history of unremitting
hoarsness of 4 months duration. O/E-Proliferative growth of the left vocal cord with
impair
mobility of the vord,neck normal
• Diagnosis and TNM staging of this case (CA larynx)
• Etiopathology
• Other clinical features and TNM staging of the diseases
• Investigations
• Treatment
Questions
1) What are the indications of tracheostomy?
2) What are the types of tracheotomy?
3) Mention the different tracheostomy tubes used?
4) Mention the complications of tracheostomy?
SOUNDBYTES
1.RETRACTION OF TM: GRADING

I. retraction not touching long process of incus

II. touching long process of incus
III. Atelectasis (mobility on siegelization)
IV. Adhesive otitis media

2. CONCHAE BULLOSAE -Pneumatised middle turbinate hypertrophy

3.TRAUMATIC TM PERFORATION--Margins will be dragged & blood stained

4.GRAFT/HEALED TM- Dimeric( middle fibrous layer absent)

5. DDs OF U/L TONSILLAR ENLARGEMENT- malignancy tonsil/ lymphoma/para pharyngeal

abscess/ para pharyngeal ca/tonsillolith/ tonsilar cyst.( if pulsatile –internal carotid artery
aneurysm)

6. MALIGNANT OTITIS EXTERNA- Skull base osteomyelitis(synonym)

7.COTTLE’s area-vestibule ,nasal valve ,attic ,turbinal , choanal (pg 164)

8. LINCOLN’s HIGHWAY-(parapharyngeal abscess—carotid sheath—track down to superior

mediastinum)

9. Boundaries of FACIAL RECESS – above-fossa incudis, medially-vertical se segment of facial

nerve,,laterally-chorda tympani.

10. PROTYMPANUM- portion of middle ear around tympanic orifice of Eustachian tube.

11. WHY ANTROCHOANAL POLYP GROWS POSTERIORLY?

Maxillary ostium& accessory ostium grow posteriorly.

Post.chona wider than anterior nares.

Gravity pulls posteriorly

Mucociliary clearance
PRACTICALS
CLINICAL EVALUATION OF ENT CASES

Name: Sex:
Age: Address Occupation
History taking
1. Chief complaints:
2. History of present illness
3. Past history
4. Treatment history
5. Personal history
6. Family history
7. Menstruation history+vaccination [if women]
8. Birth history+vaccination [if child]
9. Socio-economic status
And the following
1. General examination, Vital signs
2. Systemic examination
3. Local Examination

CLINICAL EVALUATION OF EAR CASES

Chief complaints [must include site and duration]

1. Ear discharge/otorrhoea
2. Impaired hearing/hearing loss
3. Earache / otalgia
4. Tinnitus
5. Vertigo
6. History of fullness of ear
7. Itching
8. Deformity of the pinna
9. Swelling around the ear
10. H/O of etiology

H/O Present illness

1. Ear discharge
a. Site: rt/lt/bilateral h. Progress-continuous/intermittent
b. Duration i. Colour
c. Onset j. Blood stained discharge +/-
d. Severity Scanty/Profuse k. Foul smelling +/-
e. Characteristics: watery/mucoid/purulent/mucopurulent
f. Associated URT infection
g. How long does each attack last, When was the last discharge?

2. Impaired hearing
a. side g. History of fever
b. duration h. history of drug abuse
c. Onset: since birth/acquired i..h/o topical ototoxicity
d. progress: progressive/intermttent/stable j. Family history of deafness
e. Painful or uncomfortable k. related to pregnancy
f. H/O noise induced trauma

3. Ear pain
a. site
b. duration
c. onset
d. type: burning/ prickling/ throbbing/stabbing
e. severity: disturbs sleep constantly
f. localisation of pain [referred pain]
1. behind the ear
2. ear
3. deep in the ear
g. aggravating factors / relieving factors
chewing, eating, sneezing, lying on the affected ear , applying pressure on
the tragus, pulling auricle , association with otorrhoea

4. Tinnitus
a. Side
b. duration
c. progress: progressive/continuous/intermittent/constant
d. character – hissing, buzzing, stammering, bell sound
e. high pitched / low pitched
 f. sleep disturbance[+/-]
g. h/o drug abuse: salicylates, quinines, aminoglycoside

5. Vertigo
a. duration
b. episodes: constant/periodic
c. frequency of attacks
d. aggravating causes: increased by change of position
e. relieving factors
f. association with hearing loss/otorrhoea
g. accompanied by nausea, vomiting

6. H/o fullness of ear

7. H/o of itching and irritation of the ear
8. Any pinna deformity
9. Any swelling around ear
10. H/o of etiology
Nasal obstruction/nasal discharge
Post nasal discharge
Facial pain
Throat pain
Dysphagia/odynophagia
Change of voice
H/o any intracranial complication - headache, nausea, vomiting

LOCAL EXAMINATION
·
PHYSICAL EXAMINATION OF THE EAR

1. Pinna
Size: microtia/macrotia
Shape: contour abnormalities/ cauliflower ear
Position:
Redness: abscess/furuncle
Swelling: hematoma/abscess
Scars: trauma/operation/burns
Ulceration
2. Preauricular region
Scar, trauma, previous operation
Swelling: zygomatic abscess, lymph nodes
Sinus: mastoid fistula
3. Post auricular
Scar, trauma, previous operation
Swelling: mastoid abscess, lymph nodes, oedema in lateral sinus
Fistula: mastoid fistula
4. External auditory canal
Size of the meatus: narrow/ wide
Contents of lumen: wax/debris/ discharge/ granulation
Swelling ofthe wall: furuncle/papilloma/neoplasm/osteoma
5. Tympanic membrane
a. cone of light+/-
b. Colour ::
Normally-pearly white
Red — Acute otitis media
Blue— Secondary otitis
media/otosclerosis/hemotympanumTympanosclerosis: chalky plaque
c. Surface of the membrane
Perforation seen in CSOM
Perforation may be central [pars tensa], attic [pars flaccida],
marginal[at the periphery involving the annulus.
Central perforation may be small/medium/large/subtotal/total]
d. Position of tympanic membrane
Bulged: eg ASOM, hemotympanum, neoplasm
Retracted: serous otitis media, tubal obstruction, retraction pocket
6. Middle ear mucosa
a. Pale/congested
b. oedematous/dry crusty discharge
d. granulation
e. polypoidal
7. Mastoid
a. swelling
b. obliteration of retroauricular groove
c. fistula
d. scar
 In mastoiditis, tenderness is elicited by applying pressure at 3 sites:
1. over the antrum
2. over the tip
3. over the part between the mastoid and antrum

Functional examination of the ear

·Auditory function
Tuning fork test
1. Rinne test
2. Weber’s test
3. Absolute bone conduction test
·Vestibular function
1. Fistula test
2. Positional test
3. Spontaneous nystagmus

Give complete diagnosis: eg. Rt/Lt CSOM , active/inactive

EXAMINATION OF NASAL CASES

History Taking
Chief complaints
· Nasal obstruction
· Nasal discharge
· Facial ache/headache
· Disturbance of smell
· Sneezing
· Bad odour
· Hawking sensation
· Cough with/without expectoration
· Change in voice
· Snoring
· Epistaxis
· Swelling or deformity of the face
 H/O PRESENT ILLNESS

Nasal obstuction
· Site, duration, severity, progressive or not, allergy, relieved with medication
Nasal discharge
· Site,duration, type(watery, mucoid, purulent), colour, blood stained, foul
smelling, crusting,
Facial pain / headache
· site
· side
· duration
· character
· periodicity
aggravating factors and relieving factors
H/o smell disturbance
· Loss of smell: duration
· Foul smell
· h/o allergy
· h/o bouts of sneezing, watery eyes.
· Precipitating factors
Bad odour
Hawking sensation: post nasal drip
Cough with or without expectoration
H/o change of voice
· Snoring / Epistaxis
· Duration,
· Quality: mild/ moderate/ severe
· Aggravating factors
· Relieving factors
• Swelling / deformity of face
LOCAL EXAMINATION
Examination of face
· Examination of external nose
· Examination of vestibule
· Examination of the paranasal sinuses
· Examination of the nasal cavity -Anterior rhinoscopy& Posterior rhinoscopy
Examination of the external framework
 · Signs of inflammation: furuncle, septal abscess
· Scars: trauma, operation
· Sinus: congenital dermoid
· Swelling: glioma,dermoid
· Crease in tip of nose: allergic salute
· Signs of neoplasm: basal cell ca or sq cell ca
Cold spatula test
Examination of the vestibule
· Anterior nares
· Scar/swelling/ulcer
· Columella
· Intact or dislocated
Examination of the nasal cavity
Anterior rhinoscopy
* Nasal passage
· Narrow: DNS/ poylps/hypertrophy of turbinates
· Wide: atrophic rhinitis
* Nasal septum: DNS/spur/ulcer/perforation/ swelling/growth
* Nasal mucosa: oedema/dry/crust/granulation
* Floor of nose
· Defect: cleft palate/fistula
· Swelling: dental cyst
· Neoplasm: hemangioma
· Granulations (foreign body or osteitis)
* Roof
· seen in cases of atrophic rhinitis
* Lateral wall
· turbinates and their corresponding meatus can be visualised
1. Colour of mucosa
congested in inflamation
pale in allergy
2. Size of turbinates
hypertrophied in hypertrophic rhinitis [enlarged and swollen]
atrophied in atrophic rhinitis[small and rudimentary]
3 Crusts
Atrophic rhinitis, rhinitis sicca, rhinitis caseosa, wegeners granuloma
4 Discharge: seen in middle meatus, indicates infection of sinuses.
 Pus / mucoidal discharge/source of epistaxis
5 Mass: polyp/rhinosporidiosis/ carcinoma/ foreignbody
if mass is present describe: site, size, color, surface, multiple/ single.
6 Probing test -.sensitivity, bleeds on touch, consistency, mobile, margin.

Posterior rhinoscopy
if possible, look for,
1. Hypertrophy of posterior ends of middle turbinate
2. Discharge in the middle meatus
3. Atresia/choanal polyp
4. Enlargement of the adenoids
5. Growth in the nasopharynx as JNA/NPC
6. Eustachian tube opening
7. Tubal elevation

Examination of the paranasal sinuses:

Elicit tenderness
Give complete diagnosis

CLINICAL EVALUATION OF THROAT CASE

This consist of
1) Examination of oral cavity
2) Examination of oropharynx
3) Examination of larynx and hypo pharynx
History taking
Chief complaints
a) Sore throat
b) Odynophagia
c) Dysphagia - Epiglottits, aspiration of secretion due to laryngeal paralysis
d) Disorders of voice - Hoarseness, aphonia, puberphonia or fatigability of voice
e) Earache
f) Snoring
g) Halitosis
h) Hearing loss
i) Abnormal appearance
j) Respiratory obstruction
 k) Cough & expectoration
l) Repeated cleaning of throat
m) Pain in throat
n) Mass in neck
o) Neck pain

H/o present illness

H/o throat pain / sore throat
· Site
· Duration
· Number of attacks per month / year
· Recurrent +/-
· Aggravating factors
· Relieving factors
H/O dysphagia
· Duration
· Onset - Gradual or sudden
· Liquids/ Solids/ Semisolids
· Pain while swallowing
· Progressive or non progressive
· H/o F/B swallowing +/-
· H/o Tonsillectomy
H/o of feeling of lump in the throat / irritation
H/O of Dyspnoea
· Inspiratory / expiratory
· Spasm in chest +/-
· H/o FB swallowing
H/O of Change of voice / Hoarseness
· Duration
· Onset- Acute/ Chronic .
H/o of smoking
· Occupation .
Hemoptosis
· H/O Voice abuse .
Cough
· With/without expectoration
· Associate fever (esp evening rise of temp)
 · Weight loss
· Loss of appetite
H/o Headache

H/o regurgitation
· Hawking
· Excessive secretions
· Stridor
· Duration
· Onset
· Progress
· In children
· Mouth breathing - night time
· H/o of bilateral nasal obstruction & discharge
· H/o ear pain or blocked sensation
· H/o respiratory tract infection
· Change of voice
· Nausea &vomitting and fever with or without chills and rigors
· Loss of weight
· H/o GI disorders
· Other History

LOCAL EXAMINATION

Examination of oral cavity, oropharynx & Larynx and hypopharynx

1. Lips
2. Angles of mouth
3. Gingiva buccal ,Gingivo labial folds
4. Vestibule of mouth, Retromolartrigone, teeth
5. Palate-hard & soft
6. Tongue-Anterior two third
7. Floor of mouth
8. Tonsillarpillors -Ant & Post
9. Tonsills -Size/ Congestion / Presence of follicles
10. Uvula & soft palate
11. Posterior pharyngeal wall
Congestion
 Lymphnode hyperplasia
Posterior nasal drip
Hypopharynx and larynx (indirect laryngoscopy -Say patient gagged if not able to do it)
· ILS
· Base of tongue
· Glossoepiglottic fold
· Vallecullae
· Epiglottis
· Aryepiglottic fold
· Ventricular bands
· Arytenoids
· Vocal cords
· Pyriform fossa
Nodes
· Number of nodes
· Size of the nodes
· Consistency
· Metastatic nodes are fixed
· Hyperplastic nodes are soft
· Lymphoma nodes are rubbery and firm
· Discrete or matted nodes
· Tenderness (Inflammatory nodes are tender)
· Fixity to overlying skin or deeper structures
· Mobility
EXAMINATION OF NECK

Laryngeal framework
Laryngeal crepitus
Position of trachea
Thyroid
b/l carotid palpable or not
jugular tenderness +/-
lymph nodes

GIVE COMPLETE DIAGNOSIS

CASES KEPT FOR CLINICAL EXAMINATION

 ·* Chronic suppurative otitis media -Tubo tympanic disease (long case)
· Aural polyp
· Bell’s palsy
·*Deviated nasal septum
·* Chronic sinusitis / Atrophic rhinits
·*Bilateral Ethmoidal polyps
·* AntroChoanal polyps
·* Rhinosporidiosis
· Septal perforation
· Tumour maxilla
·* Chronic Tonsillitis
· Tonsil Cyst
· Malignant ulcer tonsill
· Neck node
· Thyroglossal cyst

IMPORTANT AREAS TO BE NOTED FOR VIVA

CSOM :
1.etiopathogenesis, diagnosis, management
2.why EUM essential for CSOM?
3. Canal wall up/ down with eg;
4.Grafts in myringoplasty[ temporalis fascia[why?], fascia lata, tragal perichondrium,
saphenous vein,cadavericdura-dura not prefered now- creutzfeldt Jacob disease]
5.complications of surgery, types of tympanoplasty , imp. Landmarks in surgery
6. referedotalgia
7. tuningfork test- method, why 512Hz prefered
8 OAE, BERA
9.Tympanicmemb.perforation-types
10.difference b/w overlay &underlay technique

TONSILLITIS
1.Etiopathogenesis, a/c,c/c—differences.
Signs of c/c tonsillitis :.irwinemoore sign[pressure on ant. Pillar produce pus:], anterior pillar
congestion, non tenderjugulodigastric node.
2. Grading of tonsillitis
1. Enlargement within the pillar
2. Upto the pillar
3. b/w pillar & midline
4. upto midline

3.. tonsillectomy- indications[criteria-paradise], steps, complications,contraindications(polio

epidemic—polio virus in nasopharynx –during surgery can cause bulbar poliomyelitis).
Reactionary h’ge is the most dangerous (patient is sedated hence chance of aspiration, if at all
ligation surgery is to be done;2 GA given at short interval is riskier)
4.adenoidectomy-indications, steps, complications[grieselsyndrome,management]

DNS
1.etiopathogenesis, types, management
2.sluder’s neuralgia ( spheno palatine nerve), cottle,s line (line joining spine of frontal bone &
spine of maxilla)
3. diff. b/w septoplasty& SMR
4. Absolute indications of septoplasty[ age<17, dislocation ant. To cottle,s line, as part of
septorhinoplasty]
5. non-septal indications-vidianneurectomy, trans septal trans sphenoid hypophysectomy
,graft for tympanoplasty

SPOTTERS
 Postaural scar—complications,indications,aural incisions(410)
 Preauricular sinus—causes ,Rx,complication(54)
 Patient with tracheostomy tube insitu –indication,complication,type of tube,
management of complication,difficulties in decannulation(pg339),
indications for portex tube ,type of laryngeal cartilage.
 Ryles tube ,complication,
 Mastoid dressing –indications,complication(cavity)-korners septum
 Audiogram- SNHL,CHL, otosclerosis[causes,treatment]
  Anterior Nasal pack - Indications,complications,methods of controlling
epistaxis(191)
 post nasal pack(192) - indication, procedures.( sedatives are contraindicated
due to fear of aspiration.)
 Tympanogram : graphs..
.
1. Thudicums Nasal Speculum
Uses
a. Anterior Rhinoscopy(structrues seen in anterior rhinoscopy)
b. Removal of FB
c. Nasal Packing

2. St. Clair Thomson’s Long Blade Nasal Speculum

a. Used only after anaesthetizing
b. Used in SMR/Septoplasty
3. Rose Eustachian Tube Catheter
Metallic catheter with a curved proximal end and a ring at its base.12-15 cm in
length.
Uses
a. To know the patency of the ET
b. To inflate the middle ear
c. Remove FB from the nose
d. Instill medications into the middle ear
Complications
· Epistaxis
· Syncope
· Eustachian tube stenosis (not used nowadays for ear procedures)
Use of the ring at the end of the tube?
· To know the direction of tip of tube
Tests of Eustachian tube dysfunctions
1. Valsalva manoeuvre
2. Toynbee manoeuvre
3. Frenzel manoeuvre
4. Politzerization
5. Siegalisation
6. Endoscopy
7. CT Scan
 8. MRI
9. X-ray after radioopaque dye inj
10. Catheterisation
11. Saccharin/Methyleneblue test

4. Tilley LichwitzAntrum Puncture Trocar and Cannula

Uses
a. Confirm presence of pus in chronic maxillary sinus
b. Drainage of maxillary sinus in case of chronic maxillary sinusitis - Oro antral
fistula
c. Proofpuncture in case of malignancy of maxillary sinus
Anaesthesia:
Local anaesthesia with 4% lignocaine & adrenaline pack in inferior & middle meatus
for 10-15 min- Adults, General Anaesthesia - Children
Position:
Sitting position in adults & Rose’s position in children
Complications
1. Hemorrhage (most common)
2. Puncture of anterior wall of maxillary sinus resulting in swelling of cheek.
3. Puncture of orbital wall
4. Osteomyelitis / Osteitis
5. Air embolism
Indication for antral puncture
· Chronic maxillary sinusitis not responding to medical management
· To collect specimen of antral contents for culture & sensitivity
· Antrum is punctured through inferior meatus.
· Irrigation done by -Normal Saline at 37°C
Contraindications
A. Acute maxillary sinusitis Age below 3 years
B. Bleeding disorders
C. Clotting disorders
D. Disruption of maxilla
X ray PNS Waters view is a must to r/o maxillary hypoplasia before antral puncture

5. HIGGINSON’S RUBBER SYRINGE

Uses
· Antral wash
 · Nasal douching in atrophic rhinitis
Parts
· Bulb with red rubber tubing in either side one ends in a valve & the other in
nozzle
· Valve end is dipped in water and the nozzle end attached to trochar and Canula.
Valve makes the flow of the fluid in only one direction
· Capacity of ball - 50 ml or 60 ml
· Made of red rubber

6. BALLENGER’S SWIVEL KNIFE

Uses:
For removing the quadrilateral(septal) cartilage in SMR
Knife can rotate around the bar for 360°
Why called swivel?
· Cutting blade can revolve around the two bars
Indications of SMR
1. DNS causing nasal obstruction, head ache or sinusitis
2 As a part of hypophysectomy(trans-septal, trans- sphenoidal
3. Recurrent epistaxis due to septal spur
4. Cosmetic reasons
5. Rhinoplasty
6. Trans-septalvidianneurectomy
7. Cartilage graft in tympanoplasty
Contraindications:
1. A/c RTI
2. Age <17yrs
3. Bleeding diathesis
4. Uncontrolled DM, HT
5. Anterior/ Dorsal deviation of septum
 Notes:
1. Deviation anterior to Cottles line is called anterior dislocation
2. Cottles line is the line joining nasal spine of frontal bone & nasal spine of maxilla
3. Cottles test is pulling the cheek laterally backward to open nasal valve. Done
to check whether obstruction is in the valvular area or not. Lower border of
upper lateral cartilage , anterior end of inferior turbinate & corresponding area
on septum form nasal valve. An obstruction here causes 3/4th reduction of
airflow
4. Cottle’s approach is septoplasty
5. Cottles elevator is used in septoplasty to elevate mucoperichondrial flap
6. Cottles areas- Vestibular, Valvular, Turbinate, Attic, Posterior choanal.
Deviation in areas 1&2 require septoplasty, 3&5 require SMR or septoplasty&
forSeptorhinoplasty
7. Anterior deviation of nasal septum, patient’s age <17 yrs&septal surgery
associated with rhinoplasticprocedures(septum cannot support) form specific
indications of septoplasty.

7. LUC’S FORCEP’S
Uses
· in various nasal surgeries
· as a substitute for tonsil holding forceps

8. ST CLAIR THOMSON POST NASAL MIRROR

Uses:
Posterior rhinoscopy
Structures seen:-
· Roof of nasopharynx
· Posterior choana
 · Posterior aspect of nasal septum
· Posterior end of infturbinates
· Eustachian cushions
Q.Size of the mirror? (indicated behind the mirror)
Ask the patient to breath through the nose while keeping mouth open

9. SIMPSON’S AURAL SYRINGE

Uses:
1. Removal of FB from ear
2. Removal of wax
3. Caloric test 4. Enema
Precautions
a. Saline at body temperature
b. Direction of water towards posterior superior canal wall, not TM
· Protects TM. Allow water to get behind the mass
c. Tip of syringe should be blunt ]
d. Dry mopping after syringing
Contraindications
· Perforated TM-ASOM/CSOM
· Hygroscopic FB & button batteries
· Otitis externa
· CSF otorrhea
Side Effects
· Trauma to EAC - otitis externa
· TM rupture
· Activates latent otitis media
· Vertigo
· Vasovagal attack
TYPES
2. types- Adult, Paediatric
· Capacity - 150 ML (Adult)
Why normal saline at body temperature
· Otherwise it will cause Labyrinthine stimulation and vertigo.
PROCEDURE:
Patient in sitting position with head slightly tilted to the side of procedure.
Shoulders covered with towel and a kidney tray placed near the ear. water boiled
 and cooled to body temperature is syringed in the direction of posterosuperior
canal wall after pulling the pinna upwards and backwards

10. JOBSON HORNE’S PROBE & RING CURETTE

Uses:
a. Probe end
· Cotton swab carrier for cleaning discharge
· for tracing a sinus track
· Curette
· Removal of wax, FB

11. MOLLISON’S SELF - RETAINING HEMOSTATIC MASTOID RETRACTOR

Uses
1. Mastoid Surgery
2. Harvesting graft in myringoplasty
3. Tympanoplasty
4. Laryngofissure surgery
5. Frontal trephining
6. Ext. frontoethmoidectomy
7. Craniotomy
Advantages
1. Self retaining
2. Secures hemostasis
3. Retracts laterally away from field of operation.

12. BOYLE DAVIS MOUTH GAG

Parts 1. Tongue plate
2. Jaw piece
Uses
1. Surgeries of oral cavity: Surgeries of palate-Palatopharyngoplasty
2. Surgeries of oropharynx: Tonsillar surgeries
3. Surgeries of nasopharynx:Adenoidectomy, antrochoanal polyp,
postnasal angiofibroma, rhinosporidiosis
Complications
1. Injury to incisor tooth
2. Swelling of lips / teeth/gums/palate
3. TM joint dislocations
 Demonstrate how to hold the instrument and asses the parts?
Indications of tonsillectomy:
Absolute:
1. Recurrent infections of throat
a. 7 or more episodes in 1 year or
b. 5 or more episodes for 2 yrs or
c. 3 or more episodes for 3 yrs or
d. 2 weeks or more of lost school or work in 1 year
2. Peritonsillarabscess(quincy )
3. Tonsillitis causing febrile seizures
4. Hypertrophy of tonsils causing airway obstruction(sleep apnoea), dysphagia,
interference with speech
5. Suspicion of malignancy
Relative:
1. Diphtheria carriers not responding to antibiotics
2. Streptococcal carriers acting as source of infection for others
3. Chronic tonsillitis with bad taste or halitosis
4. Recurrent streptococcal tonsillitis in a patient with valvular heart disease
As part of other surgeries:
1. Palatopharyngoplasty to correct sleep apnoea
2. Glossopharyngeal neurectomy
3. Removal of styloidprocess( Eagles syndrome)
Contraindications
1. Hb<10g%; during mensus
2. A/c URTI
3. Submucous cleft palate
4. Children <3 yrs
5. Bleeding disorders
6. At the time of polio epidemics
7. Uncontrolled systemic d/s like DM, HT, Cardiac d/s, Asthma
Notes:
1. Daughtys tongue blade is connected via DRAFFINS BIPOD and
MAGAURAN”S PLATE
2. Position is rose’s position where neck is extended by placing a pillow under the
shoulder and a head ring is placed to stabilize the head

13. LACKS TONGUE DEPRESSOR

 · Doughty’s tongue blade / depressor is the one with a slot for ET tube
· Place the tongue depressor in midline in the anterior 2/3rd of the tongue to
prevent gagging.
. Uses: to depress tongue, for cold spatula test

14. EVE’S TONSILLAR SNARE

Uses
· In tonsillectomy to snare the lower pole of tonsil
Advantages
· Crushes the tissue & vessels, bleeding is less
(crushing releases thromboplastin which is a powerful vasoconstricitor and
assist clotting)
Q.Why inferior pole of the tonsil crushed?
Most of the vessels enter & leave from the inferior pole
Other snares
· Aural Snare (Cutting type) used for cutting aural polys {Krause}
· Nasal Snare (avulsion type) {Glegg}
Q. Averagebloodlose in Tonsillectomy? 50 mL.
Q. interval/cold tonsillectomy
Tonsillectomy done after a period of 6 to 8 wks of acute attack of peritonsillar abscess
Q.Wire used & its G uage’
Piano wire, 18-22 FG
Q.Structures passing through the inferior pole?
· Ascending pharyngeal artery
· Lesser palatine artery
· Dennis Brown Vein?
· Para tonsillar veins
· Abscess tonsillectomy?
· Emergency tonsillectomy done during A/C Quinsy
Blood supply of tonsils: branches of external carotid
1. Dorsal lingual branches of lingual artery
2. Ascending palatine and tonsillar branches of facial artery
3. Tonsillar branches of ascending pharyngeal
4. Descending palatine branch of maxillary artery
Tonsillectomy types:Hot& Cold methods
Hot methods:
1. Electrocautery
 2. Laser tonsillectomy &tonsillotomy
3. Coblation tonsillectomy
4. Radio frequency
Cold methods:
1. Dissection & snare method(followed here)
2. Gullotine method
3. Intracapsular tonsillectomy with debrider
4. Harmonic scalpel(ultrasound)
5. Plasma mediated ablation method
6. Cryosurgical technique
Notes:
1. Paratonsillarveins(Dennis Brown Veins)- commonly torn in tonsillectomy
2. Cold/interval tonsillectomy - done 4-6 wks after quinsy
3. Hot/abscess tonsillectomy- done during acute quinsy
4. Structures passing through lower pole of tonsils- Triangular fold, dorsal lingual
branch of lingual artery, lymphatics
Complications of tonsillectomy:
Immediate:
1. Primary haemorrhage
2. Reactionary haemorrhage
3. Injury to pillars, uvula, soft palate, tongue, teeth
4. Aspiration of blood
5. Facial edema
6. Surgical emphysema
Delayed:
1. Secondary haemorrhage- sepsis, premature seperation of membranes
2. Infections of tonsillar fossa causing otitis media
3. Lung complications- atelectasis, lung abscess, aspiration
4. Scarring of soft palate & pillars
5. Tonsillar remnants leading to recurrent infections
6. Hypertrophy of lingual tonsils

15. MOLLISONS BLUNT TONSILLAR DISSECTOR & ANT PILLAR

RETRACTOR
1.Dissecting end
· To divide mucosa close to anterior
· To follow the exposed capsule down to the base of tonsil with minimal trauma.
 2.Retracting end
· To retract the anterior pillar
(a) to look for bleeding points
(b) any tags of tonsillar tissue left
(c) formalcing incision
Precautions
· Avoid injury to uvula, ant.pillar, post, pillar

16. DENNIS BROWN TONSIL HOLDING FORCEPS

· To hold the tonsil during dissection

17. NEGUS LIGATURE SLIPPER

Uses
· To slip the ligature over the tip of Negus or Wilson forceps during the ligation
of blood vessels following tonsillectomy

18. WAUGH’S LONG DISSECTING FORCEPS WITH TOOTH

· To catch the bleeding point
· To pick cotton balls

19. ST. CLAIR THOMSON QUINSY DRAINING FORCEPS

Uses:
To drain peritonsillar abscess
Site of Incision:
· Point of maximum bulge
OR
· Just lateral to the point of junction of anterior pillar with a line drawn through
the base of uvula
OR
· Through crypta magna
Q. Hot tonsillectomy ?

Q.Define Quinsy-abscess b/w capsule of tonsil and tonsillar bed

DD’s of Quinsy :Tonsillar cyst, tonsillolith, intra-tonsillar abscess, parapharyngeal
abcess, sq. cell carcinoma of tonsils, NHL
DD’s of unilateral tonsillar involvement: Tonsillar cyst, tonsillolith, quinsy, malignancy,
carotid artery aneurysms, Phegmen tonsils
 Complications:
1. Parapharyngeal abscess
2. Laryngeal edema
3. Septicemia
4. Lung abscess, aspiration pneumonia
5. Jugular vein thrombosis

20. LARYNGEAL MIRROR

 21. FULLER’S BI VALVED TRACHEOSTOMY TUBE
Parts
1. Outer biflanged tube
2. Inner tube with an opening in the posterior wall
· Inner tube is always longer than the outer so the outer tube never gets blocked
by secretions, if inner tube is blocked, it can be cleaned leaving patent outer tube
in place.
Advantages
1. Acts as a tracheal dilator
2. Posterior wall opening of inner tube helps in
· Phonation
· Re educating the patient for normal speech during decannulation
· To determine whether normal air passage is established or nor, by blocking the
tracheostomy stoma.
Disadvantage
· Biflanged tube tip is sharp, hence is an irritant
· Flanges are weak, can break and can become FB bronchus

22. JACKSON’S METALLIC TRACHEOSTOMY TUBE

Parts
1. Outer tube with lock mechanism
2. Inner tube
3. Pilot obturator
Advantage
· Lock prevents inner tube from falling out during cough.
· Fuller’s tube flanges can beapproximated& acts as a tracheal dilator. Jackson’s
cannot and hence pilot is used which acts as a tracheal dilator.
· Jackson’s has a locking mechanism
· Jackson’s doesn’t have an inner opening as fuller hence all the exhaled air is
directed towards the opening of the tube and the pressure exerted there pushes
the inner tube out resulting, in decannulation
Size (both Jackson & Fuller)
Adult male 32, female 30.

23. PORTEX CUFFED TRACHEOSTOMY TUBE

Advantages
 1. Prevents aspirations
2. Can be connected to ambubag
3. During Radiotherapy
4. MRI/CT
Disadvantages
· Tracheal necrosis
· Cannot be kept for too long
Precaution: Deflate cuff at regular intervals
Q. Surgical Emphysema after Tracheostomy Management?
A. Remove sutures
B. Depress cought (4% xylocaine)
C. Avoid Movements of tube

24. LARYNGEAL SPECULUM / DIRECT LARYNGOSCOPE

It is actually laryngeal speculum as it has got a sliding plate which can be re
moved facilitating endotracheal intubations. this is an advantage. Held in the left hand
with thumb mark at the bend.
Indications
Diagnostic :
1. Where indirect laryngoscopy not possible as in infants and children
2. Where indirect laryngoscopy not possible due to excessive gag reflex or over
hanging epiglottis
3. To examine the hidden areas of larynx- i.eInfrahyoid epiglottis, ventricles,
anterior commisure, subglottis,posterior cricoid region.
Therapeutic
1. Removal of benign lesion like papilloma, fibroma, vocal nodule, polyp or cyst.
2. Removal of foreign bodies from larynx and hypopharynx
3. Dilatation of strictures
Contraindications
1. Diseases of cervical spine
2. Moderate dyspnoea unless tracheostomy has been done
3. Recent MI
Macintosh Laryngoscope= Anaesthetist’s laryngoscope. It can be lifted on reaching
vallecullae itself unlike the other one which can be lifted only after reaching the
epiglottis.
Position of Patient
 · Boyce position: Patient supine, flexion at lower cervical spine, extension
at Atlanto- Axial joint
Complications
1. Injury to lips/tongue/teeth
2. Laryngospasm
3. Bradycardia
4. Cardiac arrest

25. ST. CLAIR THOMSON ADENOID CURETTE WITH OR WITHOUT GUARD

Uses
· Adenoidectomy - producing obstruction with SOM
Use of guard / cage
· Prevents the slipping of adenoid tissue into nasopharynx/laryrnx
· Cage also ensures complete removal
Q.Inadenotonsillectomy which is done first?
· Adenoidectomy
Q.Griesel’s syndrome, management?
Injury to atlanto - occipital joint: To prevent it we have to flex the head while
removing adenoids.
Management:
· Cervical traction
· Analgesics
· Antiinflammatory
· I/V antibiotics
Indications of adenoidectomy:
1. Adenoid hypertrophy causing snoring, mouth breathing, sleep apnoea or speech
abnormalities
2. Recurrent rhinosinusitis
3. CSOM associated with adenoid hyperplasia
4. Recurrent ear discharge in benign CSOM
5. Dental malocclusion
Contraindications of adenoidectomy
1. Cleft palate or submucous cleft palate( causes velopharyngeal insufficiency)
2. Haemorrhagic diathesis
3. A/c URTI
Complications of adenoidectomy:
1. Haemorrrhage
 2. Injury to Eustachian tube, pharyngeal musculature and vertebrae
3. Velopharyngealinsufficiency(recovers in 2 wks)
4. Recurrence
Notes:
1. Physiotherapy for VPI- Inflate & deflate a balloon as it strengthens palatal
muscles
2. Adenoid curette is held in right hand & a dagger like movement is made at
wrist while left hand slighltyflexes the head to make nasopharynx in line to
avoid injury to mucosa
3. Extra care should be taken in Down’s patients as 0-20% of them have atlanto
axial instability
4. Griessels syndrome: Infection spreads to paraspinal muscles & ligaments
causing atlanto axial dislocation leading to compression of spinal cord at that
level & thus quadriplegia. This is very rare.
5. Hemostasis is achieved by nasopharyngeal pack kept for a period double of
bleeding time of that patient or till tonsillectomy is completed in adenotonsillec
tomy. Adenoid tags cause fresh bleeding after removal of pack. Then palpate,
remove tags and re-pack. If bleeding continues with no local cause then keep
post nasal pack for 24 hrs.
6. Other instruments with same name:
a. St. Clair Thomsons nasal speculum ( in our op)
b. St. Clair Thomsons quinsy draining forceps
Adenoid diagnosis is confirmed by x-ray nasopharynx, digital palpation, posterior
rhinoscopy, DNE
26. GARDINER- BROWN TUNING FORK
Parts
1. Prongs
2. Shoulder
3. Base
4. Stem
5. Foot piece
Q. frequency used- 512Hz
Falls within speech frequency ( 500 -2000 Hz)
Minimum overtones
Optimal decay time
Lesser vibration
Q. Distance between TF& auricle -2.5 cm
 Activated by striking at the junction of upper 1/3rd and lower 2/3rd (minimum
overtones heard) of its prongs ideally against a rubber piece or bony prominence of examiners
hand.

27. CHEVALIER JACKSON’S OESOPHAGOSCOPE

It does not have holes unlike bronchoscope. 50 cm long.
TYPES
1. Rigid
2. Flexible fibre optic
Indications
Diagnostic
1. Evaluation of dysphagia, hemetemesis and retrosternal burning
2. As a part of panendoscopy
3. To take biopsy
Therapeutic
1. Removal of foreign body
2. Dilataion of strictures
3. Removal of benign lesions
4. Palliative treatment in malignancy
5. Hemetemesis control by injecting scleroscents in oesophageal varices
6. Treatment of pharyngeal pouch ( Dolman’s surgery).
Position :
Boyce/ Barking dog / Morning air sniffing position. Neck flexed over thorax and
head extended at the atlanto- occipital joint. This is attained by placing a pillow under the neck
of the patient.
Notes:
killian’s dehiscence - it is between obliquefibres of thyropharyngeus and transverse
fibres of cricopharyngeouswhich are parts of inferior constrictor. It is called Gateway of
tears.
First symptom of perforation is inter-scapular pain and first sign is surgical
emphysema of neck.
In suspected perforation , if lumen of esophagus is visible then introduce a ryles
tube and NPO. If lumen not visible, provide IV fluids, parentral nutrition, broad spectrum
antibiotic coverage . If perforation not heal spontaneously, then opt for surgical
closure using flap or primary sutures.
 Panendoscopy= triple endoscopy= Nasopharyngeal laryngoscopy+ Oesophagoscopy
+Bronchoscopy. It is usually done in occult primary where secondary in necck nodes are
present.
Parts
1. Handle 2. Shaft 3. Eye piece
4. Light source 5. Light carrier
Complications
A - Arrhythmia
Aspiration pneumonia
Aortic aneurysm rupture
Air in pleura - pneumothorax
B - Bleeding
C - Cervical spine injury
D - Depression of respiratory centre
E - Oesophageal perforation
T - Trauma to lips and tooth
Q.Oesophagoscopy is done under GA or LA?
· Preferably under GA. All scopies to be done under GA. If contraindicated, LA.
Here all scopies done under LA. If contraindicated, GA

28. BRONCHOSCOPE
· Openings at the distal part-to ventilate the opposite bronchus.
· Sharp distal end
· Types: 1. Rigid bronchoscopy
2. Flexible fibre optic - bronchoscopy
Uses
1.Diagnostic
Examine the bronchial tree
Take biopsy
As a part of panendoscopy
2. Therapeutic
FB removal
Bronchial aspiration
Removal of benign lesions
Removal of mucus plugs in trachea
Dilatation in laryngo-tracheal stenosis
Complications
 1. Trauma to surrounding structure
2. Laryngeal edema
3. Hemorrhage
4. Bronchospasm
5. Aspiration
Types
1. Chevalier Jackson
2. Negus type
3. Mc Gibbon type
4. Fibre optic with micro photography
In chevalier Jackson, light is near the object
Notes
Position is Boyce position.
Flexible fibre optic bronchoscope can be used to visualise even the sub- segmental
bronchioles.

29 . CLEF ARROWSMITH SAFETY PIN CLOSING FORCEPS

OTHER INSTRUMENTS FOR NASAL SURGERIES

1. X-RAY PNS-WATER’S VIEW-showing haziness of rt maxillary sinus

DD:
· Maxillary sinusitis(if air fluid level is present ,a/c sinusitis . if no air fluid level,
don’t comment as a/c or c/c
· Mucocele
· AC polyp
· Malignancy
· Cystic lesions-dental and dentigerous cyst (dentigerous cyst arises in relation
to unerrupted tooth
· Haemosinus /haemoantrum
· Foreign body(usually dental amalgum)
Other views
· Occipitofrontal /Caldwell view- ideal for frontal sinus
· Lateral view- ideal for sphenoid sinus
 · Oblique view-ideal for ethmoid sinus
· Submentovertical view/ skull base view-sphenoid sinus
Management of sinusitis
2. X-ray showing nose and paranasalsinus,waters view open mouth showing haziness of rt
maxillary sinus with expansion and erosion of bony walls
· Diagnosis – malignancy of right maxillary sinus
· Symptoms,management

3. X-ray of nasopharynx,lateral view showing a soft tissue opacity arising from roof
and posterior wall of nasopharynxie, enlarged adenoids
· Crescent sign – seen in antrochoanalpolyp,not in adenoid
· DD:adenoids,nasopharyngealmalignancy,angiofibroma(crescent sign absent),AC
polyp,rhinosporidiosis(crescent sign present)
· Crescent sign is column of air between mass and roof of nasal cavity

4. X-ray ,lateral oblique view of skull showing nasal bone —undisplaced fracture
· DD:vascular marking on bone
· Management of nasal bone fracture
Displaced withodema-wait till odema subsides (7-10) days-closed reduction
Displaced without odema-early intervention (reduction with walshamasches
forceps(walsham –for nasal bone &asche’s for septal fracture
Undisplaced –no treatment required
If patient comes late(16-20 days)- rhinoplasty

5. X-ray soft tissue neck ,lateral view with lower part of skull and upper part of chest
showing widening of pre-vertebral soft tissue shadow with air fluid level and compression
of tracheal air column with intact cervical spine ,straightened.
Diagnosis- a/c retropharyngeal abcess
· Significant widening is greater than ¾ th thickness of vertebral body
· Straightening of spine due to painful spasm of paravertebral muscles
· Air fluid level is due to gas producing organism infection
· a/c R.Pabcess in adults- foreign body
· a/c R.Pabcess in kids –suppuration of retropharyngeal lymph nodes following ARI
· c/c always secondary to caries spine ,TB spine showing collapse and destruction
of spine.
Management of a/c R.Pabcess
 . Admit the patient .
Start on antibiotics ·
I &D under LA after preliminary tracheostomy with cuffed potex tracheostomy tube
· If bulge in oral cavity –intraoral I & D
· If bulge lower down –do hypopharyngoscopy and I & D at site of maximum bulge
· Give systemic antibiotics
Management of c/c R.P abcess
· Immobilize spine
· Anti TB drugs
· I &D – external drainage because TB prone for fistula formation
Complications- laryngeal oedema, aspiration pneumonia, lung abcess, para
pharyngeal abcess, mediastinalabcess ,septicemia

6. X-ray soft tissue neck lateral view showing open safety pin with open end down at level
of c5-c6
· Unsafe foreign body on cricopharynx
· Clef-arrowsmith forceps- to close safety pin
· Oesophagoscopy under GA and removal using foreign body removal forceps

7. X-ray PA view chest with neck and upper part of abdomen showing round radioo
paque shadow in coronal plane at junction of neck with thorax- probably coin in
cricopharynx
· Cricopharynx is narrowest region of oesophagus,plane of cricopharyngeal inlet
is in coronal plane
· In larynx(glottis) due to vocal cords ,coin lies in saggital plane
Management –oesophagoscopy/hypopharyngoscopy under GA using FB
removing forceps

8. X-ray mastoid lateral oblique view (laws view)showing cavity in mastoid bone
Causes of cavity in mastoid
· Cholesteatoma(smooth cavity with surrounding sclerosis)
· Surgical cavity(irregular cavity with no surrounding sclerosis)
· Malignancies of temporal bone(smooth cavity with eroded bony margins)
Uses of x-ray mastoid
· To know cellularity of mastoid
Cellular-80%
Sclerotic-15%
 Diploic-5%
· To know anatomical landmarks
· To rule out coalescent mastoiditis/cavity in mastoid

9. X-ray PNS –with rudimentary frontal sinus(look for DNS in x –ray)

· Normal frontal sinus has scalloped appearance

10. X-ray with broken inner tube of tracheostomy tube in bronchus

 ANATOMY & DEVELOPMENT
1. Development of Eye and Ocular structures(Pg.6)
2. Development of crystalline lens (diagram)(Pg.9)
3. Pupillary pathway for light reflex(Pg.5)
4. Visual pathway & blood supply & field defects( quadrantic anopsia
location of lesion
Upper: Top: Temporal Lesion
Lower: Pits: Parietal Lobe
5. Optic nerve, optic nerve head & Optic chiasma- anatomy, blood
supply,clinical importance(Pg.309)
CLINICAL METHODS
DIAGRAMS
A. Structures forming anterior chamber.(Pg.217)
B. Schiotz tonometer

SHORTNOTES
1. D/D of gradual painless and painful loss of vision(Pg.494)
2. D/D of sudden painless and painful loss of vision(Pg.494)
3. Causes of night blindness(Pg.494)
4. Difference between conjunctival and ciliary congestion(Pg.501)
5. Flourescin staining of cornea
6. Pseudo hypopyon(In Retinoblastoma,Leukaemia,Multiple myeloma)
7. D/D of iridodonesis(Pg.525)
8. Causes of rubeosis iridis(Pg.504,525)
9. Amaurotic cats eye reflex
10. Marcus Gunn pupil(pg.312,505)
11. D/D of redness of eye ——-SOGU CK:[Scleritis,Orbital
disease,Glaucoma,Uveitis,Conjunctivitis,Keratitis]
12. Causes of shallow and deep anterior chamber(pg.503)
13. D/D of white reflex(IMPT)
14. Causes of cherry red spot ——”Cherry Trees Never Grow Tall”
[Central retinal artery occlusion,Tay-Sachs disease,Niemann-Pick
disease, Gaucher’s disease,Trauma (Berlin’s edema)]
15. IOP
16. Retinoscopy(Pg.579)
17. Tonometry(Pg.510)
18. Perimetry(Pg.512)
19. Gonioscopy(Pg.578)
 20. Fundus flourescin angiography
21. Ocular ultrasonography
OPTICS AND REFRACTION

DIAGRAMS
1. Refraction in myopia & hypermetropia(Pg.29,32)
2. Sturm’s conoid(Pg.25)

SHORT NOTES
1. Uses of convex& concave lens (Pg.28)
2. Sturm’s conoid (Pg.25)
3. Myopia (IMPT)-Aetiology, clinical types, changes in eye, complications,
treatment (Pg.38)
4. Hypermetropia (Pg.34)
5. Aphakia (IMPT) (Pg.37)
6. Rx of Aphakia (Pg.37)
7. Pseudophakia
8. Astigmatism (Pg.42)
9. Presbyopia (Pg.47)
10. Contact lens-indication (Pg.51)
11. Radial keratotomy (Pg.52)
12. LASIK (Pg.53)
13. Low vision aids (LVA)
14. Binocular vision
15. Ophthalmoscopic changes in high myopia (Pg.33)
16. Methods of aphakic correction (Pg.37)
CONJUNCTIVA
DIAGRAMS
1. Blood supply of conjunctiva (Pg.61)
2. Parts of conjunctiva (Pg.59)
3. Pannus (Pg.69)

SHORT NOTES
1. Blood supply of conjunctiva (Pg.61)
2. Bacterial conjunctivitis (Pg.62)
3. A/C Mucopurulent conjunctivitis,(Pg.63)
4. A/C Purulent conjunctivitis
 5. A/C Membranous conjunctivitis
6. Pseudo membranous conjunctivitis
7. Angular conjunctivitis (Pg.66)
8. Trachoma- sequelae, Rx.(Pg.60)
9. Pannus
10. McCallan’s classification (Pg.64)
11. Follicular conjunctivitis
12. Allergic conjunctivitis (IMPT)(Pg.78)
13. Phlyctenular keratoconjunctivitis (IMPT)(Pg.83)
14. Pinguecula (Pg.86)
15. Pterygium (IMPT)(Pg.87)
16. Phlycten (Pg.83)
17. Ophthalmia nodosa
18. Pseudo Pterygium (Pg.88)
19. Ecchymosis (Pg.90)
20. Xerosis (Pg.91)
21. Parts of conjunctiva (Pg.59)
22. Giant papillary conjunctivitis (Pg.75)
23. Sub Conjunctival H’ge (IMPT)(Pg.82)
ESSAY
1. Acute Purulent/Mucopurulent Conjunctivitis
2. Trachoma (FISTO-Follicles, Intense, Scarring, Trichiasis, Opacities)
3. Ophthalmia neonatorum
4. Spring Catarrh(V.impt)
CORNEA
DIAGRAMS
· Histology/layers of cornea
· Stages of corneal ulcer
SHORT NOTES
1. Megalocornea
2. Hypopyon & pseudohypopyon
3. Hypopyon corneal ulcer
4. Marginal corneal ulcer
5. Herpes simplex keratitis
6. Disciform keratitis
7. Herpes zoster ophthalmicus
8. Acanthamoeba keratitis
9. Mooren’s ulcer
 10. SPK
11. Photo-ophthalmia
12. Interstitial keratitis (Pg. (TIC TAC S- TB, Inherited
Syphillis(Congenital),
Trypanosomiasis, Acute Syphillis, Cogan’s Syndrome, Sarcoidosis
13. Arcus senilis
14. Band shaped keratopathy
15. Keratoconus —CONES [Central scarring & Fleischer ring ,Oil drop
reflex/
Oedema (hydrops),,Nerves prominent ,Excessive bulging of lower lid
on
downgaze (Munsen’s sign) ,Striae (Vogt’s) ]
Systemic associations of keratoconus: ABCDEF
[Atopy,Bones (osteogenesis imperfecta),Crouzon’s syndrome,Down’
syndrome,Ehler Danlos syndrome,Fingers (Marfan’s)] clinical
features,
complications
16. Corneal opacities
17. Keratoplasty
18. Exposure keratitis, allergic keratitis
19. Keratomalacia
20. Striate keratitis
21. Anatomy, imp of each layer, maintenance of transparency
(impt)(Pg.90)
22. Hyphaema
ESSAYS
Bacterial corneal ulcer-etiology, pathology, complications, management,
Refer PARSON for drugs & doses
Fungal/ mycotic corneal ulcer
DIAGRAM
1. Staphyloma

SCLERA

SHORT NOTES
1. Episcleritis
2. Staphyloma (AC PIE-Anterior,Cilary,Poterior,Intercalary,Equatorial)
3. Post Staphyloma ———-POST SCLER
 [Proptosis ,Ophthalmoplegia ,Swelling of disc ,Thickening of sclera
(US/CT) & T sign (fluid in sub-Tenon’s space) ,Subretinal exudates
,Choroidal foLds ,Exudative RD ,Ring choroidal detachment]

ESSAY
1. Scleritis

UVEA
DIAGRAMS
1. Signs of anterior uveitis
2. Synechiae
3. Iris bombe

SHORT NOTES
1. Heterochromia iris
2. Congenital coloboma
3. Uveitis- Classification
4. Iridocyclitis
5. Keratic ppts(Pg.150)
6. Posterior synechiae(Pg.152)
7. Diff b/w granulomatous & non-granulomatous uveitis(Pg.155)
8. Secclusio & occulusio pupilae(Pg.153)
9. Iris bombe
10. Post uveitis
11. Endophthalmitis
12. Panophthalmitis
13. Evisceration
14. Behcet’s d/s(Pg.162)———-ORAL UPSET
[Occlusive periphlebitis, Retinitis, Anterior uveitis, Leakage from retinal
vessels, Ulceration (aphthous/genital), Pustules after skin trauma
(Pathergy test), Scratching leaves lines (dermatographism), Erythema
nodosum, Thrombophlebitis ]
15. VKH syndrome
16. Sympathetic ophthalmitis — Dalen fuchs nodule
17. Phaco anaphylactic uveitis
18. Fuch’s heterochromic iridocyclitis
19. Central serous choroidopathy(Pg.288)
20 Atropine in uveitis(Pg.156)
 21. Ocular toxoplasmosis(Pg.163)
22. Secclusio pupillae, Iris nodule, Masquerade syndrome
23. Enucleation & Evisceration(Pg.171)
ESSAY
A/c iridocyclitis(Pg.149)
LENS(IMPT)

DIAGRAMS
1. Adult crystalline lens(Pg.178)
2. Intraocular lens

SHORT NOTES
1. Congenital/ developmental cataract(Classification IMPT)(Pg.181)
2. Lamellar/ Zonular cataract (MC visually significant developmental
cataract)
3. Punctate cataract (Pg.183)(MC developmental cataract)
4. Stages of maturation of Senile cataract causes-CATARAct: Congenital,
Aging, Toxicity (steroids, etc),Accidents ,Radiation, Abnormal
metabolism (diabetes mellitus, Wilson’s)
5. Hypermature cataract
6. Black cataract
7. Management of cataract(Pg.193)
8. Macular function tests
9. Complicated cataract(Pg.192) ————- RIGID
[R- retinal detachment, I- inflammatory conditions like iridocyclitis,
hypopyon, choroiditis, endophthalmitis, G- glaucoma {primary &
secondary}, I- intraocular tumors, D- degenerative conditions {retinitis
pigmentosa, retinal dystrophies},surgeries: entropion]
10. ECCE – Conventional and SICS(Pg.199)
11.Anterior capsulotomy(Pg.200)
12.Phacoemulsification(Pg.203)
13.IOL – (Pg.206)Advantages, Types, Indications, SRK formula,
Implantation, Complications
14.AC IOL(Pg.206)
15.Complications of cataract surgery(Pg.209) (intraoperative, immediate &
late post op)
16.After-cataract – appearance (Pg.213)
 17.Subluxation & dislocation of lens (Pg.215)
18.Iris shadow- Immature Senile Cataract (Pg190).
19. Lens metabolism, nutrition, electrolyte imbalance (Pg.179)

ESSAYS
1. Senile cataract- immature & mature, management, treatment,
complications (Pg.185)
2. Complicated cataract (Pg.192)

GLAUCOMA
DIAGRAMS
1. Angle of anterior chamber: Structures and aqueous pathway (Pg.217)
2. Optic nerve head changes in glaucoma
3. Glaucomatous visual field changes(Pg.232)
SHORT NOTES
1. Uveoscleral outflow
2. Congenital glaucoma
3. Buphthalmos
4. Trabeculotomy
5. Primary open angle glaucoma
6. Optic disc changes in POAG
7. Bjerrum’s/ arcuate scotoma
8. Field defects in POAG
9. Water drinking test
10. Primary angle closure glaucoma-diagnosis, management.(Pg.238)
11. Acute congestive glaucoma
12. Lens induced glaucoma(Pg.247)
13. Neovascular glaucoma(Pg.249)
14. Glaucoma - in Aphakia(Pg.250)
15. Ciliary block/ malignant glaucoma(Pg.251)
16. Traumatic glaucoma(Pg.251)
17. Peripheral iridectomy (Pg.252)
18. Structures at angle of anterior chamber
19. Secondary glaucoma(Pg.247)
21. Steroid Induced Glaucoma
22. IOP-How it is maintained?
23. Pseudoexfoliative glaucoma
ESSAYS
 1. Primary open angle glaucoma- Signs, investigation, management
2. Acute angle closure glaucoma

VITREOUS
SHORT NOTES
1. Vitreous h’age
2. Vitreous detachment
3. Persistent hyperplastic primary vitreous
4. Asteroid hyalosis
5. Vitrectomy
6. Vitreous substitutes
RETINA
DIAGRAMS
· Microscopic structure of retina- rods & cones(Pg.265)
· Diagram of normal optic disc(Pg.264)
· Fundus pictures of retinitis pigmentosa, Hypertensive retinopathy,
Diabetic retinopathy, papilloedema
SHORT NOTES
1. Eales disease (Pg.268)
2. Retinal artery occlusion (Pg.269)
3. Retinal vein occlusion (Pg.270)
4. Hypertensive retinopathy (Pg.273)
5. Diabetic retinopathy (Pg.274)
6. Retinopathy of prematurity (Pg.83)
7. Exudative retinopathy of coats
8. Retinitis pigmentosa (Pg.287) [systemic d/s associated with retinitis
pigmentosa are :
L U C H RL- laurence moon biedl syn,U- usher’s synd ,C- cockayne’s synd,
H- hallgren’s synd,R- refsum’s synd]
9. Central serous retinopathy (Pg.292)
10.Cystoid macular oedema (Pg.294)
11.Age related macular degeneration (Pg.295)
12.Retinal detachment (Features- 4F’s-Floaters, Field loss, Flashes, Failing
acuity)(Pg.295)
[Treatment of Retinal Detachment “6 S”.Sealing of retinal breaks,,SRF
drainage (SRF is Subretinal fluid),Scleral buckling,SF6 pneumatic
retinopexy,Sectioning vitreous (vitrectomy),laser prophylaxis ]
13.Retinoblastoma(Pg.303)( DD for leucocoria) Classification- ABCDE-
 smAll(<3mm), Bigger(3mm macular subretinal fluid), Contained seeds,
Diffuse seeds(>3mm), Extensive(>50% globe, opaque media, NVI)
14.Soft exudates
15.Synchisis scintillans
16.Medullated nerve fibre
17.Enucleation(Pg.304)
18.CMV retinitis(Pg.165,267)
19. Complication of high myopia, Circinate retinopathy, Berlin’s oedema
20.Retinoschisis(Pg.286)
VISION AND NEURO OPTHALMOLOGY
SHORT NOTES

1. Toxic amblyopias (316)

2. AION (317)
3. Papilledema(319)
4. Optic atrophy-ICING:[Ischaemia,Compressed nerve,Intracranial pressure
[raised],Neuritis history,Glaucoma)](322)
5. DDs of night blindness (325)
6. Colour blindness (325)
7. Amaurosis(327)
8. Amblyopia(IMPT) (327,316,339)
9. Hemianopia (310)
10. Abnormalities of Pupillary reactions-AWE MAAd
Amaurotic,Wernicke’s hemianopic,Efferent pupillary
defect,Marcus gunn pupil,Argyll Robertson pupil, Adie’s
tonic pupil) (312)
11. Marcus- Gunn pupil (312)
12. Hutchinson’s pupil (332)
13. Pupils and mechanism of pupillary reflexes (RAPD) (314)
14. Cavernous sinus- Anatomy and Assosiated Syndromes.(414)
15. 3rd nerve palsy. (352)
16. Ocular manifestations of head injury.(332)
17. Field changes in pituitory tumours.((322)
18. Tubular vision.
ESSAY
1. Optic neuritis(314)
 STRABISMUS & NYSTAGMUS

SHORT NOTES
1. Strabismus(340)
2. Pseudo strabismus (341)
3. C/f of Paralytic strabismus ((351)
4. Diff b/w paralytic & non paralytic strabismus (354)
5. Nystagmus (356)
6. Internal ophthalmoplegia (353)
7. Convergent & divergent squint (345)

DISEASE OF THE EYELIDS

SHORT NOTES
1. Blepharitis (364)
2. Hordeolum externum (366)
3. Hordeolum internum (368)
4. Chalazion-Management(I & C) (368)
5. Trichiasis (369)
6. Ectropion (373)
7. Entropion (370)
8. Symblepharon (376)
9. Lagophthalmos (377)
10.Blepharospasm (378)
11.Ptosis (378)
12.Xanthelasma (382)

DIAGRAM
1. Anatomy of Eyelid (359)

LACRIMAL APPARATUS
SHORT NOTES
1. Structure of tear film (388)
2. Causes of tear film instability (389)
3. Dry eye (389)
4. Watering eye (391)
5. Dacryocystitis (393)
6. Hydrops of lacrimal sac (401)
 7. Lacrimal abscess (396)
8. Lacrimal fistula (396)
9. Management of congenital dacrocystitis (394)
10. Mx of a/c & c/c dacrocystitis (396)
11. DCR & DCT (397, 400)

DIAGRAMS
· Lacrimal apparatus (387)
. Tear film (388)
DISEASES OF THE ORBIT
SHORT NOTES
1. Proptosis (405)
2. Surgical spaces of the orbit (405)
3. Orbital mucormycosis (413)
4. Cavernous sinus thrombosis (414)
5. Orbital blowout fractures (425)
6. Types and causes of orbital inflammation (410)
7. Bones forming medial wall of orbit (403)
8. DDs of A/c inflammatory Proptosis-
Cavernous sinus thrombosis,Orbitalcellulitis,Panophthalmitis (407)
9. Periorbital cellulitis:Etiology:SIGHT:Sinusitis, Insect Bite,Globular/
Glandular Spread,Hematological spread,Trauma (411)
ESSAY
1. Orbital cellulitis (411)
2. Graves’s opthalmopathy:...NOSPECS Classification;Clinical features-
ONExamining LidEKOCP(Optic Neuritis,Exophthalmos,Lid
signs,Exposure Keratitis,Occular motility defects,Conjunctival
signs,Papillary signs) (417)

DIAGRAMS
1. Walls of Orbit (404)
2. Superior orbital fissure (404)
3. Orbital apex
4. Orbital Spaces (406)

OCULAR INJURIES
SHORT NOTES
1. Extraocular foreign bodies (430)
 2. Traumatic lesions of contusion injury (431)
3. Berlin’s oedema (434)
4. Siderosis bulbi (438)
5. Chalcosis (438)
6. Sympathetic ophthalmitis (441)
7. Intraocular foreign bodies (436)
8. Iridodialysis (432)
9. Rosette cataract (433)
10.Ultrasound in ophthalmology (522)
BASIC PRINCIPLES OF OCULAR THERAPY
SHORT NOTES
1. Acyclovir (449)
2. Antiglaucoma drugs (451)
3. Cortico steroids (456)
4. Viscoelastic substances (458)
5. Regional anaesthesia (603)
6. Topical mydriatics (582)
7. Drugs causing toxic amblyopia(316)
8. Lasers in ophthalmology: Mention two uses of Nd Yag Laser (UQ) (460)
9. Ocular side effects of TB DRUGS (470)
10.Chemotherapy of Retinoblastoma (303)
11.Botulinum toxin in Ophthalmology (378)
12.Carbonic anhydrase inhibitors & its adverse effects (454)
13.Immunosuppressives for post-uveitis (156)
14.Antifungals (450)
15.Antimetabolites, Cyclosporin
16.Intracameral medications (446)
17.Routes of drug administration (445)
18.Atropine (99,156)
19.Mydriatics & Cycloplegics(99,156)
20.Ketoconazole (451)
SYSTEMIC OPTHALMOLOGY
SHORT NOTES
1. Diabetes mellitus (191,274)
2. Xerophthalmia[WHO classification(NCBC CuT CSF-Night blindness,
Cornel xerosis, Bitot spots, Conjunctival xerosis, Corneal Ulceration
involving
one-third of corneal surface, Corneal scar, XerophthalmicFundus)] (463)
 3. Vitamin A therapy and prophylaxis (465)
4. Causes of blindness in children.(477)
5. Ocular manifestations of Connective tissue disorders
COMMUNITY OPHTHALMOLOGY
SHORT NOTES
1. Avoidable blindness
2. NPCB (479)
3. District blindness control society(480)
4. Corneal blindness (483)
5. Vision 2020 (481)
6. Eye bank (487)
7. Causes of preventable blindness

CLINICAL ESSAYS
1. 56 year old man who came for change of his glasses was found to have
raised IOP and optic disc cupping.
(July, 2010)
1) What is the most probable diagnosis?
2) What are the different methods of measuring IOP?
3) List the visual field defects he might have?
4) Discuss the management of such a case.

2. A 10 year old girl gives history of recurrent attacks of redness of both

eyes. O/E found to have Band keratopathy and evidence of c/c
iridocyclitis. (June 2009, March 2006)
1) What is the most probable etiology? (Still’s disease)
2) Name 4 causes and specific features of granulomatous
iridocyclitis.
3) What are the complications of iridocyclitis?
4) Discuss the DDs and management of A/c iridocyclitis.

3. A 45 year old female presented with severe headaches, vomiting

associated with unilateral redness, pain and diminution of vision.
(July, 2006)
1) What is the probable diagnosis?
 2) Name 4 causes for sudden loss of vision.
3) 3 DDs of acute red eye and how to differentiate.
4) Discuss the management of this patient.

4. A 60 year old lady presented with gradual progressive loss of vision,

both eyes.
1) What are the causes and DDs? (August, 2007)
2) Investgations.
3) Indications for surgery.
4) Surgical procedure.

5. A 70 year old man with Aphakia in his right eye and mature cataract in
the left eye presents with a sudden onset of pain and redness in the
phakic eye.
1) What is your diagnosis?
2) Clinical features of aphakia?
3) Disadvantages of aphakic glasses?
4) How will you manage this case?

6. 30 year old male presented with fever, headache, unilateral swelling of

lids and chemosis. He has proptosis also.
(August, 2005)
1) What is the most probable diagnosis?
2) Mention 4 causes of proptosis.
3) Describe the types and causes of orbital inflammation.
4) Discuss the complications and treatment of this patient.

7. A manual labourer presents with pain and redness in one eye following
trauma. Examination shows a congested painful eye with a white
opacity on the cornea.
1) What is your diagnosis? (Dec
2004)
2) How will you confirm your diagnosis?
3) What are the investigations that you will do?
4) What are the complications that you expect?

8. A one year old is brought with white reflex in pupillary areas of both eyes
 1) What are your DDs? (retinoblastoma, congenital cataract,
ROP)(July 2004)
2) What are the investigations that you will do?
3) Discuss in detail the treatment of any one of your DDs.

9. A 10 year old boy with h/o hay fever presented with complaints of
itching sensation in eyes, ropy discharge with seasonal variation.
(April 2002)
1) What is your probable diagnosis?
2) What are the DDs?
3) What treatment you advice?
4) What are the probable complications?

10. An adult male presents before you with the h/o defective night vision
since birth.
1) Discuss the DDs. (Oct
2003)
2) Discuss the fundus picture in RP.
3) Discuss the role of genetic counselling in hereditary retinal
diseases.
4) What is the treatment of retinoblastoma?

11. A man aged 60 years presents with painless progressive loss of vision
in both eyes, not improving with glasses.
(June 2003)
1) What is your diagnosis?
2) What are the DDs?
3) What are the advantages of IOL?
4) What is after cataract?

12. A 30 years young male presented with complaints of sudden painless

loss of vision and suffered from tuberculosis.
(July 2001)
1) Probable Diagnosis
2) Differential Diagnosis
3) Investigations
4) Treatment of Eale’s Disease.
13. A 25 year old female presented with loss of vision in LE of 2 days
duration. There was associated pain on movements of the eye. On
observation, vision in the LE was 2/60 and RE was 6/6. There was
RAPD in LE. Fundus examination was WNL in both eyes. No other
positive findings
1) Diagnosis
2) Mention four causes of sudden painless loss of vision in one eye.
3) How will you elicit RAPD? Mention two other conditions where
you will get RAPD.
4) How will you manage this patient? (Retrobulbar Neuritis)

14. A 5 month old child was brought by his mother with complaints of
watering and discharge from LE for the past three months. The cornea
of the LE appeared clear.
1) Most probable diagnosis (Dacryocystitis)
2) Differential Diagnosis
3) How will you manage this problem non-surgically?
4) What is the surgical management of this case?

15. A 40 year old woman has come to the casualty with complaints of
sudden onset of pain, redness and dimunition of vision of one eye. She
has headache and vomiting also.
1) Probable Diagnosis (acute angle closure glaucoma)
2) What are the common causes of pain and redness in eyes?
3) How will you differentiate them?
4) What is the treatment of Acute Iridocyclitis?

16. A 10 year old male child is brought to the OPD with complaints of
defective vision, more in one eye detected at school
1) What is the most likely Diagnosis?
2) What are the common Refractive errors in children?
3) What all test you will do and how will you correct these errors?
4) What are the tratment options available to correct Myopia?

17. 58 year old male with senile cortical cataract, one developed pain &
redness. Examination revealed shallow anterior chamber, pressure
47mmHg
 1) What is your diagnosis?
2) What are the measures to bring down IOP?
3) What is the management?
4) When will you do surgery?

18. A 60 year old lady with unilateral watering of eyes on examination

regurgitation test showed pus
1) What is your diagnosis?
2) What are the other signs you expect and how will you confirm the
diagnosis?
3) What are the complications?
4) What is the management?

19. A 10 year old boy presented with a small grey nodule at the limbus,
there was localised conjunctival congestion?
1) What is your clinical diagnosis?
2) What are your differential diagnosis?
3) What other ocular lesions will you look in this patient?
4) What is the management?

20. A new born child brought with watering from eyes?

1) What are the three most important causes?
2) How will you come to definite diagnosis?
3) Discuss the management of any one of them?

Name 4 :
1. Indications of tarsoraphy :7th nerve palsy, graves opthalmopathy, assist healing of a
non-healing ulcer, assist healing of skin grafts of lids in the correct position

2. 4 differential diagnosis for retinoblastoma: Congenital cataract, Coats disease,

Retrolental fibroplasia, Retinal dysplasia

3. 4 causes of limbal nodule : Dermoid, phlycten, foreign body granuloma, nodular

Scleritis

4. Tests for colour vision :Ishihara’s charts, edridge green lantern test, farnsworth
munsell 10 hue test, nagel anomaloscope

5. Causes of transient visual loss: Emboli from atherosclerotic carotid impacting on

ophthalmic artery or central retinal artery, migraine, raynaud’s disease, giant cell
arteritis,
6. Causes of hyphaema: Ocular trauma, surgery, retinoblastoma, leukemia

7. Predisposing factors for retinal detachment: Vitreous traction bands, Retinal

degenerations, myopia, trauma

8. Clinical signs of vit.A deficiency: loss of corneal lustre, bitot’s spots, keratomalacia

9. Causes of Subluxation of lens: Marfan’s syndrome, homocystinuria, sulphate

oxidase deficiency, Weil marchesani syndrome

10. Fundus changes in degenerative myopia: laquer cracks, foster fuch’s spots,
temporal crescent, tessellated fundus

11. Causes of flashes and floaters: Retinal detachment, Posterior vitreous detachment,
proliferative diabetic retinopathy, vitreous hemorrhage

12. Causes of xerosis: Sjogrens’s syndrome, vit.A deficiency, lagopthalmos, reduced

blinking rate

13. Causes of preventable blindness: Trachoma, vit.A deficiency, refractive errors,

glaucoma

14. Clinical signs of vernal keratoconjunctivitis: Papillae in the upper tarsal

conjunctiva,horner trantas spots, gel like adhesion of the tissues in limbus,superficial
punctuate keratitis

15. Systemic diseases associated with cataract: Diabetes mellitus, Atopic dermatitis,
Wilsons disease, Galactossemia

16. Causes of entropion :old age,chemical burns, facial nerve palsy,trachoma

17. Name 4 congenital cataracts: cataracta pulverulenta, lamellar cataract, blue dot
cataract,

18. Drugs causing toxic optic neuropathy: Qunine, Ethambutol,Ethanol,Methanol

19. Complications of uveitis :Glaucoma,Complicated cataract,Retinal

detachment,Phthisis bulbi

20. Causes of follicular conjunctivitis : acute bacterial conjunctivitis, trachoma,inclusion

conjunctivitis,molluscum contagiosum

21. Uniocular diplopia: intumescent cataract, iridodialysis, subluxation of the lens,

polycoria

22. Complications of a/c orbital cellulitis: Orbital apex syndrome, Superior orbital fissure
syndrome, cavernous sinus thrombosis, meningitis

23. Causes of cherry red spot: tay sach’s disease, central retinal vein occlusion,
sandhoff’s disease,

24. Features of bupthalmos: Corneal enlargement,corneal edema,Haab’s striae,deep

anterior chamber
25. Causes of unilateral disc edema: Optic neuritis, foster kennedi syndrome, orbital
apex syndrome,pseudo foster kennedy syndrome

26. Causes or rubeosis irirdis: diabetic retinopathy,sickle cell anaemiacentral retinal vein
occlusion,chronic iridocyclitis

27. Corneal lesions of herpes simplex:punctate epithelial keratitis, dendritic ulcer,

geographic ulcer,loss of corneal sensation

28. Field defects of POAG : paracentral scotoma, siedel’s scotoma,arcuate scotoma,

ronne’s central nasal step

29. Causes of bilateral proptosis: thyroid opthalmopathy, cavernous sinus thrombosis

30. Causes of unilateral proptosis: orbital cellulits, mucocele of the frontal and ethmoid
sinus,primary tumours of eyeball, congenital cystic eyeball

31. Causes of interstitial keratitis: syphilis,TB,Cogan’s syndrome,sarcoidosis

32. Indications for penetrating keratoplasty:pseudophakic bullous keratopathy,

nonhealing ulcers,corneal dystrophies, corneal opacities

33. Causes of colored haloes: acute congestive glaucoma, cataract, other conditions
causing corneal edema

34. Causes of nightblindess: vit. A defiecency, Retinitis pigmentosa, Late stages of

glaucoma, congenital stationary nightblindness

35. Causes of ptosis: 3rd nerve palsy, myasthenia gravis, horner’s syndrome,congenital

36. Causes of granulomatous uveitis: Tuberculosis, syphilis, Sympathetic opthalmia,

37. Features of aphakia: jet black pupil, 2purkinje images, iridodonesis, shallow ac

38. Causes of papiloedema: meningitis,intracranial tumours,cavernous sinus

thrombosis,intracranial abscess

1. Causes of coloured halos:

• Acute Congestive Glaucoma
• Immature cataract
• Acute mucopurulent conjunctivitis
• Corneal edema
• Pigmentary Glaucoma(intermittent glaucoma)

2. Tests for macular function:

• Colour perception
• Amsler grid test
 • Two light discrimination test
• Maddox rod test
• Entoptic visualisation

3. Organisms that penetrate the intact cornea:

• Meningococcus
• Gonococcus
• Corynebacterium

4. Causes of limbal nodule

• Phlycten
• Nodular scleritis
• Nodular episcleritis
• Limbal dermoid
• Foreign body granuloma

5. Causes of lagophthalmos
• Orbicularis oculi palsy
• Proptosis
• Severe degrees of ectropion
• Symblepharon

6. Causes of cherry red spot at macula(Code: C SBT GM Mr Niemann-Pick):

• CRAO
• Sandhoff’s disease
• Berlin’s edema
• Tay-Sach’s disease
• Gaucher’s disease
• Multiple Sulfatase deficiency
• Metachromatic leukodystrophy
• Niemann-Pick’s disease

7. Causes of granulomatous uveitis:

• Bacterial infections like TB, syphilis, brucellosis
• Sarcoidosis
• Sympathetic ophthalmia
• Vogt-Koyanagi-Harada syndrome
 8. Systemic associations of Ectopia lentis(Code:Women’s Hostel Has
MESS):
• Weil-Marchesani syndrome
• Homocystinuria
• Hyperlysinemia
• Marfan syndrome
• Ehler-Danlos syndrome
• Sulphite oxidase deficiency
• Stickler syndrome

9. Systemic associations of Retinitis Pigmentosa:

• Laurence Moon Beidl syndrome: RP, polydactyly, Mental retardation,
hypogonadism, obesity
• Abetalipoproteinemia(neuroacanthocytosis)
• Refsum disease(code=NADIR): neuropathy, ataxia, deafness,
icthyosis ,RP
• Usher syndrome: RP+SNHL
10.DD of night blindness:
• Idiopathic nyctalopia
• Retinitis Pigmentosa
• Vitamin A deficiency
• Glaucoma
• Congenital Stationary Night Blindness

11.Complications of Corneal Ulcer

Descemetocoele Ectasia Secondary Glaucoma Perforation,
Pseudocornea Fistula, Anterior Staphyloma, Cataract, Expulsion of lens,
Vitreous Haemorrhage, Panophthalmitis

1. Anomalies of ocular motility

· Eye strain (Asthenopia)
Causes: early presbyopia, uncorrected refractive error, incorrect
refractive correction, insufficient convergence, phorias.
· Diplopia (binocular)
Causes: paralytic squint, myasthenia gravis, thyroid d/s, blow out #
orbit.
 2. Disorders of ocular surface
· Watering
Excessive lacrimation- due to excessive tear production
Epiphora due to blockage of lacrimal drainage.
· Discharge
Onset, duration
Type: mucoid, purulent, Mucopurulent, ropy.
Asso: symptoms, amt of discharge, stickiness of eyes on waking
up in morning.
· Photophobia
Onset, duration, severity
Assoc: symptoms
Causes: keratitis, uveitis, keratoconjunctivitis
· Redness
onset, duration, severity
assoc: symptoms
causes: a/c conjunctivitis, keratitis, uveitis, a/c angle closure
glaucoma
· Itching
causes: dry eye, trachoma, Trichiasis

3. Visual phenomena
· Floaters
causes- vitreous h’age,/degeneration/exudates, lenticular opacity
· Flashes of light (Photopsia)
onset, duration
causes: posterior vitreous detachment, vitreous traction bands,
retinal tear, retinitis
· Distorted vision
Micropsia, macropsia, metamorphosia
Causes: chorioretinitis
· Coloured halos
onset
assoc: symptoms (pain, headache)
causes- a/c cong: glaucoma, early stages of cataract,
Mucopurulent conjunctivitis
· Uniocular diplopia
Causes: subluxated lens, incipient cataract, iridodialysis
 · Chromatopsia
Causes: after cataract extraction

4. Defective vision
onset, duration, severity
Progression
Assoc: pain
Diurnal variation

Causes of gradual ,painless progressive diminution of vision

Age >40
Age< 40

Presbyopia
Refractive errors

Age related cataract

Keratoconus

Diabetic retinopathy
Developmental cataract

RP, POAG
Juvenile glaucoma

Dry type ARMD

RP

Sudden & painless progressive diminution of vision

Unilateral Bilateral

Retinal detachment Bilateral occipital infarction

Vit & retinal H’ge Diabetic retinopathy

Exudative ARMD Posterior uveitis

Subluxation/dislocation of lens Grade 1V HTve retinopathy

Sudden and painless progressive diminution of vision

 Transient For near objects

Presbyopia
Papilloedema

Cycloplegia
Migraine

Day [Hamarlopia] Night

Central nuclear cataract vit A def

Central corneal opacity RP

5. Headache
· Ask for refractive errors
· Diurnal variation:
Increase in evening - Refractive error
Increase in early morning - Sinusitis
· Assoc, features-
(a) Vomiting - Increase ICT/ Papilloedema/ angle closure
glaucoma
(b) Aura - Visual (loss of vision, flashes)- migraine
· Relief on sleep- angle closure glaucoma

PHYSICAL EXAMINATION

A. GENERAL EXAMINATION
· Build & nourishment
· Ht- cm Wt- kg
· PICCLE PR -
· BP- Temp-
· Head to foot examination

B. SYSTEMIC EXAMINATION
 · CNS, CVS, Resp, GIT, Skeletal system

C. OCULAR EXAMINATION
1. Head posture
· Head tilt [as in nystagmus]
· Face turn [paralytic squint, diplopia]
· Chin position [complete ptosis]
2. Symmetry of face
· Any asymmetry [hypertropia/ hypotropia, micropsia/
macropsia]
· Wrinkling of forehead- absent/ present - both halves [bell’s
palsy, facial hemiatrophy]
3. Ocular posture
· Proptosis
· Ptosis
· Strabismus

4. Extra ocular movements

· Uniocular- closing one eye
· Abduction [outward mvmt]
· Adduction [ inward mvmt]
· Elevation [upward mvmt]
· Depression [downward mvmt]
· Intorsion [rotatory mvmt along AP axis- superior pole of
cornea moves medially]
· Extorsion [ rotatory mvmt along AP axis- superior pole of
cornea moves laterally]
Binocular mvmts
a. Versions
(i) Dextroversion- both eyes to the right
(ii) Laevoversion- both eyes to the left
(iii)Dextrocycloversion-Sup.poles of cornea of both eyes to
right
(iv) Laevocycloversion- Sup. poles of cornea of both eyes to
left
(v) Supraversion- both eyes up
(vi) Infraversion- both eyes down
b. Vergences
 (i) Convergence
(ii) Divergence
· Saccadic movement [quick fixation mvmts]
· Pursuit movement [slow following mvmt]
· Voluntary movements
· Involuntary movements
· Painful restriction- Panophthalmitis

5. Visual acuity
Test with the opp. eye closed using Snellen’s chart at 6 m (60,
36,24, 18, 12,9,6)
Acuity = Distance at which patient reads a particular line
Distance at which a normal person reads the same
line
Nl - 6/6,ie., the lower most line is read clearly at 6m.
· If unable to read the upper most line, ie., V.A < 6/60, then reduce the
distance by lm steps.
· If the uppermost line is not read even at lm ,ie., V.A < l/60,then look
for Counting fingers at lm- Counting fingers at 1/2m—Counting
fingers close to face—Hand mvmts—Perception of light.
· Projection of light: Identification of direction from which light is
projected accurate/ inaccurate an 4 quadrants.

6. Field of vision: confrontation method

7. Colour vision

8. Examination of lids and adnexa

· Eyelids: Examine all eyelids
· Position: ptosis / lid retraction
· Movement of lids: blinking rate[nl:12-16]
· Lagophthalmos
· Lid margin -entropion
· Ectropion
· Eyelash abnormalities [trichiasis / madarosis / poliosis /
matting]
· Swelling of lid margin
· Hordeolum externum or stye [a/c infection of Zeis gland]
 · Hordeolum internum[a/c infection of meibomian gland]
· Chalazion[c/c granulomatous infection of meibomian gland]
· Abnormalities of skin: Herpetic blister / molluscum / warts /
cysts / ulcers / traumatic scars
· Palpebral aperture: ankyloblepharon [horizontally narrow]
· Blepharophimosis
· Vertically narrow/ wide

9. Eyebrows
· same level or not
· madarosis[absent lat 1/3rd]
· scars

10. Lacrimal apparartus

· Lacrimal sac area: redness / swelling / fistula
· Lacrimal puncta[2 in each eye]: eversion / stenosis / absence /
discharge on pressure

11. Conjunctiva
· Examine both bulbar & palpebral, inf. fornix
· Congestion: conjunctival [conjunctivitis]
- Circumcomeal / ciliary [ant.uveitis, corneal pathology, a/c
congestive
glaucoma]
- Diffuse[endophthalmitis]
- Interpalpebral [allergic conjunctivitis]
· Discolouration: melanoisis/argyrosis/cyanosis/sub conjunctival
h’age
· Chemosis
· Follicles / papillae / concretions / FB [esp in UTC after eversion]
· Scarring
· Phlyctens / bitot spots / pingecula / limbal nodules

12. Sclera
· Nodules / discolouration
· Staphyloma / thinning
· Traumatic perforations / sutures
13. Cornea
· Size[nl:11-12 mm diametr]
· Shape and curvature-keratoglobus / keratoconus
· Surface: abrasions / ulcerations / ectatic scars / facets
· Opacity / ulcer, if present: comment on its
· Shape, size
· Site in clock hours
· Distance from limbus
· Relation with pupillary margin
· Surface[clear / with discharge / drug ppt]
· Margins
· Nebula [dont comment on torch light examination] / macula /
leucoma
· Pigmentation / vascularisation
· impacted FB: with / without surrounding infiltration
· Corneal vascularisation: superficial / deep
· Corneal pigmentation / staining: acute senilis / KF ring /
chalcosis / Fleischer ring / hyphaema
· Corneal sensation: to differentiate b/w adeno / herpetic corneal
ulcer
· Vth cranial nerve palsy

14. Anterior chamber

· depth: nl 2.5 mm
Deep AC: aphakia/ iridocyclitis / keratoconus / myopia
/buphthalmos
Shallow AC: angle closure glaucoma / Morganian cataract /
hyprermetropia / adherent leucoma
Irregular AC: subluxation / discontinuation of lens /
synechiae
· Aqeous: clear
· Hypopyon: in corneal ulcer / iridocyclitis / panophthalmitis
· Hyphaema: in trauma, haemorrhagic glaucoma
· Lens particle / parasitic cysts / artificial lens

15. Iris
· colour: heterochromia iridis / atrophic patches / naevi
· pattern: nl/muddy
 · Synechiae: ant / post-total annular / segmental
· Iridodonesis
· Nodules: ciliary/papillary margin
· Rubeosis iridis-new vessel formation
· Defect/ hole-coloboma/iridectomy/iridodialysis/FB track
· Aniridia

16. Pupils
· number, size(mm)
· shape
· Margins
colour: Red(vitreous h’ge); jet black(aphakia);
yellow(endophthalmitis); glistening (pseudophakia)
· Light reflex

17. Lens
· Position- NI/ subluxn(med,lat,sup,inf)/dislocation(ant,post)
· Colour
· Opacity
- colour-IMSC(grey white),MSC(pearly white),hypermature(milky
white)
- nuclear(yellow/brown/black) pattern
· Pigmentation on ant. capsule
· Aphakia/pseudophakia(PCIOL/ACIOL)
· Phacodonesis
· PCO in PCIOL

18. DIGITAL TONOMETRY

Nl-10-20mm hg
Nl / raised

Case Presentation
Name: Age: Sex: Address:
Occupation: DOA: DOE:
 Presenting complaints:
H/O of presenting illness:
Past h/o- similar illness, trauma, DM, HTN, allergy
Family h/o- similar illness, DM, HTN, allergy
Personal h/o- addictions
Treatment h/o:

General Examination
Build & nourishment
Ht- cm, Wt- kg
PICCLE
PR- BP-
Temp
Head to foot examination
Other systems

Ocular examination
· Head tilt, face turn, chin position- +
· Facial symmetry- +/-
· Proptosis,ptosis,strabismus, nystagmus- +
· Extraocular movements- full in all directionss
· Visual acuity- [R] [L]
· Field of vision : nl / not
[Always comment on the right eye 1 st
For all following examinations, say NI/ if there is any
abnormality, comment on that ]
· Lids & adnexa
· Conjunctiva- describe pterygium if present
· Sclera
· Cornea -Describe ulcer/ opacity if present
· Anterior Chamber- Mention about depth, aqueous
· Iris- colour, pattern
· Pupil- Size, shape, regular/irregular. Always mention direct &
consensual light reflexes.
· Lens-
· IOP- Digitally raised/ not raised

Case summary
 Diagnosis

1. EYE SPECULUM
The types are:
(A) Universal Eye speculum
(B) Guarded Eye speculum
(C) Wire speculum
(A). Universal Eye Speculum
Identification: It has a spring and two limbs, and a screw to adjust
the limbs. It is called universal because can be used on either
side.
Method: It is fixed to the eyelids in such a way that screw should
face outward and forward.
Uses: It is used to separate both eyelids for good exposure of the
eyeball mainly during extraocular operations
i. Pterygium excision
ii. Squint operation
iii. Evisceration and Enucleation
iv. Debridement and cautery of corneal ulcer.
v. To give sub-conjunctival or sub-Tenon’s injection.
vi. Removal of corneal foreign body.
vii. Removal o f conjunctival cyst or mass
viii. During suture removal
It is not used routinely in intra-ocular operations as it gives
pressure over the globe. This causes rise in IOP during operation.
One can put a cotton pellet or assistant can lift the instrument
during intra-ocular operation to avoid rise in IOP. Otherwise, stay
sutures to the lids are commonly used for intra-ocular operation.
Disadvantages:
(i)Since it has no guard, eyelashes of upper lid (larger) come in
the field of operation.
(ii)Not used in intra-ocular operation because of more vitreous-
upthrust and risk of vitreous loss by pressure on the
globe.
 (B) Guarded Eye Speculum
Identification: The upper limb of the speculum is having a guard
plate which keeps the eyelashes of the upper lid away from the field
of operation. So two instruments are required, one for the right eye
and the other for| left eye.
Uses: Same us universal eye speculum. It is specially useful in
squint operation in children and in pterygium operation.
Disadvantages:
(a)Operating field is reduced.
(b)It is heavier, hence gives more pressure on the globe.
(C) Wire Speculum
It is made up of stainless steel wire and there is no screw. It is of
universal type It is very light and hence gives little pressure on the
eyeball. So, it can be used safely during intraocular operation as
well as extraocular operation.
(The speculum should not be confused with Muller’s retractor,
which has got two or three right-angle sharp pointed pins (teeth)
underneath to engage the skin flap).

2. ARTERY FORCEPS (HAEMOSTAT)

Identification: This is a medium size, fully serrrated forceps with catch. It

may be
straight or curved. This curved forceps are used more frequently.
Uses:
· To hold lid stitches and superior rectus stitch, and then to fix the
suture ends with head towel
· To crush lateral canthus in lateral canthotomy.
· For haemostasis during DCR or DCT, specially if the angular vein is
damaged.
· Fasanella-Servat operation of ptosis (to clamp conjunctiva. Tarsal
plate, Muller’s muscle and levator muscle)
· To hold muscle stump during enucleation,
· To make irrigating cystitome from a 26 gauge disposable needle,
· To hold whole lacrimal sac prior to excision in DCT.

3. CONJUCTIVAL SCISSORS
 Identification: It is a straight fine scissors with pointed tips. It maybe
curved.
Uses:
1. It is used to dissect the bulbar conjunctiva in some operations:
a. Conjunctival flap in cataract operation. Here the flap may be limbal
-based or fornix-based. Limbal based flap, the conjunctiva is cut
few mm away from the limbus and then it is reflected over the
cornea from its attached base at the limbus.In fornix-based flap,
conjunctiva is cut at the limbus and retracted towards fornix.
Fornixbased flap is better than limbal-based flap.
b.Conjunctival flap in trabeculectomy operation.
c. Squint, retinal detachment, enucleation operation, etc
2. It may be used to cut the suture ends.
3. It is used to cut other tissues eg Tenon’s capsule, pterygium, skin
edges etc.

4. CORNEAL SPRING SCISSORS (UNIVERSAL)

Identification: It is a small curved spring scissors with sharp small

blades. It is called universal, as it is used cut both right and left half of
the section (right half means temporal half of right cornea and nasal
half of left cornea, left half means temporal half of left cornea and
nasal half of right cornea.)
Uses:
1. To extend ‘ab-extemo’ section in cataract operation.
2. To cut the corneal button from the donor and recipient eyes in case
of keratoplasty
3. It may be use to cut the 8-0 suture ends.
4. It may be used to cut the iris for iridectomy.

5. DE WECKER’S IRIS SCISSORS

Identification: It is a butterfly shaped spring scissors with the cutting

blades bent at an angle of 60° with the handle. On the handle, there are
two wings for index finger and thumb. Its one blade has pointed tip and
the other blade has rounded tip.
 Method: Scissors is held in such a way that the plane of blade lies at the
same plane as of iris, whereas the handle is almost vertical.

Uses:
1. It is used to cut a piece of iris tissue in iridectomy
2. It is used for anterior or open-sky vitrectomy, if there is any
vitreous loss during cataract extraction.
3. It is used to cut the trabecular tissue with a part of sclera in
trabeculectomy operation.
4. It may be used to cut the suture ends (8-0 or 10-0 sutures) during
cornea- scleral suturing.

6. VECTIS (WIRE VECTIS)

Identification : It is a ring of wire (round or oval) at the end of a narrow

limb, attached to a handle (like a large platinum loop). It may be little
curved like a spoon.

Method: Pupil must be fully dilated. Never pass it blindly. The lens edge
should be visible. Carefully pass the vectis behind the lens. Lift the lens
and then take the lens out. Vitreous loss is inevitable in vectis delivery.
Sometimes, a sector iridectomy is needed instead of peripheral
iridectomy. Open - sky vitrectomy is done after lens delivery.

Uses:
a. To remove a subluxated or dislocated lens.
b. To deliver the nucleus in ECCE with irrigating vectis.
If the vectis is not available, the instruments may be used as vectis:
1. Perforated end of Mc Namara’s Spoon
2. Intracapsular forceps- Here apply forceps with closed tips, carefully
pass it behind the lens and then open the tips little bit so that lens
sit well on it. Now, lift the lens and remove it.

7. NEEDLE HOLDER (BARRAQUER’S)

Identification: It is a medium - sized spring needle holder with two

narrow and fine curved jaws. It may be available with or without a catch.
 Uses:
i. It is used to catch the fine needles (of 5-0, 6-0, 8-0 and 10-0 sutures)
for
ii. Corneo - scleral suturing after cataract operation.
iii. Scleral suturing in squint, detachment and trabeculectomy
operations.
iv. Corneal suturing in penetrating injury or keratoplasty
v. Suturing the mucosal flaps in DCR operation
vi. Sometimes in conjunctival suturing

8. VANNA’S SCISSORS

Identification: It is much smaller scissors with spring action. It may be

straight, curved or angular.

Uses:
1. To prepare conjunctival flap.
2. To cut 10-0 sutures in cataract or keratoplasty operation
3. To cut trabecular flap in trabeculectomy.
4. To cut anterior capsular tags in ECCE.
5. To cut vitreous in open-sky vitrectomy, as in vitreous loss during
ICCE or ECCE.
6. To cut corneal button after trephination in corneal grafting.
7. To cut iris in different types of iridectomy

9 . IOL DIALLER (SINSKY’S HOOK)

Identification: It is an angular fine hook attached to a long round solid

handle.

Methods and Uses:

i. It is used to dial the IOL for the purpose of centration and bringing
the IOL - haptics in horizontal position. The hook is positioned in
the dialing holes of the optic of IOL, and then to rotate in clockwise
manner.
ii. It may be used as a left hand instrument during
phacoemulsification
a. To rotate the lens nucleus
 b. To crack the lens nucleus after doing quadrant trenching.
c. To chop the nucleus
iii. It is used to break the posterior synechiae (synichiolysis) during
ECCE.

10. . CHALAZION FORCEPS (Clam)

Identification: It is a forceps with a large screw for fixing or tightening

the limbs like a clamp. One limb has got a solid disc-shaped plate and
the other limb has a ring at its end. It is haemostatic and self- retaining.

Method: The solid plate is applied on the skin surface of the lid and the
ring side is applied on the tarsal conjunctiva, encircling the chalazion.
The screw is tightened and the lid is everted and then chalazion is
exposed for incision.
The functions of the screw are:
i. Fixation of the lid
ii. Haemostasis by means of tightening.

Uses:
1. To fix the chalazion for surgery and also to ensure haemostasis.
2. To give intralesional injection of steroids in chalazion after fixing it
with forceps.
3. Excision of a small granuloma or papilloma of the lid.

11. PUNCTUM DILATOR (NETTLESHIP’S)

Identification: It is long narrow solid cylindrical instrument with a

smooth conical pointed tip. Its body is corrugated for better gripping
with thumb and index finger.

Method of Syringing:
i. Anaesthetize the eye with 4% lignocaine or 1 % proparacaine drop.
ii. Pull the lower lid and identify the lower punctum in bright light
iii. Hold the punctum dilator vertically by right index and thumb and
place it on the punctual opening.
iv. Twist it with light pressure and introduce into the punctum.
v. Then hold the punctum dilator horizontally and push it medially by
 rotatory movement following the course of the canaliculus (first
vertically then horizontally). Then withdraw it.
vi. Take the lacrimal canula, fitted in a syringe, filled with distilled
water and introduce it in the same direction.
vii. Push the piston of the syringe to inject water into the canaliculus
and ask the patient whether water has reached the throat or not.
Alternatively note the swallowing movement of the neck.

Uses:
1. To dilate the punctum and part of the canaliculus before introducing
lacrimal canula for syringing.
2. To dilate the punctum for probing in case of congenital
dacryocystitis.
3. To dialate the punctum and then probing to identify lacrimal sac
during DCR operation.
4. For dilatation of the punctum in congenital or acquired punctual
stenosis.
5. Before Dacryocystography (DCG)
6. May be used as a marker (by dipping the pointed tip in gention violet)
in squint or retinal detachment operation.

12. CALLIPER (CASTRO VEIJIO’S)

Identification: It is a measuring calliper in which the measurement (in

mm) is adjusted by spring action of a screw. The measuring ends are
pointed like a compass, and the scale is fixed to the opposite end.

Methods: The exact measurement is taken by adjusting the spring

action of the screw which is indicated by the pointed end on the scale.

Uses:
i. To measure the size of the cornea, as in buphthalmos,
megalocornea, microcornea etc.
ii. To use in various surgeries:
a. Phacoemulsification or Small Incision Cataract Surgery- length of
incision.
b.Trabeculectomy- length of scleral flap.
c. Squint operation- amount of resection or recession of muscle.
 d.Keratoplasty - to determine the size of the donor and recipient
corneal button.
e. Retinal detachment surgery - to measure the distance for passing
encircling band.
f. IOFB removal - to measure the site of incision for IOFB removal.
g.Ptosis surgery - to measure the amount of LPS to be resected
h. To measure the length for any purpose.

13. CORNEAL TREPHINE (CASTROVEIJO’S)

Identification: It is a cylindrical instrument which has three parts:

i. A circular blade.
ii. An adjustable inner core or ‘obsturator’ and
iii. A cover to protect the sharpness of the blade.
It is available in different diameters (like 6.0,6.5,7.0,7.5......10,10.5,
etc..in mm). The obturator has a scale (marking 0,2,4,6 etc. in 1
/10th of mm) which helps the surgeon to select exact depth of the
cornea to be cut. This is important in lamellar keratoplasty.

Uses: To cut the ‘donor’ and ‘ recipient’ corneal button in penetrating

and lamellar keratoplasty.

14. INTRA OCULAR LENS

Diameter – optic – 5-7 mm ; haptic - 12mm

Types - anterior chamber IOL, posterior chamber IOL, iris supported
Based on material - Rigid IOL - PMMA
- Foldable IOL - silicon, acrylic, hydrogel,
collamer
- Rollable IOL - hydrogel
Power of IOL [SRK formula]
P = A – 2.5 L – 0.9 K
P = power of IOL
A = a constant which is specific for each lens type
L = axial length of eye ball in mm
K = average corneal curvature

15. JACKSONS CROSS CYLINDER

 Used to verify strength and axis of cylindrical lens
Commonly used cross cylinders are of ± 0.25 D and ± 0.5 D

16. MADDOX ROD

Consists of many glass rods of red colour set together in a metallic disc
Uses – macular function test, diplopia

17. RED GREEN GOGGLES

For diplopia charting

Worth’s four-dot test - Patient wears red lens on front of right eye and
green lens in front of left eye and views a box with 4 lights - 1 red, 2
th
green, 1 white [interpretation – refer Khurana 4 ed. Pg 328]

18. TRYPAN BLUE

To stain the anterior capsule during anterior capsulotomy

19. VISCO ELASTIC SUBSTANCE

Functions - Maintain anterior chamber

- Protective coating to anterior chamber in phaco
emulsification

Preparations :
· Methyl cellulose
· Sodium hyaluronate 1%
· Hypromellose 2%
· Chondroitin sulphate [20 & 50%]

Alternatives: – air, serum, balanced salt solution, other blood products

s/e – postoperative raise in IOP if not washed completely

Uses –
1. Cataract surgery with or without IOL implantation
§ Maintain anterior chamber
§ Protection of corneal endothelium
§ Coating IOL
 § Preventing entry of blood and fluid in anterior chamber
2. Glaucoma surgery
3. Keratoplasty
4. Retinal detachment surgery
5. Repairing the globe in perforating injuries

20. IRIS FORCEPS

Identification: It is a small light - weight forceps with 1:2 teeth on the

inner side of its tips. If the limbs closed, teeth cannot be seen or
felt. The shape of the forceps maybe straight, curved or angular.

Method of iridectomy:
i. Hold the instrument in such a way that its tips face towards 12 o’
clock position and angle towards 6o’ clock position.
ii. Now enter into the A/C with close tip and touch the peripheral iris.
ii. Open the forceps a little to catch a pinch of iris tissue and take out
as a triangular fold of iris out side the section.
iv. Cut a small triangular piece of iris radially with de-Wecker’s
scissors. Always check the severed iris tissue by rubbing it over
face mask. This is to see the pigmented layer has cut or not , i.e if
there is release of pigment - it means iridectomy has done in full
thickness.

Types of iridectomy with indications:

Peripheral button hole iridectomy: (at 11 and / or 1 o’ clock position)
one full thickness iridectomy is equally effective as two iridectomies.
The indications are:
i. In intracapsular cataract extraction
ii. Angle closure glaucoma.
iii. As a part of trabeculectomy operation and
iv. In penetrating keratoplasty operation. It is not mandatory in
extracapsular cataract extraction.
Peripheral iridectomy is done to prevent papillary block glaucoma and
consequent
iris prolapse in case of ICCE. As the aqueous can flow into the anterior
chamber
via this bypass channel, equilibrium between the anterior chamber and
 posterior
chamber is maintained after ICCE.
Optical iridectomy: In case of central corneal opacity where facilities
for keratoplasty are not available and rarely in polar cataracts.
It is done in the lower part of the iris, as in upper part, the new
opening will be covered by upper lid. The best site for optical iridectomy
is judged by stenopaeic slit test, and it must be at the clearest zone
.Customarily, it is said that the site of election will be down and in for
the literates, and down and out for illiterates.
Glaucoma iridectomy or Iridectomy dialysis: Done in congestive
glaucoma to facilitate drainage of aqueous. Here, iris is torn from it root
instead of cutting it with the scissors.
Broad or Complete iridectomy: To facilitate the extraction of lens
(Combined extraction of cataract) when pupil is small and rigid, or if
there is extensive synechiae, and if there is vitreous loss after cataract
extraction.
Iridectomy for prolapsed iris.
Iridectomy to remove foreign body on the iris.
Iridectomy to remove tumour or cyst.
Preliminary iridectomy: It is a test iridectomy, in uveitis causing
complicated cataract, in the first sitting to see the reaction in that
eye.
Involuntary iridectomy is the iridectomy caused by a cataract knife
during ‘ab-interno’ section, when the A/C becomes shallow or aqueous
gets drained out early before completing the section. Here, there is no
need of forceps or de-Wecker’s scissors,
YAG laser Peripheral iridectomy is better in acute attack of ACG as it is
a non-invasive (so no chance of infection) and cheap OPD procedure.

Iridotomy: Puncture of the iris without abscission of any portion to

create an artificial pupil when the true pu pil is closed or severely
updrawn.
‘4-point iridotomy’ is done by a von Graefe’s cataract knife to treat
secondary glaucoma in iris bombs.

21. VON GRAEFE’S CATARACT KNIFE

Identification: It has a thin straight blade with sharp pointed tip and a
cutting edge, the other edge is blunt. The blade may be thin or thick.
It may have sliding case arrangement where the sharp blade end
is kept in a cover to protect its tip when it is not in use..

Uses:
a. ‘ab-interno’ section in case of cataract operation.
b. Optical iridectomy
c. Paracentesis
d. Glaucoma iridectomy
e. Suture removal after cataract operation.
f. In pterygium operation to dissect the head, or in chalazion
operation to give incision.
g. 4-point iridotomy in iris bombe (quadri-puncture)

22. SCALPEL HANDLE (BARD-PARKER’ HANDLE)

Identification: It is a flat handle with a short grooved neck. Handle “No.3”

is used in ophthalmic surgeries. The blades are fitted with the neck is
No .1l or No. 15 (‘No. 11’ is triangular blade and ‘No. 15’ has curved
eliptical tip).

Uses:
a. ‘ab-externo’ corneo-scleral section for cataract surgery.
b. Trabeculectomy operation
c. Skin incision as in DCR, ptosis or other lid surgeries.
d. To dissect the pterygium head from the cornea
e. To give incision in chalazion operation.
f. For suture removal after cataract operation

Advantages in cataract operation:

a) It is a ‘guarded’ section. As there is slow release of aqueous, the
chance of quick decompression of the globe is almost nil
b) It is’ stepped’ ie. Biplaner or triplaner incision-so wound security is
better
c) Easier for the beginners.

Disadvantages:
 (a) Conjunctival flap is usually necessary before giving section.
(b) It is time consuming

23. BLADE BREAKER

Identificatiion: It is an instrument to break the razor blade (must be a

carbonsteel blade-eg., ‘Bharat’ blade). It is of medium size, with two jaw-
like plates at its tip to catch the razor blade firmly. The other end of the
instrument is having catch for better grip of the blade. At least 8(eight)
blade-fragments can be made from a single razor blade.

Advantages:
(a) It is cheaper than any other knife-blade.
(b) It is sharper than No ‘ir or No.’15’ blade

Disadvantages:
As only the breakable carbon-steel razor blade is used - rust
formation is problem.

Uses:
Blade breaker with razor blade-fragments is having the same uses
as Bard
Parker handle with knife. (Instruments used for corneo-scleral
section are: (a) Cataract Knife (b) Bard Parker knife (c) Blade
breaker with razor blade (d) Disposable super-blades (e)
Keratome (f) Diamond knife).

24. PLAIN DISSECTING FORCEPS

Identification: It is an ordinary straight forceps without any teeth at its
tips. The ends are little blunt, and on their inner surface, there are fine
serrations for better grip.
Uses:
1. To hold the bulbar conjunctiva during its dissection.
2. To hold episcleral tissue during its dissection.
3. It is also used during suturing of conjunctiva
4. To hold conjunctiva during subconjunctival injection.
5. It may used to hold small sponge swabs.
25. (a) COLIBRI FORCEPS

Idenfication: It is a curved or angular forceps with fine limbs, having 1:2

teeth at its tip. It is thicker and stout.

(b) ST. MARTIN’S FORCEPS

Identification: It is a straight small but stout forceps with 1:2teeth at its

fine tip.

Uses: Both instruments have similar uses:

i. To hold the cornea and scleral lips during corneo-scleral suturing
after cataract surgery, and corneal lips in repair of penetrating
injury or wound closure in keratoplasty,
ii. It is also used to hold the scleral lip for dissection and scleral
suturing (as in trabeculectomy operation)
iii. It is used to hold the corneal lip in cataract operation to extend the
section with corneal scissors,
iv. To lift the cornea upwards during application of the cryoprobe
v. It may be used to catch the iris for iridectomy

26. SUPERIOR RECTUS HOLDING FORCEPS

Identification: It is a stout forceps with double curvature (S-shaped) at

its ends. It has 1:2 teeth at its tip. Its curvature at the tip is to fit with the
curvature of the globe.

Uses : It is used to catch the superior rectus muscle belly for passing
stay (bridle) sutures, so that the eyeball can be rotated and fixed
downwards in cataract, glaucoma or other surgery. It is also used to
catch the inferior rectus muscle as in keratoplasty.

27. SUTURE TIER FORCEPS

Identification: It is a small straight or curved forceps with long fine

limbs. It does not have tooth at its tip. The tips are made stout by extra
thick platform.
 Uses:
1. To hold the suture ends during tying the sutures after proper
tightening.
2. To hold the cut ends of the suture during its removal
3. May be used to catch the margin of incised conjunctiva during
suturing.
4. To remove caterpillar hair.

28. MCPHERSON’S FORCEPS

Identification: It is a fine medium size toothless forceps with an

angulation at about 7-8 mm from its tip.

Uses:
1. It is used to hold the intraocular lens during its placement in the
posterior chamber.
2. It is used to catch and remove the loose anterior capsule after
completion of capsulotomy.

29. SELF RETAINING LACRIMAL WOUND (MULLER’S) RETRACTOR

Identification: Made up of two limbs with three curved pins on each for
engaging the edges of the skin incision. The limbs are kept in a
retracted position with the help of a fixing screw.

Uses: To retract the skin during surgery on the lacrimal sac(eg. DCT or
DCR)
30.KERATOMES

Identification: Has a thin diamond – shaped blade with a sharp apex

and two cutting edges.

Uses: To make valvular corneal incisions for entry into the anterior
chamber for all modern techniques of cataract extraction viz.
phacoemulsification, SICS and even conventional ECCE and other
intraocular surgeries, eg. Iridectomies and paracentesis

31.PARACENTESIS NEEDLE
 Identification: It is a small lancet shaped needle with sharp cutting
edges resembling in appearance to a small keratome. It has got a guard
to prevent inadvertent injury to the deeper structures.

Uses:
1. For paracentesis.
2. To make very small corneoscleral incisions.

32. 15˚ SIDE PORT ENTRY BLADE

Identification: Fine straight knife with a sharp pointed tip and cutting
edge on one side.

Uses: To make a small valvular clear corneal incision( commonly called

as side port incision) in phacoemulsification and other intraocular
surgeries including pars plana vitrectomy.

33.MVR or V LANCE BLADE

Identification: Fine straight but triangular knife similar to 150 side port
entry blade but with cutting edges on both sides.

Uses: similar to 150 side port entry blade

34.CRESCENT KNIFE

Identification: Blunt-tipped, bevel up knife having cut-splitting action at

the tip and at both sides. Its blade is curved and either mounted on a
plastic handle(disposable) or can be fixed with metallic handle.

Uses: Used to make tunnel incision in the sclera and cornea for
phacoemulsification, manual SICS and sutureless trabeculectomy

35.LID CLAMP OR ENTROPION CLAMP

Identification: Consists of a D-shaped plate opposed by a U-shaped rim,

which when tightened with the help of a screw, clamps the tissues.Two
 clamps are required; one can be used for right upper and left lower lid
and the second for right lower and left upper lid. While applying the lid
clamp, the plate is kept towards the conjunctival side, the rim on the
skin side, and the handle is always situated on the temporal side.

Advantage over lid spatula: It is a self retaining instrument and does not
need an assistant to hold.

Disadvantages:
1. Operative field is less.
2. Pressure necrosis can occur if fitted tightly.

Uses: Used in lid surgery eg. Entropion, and ectropion corrections(

*protects the eyeball *supports the lid tissue and *provides
haemostasis during surgery)

36. TWO WAY IRRIGATION & ASPIRATION CANNULA

It is available in various designs, commonly used are Simcoe’s classical

or reverse cannula

Uses:
1. For irrigation and aspiration of the lens matter in ECCE
2. Aspiration of hyphaema

37.IOL HOLDING FORCEPS

Identification:It is a spring action forceps with short, blunt and curved

blades having smooth edges and tips with platform( no teeth or
serrations)

Uses: To hold optic of non-foldable PMMA IOL during implantation.

38.CHALAZION SCOOP

Identification: Has a small cup with sharp margins attached to a narrow

handle.
 Use: To scoop out the contents of the chalazion during incision and
curettage.
39. LACRIMAL PROBES( BOWMAN’S)

Identification:These are a set of straight metal wires of varying

thickness(0-8) with blunt rounded ends and flattened central platform.

Uses:
1. To probe nasolacrimal duct in congenital block
2. To identify the lacrimal sac during DCT and DCR operations.

40. BONE PUNCH

Identification:Consists of a stout spring handle and two blades attached

at right angle. The upper blade has a small hole with a sharp cutting
edge.’The lower blade has a cup- like depression.

Uses: To enlarge the bony opening during DCR operation by punching the
bone from margins of the opening ( Carelessness during this step can
cause accidental damage to the nasal mucosa and the nasal septum)

41. OPTIC NERVE GUARD(WELLS ENUCLEATION SPOON)

Identification: It is a spoon- shaped instrument with a central cleavage.

Uses: To engage the optic nerve during enucleation.

42. EVISCERATION SCOOP

Identification: Consists of a small but stout rectangular blade with slightly

convex surface and blunt edges attached to a handle

Use: To separate out the uveal tissue from the sclera during evisceration
operation

43. SCLERAL RING

44. VITRECTOMY PROBE

45. NUMBER 11 blade, NUMBER 15 blade

46. PERIOSTEAL ELEVATOR

47. DRUGS

I. Anti-glaucoma drugs
1. Pilocarpine
Indications – open angle glaucoma – 2 & 4 %
- angle closure glaucoma – 2 %
C/I – Inflammatory glaucoma, Malignant glaucoma
Preparations – eye drops, occuserts, gel
MOA - open angle glaucoma – increase trabecular outflow by
increasing ciliary muscle tone
- angle closure glaucoma – due to miotic effect. Contraction of
pupil – moves iris
away – opening of angle
s/e – Systemic- bradycardia, increased sweating
Local – blurred vision

2. Prostaglandin analogues
Bimatoprost - .03 % ; Latanoprost – 0.005%
Bimatoprost
MOA – increase trabecular outflow, increase uveoscleral outflow.
S/e – blurring of vision, irritation, increased iris pigmentation, pain,
thickening and darkening of eyelashes.

3. Sympathomimetic á2 agonists
Brimonidine tartarate – 0.2 % ; apraclonidine – 0.25 – 1%
Brimonidine tartarate
MOA – increase uveoscleral outflow ; decrease aqueous production
s/e – dry mouth, sedation, fall in BP

4. Carbonic anhydrase inhibitors

Dorzolamide 2%
MOA – decrease aqueous production
 s/e – ocular stinging, burning, itching, bitter taste

5. â blockers
Timolol malleate - 0.25 – 0.5%
Betaxolol - 0.25 – 0.5%

II. Steroids
Triamcinolone acetonide
MOA – Decrease leucocytic and plasma exudation
Maintenance of cellular membrane integrity
Inhibition of lysosomal release
Suppression of circulating lymphocytes
III. Cycloplegic–mydriatic
Atropine 1%
Uses – Fundus examination in children
Retinoscopy – refraction
Corneal ulcer
Uveitis
s/e – photophobia, blurred vision

48. LENS - convex, concave, cylindrical (identify)

49. PRISM [identify]

(Preferably entire topics should be revised. These are only ‘hot topics’)

Cataract- including complication & surgery

Lens induced glaucoma
Traumatic lesions in contusion injury
Corneal ulcer
Drugs & their routes of administration.
Lasers
Ocular symptomatology: DDs of defective vision, redness,
amblyopia
Clinical methods,Procedures done in RIO
Pupillary reflex, RAPD,Blindness,Diabetic retinopathy
 COMMUNI
TYMEDI
CINE

MAN&MEDI
CINE:TOWARDSHEALTHFORALL
ShortNotes
1.Sani
tar
ya wakening(i
mp)(5)
2.Soci
alme di
cine(7)
3.Healt
hf ora
ll(10)
4.Changingconceptsi
npubl
ichea
lt
h(8)

CONCEPTOFHEALTH&DI
SEASE
Diagrams
1.Epidemi ologicaltriad( 31)
2.Ic
e-be rgofdi sease( 37)
3.CalculationofHDI( 16)
4.CalculationofHPI
5.Naturalhi st
oryofdi se a se( 32)
6.Tables:t able1( 21) ,ta bl e2( 25)
Shortnot
es
1.WHOde finit
ionofhe a lth( 13) ;Whyi tisconsi
de r
edt obea nidealone?
2.Di me ns ion sofhe alth( 13)
3.Po sit
ivehe al
th(15)
4.He altha sar elat
ivec onc ept( 15)
5.Ph ysica lqua lit
yofl if ei nde x- PQLI( 16)
6.Huma nde velopme nti nde x( 16)
7.Huma npove rtyInde x
8.Sp ectrumofhe a
lth( UQ)( 17)
9.Se l
fc arei nHe alt
h( 20)
10.Lessonsf romKe ralas ta t
e( 21) ;WhyKe ral
ac a
nbec onsider
edYa rdst
ic
kforjudgi
ng
healt
hs ta tusinthec ount ry? (22)
11.In
dica t
or sofhe alt
h[ Mor tality,Mor bidi t
y,Disabil
ityra t
es]
(22)
12.Sull
iva n’ sindex-Expe ctationofl i
fefre eofdis
a bi
lity
13.DALY- Di sa
bili
ty-Adj ustedLi f
eye ar[ UQ]:“Pr e
ma turedeath”(
24)
14.Health-re late
dMDGs( TABLE3)( 26)
15.Contras tsinhe alth[ he a lt
hga p][
UQ]( 27)
16.Epidemi ologicalTr ans i ti
on
17.Levelsofhe alt
hc are( 27)
18.Healtht ea mc onc ept[ UQ]( 28)
19.Pri
ma ryhe al
thc are( 10,28)
20.Conc eptso fcausation[ UQ][ Multif
ac tori
al
,We b]( 31)
21.Naturalhi st
oryofdi se a ses[ UQ][ Prepa t
hogeni
cpha se,Agentfac
tors-(UQ)](32)
22.Spectrumofdi sease( 37)
23.Ic
ebe rgphe nome nonofdi sea se(37)
24.Riska ppr oa c
h( 36)
 25.Monitoring&s urve il
lanc e(38)
26.Dise
as eeliminati
on( 37)
27.Dise
as eeradicati
on( 38,91)
28.Sent
inels urvei
llanc e( UQ)( 38)
29.Level
sofpr evention( UQ)( 39)
30.Mode sofi nter
vent ion( 40)
31.Conceptofdi sability-I mpairment,di
sabi
li
ty,ha
ndi
cap(41)
32.Communi tyofdia gnos is(UQ)( 46)
33.Communi tytreat
me nt( UQ)( 46)
34.ICD=I nternat
iona lcla ss
ifi
cati
onofdiseas
e s&wasla
strevi
sedonJ
anua
ry1,1993(
47)
35.Disa
bilitylimitat
ion( 41)

PRI
NCI
PLESOFEPI
DEMI
OLOGY&EPI
DEMI
OLOGI
CMETHODS
Diagra
ms
1.I nterna ti
ona lfor mofDe athce rtif
icate(54)
2.Re latio ns h i
pbe t we e ni ncid e
nc e&pr eval
ence(
59)
3.Epi de mi cc urve( 62)
4.Bi moda lityi nHodgki n’ sdi sea se(66)
5.Fr amewor kofc asec ont rol&c ohortstudy(
68,72)
6.De signofRCT( 79)
7.Spotma p( 65)
8.I ndir ec ta ssoc iation–Mode l( 84)
9.Mul tifac torialc a us ation( 85 )
10.Cha inofi nfec tion( 91)
11.Incuba tionpe riod( 96)
12.Prima ryi mmuner es pons e( 97)
Tables
1. Ta ble13- Adva nta ge s&Di s
a dva ntagesofCase
-Cont
rols
tudi
es(
71)
2. Ta ble34- AEFI( 105)
3. Ta ble44- Fi nalr epor tonEpi de mi c(124)
ShortNote s
1.De fini tionofe pi de mi ol ogy(JM La s
t)(50)
2.Ai msofe pide mi ol ogy( 51)
3.To ol sofme as ur eme nt-Ra t
e( UQ)( 52)
4.I nter na tiona lde athc ertificate( 53)
5.Ca sef ata lit
yr a te( Ra ti
o)( UQ)( 55)
6.Su rvi va lr ate( 56)
7.SMR( St a nda rdi zedMor tali
tyRa te)(57)
8.I ncide nc e( UQ)( 58)
9.Pr e va lenc e( UQ)( 58)
10.De sc ript ivee pi de mi ology( UQ)( 60)
11.Propa ga te de pi de mi c s( 62)
12.Per iodi cf l
uc tua tions( UQ)( 62)
13.Cyc lict re nds( 62)
14.Lo ngt ermors ecula rtrends( UQ)( 63)
15.SpotMa porSha de dMa ps( UQ)( 64)
16.Ca sec ont rols tudy( UQ)( 68)
17.Ma tc hingi nc a sec ont rols tudy( 69)
18.Conf oundi ngf a ctor( 69)
19.Oddsr atio( UQ)( 70)
20.Bia s( UQ)( 70)
21.Adva nt age&di sadva nt age sofc asec ontrolstudi
es-Table13( 71)
22.Cohor ts tu dy( UQ)( Code ;Ca nfindAI R=At tr
i.
ri
skI nci
dr a
te;Relat
iveri
sk)(72)
23.Re lativer isk&At tri
but abler isk( UQ)( 75)
24.,
Expe rime nt ale pide miol ogy( UQ)( 77)
25.Ra ndomi ze dc ont rolledt rials( i
mp)( 78)
26.Blindi ng( 80)
27.As soc iation&Ca us ati
on( 84)
28.Onet oonec aus ation&Mul tipleca usation( 85)
29.Hill’sc riteriaofc aus ation( 85)
30.Tempor a la ssoc iati
on( 86)
31.Biol ogi ca lpl ausibility( 87)
32.Us esofe pi demi olo gy( UQ)( 87)
33.De fine-En demi c ,Pa nd emi c, Zoon oses,An th r
opozoonoses,Zooanth
roponos
es(UQ)( 9
0)
34.Iat
r oge ni cdi se ases( UQ)( 90)
35.Re ser voi r&Ca rri
e rs(UQ)( 91,92)
36.Mode sofTr ans mi ssion( UQ)( 92);di recttransmiss
ion&Bi ologi
caltr
ansmis
s i
on(93)
37.Incuba tionpe riod( UQ)( 95)
38.Ge ne rationt ime( 96)
39.Communi c ablepe ri
od( 96)
40.Sec onda rya tt
a ckr ate( UQ)( 96)
41.Immuner espons e( UQ)( 97)
42.Ac tivei mmuni ty( 97)
43.He rdI mmuni ty( imp)( 98)
44.Cros si mmuni ty
45.Immuni z ingAge nt( 99)
46.Adj uva nts( 101)
47.Immunogl obul in( UQ)( 101)
48.Ant i-se raORAnt itoxin( 102)
49.Th ec ol dc ha i
n( UQ)( 102)
50.Va cc inec arrier( UQ)( 104)
51.Va cc inevi alMoni tor( 104)
52.Ha za rdsofI mmuni zation( Imp:St udyTa ble34a tl
ea s
t)(105)
53.Inve stiga tionofa nAEFI( 109)
54.Dis ea sepr event ion&c ont rol( Notification( UQ),Isolat
ion,Qua r
anti
ne(UQ))(111)
 55.Na t
iona li mmuni zations che dul e.(
114)( Type sofvacci
nes:Code
:“KARTS”=Ki
ll
ed(
ina
cti
vat
ed)
,
Attenua ted( li
ve ),
Re combi na nt,Toxo i
d,Subunit)(I
mpUQ)( 99)
56.Combi ne da ct
ivea ndpa s
s ivei mmuni sat
ion(117)
57.Che mopr ophyl axis( UQ)( 117)
(Diseas eCode :MI DPC=Ma lari
a,Influe
nza,Di pht
heri
a,Pla
gue,Chol
era
)
58.He al
tha dvicet otra vellers( 118)
59.Disinfec tion,type s( UQ)( 118)
60.Disinfec tionoff ae ces&ur ine ,Sputum,Room( 122)
61.Investiga ti
onofa nEpi demi c( 122)
62.Ampl ifie rhost( UQ)( 92)
Di
ff
erenti
atebe twe en
1.Ca sec ont rolandCohor tstudy( i
mp)- Table22( 76)
2.Re lativea ndattribut ableris k( imp)( 75)
3.I nci
de nc e&pr eva lenc e(58)
4.Pr ima r
y&Se conda ryi mmuner es
pons e(97)
5.Ki ll
e d&Li veva ccine s(99 ,100)
6.Pa ssive&a cti
vei mmuni ty( 97,98)

SCREENI
NGFORDI
SEASE
Diagrams
1. Mode lfore arl
yde tect
ionprogr amme s-128;Fig1
2. Bi moda l&uni moda ldis
tri
bution-133; Fig3
Shortnotes
1. I cebergphe nome nonofdi s
ease( UQ)-127
2. Comme nton ”Le adtimeisa na dvantagega i
nedbyscr
eening”(UQ)-128
3. Type sofs cre
ening( UQ)-129
4. Mul t
ipha sescree
ning-129
5. Cr iter
iaf orscree
ning( UQ)-129
6. Va l
idity/Ac curacyofs cr
eeningt est(UQ)-130
7. Eva l
ua tionofas c r
eeningtest(UQ)-131
8. Pr edictivea ccuracy-131
9. Yi eld-132
10.I fyoua replanningt oint
roduceas creeningprogr
ammei navie
wt oreducetheinci
denc
eof
diabeticr eti
nopathy,howwi llyoupr oceedwi t
hthee
valuat
ionoftha
ts c
reeningte
st?
Diff
erenti
atebe tween:
1. Sc reen inga ndDi agnosti
ctests-127
2. Pr ospe ctive&Pr esc
ripti
vescree ni
ng( UQ)-128
3. Se nsitivity&s pecif
ici
tyinas cre e
ningt est(
UQ)-131
 EPI
DEMI
OLOGYOFCOMMUNI
CABLEDI
SEASES
Diagra
ms
1. Tube rcleba cill
i–AFBs tai
ning
ShortNotes
1. Sma l
lpox-e radicationi tsepidemi ologic
alba sis-135
2. Chi ckenpox&Sma llpox-s kinlesions(UQ)- 136
3. Chi ckenpox-pr eve ntioni e,VZI G&Va cc i
ne -137
4. WHO’ sme a sleselimi nations tra
tegyi eCa t
c hup,Ke epupa ndFollowup-138(
UQ)
5. Me asl
e s-Epi de miol ogi c
a ldetermina nt
s&I ncubationper
iod-138,139
6. Pr eventionofme a
s l
e s-140
7. Cont rolme a suresforme asles-141
8. Rube lla-Conge ni
ta lrube ll
a( UQ)–141, 142
9. Rube lla-Va ccinations t
ra t
egy-143
10.Mumps -pre vent i
on-144
11.Mumpss urve ill
anc e-144
12.Avi ani nflue nzaa ndi t
sc ontrol(UQ)-147
13.Swi nei nf l
ue nza( UQ)-147
14.Di phthe r
ia( Sc hickt est( UQ) ,control,immuni z a
tion)-
151.152,153
15.Cont rolofwhoopi ngc ough- 155
16.Me ni
n goc oc calme ni ngitis-156
17.A/ Cr espi r
ator yinfe ctions-Cont r
ol ,Classi
ficati
on&ma nageme nt(Ve
ryi
mp,UQ)–159,
160,
161
18.Hi bva cc i
ne163
19.SARS( UQ)-164
20.“ PPD- RT- 23wi t
hTwe en80 ”-172
21.RNTCP–di agnostica lgori
thm,4Pi llar
s,(v.i
mpt )–396,181
22.Tr eat
me ntofne wc as eofpul monaryTbunde rRNTCP( UQ)-175
23.DOTS- Che mot herapy-175
24.BCGv a ccina ti
on( UQ)-178
25.DOTSpl us-( UQ)- 177
26.St opTBs t
ra tegy-181
27.I mplicationofHI V-TBi npubl i
che alt
h( UQ)-182

28.Epidemiologi
calbas
isofs mallpoxe ra
dic
ati
on
Writ
ea bouthowthedise
a seisame nabletoera
dicat
ion,aboutthefact
orsfavouri
ngit(thest
rat
egie
sadopted,
theimmuni za
ti
on,properti
esoft hevacci
ne)anda gai
nstit(c
hroni
city,anyres
ervoirorcar
rie
rstat
e)and
thesta
tuso fi
mmunityoft heindividual(
whetherlif
elongimmunityornot )a
nda boutanyspeci
alfor
ms
ofimmuni ty(l
ikehe
rdi mmuni ty).

29.Out
brea
kc ontr
olmeasur
esofchic
kenpox.Defineoutbr
eak(i
e,eve
nas i
ngl
ecaseofChic
kenpox),
i
nves
ti
gati
onofe pi
demic,st
rat
egi
esadopt
edtopreventt
hesprea
d(spe
cif
icpre
vent
iveandcont
rol
mea
suresofthedis
eas
eas ke
d)andimmuniza
tionifany.
Dif
fer
entiat
ebe tween:
1. Chi ckenpoxa ndsmallpox-136
2. NTC&RNTCP-394
Comme nton:
1. “ Mea sl
eslikes mal
lpoxi samenabletoer
adicat
ion”–138, 141
2. “ DOTSs tr
ategyisama jorbrea
kthroughincontrolofTBi nIndi
a”-175
Ess
ays:
1. Ama nuall
a boure
raged40,wa sha vi
ngcougha ndf e
verformorethan3we eksdura
ti
on.Hecompl
aine
d
ofti
redness,nightsweats,wei
ghtlossandbloodt i
ngedsputum.Hiswifeand2ye a
rchil
dals
ocame
wit
hhi m.AsaMOl i
stouttheser
vi c
esyouwi l
lprovideforthei
ndivi
dualfa
mi l
yandthecommuni
ty?

2. Aladycome swithfeverandcoughfor>2we eksdur

ati
on.Sheha
s2c hi
ldr
ena
ged5ye
arsa
nd2mont
hs:
• Howwi llyoudoas putume xa
minati
on?
• Ifposit
ive,whatisthelineofmanagement
?
• Wha taretheste
psint hema na
geme n
tofcont
acts?
• Wha tspe c
ifi
cpreca
ut i
ontobetakentopre
ventthedi
sea
setra
nsmi
ssi
on?
• Wha taretheadvantagesofRNTCPa ndNTCP?
• Wha tisstopTBs tr
ategy?

INTESTI NALI NFECTI ONS

Diagrams
1.Se rologica lma rke rsofhe pa t
itisB-1 94
Shortnotes
POLI O
1.Pol ioAFPs urve il
lance( UQ)-184
2.Pr ovoc at
ivepol iomye lit
is-(UQ)
3.Cur rents tatusofpol i
oi nI ndia-184
4.Pol io-Pr e vention( UQ) ,St rategiesfore r
adicat
ion-186, 189
5.Pul sepol ioi mmuni zat
ion( UQ) -189
6.Wha tisI ntensifiedpul sepol iopr ogramme ?
7.Epi de miologi calba si
sofpol ioe radicat
ion
8.Wr i
tea bouthowt hediseas eisa me nabl
et oeradicati
on,a boutthefac t
orsfavouri
ngit(t
hestr
ategies
adopted,t hei mmuni zati
on ,pr operti
esoft hevaccine)a nda gai
ns ti
t(chronici
tyanyreser
voi
rorc ar
ri
er
stat
e)a ndt hes t
a tusofi mmuni t
yoft heindividual(wh etherlif
elongimmuni tyornot)andabouta ny
specialformsofi mmuni ty( likehe rdimmuni ty)
9.Out br eakc ontrolme asuresofpol io,chickenpox.De fineout break(i
e ,evenas i
nglecas
eofpolio),
investi
ga t
ionofe pidemic,s tr
a tegi
e sadoptedtopr eventthes pre
a d(specif
icprevent
iveandcont
r ol
me asuresoft hedi seas
ea ske d)a ndi mmuni zati
onifa ny.
VIRALHEPATI TI S
1.He patit
isA-Modeoft ransmi s sion ,Di agnos i
s( imp)&pr evention–191, 192
2.He patit
isB-Va ccina ti
on( UQ) -195
3.Pos texpos ur epr ophyl axisofhe pa ti
tisB( UQ)- 196
ACUTEDI ARRHOEALDI SEASES
1.WHOi ni ti
ate dADDpr ogra mmei n198 0-200
2.Cont rolofADD&Compone nt sofDi a
rrhoealDi sease sCont r
olPr ogramme( UQ)-203
3.ORS-203
4.Adva nta gesa nddi sa dva ntage sofORS-203
5.Lowos mot i
cORS-203
6.Zi ncSuppl e me ntationi nADD-205
7.Ca r ri
ersi nChol era( UQ)-209
8.Cont rolofc hol era-210
9.Typhoi df e
ve r-control-214
10.Ty21ava ccine-216
FOODPOI SONI NG
1. Fo odpoi soni ng- Type s( UQ)-216
2. Bot ulism( UQ)-217
3. Cha ndl er’si nde x/Ende mi ci nde x-221
Dif
fe r
entiatebe twe en:
1. I PV( Sa lkt ype )&OPV( Sa bi nt ype )-186
2. Chol e
ra&f oodpoi soni ng
3. Pne umoni a&s eve r
epne umoni a-161
Essay:
1.A5mont hol df e ma lec hildwa sbr ou ghttot heme dicalcollegec a sua
ltyfromaslumar
eawit
hahis
tor
y
ofpa ssingwa terys toolsofoneda yd urati
on:
a .Li stoutt hedi ffe r
e ntc aus esofDi ar
rhoe a
b.Howwi l
lyoua sses sthede gr eeofde hydr at
ion?
c .Wha ta rethes tepsi nt hema nageme nt?
d.Wha ta dvic esa retobegi ve nt othepa tienttopr eventf urtheratt
acks?
e .Di ar rhoe aldi seasesc ont rolpr ogramme
2.A2ye a rol dc hildi sbr oughtt ot heOpwi thc ompl aintsofvomi t
inga nddiar
rhoe
a.O/
E,th
echil
dis
dr ows y:-
a .Howwi l
lyoua sses sthede hydr ati
ons tatusoft hec hil
d?
b.Howwi l
lyouma na get hec hil
d?
c .Wha tisORS?
d.Wha tisORTa ndORTc or ne r
?
3.Ac hilda ge d5ye a r
si sbr oughtt ot hec asualtywi thdi a
rrhoeaf orthelast5days:
a .Wha ta retheba ct
er i
a lor ga ni s
msa s
soc iate
dwi t
hdi arrhoe a?
b.Wha ta rethepa r
asi t
icor ga nismsa s
soc ia
t e
dwi t
hdi arrhoe a?
c .Howwi l
lyouma na get hec ase?
 4.A1ye
aroldchi
ldisbroughtt
otheOPwi t
hcompla
int
sofsudde
nonse
toffe
ver
,coryz
a,re
dne
ssofeye
s
a
ndmacul
opa
pularras
he swhi
chfir
stbe
ganbehi
ndtheea
rsandthe
nexte
ndedt
othefac
eandnec
k.The
c
hil
dhadtakenimmunis
ati
ononlyti
l he10thwe
lt e
k.AsMOhowwi l
lyoumanaget
hecase
?
5.Afewcas
esoffoodpois
oningarebr
oughtt
ot hehospi
ta
lfromaPHCa r
ea.AsMOofthePHCwha ta
ll
a
cti
onswouldyousugge
sttofi
ndouttheca
us esofout
brea
ksanda
lsomenti
ont
hecont
rolmea
sur
es.

ARTHROPOD- BORNEI NFECTI ONS

Diagrams
1.Ma nifes tat
ionofde ngues yndr ome–226,Fi g1
Shortnote
s
1. Cl ass i
ca lDe ngue ,DHF-227
2. Cr it
e riaofc l
i nical&l abdi agnos i
sofDHF-228
3. Cont rolme asur esa ndma nage me ntofac asewi t
hDe ngue-229,232
4. Ve c tori ndice sfora e de s
5. Di agnos isofMa laria-237
6. Me as ureme ntofma l
a ria-2 39
7. Ma larias urve ill
anc e( UQ)-385
8. Di sea sec ontr olinMa la ria(UQ)-239
9. Enha nc edma lar
iac ont r olpr ogr amme( UQ)-383
10.Tr eatme ntofma lar
i a( UQ)ve ryimp-239
11.Re comme nda ti
onsa ga ins tthema ssprophylaxisofinChildrenunder5ye ar
s
12.Ma lariava cc ines( UQ)-24 4
13.Rol lba c kma lariaGl oba lstrategicplan-244
14.Oc c ultFi la
r i
a sis(UQ)-247
15.Fi l
ar iasis-( Sur vey,c ont rolme asures
)[Chemot hera
py(UQ) ,Massthe r
apy(
UQ)Ve ct
or
control(UQ) ]-248, 249, 250
16.Ma ssd ruga dmi ni s
tra tioni nFi l
arias
is(UQ)-250
17.Lymphoe demama na ge me nt-247
18.Ve c torc ontroli nf i
la ria( UQ)-250
19.I nt
egr ate dve c t
orc ont rol-4ma j
orbreakthroughsincaseoffila
ria
sis(UQ)-250
Diff
e r
enti
atebe twee n:
1.DHF&DFc linically–229( Table2)
2.W.ba nc roft
i&B.ma layi-246
Essay:
1.Fe wpe oplei nt hePHCa r
e aa rereporte
dt otheOPwi t
hcompl ai
ntsofhighfever
,he
adach
e,mus
clea
nd
joi
ntpa in.Somepe rsonsc ompl ai
ntofretroorbit
alpainandha dpinpointe
rupti
ononfa
ceandne
ck.
a .Wr itet hepr oba bl edi agnosis
b.La bi nve sti
ga tions
c .Wha ti sthel ineofMa nageme nt?
d.Wr itebr ieflya boutt hec ontr
olme asuresatthecommuni t
yl evel
?
 2.Ma
lar
ia(
Vec
tor
s,Cont
rol
,Di
agnos
is,Tr
eat
ment
,SURVEI
LLANCE)
St
abl
emal
ari
a Unst
abl
emal
ari
a

Hi
ghi
mmuni
tyi
nadul
ts Lowi
mmuni
tyi
nadul
ts

Af
fect
syoungchi
l
dren,
pregnant Af
fect
sal
lages

Ef
fi
cientv
ect
ors I
nef
fi
cientv
ect
ors

Pl
asmodi
um f
alci
par
um Pl
asmodi
um v
ivax

Moder
atet
ohi
ght
ransmi
ssi
on Lowt
ransmi
ssi
onexcepti
nepi
demi
c

Seasonal v
ariat
ioni
ninci
denceis Pr
onouncedseasonal
variat
ioni
n
notpronounced,nomarked inci
dence,
hencecall
edunstabl
e
fl
uctuati
on

Epi
demicunli
kel
yinindi
genous Epi
demi
cli
kel
yinsui
tabl
ecl
i
mat
e
populat
ionduetohigh
prev
alenceamongadults

Zoonos es
Diagrams
1.Li fec yc l
eofma lar
ialpa rasite–235,Fi g1
Shortnotes
1. De f
ineZoonos is,Ant hropoz oonos es(UQ)-251
2. Pos te xpos urepr ophyl axis-253
3. I ndicationsf ora nti
-r abiestrea tme nt-254
4. Va ccinea dmi nistra
tioni nc a s
eofRa bies–254, 255
5. Pr ee xpos urepr ophyl axisinr a bies(UQ)-255
6. 17Dva c ci
ne( UQ)( forye l
lowf ever).Wha ti
sva cci
nat
ioncer
ti
fi
cate?(Viva)
-257,258
7. J apane see ncepha li
tis-c ontrol,cas ec l
assif
ica
tion&pr eve
nti
on-260,261,
262
8. Chi nkungunyaf e vere sp.itsc ontrol( UQ)-264
9. Condi tionsf a
vour i
ngc hikungunyas pre
a dinKe ral
a(UQ)-264
10.Le ptos pirosis
-266
11.Bl ocke df lea(UQ)-268
12.Pa rti
a ll
ybl ocke df l
ea-268
13.Fl eaindi ces(UQ)-268
14.Epi zoot iologyofpl ague-2 68
15.Cont r oloff le
a-270
16.Sc rubt yphus( UQ)-274
17.Le ishma niasi
s-278
18.Bi ologi calcontrolofa rthropods( UQ)–713, 717
Comme nton
1. I ndi
aisaYe ll
owf everr ecept i
vea re a
2. Si l
entpe r
iodsofl ongdur ationf ollowe dbys udde ne xplosiveoutbreaksofr odent/huma
npla
guei
s
observed-27 1
3. Le ptospir
o sisa sas ignificantr i
skf orpoorpopul ati
oni nbot hurba na ndruralar
eas
Ess
a y
1.A13ye aroldboyc ome swi t
hhi s t
or yo fdome sti
cdogbi teont hetrunk
• Wha ti st hec lassofe xpos ur e?
• Wha ta ret her abi esva ccine sa va i
la ble ?
• Gi ves c he dulef orthePos te xpos urepr ophylaxisf orclas
s3e xposure?
• Wha ta ret hes idee ffec t
sofne ur alva c ci
ne?
• Howwi llyouma nget hec a se?
2.2pa tie
ntsr esidingonyourPHCa reaa r ea dmi t
tedinMCHwi t
hr e
na lfai
lure.Anti
bodyt
it
rei
npos
it
ion
forleptospiros i
s .AsaMOoft ha tPHC
• Enl isttheme asur eyouwi llimpl eme nttoc ontaint heoutbreak?
• Wha tme thodsa ndme diawi llyoua doptf orthehe al
thande duc a
tionofthe
commu nity?
• I nt hisc ont ext,youa rei nvi tedt ode liverahe althta l
kinahi ghs chool.
Wr i
tebr ieflya boutt hec ont e ntoft heh ealthtalk?

Surf
a c
eInfect
ions
ShortNotes
1.Avoi da bleblindness-373
2.Pr eve n t
ablebl i
ndness-t r
eatme ntandc a
uses(UQ)-373
3.Cont rolofTr ac
homa( UQ)–282, 283
4.Bl anke ttr
eatme nt(UQ)-282
5.Te tanus-pr evention-285
6.Ne ona taltet
anus- Str
a t
e gyforne onatalt
etanusel
imi
na t
ion(
UQ)-286
7.Le pr os y-(Cl as
s i
fi
cation,Di agnosis,Contr
ol)–291-296
8.Mor phol ogicalindexi nl epr
os y(UQ)-293
9.Le pr os yMul tidrugthe rapy(WHOr egimen).(UQ)-295
10.Lepr os ycontrol(UQ)–294,295,296
11.Lepr ar eacti
on-297
12.Differe nti
atebe t
we enr eversalreacti
on&ENL-297
13.Communi tyba sedreha bili
ta
tioni nLe pr
osybyWHO-300
14.Socia lf a
ctorsinSTDs( UQ)-304
15.In
ter ve nti
ons tr
ategiesinSTDs-3 12
16.Syndr omi ca pproachofSTDs-305
17.Cont ac ttr
acing( UQ)-312
18.Cluste rtesti
ng( UQ)-312
19.Treatme nt2.0-317
20.Ma jors i
gnsofAI DS( UQ)-322
21.Post-e xposurepr ophylaxisinAI DS( UQ)-327
 22.AIDSs urveilla
nce( UQ)–402, 403
23.WHOr ecomme nda ti
onsforART-326
24.AIDSc ont r
olme as ure
s(UQ)-324
25.NACOs t
rategy-399
26.Educa ti
onofwi feinPLWHA
27.Ma i
nt enanceoff ollowupi nPLWHA
28.HIV- TBc o-inf
ection(star
tART2we eksaf
ters
tar
ti
ngATTirr
espe
cti
veofCD4count)–398,
405
Comme nton:
1. Fe asibilit
yofl epros yera
dic a
tioninI ndia
Essay:
1.A32ye aroldma rriedma leist est
edpos i
ti
veforHIVwhenhedonat
edbl
oodinablood
donationc amp
• Howwi l
lyouc onfir
mt hec a s
e?
• Wha twillyoudowi tht hesa mplecolle
cte
d?
• Wha tistheadvi cetobegi ve ntohim?
• Howwi l
lyouc onvincehi swi f
e?
• Howdoyouma intai
nf oll
owup?

Emergi
nga ndRe-emergingdi
sea
ses
Shor
tNote
1. Di f
fer
entia
tebetwe
e nEMERGI NGANDRE-EMERGINGDISEASES( UQ)-328,
329
2. Comme ntonthere
-eme r
genc
eofdys
ent
eryi
ntheSout
handCent
ralAfr
ica-331

Nosocomi alInfe
cti
ons
Shortnote
1. Nos ocomialInfec
tions(
UQ)-331
2. St andardprecauti
ons(UQ)–332,
333
3. Me asurestopreventNosoc
omi
ali
nfe
cti
ons(
UQ)-
332
 EPI
DEMI
OLOGYOFCHRONI
CNON-
COMMUNI
CABLEDI
SESASES
Diagrams
1.Ruleofha lves-345
2.Tracki ngofBP-345
3.Natur alhi st oryofs t
roke-348
Shortnot
es
1.Ri skf a ctorsofc or ona r
yhe artdi sease-339
2.Pr eve ntionofCHD-Pr imordi alpreve nt
i on(UQ)-341
3.MRFI T-Mul ti
pl eRi skFa ctorI nter
ve nti
onTr i
al-343
4.Rul eofha lvesf orhype rtension( UQ)-Di a
grama l
so-345
5.Tr acki ngofbl oodpr ess ure(UQ)-34 5
6.Ri skf a ctorsofhype rtens ion,Pr event i
on-345, 346
7.Ri skf a ctorsofs tr oke( UQ)-349
8.Pr eve ntionofRhe uma ticHe artdisease( UQ)-351
9.Di eta ryf ac torsofc ance r(UQ)–355, 600
10.Preve ntionofc anc er( UQ)-356
11.Earlywa rnings igns( da ngers igns)ofc ancer(UQ)-356
12.Canc e rre gis t
ries( UQ)-356
13.Scree ningofo ra lc anc er-358
14.Scree ningofBr ea stc anc er-357
15.Preve ntionofl ungc a nc er(UQ)-361
16.Cli
ni ca lc las s
ificat i
onofDM -362
17.Syndr omeX-363
18.Epide mi ol ogica lde t
e rmi nantsofDM ( UQ)-364
19.Scree ningf ordi a be t
e s( UQ)-365
20.Selfc ar eindi abe tes( UQ)-366
21.Tertiarypr e ventioni ndi abetes( UQ)-366
22.UseofBMIt oc la ssifyobe sity-369
23.Wa istc ircumf ere nc e&wa isthipr ati
o–369, 370
24.Preve ntionofbl indne ss( UQ)–373
25.Categor iesofvi sua li mpa ir
me nt–Soc ia
lbl i
ndness–371;Tabl
e1
26.Cha ng ingc onc ept si ne yehe althcar e-372
27.Wha tis“ Avoi da bl ebl indne ss”?- 373
28.Vision2020–374, 407
29.Acc ide ntpr one ne s s
30.Mul tiplec aus at
ionofa ccident s(withc ha rt
)(UQ)–377;Fig1
31.Dome s ti
ca c c
ide nt s(UQ)-378
32.Preve ntionofa cc ide nt–377,378
33.Obe sity-367
34.Highr iskgr oupf orDM -365
35.Districtbl indne ssc ont rols oc i
ety( UQ)-406
36.WHOSTEPa ppr oa ch? (1=hi storya ndque s
tionna
ire
,2=meas
ure,
3=l
ab)
Wha
tis“
INTER
HEALTH” ?
 37.
Pre
pla
ceme
nte
xami
nat
ion

HEALTHPROGRAMMESI NI NDIA
STUDYLATESTEDI TIONPARK;Ve ryimport
antcha
pter
Forea
chprogr
amme-s t
udytheyea
r,s
ett
ingwhic
hledtothedeve
lopmentoft
hepr
ogr
amme
,pha
ses
,
obj
ect
ive
sandgoa
ls,s
trat
egi
esandcomponent
s,c
urre
ntposi
ti
on

Diagrams
1.Struc t
ureo fRNTCPLa bne twor k–395;Fi gure2
2.Di agnosisofTBi nRNTCP–396,Fi gure3
Shortnot
es
1.I n
tegratedve ctorMa na geme nt-386
2.Na tionalanti-ma lari
a lpr ogra mme( NAMP)-383
a.Spe cificint erve ntions
b.Spe cificpr ophyl axisa gains tMa lar
ia
c.Rol lba ckMa laria
d.Dr ugr es i
s tantMa laria
e.Sur veill
a nc einMa l
aria( UQ) -382
f. Cl assi
fic ationofe nde mi ca re asi
nma l
ari
a
g.Cur rents ta t
usofma l
a ri
apr ogramme
3.El i
mi nati
onofFi lariasis–St rategie s–389,39 0
a.Ma ssdr uga dmi nis t
ration
b.Di sabili
t yl imitation
c.Cur rents ta t
usofe li
mi nation
4.St r
ategiestoe limi n at
e-390,391
a.Ka laa za r
b.J E
c.De ngues yndr ome
d.Chi kungunya
5.Na tionalLe pros yEr a
di cationPr ogr amme( NLEP)–391,392
a.I nfrastruc tureofna t
iona llepr osyeradi
cati
onpr
ogramme(
UQ)
b.Modi fi
e dl epros ye l
imi nationc ampaign
c.Di sabili
t ypr eve ntion( UQ)
d.Me dicalRe habi li
ta t
ion
e.Cur rents trategie s&Ma nage me nt
6.Na tionalTBCont rolpr ogr amme-39 4
7.Di stri
ctTBc ont rolpr ogr amme
8.Re visedna ti
ona lTBc ont rolpr ogr amme( UQ)–394,395
a.DOTS&DOTSpl us( UQ)
b.Pa ediatricTBma na ge me nt
c.Cont rolofTB
d.Cur rents ta t
usi nTBc ontrol
 9.Na ti
ona lAI DSc ont rolpr ogr amme-399
a.Ant ir etrovi ra lthe rapy
b.Bl oods af ety
c.STDc ont r
ol
d.Ta rge tedi nt erve ntions
e.HI Vs urve illa nce
f. HI VSe ntine ls ur ve i
llanc e
g.Be ha viour a lSur ve ill
anc e
10.Na ti
ona lAI DSpr e ve ntion&c ontrolpol icy( UQ)-400
11.Integra t
e dCouns e llinga ndt e
stingc entresforHI V-404
12.Na ti
ona lprogr ammef orc ont rolofbl indnes s(UQ)–405, 406
13.Na ti
ona lPol ioe ra dic ati
onPr ogr amme-St ra t
egie
s&Ac hieveme nt
s-189
14.Goa lsf or10t hf iveye arpl an( UQ)
15.Vis i
on2020:Ther ightt os ight–374 ,407
16.Uni vers alimmuni za ti
onpr ogra mme( UQ)-408
17.Na ti
ona lrura lHe althMi ssion( UQ)-412
18.ASHA( UQ)–413( Code :MEDI CoS)
19.Re produc t
ivea ndc hi ldhe althPr ogr amme( UQ)-415
20.Chi l
ds urviva la nds a femot herhood( CSSM)( UQ)-415
21.Rol eoff i
rstr e f
e rraluni t(FRU)i ne me rgenc yobst
et
ricsca r
e( UQ)-416
22.Jana niSur a kshaYoj na-419
23.Va nde ma tha rams che me-419
24.Integra t
e dma na ge me ntofc hil
dhoodi ll
ne ss(IMNCI )-423
25.Ac uter espir atoryi llne ssc ontrol( UQ)-417
26.Ac utedi arrhoe aldi s ease s( UQ)–200,417
27.Na ti
ona lgui ne awor me radi cationpr o gramme( UQ)-428
28.Na ti
ona lcanc e rc ont rolpr ogramme( UQ)-424
29.Na ti
ona lme ntalhe althpr ogr amme( UQ)-426
30.Preve ntiona ndc ont rolofNCD–s t
rokea ndc an
cer–424, 425
31.Integra t
e ddi se ases urve ill
a ncepr oject( I
DSP)–426, 427
32.Na ti
ona lwa te rsuppl ya nds anitationpr ogra mme( UQ)–424, 425
33.Mi nimumne edspr ogr amme-428
34.20poi ntpr ogr amme-429
35.Preve ntionofunde rnut r it
ion
36.ICDS- referr evis edda taona nga nwa dis-546
a.Ot he rpr ogr a mme st opr eve ntunde rnut r
it
ion
b.Ana emi apr ophyl axi spr ogr amme
c.Vi tami nApr ophyl a xi
spr ogr amme
Es
says
1.Ac aseoff alcipa rumma lariaisc onf irme dinyourPHC.AsMOofyourPHC,
a.Wha tist het reatme ntgi ven?
b.Wha tisa ctives ur ve il
lanc e?
c.Wha tispr e sumpt i
vet re at
me nt?
 d.Wha tisma sss urvey?
e.Wha tme a sure swoul dyout akea sperNAMP?
2.A24yroldwoma nwhoi si ne arlypr egnancyc amet othePHCf orante
nata
lcare
.AsMOoft hePHC,
a.Listt heimpor t
anta ntenatals ervicesthatyouwoul drender.
b.Wha tisriska pproa ch?
c.Wha tisCSSM?Li sti t
sc ompone nts.
d.Wha tisne o na t
altetanus ?
e.Wha tare5c leans?
3.A2yrol
dc hildisbr oughtt ot hePHCwi thsympt omsofAFP.Ast heMOofPHC,
a.Wha tstepswi l
lyout ake?
1.Re portt oDi stri
c tImmuni sat
ionOfficer
.
2.Col l
e ct2s ampl e sofstool2we eksapartwithin2weeksofonse
tof
sympt oms
3.a nds endfora nalysis
.
4.Gi veOPVt ot ha tchil
d
5.Gi veOPVt oa l
lc hil
dren<5yr sinthatcommunity-ORI
6.Ac ti
vec asese archinga mongc hi
ldren<15yr s
7.Fol lowupt hatc hildanda llcas
esfor60da yssi
nceonse
tof1stsympt
om
b.De fineAFP
c.2ke yi ndic atorsofAFPs urve i
llance
1.Se ns it
ivityofr e
por ti
ng
2.Compl e t
ene s
sofs pecimenc ult
ure
d.Wha taret hes t
rategiesunde rNPEP?
e.Wha tisPPI ?
f. Wha tisc urre ntstatusofpol i
oi nI ndia?
 DEMOGRAPHYANDFAMI
LYPLANNI
NG
Diagrams
1. Agep yrami d–445( Figure2)
2. Coppe rT–457( Figure7)
3. Sa fepe r
iod–468( Fi gure8)
Shortnote
s
1.De mogr aphi ccycle( UQ)-441
2.De mogr aphi cgap
3.Gr owt hr ates(UQ)-443
4.AgePyr ami d(UQ)-444
5.De pe nde nc yrat
io-446
6.Ur ba nisationandhe alt
h-4 46
7.Fe rt
ilityr elat
eds t
atisti
cs(UQ)-450
8.De finitionoff ami l
ypl anning(UQ)-452
9.Sc opeoff amil
ypl anning-453
10.Eli
gibl ec ouple-45 4
11.Targe tcoupl e-454
12.Sma llf ami l
ynor m-454
13.Coupl epr otecti
onr ate-454
14.Nationa lPopul ati
onPol icy(UQ)-455
15.Int
raut eri
nede vices( UQ)-457
16.Secondge nera
tionI UD( UQ)-457
3rdge
17. nerationI UD( UQ)-458
18.
Me chanisma ndC/ IofI UD–458, 459
19.
IdealIUDc andida te(UQ)-459
20.
IUDf ollow- up( UQ)-459
21.
Sideeffectsa ndc ompl i
cati
onsofI UD( UQ)-459
22.
Hor mona lc ontrace ptivesandc la
ssifi
cat
ion-461
23.
Or a
lpills( UQ)-461
24.
Ma lepill(UQ)-462
25.
Eme rgenc yc ontrac eption-462
26.
Adve rs
ee f f
e ctofor alpill-463
27.
Inject
ablec ont ra
c ept i
ve s-464
28.
Subde r
ma limpl ant s-466
29.
MTPAc t1971( UQ)-467
30.
Indicat
ionsf orMTP( UQ)-467
31.
Safepe ri
od( rhythmme t
hod)( UQ)-4 68
32.
Na t
uralfami lypla nningme t
hod-469
33.
Ce r
vicalmuc usme thod( UQ)-469
34.
Breastfeedi ng( UQ)-469
35.
Ma lesteri
liz ati
on( UQ)-469
36.
Nos calpelva sect
omy( UQ)-470
37.
Tube ct
omy /Fe ma leSt eril
iza
tion-470
 38.Minil
apope r
ation( UQ)-471
39.Pear
linde x(UQ)-471
40.Unme tneedf orfa milypl anni ng-471
41.Communi t
yne edsa s s
ess me ntappr oa
c h-475
42.Eval
ua t
ionoff ami lypla nning( UQ)-477
Es
says
1.A24ye a roldma rr
iedwoma nwi t
hr egularmens
trualcycl
eca
mef
orc
ont
rac
ept
ivea
dvi
cet
oyou
a.Wha tisthei dealme thodofc ontrace
pti
onf orher
?
• Cl assi
fyc ontracept i
veme thods.
• Wha tistheme cha nismofa ct
ionofI UCD?
• Wha tarethema jora dve r
see ffec
tsofOCP’ s?
• Pos tope r
ativea dvi c
ea f
tervasectomy?

PREVENTI
VEMEDI
CINEI
NOBSTETRI
CS,PAEDI
ATRI
CS&GERI
ATRI
CS
Diagrams
1.WHOgr owt hc ha r
t-505
Shortnot
e s
1.Mot he r&c hild-oneuni t-480
2.So c i
a lobs t
etrics-481
3.MCHpr ob lems( UQ)-481
4.Obj ective sofa ntenatalcar
e( UQ)-483
5.Ant ena t
a lvis i
ts( UQ)-483
6.Pr eve ntives ervicesformot her-484
7.Ri ska ppr oach( UQ)-486
8.Pr ena tala dvic e( UQ)–486
9.Domi cili
a ryc a r
e( UQ)-486
10.Roomi ngi n-489
11.Car eofmot he r-489
12.Bre astfee ding( UQ)-490
13.APGARs cor e( UQ)-492
14.Ne ona tals creening( UQ)-494
15.Id
e ntificationof“ atri
sk”infant
s-494
16.Lowbi rt
hwe ight( UQ)-495
17.Riskf a ctorsofLBW –495( Tabl
e4)
18.Preve ntionofLBW -496
19.Bre astfee dingofi nfants-advanta
ges(UQ)-498
20.Growt hc ha rt-WHO&I ndia(UQ).r
efe
rnewGROWTHCHART-504,
506
21.Use sofgr owt hc hart(UQ)-507
22.Ma lnut ri
tioni nc hil
dren-508
23.Proteine nergyma lnutri
ti
on-509
24.Mi cronut ri
tiona lma lnutri
ti
on-509
25.Unde r5mor talit
y[ withDi agr
am](UQ)-530
26.Spe cificobj ec ti
ve sofMCH-514
 27.Riska pproachi nMCHc are(UQ)-5 14
28.Babyf riendlyhos pi t
als(UQ)-499
29.Ma terna lmor talit
y:c auses(UQ)-517
30.Preve ntion&s ocialme asur
e sofma ter
nalmor t
ali
ty-520
31.Perina talmor talit
yr ate(UQ)-521
32.Ne ona talmor talit
yr ate(UQ)-523
33.Infantmor tal
ity:c auses-526
34.Fac t
or sa f
fectingi nfantmor t
a lit
y-52 7
35.Chi l
ds urvi
va linde x-532
36.Prena taldiagnos is(UQ)-534
37.Obj ectivesofs choolhe al
ths ervices(UQ)-534
38.Aspe ctsofs choolhe althservic es(UQ)-535
39.He altha ppraisal(UQ)-535
40.Mi d-da ySc hoolMe al(UQ)-536
41.He althe ducation( UQ)-536
42.Juve nileDe li
nque ncy( UQ)-540
43.Chi l
dgui dancec l
inic( UQ)-544
44.Chi l
dpl aceme nt(UQ)-544
45.ICDS-546
46.He althpr oblemsi na ge d-549
47.Da nge rsofe arlywe aning(UQ)–499, 527
Es
says
1.Ma terna lMor ta l
it
yr ate
a.Cur r
entMMRofI ndia ?I MR?
b.I ndicatorsofMMR,I mpor t
anceofMMR?
c.WhyMMRi ss t
il
lnotr educedtothetar
getma rkinIndi
a?
d.Ke ra
laMode l
2.Ac h i
lda ged9mo nthsisbrough ttothePHCwi thcomplaint
sofnotg a
inin
gwe i
ght
dur
ingt
hel
ast3mont
hs.
Themot heroft hisc hildisi
nt he2ndt ri
me s
terofher4thpregnancy
a.Wha tc ouldbet hediagnos i
s?Howwi l
lyouc la
ssi
fythedi s
ease?
b.Howwi llyouma nagei ti nthePHCs ett
ing?
c.Wha ta dvic eca nbegi ve ntothemotherregardi
nghe rpr
e gnancy?
d.Wha ts ervicesc anbepr ovidedchil
drenaged2a nd3ye ars?

NUTRI
TION&HEALTH
Diagrams
1.Foodguidepyra
mid–591( Figur
e1)
2.Ma l
nutr
it
ion/i
nfec
tioncycl
e–592( Fi
gur
e2)
Shortnot
es
1.Nut ri
ti
onalepi
demiology-563
2.Bi ol
ogical
lycompletepr
otei
n(UQ)-564
3.Su pple
me nt
aryact
ionofprote
in-564
4.Ne tpr ote i
nut il
i za tion-NPU( UQ)–565,588
5.Fu nc tionsoff at-566
6.Vi sibl e&i nvi si bl ef a ts-566
7.Hydr oge nationoff a t-566
8.Ph re node r
ma-567
9.Di e t
a ryf ibre( UQ)-568
10.Vitami nA-De fic ienc y-Ni ghtbli
ndnes
sBitot
’ss
pot,Ke
rat
omalaci
a(UQ)-570
11.Trea tme nt&pr e ve nt ionofvi taminAdefi
cie
ncy(UQ)–570,571
12.Trac ee leme nt s( UQ)-575
13.Goi troge ns-578
14.Effec tsofMi llingr ic e-581
15.Parboi ling( UQ)-581
16.Ref erenc esma n&woma n( UQ)-586
17.RDA-585
18.Vul ne rablegr oups-589
19.Ref erenc epr ot ein( UQ)–588
20.Compl etepr ote in-564
21.Bala nc edd ie t(UQ)-591
22.Die t
a rygoa ls-591
23.Lowbi rthwe ight( UQ)-592
24.Prote ine nergyma lnut riti
on( UQ)-592
25.Gome z’sc l
a ss i
f ica tion-593
26.Wa te rlow’ sc las sific ation-593
27.Xe ropht ha l
mi a-594
28.Nut riti
ona la na e mi a-595
29.Io
di nede f
icie nc ydi s orders-596
30.Goi trec ontrol-597
31.Ende mi cfluor os i s-597
32.Lathyr ism-598
33.Nut riti
ona lf ac tor si nCVD( UQ)-599
34.Nut riti
ona lf ac tor si nc ance r(UQ)-600
35.Ass es sme ntme thods&i ndic at
orsofnut
ri
ti
onalst
at
us(UQ)–601,604
36.Ass es sme ntofdi e taryi nt
a ke( UQ)-603
37.Prote inqua lity( UQ)-588
38.Gre enl ea f
yve ge ta ble( UQ)-582
39.De finema lnut riti on( UQ)-604
40.Ecol ogyofma lnut rition( UQ)-605
41.Paste urizationofmi lk( UQ)-608
42.Foodha ndle rs( UQ)-609
43.Ne urol athyris m-598
44.Epide micdr ops y-610
45.Fooda dditi
ve s-610
46.Foodf or ti
fi
c a ti
on( UQ)-611
 47.Fooda dul t
erati
on( UQ)-611
48.Pr
e ventionoff ooda dulte
rati
ona c
t-612
49.Foods tanda r
ds-Code xa l
iment
a r
ius(UQ)-612
50.Communi t
ynut ri
tionpr ogramme( UQ)-612
51.Mid-da yme a
lpr ogra mme( UQ)-613
52.Trans-fattyacid-567
53.Choiceofc ookingoi l-568
54.Thiaminede f
icienc y-573
55.Pel
lagra-574
56.Epidemi ologicala s
s essmentofiodinedef
ici
enc
y-408,
596
57.Dietar
ya nti
oxida nts-580
58.Skimme dmi lk,tone dmi lk-584
59.Growt hmoni t
oring&nut ri
ti
onalsurve
il
lanc
e-603
60.Type2DM –The r
ape uti
cdiet
61.Pr
e ventiveme as
ur esforPEM -594
Es
say
1.Vi t
a minA( UQ)-569

MEDI
CINE&SOCI
ALSCI
ENCES
ShortNotes
1.Me dica ls ociology( UQ)-622
2.Ac c ultura ti
on( UQ)-624
3.Soc ialc ont rolme cha nis
m-623
4.Soc ialpa thology( UQ)-62 4
5.Soc ials ur veys( UQ)-625
6.Ca ses tudy( UQ)-625
7.Fi e
lds tudy( UQ)-625
8.Type sofl earni ng-628
9.I nt
ellige nc eq uot i
ent-631
10.Sociology( UQ)-622
11.Thef ami l
y( UQ)-634
12.Diffb /wj ointa ndnuc l
earfamil
y(UQ)-635
13.Thre ege ne rationf ami l
y-635
14.Fami lyi nhe altha nddi s
ease-636
15.Diffb /wbr oke nf ami lyandprobl
emfami
ly(UQ)-63
7
16.Socialmobi lity( UQ)-639
17.Sic
kr ole-644
18.Me dica ls ocialwor ker(UQ)-644
19.Ope rationa lre search( UQ)-646
20.Delinque ncy( UQ)-647
21.Alcohola buse( UQ)-648
22.Sociala s sist
a nc e-647
 23.
Socialsecur i
ty(UQ)-652
24.
Cult
ur eshoc k(UQ)
25.
Socialmor bi
dit
y( UQ)
26.
Healthec onomi cs,socia
lma r
ket
ing
27.
Scopeofc onsume ra cti
nme di
calc
are-645
28.
Tempor arys oci
a lgroups(UQ)-633
29.
Grossn ationalincome( UQ)-650
30.
Socialdefe nce-625
31.
Defenceme c
hanisms -629
32.
Socioe c
onomi cs t
at
uss cal
e-640
33.
Int
erviewt ec
hnique-646
34.
Focusgr oupdi scussion(UQ)

ENVI
RONMENT&HEALTH
Diagrams
1.Se ctionoff ilt
e rbe d:Fi gur e5-661
2.Ra pids a ndf iltrati
on-f lowdi agram:Fi gure6-662
3.Sa nitarywe l
l:Fi gur e3-658
4.Sa nitationba rrier:Fi gur e2-702
5.Wa ters eal:Fi gur e5-704
6.Mode rns ewa get re atme ntplan:Fi gure13-708
7.Oxi da ti
onpond:Fi gur e15-711
Shortnot
es
1.En vironme nt-de finitiona ndc ompone nts-654
2.Us esofwa te
r-655
3.Di ffb/ ws hallowwe lla ndde epwe l
l–657( Table2)
4.Sa nitarywe l
l( UQ)-658
5.Wa terre lateddi se aseswi the xampl es(UQ)-659
6.Pu rificati
onofwa te r-660
7.Ra pids a ndorme cha nic alfil
ters( UQ)-661
8.Compa riso nofr a pida nds lows a ndfil
ters–663( Table3)
9.Princ iplesofc hlor ina t
ion( UQ)-663
10.Supe rchl orina ti
on( UQ)-664
11.Orthotol i
di net est( UQ)-664
12.Orthotol i
di ne-Ar se nitet est(UQ)-664
13.Che mi caldi sinfec t
ion( UQ)-665
14.Disinfec t
io nofwe lls( UQ)-666
15.Thedoubl epotme thod( UQ)-667
16.Crit
e ri
af orwa te
rqua l
ity-667
17.Mic robi ologi cala spe cts-ba c
teriologic
a li
ndi
cators,bi
ologi
cala
spe
ct(
UQ)–669,
670
18.Bacte r
iologi ca lqua lityofdr i
nkingwa ter–670( Table5)
19.Pr
e sumpt ivec olifor mc ount-674
20.Ha rdne ssofwa ter-674
21.Spe c i
a lt reatme nt- r
e mova lofha rdne s
s-675
22.Indic esoft he rma lcomf ort-679
23.Moni tor ingofa irpol lution(UQ)-683
24.Airpol lutionmoni tor i
ngi nI ndia( UQ)-684
25.Effe ctsofa irpol lution( UQ)-684
26.Preve nt iona ndc ontr olofa irpollution-685
27.Dis infe ctionofa ir-685
28.Effe ctsofnoi see xpos ure( UQ)-689
29.Nona udi t
or ye ffe cts( UQ)-689
30.Cont rolofnoi se-689
31.Biol ogi c ale ffec tsofr adiati
on( UQ)-691
32.Ra dia tionpr ot ection( UQ)-691
33.Ka tat he r mome ter-693
34.Effe ctsofhe ats tress( UQ)-694
35.Globa lwa rmi ng,gr ee nhous ee ffect-694
36.Ove rc rowdi ng-698
37.Indic ator sofhous ing-698
38.Indir aAwa sYoj ana-699
39.Dis pos a lofwa s
t e( ESSAY) -Me thodsofdis
pos
al-
cont
rol
le
dti
ppi
ng,i
nci
ner
ati
on,
compos ting–699, 700, 701
40.Sani tationba rrier( UQ)-702
41.Dugwe lllatrine-703
42.Crite riaf ors anita ryl atrine–702, 703
43.RCAl atrine-704
44.Sept ict a nk-705
45.Wor ki ngofas e ptict ank-705
46.Aquapr ivy-706
47.Communi tyl a tr
ine( UQ)-706
48.Che mi ca lc los et( UQ)-706
49.Sewa ge( UQ)-707
50.Ex pr ess ionofs trengt hofs ewa ge-708
51.Mode rns ewa get rea tme nt-708
52.Sec onda r yt reatme nt( UQ)-709
53.Oxi da tionpond( UQ)-710
54.Arthr opodbor nedi seas e–712( Ta ble3)
55.Biol ogi c alc ont rolofa rt
hropods-713
56.Mos qui toc ont rolme asur e
s( UQ)-716
57.Integr a t
e dve c t
orc ont rol-716
58.Ae de sa egypt iinde x-716
59.Flyc ont rolme as ures-719
60.Gui ne awor me radi ca t
ion–224, 428
61.Bloc ke df lea ,fleai ndi ce s(UQ)-268
 62.Publ i
che alt
hi mpor tanceofha rda nds oftticks–724, 725
63.Sca bi
esc ontrol-726
64.Inorganicc onstituents-fluor i
de-670
65.Chl or
inede ma nd( UQ)-663
66.Comf ortz one( UQ)-680
67.Oz onede pleti
on( UQ)
APPLI CATI ONQUESTI ONS
1.I ma gi
neyo ua ret heDMO,t heno.ofde nguec asesareontherise
a.Howc anyouc onfirmt hatiti sane pi de
mi cofdengue?
b.Wha taret hee nvi r
onme ntalc onditionsfavouri
ngde ngueoutbrea
ki nKe ral
a?
c.Wha taret he5ma ins trat
egie stopr eventandma nageoutbreaksofmos quitobornedis
ease
s?
2.Youa r
et heMOofaPHCi nKa sargode ;younot ice
dt hatmanychildre
na rebornwi t
hcongenit
al
anoma li
es .Itissa idtha tthec auseoft hisde fec
tisduet ochemicalusedina gr
icult
uralfi
eld
s.
a.Howwi llyouc onf irmt hee pidemi c?
b.Howwi llyoui nve sti
ga t
ethee pidemi c?
3.Th eno.ofhe patitisAc asesa reincr easi
ngi nyourPHC,howwi llyoudisinfectthewe l
lduri
ngthe
outbreaka ndb/ wt heout br eak?
HOSPI TALWASTEMANAGEMENT( ESSAY)
ShortNotes
1.Bi ome dicalwa ste .Wha tar ethec ategories?-738( Table4)
2.I nciner
ation( UQ)-735
3.Ne edforhe althc a r
ewa stema nageme nt(UQ)-735
4.Col ourc oding&t y peofc ontainer–739( Ta bl
e5)
DI SASTERMANAGEMENT

Diagra
m
1. Flowd i
agra
mofdisas
terma
nage
ment–741(
Figur
e1)
ShortNot
es
1. Disast
ercycl
e-741
2. Tria
ge-741
3. Disast
erpre
pare
dne
ss-743

OCCUPATI
ONALHEALTH

Diagram
1. ESIs chema t
icdia
gram
Shortnot
es
1. Er gonomics-748
2. Oc cupat
ionalhazar
ds-749
3. Oc cupat
ionaldise
ases-750
4. Pne umoconiosi
s-751
5. Le adpoisoni
ng-752
6. Oc cupat
ionalcancer-753
 7. Occupationalder
ma t
it
is-754
8. Radia
ti
onha zar
d-754
9. Occupationalhazardsofagri
cult
ura
lworker
s-754
10.Si
cknessa bsent
ee i
sm-755
11.Pre
ventionofoc cupati
onaldis
eases
-Pr
epla
cementExami
nat
ion-757
12.TheFac t
or i
esAc t-759
13.ESIAc t-Me di
calbenefi
t,Exte
ndedsi
cknessbe
nefi
t–760,
761
14.Byssi
nos is-751
15.Si
lic
osis-751

GENETI
CS&HEALTH(
P2)
Diagram
1.Cl assicalMe ndeli
anPa tte
rnofI nheri
tanc
e–767( Figur
e1)
Shortnot
es
1. Ge not ype&Phe not ype-765
2. Chr omos oma labnor ma l
it
y-765
3. La wsofI nhe ri
tance-765
4. Mul t
ifactorialdisorders-769
5. Kl i
ne felterSyndr ome ,Turner’ssyndr
ome ,Downs yndr
ome,Superfe
ma le
s-766
6. Ge net he rapy(UQ)-770
7. Pr eventives ocialme asure,Eugenics(UQ),Eut
henics(UQ)
,Ge ne
ticcounsel
li
ng(
UQ)
,ot
her ge
net
ic
pre
ve n t
iveme as
ur es-771
8. Ea rlydia gnos i
s&t reat
me nt(UQ)–772
9. Si c
kl ece llanaemi a-768
MENTALHEALTH(
P2)

Shor
tNotes
1. DrugDe pendence-776
2. Me nt
a lhealt
hSe r
vices-776
3. Alcoholisma nddrugdependence-776
4. SocialaspectsofAlcohol
isma ndpr
event
ion–778,
781
HEALTHI
NFORMATI
ONANDBASI
CMEDI
CALSTATI
STI
CS

Diagram
1.a )
Ba rc hart,b)Fre quencypolygon,c)Piechar
t,d)Linediagra
m,e)Pic
togr
am(UQ)–787-
789
2.Nor ma lc urve–792( Fi
gure15)
Shortnote
s
1.Us esofhe althinforma t
ion-782
2.Sour cesofhe a
lt
hi nformati
on-census-783
3.Sa mpl ere gistr
ati
ons ystem(UQ)-783
4.Re cordl i
nka ge-785
5.Cha rts&di agrams,ba rchar
ts,hi
s t
ogra
m,frequencypolygon,l
inedi
agr
am,pic
togr
am(
UQ)
6.St a
tist
ic a
la ve r
ages -
me an,median,mode–789, 790
 7.Standar ddeviat
ion(UQ)-791
8.Nor ma ldist
ri
bution(UQ)-normalcur
veandsta
ndar
dnor
malcur
ve–791,
792
9.Sa mpling-Samplingmethods,s
ampl
inger
rors
,sta
ndar
der
ror
s-792
10.Testofs i
gnif
icance(
UQ)-793
11.Chi-s
qua rete
st-795
12.Mea s
ure sofcentr
alt
endency-789

COMMUNI
CATI
ONOFHEALTHEDUCATI
ON(
P2)
Diagra
m
1.Communi c at
ionpr oce ss–797(Fi gure1)
ShortNot
es
1. Diff
erentiat
ebe t
we e ncontr
oll
eda ndunc ont
rol
le
daudie
nce-797
2. Socrat
icMe thod-798
3. Barri
ersofc ommuni cat
ion-799
4. Counselling( UQ)-800
5. Healt
he duc ation-800
6. Healt
he duc ationandpr opaganda( t
a bl
e)(UQ)-802
7. Motivati
ona lmode lofhe a
ltheduc a
tion-802
8. Contentsofhe al
the ducati
on-803
9. Pri
nciplesofhe al
the ducat
ion-804
10.Audiovisuala ids(UQ)-80 5
11.Me t
hodsi nhe a l
thc ommuni ca
tione ducat
ion(UQ)-805
12.Groupdi scussion-807
13.Paneldiscussion( UQ)-808
14.Sympos ium-808

HEALTHPLANNI
NGANDMANAGEMENT(
PII
)

Diagra
m:
1.Planningc ycle–812( Figur e1)
2.Ne tworka nal
ys is–815( Figure2)
ShortNot
e s
:
1.He alt
hpl anni
nge ducat
ion( UQ)–pr epl
anni
ng–811,
812
2.Planningc yclee ducat
ion( UQ)-812
3.Cos tbene f
itanalysiseduc ati
on(UQ)-814
4.Cos teffect
ivea nalysi
s( UQ)-814
5.Cos taccounting-814
6.Ne tworka nal
ys is(UQ) ,PERT( UQ),CPM (
UQ)-815
7.Wor ks ampl i
ng-815
8.Na ti
ona lheal
thPol icy2002-815
9.He alt
hpl anni
ngi nIndia(UQ) ,Bhorecommit
te
e(UQ),Sr
iva
sta
vcommi
tt
ee–816,
817
10.Centra
lc ouncilofhe al
th( UQ)-821
11.Pa
nc hayatira
j-823
 12.
Communi
tyde
vel
opme
ntpr
ogr
amme–823

HEALTHCAREOFTHECOMMUNI TY
(Donotconf
usePHcar
eandPHcent
re
St
udy4pi
ll
arsa
nd8e le
ment
sofpr
imar
yheal
thc
are
)
Diagram:
1.He al
ths ystemsi nI ndia
2.Mode lofhe a lt
hc aredeliverysyst
em-836
Shortnotes:
1.Le velsofhe a lt
hc are-831
2.El eme ntsofPr ima ryhe alt
hc a
re–832(Code:ELEMENTS)
3.Pr inci
pl esofPr ima ryhea l
thcare(UQ)-832
4.NGOsi nh ealth
5.MDGs ,e spec iall
yhe althrelat
edgoals(
Code:PM Ma
nmoha
nDED)-835
6.PEM ( UQ)-840
7.LBW ( UQ)-840
8.Vi lla
gehe althgui de s-843
9.Anga nwa diwor ke r(UQ)-843
10.Subcent releve l(UQ)-843
11.PHCl e vel-func ti
onsofPHC( UQ)-845
12.CHC( UQ)-847
13.Me dicalof f
ic er,PHC-848
14.He al
thwor ke rma lea ndf e
ma l
e-849
15.He al
thi nsura nce( UQ)-854
16.Functionsofvol untaryhe al
thagenci
es-855
17.India
nr e dc rosss ociety(UQ)-856
18.Ka st
urb ame mor ialFund-856

I
NTERNATI
ONALHEALTH
Shor
tNote
1.WHO–wor k( UQ)-860
2.UNI CEF-GOBIc ampa ign(UQ)-862
3.FAO-863
4.Wor l
dBa nk-863
5.Inte
rnat
ionalRe dCross-864
6.India
nredcr oss(UQ)-865
7.IHR
8.Disease
sunde rsurvei
ll
a nce
9.Inte
rnat
ionalhealt
ha genc i
es