Student Date OF Birth Batch No Sait otan-00 ‘Academie Session Subject Exam 2oni-22 Preprof EYE + ENT (Block ll Renal (22118) Endocrine + Reproduction) Marks Total Marks: Marks Obtain Paper Question & Answers Details ‘840 yoars old female presented with complaints of fet facial pain rom the last 3 years. Her nasal cavity examination was, normal, however CT scan revealed a fungal ball (mycetoms) In left maxilary sinus, The next step in management ofthis. pationt would be ‘430 yoars ld female presented with severe headache from tho last 6 months. According to her, pains episodic, starts Inthe frontal area and then spreads tothe occiput. She complained of flashes of ight and aural sensitivity preceding the headaches, Examination of nasal cavity was normal, The pathology inthis case is: ‘AS years old female fell from bed and received nasal trauma. ‘She didnot have any nasal bleed atthe moment. She presented with complaints of bilateral nasal obstruction 5 days later. OVE thors was bila cavity. She is suttering from: swaling Inthe nasal 'A25 yoars old female prosonted with complaints of headache, left sided facal pain and fever from the last 7 days, 0, she had tenderness in left maxillary sinus and ‘mucopus seen In nasal cavity, X ray PNS revealed haziness: In left maxillary sinus. She is diagnosed with acute maxillary sinusitis, The next step in management ofthis patient Is ‘A335 years old male with nasal polyposis and seasonal re tints fs evaluated in clinic. Upon enquiry, {ound tobe allergic to aspirin too. You are suspecting that this patient has samter’stlad, What other pathology would ‘you expect in this pation asa part of this triad: ‘A410 yoars old female presented with recurront attacks of natal polyposis and chest infections from the last § years. Despite aggrossive eatment stratagie, her polyps recur and her chest infections also are getting worse. Her sweat chloride test was ordered and it was abnormal. The child is suffering rom ‘86 years old female presented with complaints of left sided nasal obstruction and foul smelling nasal discharge from tho last 4 year. Her parents denied any history of fever. X ray NS revealed a radio opaque lucency in lft side nasal cavity. The diagnosis in this case would be ‘A40 years old mate with uncontrolled diabetes presents with loft sided facial pain and swaling trom the last 6 days. OE ‘Ranibiotes B antifungals >) Ere assure and discharge “RAypical facial pain B cluster headache € migraine [7 D tension headache E vigaminal neuralgia C Rhinol 0 Septal hematoma f nasal polyposis eft Caldwell Fess Wantbiates (7) D nasal endoscopy Re assure and escharge ‘Rano 8 Bronchial asthma [ C doxtrocaria D infer E sensorineaual heating ass ‘allergic rins 8 chvonicrinosinusis oystie orosis D Rhinolth B enlarged adenoids © foreign body nose D nasal polyposis E seasonal allergic rhinitis Rant fungal BIV antbiotishe had fungal debris occupying let maxilry sinus and loft ‘ethmoids thas breached the left lamina papyracae buthas 0 not yot involved the orbit He is diagnosed as having acute fulminant fungal rhinosinusitis, The key to achieving di control in this case is: 'A35 yoars old fomale presented with loosening of lft upper ‘molars and eft faclal pain from the last 1 year. OIE her 2nd last loft upper molar has fallen off with loosening ofthe rest. Nasal examination revealed a fungating growth arising from 41 left maxillary sinus with blood stained discharge. you are suspecting sinonasal malignancy. Which Investigation would {you order to assess spread ofthe disease: ‘A. years old male presented with complaints of nasa jbstruction and snoring from the last 2 years. He was Investigated and found to have enlarged adenoids. He underwent adenoidectomy which was uneventful and then 0 discharged home, He presented again after a woek with complaints of nasal regurge of food and nasal speech. The next stop would be ‘A15 yoar old boy came to ophthalmology emergency after he suffered trauma to the right eye with fist. He is having Aificulty in opening his eye to bright light. His visual acuity is 69 on Snellen visual acuity chart. On examination, his anterior segment is unremarkable except mid dilated pupil ‘The pupllis not reactive to light is fundus examination Is ‘also normal. He denles use of any topial or systemic ‘examination. What isthe most probable diagnosis? 'A25 year old patient comes to Ophthalmology outpatient department with complaints of redness and pain in is eight ‘ye. The pains dul, continuous and associated with ‘decreased vision, On examination, he has cicumeliany 1 redness, mid corneal edema, and #2 cells and flare inthe “anterior chamber. The rest of eye examination is unremarkable. What is the most likely diagnosis? 27 years male presented to eye OPD with ight eye pan, photophobia and dacrease vision since lat three days, he had trauma witha tree branch one week back, On ° ‘examination he is having right corneal ulcer, what Is the mostly causative organism? ‘The most common fungal specie causing commeal ule temperate climate is? ° 183 years old female diagnosed tobe having lft comme Llcer On sit imp examination there isa whitish opacity with overlying epithelial oedema. Histopathologic ° ‘examination reveals polymorph nuctearleuckocyctlc Infiltration of epithelium and stroma, stage of corneal ulcer ts, '9)A73 years old lady prosonts to oye OPD withthe complaint of burning sensation, ration and foreign body sensation in both eyes which becomes worse in hot climate. She also complain of ocular pin, photophobia, stringy mucous discharge and transient bluring of vision. On ‘examination she has reduced volume of ears in the marginal 0 tear strip and thinning of perconeal tear flm. Mucous strands and debris are present in the conjunctiva, On ‘tuorescein staining punctate corneal erosions and comeal filaments are seen. Tear breakup time is ess than 10 seconds, The lady is sutfering from: D hyperbaric Oxyger E ste glucose conto Angiography 8 CT scan [7] © Nasal endoscopy E Xray PNS ‘lnavenaus antbioes B Pass an NG for feeding © Perform a tonsilectomy Re assure and manage conservatively [ ‘Posterior synechas ' Damage to sphincter pupilae muscle 7 ¢ Oeulomotor nerve palsy D Ad's Pupi Sympathetic overstimulation eric Conjuncvis © Bacterial conjunctive Anterior Weis [7] Acute congestive glaucoma B virus C fungus spiochete[ ‘AAspergilus 8 Fusariur Bb) Regressive stage 0 ¢)Initrative stage (7 E-e)Alofthe above 7a) Ulseratvebiephais © 8») Squamous bepharis Ce) Melbomianitis 0.) Dry eye syndrome (7)7) 33 years old farmer presents to eye OPD withthe ‘Aa) Ulcerative bepharis complaint of doposition of whitish fake and scales lke 8 b) Squamous blepharts [7 material at the lid margins. tis associated with rlld discomfort, iration and fling of eyelashes. On Ge) Mebomlortis ‘examination the eyelid margins have a shiny waxy ° © D4) Herdeotum externur ‘appearance and moderate erythema and telangiectai « Honnsia nteman ‘eyelashes are greasy and the eyelid margins are ‘edematous. The patient i suffering from, ‘A30 yrs old man s suffering from right chronic anterior ‘APigmentary glaucoma Uveitis forthe last 3 months, On examination he has aqeous B Intammatory glaucoma flare and coll in the right anterior chamber. He has 360 ° degrees posterior synechiae and Intraocular C Neovascutr laucoms “4ommHg. The man is sutfering fom ) © Phacomorphic glaucome Pseudoextoliar [Athree month old infant with watering I ‘ADacryoeystorhinostomy pressing causes regurgitation of mucous material. what is 0 8 probing the appropriate treatment? © probing with syringing DD massage with antibiotics upto the age of 6 months [T] 'A25 yoars old lady come to the eyo opd withthe complaint (© Auieerative biephentis of deposition of whitish material at ld margins, mild B squamous bephertis [1 discomfort, Initation and fling of eyelashes. on ‘examination the eyelid margin has a waxy shiny appearance 0 with mild to moderate erythema and Telanglectasia there are D tichiasis dandruff ke flakes and scales along the Id margins the ‘eyelashes are greasy the lady is suffering fom. keratoconjunctivis soca ‘840 yoars old male presented with complaint of aft side ‘A Biopsy under local anaesthesia [ nasal bleeding and pain from the last 6 months, OE, patient had a fungating growth arising from left maxilary sinus and ‘extending out inthe nasal cavity There were extensive ‘erosions but no cervical Iymhadenopathy, The next step in © D surgical resector management of this patient would be ~ ° C nasal endoscopy E walt and wate ‘825 years old male presented with complaints of runny O Adhuonierihesiustis nose, sneszing and itching from the last 5 years. According 8 fungal nosinustis ‘ohm, his symptoms got worse every spring during the 0 pollen season. OE, he has pale looking nasal mucosa and ‘whitish nasal discharge. The patient ls suffering from © seasonal allergic ints 7 E vasomator tins 'A40 years old male who is a wood worker by profession ‘AAdenoid cyst carcinoma [ presented with complaints of right sided blood stained nasal © BMucoepia Aischarge and right sided peri orbital pain from the last 3 ‘months. On nasal endoscopy, patient had an ulcerated and. ‘ungating growth arising from the right anterior ethmolds. 1 squamous cel carcinoma Histopathology of tumor this patient wil ikely reve ° CC nasopharyngeal carcino E Undifferentiated carinome 'A13 years old boy with anglofbroma Is due to undergo cl salvage devioes surgery However there are concerns regarding per operative B extemal cart anary gation blood loss owing tothe highly vascular nature ofthe tumor. 1 ‘Which ofthe following would you request to reduce par © Cembotzation operative blood loss inthis patient: © hormonal therapy E transfuse whole blood pre of ‘430 yoars old male prosented with a ‘ABuergers dsease dorsum from the deformity gradually worsened with time, OE, there is a eptal perforation with crusting and a saddle nose. Upon {urthor enquiry the patont also had red cel casts in urine Dtuberculosi and decreased renal function. Blood tests were ord his C-ANCA came out tobe positive. The patient Is suf 5) E Wegener‘A. years old adolescent boy presented with complaints of brisk apistaxis from the last 6 months. According to him, the bleeding s so severe that he required a blood transfusion on fone instance. O, patient had a polypoldal growth ight side natal cavity. The next step in management ofthis patiant would be ‘A30 yoars old male with involved ina road trafic accident. He presented to ER witha concussion and a fractured nose, He is managed conservatively and is making good progress. after being shifted to ward. The next day, the surgeon on call receives a call rom the ward thatthe palent has clea lla coming out from nose, particularly on bending forward and Is unable to sniff it back. The Investigation tobe received arenal transplant. 1 month after surgery, he Presented with facial pan, decreased vision right eye and ‘swalling ofthe right orbit. O/E he had oxtonsiv black ‘eschars and erusting right side nasal cavity. The right eye had complete ophthalmoplegia with paralysis ofall muscles, no pupillary tflexes and no vision. The mechanism which ‘would explain the findings in right eye would be 'A4S years old female who was on chematherapeutics for her breast cancer presented with facial pain from the ast 10 days. OFE extensive black eschars and crustings were noted In both sides of nasal cavity. he underwent FESS and siggressive surgical debridement. Post op she was put on “amphotericin to control the spread of her nasal pathology. Which ofthe following parameters will need strict monitoring: ‘A60 years old diabetic female with active covid infection presented with complaints of loft facial swalling and decreased vison lft eye from the ast 7 days. OFE there is atuse erythema left side face and extensive black eschar Is seen in nose, The patient also has complete ophthalmoplegia left eye and necrotic patch on hard palate ‘Tho clinical diagnosis in this caso is: 'A30 yoars old female pationt prasonts to eye OPD with history of decreased vision and mild pain in her right oye tines last § months, She ie aknown case of rheumatoid arthitis- On examination she has mutton fate, keratic precipitates on the cornea, mild anterior chamber reaction, Ins nodules and posterior synechiae, Whats the most kely diagnosis? ‘$60 years old male patient was operated for right eye cataract surgery. Now he has presented with sudden onset of decrease vision , severe pain, watering and redness 3 days after surgery. He was dlagnosed asthe case of post ‘operative endophthalmitis, Whats the mainstay of treatment inthis cate ‘8.35 years old lady presents to eye OPD withthe complaints of gradual blurring of vision and floaters in right eys. On ‘examination the eye Is white but small round grey white color keratc precipitates scattered difusely over the ‘entire comeal endothelium. Anterior chambar shows faint flare and mild cals. There are some difuse iris atrophic patches and hypochromia in right eye, Posterior synechia fare absent. Vitreous shows cell and stringy opacities. The ‘most probable diagnosis is 'A55 yoars old lady was operated for cataract surgory 3 days ‘ago. Now she has presented with sudden onset ofp decrease vision, watering and redness in the operated eye Hor visual acuity is counting finger close tothe eye. On ‘examination she has severe comeal edema, 2mm hypopyon inthe anterior chamber and ne fundus view, Her B scan shows hyper-echogenle shadows in vitreous. Whats the most kaly agnosis in her case? ‘Adsrange for nasal endoscopy 8 Manage conservatively © Order a CT sean [i 1 Request coagulation profie E Shit fo sugery ‘RB2 vansfecin 8 CSF analysis serum aldosterone levels MRI brain wcnary catecholamines ‘Cavernous snus twombosis [] 8 Direct invasion of rot Involvement of ope nerve D Loss of comeat reflex E Relative afferent pupil detect ‘ABlood sugar levele 8 Cardiac enzymes C Electrolytes 5) 8 Prothrombin Time E Renal profile [7 ‘RChronierhinasinusis 8 Inverted papilloma (¢ Mucormycosis [7] 0 Sarcoidosis E Sinonasal malgnancy oni anterior Wve [ CC fuchs heterochromie Uvels E endophthalmitis Topical antbioies B lavaviteal antbiates[ D topical steroids E cyclopleies ) A Fuchs Uvelis syndrome [ 8 Posterior vets CC Homer syndrome DWhite dot syndron \dophthalmitis ‘Rao 8 Acute posterior wel (Post op endophihal © D keratitis'A.3¢-yearold factory worker is brought tothe emergency ‘with complaints of pain, decreased vision, watoring, and redness of eyes. He gives a history of accidental trauma with ‘an acidic chemical 10 minutes ago, What isthe most Improprite next stop in his management? 'A2 year old patient comes to Ophthalmology outpatient dopartment with complaints of redness and pain in is right ‘eye. The pain is dul, continuous and assoclated with decreased vision, On examination, he has eircumeliary redness, mild corneal edema, and 63 colle and flare inthe “anterior chamber. The rest of eye examination is unremarkable, Whats the most likely diagnosis? ‘A 202year old boy is brought tothe emorgoncy department ‘after suffering from trauma to te lef ye with tennis ball He i complaining of double vision. On examination, he has restricted eye movements in upgaze. He has paresthesia ‘over his lower ld and cheek. The left eyeball appears sunkan as compared tothe right eye. Whats the most ikely lagnosis? {9.35 year old lady from Afghanistan Is brought to Ophthalmology outpatient department with complaints of pain, redness and decreased vision In her right eye. She Suffered from penetrating trauma to her other eye 1 week. ‘Sho was advisod surgical repair but she rafused to undergo surgery. On examination, she has uveal prolapse in her ight ‘eye, She has conjunctival congestion, comeal edema, anterior chamber cells and dense vitits inher left eye. Whs Is the most lkely diagnosis in her left eye? ‘816 year old boy came to ophthalmology emergency after he suffered trauma tothe right eye with fist, He is having aificulty In opening his eye to bright light. His visual acuity 1s 69 on Snellon visual aculty chart On examination, his “anterior segment is unremarkable except mid dilated pupil ‘The pupllis not reactive to light. His fundus examination Is also normal. He denios use of any topical or systemic ‘examination. What isthe most probable diagnosis? ‘A.33-year-old lady is brought to ophthalmology emergency aftr sho sutfored trauma to her right eye with scissors, Her isual acuity is counting fingers close tothe eye. On ‘examination, she has cormeal edema, and corneal perforation at 5 o'tock with rs prolapse, What isthe most likely diagnosis? BPe ‘Take a detailed history ater admission scribe antibiotic medications and review whan the patients pain Perform immetiate eye wash with saline 7 D Presorbe sterlds and review ater 2 weeks Patch the eye to avod further aggravation af symptoms orgie Conjuncvis B Nodular Scents © Bacterial conjunctivitis Anterior Weis [] Acute congestive glaucoma 'AA. Blow out facture of te orbit [T] 8.8, Traumatic Cataract CC, Retinal detachment 10D, Disinserion of evatorpaipabraesuperoris EE, Choroidal rupt ‘AAnterior wis 8 Sympathetic ophthalmis [ C Vireous hemonage 1 Retinal Detachment E Posterior wt ‘APosteriorsynechae ' Damage to sphincter pupilae muscle [7 € Oeulomotor nerve palsy D Ad's Pupi Sympathetic overstimulation ‘A Closed globe injury 8 Open globe injury I. © Corneal lear E Traumatic cataract