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###Rationale: Third nerve palsy can result in ptosis of the eyelid. There is also loss of the ability to open the eye, and the eyeball is deviated outward and slightly downward. With complete lesions, the pupil is dilated, does not react to light, and loses the power of accommodation. In diabetes, the pupil is often spared. The sixth cranial nerve can also be affected by diabetes, but this is much less common. ###Answer: OPTION C IS CORRECT.

###Question: A 60-year-old man is brought to the emergency department because of new symptoms of double vision and discomfort in his left eye. He reports no other neurologic symptoms. On physical examination, there is ptosis of the left eyelid, the eye is rotated down and out, and the pupil is 3 mm and reactive to light. The right eye is normal, and there are no other focal neurological deficits. Which of the following is the most likely diagnosis? ###Options: A. fourth nerve palsy B. diabetic autonomic neuropathy C. third nerve palsy D. sixth nerve palsy

Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description. Analyze the question and answer with the best option.

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###Rationale: Brainstem death is defined by the absence of all brainstem mediated cranial nerve reflexes. Pupillary Light Reflex is a brainstem mediated cranial nerve reflex that is absent in brainstem death. The pupils are usually midsized but may be dilated (should not however be small). Occulo-cephalic (Doll&;s eye) reflex and Vestibulo-ocular (Caloric) reflex are both brainstem mediated cranial nerve reflexs that should be absent in Brainstem death. Criteria for Brain Death/Brainstem death The definition of Brain stem death requires simultaneous demonstration that the patient has irreversibly lost the capacity of consciousness (Coma) and the capacity to breathe (Apnoea) both of which are dependent on intact brainstem. Clinical assessment of the integrity of Brainstem has two components including assessment of the integrity of brainstem mediated cranial nerve reflexes and the Apnea test. REF: Harrison book of internal medicine 21ST EDITION ###Answer: OPTION B IS CORRECT.

###Question: Criteria for Brainstem death includes: ###Options: A. Positive Doll's eye Reflex B. Absent pupillary light reflex and delated pupils C. Pinpoint pupils D. Positive vestibulo-ocular reflex

As a medical professional, your responsibility is to address the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: The critical period of developed of fixation reflex is 5-6 months of age. This is the reason why unilateral cataracts in children should be operated early. Remember – Binocular vision develops at 5-6 years. ###Answer: OPTION D IS CORRECT.

###Question: Central macular fixation developed at : ###Options: A. 3 weeks B. 3 months C. 6 weeks D. 6 months

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans. Macula ###Answer: OPTION A IS CORRECT.

###Question: Optical coherence tomography is most useful in disorders of: ###Options: A. Macula B. Crystalline lens C. Refractive errors D. Intraocular tumours

Your role as a doctor requires you to answer the medical questions taking into account the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'd' i.e., Tachycardia * Amiodarone is a broad spectrum anti - arrhythmic drug which belongs to class III of the anti - arrhythmic drugs.* Following are the adverse effects -i) Fall in BP, bradycardia and myocardial depression occurs on i.v. injection.ii) Photosensitization and skin pigmentation occurs in about 10% of patients.iii) Corneal microdeposits may cause headlight dazzle, but is reversible on discontinuation.iv) Pulmonary fibrosis and alveolitis is most serious side effect seen on prolonged use.v) Peripheral neuropathy generally manifests as the pelvic and shoulder muscle weakness.vi) Amiodarone interferes with thyroid function and prevents peripheral conversion of T4 to T3 and hypothyroidism. ###Answer: OPTION D IS CORRECT.

###Question: Which of the following is NOT a side effect of amiodarone? ###Options: A. Pulmonary fibrosis B. Corneal microdeposits C. Photosensitivity D. Tachycardia

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Diurnal variation of IOP: Usually, there is a tendency of higher IOP in the morning and lower in the evening. This has been related to diurnal variation in the levels of plasma coisol. Normal eyes have a smaller fluctuation (< 5 mm of Hg) than glaucomatous eyes (> 8 mm of Hg). Reference :- A K KHURANA; pg num:-210 ###Answer: OPTION B IS CORRECT.

###Question: True for diurnal variation of intraocular pressure (IOP) is ###Options: A. IOP is usually low in the morning hours B. IOP is usually higher in the morning hours C. IOP variation is related to plasma acetylcholine level D. In normal eye lOP fluctuation is <10 mm of Hg.

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: Dimension of eye ball Anteroposterior- 24mm Circumference- 75mm Volume of each eye- 6 ml Volume of each orbit = 30 ml Weight- 7gm ###Answer: OPTION C IS CORRECT.

###Question: Axial length of eye ball is: ###Options: A. 16 mm B. 20 mm C. 24 mm D. 28 mm

You're a doctor, kindly address the medical queries according to the patient's account. Analyze the question and answer with the best option.

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###Rationale: Persistant hyperplastic primary vitreous,Fungal endopthalmitis,Retinoblastoma ,coloboma of choroid, exudative retinopathy of coats and retinopathy of prematurity. Ref: ak khurana 6th edition ###Answer: OPTION B IS CORRECT.

###Question: Leucokoria can be seen in all except - ###Options: A. Persistant hyperplastic primary vitreous B. Congenital glaucoma C. Fungal endopthalmitis D. Retinoblastoma

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Answer is B (Craniopharygioma): Presence of headache, visual field defects and suprasellar calcification suggests a diagnosis of suprasellar neoplastic lesions. The most common suprasellar neoplastic lesion in children (6 years) associated with suprasellar calcification is craniopharyngioma which is the single best answer of choice. ###Answer: OPTION B IS CORRECT.

###Question: A 6 year old boy has been complaining of headache, ignoring to see the objects on the sides for four months. On examination, he is not mentally retarded, his grades at school are good, and visual acuity is diminished in both the eyes. Visual chaing showed significant field defect. CT scan of the head showed suprasellar mass with calcification. Which of the following is the most probable diagnosis? ###Options: A. Astrocytoma B. Craniopharyngioma C. Pituitary adenoma D. Meningioma

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: - The diagram is showing inner ear & the arrow marked structure is endolymphatic sac . ###Answer: OPTION D IS CORRECT.

###Question: The arrow marked structure is ? ###Options: A. Macula B. Utricle C. Saccule D. Endolymphatic sac

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: In Unilocular diplopia an object appears double from the affected eye even when the normal eye is closed. CAUSES Subluxated clear lens. Subluxated intraocular lens. Keratoconus (irregular refraction from corneal surface) Double pupil (congenital / large iridectomy / iridodialysis) Incipient cataract (this usually causes polyopia - due to irregular refraction due to multiple water clefts within the lens) Ref;A.K.Khurana; 6th edition; Page no:344 ###Answer: OPTION B IS CORRECT.

###Question: Commonest cause of uniocular diplopia ###Options: A. Cataract B. Subluxated lens C. Third nerve palsy D. Astigmatism

Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description. Analyze the question and answer with the best option.

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###Rationale: Occurrence of glaucoma in eye with pseudoexfoliation is called glaucoma capsulareReference: Aravind FAQS in Ophthalmology; First Edition; Page no: 232 ###Answer: OPTION B IS CORRECT.

###Question: Glaucoma capsulare is caused by ###Options: A. Neovascular glaucoma B. Pseudoexfoliative glaucoma C. Pigmentary glaucoma D. Angle recession glaucoma

In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description. Analyze the question and answer with the best option.

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###Rationale: - Nuclei of papillary carcinoma cells contain finely dispersed chromatin, which impas an optically clear or empty appearance of nuclei, giving rise to designation ground-glass or Orphan Annie eye nuclei. ###Answer: OPTION A IS CORRECT.

###Question: Orphan Annie eye nuclei appearance is characteristic of: ###Options: A. Papillary carcinoma thyroid B. Carcinoma pituitary C. Paraganglioma D. Meningioma

As a medical professional, your responsibility is to address the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Gonioscopy Owing to the lack of transparency of corneoscleral junction and total internal reflection of light at the anterior surface of cornea, it is not possible to visualize the angle of anterior chamber directly. Therefore, a device (goniolens) is used to divert the beam light and this technique of biomicroscopic examination of the angle of anterior chamber is called gonioscopy. In many conditions such as glaucoma, foreign bodies or tumours, a close inspection of this region is important. ###Answer: OPTION C IS CORRECT.

###Question: Gonioscopy is used to study – ###Options: A. Ant. Chamber B. Post chamber C. Angle of anterior chamber D. Retina

In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description. Analyze the question and answer with the best option.

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###Rationale: C i.e. Aeriolar dilatation In diabetic retinopathy aeriolar changes consist of narrowing Q (not dilation) silver-wiring and obliteration resembling branch retinal aery occlusion. And venous changes are bending, looping and sausage like segmentation. ###Answer: OPTION C IS CORRECT.

###Question: Which of following is not a feature in diabetic retinopathy on fundus examination ###Options: A. Microaneurysms B. Retinal hemorrhages C. Aeriolar dilatation D. Neovascularisation

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'c' i.e., Unilateral condition Corneal dystrophies are bilateral. Fuch's epithelial endothelial dystrophy Fuchs dystrophy is frequently seen as a slowly progressive bilateral condition affecting females more than males, usually between fifth and seventh decade of life. Primary open angle glaucoma is its common association. Clinical features can be divided into following four stages :? Stage of cornea guttata. It is characterised by the presence of Hassal-Henle type of excrescenses in the central pa of cornea. A gradual increase of central guttae with peripheral spread and confluence gives rise to the so called 'beaten-metal ' appearance. The stage is asymptomatic. Oedematous stage or stage of endothelial decompensation is characteirsed by the occurrence of early stromal oedema and epithelial dystrophy. Patients complains of blurring vision. Stage of bullous keratopathy. This stage follows long-standing stromal oedema and is characterised by marked epithelial oedema with formation of bullae, which when rupture cause pain, discomfo and irritation with associated decreased visual acuity. Stage of scarring. In this stage epithelial bullae are replaced by scar tissue and cornea becomes opaque and vascularized. The condition may sometiems be complicated by occurrence of secondary infection or glaucoma. ###Answer: OPTION C IS CORRECT.

###Question: Not true about Fuch's corneal dystrophy ? ###Options: A. Posterior dystrophy B. Endothelial dystrophy C. Unilateral condition D. Occurs in old age

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###Rationale: Ans. Hea ###Answer: OPTION B IS CORRECT.

###Question: Rigor mois stas in: UP 08 ###Options: A. Eyelids B. Hea C. Voluntary muscle D. Limbs

Your role as a doctor requires you to answer the medical questions taking into account the patient's description. Analyze the question and answer with the best option.

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###Rationale: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease which results from the reactivation of John Cunningham virus (JC virus) infecting oligodendrocytes(which provide suppo and insulation to axons in CNS) The term Leukoencephalopathy refers to all of the brain white matter diseases Toxic leukoencephalopathy or toxicspongiform leukoencephalopathy is a rare condition that is characterized by progressive damage (-pathy) to white matter (-leuko-) in the brain (-encephalo-), paicularly myelin, due to causes such as exposure to drug abuse, environmental toxins, or chemotherapeutic drugs ###Answer: OPTION D IS CORRECT.

###Question: Progressive multifocal leukoencephalopathy spares ###Options: A. White matter of cerebrum B. White matter of parietal lobe C. White matter of periventricular area D. Spinal cord and optic nerve

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###Rationale: Prolonged use of high doses (as needed for rheumatoid ahritis, DLE, etc.) may cause loss of vision due to retinal damage. Corneal deposits may also occur and affect vision, but are reversible on discontinuation. ESSENTIALS OF PHARMACOLOGY page no. 823 ###Answer: OPTION B IS CORRECT.

###Question: Which of the following drug is deposited in the retina? ###Options: A. Isoninazid B. Chloroquine C. Rifampicin D. Pyrizinamide

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: Lid lag - Von graefe's sign. Fullness of eyelids - Enroth's sign. ###Answer: OPTION B IS CORRECT.

###Question: Stellwagg's sign of graves disease is ###Options: A. Difficulty in eversion of upper lid B. Infrequent blinking C. Fullness of eyelids D. Lid lag

You're a doctor, kindly address the medical queries according to the patient's account. Analyze the question and answer with the best option.

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###Rationale: Ans. Nerve fibre bundle defect ###Answer: OPTION A IS CORRECT.

###Question: The most characteristic visual field change in primary open-angle glaucoma is: ###Options: A. Nerve fibre bundle defect B. Enlargement of blind spot C. Generalised constriction of field D. Sector-shaped defects

As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions. Analyze the question and answer with the best option.

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###Rationale: Ans. B: Commonly perforates Causative fungi: Filamentry fungi - include- Aspergillus, fusarium, cephalosphorium, curvuluria, penicillium. Yeast - Candida, Cryptococcus Mode of infection: Injury by vegetative materials (Common sufferers are field workers specially in harvesting season) Injury by animal tail Secondary fungal ulcer - is commonly found in immunosuppresed hosts. Patients who are suffering from dry eye, herpetic Keratitis, bullous keratopathy and Post-operative case of keratoplasty Fungi do not infect the cornea easily - they require trauma, immunological compromised state & tissue devitalization. Fungal corneal infections tend to spread deep into the corneal stroma, where the organisms are inaccessible to the usual diagnosis and therapeutic measure. Fungi even may penetrate an intact Descement's membrane into the anterior chamber. Clinical features: Pain Watering - reflex hyperlacrimation Photophobia - Stimulation of nerve ending Redness - Congestion of circum-corneal vessels, Dry eye, grayish white with elevated rolled out margins Feathery figure like extension surround the stroma under intact epithelium, Yellow line demarcation (sterile immune ring) known as Wessley's ring due to deposition of immune complex and inflammatory cell around the ulcer. Multiple small satellite lesions may present around the ulcer Hypopion - Big, thick, immobile, not sterile may be present Perforation - rarely Corneal vascularisation are conspicuously absent. Diagnosis: - Wet KOH - Direct smear immediately fixed with methyl alcohol. - Giemsa stain - Show ghosting of fungal wall and yeast budding is may be noted. - Gomori methanamine Silver technique - Delineate the hyphae as sharp black structure against a pale green background. - Gram stain - fungus can be seen directly - Periodic acid schiff (PAS) - Calco fluor white ###Answer: OPTION B IS CORRECT.

###Question: Which of the following is not true regarding fungal corneal ulcer: March 2009 ###Options: A. Convex hypopyon B. Commonly perforates C. Hyphate margins D. Satellite lesions are seen

In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans. c. 1 service center for 5,00,000 population (Ref: Khurana 5/e p484 4/454)According to Vision 2020, the recommendations for secondary care sendees including cataract surgery is 1 service center for 5,00,000 population."There is need to develop 2000 service centres at secondary level. Each with 2 Ophthalmologist and 8 paramedics (Hospital based MLOP), and one eye care manager covering a population of 5 lacs.""Vision 2020': The Right to Sight'Vision 2020': The Right to Sight, is a global initiative launched by WHO in 1999 in a broad coalition with a 'Task Force of International Non-Governmental Organizations (NGOs)' to combat the gigantic problem of blindness in the world.Objective of Vision 2020:To eliminate avoidable blindness by the year 2020 and to reduce the global burden of blindnessQGovernment of India has adopted 'Vision 2020: Right to Sight' under National Programme for Control of Blindness.Infrastructure Pyramid Based on WHO RecommendationsPrimary level Vision Centres:There is need to develop 20,000 vision centresQEach with one Ophthalmic Assistant or equivalent (Community based MLOP)Covering population of 50,000QService Centres:There is need to develop 2000 service centres at secondary levelQEach with 2 Ophthalmologist and 8 paramedics (Hospital based MLOP), and one eye care managerCovering a population of 5 lacsQTraining Centres:There is need to develop 200 Training Centres' for the training of OphthalmologistQCovering population of 50 lacsQCentre of Excellence (COE):There is need to develop 20 COE with well developed all subspecialties of OphthalmologyQ.Covering a population of 5 croreQBasic Strategies Linder Vision 2020:Disease prevention and controlTraining of personnelStrengthening the existing eye care infrastructureUse of appropriate and affordable technologyMobilization of resourcesGlobal Vision 2020 (5 diseasesQ)Indian Vision 2020 (7 diseasesQ)* Cataract* Refractive errors and low vision* Childhood blindness* Trachoma* Onchocerciasis* Cataract* Refractive errors and low vision* Childhood blindness* Trachoma (Focal)* Glaucoma* Diabetic retinopathy* Corneal blindness ###Answer: OPTION C IS CORRECT.

###Question: According to Vision 2020, the recommendations for secondary care services including cataract surgery is: ###Options: A. 1 service center for 5000 population B. 1 service center for 50,000 population C. 1 service center for 5,00,000 population D. 1 service center for 50,00,000 population

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###Rationale: Ans: c (Astigmatism) Ref: AK Khurana, 4th ed, p. 81Corneal astigmatism may occur in pterygium due to fibrosis in regressive stage.Pterygium:* Wing shaped fold of conjunctiva encroaching cornea from either side within the palpebral fissure* Degeneration & hyperplastic condition of conjunctiva* May be unilateral or bilateral, usually starts nasally (triangular fold of conjunctiva)* Symptoms-usually asymptomatic- Visual disturbance due to corneal astigmatism]- Diplopia* Psuedopterygium- Due to chemical bums* Treatment-Surgical excisionRecurrent recalcitrant pterygium - Surgical excision + lamellar keratectomy+lamellar keratoplasty ###Answer: OPTION C IS CORRECT.

###Question: Progressive pterygium causes: ###Options: A. Myopia B. Hypermetropia C. Astigmatism D. Cataract

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###Rationale: *Superior orbital fissure syndrome consists of deep orbital pain, frontal headache and progressive paralysis of CN 6, 3 and 4 and in that order. *Orbital apex syndrome is superior orbital fissure syndrome along with the involvement of optic nerve and maxillary division of trigeminal nerve. *Both these syndromes can occur as a complication of sinusitis. Ref: Dhingra 5th/e p.213 ###Answer: OPTION B IS CORRECT.

###Question: Orbital apex syndrome constitutes all except- ###Options: A. Ptosis B. CSF rhinorrhea C. Ophthalmoplegia D. Pain over distribution of optic nerve

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###Rationale: Refractive index of the cornea (1.37), Refractive index of the aqueous humour (1.33), Refractive index of the crystalline lens (1.42), and Refractive index of the vitreous humour (1.33) Ref:Khurana 4e pg: 26 ###Answer: OPTION C IS CORRECT.

###Question: Refractive Index of cornea is about ###Options: A. 1.3 B. 1.33 C. 1.37 D. 1.42

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###Rationale: a) Microdontia; b.Slit pupil and iris atrophy; c.Corectopia with iris atrophy; d,e.Posterior embryotoxon; f.Broad peripheral anterior synechiae. Axenfeld anomaly is seen in glaucoma associated with iridocorneal dysgenesis. It is a posterior embryotoxon characterised by prominent Schwalbe's ring. Ref: Comprehensive Ophthalmology, A. K. Khurana, 4th edition, p214. ###Answer: OPTION C IS CORRECT.

###Question: Axenfeld anomaly is seen in glaucoma associated with ###Options: A. Aniridia B. Phakomatosis C. Iridocorneal dysgenesis D. Ectopia lentis

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###Rationale: Ans. is All ###Answer: OPTION D IS CORRECT.

###Question: True about Reye's syndrome - ###Options: A. Microvesicular fatty infiltration B. Hepatic encephalopathy C. Brain edema D. All

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###Rationale: In intumescent cataract, the lens may take up fluid during cataractous change, increasing markedly in size. It may then encroach upon the anterior chamber, producing both pupillary block and angle crowding and resulting in acute angle closure. Treatment consists of lens extraction once the intraocular pressure has been controlled medically. Ref: Salmon J.F. (2011). Chapter 11. Glaucoma. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e. ###Answer: OPTION C IS CORRECT.

###Question: Which type of senile cataract is notorious for glaucoma formation? ###Options: A. Incipient cataract B. Hypermature morgagni C. Intumescent cataract D. Nuclear cataract

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###Rationale: Ans. Veical ###Answer: OPTION A IS CORRECT.

###Question: Smallest diameter of the eyeball is: ###Options: A. Veical B. Horizontal C. Anteroposterior D. More than 24 mm

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###Rationale: Ans: A (Glaucoma) Ref: Parson's Diseases of the Eye Pg:358: Basok Diseases of the Eye 5th edition, pg no 50Explanation:STEROIDSSystemic and topical steroids - causes. Posterior subcapsular cataractTopical steroids - causes, Open angle glaucomaThere is no safe dosageWho is Steroid responder?After 6 weeks of topical steroids, if the IOP>30mmHg - high responders22-30mmHg - moderate respondersNo change - non respondersStrong steroids (dexamethasone. betamethasone, prednisolone] - more potent in increasing the IOPFluoromethalone - lesser propensity to increase IOPDifluprednate - strong steroid but least potent to increase IOPOther Local Side Effects:Increased risk of super infectionDelayed wound healingCorneal meltingIndications of steroids in eye:Sterile ocular inflammationDisciform keratitisEpiscleritisScleritisUveitisOptic neuritisAllergic problemsPhlyctenVernal catarrahAllergic blepharoconjunctivitisPost operativeFollowing cataract surgeryKeratoplastyVitrectomyTrabeculectomy ###Answer: OPTION A IS CORRECT.

###Question: Topical glucocorticoids in eyes causes: ###Options: A. Glaucoma B. Optic atrophy C. Retinal detachment D. Corneal ulcer

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###Answer: OPTION C IS CORRECT.

###Question: Which of the following drug is not used in treatment of iridocyclitis: ###Options: A. Atropine eye ointment B. Pilocarpine eye drops C. Timolol eye drops D. Steroid eye drops

In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description. Answer with the best option directly.

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###Rationale: Ans. (a) MyopiaRef: Khurana 4/e, p 275, Kanski 7/e, Chapter 16, Parson's 21/e, p 326 ###Answer: OPTION A IS CORRECT.

###Question: Most common cause of retinal detachment is? ###Options: A. Myopia B. Hypermetropia C. Tractional D. Exudates

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###Answer: OPTION A IS CORRECT.

###Question: Abduction of eyeballs is by the action of ###Options: A. Lateral rectus, superior oblique and the inferior oblique B. Medial rectus, superior rectus and the inferior rectus C. superior oblique and the superior rectus D. Inferior oblique and the inferior rectus

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###Rationale: It is an idiopathic inflammation of the peripheral retinal veins, characterised by recurrent vitreous hemorrhage. Etiology not exactly known, but consider to be a hypersensitivity reaction to tubercular protiens. Bilateral disease, typically affecting young adult males. Ref : khurana 6 th edition , page no. 265 Eales disease (ED) is an idiopathic, inflammatory retinal venous occlusive disease characterized by 3 stages: vasculitis, occlusion and retinal neovascularization, leading to recurrent vitreous hemorrhages and vision loss. Ref AK khurana 6/e p240 ###Answer: OPTION B IS CORRECT.

###Question: Eale's disease ###Options: A. Recurrent anterior uveitis B. Recurrent vitreous haemorrhage C. Recurrent macular haemorrhage D. Recurrent subconjuctival haemorrhage

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###Rationale: Ans. is 'b' i.e., Mycotic Ulcer Mycotic (fungal) corneal ulcero The incidence of corneal ulceration due to fungi has increased significantly due to long-term unwarranted use of antibiotic and steroid. The most common mode of infection is injury by vegetative material such as crop leaf, horn, wooden stick. The causative fungus are Aspergillus fumigatus (most common), Candida albicans and fusarium.Clinical featureso Symptoms are similar to bacterial comeal ulcers but in general they are less marked than the equal size bacterialulcer.On the other hand signs are very prominent, i.e. signs are more prominent than symptoms, o Following signs can be seen: -i) Greyish-white dry looking ulcer with the elevated rolled out feathery & hyphate margins.ii) Feathery finger like extension into surrounding stroma under intact epithelium.iii) A sterile immune ring (yellow line) of Wesseley.iv) Multiple small satellite lesions.v) Non-sterile (infected) hypopyon (Pseudohypopyon-Hence penetrated the endothelium)vi) Perforation is rare and comeal vascularization is conspicuously absent.Diagnosiso Examination of wet KOH will show:-i) Flamentous fungi (branched septate hyphae ):- Aspergillus fumigatus, Fusarium.ii) Non-filamentous (yeast like fungi): - Candida.Treatment of fungal corneal ulcero Treatment of comeal fungal ulcer involves:- 1) Specific (definitive) treatment, and 2) Adjunctive (concurrent) treatment.1) Definitive treatment: - It includes antifungal drugs: -A) Topical antifungals -i) For filamentous fungi (Aspergillus,fusarium):- Natamycin (5%) eye drops (drug of choice), Miconazole ointment, Amphotericin B drops.ii) For yeast (Candida): - Amphotericin B (Drug of choice), nystatin, flucytocine.B) Systemic antifungals: - May be required in severe cases. Fluconazole or ketoconazole may be used.2) Adjunctive/Concurrent therapy: - This follows the same principles as in any other infectious comeal diseases.# Cycloplegic (1% atropine ointment or drop is the DOC) should be used to: - i) Reduce pain from ciliary spasm; ii) Prevent posterior synaechiae; iii) Reduce uveal inflammation.# Topical steroids enhance fungal replication and comeal invasion and are contraindicated during early therapy of a fungal comeal ulcer. ###Answer: OPTION B IS CORRECT.

###Question: A 48 year old diabetic with orbital cellulitis presented with a corneal ulcer. An aqueous tap showed branched hyphae. Diagnosis is - ###Options: A. Herpetic ulcer B. Mycotic Ulcer C. Bacterial Ulcer D. Anterior staphyloma

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###Rationale: A i.e. Primary Optic Atrophy ###Answer: OPTION A IS CORRECT.

###Question: Fundoscopy of a patient shows chalky white optic disc with well defined margins. Retinal vessels and surrounding retina appears normal. Which of the following is the most likely diagnosis: ###Options: A. Primary Optic Atrophy B. Post-neuritic secondary optic atrophy C. Glaucomatous optic atrophy D. Consecutive optic atrophy

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###Rationale: Cornea air interface is 46 degree. ###Answer: OPTION B IS CORRECT.

###Question: The critical angle of cornea-air interface is: ###Options: A. 36o B. 46o C. 56o D. 66o

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###Rationale: A i.e. Choroid plexus Coiconuclear fibers pass through the genu of internal capsule.Biondi ring tangles are inclusion bodiesfound in choroidal plexus epitheliumCrossed occulomotor (111,9 nerve palsy i.e. IlIrd nerve plasy with crossed (contralateral) hemiplegia (Weber's syndrome)or with crossed (C/L) ataxiaQ (Claude syndrome) is found in occlusive syndromes of Posterior cerebral aery (P1 segment). ###Answer: OPTION A IS CORRECT.

###Question: Biondi Ring Tangles (B) are found in: ###Options: A. Choroidal plexus cells B. Golgi type II cells C. Basket cells D. Piamatter

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###Rationale: Ans. Separation of sensory retina from pigment epithelium ###Answer: OPTION C IS CORRECT.

###Question: In retinal detachment: ###Options: A. Effusion of fluid into the suprachoroidal space B. Retinoschisis C. Separation of sensory retina from pigment epithelium D. None of the above

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: (D) Convergence# ONE AND A HALF SYNDROME is a rare ophthalmoparetic syndrome characterized by Ma conjugate horizontal gaze palsy in one direction and an internuclear ophthalmoplegia in the other".> Most common manifestation of this unusual syndrome is limitation of horizontal eye movement to abduction (moving away from the midline) of one eye (e.g. right eye in the diagram on the right) with no horizontal movement of the other eye (e.g. left eye in the diagram on the right).> Nystagmus is also present when the eye on the opposite side of the lesion is abducted. Convergence is classically spared as Cranial Nerve III (oculomotor nerve) and its nucleus is spared bilaterally. ###Answer: OPTION D IS CORRECT.

###Question: In one and half syndrome w hich movement is classically spared? ###Options: A. Limitation of horizontal eye movement to abduction in one eye B. No horizontal movement of the other eye C. Presence of nystagmus when the eye on the opposite side of the lesion is abducted D. Convergence

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###Rationale: The child presents with acute onset of bleeding, along with the following laboratory anamolies. Thrombocytopenia    (iii) Increased partial thromboplastin time. Increased prothrombin time    (iv) Decreased Fibrinogen These hematological abnormalities indicate Disseminated intravascular coagulation The peripheral blood smear of the patient is suggestive of acute myeloblastic leukemia (mentioned in the question) The AML most likely to occur in this setting is promyelocytic leukemia as it is the most common myeloid leukemia associated with DIC. Promyelocytic (AML-M3) leukemic promyelocytes liberate tissue thromboplastin leading to disseminated intravascular coagulation. ###Answer: OPTION C IS CORRECT.

###Question: A 15-year-old boy presented with one day history of bleedig gums, subconjunctival bleed and purpuric rash. Investigations revealed the following results:Hb-6.4 gm/dL; TLC-26,500/mm3 Platelet 35,000 mm3; prothrombin time-20 sec with a control of 13 sec; partial thromboplastin time-50sec; and Fibrinogen 10ing/dL. Peripheral smear was suggestive off acute myeloblastic leukemia. Which of the following is the most likely - ###Options: A. Myeloblastic leukemia without maturation B. Myeloblastic leukemia with maturation C. Promyelocytic leukemia D. Myelomonocytic leukemia

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###Rationale: Some patients experience difficulty in dark adaptation. ###Answer: OPTION B IS CORRECT.

###Question: Open angle glaucoma causes – ###Options: A. Sudden loss of vision B. Difficulty in dark adaptation C. Amaurosis fugax D. Uniocular diplopia

Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account. Analyze the question and answer with the best option.

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###Rationale: Ans. A: Nightblindness more than 1% Criteria for determining the "Xerophthalmia problem" in a community includes prevalence o f night blindness of more than 1.0% Prevalence criteria for determining the xerophthalmia problem Nightblindness: More than 1% Bitot's spots: More than 0.5% Corneal xerosis/corneal ulceration/ keratomalacia: More than 0.01% Corneal ulcer: More than 0.05% Serum retinol (less than 10 mcg/ dB: More than 5% ###Answer: OPTION A IS CORRECT.

###Question: Which of the following prevalence rates indicates xerophthalmia problem in the community: September 2011 ###Options: A. Nightblindness more than 1% B. Corneal xerosis more than 1% C. Bitot spot's more than 1% D. Conjunctival xerosis more than 0.5%

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###Rationale: The presentation is typical of sickle cell retinopathy Sickle cell Retinopathy SS genotype causes more severe systemic disease than SC and S-Thal genotypes, while the SC and S-Thal genotypes present with a greater incidence of ocular manifestations, including proliferative sickle cell retinopathy. The underlying systemic and ocular manifestations of SCD (Sickle Cell Disease) are a result of vaso-occlusive ischemia due to the blocking of blood vessels by sickle-shaped erythrocytes. Figure 1. Salmon-patch Figure 2. Sea fan formation with neovascularization. ###Answer: OPTION B IS CORRECT.

###Question: A patient came to eye OPD with h/o dactylitis, anemia and growth retardation. In fundus there is sea fan neovascularization and salmon patches. What is the probable diagnosis ###Options: A. Syphillis B. Sickle cell anemia C. Toxoplasma D. Histoplasmosis

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###Rationale: Deposition of pigment granules in posterior surface of cornea is called krukenbergs spindle it is seen in pigment dispersion syndrome Ref:Comprehensive ophthalmology -6th edition chapter -10 page no :250 ###Answer: OPTION D IS CORRECT.

###Question: Pigmentary glaucoma- findings seen is - ###Options: A. Fevy line B. Flesscher's line C. Hadson hauti line D. Krukenberg's spindles

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###Rationale: Retinal detachment is not a complication of orbital cellulitis Orbital Cellulitis Inflammation of orbital septum Complications Exposure keratopathy Compression of optic nerve Central retinal aery occlusion Orbital Abscess Intracranial spread of infections Septicemia ###Answer: OPTION D IS CORRECT.

###Question: Not a complication of orbital cellulitis ###Options: A. Exposure keratopathy B. Optic neuritis C. Subperiosteal abscess D. Retinal detachment

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###Rationale: Ans. Photophobia ###Answer: OPTION B IS CORRECT.

###Question: Congenital glaucoma presents as: ###Options: A. Microphthalmos B. Photophobia C. Leucocoria (white reflex) D. Pain

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###Rationale: Ans. is 'd' i.e., Silver Local reaction of the ocular tissues to a foreign body varies with chemical nature of the foreign body. Glass, plastic and porcelain are ine. Stone may occasionally give rise to chemical changes, depending on its composition. Of the metals :- La Gold, silver, platinum and titanium are ine. u Lead, usually occuring as shot-gun pellets, becomes coated with the carbonate and excites little reaction. 1:1 Aluminium frequently becomes powdered and excites a local reaction; so does zinc; which may excites suppuration a reaction often associated with nickel and constantly with mercury. u Iron and copper, the two most common material found, undergo electrolytic dissociation and are widely deposited throughout the eye causing impoant degenerative changes. ###Answer: OPTION D IS CORRECT.

###Question: Ine foreign body in the eye ? ###Options: A. Nickel B. Copper C. Iron D. Silver

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###Rationale: Ans. Interstital keratitis ###Answer: OPTION C IS CORRECT.

###Question: In Waardenburg's syndrome, following are seen except: ###Options: A. Widening of the eyebrow B. Sho palpebral fissure C. Interstital keratitis D. Heterochromia iridis

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###Rationale: It is an autosomal recessive disorder in which paly calcified cailaginous intercellular ground substance is not regularly reabsorbed and replaced by regular osteoid tissue & bone. Clinical features are Multiple fractures, hepatosplenomegaly, growth retardation, blindness, dental problems, macrocephaly, deafness, etc. Ref: Ghai, 6th Edition, Page 600; Nelson, 18th Edition, Page 2882 ###Answer: OPTION A IS CORRECT.

###Question: Which of the following characteristics are TRUE or FALSE about osteopetrosis in a child? 1. Growth retardation 2. Mental retardation 3. Multiple fracture 4. Cataract 5. Hepatosplenomegaly ###Options: A. 1,3, 5 True & 2,4 False B. 1,3,4, True & 2,5 False C. 1.3,4, True & 5,2 False D. 2,3 False & 1,4,5 True

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###Rationale: Lid signs: Retraction of the upper lids producing the characteristic staring and frightened appearance (Dalrymple's sign); Lid lag (von Graefe's sign) i.e., when globe is moved downward, the upper lid lags behind Fullness of eyelids due to puffy oedematous swelling (Enroth's sign) Difficulty in eversion of upper lid (Gifford's sign). Most common amongst these is lid retraction producing the characteristic staring look. ###Answer: OPTION B IS CORRECT.

###Question: Which is the most common ocular manifestation of Thyroid Eye disease? ###Options: A. Exophthalmos B. Lid retraction C. Congestion of blood vessels over the inseion of the lateral rectus D. Corneal exposure keratopathy

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###Rationale: Iris pearls (also called miliary leproma) are spherical yellowish opaque micronodules near pupillary margins. They are pathognomonic for leprosy. ###Answer: OPTION A IS CORRECT.

###Question: Iris pearl is seen in – ###Options: A. Leprosy B. Sarcoidosis C. Tuberculosis D. Chloasma

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###Rationale: B i.e. Pilocarpine ###Answer: OPTION B IS CORRECT.

###Question: Treatment of choice for acute angle closure glaucoma is ###Options: A. Timolol B. Pilocarpine C. Steroid D. Atropine

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###Rationale: Answer- B. Does not seen in Ehlers-danlos syndromeBlue Sclera is characterized by marked, generalized blue discolouration of sclera due to thinning, The uveal pigment shines through the thin sclera and produces the blue colour.Causes of blue Sclera:Pseudoxanthoma elasticumOsteogenesis imperfectaEhlers-Danlos syndromeMarfan's syndromeAlkaptonuriaHypophosphatasiaJuvenile paget's diseaseNormal in newbornsVan der Hoeve's syndrome ###Answer: OPTION B IS CORRECT.

###Question: Not true about blue sclera ###Options: A. Seen in osteogenesis impeca B. Does not seen in Ehlers-danlos syndrome C. Blue colour is produced by underlying uveal pigment D. Seen in marfan's syndrome

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###Rationale: Alpha 2 antagonists like prazosin, tamsulosin are used in BPH, as they relax urinary bladder neck and the prostate capsule. All the others are the uses of alpha 2 agonists. From medical pharmacology Padmaja 4th edition page no 101,103 ###Answer: OPTION C IS CORRECT.

###Question: Uses of alpha 2 agonists are all EXCEPT ###Options: A. To produce sedation B. Glaucoma C. Benign hyperplasia of prostate D. Hypeension

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###Rationale: Coloured halos, blurring of vision and normal IOP suggest the diagnosis of latent PACG (Prodrome stage). ###Answer: OPTION A IS CORRECT.

###Question: A patient has complaint of seeing coloured holoes in the evening and blurring of vision for last few days with normal IOP - ###Options: A. Prodromal phase of acute angle closure glaucoma B. Acute angle closure glaucoma C. Chronic glaucoma D. Epidemic dropsy

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###Rationale: Reach in approach and not reach out approach is used in NPCB NATIONAL PROGRAM FOR CONTROL OF BLINDNESS * 100 % centrally funded scheme * Rapid Survey on Avoidable Blindness in 2006-07 showed reduction in prevalence of blindness from 1.1% (2001-02) to 1% (2006-07). * Target: 0.3% by 2020. Main causes of blindness- * Cataract (62.6%) > Refractive Error (19.70%) >Glaucoma (5.80%), Revised Strategies * Outreach activities o Shifted from eye camp approaches to fixed facilities surgical based approaches e.g. Reach In Programme o Making more comprehensive catering others cause of blindness (refractive errors and low vision, childhood blindness, corneal blindness, glaucoma, diabetic retinopathy) * Services in rural/tribal and other difficult areas-Infrastructures development and appointing contractual ophthalmic manpower * Strengthening Public Private Panership ###Answer: OPTION D IS CORRECT.

###Question: Not a feature of NPCB- ###Options: A. Reduce backlog of cataract surgery B. Strengthening of RIO C. Increase community awareness D. Reach out approach

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###Rationale: Ans. Retro-orbital hematoma ###Answer: OPTION C IS CORRECT.

###Question: A man presents 6 hrs after head injury complaining of mild proptosis and scleral hyperemia: ###Options: A. Pneumo-orbit B. Caroticocavernous fistula C. Retro-orbital hematoma D. Orbital cellulitis

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###Answer: OPTION A IS CORRECT.

###Question: Which drug is contraindicated in a glaucoma patient suffering from bronchial asthma: ###Options: A. Timolol maleate B. Latanoprost C. Betaxolol D. Brimonidine

Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account. Answer with the best option directly.

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###Rationale: Ophthalmodynamometry is used to estimate the pressure in the ophthalmic aery (OA) at the site of origin of the central retinal aery (CRA). Measurements are performed by increasing IOP by gradually applying pressure to the globe and observing the aeries on the optic disc until they begin to pulsate. The pressure required to produce aery pulsations on the optic disc reflects the OA diastolic pressure, whereas the force required to cause cessation of aerial pulsations reflects the OA systolic pressure. In OIS(occular ischemic syndrome), the CRA perfusion pressure is low and for this reason the pressure necessary for the pulsations to appear is reduced. Diastolic readings are decreased in OIS, and may improve or return to normal after carotid aery surgery. They are considered to be more reliable than systolic readings. ###Answer: OPTION A IS CORRECT.

###Question: What is true about Ophthalmodynamometry? ###Options: A. Measures the pressure of the ophthalmic aery B. Measures the IOP of the eye C. Measures the velocity of blood flow in the central retinal aery D. Indirectly measures the pulsation of the central retinal vein

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###Rationale: Also called commotio retinae is oedema at the macula due to blunt trauma .It present as cherry red spot at the macula Refer khurana 6/e 431 ###Answer: OPTION B IS CORRECT.

###Question: Berlin's oedema occurs due to ###Options: A. Penetrating injury to eye B. Blunt trauma to eye C. Radiation injury to eye D. Chemical injury to eye

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###Rationale: Answer- A. Applied on right eyeTwo types of illumination is used in otolaryngologcial examination:Semi mobile illumination like the Bull's lampMobile illumination like the Clair's head light, or cold light based head bands.Bull's lamp: is a semi mobile source of illumination.The approximate focal length of the mirror is about l0 inches.The mirror is fured over the right eye in such a way pa of the mirror touches the nose.The minor is adiusted while keeping the left eye closed and the right eye is kept open to focus. Then both eyes are opened while examining. ###Answer: OPTION A IS CORRECT.

###Question: True regarding the use of head mirror is/are? ###Options: A. Applied on right eye B. Focal point should be within 6 inches C. One eye should be closed while examining D. Both eye should be open while focusing

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###Rationale: Intraocular lesn power calculation:- Which requires Keratometry (K), Axial length of eyeball or Biometry (L) and a constant (A). It is calculated SRK formula :- (Ref: Yanoff; Jay S. Duker 2009 Ophthalmology 3rd/e p.416-419) ###Answer: OPTION A IS CORRECT.

###Question: SRK formula is used to calculate - ###Options: A. Power of intraocular lens B. Corneal curvature C. Corneal endothelial cell count D. Extent of retinal detachment

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###Rationale: Man sometimes get infection in the same way as the pig .These cysticercus cellulosae may develop in any organ but are usually present in the subcutaneous tissues and muscles. The oncosphere is filtered out principally in the muscles,where they develop into larval stage in about 60-70 days Ref: panikers textbook of Medical parasitology 8th edition page 126 ###Answer: OPTION C IS CORRECT.

###Question: The most commonly affected tissues in cysticercosis is - ###Options: A. Brain B. Eye C. Muscle D. Liver

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###Rationale: Most resistant Layer - RPE. Most resistant layer of Neurosensory retina - Ganglionic cell layer. ###Answer: OPTION A IS CORRECT.

###Question: Most resistant layer of Neurosensory retina ###Options: A. Ganglionic cell layer B. Layer of Rods & cones C. Retinal pigment epithelium D. Nerve fibre layer

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###Rationale: Cataract centralis pulverulenta (Embryonic nuclear cataract) -It has dominant genetic trait and occurs due to inhibition of the lens development at a very early stage and thus, involves the embryonic nucleus. -The condition is bilateral and is characterised by a small rounded opacity lying exactly in the centre of the lens. -The opacity has a powdery appearance (pulverulenta) and usually does not affect the vision. ###Answer: OPTION C IS CORRECT.

###Question: Which type of congenital cataract presents with a disc of opacity involving the fetal and embyonal nucleus with many white dots looking like dust? ###Options: A. Lamellar cataract B. Punctate cataract C. Pulverulent cataract D. Coronary cataract

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: Unilateral or bilateral abducens palsy is a classic sign of raised intracranial pressure. The sixth cranial nerve innervates the lateral rectus muscle. A palsy produces horizontal diplopia, worse on gaze to the side of the lesion. An abducens nuclear lesion produces a complete lateral gaze palsy from weakness of both the ipsilateral lateral rectus and the contralateral medial rectus. Ref: Hoon J.C. (2012). Chapter 28. Disorders of the Eye. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. ###Answer: OPTION D IS CORRECT.

###Question: A patient is admitted in ICU due to increased intracranial pressure from secondary metastases. He developed left sided sixth nerve palsy. It would lead to: ###Options: A. Accommodation paresis of left side B. Ptosis of left eye C. Adduction weakness of left eye D. Diplopia in left gaze

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###Rationale: A. i.e. III ###Answer: OPTION A IS CORRECT.

###Question: A boy presents with eye deted laterally and slightly downward. The upward gaze is impaired and medial rotation is not possible. Which nerve is involved. ###Options: A. III B. IV C. V D. All

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###Rationale: The disorder is frequently associated with blue sclerae, dental abnormalities and progressive hearing loss. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 3207 ###Answer: OPTION A IS CORRECT.

###Question: Blue coloured sclera is frequently associated with: ###Options: A. Osteogenesis imperfecta B. Ehler danlos syndrome C. Chondrodysplasia D. Alpo syndrome

As a medical professional, your responsibility is to address the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Aldose reductase (AR) is an enzyme of aldoketo reductase super-family that catalyzes the conversion of glucose to sorbitol in the polyol pathway of glucose metabolism. In this context, aldose reductase inhibitors (ARIs) have received much attention worldwide. Decreased sorbitol flux through polyol pathway by ARIs could be an emerging target for the management of major complications of diabetes. The ARIs developed vary structurally, and representative structural classes of ARIs include i) carboxylic acid derivatives (such as Epalrestat, Alrestatin, Zopalrestat, Zenarestat, Ponalrestat, Lidorestat, and Tolrestat), ii) spirohydantoins and related cyclic amides (such as Sorbinil, Minalrestat, and Fidarestat), and iii) phenolic derivatives (related to Benzopyran-4-one and Chalcone). Among these inhibitors, Epalrestat is the only commercially available inhibitor till date. In addition, some other ARIs such as Sorbinil and Ranirestat had been advanced into late stage of clinical trials and found to be safe for human use. Adapting ARIs could prevent sepsis complications, prevent angiogenesis, ameliorate mild or asymptomatic diabetic cardiovascular autonomic neuropathy and appear to be a promising strategy for the treatment of endotoxemia and other ROS-induced inflammatory diseases . Ref - pubmed.com ###Answer: OPTION B IS CORRECT.

###Question: Aldose reductase drugs are useful in ###Options: A. Cataract B. Diabetes mellitus C. Hereditary fructose intolerance D. Essential fructosuria

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###Rationale: Ans. d. Ring fracture of foramen magnum with lumbar spine injury (Ref: Ready 33/e p247; Parikh's 6/4.94-4.97)"Ring fracture: This term is commonly used to signify any fracture around the foramen magnum. Technically it means a fissured fracture about 3.5 cm outside the foramen magnum at the back, involving middle ear sideways and roof of nose anteriorly. It is rare and usually requires a lot of force to produce. It results from fall from a height on feet or buttocks, sudden violent turn of head on spine, severe blow on the vertex which drives the skull downwards on the vertebral column or heavy blow directed underneath the occiput or chin. "Ring or Foramen FracturesIt is fissured fracture, which encircles the skull in such a manner that the anterior third is separated at its junction with the middle and posterior third.But usually the term is applied to a fracture, which runs at about 3 to 5 cm outside the foramen magnum at the back and sides of the skull, and passes forwards through the middle ears and roof of the nose, due to which the skull is separated from the spine.They are rare and occur after falls from a height on to the feet or buttocks.QSkull-vault fractureType of fractureDescriptionDiastatic fracture(sutural fractures)* Separation of suturesQ* Occurs only in young persons due to blow with blunt weapon or from cerebral edemaQFissured fracture* A linear fracture or crack involving the outer or inner table or both.* Fracture only involving inner table cannot be detected on X-ray. It can be detected at autopsyDepressed fracture* Caused by a heavy weapon with a small striking surface e.g., hammer* Its shape may indicate the type of weapon with which it is produced. It is therefore called as signature fractureQ.Comminuted fracture* It has stellate appearance when there is no displacement of fragments.* Also called spider web fractureQPond fracture* Occurs in children due to elasticity of their bones* Also called indented fracturesQGutter fracture* When a part of thickness of bone is removed to form a gutter e.g., glancing oblique bullet woundsQElevated fracture* Result from a blow of moderately heavy sharp edge weapon e.g., axe which elevate one end of bone above the surface while other end may dip down to injured duraQRing fracture* Any fracture around the foramen magnumQ ###Answer: OPTION D IS CORRECT.

###Question: A man fell down from a height of 35 feet. Eyewitnesses say that he landed on his feet. Which of the following injury is possible? ###Options: A. Gutter fracture skull with cervical spine injury' B. Pond fracture skull with cerv ical spine injury C. Depressed fracture skull with cervical spine injury' D. Ring fracture of foramen magnum with lumbar spine injury

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###Rationale: From the Lateral geniculate Nucleus (LGN), a magnocellular pathway (from layers 1 and 2) and a parvocellular pathway (from the rest of the layers) project to the visual coex. Parvocellular Pathway Magnocellular pathway Receive input entirely from type X retinal ganglion cells, trasmit color. Formed by Y ganglion cells, project to magnocellular layers of LGN Convey accurate point-to-point spatial information Color blind, transmitting only black- and white information Terminate in layer 4 C of primary visual coex Terminate in layer 4 C of primary visual coex Moderate velocity of conduction Rapidly conducting pathway Carries signals for color vision, texture, shape , and fine details Carrie signals for detection of movement, depth, and flicker Ref: Guyton and Hall 13th edition Pgno: 663 ###Answer: OPTION A IS CORRECT.

###Question: Parvocellular pathway carries signal for detection of ###Options: A. Color contrast B. Luminous contrast C. Temporal frequency D. Saccadic eye movements

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###Rationale: Hassall henle bodies are drop like excrescences of hyaline material which project into the anterior chamber around the corneal periphery. They arise from the descemet's membrane. It is the most common senile change seen in the cornea. In pathological conditions when they become larger and invade the central area it is called cornea guttata. Vogt's limbal girdle appear as bilateral chalky white opacities in the interpalpebral area both nasally and temporally. This opacity is at the level of Bowman's membrane. Ref: Ophthalmology By A. K. Khurana page 136. ###Answer: OPTION B IS CORRECT.

###Question: Which of the following type of corneal degeneration is associated with formation of drop like excrescences of hyaline material which project into the anterior chamber around the corneal periphery? ###Options: A. Vogt's limbal girdle B. Hassall henle bodies C. Lipoid keratopathy D. Hyaline degeneration

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###Rationale: After cataract: It is also known as 'secondary cataract'. It is the opacity which persists or develops after extracapsular lens extraction.Causes. (i) Residual opaque lens matter may persist as after cataract when it is imprisoned between the remains of the anterior and posterior capsule, surrounded by fibrin (following iritis) or blood(the following hyphaema). (ii) Proliferative type of after cataract may develop from the left-out anterior epithelial cells. The proliferative hyaline bands may sweep across the whole posterior capsule.Clinical types. After cataract may present as a thickened posterior capsule, or dense membranous after cataract or Soemmering's ring which refers to a thick ring of after cataract formed behind the iris, enclosed between the two layers of the capsule or Elschnig's pearls in which the vacuolated subcapsular epithelial cells are clustered like soap bubbles along the posterior capsule.Treatment is as follows :i. Thin membranous after cataract and thickened posterior capsule are best treated by YAG-laser capsulotomy or desiccation with cystitome or Zeigler&;s knife.ii. Dense membranous after cataract needs surgical membranectomy.iii. Soemmering's ring after cataract with clean central posterior capsule needs no treatment.iv. Elschnig's pearls involving the central pa of the posterior capsule can be treated by YAG laser capsulotomy or desiccation with cystitome.Ref: Khurana; 4th edition; Pg. 201 ###Answer: OPTION B IS CORRECT.

###Question: Elsching pearls are seen in ###Options: A. Wilsons disease B. Secondary cataract C. Complicated cataract D. Congenital cataract

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###Rationale: D i.e. Perimetry Investigations for Optic Nerve Disease Perimetry : Visual field defects are best detected by Goldmann kinetic perimetry (full-field) & Humphery automated threshold perimetry MRI: Best investigation for imaging of optic nerves Visually evoked potential Fluorescein angiography: Occasionally helpful in differentiating papilloedema(showsdisc leakage) from optic disc drusen (no leakage). Ophthalmoscopic appearance of the disc may vary considerably from normal to elevated to arophied, so they may not help in diagnosis, though may be useful in differential diagnosis. USG is not used for evaluation of optic nerve but for retinal function and structure. ###Answer: OPTION D IS CORRECT.

###Question: Best investigation for optic nerve damage amongst the following is: ###Options: A. Opthalmoscopy B. Flourscence angiograhy C. Ultrasound D. Perimetry

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Anterior uveitis , also known as iridocyclitis and iritis, is the inflammation of the iris and anterior chamber. Anywhere from two-thirds to 90% of uveitis cases are anterior in location. Injection, photophobia, pain, and blurred vision usually accompany iritis (anterior uveitis or iridocyclitis). Ref : Braverman R.S. (2012). Chapter 16. Eye. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e. ###Answer: OPTION A IS CORRECT.

###Question: Painful eye movement is a feature of : ###Options: A. Iridocyclitis B. Papilledema C. Corneal ulcer D. Vernal catarrh

Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description. Analyze the question and answer with the best option.

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###Rationale: Sterm cells are located in the lower half (base) of intestinal glands (Crypts of Lieberkuhn).The new epithelial cells are formed from the stem cells, and they migrate upwards and reach the tips of the villi.These cells have rapid turnover and are shed after about every 5 days. ###Answer: OPTION C IS CORRECT.

###Question: Stemcells are seen in ###Options: A. Retina B. Endometrium C. Base of intestinal crypts D. None of the above

As a medical professional, your responsibility is to address the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Hallpike maneuver is done for BPPV (benign paroxysmal positional veigo) due to displacement of otoconia into posterior semicircular canal. Diagnosis confirmed by Hallpike's maneuver. The Patient sits on a couch & examiner holds the patients head, turn it 450 to the right and then places the patient in a supine position so that his head hangs 300 below the horizontal. Patients eyes are observed for nystagmus. test is repeated with head turned to left and then again in straight head hanging position. In BPPV - veigo, nystagmus appears after a latent period of 2-20 seconds lasts for less than 1min. ###Answer: OPTION A IS CORRECT.

###Question: Hallpike maneuver is done for: ###Options: A. Vestibular function B. Audiometry C. Cochlear function D. Corneal test

You're a doctor, kindly address the medical queries according to the patient's account. Analyze the question and answer with the best option.

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###Rationale: This 42-year-old man who believes that his fellow employees are conspiring to get him fired is most likely to have delusional disorder, paranoid type. This disorder is characterized by one chronic and fixed non-bizarre delusional system such as the patient's belief in a non-existent conspiracy. Hallucinations are usually absent in such patients ###Answer: OPTION C IS CORRECT.

###Question: A 42-year-old man who has been employed by a company for the past 2 years believes that,h is fellow employees have hatched a conspiracy to get him fired, he believes that they have tapped his phone and that they follow him home. He frequently checks his home for cameras as he believes that fellow employees are keeping an eye on him. He denies having auditory hallucinations and there are no other symptoms. Which of the following is the most appropriate diagnosis for this man? ###Options: A. Paranoid schizophrenia B. Catatonic schizophrenia C. Delusional disorder (paranoid type) D. Paranoid personality disorder

As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions. Analyze the question and answer with the best option.

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###Rationale: Ans. (a) Laser Iridotomy\Ref.: A.K. Khurana 6th ed. 1247-48* Please refer to above explanation* Treatment of choice for primary angle closure glaucoma (fellow eye, latent stage, subacute or intermittent stage , chronic stage) is laser iridotomy* Peripheral surgical iridectomy can also be used.* In acute congestive stage of PACG drug of choice is Pilocarpine, till the time laser iridotomy can be performed. Treatment of choice for fellow eye | | |Primary open angle glaucoma Primary angle closure glaucoma | | Laser trabeculoplasty Nd YAG Laser Iridotomy ###Answer: OPTION A IS CORRECT.

###Question: In acute congestive glaucoma, best prophylaxis for the other eye is: ###Options: A. Laser Iridotomy B. Topical steroids C. Trabeculectomy D. Surgical peripheral Iridectomy

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Blue dot cataract: It is also called cataracta punctata-caerulea. It usually forms in the first two decades of life. The characteristic punctate opacities are in the form of rounded bluish dots situated in the peripheral pa of an adolescent nucleus and deeper layer of the coex. Opacities are usually stationary and do not affect vision. However, large punctate opacities associated with coronary cataract may marginally reduce the vision.Ref. Khurana; 4th edition; Pg. 173 ###Answer: OPTION A IS CORRECT.

###Question: Minimum vision loss is seen in which cataract? ###Options: A. Blue dot B. Zonular C. Anterior polar D. Posterior polar

Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description. Analyze the question and answer with the best option.

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###Rationale: Other manifestation Madarosis, Lagophthalmos, episcleritis,Uveitis...etc. ###Answer: OPTION D IS CORRECT.

###Question: Ocular lesions of leprosy includes all except ###Options: A. Iritis B. Cataract C. Secondary glaucoma D. Fasicular keratitis

Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account. Analyze the question and answer with the best option.

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###Rationale: Ans. Keratoconus ###Answer: OPTION B IS CORRECT.

###Question: Complication of vernal kerato conjunctivitis: ###Options: A. Cataract B. Keratoconus C. Retinal detachment D. Vitreous hemorrhage

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: Children born to phenyl ketonuria mothers have following features Mental retardation              Microcephaly       Growth retardation  Congenital heart disease ###Answer: OPTION A IS CORRECT.

###Question: A child of phenyl ketonuria mother may develop – ###Options: A. Microcephaly, mental retardation, congenital heart disease B. Mental retardation, cataract, congenital heart disease C. HydrocephaluS, cataract. D. Microcephaly, cataract, renal dysplasia.

Being a doctor, your task is to answer the medical questions based on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'a' i.e., Flexor retinaculum of hand Transverse Carpal Ligament:o It is also called flexor retinaculum or anterior annular ligament.o It is a fibrous band on the palmar side of the hand near the wrist.o It arches over the carpal bones of the hands, covering them and forming the carpal tunnel. ###Answer: OPTION A IS CORRECT.

###Question: Transverse carpal ligament is - ###Options: A. Flexor retinaculum of hand B. Extensor retinaculum of hand C. Radial collateral ligament D. Intercarpal ligament

Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account. Analyze the question and answer with the best option.

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###Rationale: Eye examination may reveal choroidal tubercles, which are pathognomonic of miliary TB, seen in up to 30% of cases. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 1349 ###Answer: OPTION B IS CORRECT.

###Question: The pathognomonic finding in miliary TB is which of the following? ###Options: A. Bone marrow infiltrations B. Choroid tubercles C. Miliary mottling in chest X-Ray D. Histological finding in liver biopsy

As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions. Analyze the question and answer with the best option.

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###Rationale: Primary glaucomas are : i)  Congenital / developmental :- True congenital glaucoma, infantile glaucoma, juvenile glaucoma. ii)  Adult :- Primary open angle glaucoma, primary angle closure glaucoma, primary mixed mechanism glaucoma. Pigmentary glaucoma and steroid induced glaucoma are secondary glaucomas. ###Answer: OPTION A IS CORRECT.

###Question: Which of the following is primary glaucoma –a) Juvenile glaucomab) Steroid induced glaucomac) Pigmentary glaucomad) Congenital glaucomae) Infantile glaucoma ###Options: A. ade B. bde C. abd D. ad

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: .One of the first signs of vitamin A deficiency is night blindness. A lack of vitamin A causes the cornea to become very dry, leading to clouding of the front of the eye,corneal ulcers and vision loss. Depending on the cause, treatment for corneal infections may include: Antibiotic, antibacterial, antifungal, or steroidal eye drops. Topical or oral antiviral medication. Phototherapeutic keratectomy (laser surgery) Corneal transplant. Reference: GHAI Essential pediatrics, 8th edition ###Answer: OPTION D IS CORRECT.

###Question: Case of proven vitamin A deficiency in a child who has clouding of cornea is treated with_______ ###Options: A. Oral vitamin A tablets 100 IU/day B. Oral syrup of vitamin A single does 1,000 IU/day C. IM injection vitamin A 5,000 IU once D. IM injection vitamin A 50,000 IU once

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: Orphan Annie eye nuclei is a feature of papillary carcinoma of thyroid due to presence of finely dispersed chromatin. But Hashimotos thyroiditis is an autoimmune condition which causes follicular destruction due to presence of auto antibodies against thyroid cells. It also shows lymphocytic infiltration and oncocytic metaplasia. (Ref :ROBBINS textbook of pathology endocrinology) ref img ###Answer: OPTION D IS CORRECT.

###Question: All of the following are true about Hashimoto's thyroiditis, except ###Options: A. Follicular destruction B. Increase in lymphocytes C. Oncocytic metaplasia D. Orphan Annie eye nuclei

Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'a' i.e., Pilocarpine Angle closure glaucomao Treatment of choice for acute congestive glaucoma - Laser iridotomy (1st choice), Peripheral iridectency (2nd choice)o Drug of choice for acute congestive glaucoma - Pilocarpineo Initially IOP is controlled (first drug used) - Systemic mannitol or acetazolamideOpen angle glaucomao Treatment of choiceo Drug of choiceo Surgery of choiceTopical antiglaucoma drugsb - blocker (Timolol, betaxolol, levobunalol)Argon or diode laser trabeculoplasty ###Answer: OPTION A IS CORRECT.

###Question: Which muscarinic agonist is used in the treatment of angle closure glaucoma? ###Options: A. Pilocarpine B. Neostigmine C. Brimonidine D. Dipiveffine

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Cytomegalovirus (CMV) retinitis is a sight-threatening disease associated with AIDS (acquired immune deficiency syndrome) -- a serious disease of the immune system caused by infection with HIV (human immunodeficiency virus). In the past, about a quaer of active AIDS patients developed CMV retinitis. Ref ananthnarayana and panikers microbiology textbook 8/e ###Answer: OPTION A IS CORRECT.

###Question: Which is the most common oppounistic retinal infection associated with HIV ###Options: A. CMV retinitis B. VZV C. Syphilictic retinitis D. Herpes simplex

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: If the head scales are large, it may be poisonous or non poisonous. Look for the 3rd supra labial and if it is touching the eye and the nasal shield, it is poisonous (cobra or coral snake) Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 511 ###Answer: OPTION D IS CORRECT.

###Question: If the 3rd supralabial scales are large and touching the eye and nasal shield, the snake may be ###Options: A. Krait B. Pit viper C. Saw scaled viper D. Cobra

You're a doctor, kindly address the medical queries according to the patient's account. Analyze the question and answer with the best option.

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###Rationale: C i.e. Galactosemia Galactosemia presents with B/I., oil droplet cataract, convulsion, Hepatosplenomegaly, ascitis, jaundice, and reluctance to ingest breast milk Q. ###Answer: OPTION C IS CORRECT.

###Question: Cataract associated with convulsion is seen in ###Options: A. Toxoplasmosis B. Tay Sac's disease C. Galactosemia D. Bih asphyxia with prematurity

Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account. Analyze the question and answer with the best option.

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###Rationale: Revised Glasgow Coma Scale 2014 Revised GCS (2014) Eye Opening Verbal Response Best Motor Response(M) Spontaneous 4 Oriented 5 Obeying commands 6 To speech 3 Confused 4 Localizing 5 To pressure 2 Words 3 Normal flexion(withdraw) 4 None 1 Sounds 2 Abnormal flexion 3 None 1 Extension 2 None 1 GCS specifically recommends avoiding sternal rubs as it causes bruising & responses can be difficult to interpret. They also do not recommend routine use of retromandibular pressure. Revised GCS (2014) changes are highlighted in the above table Best predictor of outcome: Motor response Repoing of non-testable score Aspects: In case of a non-testable aspect, the new GCS should be marked as NT, for "Not teste stable" For intubated patients or patients with tracheostomy, VNT is used it is no longer recommend to assign 1 point to non-testable elements, therefore a combined score should not use. Pupils Unreactive to Light Pupil Reactivity Score Both Pupils 2 One Pupil 1 Neither Pupil 0 How do I score GCS-P? * GCS-P is calculated by subtracting the Pupil Reactivity Score (PRS) from the Glasgow Coma Scale (GCS) total score GCP-P = GCS minus PRS GCS-P is Ranging from 15 to 1 From the given case of a patient with head injury: E: Pressure / Pain=2 V: Confused =4 Best Motor response M: Localizing =5 Total = 11 ###Answer: OPTION B IS CORRECT.

###Question: Glasgow coma scale of a patient with head injury who is confused, able to localize on right side and does flexion on left side and opens eye for painful stimuli on sternum: ###Options: A. 6 B. 11 C. 12 D. 7

Your role as a doctor requires you to answer the medical questions taking into account the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'a' i.e., Small pupil Pilocarpine Pilocarpine induces contraction of the ciliary muscles and results in accommodation and ensuing fluctuating myopia. Pilocarpine is a miotic and thus results in the pin point pupils. This leads to decreased amount of light entering the eyes and thus worsens night blindness and also causes contraction of the peripheral visual field. Thus we can say that pilocarpinewosens the myopia in an already myopic patient and causes blurring of vision due to miosis (small/ pin point pupils, contraction of the ciliary muscles. It also causes decreased visual acuity in the patients with axial lens opacities. ###Answer: OPTION A IS CORRECT.

###Question: Patient with open angle glaucoma with 71) of myopia, complains of blurring of vision on administration of pilocarpine. What is the reason for the blurring? ###Options: A. Small pupil B. Increased myopic asymmetry C. Increased hypermetropic asymmetry D. Increased astigmatism

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'a' i.e., DiabetesNeovascular glaucoma (Rubeosis iridis)o It is a secondary angle closure glaucoma which results due to formation of neovascular membrane over the iris i.e., neovascularization of iris (rubeosis iridis). Causes of rubeosis iridis are :-Common :- Diabetic retinopathy (most common cause% central retinal vein occlusion. Gale's disease, sickle- cell retinopathyRare causes: - Long standing retinal detachment, central retinal artery occlusion, intraocular inflammation (uveitis), intraocular tumors (choroidal melanoma, retinoblastoma), radiation retinopathy, ocular ischemic syndrome (carotid artery disease, carotid - cavernous fistula), Fuseli's heterochromic iridocyclitis.o In central retinal vein occlusion (CRVO), glaucoma manifests about 100 days after thrombosis of central vein, therefore, it is also called 100 days glaucoma.o The most widely accepted theory for neovascularization is that the hypoxic retina produces diffusible angiogenic factor (VEGF) that stimulates new vessel proliferation.o Treatment of choice is panretinal photocoagulation as it terminates the angiogenic stimulus for neovascularization of retina. ###Answer: OPTION A IS CORRECT.

###Question: Most common cause of neovascular glaucoma - ###Options: A. Diabetes B. CRAO C. CRVO D. Eale's disease

You're a doctor, kindly address the medical queries according to the patient's account. Analyze the question and answer with the best option.

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###Rationale: Ans. (a) MicroaneurysmsRef.: A.K. Khurana 6th ed. /276-77DIABETIC RETINOPATHY* The retinal change seen in diabetes are called as diabetic retinopathy. In diabetes, there is pericytes necrosis. Normally ratio 1 pericytes: 1 endothelial cell. But in diabetic retinopathy 1 pericyte: 3 endothelial cell. The vessels wall is weakened and leakage occurs. Classification--# Non proliferative diabetic retinopathy# Proliferative diabetic retinopathyNon proliferative diabetic retinopathyProliferative diabetic retinopathy* Microaneurysms- early manifestation* Dot and Blot hemorrhages* Hard exudates* Soft exudates* Neovascularization of the disc* Neovascularization of anywhere else from the disc* Neovascularization of iris- RUBIOSSIS IRIDIS ###Answer: OPTION A IS CORRECT.

###Question: Early stage non proliferative diabetic retinopathy is present as: ###Options: A. Microaneurysms B. Dot and Blot hemorrhages C. Hard exudates D. Soft exudates

In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ocular involvement occurs in 20-35% of cases. Involvement is assynzetrical. The two pathognomic changes are - Retinal pigmentary changes with mottled diffuse hypopigmentation. Abnormal peripheral retinal vessels with areas of non perfusion (a vascularity). ###Answer: OPTION D IS CORRECT.

###Question: True about incontinenta pigmenti include the following except – ###Options: A. X-linked dominant B. Primary skin abnormality C. Avascularity of peripheral retina D. Ocular involvement is seen in almost 100% cases and is typically unilateral

Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description. Analyze the question and answer with the best option.

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###Rationale: Endophthalmitis refers to inflammation of the inner structures of the eyeball such as uveal tissue, retina and vitreous humour. It is associated with pouring of exudates into the vitreous cavity, anterior chamber and posterior chamber. When sclera is involved along with the other coats of eye it is called panophthalmitis. Ref: Ophthalmology By A.K Khurana, 4th Edition, Page 151-2 ###Answer: OPTION B IS CORRECT.

###Question: Endophthalmitis refers to inflammation of all of the following structures of the eye, EXCEPT: ###Options: A. Uvea B. Sclera C. Retina D. Vitreous

Your role as a doctor requires you to answer the medical questions taking into account the patient's description. Analyze the question and answer with the best option.

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