Clarendonz’16

III YEAR MBBS QUESTION BANK

OPHTHALMOLOGY & ENT
(Short answers)

Best wishes
CLARENDONZ’16 TVMC
UPDATED BY TNMSA ACADEMIC WING
CLARENZ’ 16 Ophthalmology TVMC

1. Daily Requirements and Dietary Source of Vitamin A

900 micrograms for adult male
700 micrograms for adult female
Sources - Carrot, Papaya, Green leafy Vegetables, Drumsticks

2. Two Causes for Ptosis

Neurogenic Ptosis - 3rd Nerve palsy, Horner’s Syndrome, Multiple Sclerosis
Myogenic Ptosis – Myasthenia Gravis, Dystrophica Myotonica, Ocular Myopathy
Aponeurotic Ptosis – Senile Ptosis, Post operative Ptosis
Mechanical Ptosis – Lid Tumors, Multiple Chalazia

3. Two Risk factors for ROP

Low gestation age
Low birth weight
Supplemental oxygen therapy

4. Two Causes for Ambylopia

 Visual deprivation as occurs in anisometropia
 Light deprivation due to congenital cataract
 Abnormal binocular interaction as in strabismus

5. Two Causes for Roth’s spots

 Infective Endocarditis
 Collagen vascular diseases
 Diabetic Retinopathy
 Hypertensive Retinopathy
 Leukemia
 Pre eclampsia

6. Two tests for colour vision

 Pseudo isochromatic charts * Holmgren’s Wools test
 Edridge Green Lantern test. * Nagel’s Anomaloscope

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7. Two Anti fungal drugs

 Topical – Natamycin (5%) , Amphotericin B (10-1.25 mg/ml), Fluconazole (0.2%)
 Systemic – T. Fluconazole, T. Ketoconazole

8. Clinical Features of Retinitis Pigmentosa

 Visual Symptoms – Night blindness, Tubular vision
 Fundus – Retinal Pigmentary changes, Attenuated Retinal arterioles, pale optic disc
 Choroidal Sclerosis, cystoid macular edema, cellophane maculopathy

9. Two indications for Paracentesis

 Acute angle closure Glaucoma
 Central Retinal Artery Occlusion

10. Types of Central Venous Occlusion

 Non ischemic CRVO or venous stasis Retinopathy
 Ischemic CRVO or Hemorrhagic Retinopathy

11. Two investigations for Intra Ocular Foreign Body

 Slit lamp examination with gonioscopy
 Plain X ray orbit
 Limbal ring localisation
 Ultrasonographic localisation

12. Two Differences between Paralytic and Concomitant squint

 Paralytic squint – Sudden onset
Diplopia (+)
Ocular movements limited in the direction of paralysed muscle
False projection (+)
 Concomitant Squint – Slow onset
Diplopia (–)
Ocular movements full

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False projection (–)

13. Two tests to evaluate vision in children

 Dot visual acuity
 Miniature toy test
 Coin test
 Marble game test

14. Two treatment modalities for posterior capsule opacification

 In children Anterior vitrectomy and posterior capsulotomy
 In adults Nd:YAG laser posterior capsulotomy

15. Action and Nerve Supply of lateral rectus

 Action – Abduction
 Nerve supply – Abducent Nerve

16. Two uses of ultra sound in ophthalmology

 A scan :
(i) Measurement of Axial length
(ii) Anterior chamber depth and Intra Ocular distance
(iii) Thickness of Intra Ocular mass
 B scan :
(i) Assessment of posterior segment in presence of opaque media
(ii) Study of Intra Ocular tumors, orbital tumors, other mass lesions
(iii) Localisation of intraocular and Intra orbital foreign bodies

17. Two syndromes associated with Retinitis Pigmentosa

 Lawrence Moon Biedl Syndrome
 Cockayne’s syndrome
 Refsum’s syndrome
 Usher’s syndrome
 Hallgren’s syndrome

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18. Two types of Surgery for Glaucoma

 Laser peripheral iridotomy
 Trabeculectomy
 Filtration surgery
 Prophylactic laser iridotomy

19. Two types of lenses to visualise retina

 Hruby lens
 78 D lens
 90 D lens
 Volk lens

20. Two Causes for Axial Proptosis

 Intra conal masses
 Thyroid Associated Ophthalmopathy
 Optic nerve glioma
 Cavernous hemangioma

21. Two Differences between corneal ulcer and opacity

 Corneal ulcer –
(i) Discontinuation in the normal epithelial surface of cornea
(ii) They may be of Infective, allergic, trophic, peripheral Ulcerative types
(iii) Only the epithelium is involved, other layers are intact
(iv) Topical antibiotics are the main line of treatment
 Corneal opacity –
(i) Loss of transparency of cornea due to scarring
(ii) Nebula, Macula, Leukomatous are the major types
(iii) Stromal involvement is predominantly seen in opacity
(iv) Optical iridectomy and keratoplasty are the main line of management

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22. Two complications of acute dacryocystitis

 Acute conjunctivitis
 Corneal abrasion and ulceration
 Lid abscess
 Osteomyelitis of lacrimal bone
 Orbital Cellulitis
 Facial Cellulitis
 Acute ethmoiditis

23. Two Causes of Nyctalopia

 Vitamin A Deficiency
 Tapetoretinal degeneration
 Congenital high myopia
 Familial congenital night blindness
 Oguchi’s disease

24. Two systemic diseases associated with Scleritis

 Autoimmune Collagen disorders – RA, Wegener’s granulomatosis, SLE, PAN
 Metabolic disorders – Thyrotoxicosis, gout
 Granulomatous disease – TB, syphilis, sarcoidosis, leprosy

25. Nerve supply and action of Superior oblique

 Nerve supply – Trochlear Nerve
 Action –
(i) Primary action – Intorsion
(ii) Secondary action – Depression
(iii) Tertiary action – Abduction

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26. Retinitis Pigmentosa - Fundus findings

 Retinal Pigmentary changes – typically perivascular and resemble bone corpuscles
 Attenuated Retinal arterioles
 Pale optic disc
 Choroidal Sclerosis and cystoid macular edema
 Cellophane maculopathy
 Optic atrophy

27. Indications for Enucleation

 Absolute indications – Retinoblastoma and Malignant melanoma
 Relative indications –
(i) Painful blind eye
(ii) Mutilating Ocular injuries
(iii) Anterior staphyloma
(iv) Phthisis bulbi
 Eye donation from cadaver – most common indication

28. Organisms invading normal Corneal epithelium

 Neisseria gonorrhoeae, Neisseria menigitidis
 Cornyebacterium diphtheria

29. EOM supplied by 3rd Nerve

 Superior Rectus
 Inferior Rectus
 Medial Rectus
 Inferior Oblique

30. Two Causes of Complicated cataract

 Inflammatory conditions – iridocyclitis, hypopyon Corneal ulcer
 Degenerative conditions – Retinitis Pigmentosa, Retinal Dystrophies
 Retinal detachment
 Glaucoma, Intraocular Tumors – Retinoblastoma, Melanoma
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31. Two uses of Electroretinography

 Diagnosis and prognosis of Retinal disorders such as RP, Retinal ischemia
 To assess Retinal function when Fundus examination is not possible (in Dense cataract)
 To assess Retinal function of babies where possibilities of impaired vision is considered

32. Two Anti mitotic drugs

 5 fluorouracil
 Mitomycin C
 Indications – intermediate uveitis, peripheral ulcerative keratitis, OSSN

33. Two dyes used for Corneal staining :

 Fluorescein
 rose bengal
 Alcian blue

34. Two types of tonometry :

 Indentation tonometry – Schiotz tonometer
 Applanation tonometry –
(I) Goldmann tonometer
(II) Perkin’s tonometer
(III) Pneumatic tonometer
(IV) Pulse air tonometer
(V) Tono pen

35. Two indications for Evisceration

 Panophthalmitis
 Expulsive Choroidal Hemorrhage
 Bleeding Anterior staphyloma

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36. Anti VEGF Agents

 Indications –
(i) Choroidal Neo vascularization (wet ARMD)
(ii) Retinal Neo vascularization
(Diabetic Retinopathy, Sickle cell Retinopathy, Neo vascular Glaucoma)
 Drugs –
(i) Ranibizumab
(ii) Pegaptanib
(iii) Bevacizumab

37. Hyper mature cataract

 When the mature cataract is left insitu, hyper maturity sets in.
 Two types : Morgagnian and Sclerotic
 Morgagnian cataract :
(i) Whole cortex liquefies and lens converted to bag of milky fluid
(ii) Small brownish nucleus settle at bottom
 Sclerotic cataract :
(i) Cortex disintegrated and lens shrunken due to leakage of water
(ii) Anterior chamber become deep and iridodonesis is seen

38. Applanation tonometry

 Introduced by Goldmann in 1954
 Based on Imbert Fick Law ie., Pressure (P) = Force (W) / Area (A)
 Commonly used Applanation tonometers are :
 Goldmann tonometer
 Perkin’s tonometer
 Pneumatic tonometer
 Pulse air tonometer
 Tono pen

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39. Nyctalopia :
 Also called Night blindness
 Conditions where functioning of rods is deranged lead to Nyctalopia
 Causes :
 Vitamin A Deficiency
 Tapetoretinal degeneration
 Congenital high myopia
 Familial congenital night blindness
 Oguchi’s disease

40. Posterior synechiae

 Adhesions between posterior Surface of iris and Anterior capsule of crystalline lens
 Morphological types – Segmental, annular, total
 Segmental – Adhesions of iris to lens at some points
 Annular –
(i) 360 degrees adhesions of pupillary margin to Anterior capsule of lens.
(ii) Leads to formation of seclusio pupillae and iris bombe
 Total –
(i) Plastering of total posterior Surface of iris to Anterior capsule of lens
(ii) Results in deep Anterior chamber

41. Clinical Features of Complicated cataract

 Starts as posterior sub capsular Cortical cataract
 Bread crumb appearance in Slit lamp examination
 Polychromatic lustre of reds, greens, and blues are seen
 Diffuse yellow haze seen in adjoining cortex
 Lens become opaque giving chalky white appearance

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42. Preservation of donor cornea

 Short term preservation up to 48 hours – preserved at 4 degree celsius
 Intermediate storage up to 2 weeks – done in McCarey Kaufman & optisol medium
 Long term storage up to 35 days – done by organ culture method or cryo preservation

43. Legal blindness

 Vision in better eye <1/60 to perception of light

44. Causes of Vitreous Hemorrhage

 Retinal tear, RD, PVD
 Trauma to eye
 Inflammatory diseases – acute chorioretinitis, periphlebitis retinae
 Vascular Disorders – Hypertensive Retinopathy, CRVO
 Metabolic disorders – Diabetic Retinopathy
 Exudative age related macular degeneration
 Blood dyscrasias – Retinopathy of Anaemia, Leukemia, polycythemia
 Bleeding disorders – purpura, haemophilia, scurvy
 Neoplasms – Acute necrosis in Retinoblastoma and Malignant melanoma of choroid
 Others – Coat’s disease, radiation retinopathy, retinal capillary aneurysm

45. Differential diagnosis for Limbal nodule

 TB conjunctiva
 Phlycten
 Ophthalmia nodosa
 VKC
 Cysticercus
 Leprosy
 Nevus
 Dermoid
 Lipodermoid

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46. Iris nodules

 Typically seen in granulomatous uveitis
 Koeppe’s nodules – situated in pupillary border and initiate posterior synechiae
 Busacca’s nodules – situated near the collarette are large

47. Presbyopia
 Physiological insufficiency of accommodation leading to a progressive fall in near vision
 Condition of failing near vision due to age related decrease in the amplitude of accommodation
or increase in punctum proximum is called Presbyopia
 Causes :
(i) Age related changes in lens – decrease in elasticity or Sclerosis of lens
(ii) Age related decline in ciliary muscle power
 Symptoms :
(i) Difficulty in near vision
(ii) Asthenopic symptoms due to fatigue of ciliary muscle
 Treatment :
(i) Appropriate convex glasses for near work
(ii) Presbyopic spectacles
(iii) Presbyopic bifocal LASIK

48. Three causes of preventable blindness

 Vitamin A Deficiency
 Trachoma
 Refractive errors

49. Phlycten
 Nodule occurring as an allergic response of conjunctival and Corneal epithelium to some
endogenous allergens
 Causative allergens :
(I) Tuberculous Proteins
(II) Staphylococcal proteins

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(III) Proteins of Moraxella Axenfeld bacillus

 Delayed hypersensitivity response to endogenous microbial proteins
 Treatment :
(i) Topical steroids
(ii) Antibiotic drops
(iii) Atropine 1% eye ointment

50. Cycloplegics
 Cause paralysis of accommodation and dilate the pupil
 Commonly used Cycloplegics –
(i) Atropine 1% ointment
(ii) Homatropine 2% drops
(iii) Cyclopentolate 1% drops
 Retinoscopy performed after instilling cycloplegics is called Wet Retinoscopy

51. Layers of Cornea

 Epithelium
 Bowman’s membrane
 Stroma
 Dua’s layer
 Descemet’s membrane
 Endothelium

52. Scleromalacia Perforans

 Anterior necrotizing Scleritis without inflammation
 Occurs in elderly females with long standing Rheumatoid Arthritis
 Melting sclera together with overlying episclera and conjunctiva separates from normal sclera
due to obliteration of arterial supply
 Spontaneous perforation extremely rare

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53. Types of Iridectomy

 Iridectomy is an abscission of part of iris
 Types –
(i) Peripheral iridectomy
(ii) Key – hole iridectomy
(iii) Broad or sector iridectomy

54. Causes of Childhood blindness

 Vitamin A Deficiency
 Measles
 Conjunctivitis
 Ophthalmia neonatorum
 Congenital cataract
 Retinopathy of Prematurity

55. Axial biometry

 Axial biometry is the process of measuring the Axial length of the eyeball
 Ocular A – scan is used for Axial biometry
 It produces unidimensional image and echoes are plotted as spikes
 Axial length of normal eye ball – 22.0 to 24.5 mm

56. Causes of cherry red spot

 CRAO
 Tay Sach’s disease
 Niemann Pick’s disease
 Gaucher’s disease
 Berlin’s Oedema

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57. Evisceration and indications

 Removal of the contents of eyeball leaving behind sclera
 Indications –
(i) Panophthalmitis
(ii) Expulsive Choroidal Hemorrhage
(iii) Bleeding Anterior staphyloma

58. Social blindness and Legal blindness

 Social blindness – Vision in better eye <3/60 to 1/60
 Legal blindness – Vision in better eye <1 /60 to perception of light

59. Atropine
 Commonly used Cycloplegic
 Available as 1% Atropine sulphate eye drops or ointment
 In iridocyclitis, Atropine
(i) Gives comfort and rest to eye by relieving spasm of iris sphincter and ciliary muscle
(ii) Prevents the formation of synechiae and break already formed synechiae
(iii) Reduces exudation, relives hyperaemia, reduce vascular permeability
(iv) Increases blood supply to Anterior uvea

60. Causes of Shallow Anterior chamber

 Primary narrow angle glaucoma
 Hypermetropia
 Post operative shallow Anterior chamber
 Malignant Glaucoma
 Anterior perforations
 Anterior subluxation of lens
 Intumescent lens

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61. Causes of Symblepharon

 Thermal or chemical burns
 Membranous conjunctivitis
 Injuries
 Conjunctival ulcerations
 Ocular Pemphigus
 Steven’s Johnson syndrome

62. Define Ptosis

 Abnormal drooping of upper eyelid is called Ptosis
 Two types – Congenital and Acquired Ptosis
 Causes of Acquired Ptosis :
 Neurogenic Ptosis – 3rd Nerve palsy, Horner’s Syndrome, Multiple Sclerosis
 Myogenic Ptosis – Myasthenia Gravis, Dystrophica Myotonica, Ocular Myopathy
 Aponeurotic Ptosis – Senile Ptosis, Post operative Ptosis
 Mechanical Ptosis – Lid Tumors, Multiple Chalazia
 Treatment :
 Congenital Ptosis – Fasanella Servat Operation, Levator resection, Frontalis sling surgery
 Acquired Ptosis – Treat the cause

63. Common Fungi affecting cornea

 Filamentous Fungi – Aspergillus and Fusarium
 Yeasts – Candida

64. Two gram negative microorganisms

 Escherichia coli
 Klebsiella
 Proteus
 Pseudomonas
 Neisseria gonorrhoeae

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65. Four signs of Thyroid Ophthalmopathy

 Dalrymple’s sign – Retraction of upper eyelids producing staring look
 Von Graefe’s sign – when globe is moved down upper eyelid lags behind
 Enroth’s sign – Fullness of eyelids due to edema
 Giffords sign – Difficulty in Eversion of upper eyelid
 Stellwag’s sign – Infrequent blinking

66. Two common types of congenital cataract

 Lamellar cataract
 Blue dot cataract are the two most common types of congenital cataract

67. Advantages of indirect Ophthalmoscope

 Ophthalmoscopy is a clinical examination of interior of eye by ophthalmoscope
 Indirect Ophthalmoscopy is now very popular method for examining posterior segment
 Advantages
(i) Visualisation through hazy media is possible due to inbuilt illumination.
(ii) Field of view is much larger than direct ophthalmoscopy
(iii) Examination of peripheral retina up to ora serrata is possible
(iv) Depth perception of the lesion is possible due to stereposis
(v) Visualisation of Fundus in very high refractive error is possible

68. Buphthalmos
 Also called as Bull’s eye
 Corneal enlargement seen in Congenital Glaucoma is termed as Buphthalmos
 It occurs when the onset of congenital glaucoma is especially before 3 years
 Normal Corneal diameter in infant is about 10.5 mm
 Diameter more than 13 mm confirms Buphthalmos
 Lacrimation, photophobia and blepharospasm - classical triad of congenital glaucoma

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69. Two eye drops to treat open angle glaucoma

 Topical beta blockers – Timolol maleate 0.5% bd, Betaxolol 0.25% bd
 Prostaglandin analogues – Latanoprost 0.005% HS, Travoprost 0.004% HS
 Adrenergic drugs – Epinephrine hydrochloride, Brimonidine 0.2% bd
 Dorzolamide – 2% bd
 Pilocarpine – 2% tds

70. Causes of Aphakia

 Congenital absence of lens
 Surgical aphakia
 Aphakia due to absorption of lens matter
 Traumatic extrusion
 Posterior dislocation

71. Treatment for chronic dacryocystitis

 Conservative treatment by repeated lacrimal syringing
 Balloon catheter dilatation
 Dacryocystorhinostomy
 Dacryocystectomy
 Conjunctivo dacryocysto rhinostomy

72. Newer drugs in Glaucoma

 Rho – kinase associated proteins inhibitor – Ripasudil
 Adenosine receptor agonist
 BkCa ionic channel modulator – Latanoprostene bunod
 Latrunculinic derivatives

73. Four Causes of dislocated lens

 Marfan’s syndrome  Ehler’s Danlos syndrome
 Homocystinuria  Hyperlysinaemia, Sickler syndrome
 Weil Marchesani Syndrome
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74. Vitamin A Prophylaxis

 Infants 6 – 12 months and older child < 8kg - 1 lakh IU orally every 3 to 6 months
 Children 1 to 6 years. - 2 lakh IU orally every 6 months
 Lactating mothers - 20000 IU orally once at delivery
 Infants < 6 months not breast fed. - 50000 IU orally before 6 years

75. Causes for Tubular vision

 Glaucoma
 Retinitis Pigmentosa
 Retinal detachment
 Ocular migraine

76. Vossius ring

 It occurs due to blunt Trauma – closed globe injury
 It is a circular ring of brown pigment seen on anterior capsule
 Occurs due to striking of contracted pupillary margin against crystalline lens
 It is always smaller than size of pupil

77. Ocular Hypertension

 When patient has an IOP constantly more than 21 mm Hg but no optic disc and visual field
changes
 High risk factors :
(i) Significant diurnal variation in values of IOP
(ii) Water drinking provocative test positive
(iii) Associated splinter Hemorrhages near or over Optic disc
(iv) Retinal nerve fibre large defects
78. Hutchinson triad
 Common form of presentation of congenital syphilis
 Interstitial keratitis
 Malformed teeth of Hutchinson teeth
 8th Nerve deafness

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79. Histopathology of Retinoblastoma

 Small round cells with large nuclei
 Flexner Wintersteiner rosettes
 Homer Wright rosettes
 Pseudo rosettes
 Fleurettes formation
 Necrosis and calcification

80. Grades of binocular Vision

 Grade I – Simultaneous macular perception
 Grade II – Fusion
 Grade III – Stereposis

81. Two Differences between Pterygium and Pseudo Pterygium

Pterygium Pseudo Pterygium

Etiology Degenerative process Inflammatory process
Age Usually in elder persons Occurs at any age
Site Situated in palpebral aperture Occurs at any site
Stages Progressive, regressive or Always stationary
stationary
Probe test Probe cannot be passed Probe can be passed under
underneath neck

82. Causes for congenital cataract

 Idiopathic
 Hereditary – Trisomy 21, Stickler syndrome, cerebro oculo facial syndrome
 Familial – Cataracta pulverulenta
 Maternal factors –
(I) Malnutrition (III) Thalidomide or steroid ingestion
(II) Rubella, Toxoplasmosis, CMV (IV) Radiation exposure

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 Fetal factors –
(I) Fetal anoxia (III) Congenital anomalies – Lowe
(II) Metabolic – Galactosemia, syndrome, Myotonia Dystrophica
Galactokinase deficiency (IV) Persistent Hyperplastic Primary
Vitreous

83. Siderosis and Chalcosis

 Siderosis – Degenerative changes produced by an iron foreign body
 Clinical manifestations
(i) Rusty deposits arranged radially in Anterior epithelium
(ii) Lens become cataractous
(iii) Iris first stained greenish then reddish brown
(iv) Pigmentary degeneration occurs in retina
(v) Secondary open angle type of glaucoma

 Chalcosis – Specific changes produced by the alloy of copper in eye

 Clinical manifestations
(i) Kayser Fleischer Rings occur in Descemet’s membrane of cornea
(ii) Sunflower cataract
(iii) Golden plaques in posterior pole of retina

84. Entropion and its types

 Inturning of the lid margin is termed as Entropion
 Types :
(i) Congenital Entropion
(ii) Cicatricial Entropion
(iii) Senile Entropion
(iv) Mechanical Entropion
 Symptoms :
(i) Foreign body sensation (iii) Lacrimation
(ii) Irritation (iv) Photophobia

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85. Two Causes for sudden painless loss of vision

 Central Retinal Artery Occlusion
 Massive Vitreous Hemorrhage
 Retinal detachment involving macular area
 Ischemic Central Retinal Venous Occlusion

86. Accommodation – changes occurring in eye

 Convergence of eye ball
 Constriction of pupil
 Increase in Anterior curvature of lens

87. Berlin’s Oedema

 Also called Commotio Retinae
 Common occurrence following a blow on the eye
 Milky white cloudiness involving considerable area on posterior pole
 Associated with cherry red spot in foveal region
 Disappear after few days or replaced by pigmentary changes

88. Causes of Bilateral Proptosis

 Developmental anomalies of skull – craniofacial dystosis
 Osteopathies – Osteitis deformans, rickets, acromegaly
 Inflammatory conditions – Mikulicz’s syndrome, Cavernous sinus Thrombosis
 Endocrinal – Thyroid Associated Ophthalmopathy
 Tumors – Symmetrical Lymphomas, Secondaries from Retinoblastoma
 Systemic disorders – Systemic amyloidosis, Wegener’s granulomatosis

89. WHO Classification of Trachoma

 TF – Trachomatous Inflammation – Follicular
 TI – Trachomatous Inflammation – Intense
 TS – Trachomatous Scarring
 TT – Trachomatous Trichiasis
 CO – Corneal Opacity
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90. Intravitrial drugs used in Endophthalmitis

 Vancomycin 1 mg in 0.1 ml plus Ceftazidime 2.25 mg in 0.1 ml
 Vancomycin 1 mg in 0.1 ml plus Amikacin 0.4 mg in 0.1 ml
 Dexamethasone 0.4 mg in 0.1 ml

91. Two Causes for Rubeosis Iridis

 Retinal ischemic diseases – CRAO, CRVO, Retinal detachment, Diabetic Retinopathy
 Tumors – Choroidal Melanoma, Retinoblastoma
 Inflammatory conditions – Uveitis, Bechet’s disease
 Sympathetic Ophthalmia

92. Four Mydriatics

 Atropine, Homatropine
 Phenylephrine
 Tropicamide
 Cyclopentolate
93. Two main advantages of Phacoemulsification
 Topical anaesthesia may be sufficient
 Post operative congestion is minimal after Phacoemulsification
 Small incision than SICS (3.2 mm)
 Less Corneal Complications
 Visual rehabilitation is comparatively quicker
 Less post operative astigmatism

94. WHO definition for Blindness

 Visual acuity of less than 3/60 or its equivalent. (1972)
 Inability to count fingers in day light at a distance of 3 meters (1979)

95. Two Causes for toxic optic neuropathies

 Tobacco  Methanol
 Ethanol  Quinine
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96. Elevators of upper eyelid and Nerve Supply

 Levator palperbrae superioris – Oculo motor Nerve
 Muller’s muscle – Sympathetic Supply

97. Fundus findings in Grade 4 Hypertensive Retinopathy

 Grade I – mild generalised arteriolar attenuation
 Grade II – marked generalised narrowing, Salus’ sign +
 Grade III – Grade II changes plus
- Copper wiring of arterioles
- Banking of Veins Distal to AV crossings (Bonnet sign)
- Tapering of veins on either side of crossings (Gunn sign)
- Right angle deflection of veins (Salus’ sign)
 Grade IV – Grade III changes plus silver wiring and papilledema

98. Components of SAFE strategy

 For Prophylaxis against Trachoma infection and prevention of blindness
 S : Surgery for Trichiasis and Entropion – Tertiary Prevention
 A : Antibiotics – Secondary Prevention
 F : Facial Hygiene – Primary Prevention
 E : Environmental cleanliness – Primordial prevention

99. Parameters to calculate IOL power : SRK formula

 P = A – 2.5 L – 0.9 K
 P = Power of IOL
 A = Constant which is specific for each lens type
 L = Axial length of the eyeball in millimeter determined by A scan
 K = Average Corneal curvature determined by Keratometry

100. Two Viscoelastic substances

 Methyl cellulose  Hypromellose
 Sodium Hyaluronate  Chondratin sulfate
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CLARENZ’16 ophthalmology TVMC

101. Two syndromes associated with retinitis pigmentosa

a)laurence moon biedl syndrome
b) cockayne's syndrome
c) refsum's syndrome

102. Two causes of Lagopthalmosis

a.Facial nerve palsy
b.Leprosy
c.Myxoedema

103. Two cause of congenital cataract

a.Birth trauma
b.Down syndrome
c.Rubella
d.Lowe's syndrome

104. Ocular manifestations of human deficiency syndrome(any 2)

Retinal microvasculopathy Herpes zoster ophthalmicus
Toxoplasmosis- chorioretinitis

105. Two dyes used in opthalmology

a.indian ink - for tattooing cornea
b.Tryphan blue - to stain anterior capsule of lens during cataract surgery
Candida endophthalmitis
Burkitts lymphoma of orbit.
CLARENZ’16 ophthalmology TVMC

106.Two ocular signs of thyroid ophthalmopathy

Lid signs - retraction of upper eye lid : staring frightened appearance (dalrymple sign)
1.Lid lag(Von graefe's sign)
2.Fullness of lid(Enroth sign)
3.Difficulty in Eversion of upper lid( Gifford's sign)
4.Infrequent blinking ( Stellwag's sign)
5.Increased pigmentation of lid(Jellinek’s sign)
6.Poor forehead wrinkling on looking up (Joffroy's sign)
Conjunctional signs- deep injection and chemosis)
Papillary signs- inequality of pupil dilation
Ocular mobility defect- Mobius sign, restrictive ocular myopathy
Exophthamos
Exposure keratitis
Optic neuropathy

107. Two clinical features of trachoma

trachoma - causes chronic keratoconjunctivitis

two features-
a.pannus formation ,
b.corneal opacity ,
c.trichiasis

108.Drugs causing cataract:

1. Corticosteroids
2. Phenothiazine
3. Strong mitotics
CLARENZ’16 ophthalmology TVMC

109.Difference between direct and indirect ophtholmoscopy

Direct Indirect
opthalmoscopy opthalmoscopy
Condensing lens: not required Required

Image virtual erect Real inverted

Magnification 15 times 2.5 times

110. Post operative complications of keratoplasty

early complications
flat anterior chamber,iris prolapse,infection,secondary glaucoma,epithelial defects,primary
graft failure
late complications
graft rejection,recurrence of disease, marked astigmatism and cystoid macular edema
CLARENZ’16 ENT TVMC

1. Signs of retracted tympanic membrane

Loss of lustre

Loss of cone of light

Foreshortening of handle of malleus

Prominent lateral process

Sickle shaped anterior and posterior malleolar folds

2. Haller cell

It’s a part of anterior group of ethmoid air cells

Situated in floor of orbit

More common on left side

3. Causes of unilateral tonsillar enlargement

Peritonsillar abscess

Tonsillolith

Foreign body in tonsil

4.Conditions causing trismus

Peritonsillar abscess

Ludwig angina

Lingual tonsil abscess

5. Uses of laser in ENT

Argon- hemangioma, telangiestasia treatment, to create hole in stapes footplate

KTP- micro laryngeal surgery, endoscopic sinus surgery

Nd YAG- debunk esophageal and trachea bronchial lesions

CO2- transverse cordotomy

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CLARENZ’16 ENT TVMC

6. Carharts notch

Seen in otosclerosis

Bone conduction curve shows maximum loss at 2000Hz

Disappears after successful stapedectomy

7. Functions of Eustachian tube

ventilation and regulation of middle ear pressure

clearance of middle ear secretions

Protection against nasopharyngeal sound pressure

8. Cottles line

Imaginary line extending from anterior nasal spine of maxilla to nasal spine of
frontal bone

Anterior to this line septoplasty is done and submucosal resection extends

posterior to this line

9. Immediate complications of tracheostomy

Haemorrhage

Apnea following opening of an obstructed tube

pneumothorax

Aspiration of food

Injury to esophagus, laryngeal nerve

10. Major complications of FESS

Orbital haemorrhage CSF leak

Loss of vision Meningitis and brain abscess

Diplopia Intracranial haemorrhage

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CLARENZ’16 ENT TVMC

Injury to ICA, NLD

11. Prevertebral shadow widening

Opposite to C2 - more than 7mm or more than width of body of C2

Opposite to C6 - more than 14mm in children and 22mm in adults

Causes:Retropharyngeal and retroesophageal abscess

12. Laryngomalacia

Excessive flaccidity of supraglottic larynx which is sucked in during inspiration

producing stridor and cyanosis

Subsides in prone position

On direct laryngoscopy: omega shaped epiglottis

Most common congenital laryngeal anomaly

Rx: conservative, tracheostomy, supraglottoplasty

13 . Medical treatment of meniers disease

reassurance and psychological support

Bed rest with elevated head end

IV fluids and electrolytes administration

Vestibular sedatives- dimenhydrinate, promethazine, prochlorperazine

Diazepam 5-10mg I’ve

Vasodilator- carbogen (5%co2 with 95% o2)

14. Causes and treatment of secondary hemorrhage

 Seen between post op day 5 to 10

 Due to sepsis and premature separation of membrane
 Rx: conservative management, suction if needed

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CLARENZ’16 ENT TVMC

15. Premalignant lesions of larynx

Squamous papilloma

Chondroma

Hemangioma

Granular cell tumor

Glandular tumor- oncocytoma

16. Complications of cortical mastoidectomy

Facial nerve injury

Dislocation of incus

Injury to horizontal semicircular canal

Injury to sigmoid sinus

Injury to Dura of middle cranial fossa

17. Unpaired cartilages of larynx

Thyroid

Cricoid

Epiglottis

18. Indications for radical mastoidectomy

 Invasive cholesteatoma  Removal of gloms tumour

 Approach to petrosal apex  Carcinoma middle ear
 Failure of previous attempts

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CLARENZ’16 ENT TVMC

19. Causes of left recurrent laryngeal nerve palsy

Accidental trauma

Thyroid disease/ surgery

Bronchogenic cancer

20. Boundaries of parapharyngeal space

Base - base of skull

Apex- hyoid bone

Medial- buccopharyngeal fascia covering the constrictors

Posterior- prevertebral fascia covering prevertebral muscles and transverse

process of cervical vertebra

Lateral- medial pterygoid muscle, mandible, deep surface of parotid.

21. Complications of tonsillectomy

Immediate Delayed

Primary and reactionary hemorrhage Secondary hemorrhage

Injury to tonsillar pillars, uvula, teeth Infection

Aspiration of blood Lung complications

Facial edema Scarring in soft palate and pillars

Surgical emphysema

Tonsillar remnants

Hypertrophied lingual tonsil

22. Maxillectomy - types and indications

Types:

Medial maxillectomy Supra structure maxillectomy

Infrastructure maxillectomy Subtotal and total maxillectomy

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CLARENZ’16 ENT TVMC

Granulomatous lesions of maxilla

Indications: Maxillary fibrous dysplasia

Oral cavity malignancy

SCC of maxilla

23. Cricothyrotomy/ laryngotomy/ mini tracheostomy

Opening the airway through cricothyroid membrane

Skin in this area is incised vertically and cricothyroid membrane cut with
transverse incision and the space kept open

Uses: Buys time to allow patient to be carried to OT

Elective procedure to clear bronchial secretions post thoracic surgery

24. Littles area

Situated in anterior inferior part of nasal septum just above vestibule

Arteries forming vascular plexus (Kiesselbach plexus):

 Anterior ethmoidal A.
 Septal br of superior labial A.
 Septal br. Of sphenopalatine A.
 Greater palatine A.

Usual site of epistaxis

25. Esophageal / hypopharyngeal diverticulum

Pulsion diverticulum of pharyngeal mucosa which herniated through killians

dehiscence

Due to spasm of cricopharyngeal sphincter

Features: dysphagia, regurgitation, cough and aspiration pneumonia

Rx: dohlmans procedure, laser

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CLARENZ’16 ENT TVMC

26 . Indications of cochlear implant

1. Bilateral severe to profound 3. No medical contraindications

SNHL for surgery
2. No benefit from hearing aids

27. Levels of neck lymph nodes

1A- Submental

1B- Submandibular

2A- Upper jugular anterior to 11th cranial nerve

2B- Upper jugular posterior to 11th cranial nerve

3- Midjugular

4- Lower jugular

5- Posterior triangle

6- Prelaryngeal, pre and paratracheal

7- upper mediastinal

28. Otosclerosis – diagnosis and medical management

Diagnosis:

Schwartz’s sign- reddish hue on promontory through tympanic membrane

Normal Eustachian tube function

Negative rinne test, lateralisation of Weber’s test to ear with greater conductive
loss

PTA- loss of air conduction for lower frequencies , Carharts notch

Medical management:

Sodium fluoride given to hasten the maturity of focus and to arrest cochlear loss

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CLARENZ’16 ENT TVMC

29. Surgery for facial palsy

Nerve decompression of vertical or tympanic or labyrinthine segment

Approach- post aural and middle fossa approach

30. Gradenigo syndrome

Ear discharge

Diplopia

Retro orbital pain

Occurs due to petrositis as a complication of otitis media

31. Parts of hypopharynx

Pyriform sinus/fossa

Postcricoid region

Posterior pharyngeal wall

32. Rhinitis sicca

Crust forming disease seen in patients who work in hot,dry, dusty conditions

Characterised by squamous metaplasia with atrophy of seromucinous glands

Rx: bland ointment with steroid and antibiotic, nasal douche

33. Laryngocele

Dilatation of laryngeal saccule

Extends between thyroid cartilage and ventricle

Bryce sign- gurgling sound on pressing

Rx- excision

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CLARENZ’16 ENT TVMC

34 . Signs of malignant otitis externa

 Excruciating pain  Facial paralysis

 Granulation tissue  Cranial nerve palsies

35. Rehabilitation methods after total laryngectomy

Esophageal speech

Electrolarynx

Transoral pneumatic device

Tracheoseophageal speech

Aphonic lip speech

36. Features of laryngeal TB

Symptoms:

 Weakness of voice
 Hoarseness
 Severe radiating pain to ears
 Dysphasia

Signs:

 Vocal cord hyperaemia

 Pseudo edema of epiglottis/ turban epiglottis
 Granulation tissue in inter-arytenoid region

37. Dangerous area of face

Comprises the area bounded by nose, upper lip and corners of mouth

Any boil or infection in this area can spread to cavernous in us resulting in

cavernous sinus thrombosis due to retrograde venous drainage of these areas to
cavernous sinus

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CLARENZ’16 ENT TVMC

38. Secretory otitis media

Also known as serous/mucoid otitis media, glue ear

Insidious accumulation of non-purulent effusion in middle ear cleft occurring in

school going age group

Causes:

 Malfunctioning of Eustachian tube

 Allergy
 Unresolved otitis media
 Viral infections

Characterised by hearing loss, defective speech, mild earache, tympanic

membrane retraction

Rx: decongestant, antihistaminics, myringotomy, grommet insertion

39. Tullio phenomenon

Vertigo induced by loud sound

Seen in congenital syphilis when 3 functioning windows are present- oval window,
round window, extra window- fistula of semicircular canal or fenestration
operation.

40. Vasomotor rhinitis

also known as non-allergic, non-infective perennial rhinitis

Due to unstable autonomic nervous system and hyper reactive nasal mucosa
which responds to nonspecific stimuli

Features: paroxysmal sneezing, excess rhinorrhea, nasal obstruction

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CLARENZ’16 ENT TVMC

41. Killians dehiscence

potential gap between thyropharyngeus and cricopharyngeus

Also known as gateway of tears

Site of perforation during esophagoscopy, site for herniation of pharyngeal

mucosa.

42. Achalasia cardia

Condition due to absence of peristalsis in body of esophagus and high resting

pressure in lower esophagus

Dysphagia more to liquids

Ba swallow- bird beak appearance

Rx: modified Heller myotomy

43. Trautmanns triangle

Boundaries

 Anterior- bony labyrinth

 Posterior- sigmoid sinus
 superior- dura or superior petrosal sinus

It is a landmark to approach mastoid air cells after cortical mastoidectomy

44. Travelling wave theory of Von bekesy

A sound wave depending on its frequency reaches maximum amplitude on a

particular place on the basilar membrane and stimulates that segment.

45. Sulcus vocalis

Voice disorder that cause perpetual weaknesss and voice hoarseness

Due to thinning of laminate of vocal cords

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CLARENZ’16 ENT TVMC

46. Sialolithiasis/ salivary calculi

Formed by deposition of calcium phosphate on the organic matrix of mucin or

cellular debris

More common in submandibular gland

Meal time syndrome- intermittent swelling of gland and pain due to obstruction to
outflow of saliva at meal time

80% stones are radio opaque

47. Ventilation tube/ grommet

Inserted on the tympanic membrane to provide continued aeration of middle ear

Usually inserted in antero inferior quadrant

Used in otitis media with effusion when other treatment methods fail

48. Indications for total laryngectomy

Laryngeal cancers with

T3/T4 lesion

Invasion of thyroid/ cricoid cartilage

Bilateral arytenoid involvement

49. Intra-temporal complications of CSOM

Acute mastoiditis

Petrositis

facial paralysis

Labyrinthitis

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CLARENZ’16 ENT TVMC

50. Causes of referred otalgia

Via 5th cranial nerve- caries tooth,ulcers of tongue,ill fitting dentures..

Via 9th cranial nerve- acute tonsillitis, peritonsillar abscess

Via 10th- ulcers of larynx, esophgagus

Via C2,C3- cervical spondylosis

51. Tonsillolith

Crypt of tonsil blocked with debris

Made of inorganic salts of calcium and magnesium

Rx: removal of stone/ tonsillectomy

52. Functional aphonia

Hysterical abduction of vocal cords on phonation in the presence of normal

adductors

more common in emotionally labile females of 15-30 yrs

Rx: reassurance, psychotherapy

53. Furuncle of nose

Acute infection of hair follicle of nasal vibrissae

By staphylococcus aureus

Exquisitively painful and tender lesion

Rx: warm compress, analgesics, antibiotics, I&D

Complications: cavernous sinus thrombosis, upper lip cellulitis, septal abscess

54. Clinical features in fungal sinusitis

Mucor- vasculoinvasive; causes ischemic necrosis with black eschar

Aspergillus- acute fulminant sinusitis with tissue invasion

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CLARENZ’16 ENT TVMC

55. Common sites of CSF leak in nose

Frontal sinus

Cribriform plate

Roof of ethmoid air cells

Sphenoid sinus

56. Functions of nose

 Respiration  Vocal resonance

 Air conditioning of inspired  Nasal reflex
air  Olfaction
 Protection of lower airway

57 . Laryngeal papillomatosis

Juvenile type- by HPV 6, 11

Most common benign laryngeal neoplasm in children

Adult type- single, smaller, arise from anterior half of vocal cord

Rx: micro-laryngoscopy, CO2 laser excision, IFN 2alpha, 13 CIS retinoic acid

58. Aphthous ulcers

Recurrent, superficial ulcers of oral cavity sparing hard palate and gingiva

Minor form- more common, ulcers are 2-10 mm size, multiple with central
necrosis & red halo

Major form- 2-4 cm size, heals with scar followed by another ulcer

59. Complications of septal surgery

 Bleeding  Perforation
 Septal hematoma  Depression of nasal bridge
 Septal abscess  Flapping of nasal septum

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CLARENZ’16 ENT TVMC

60. Surgical management of atrophic rhinitis

Young’s operation - bilateral occlusion of nostrils by flaps

Modified Young’s operation- partial closure

Narrowing of nasal cavities by Teflon, fat, cartilage..

61 . Investigations for dysphagia

Detailed history

Clinical examination

Blood investigation to know nutritional status and to rule out Plummer Vinson
syndrome

Chest X-ray

X-ray neck lateral view

Barium swallow to rule out achalasia,strictures, diverticula

Manometers to rule out esophageal motility disorders

Esophagoscopy

62. Quinsy

Peritonsillar abscess following acute tonsillitis

Causes: s.pyogenes, s.aureus, anaerobes

Presents with septicaemia, severe throat pain, hot potato voice, trismus

Rx: I&D, hospitalisation and i.v antibiotics, analgesics, oral hygiene

63. Otogenic brain abscess

Sequelae of csom in adults and acute otitis media in children

Direct extension of middle ear infection through tegmen or by retrograde

thrombophlebitis

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CLARENZ’16 ENT TVMC

4 stages:

 Invasion/ initial encephalitis

 Localization/latent abscess
 Enlargement/ manifest abscess
 Termination/.rupture of abscess

64. Bilateral abductor paralysis

Bilateral recurrent laryngeal nerve palsy occurring after thyroid surgery or

malignancy

Position of vocal cord: median/paramedian

Presents as dyspnea/stridor

Rx: tracheostomy, transverse cordotomy(kashima operation)

65. Pure tone audiometry

It is a measure of threshold of hearing by air and bone conduction and thus degree
and type of hearing loss

66. Masking

When difference in air conduction thresholds between two ears is 40dB or more
masking is done

It avoids getting a shadow curve from non-test better ear

Done by narrow band noise / barany box

67. Keratosis obturans

Collection of pearly white mass of desquamated epithelial cells in deep meatus

Due to its pressure effect it causes absorption of meatal bone exposing facial
nerve

Rx: syringing, keratolytics like 2%salicylic acid in alcohol

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CLARENZ’16 ENT TVMC

68. Bell’s palsy

Idiopathic peripheral facial paralysis of acute onset

Etiology:

 Viral infection  Hereditary

 Vascular ischemia  Autoimmune disorder
Features: bell’s phenomenon, epiphora, facial asymmetry, ear pain, noise intolerance

69. Rhinolith

Stone formation around the nucleus of small foreign body, blood clot or inspissated
secretions by slow deposition of ca and mg

Leads to pressure necrosis

Features: epistaxis, neuralgic pain

Rx: removal under GA, lateral rhinotomy

70. Sluders neuralgia

Neuralgic pain in lower half of face along with

Nasal congestion

Rhinorrhea

Increased lacrimation

It’s due to neralgia of sphenopalatine ganglion

71. Obstructive sleep apnea (OSA)

Apnea occurring during sleep due to collapse of upper airway—> CO2 retention—>
pulmonary constriction —> congestive heart failure, cardiac hypoxia, hypertension

Gold standard diagnosis: polysomnography

Rx: weight reduction, diet modification, cpap, upper airway surgery

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CLARENZ’16 ENT TVMC

72. Reactionary haemorrhage

Haemorrhage after tonsillectomy occurring within 24hrs

Due to the presence of a clot which prevents the clipping action of superior constrictors

Rx: clot removal, application of pressure/ vasoconstrictor, ligation and electro

coagulation of bleeding vessel

73. Dysphagia lusoria

Compression of esophagus by aberrant right subclavian A. causing dysphagia

Here, Rt. Subclavian A. Arises from thoracic aorta and passes in front of or behind the
esophagus

74. Adenoid facies

 Elongated face with dull expression

 Open mouth
 Prominent and crowded upper teeth
 Hitched up upper lip
 Pinched in nose
 High arched hard palate

75. Turban epiglottis

Due to infiltration of epiglottis caused by laryngeal TB.

76. Fistula test

 In the presence of fistula between external auditory canal and labyrinth, pressure
changes in external canal can be transmitted to labyrinth producing nystagmus.
 Done by applying intermittent pressure to Targums or by siegels speculum
 Positive in cholesteatoma, fenestration operation, post stapedectomy fistula,
round window membrane rupture
 False positive in congenital syphilis, meniere disease (hennebert sign)
 False negative in cholesteatoma covering the fistula site

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CLARENZ’16 ENT TVMC

77. Rhinoscleroma

 Caused by gram negative coccobacillus Klebsiella rhinoscleromatis

 3 stages- catarrrhal, granulomatous and cicatrising
 Causes woody infiltration of upper lip
 Histology: Mickulicz cells and Russell bodies

78. Waldeyers ring

 Aggregation of subepithelial lymphoid tissue masses scattered throughout

pharynx
 Adenoids
 Palatine tonsil
 Lingual tonsil
 Tubal tonsil
 Lateral pharyngeal bands
 Nodules in posterior pharyngeal wall

79. Greisingers sign

Edema over mastoid seen in lateral sinus thrombosis

Due to thrombosis of mastoid emissary vein impending the venous drainage

80. Blood supply of tonsil

 Tonsillar branch of facial a.

 Ascending pharyngeal a. From external carotid
 Ascending palatine branch of facial a.
 Dorsal lingual branches of lingual a.
 Descending palatine branch of maxillary a.

81. Potato nose/ rhinophyma

 Hypertrophy of sebaceous glands of nose

 Associated with acne rosacea
 Rx: CO2 laser excision
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CLARENZ’16 ENT TVMC

82. Reinkes space

Potential sub-epithelial space in vocal cords

Boundaries:

 Above and below :Arcuate line

 In front : Anterior commissure
 Behind: vocal process of arytenoid

83. Steeple sign

Seen in acute laryngotracheobronchitis

On AP view of neck X-ray

84. Impedance audiometry

Objective test for hearing

It consists of tympanometry and acoustic reflex measurements

85. Sermons law

“In a progressive lesion of recurrent laryngeal nerve, the abductors are paralysed first
before the adductors”

86. Wagner grossman theory

In complete paralysis of recurrent laryngeal nerve the cord lies in the paramedian
position because the ntact cricothyroid muscle adducts the cord.

87. Woodruffs plexus

Plexus of veins situated inferior to posterior end of inferior turbinate

Site of posterior epistaxis in adults

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CLARENZ’16 ENT TVMC

88. Trotters triad

Seen in nasopharyngeal carcinoma which spreads laterally to involve sinus of morgagni

involving mandibular nerve

Components

 Conductive hearing loss

 Ipsilateral immobility of soft palate
 Neuralgic pain along V3

89. Samter triad

Nasal polyps

Bronchial asthma

Aspirin insensitivity

90. Hidden areas of larynx

 Infrahyoid epiglottis
 Anterior commissure
 Subglottis
 Ventricle
 Apex of pyriform fossa

91. Freys syndrome/ gustatory sweating

Complication of parotid surgery

Sweating and flushing of preauricular skin during mastication

Result of aberrant innervation of sweat glands by parasympathetic secretomotor fibres

Rx: tympanic neurectomy, subcutaneous botulinum toxin, rising flap

92. Middle ear risk index (MERI)

To predict success of middle ear reconstruction procedures

Based on several factors like otorrhea, presence of granulation tissue, perforation.

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CLARENZ’16 ENT TVMC

93. Paterson brown Kelly / Plummer Vinson syndrome

Includes

 Iron deficiency anemia

 Esophageal web
 Angular ceilings and koilonychia
 Risk factor for post cricoid carcinoma

94. Rhinomanometry

 Measures pressure changes in nasal cavity

 Objective test
 To calculate nasal resistance

95. Tolosa hunt syndrome

Unilateral orbital pain with episodic palsies of cranial nerves 3,4,6.

There is granulation tissue in cavernous sinus, superior orbital fissure or orbit

Rx: steroids

96. Eagle syndrome

Occurs due to elongated styloid process impinging on glossopharyngeal nerve

Features: discomfort in throat, ear pain, dysphagia, pain in upper neck

97. Battle sign

 Ecchymosis over mastoid

 Seen in temporal bone fractures

98. Paracusis willisii

Otosclerotic patient hears better in noisy than in quiet surroundings. This is because a
normal person will raise his voice in noisy surroundings
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CLARENZ’16 ENT TVMC

99. Complications of stapedectomy

 Tear of tympanomeatal flap

 Injury to chorda tympani
 Incus dislocation
 Vertigo
 Conductive loss

100. Reinkes edema

 Collection of fluid in reinkes space

 Due to vocal abuse and smoking
 Rx: longitudinal incision and drainage of gelatinous fluid

************

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CLARENZ’16 ENT TVMC

101.Acute Epiglotitis -organism and radiological findings:

• It is an acute inflammatory condition confined to the supraglottic structures

i.e. Epiglottis ,aryepiglottic folds and arytenoids

• Aetiology

H.influenza B

• Radiological findings

Thumb sign – lateral soft tissue x-ray of neck may show swollen epiglottis

102.Cricothyroid membrane -Surgical importance

• Cricothyrotomy/laryngotomy/mini tracheostomy
• A transverse incision is made in the cricothyroid membrane
• This space is kept open with a small tracheostomy tube
• Its used as

Elective procedure – to clear bronchial secretions following thoracic surgery.

Emergency procedure- till patient can be intubated or Tracheostomized.

103.Two causes of objective tinnitus:

1) vascular

• AV shunts

Congenital AV malformations

Glomus tumour of middle ear

• Arterial bruit

Carotid aneurysm

Carotid atenosis

• Venus hum

Dehiscent jugular bulb

2) Patulous eustachian tube.

3) Palatal myoclonus.

4) Tensor tympani myoclonus.

5) clicking of TM joint.
CLARENZ’16 ENT TVMC

104. Saddle nose deformity:

• Depression of nasal dorsum involving

Bony (or)

cartilaginous (or)

Both Bony and cartilaginous components of the nasal dorsum

• Aetiology:

Nasal trauma

As a complication of SMR

Destruction of septal cartilage by

a. Hematoma or abscess
b. Leprosy
c. Tuberculosis
d. Syphilis
• Treatment:

Augmentation rhinoplasty.

105. water's view:

• occipitomental view (or) nose-chin position. It is taken in such a way of that the nose and chin of
the patient touch the flim while the x ray beam is projected from behind

structures seen:

• maxillary sinus
• frontal sinus
• sphenoid sinus( if the flim is taken with open mouth)
• zygoma
• zygomatic arch
• nasal bone
• frontal process of maxilla
• superior orbital fissure
• intra temporal fossa
CLARENZ’16 ENT TVMC

106. Ramsay hunt syndrome

• Also known as Herpes zoster oticus There is facial paralysis along with vesicular rash in the
external auditory canal and pinna.
• There may also be anaesthesia of face,giddiness and hearing impairment due to involvement of
5th and 8th nerves.

107. Singer's nodule:

• Also called vocal nodules or Screamer's node.
• They appear symmetrically on the free edge of vocal cord, at the junction of anterior
1/3rd with the posterior 2/3rd.
• This is the area of maximum vibration of the cord and thus subject to maximum trauma
• It is caused by vocal trauma or vocal abuse
• It causes oedema and haemorhage in the submucosal space which undergoes
hyalinization and fibrosis.
• The overlying epithelium also undergoes hyperplasia forming a nodule
• Early stage-Soft, reddish, oedematous
• Later stage - Greyish colour or white in colour.

108. Retrocolumellar vein.

• It runs vertically downwards just behind the columella, crosses the floor of nose. and
joins venous plexus on the lateral nasal wall.
• This is the common site of venous bleeding in young people.

109. Intratympanic Gentamycin.

• Also called chemical labyrinthectomy.
• It is vestibulotoxic.
• on daily or bi-weekly injections into the middle ear it is absorbed through the round window and
causes destruction of the vestibular Labyrinth, thus controlling vertigo.
• Hearing loss has been reported in some cases.
CLARENZ’16 ENT TVMC

110. pleomorphic adenoma.

• It is a benign tumour of salivary glands.
• It is a slow growing tumour.
• They are called mixed tumours because both epithelium and mesenchymal elements are seen in
histology.
• Though it is encapsulated, it sends pseudopods into the surrounding gland which are left behind
if tumour is simply shelled out.

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