ࡱ>  }yq  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry6PageMakerM       !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|~  M M 2t00-+MPR- 088 88 hL  2 kZ 4&@ } @ Pd 0  @@@ Lg  .  ^U N & &4 h  :8` $7 MS*  B@ & >  ; G3Ld 26 kZ 3L @@ @  @   @}@@@@K  o l C3_<@<ݺp@~"xUUUU.U@U@U@ @ h @t , < O7$ 2  @W k @fCP U$\0PP T\@MEP@@@; @ @  o k &  2 @S 4 LqDT")h(P jC&\@@@@/ a @@K@8@"3@8UUU~U@qURUU~M@@K  +M @@cP LQ&\0PP'\!!%&'()*! !"#!@]@DC@4 #@1 : Zi 7 V@ ; %@J]DC@R@r@@@A @@@@4@@t+@@@@@ @*+@OO@@P@5,@ l h>hU:hhXXX#X,@ l ,@ l ,@ l JX5XHXSXDocument Master0񄋋D_-kD'|x%A\Pb` D_-kD'|x%A\Pb0߸pP0PP Document Masterj%0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP 456789!l:;<=>?!m!!%&'()*! !"#!U$< O7$\-hX)X=X3X,@ l c,@ l ,@ l l,@ l ,@ l IXAXUXIX ,@ l l,@ l ,@ l @@@ @-/25c@@@@@@@@/@O@b@d@o@@n.@] @@ @"3@8;> ,@@@.@<@>V   bM @MUR&&N%V(OOWUUUU.U@U@U@!P LQ&\0PP'\d@f ~@@@@@ .@M] @@@93@8;>R@@q@@@@@@.E@@@@;@<@6 @V   +M @~CJ@]DC   @ h @t ,  *; -@ *@ @  ' U$456789!l:;<=>?!m!!%&'()*! !"#%P E`'\0P8D\@@/GP pG%\0PF`\@@4EFJ,< O7$@>6,@ l 6 (xKddZGdtext6h6h(xKdddkZGdtab ,@ l ,(xKddZGdbhh<(xKdddZGdq)X)X(xKddd)ZGdans,@ l  (xKddZGdref6,@ l 6 (xKdd22Gdline(xKdddZGdtab1##(xKddd ZGdtab2,@ l  x(xKddZGdc(xKdddxGMMdNormal(xKdddx GMMdAnswer(xKdddd GMMdStyle1(xKdddxGMMdDefault Paragraph Font(xKdddxGMMdStyle Arial Narrow(xKddddGMMdheading 2(xKddddGMMdheading 1dd(xKdddxGMMdNormal (Web)(xKdddxGMMdspelledd(xKdddxGMMdTitle(xKddddGMMdheading 3(xKddddGMMdBody Text(xKdddxGMMdHyperlink (xKdddGMMdStyle Heading 2 + Justified Cha   (xKdddxGMMdStrong  (xKdddxGMMdEmphasis  x(xKdddxGMMdReference  (xKddddGMMdheading 4 <(xKdddnGMMdheading 6(xKdddxGMMdheading 7sdd(xKdddxGMMdmsonormalsst(xKddddGMMdheading 5t(xKddddGMMdBody Text 2(xKddddGMMdBody Text 3@6 T-52  O< O7$@|@@K @@@P I&\0PH H \NoneRegistrationPaperBlackRedGreen77Blue||75new@@@@@@@@@@@@yyn??????CyanMagentaYellowDark MagentaWP5Color_1Dark Redpinkch-2333333ch-1333333royalch-3ffLffLffL֩֩brwR8R8R8ccexpR8+pR8+pR8+xxDIC 2226pbrownGGGLight GrayGKK1111KK1111Dark CyanEEEEDark Blue^^^^Dark GreenII\\II\\Serifa Th BTSouvenir Lt BTStaccato222 BTBSwiss911 XCm BT"TypoUpright BTBZapfEllipt BTZurich Ex BT"Kruti Dev 031Kruti Dev 014Kruti Dev 016Kruti Dev 021Kruti Dev 022Kruti Dev 024Kruti Dev 025Kruti Dev 026Kruti Dev 030Kruti Dev 013LinePrinter1OzHandicraft BTDocument Master0񄋋D_-kD'|x%A\Pb` D_-kD'|x%A\Pb0߸pP0PP Document Masterj%0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP pP0PP @@P Kl'\0PJl$\1507500.0450 R'&CDR`'`'Ec `FRN &%G4O HZP`'&IMQ$l$J4sR'l'K2S\LnDT")h(MMUR&&N%V(OOWd('PTX&&Q:Y RlZl'l'S>[T>\$$UL?8344general.ppdLetter.60lpi.300dpi1507500.0450600600600600,Cassette60.045.0\0PH H \@ @! ; .i @  @ @ C2@B 158 to 163 Straight forward Questions 6 164 to 167 Questions with a catch 4 168 to 170 Questions with 2 answers in 2 books 3 158. A one-year-old child having leucocoria was detected to be having a unilateral, large retinoblastoma filling half the globe. Current therapy would involve: A. Enucleation. B. Chemotherapy followed by local dyes. C. Direct laser ablation using photodynamic cryotherapy. D. Scleral radiotherapy followed by chemotherapy. Answer: A (Enucleation) Ref: SK Basak 2nd edn, 258; Kanski 4th edn, 341; Parson 19th edn, 400 Status: Spotter QTDF: Repeat Discussion Enucleation is indicated in unilateral and bilateral retinoblastomas involving more than half of the globe. Explanation A. Enucleation is done as the retinoblastoma is filling half the globe. B. Chemotherapy followed by local dyes will not be effective. C. Direct laser ablation using photodynamic cryotherapy will not be effective. D. Scleral radiotherapy followed by chemotherapy will not be effective. Comments Two questions have been asked about retinoblastoma (the other is given in Pathology). Another theme couple. Tips Management of tumours of eye with regard to the size Small tumours Laser photocoagulation or transpupillary thermotherapy Cryotherapy Medium tumours Brachytherapy: Tumour less than 12 mm in diameter and less than 6 mm in thickness Chemotherapy with carboplastin, vincristine, etoposide External beam irradiation Large tumours Enucleation Chemotherapy 159. A 20-year-old man complains of difficulty in reading the newspaper with his right eye. Three weeks after sustaining a gunshot injury to his left eye. The most likely diagnosis is: A. Macular oedema. B. Sympathetic ophthalmia. C. Optic nerve avulsion. D. Delayed vitreous haemorrhage. Answer: B (Sympathetic ophthalmia) Ref: Basak 2nd edn, 156; Nema 4th edn, 302; Kanski 4th edn, 659; Khurana, 395 Quality: Spotter Status: Repeat QTDF: All books Discussion Sympathetic ophthalmia refers to the development of panuveitis in the opposite sympathising eye following penetrating trauma to the primary or exciting eye, thus resulting in granulomatous uveitis. Dalen Fuchs granules are seen. Explanation A. Macular oedema doesnt will not cause difficulty in the opposite eye. B. Sympathetic ophthalmia is the correct diagnosis. C. Optic nerve avulsion will not cause difficulty in the opposite eye. D. Delayed vitreous haemorrhage will not cause difficulty in the opposite eye. Comments Predisposing factors: Injury Incarceration of iris: Wound in the region of ciliary body (Dangerous Zone) Infection absent Treatment is: Steroids Cycloplegics Immunosuppression Tips @}BellGothic Blk BT"BellGothic BT"Belwe Bd BTBelwe Cn BTBelwe Lt BTBenguiat Bk BTBenguiatGot Bk BT"BenguiatItcTEERBergellBermuda LP SquiggleBernhard BdCn BTBernhardFashion BTRBernhardMod BTBernhardTango BTBBertramBibleScrTBickley ScriptBinnerDBinnerDEERBlackletter686 BTBlacklightDBlippo Blk BT"BlippoBlaDEERBodoni Bd BTBodoni BdCn BTBodoni Bk BTBodoni BTBoinkBolt Bd BT"BookmanITC Lt BTBorders1RBorders2RBoxesRBremen Bd BTRBremen Blk BT"BriskBroadway BTBroadwayEngraved BTBrochureBrodyDBronxBruceOldStyle BTBrush455 BTBBrush738 BTBrushScrDEERBrushScript BTBBuildingsRBullets1RBullets2RBullets3RBulmer BTBusiness&GovernmentRBusorama Md BTBusterDBuxomDCaflischScript RegularCalligraph421 BTBCalligraph810 BTCamelliaDCamelliaDEERCancunCandidaCandida BTCarletonCarmina Blk BTCarmina Lt BTCarmina Md BTCasablancaAntiqueCaslon Bd BTCaslon224 Bk BTCaslon540 BTCaslonOldFace BTCaslonOldFace Hv BTCaslonOpnface BTCastleTCastleTLigCastleTUltCataneo BTBCataneo Lt BTBCataneo Swash BTBCaxton Bk BTCaxton Lt BTCentSchbook BdCn BTCentSchbook BTCentSchbook Mono BT2Dark GreSerifa Th BTSouvenir Lt BTStaccato222 BTBSwiss911 XCm BT"TypoUpright BTBZapfEllipt BTZurich Ex BT"Kruti Dev 031Kruti Dev 014Kruti Dev 016Kruti Dev 021Kruti Dev 022Kruti Dev 024Kruti Dev 025Kruti Dev 026Kruti Dev 030Kruti Dev 013LinePrinter1\_<@<ݺp@~"x  @ BS Ophthalmology GMMd (xKddd @ B Ophthalmology GMMd@@@@  @+@.@/25cf~@@@@@@@@@/@O@b@d@o@~@@@@@ .@M] @@ @93@8;>R@@q@@@@@@,E@@@@.@<@@|@@>V   b{# (xKddd fc//c@c.@@<.--00%%((   @     @ @5     1  @1 @4< =    2 4da  @  9 9 @: :     +< @< < @= c@BBKruti Dev 026Kruti Dev 030Kruti Dev 013LinePrinter1ddd:X(xKddd3Ch@B,.hZGdZGdZGdZGdZGdZGd3ZGd ZGdZGdZGdZGdZGdZGd ZGd ZGdZGd ZGdZGdZGdZGd/ZGdZGdZGdZGd)ZGdZGd^ZGdZGd[ZGdZGdZGdZGdZGdZGd"ZGdZGd(ZGdZGd0ZGdZGdVZGd ZGd*ZGdZGdZGd ZGdZZGdZGdZGdZGdZGd ZGdZGd ZGdZGd%ZGdZGd(ZGdZGdVZGdZGd\ZGd ZGd8ZGdZGdFZGdZGda5#hX,@ l ,@ l ,@ l ,@ l )X,XZX`X ,@ l 8,@ l ,@ l F,@ l ,@ l aZ CNoneRegistrationPaperBlackRedGreen77Blue||75new@@@@@@@@@@@@yyn??????CyanMagentaYellowDark MagentaWP5Color_1Dark Redpinkch-2333333ch-1333333royalch-3ffLffLffL֩֩brwR8R8R8ccexpR8+pR8+pR8+xxDIC 2226pbrownGGGLight GrayGKK1111KK1111Dark CyanEEEEDark Blue^^^^Dark GreenII\\II\\Z3+ C camChr @B, Cca:CX?caN0CXwcaDCXLca0*CX @B, Cz?#C cC,?c5#,%C @B,Cr8#5#6#:#=#9#:#)CcC,CTca<7#hX:#hX/Ch@@<ca:"CX caN(CX caD0CXca04#Xh"CX @B,3C4@BC @@xC@@@#"c C@ @@ CCC @@, C9#6#C}@B, Cca:%CXo caN(CX caD8#XhCXca08#Xh$CX @B, Cz8C@B,Cr=# CCC@:CCC("h(xKddd ,(xKddX(xKddd4X(xKddd X(xKddd.X(xKddd ,(xKdd (xKdd ,(xKdd (xKdd (xKddh<(xKddd&X(xKddd,X(xKddd4X(xKdddZX(xKddd ,(xKdd+ ,(xKdd x(xKdd x(xKdd (xKdd (xKdd[ (xKdd (xKdd (xKdd ,(xKdd (xKdd ,(xKdd)X(xKddd,X(xKdddZX(xKddd`X(xKddd ,(xKdd8 (xKdd ,(xKddF (xKdd (xKddca04#XhP U$\0PP T\9#6#CP rMh(\0P0 L\\ Cz8C@B,Cr=# CCC@yZGdZGdZGdZGdRZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGdcZGdZGdZGd;ZGd ZGdZGdZGdkZGdZGdZGdZGdZGdZGd ZGdZGd ZGd ZGd ZGdZGdZGd9ZGd)ZGd ZGd ZGdZGdZGdZGdZGd ZGd9ZGd ZGdZGd)ZGdZGd;ZGdZGdZGd'ZGdZGdZGd ZGd ZGdZGdZGdSZGdZGdIZGdZGdZGdZGdZGdZGdZGdZGdZGdZGddd0PAcanthamoeba has only a cyst and trophozoite form, of which only the trophozoite form is invasive. Free living Oppurtunistic Cases of Acanthamoeba keratitis have usually followed incidents of corneal trauma involving flushing with contaminated water, or in contact lens wearers whose lenses have been contaminated with acanthamoeba. Diagnosis by calcoflour white. Explanation A. Propamidine can be used. B. Nemycin is used. No idea regarding Neosporine. C. Ketocanazole also is used. D. Polyhexamethylene biguanide can be used. Comments PHB is superior to Propamidine as it is cationic in nature and penetrates the cornea better. Any how ...You decide !!! But one thing is confirmed. The best antiseptics are Chlorhexidine and Hydrogen peroxide. Tips Naegleria, Acanthamoeba, and Balamuthia are small, free-living amoebas that cause human meningoencephalitis. Amoebic meningoencephalitis has two distinct clinical presentations. The more common presentation is that of an acute, usually fatal infection of the central nervous system (CNS) occurring in previously healthy children and young adults; granulomatous amoebic meningoencephalitis usually occurs in immunocompromised individuals. 170. A vitreous aspirate has been collected in an emergency at 9 pm what advice you like to give to the staff on duty regarding the overnight storage of the sample. A. The sample should be kept at 4C. B. The sample should be incubated at 37C. C. The sample should be refrigerated deep freezer. D. The sample should be refrigerated for the initial 3 hours and then incubated at 37C. Answer: B (The sample should be incubated at 37C) Ref: Stephen and Elders Quality: Supposed to be a Spotter (But if our "mind" is "blind" to these topics. How can we see?) Status: New QTDF: Ward Rounds in AIIMS !!! Discussion Vitreous sample collected in emergency is best stored at 37Cthe body temperature where as the cornea is best stored/transported in 4C. Explanation A. 4C is needed when cornea is stored. B. The sample should be incubated at 37C. C. The sample should not be refrigerated in deep freezer, because the cells would lyse. D. The sample should not be refrigerated for the initial 3 hours because the cells would lyse. Comments A question that some one from AIIMS can only answer.!!! Tips Questions like this are given to make sure that we dont get 300/300 aract should be operaNoneRegistrationPaperBlackRedGreen77Blue||75new@@@@@@@@@@@@yyn??????CyanMagentaYellowDark MagentaWP5Color_1Dark Redpinkch-2333333ch-1333333royalch-3ffLffLffL֩֩brwR8R8R8ccexpR8+pR8+pR8+xxDIC 2226pbrownGGGLight GrayGKK1111KK1111Dark CyanEEEEDark Blue^^^^Dark GreenII\\II\\@@ @ @@@@@@@-@../@01@1@3@c@df@@@@@@@@@@@@@@@@@@@@@@@@/@Ka~@@@@ .@M@@@93@8;>RR@r@@@@@@@@@4EFJ,@w@@@@;@<@@|@@@6 @V   +M @3 1 0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-k  0pP0PP T 2 # '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-k0h0pP0PP U 3N#0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0hPp0PP V@MI  '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP WAl0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP XB '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP YC0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP ZDO8U '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP [E0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP \theliomas. Comments Though SK Basak, Pg P xO\0PN&\lowing is the best drug for treatment: A. ProP LQ&\0PP'\Page 147 Propamidine. Harrison 15th editioP Sl'\0PH R \s. Oxford Textbook of Medicine AmphotericiP U$\0PP T\e have recently been successful. Quality: Conf3  ,YK .HP LaserJet 2100 Series PCL 6HP LaserJet 2100 Series PCL 6LPT1:@@xGMMd(xKdddContents^tIndex ,^>;^>^=.^>X C:\PM6\RSRC\USENGLSHxA88dd0PP  db ..--__  tions like this are given to make sure that we dont get 300/300 It is done in cases where the levator function is adequate and at least 10 mm and ptosis is not more than 2 mm Indicated in: Horners syndrome Cases of mild congenital ptosis Explanation A. Congenital ptosis, if mild can be managed by Fasanella Servan operation. B. Steroid-induced ptosis. C. Myasthenia gravis needs medical management or thymectomy. D. Fasanella Servan operation is best suited for Horners syndrome. Comments Though Fasanella Servan operation is also done for few cases of congenital, the fact that it can be done for most cases of Horner's syndrome make that a preferred choice as the question says specifically. Tips Named surgeries and the main steps and indications are important in Ophthal, ENT and Orthopaedics. 167. Type IV hypersensitivity to Mycobacterium tuberculosis antigen may manifest as: A. Iridocylitis. B. Polyarteritis nodosa. C. Phlyctenular conjunctivitis. D. Giant cell arteritis. Answer: C (Phlyctenular conjunctivitis) Ref: SK Basak 2nd edn, 104; Nema 4th edn, 123 Quality: Spotter Status: Repeat QTDF: All books Discussion Phlyctenular conjunctivitis: Delayed hypersensitivity To endogenous microbial protein Tubercular Staphyloccoccal Unilateral Irritation, discomfort and reflex lacrimation Phlycten at limbus is characteristic Mononulear infiltration in a triangular area Corneal ulcers are Fascicular ulcer Ring ulcer Scrofulous ulcer Treated with steroids Explanation Self Explanatory Comments Though iridocyclitis also can be produced by hypersensitivity, since this is a classical description for phylcten, we go for this answer. Tips Phylcten is commonly due to TB, but TB commonly causes iridocyclitis. 168. Vortex vein invasion is commonly seen in: A. Retinoblastoma. B. Malignant melanoma. C. Optic nerve gliomas. D. Medullo-epitheliomas. Answer: B (Malignant melanoma) A (Retinoblastoma) Ref: Parson 19th , 397; Khurana, 181; Kanski http://www.pathinfo.com/cgi-bin/lh.cgi?tx=veins Quality: SpotterConfusa Status: Repeat QTDF: Parson Discussion Malignant melanoma of choroids invades the vortex veins leading to glaucoma. Explanation A. Retinoblastoma also invades vortex vaein, but less commonly than malignant melanoma. B. Vortex vein invasion is commonly seen in malignant melanoma. C. Vortex vein invasion is not commonly seen in optic nerve gliomas. D. Vortex vein invasion is not commonly seen in medullo-epitheliomas. Comments Though SK Basak, Pg 237 says retinoblastoma, we go by all other books and most authorities. Tips Tumours are important, in all topics and in all subjects. 169. A patient using contact lens develops corneal infection. Laboratory diagnosis of acanthamoeba keratitis was established. The following is the best drug for treatment: A. Propamidine. B. Neosporine. C. Ketocanazole D. Polyhexamethylene biguanide. Answer: A (Propamidine) D (Polyhexamethylene biguanide) Ref: Basak 2nd Edition Page 121 Propamidine. Kanski 4th Edition Page 108 Polyhexamethylene biguanide. Nema 4th Edition Page 147 Propamidine. Harrison 15th edition chapter 213 Propamidine. Many premier ophthal institutes use Polyhexamethylene biguanide. Nelson Amphotericin B in combination with rifampin, sulphadiazine, chloramphenicol, or ketoconazole were the components of the successful regimens. Oxford Textbook of Medicine Amphotericin B or flucytosine will be the initial choice for systemic use. Eye lesions have sometimes responded to local propamidine and neomycin, but the latter is not cysticidal; combinations of topical propamidine 3 with chlorhexidine or 3 polyhexamethylene have recently been successful. Quality: Confusa Status: New QTDF: ?? Discussion Acanthameoba GCentury725 BdCn BTCentury725 Blk BTCentury725 BTCentury725 Cn BTCentury731 BTCentury751 BTCenturyExpd BTCenturyOldst BTCenturyOldStyTEERCenturySchTEERChaparral DisplayCharlesworthRCharter Bd BTCharter BTChartingRCheltenhamItcTEERCheltenhm BdCn BTCheltenhm BdHd BTCheltenhm BdItHd BTCheltenhm BTCheltenhm XBdCn BTChelthmITC Bk BTChillerChiselDCircleDCityDBolCityDEEBolRCityDEELigRCityDEEMedRCityDLigCityDMedClarendon Blk BTClarendon BTClarendon Cn BTClarendon Hv BTClarendon Lt BTClassGarmnd BTClocksRCloisterBlack BTCloisterOpenFace BTCommercialScrDEERCommercialScript BTBCommonBullets"Compacta Bd BT"Compacta Blk BT"Compacta BT"Compacta Lt BT"CompactaPEEBlaRComputersRCooper Blk BTCooper BlkHd BTCooper BlkIt BTCooper BlkItHd BTCooper BlkOul BTCooper Lt BTCooper Md BTCopprplGoth Bd BT"CopprplGoth BdCn BT"CopprplGoth BT"CopprplGoth Cn BT"CopprplGoth Hv BT"CosmicCosmicTwoCottageCountdownDCourier10 BT2CourierMCYQCrazy Creatures"Crillee It BT"Critter"CroissantDCushing Hv BTCushingItcTEEHeaRCutout"CzarDF Calligraphic OrnamentsEckmannDEgyptian505 BTEgyptian505 Lt BTEgyptian505 Md BTEgyptian710 BTEklekticElectronicsRElegaGarmnd BTEmbassy BTBZGd?ZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGdZGdZGdZGd ZGd ZGdZGdZGdZGdZGd ZGdwZGd ZGdZGdIZGdZGdZGdZGd<ZGdZGdAZGd ZGdmZGdZGdMZGd ZGdZGdZGdcZGdZGdZGdYZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGd.ZGd ZGd ZGdZGdZGdZGd ZGd ZGdZGd\ZGd ZGdZGd ZGdZGdZGdFZGdZGd5ZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGdZGdZGdZGd ZGdZGd/ZGdZGd ZGdZGdZGdZGdZGdZGd ZGdMZGd ZGdZGdUZGdZGd=ZGdZGdBZGdZGdCZGd ZGd\ZGdZGd:ZGdZGdZGd ZGdZGd ZGdZGd ZGdZGdZGd ZGdZGdZGdZGdZGdZGd-ZGdZGd?ZGdZGdBellGothic Blk BT"BellGothic BT"Belwe Bd BTBelwe Cn BTBelwe Lt BTBenguiat Bk BTBenguiatGot Bk BT"BenguiatItcTEERBergellBermuda LP SquiggleBernhard BdCn BTBernhardFashion BTRBernhardMod BTBernhardTango BTBBertramBibleScrTBickley ScriptBinnerDBinnerDEERBlackletter686 BTBlacklightDBlippo Blk BT"BlippoBlaDEERBodoni Bd BTBodoni BdCn BTBodoni Bk BTBodoni BTBoinkBolt Bd BT"BookmanITC Lt BTBorders1RBorders2RBoxesRBremen Bd BTRBremen Blk BT"BriskBroadway BTBroadwayEngraved BTBrochureBrodyDBronxBruceOldStyle BTBrush455 BTBBrush738 BTBrushScrDEERBrushScript BTBBuildingsRBullets1RBullets2RBullets3RBulmer BTBusiness&GovernmentRBusorama Md BTBusterDBuxomDCaflischScript RegularCalligraph421 BTBCalligraph810 BTCamelliaDCamelliaDEERCancunCandidaCandida BTCarletonCarmina Blk BTCarmina Lt BTCarmina Md BTCasablancaAntiqueCaslon Bd BTCaslon224 Bk BTCaslon540 BTCaslonOldFace BTCaslonOldFace Hv BTCaslonOpnface BTCastleTCastleTLigCastleTUltCataneo BTBCataneo Lt BTBCataneo Swash BTBCaxton Bk BTCaxton Lt BTCentSchbook BdCn BTCentSchbook BTCentSchbook Mono BT2Century725 BdCn BTCentury725 Blk BTCentury725 BTCentury725 Cn BTCentury731 BTCentury751 BTCenturyExpd BTCenturyOldst BTCenturyOldStyTEERCenturySchTEERChaparral DisplayCharlesworthRCharter Bd BTCharter BTChartingRCheltenhamItcTEERCheltenhm BdCn BTCheltenhm BdHd BTCheltenhm BdItHd BTCheltenhm BTCheltenhm XBdCn BTChelthmITC Bk BTChillerChiselDCircleDCityDBolCityDEEBolRCityDEELigRCityDEEMedRCityDLigCityDMedClarendon Blk BTClarendon BTClarendon Cn BTClarendon Hv BTClarendon Lt BTClassGarmnd BTClocksRCloisterBlack BTCloisterOpenFace BTCommercialScrDEERCommercialScript BTBCommonBullets"Compacta Bd BT"Compacta Blk BT"Compacta BT"Compacta Lt BT"CompactaPEEBlaRComputersRCooper Blk BTCooper BlkHd BTCooper BlkIt BTCooper BlkItHd BTCooper BlkOul BTCooper Lt BTCooper Md BTCopprplGoth Bd BT"CopprplGoth BdCn BT"CopprplGoth BT"CopprplGoth Cn BT"CopprplGoth Hv BT"CosmicCosmicTwoCottageCountdownDCourier10 BT2CourierMCYQCrazy Creatures"Crillee It BT"Critter"CroissantDCushing Hv BTCushingItcTEEHeaRCutout"CzarDF Calligraphic OrnamentsEckmannDEgyptian505 BTEgyptian505 Lt BTEgyptian505 Md BTEgyptian710 BTEklekticElectronicsRElegaGarmnd BTEmbassy BTBHelvetica Ins"Hobo BTHoboDEERHollyweirdHomePlanningRHomePlanning2RHonda"HoratioDBolHoratioDLigHoratioDMedHorizon BT"HorndonDHouseholdRHumanst521 BT"Humanst521 Cn BT"Humanst521 Lt BT"Humanst521 UBd BT"Humanst521 XBd BT"Humanst521 XBdCn BT"Humanst531 Blk BT"Humanst531 BT"Humanst531 UBlk BT"Humanst970 BT"Humnst777 Blk BT"Humnst777 BT"Humnst777 Lt BT"HumstSlab712 Blk BTHumstSlab712 BTHuxleyVertical BT"HygieneRIceAgeDImperial BTImpress BTImpuls BTIncised901 Bd BT"Incised901 BdCn BT"Incised901 BT"Incised901 Ct BT"Incised901 Lt BT"Incised901 Nd BT"Incised901 NdIt BT"Industrial736 BTInformal011 Blk BT"Informal011 BT"IowanOldSt Blk BTIowanOldSt BTIrelandITC Officina Sans Book"ITC Officina Serif BookKabarettDKabel Bd"Kabel Bk BT"Kabel Dm BT"Kabel Md BT"Kabel Ult BT"KabelItcTEERKabelItcTEEDemRKabelItcTEEMedRKabelItcTEEUltRKaufmann Bd BTBKaufmann BTBKeypunchKeystrokeKhaki Two"KidnapRKidsKis BTKorinna BTKuenst480 Blk BTKuenst480 BTKunstlerschreibschDBolKunstlerschreibschDMedLandmarksRLandscapePlanningRLetterGotLCYBolRLetterGotLCYMedRLifeTEERLithos Regular"LubalinGraItcTEERLubalinGraItcTEEMedRLucidaSanTCYRMachineItcDEERMaximaCyrTCYLigComRMedicineRMicrogrammaDEEBolExtR@<// 5c@c.@M .--/00%%-((   @     @ @5   + @   @ @4< =    2 4da  @  9 9 @: :     +< @< < @= @bcdBBd x(xKdd x(xKdd1 x(xKdd (xKdd. (xKdd ,(xKddM (xKdd ,(xKddYX(xKdddAX(xKdddFX(xKdddGX(xKddd ,(xKdd\ (xKdd ,(xKdd; (xKddh<(xKdddX(xKdddX(xKdddX(xKddd"X(xKddd ,(xKdd ,(xKdd" ,(xKdd x(xKdd x(xKddh(xKddd(xKddd h(xKddd (xKdddh(xKddd(xKddd&h(xKddd(xKddd(h(xKddd (xKddd h(xKddd'(xKddd(xKddd(xKddd(xKddd@(xKdddh(xKddd(xKddd=(xKddd2(xKddd(xKddd0(xKddd((xKdddO(xKddd( (xKdd ,(xKdd (xKddfh(xKdddh(xKdddh(xKddd:h(xKddd*(xKddd)(xKdddV(xKdddEmboss"Empire BT"EnglischeSchTEnglischeSchTDemBolEnglish111 Adagio BTBEnglish111 Presto BTBEnglish111 Vivace BTBEnglish157 BTBEngraversGothic BT"EngravrsRoman Bd BTEngravrsRoman BTEngrvrsOldEng Bd BTEngrvrsOldEng BTEnviroDEnviroDEEREras Bd BT"Eras Bk BT"Eras Contour"Eras Lt BT"Eras Md BT"Eras Ult BT"ErasItcPEEUltRErasItcTEERErasItcTEEDemRErasItcTEELigRErasItcTEEMedREwieDExotc350 Bd BT"Exotc350 DmBd BT"Exotc350 Lt BT"ExpoExPonto Regular"FestiveRFirenze"FlamencoDFlamencoInlDFlareserif821 BT"FlashDBolFlashDLigFlemishScript BTBFolioTEEBolConRFolioTEEMedRFoodRFranklinGotItcTEEBooRFranklinGotItcTEEDemRFranklinGotItcTEEHeaRFreehand471 BTFreehand521 BTBFreehand575 BTBFreehand591 BTBFreestyle Script"FreestyleScrDFreestyleScrDEERFrizQuadrata BT"FrizQuaItcTEERFurnitureRFuturaTEERFuturaTEEBolConRFuturaTEELigRFuturaTEELigConRFuturaTEEMedRFuturaTEEMedConRGaramond BookCondensedGaramond LightCondensedGaramondItcTEERGaramondItcTEEConRGaramondNo4CyrTCYLigRGaramondNo4CyrTCYMedRGaramondNo4TEELigRGaramondNo4TEEMedRGeographicSymbolsRGiddyup"GoudyOldStyTEERGoudyOldStyTEEExtBolRGreymantle MVB"HandelGotDBolHandelGotDLigHandelGothic BTHarlowDHarpoonHazelHehenHebTBolRHelv"Modern"Helvetica 55"fc//c@c.@E.--f00%%((   @     @ @5     1  @1 @4< =    2 4da  @  9 9 @: :     +< @< < @= @.c@BB"X"X#X,@ l !,@ l \,@ l ,@ l ,@ l h hh hhhDh/h6h ,@ l XIX6X8X ,@ l A,@ l ,@ l W,@ l hXX:XFX,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l L,@ l ,@ l hXX#X'X,@ l ,@ l ,@ l ,@ l P,@ l 1,@ l Khurana, 341 Quality: Spotter Status: New Discussion Entropion is inward rotation of turning of the lid margin towards the globe. It can be congenital, spastic, cicatrical or senile entropion. 1. Congenital entropion: Rare Present since birth Management 3 Plastic reconstruction 2. Spastic entropion: Due to spasm of orbicularis oculi Management 3 Treatment of cause of spasm 3 Botulinum toxin 3. Cicatrical entropion: Most common in upper lid Due to 3 Trachoma, 3 Burns, 3 Pemphigus 3 Steven Johnson syndrome Management 3 Modified burrows 3 Joesche Arlts 3 Modified Ketessey 3 Resection of skin, muscle and tarsus 4. Senile entropion: Most common in lower lid Seen in elderly Management 3 Jones, Reeh and Wobig operationTucking or plication of inferior lid retractors 3 Modified Wheelers 3 Weiss 3 Blick Explanation 1. Plastic operations are done for senile ectropion. For spastic ectropion the cause is treated. 2. Senile entropion is managed with Jones, Reeh and Wobig OperationTucking or plication of inferior lid retractors, modified Wheelers, Weiss, Blick operations. 3. Cicatricial entropion is managed with modified burrows, Joesche Arlts, modified Ketessey, resection of skin, muscle and tarsus 4. Paralytic entropion is managed with plastic surgeries. Comments The question is one of the few where the question can be attempted (with a risk, of course) without knowing the subject, by careful analysis of choices. Tips You can see that senile appears 2 times and entropion 3 times. Now you consider yourself as the question setter and assuming senile ectropion to be the correct answer give three more choices. See whether these are the choices given in the Q, Paper. Proceed for the other three choices. Choice B stands out. But you cannot apply this method if the choices were. A. Senile ectropion. B. Senile entropion. C. Cicatricial ectropion. D. Cicatricial entropion. There analysis leaves you with 2-2 and 2-2. So the answer can be anything else. But our question paper had 2-1-1 and 3-1 telling that the answer probably has senile and also entropion. But I have to warn you that method is one of chance and can also fail. If you cannot understand what I have told you dont worry. There will be an online tutorial soon in www.targetpg.com about the strategies for attempting MCQs. 164. A patient is on follow-up with you after enucleation of a painful blind eye. After enucleation of the eyeball, a proper sized artificial prosthetic eye is advised after a postoperative period of: A. About 10 days B. About 20 days. C. 6-8 weeks. D. 12-24 weeks. Answer: C (6-8 weeks) Ref: Parson 18th edn, 311 deals with Proper Sized Prosthesis; Basak 2nd edn, 339 deals with Prosthesis Quality: Thinker Status: New QTDF: Parson 18th Edition Discussion An artificial eye of plastic should not be worn less than 2 weeks after excision. A small eye may be worn for an hour or two a day till the conjunctiva becomes used to the foreign body. Eight or nine weeks after the operation a full-sized eye may be worn; a plastic eye need only be taken and washed once a week. Explanation A. Anything should not worn about 10 days . B. A small eye is worn for an hour or two from about 20 days. C. A proper sized artificial prosthetic eye is advised after 6-8 weeks. D. 12-24 weeks is too long a time. Comments Even though most of the books recommend initiation of the prosthesis after 3 weeks, according to Parson, small prosthesis are worn after 3 weeks following surgery And a proper sized prosthesis is worn after 8 weeksSince our question also has the word proper, we go for choice C. Tips Be careful to the words, full, proper, definite, etc. in the question paper. 165. In a patient with AIDS chorioretinitis is typically caused by: A. Cytomegalovirus. B. Toxoplasma gondii. C. Cryptococcus neoformans. D. Histoplasma capsulatum. Answer: A (Cytomegalovirus) Ref: Harrison 15th edn, 185; Parson 19th edn, 257 Quality: Spotter Status: Repeat QTDF: Parson Discussion Cytomegalovirus (CMV) retinitis is an important cause of blindness in immunocompromised patients, particularly patients with advanced AIDS. One of the most devastating consequences of HIV infection is CMV retinitis. Patients at high risk of CMV retinitis (CD4+ T cell count <100/uL) should undergo an ophthalmologic examination every 3 to 6 months. The majority of cases of CMV retinitis occur in patients with a CD4+ T cell count <50/uL. Prior to the availability of HAART, this CMV reactivation syndrome was seen in 25 to 30% of patients with AIDS. CMV retinitis usually presents as a painless, progressive loss of vision. Patients may also complain of blurred vision, floaters, and scintillations. The disease is usually bilateral, affecting one eye more than the other. CMV infection of the retina results in a necrotic inflammatory process, and the visual loss that develops is irreversible. Intravitreal injections of cidofovir are generally avoided due to the increased risk of uveitis and hypotony. Explanation A. Cytomegalovirus causes chorioretinitis in 30 % of HIV Cases. (Harrison) B. Chorioretinitis due to toxoplasmosis can be seen alone or, more commonly, in association with CNS toxoplasmosis, but is less common than CMV chorioretinitis. C. Cryptococcus neoformans causes meningitis. D. Histoplasma capsulatum affects the lungs. Comments CMV retinitis may be complicated by rhegmatogenous retinal detachment. Therapy for CMV retinitis consists of intravenous ganciclovir or foscarnet, with cidofovir as an alternative. Combination therapy with ganciclovir and foscarnet has been shown to be slightly more effective than either ganciclovir or foscarnet alone in the patient with relapsed CMV retinitis. Tips P. carinii can cause a lesion of the choroid that may be detected as an incidental finding on ophthalmologic examination. These lesions are typically bilateral, are from half to twice the disc diameter in size, and appear as slightly elevated yellow-white plaques. 166. Fasanella Servan operation is specifically indicated in: A. Congenital ptosis. B. Steroid-induced ptosis. C. Myasthenia gravis. D. Horners syndrome. Answer: A (Horners syndrome) Ref: Kanski 4th edn, 39; SK Basak 2nd edn, 83; Khurana Quality: Spotter Status: New QTDF: ?? Discussion Fasanella Servan operation is a surgical procedure for management of ptosis. The upper border of tarsus is excised with the lower border of Mullers muscle and overlying conjunctiva. ,@ l ,@ l ,@ l ,@ l ,@ l hh%2h AchMilitaryRMilitaryIDRMinion CondensedMinion OrnamentsRMojo"MorseCodeRMurrayHilDEERMusicRMusicalSymbolsRMyriad Roman"Myriad Tilt"NauticalFlagsRNevisonCasDEERNicolasCocTEEBlaRNicolasCocTEERegRNimbusRomDCYRNimbusSanLCYRNimbusSanNo5TCYRNimbusSanNo5TCYMedRNueva BoldExtendedNueva RomanNuptialScriptNyxOCRA Alternate"OfficePlanningROuch"ParkAveDEERPeopleRPITARA-A01RELIGIOUSPITARA-A02RELIGIOUSPITARA-A03RELIGIOUSPITARA-A04RELIGIOUSPITARA-A05RELIGIOUSPITARA-A06RELIGIOUSPITARA-A07RELIGIOUSPITARA-A08RELIGIOUSPITARA-A09RELIGIOUSPITARA-A10RELIGIOUSPITARA-A11RELIGIOUSPITARA-A12RELIGIOUSPlantsRPoetica ChanceryIPompeia Inline"Postino ItalicRevuePEERSanvito LightSanvito RomanScienceRSemaphoreRSerifaDEERSerifaDEELigRSerpentineDEEBolRShapes1RShapes2RShuriken Boy"Sign LanguageRSignsRSouvenirItcTEEDemRSouvenirItcTEELigRSpaceRSports&HobbiesRSportsFiguresRSpumoni LPStars1RStars2RStencilDEERSymbolProp BTkRTechnologyRTektoMM_100 LT 250 CN"TektoMM_100 LT 564 NO"TektoMM_100 LT 850 EX"TektoMM_240 RG 250 CN"TektoMM_240 RG 850 EX"TektoMM_503 BD 250 CN"TektoMM_503 BD 488 NO"TektoMM_503 BD 850 EX"TimelessTCYLigRTms RmnRomanToolsRTracksRTransportationRUmbra BTUnivrstyRoman Bd BTUnivrstyRoman BTZGd ZGdZGdZGdZGdZGd ZGd ZGdZGdZGdZGdZGd ZGd)ZGd ZGdZGd*ZGdZGd ZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGduZGdZGdZGdZGd ZGdZGdZGd?ZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGdZGdZGdZGd ZGd ZGdZGdZGdZGdZGd ZGdzZGd ZGdZGdIZGdZGdZGdZGd<ZGdZGdAZGd ZGdmZGdZGdMZGd ZGdZGdZGdcZGdZGdZGdYZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGd.ZGd ZGd ZGdZGdZGdZGdXX,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l Phmhqhh# ,@ l MXX@XEX ,@ l ,@ l ,@ l c,@ l ,@ l hYhXX"XX,@ l ,@ l 7,@ l ),@ l ,@ l ,@ l h#hh1h(h0hhh ,@ l ,@ l ,@ l ,@ l ,@ l F,@ l ,@ l 0hXXXX,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l 1,@ l ,@ l .,@ l ,@ l M,@ l ,@ l YXAXFXGX ,@ l \,@ l ,@ l ;,@ l hXXX"X,@ l ,@ l ",@ l ,@ l ,@ l h h h&h(h  h'Uptight Neon"UtopiaVAG Rounded Lt"VAG Rounded Th"VanDijkDEERViva BoldExtraExtendedViva RegularWalkman-Chanakya-901"Walkman-Chanakya-Bd-Italix-901"Walkman-Chanakya-Boldx-901"Walkman-Chanakya-Italix-901"WeatherRWillowWoodtype Ornaments 1RZapfDingbats BToRMarlettLucida Console1Tahoma"Courier New1WingdingsArial Black"Comic Sans MSBImpact"Verdana"WebdingsWP Greek CenturyWP MultinationalA Courier1WP MultinationalB Courier1WP BoxDrawing1 WP Greek Courier1WP Hebrew DavidWP MultinationalA HelveWP MultinationalB HelveWP Phonetic"WP TypographicSymbolsWP IconicSymbolsAWP IconicSymbolsBWP MathAWP MathBWP MathExtendedAWP MathExtendedBWP Greek HelveWP JapaneseWP MultinationalA RomanWP MultinationalB RomanWP CyrillicAWP CyrillicBWP Arabic SihafaWP ArabicScript SihafaHaettenschweiler"Bookman Old StyleMonotype SortsGaramondMS OutlookBookshelf Symbol 1"Bookshelf Symbol 2Bookshelf Symbol 4"Bookshelf Symbol 5Albertus Extra Bold"Albertus Medium"Antique Olive"CG Omega"CG TimesClarendon CondensedCoronetBLetter Gothic1MarigoldBUnivers"Univers Condensed"Palatino-Bold ThPalatino-ItalicBook AntiquaDauphinFuturaBlack BTRFutura Md BT"Futura XBlk BT"Futura Lt BT"GoudyHandtooled BTRGoudyOlSt BTLithographLithographLightRMT ExtraOzHandicraft BTBPosterBodoni BTSerifa BT,@ l F,@ l ,@ l : E T h @t -  *@ -@ *@ @  ' 3>CcC,cC, c+C, c:#,CWcC,cC,c&C,1 cC,@BcC,@BcC,'Cb @B, C@B, CcC,cC,wcC,.caD3CXca: CXcaN CX caD CX)ca0CXecc, C@BcC,@BcC,C0@@,CC@B, C@B,!Cs cc, cBC@ cc, c c@ Ccc,Ccc, Ccc,Ccc, Cbcc, Ccc, c1C@ CCcC,C c c,c@ Cl cc, c@ CCc C,cC,c C, Cc C,5cC,GcC,CChCCC 52. True about calcium is/are a. Entry is regulated by calmodulin uptake b. Extracellular concentration of calcium is 10,000 times more than intracellular c. Symport uptake d. Entry into cell is passive c. Released by sarcoplasmic reticulum Ref:: ganong 35, Quality::::spotter thinker reader BATA Discussion Explanation Correct choices: b, e . C. Which of the following are organophosphates: A. dieldrin B. parathion C. malathion D. Kepone 5. Propoxur Ref::Trip 5th Page 81 Park 550 table Quality::::reader Discussion Explanation: anticholinesterases Reversible Carbamates Acridine Physostigmine (Eserine) Neostigmine Pyridostigmine Edrophonium Rivastigmine Donepezil tacrine Irreversible Organophosphates Carbamates Dyflos DFP Echothiophate Parathion Malathion Diazinon TIK 20 Tabun Sarin Soman Carbaryl (Sevin) Propoxur(Baygon) Explanation A. dieldrin-organochlorine pesticide. incorrect choice. B. parathionirreversible OPC. correct choice. C. malathion irreversible OPC. correct choice D. Kepone/chlordecone- organochlorine pesticide. incorrect choice pesticide 5. Propoxurirreversible carbamates. incorrect choice Correct choices: b c 203. Which of the following are features of spinal shock a. Spasticity b. Urinary retention c. Areflexia d. Sensory level e. Increased DTRs Ref::clinical acumen Quality::::spotter thinker reader BATA Discussion Spinal shock(neuronal) is the initial state just after an acute insult causing an UMN lesion caused by the temporary depressant effect on the anterior horn cells. Characterized by paralysis,areflexia,flaccidity,the chracteristic hypertonia and increased relexes of cotticospinal lesion appear after few hrs-days. Explanation Correct choices B C d 217. Which of the following predispose a patient to prehepatic encepalopathy a. Constipation b. Bacterial peritonitis c. Hemorrhage d. Hyperkalemia e. Dehydration Ref: HPIM 1715 Quality::::spotter thinker reader BATA Discussion Common precipitants of hepatic failure Increased nitrogen load GIT bleeding Excess dietary protein Azotemia Constipation Electrolyte & metabolic imbalance Hypokalemia Alkalosis Hypoxia Hyponatremia Drugs Narcotics and Tranqulizers Sedatives Diuretics Miscellaneous Infection surgery Superimposed acute liver disease Progressive liver disease Explanation: A. Constipation B. Bacterial peritonitis being an infection. correct choice. C. Hemorrhage D. Hyperkalemia: Hypokalemia not Hyperkalemia is known to worsen hepatic Encephalopathy. 5. Dehydration can cause hypovolemia & electrolyte disturbances that can ppt. hepatic Encephalopathy Correct choices: a b c e 8. the drugs useful in the treatment of ectopic pregnancy is A. Methotrexate B. Actinomycin D C. Cyclophosphamide D. Potassium fluoride 5. Adriamycin Ref:: Dutta 202 Quality:::: spotter Explanation A. Methotrexate: used in medical therapy. correct choice. B. Actinomycin D. correct choice. C. Cyclophosphamide. Incorrect choice. D. Potassium fluoride: potassium chloride is used in ectopic pregnancy. Incorrect choice. 5. Adriamycin is not used in ectopic pregnancy. Correct choices A b 210. Adventitial bursitis due to tuberculosis is found in which of the following sites commonly a. Prepatellar b. Greater trochanter of femur c. Sub acromial d. Metatarsal e. Sub olecranon 209. Snow ball opacities in vitreous is seen in which of the following a. Parsplanitis b. Rheumatoid arthritis c. Anterior unietis d. Retinitis pigmentosa e. Endothelial dystrophy Ref: http://www. indmedica. com/cos/journal/vasculitis. html Quality::::spotter thinker reader BATA Explanation A. Parsplanitis is characterized by snowball opacities. B. Rheumatoid arthritis is one of the causes of pars planitis hence may show snow ball opacities C. Anterior uveitis D. Retinitis pigmentosa 5. Endothelial dystrophy Correct choices: A b 77. The left border of the heart is formed by a. Pulmonary Artery b. Pulmonary vein c. Right ventricle d. Ascending aorta e. Arch of aorta Ref:: BDC 226,Grays 38th 1476 Quality:::: spotter thinker reader BATA Discussion Anatomically Right border is formed by RA. Left border of heart is formed by LA and LV. Upper border formed by LA, asc aota & pul trunk infron of it. Inferior border of the heart is formed by RV and contribution of LV at the apex. Correct choices NONE OF THE CHOICES ARE CORRECT Or 77. left border of the heart in chest XR is formed by a. pul artery b. pul vein c. abdominal aorta d. arch of aorta e. right ventricle Quality:::: :reader Ref:: Discussion: Borders of cardiac silhouette on PA view Right border from above downwards Superior vena cava Outer border of R atrium Sometimes asc, arch of aorta & inferior vena cava Left border from above downwards Aortic knuckle Pul. Trunk or L pul artery L atrial appendage outer border of L ventricle correct choice: a d 9. the resting membrane potential depends on which of the following ions A. Magnesium B. Calcium C. Potassium D. Sodium 5. Chloride Ref:: Ganong 50 Quality:::: spotter Discussion The ionic basis of RMP: Explanation A. Magnesium has no role in RMP. B. Calcium has role in action potential in muscle cells not RMP C. Potassium. The major ion whose movements produce RMP. Correct choice. D. Sodium. incorrect choice. 5. Chloride. No role. Correct choices C 79. In acute inflammation the migration of neutrophils and its attachment to endothelium is mediated by which of the follwing. a. Integrins b. Selection s c. Adhesins d. Perforins e. Opsonins Ref:: Robbins 29, 273 Quality::::spotter thinker reader BATA Explanation a. Integrins are transmembrane glycoproteins that function as cell receptors for extra cellular matrix. correct choice. b. Selectins=the loose and transient adhesions involved in rolling of leucocytes over endothelial cells are accounted for by the selectin family of molecules. E-selectin are present on on endothelial cells, P-selectin on platelets and endothelial cells and L-Selectins on leucocytes. c. Adhesins-are molecules that bind bacteria to cells e. g. lipoteichoic acid and protein F. d. Two classes of cytotoxins include perforins and granzymes. . The perforins form pores in the targets cell membranes. incorrect choice. e. Opsonins are protiens or peptides that label targets for phagocytosis by PMNs and/or macrophages. incorrect choice, Correct choices b 102. Susruta samhita was translated by a. Celsius b. harnel c. Bhargabhatta d. heslar e. Bernard Ref: http://www. ayurveda. com/online%20resource/ancient_writings. htm Quality:::: BATA Discussion: http://www. ayurveda. com/online%20resource/ancient_writings. htm Sushruta Samhita The Sushruta Samhita deals with the practice and theory of surgery, is an important source of Ayurvedic aphorisms. This work is the first to enumerate and discuss the pitta sub-doshas and the marmas. With its emphasis on pitta, surgery, and blood, this work best represents the transformational value of life. It is dais that this work was first redacted by Nagarjuna. This work, originally written in Sanskrit, is now available in English with Devanagari. Bhishagratnas translation is English and Sanskrit. P. V. Sharma has recently written a translation with both the Sanskrit/Devanagari and English that includes Dallanas commentary. Dallana has been regarded as the most influential commentator on Sushrutas work. Explanation Correct choices B d 21. Prozone phenomenon in precipitation reaction indicates a. False positive reaction b. False negative reaction c. due to excess antibodies d. Due to excess antigens e. Broken antibodies Ref: : AN 91 Quality:::: spotter 203. Which of the following are features of spinal shock f. Spasticity g. Urinary retention h. Areflexia i. Sensory level j. Increased DTRs Ref::clinical acumen Quality::::spotter thinker reader BATA Discussion Spinal shock(neuronal) is the initial state just after an acute insult causing an UMN lesion caused by the temporary depressant effect on the anterior horn cells. Characterized by paralysis,areflexia,flaccidity,the chracteristic hypertonia and increased relexes of cotticospinal lesion appear after few hrs-days. Explanation 6. Spasticity appears hrs day after spinal shock has passed in an UMN lesion. 7. Urinary retention is a feature of spinal cord disease. appears first in case of disease originating from the canal and spreading outwards and last in mass lesions compressing spinal cord from the outside. Its a feature of spinal shock. 8. Areflexia is a feature of spinal shock. 9. Sensory level is seen in case of corticospinal lesion. 10. Increased DTRs will be seen after the spinal shock has passed. Correct choices B C d 202. Diseases inherited with triple repeat sequences include a. Huntingtons chorea b. Alzheimers disease c. Spinocerebellar ataxia d. Amyotrophic lateral sclerosis e. Ataxia telangiectasia Ref:: Robbins 197,739,741,157 Quality::::spotter thinker reader BATA Discussion Harrison 2294 table gives explicit information about genetic defects in neurological disease. Robbins has enumerated three diseases having triple repeat sequences: Fragile X syndrome Huntington;s ds, Myotonic dystrophy Explanation A. Huntingtons chorea:AD : CAG triple repeats in gene encoding proein huntingtin B. Alzheimers disease:AD mutations presenilin,apolipoprotein E4,APP genen C. Spinocerebellar ataxia:expansion of trinucleotide repeats in ataxin gene D. Amyotrophic lateral sclerosis:AD mutation in Cu-Zn superoxide Dismutase SOD. 5. Ataxia telangiectasia AR mutation in ATM gene which causes triple repeat sequences and abnormal production of protein. Correct choices A c e 59. Tumor markers of hepatocellular carcinoma include a. CEA b. Des gamma carboxyprothrombin c. CA 19-9 d. Fucosylated alpha protein e. Alpha fetoprotien elevated in greater than 70% Ref:: HPIM 579, CMDT 689 http://www. intouchlive. com/consults/ccn9903b. htm Quality::::spotter thinker reader BATA Discussion Alpha fetoprotein levels raised in Cirrhosis Massive liver necrosis Chronic hepatitis hepatocellular carcinoma Normal pregnancy Fetal distress or death Fetal neural tube defects-enencephaly & spina bifida Gonadal germ cell tumours teratoblastoma, Levels above 1000 ng/ml HCC CEA (Carcino Embryonic Antigen) elevated in: malignancies of the gastrointestinal tract (pancreas, colon, rectum), lung, breast, prostatic and ovary. inflammation and heavy smoking. CA-125 normally found in adult female fallopian tube, endometrium and endocervix. CA-15 elevated breast and lung cancer. . CA-199 elevated in intra-abdominal carcinomas, adenocarcinomas of the lung, gastric, biliary and colonic neoplasms. Explanation a. serum CEA levels alone are not specific for hepatocellular carcinoma but are nonetheless raised. correct choice. b. Des gamma carboxyprothrombin, an abnormal typre of [rothrombin which correlates with h levels of AFP. c. CA 19-9 levels are elevated in HCC. D most of the patients with hepatocellular carcinoma have an elevated serum concentration of fucosylated alpha-fetoprotein. correct choice. e. Alpha-fetoprotein elevated in greater than 70% . true. Correct choices A bcde 67. Which of the following are causes of posterior mediastinal mass: A. Neuroenteric cyst B. Neurogenic cyst C. Anterior thoraxic meningocele D. Lymphoma E. Bronchogenic cyst Anterior mediastinum: Middle Mediastinum: Posterior mediastinum: Germ cell neoplasm Lymphoma: Morgagni hernia Pericardial cyst Thymic lesions: Thyroid (Retrosternal goiter) Foregut duplication cysts Castlemans disease Lymphangioma Lymphoma Bronchogenic cyst Bochdalek Hernia Extramedullary Hematopoiesis Ganglioneuroma Ganglioneuroblastoma Neuroblastoma Lateral thoracic meningocele Malignant tumor of nerve sheath origin Neurofibroma Paraganglioma Pheochromocytoma Schwannoma Explanation A. Neuroenteric cyst is present in the posterior mediastinum or paravertebral area. B. Neurogenic cyst is present in the posterior mediastinum C. Anterior thoracic meningocele is present in the posterior mediastinum D. Lymphoma is a tumour of the middle or anterior mediastinum E. Bronchogenic cyst is a tumour of the middle mediastinum. Correct choices Abc 213. Peripheral neuropathy is seen in all of the following except a. Tuberculosis b. Polyarteritis nodasa c. Diabetes mellitus d. SLE 89. Diabetes mellitus is associated with all of the following except: a. Neuropathy b. Encephalopathy c. Myopathy d. Myelitis e. Myelopathy Ref: CMDT 1191,HPIM 2481 Quality::::spotter thinker reader BATA Discussion Diabetic neuromuscular involvement may manifest as: A. Distal symmetric polyneuropathy B. Isolated peripheral neuropathy-mononeuropathy C. Mononeuritis multiplex D. Painful neuropathy 5. Autonomic neuropathy 6. Cranial neuropathypainful opthalmoplegia 7. Diabetic amyotrophy/proximal neuropathy/lumbosacral plexopathy 8. Ischemic myopathy of thigh muscles D e 127. In carbon monoxide toxicity a. There is left shift of oxygen dissociation curve b. Saturation of oxygen at 50% PaO2 is decreased c. Oxygen content of arterial blood is decreased d. Induces a state of metabolic acidosis e. Oxygen is used in treatment Ref: Ganong 17th 633 Quality::::spotter thinker reader BATA Discussion Explanation a. There is left shift of oxygen dissociation curve. COHb shifts the curve of the remaining HbO2 to left decreasing the amount of O2 released by the normal saturated Hb. b. Saturation of oxygen at 50% PaO2 is decreased. I think this choice should be saturation of Hb at given PO2 is decreased which is untrue because the curve shifts to the left. This increases the saturation of Hb at givenPO2 and even makes the available HbO2 useless for oxygenation because it wont release the O2. c. Carboxu Hb reduces oxygen transportation by Hb thus Oxygen content of arterial blood is decreased. correct. d. Induces a state of metabolic acidosis because of the hypoxia e. Ventilation with O2 is preferable to ventilation with fresh air since O2 hastens the dissociation of COHb. Hyperbaric O2 is useful. Correct choices A c d e \E Y @nZGdZGdZGd*ZGdZGdQZGdZGdZGdZGdZGdZGd%ZGdZGdZGdZGdZGdZGd ZGd ZGdZGdZGdZGdZGdZGdZGdZGd2ZGdZGdZGdZGd ZGdZGd ZGdZGdZGdZGdZGd ZGdZGdZGdZGdZGd ZGdZGdZGd ZGd!ZGdZGd ZGdZGdZGdZGdZGdZGd ZGdZGdZGdZGd ZGdZGd ZGdZGdZGdZGd ZGdZGdZGdZGd ZGdZGd ZGdZGd ZGdZGd ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGd5ZGdZGd,ZGdZGd+ZGdZGdHZGdZGdZGd6ZGdZGdZGd ZGd9ZGdZGdZGdZGdZGdZGd ZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGd9ZGdZGd ZGdZGdZGdZGdZGdZGdZGdKZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGdZGd ZGdZGd&ZGdZGdZGdZGd ZGdZGdZGdZGdZGdZGd ZGdZGd!ZGdZGd ZGdZGd ZGdZGdZGdZGd ZGdZGdZGdZGdZGdZGd ZGdZGd ZGdZGd ZGdZGdZGdZGd ZGdZGdZGdZGd ZGdZGd ZGdZGd:ZGdZGd ZGdZGdVZGdZGdZGdeZGd+ZGd<ZGdZGdZGd ZGdZGd ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGdZGd ZGdZGd7ZGdZGdZGdZGd$ZGdZGdWZGdZGdZGd1ZGdZGdZGdZGdZGd ZGd_ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd&ZGdGZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd7ZGdZGdZGdZGdZGd ZGdZGdZGd5ZGdZGd]ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd-ZGdZGdZGdZGdZGdZGdZGd*ZGdZGdZGdZGd ZGdZGdZGd ZGdZGd ZGdZGdZGdZGd-ZGdZGd>ZGdZGdQZGdZGdZGdZGdZGdZGd6ZGdZGdZGdZGd ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGd(ZGdZGd!ZGdZGdZGdZGdZGdZGd1ZGdZGd ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdHZGdZGdZGd ZGdZGdZGdZGd ZGdZGdZGdZGdZGd ZGdZGdZGd ZGd ZGdZGd ZGdZGdZGd ZGdZGdZGdZGd<ZGdZGdFZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGd,ZGdZGd"ZGdZGd2ZGdZGdZGdZGdZGdZGd ZGdZGd ZGdZGdZGdZGd ZGdZGdZGdZGd ZGdZGdyZGdZGdZGdZGd^ZGdZGd'ZGd ZGdZGd ZGd>ZGdZGd ZGdZGdjZGdZGdZGdZGd#ZGdZGdZGd ZGdZGd ZGdZGdZGdZGd ZGdZGd ZGdZGdZGdBZGd ZGdZGdZGd ZGdZGdAZGdZGdZGdZGd6ZGdZGd;ZGdZGd`ZGdZGd ZGdZGdZGdZGd;ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGd ZGdZGdZGd9ZGdZGdZGdZGdZGdZGd ZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGd9ZGdZGd ZGdZGdPZGdZGdZGdZGd,ZGdZGd;ZGdZGdEZGdZGdZGdZGdZGdZGd<ZGdZGdZGdZGdZGdZGdZGdZGd!ZGdZGdZGdZGdZGdZGd ZGdZGd^ZGdZGdGZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGdOZGdZGdGZGdZGdHZGdZGdMZGdZGdZGd{ZGdZGdZGdZGd%ZGdZGdZGdZGdZGdZGd ZGdZGd ZGdZGdZGd4ZGdZGdZGdZGdZGd3ZGd ZGdZGdZGdZGd ZGdZGd"ZGdZGd ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd4ZGdZGdZGdZGdZGdZGdZGd!ZGdZGdZGdMZGdZGd ZGdZGdZGdZGd ZGdZGdZGdZGdZGdZGd(ZGdZGd ZGdZGdsZGdZGdjZGdZGd(ZGdZGdZGdZGd:ZGdZGdZGd;ZGdGZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGdZGdZGdAZGdZGdZGdZGd ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGd ZGdZGd#ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd'ZGdZGd ZGdZGdZGdZGdZGdZGd ZGdZGd ZGdZGdRZGdZGd8ZGdZGdFZGdZGd;ZGdZGd:ZGdZGdZGdZGdZGdZGdAZGdZGdZGdZGdZGdZGdZGdZGdZGd'ZGd/ZGdZGdZGdZGdZGdZGdZGd ZGdZGd ZGdZGdZGdZGdZGd ZGdZGdZGd ZGdZGd9ZGdZGdZGd-ZGdZGdZGdZGdZGdZGdZGdZGdZGd-ZGdZGdBZGdZGd&ZGd ZGdZGdZGd ZGdZGd4ZGdZGd1ZGdZGd1ZGdZGd)ZGd'ZGdZGdZGdZGd ZGdZGdZGd ZGd ZGdZGdZGdZGd=ZGdZGdpZGdZGdAZGdZGdZGdZGdZGdZGd ZGdZGdd@]c@W@ (xKdd (xKdd (xKdd, (xKddS (xKdd (xKdd (xKdd' (xKdd (xKdd (xKdd (xKdd' (xKdd ,(xKdd ,(xKdd (xKdd (xKdd (xKdd7X(xKddd X(xKdddX(xKdddX(xKddd X(xKddd (xKdd (xKdd (xKdd (xKdd ,(xKdd! ,(xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd ,(xKdd:X(xKddd1X(xKddd0X(xKdddMX(xKddd8 (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd; (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd' (xKdd ,(xKdd; (xKdd ,(xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKddN (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd' (xKdd ,(xKdd( (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd# (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd" (xKdd (xKdd ,(xKddX(xKddd?X(xKdddX(xKddd[X(xKdddg (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd> (xKddX(xKdddX(xKdddX(xKdddX(xKddd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd ,(xKdd<X(xKddd$X(xKddd)X(xKddd\X(xKddd3 (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdda (xKdd (xKdd! (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKddI (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd9 (xKdd (xKdd' (xKdd (xKdd ,(xKdd (xKdd:X(xKdddbX(xKdddX(xKdddX(xKddd (xKddh<(xKddd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd/ (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd( (xKdd ,(xKdd (xKdd (xKdd/ (xKdd@ (xKddS (xKdd (xKdd! (xKdd (xKdd (xKdd8 (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd x(xKdd ,(xKdd* (xKdd# (xKdd (xKdd (xKdd3 (xKdd" (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKddJ (xKdd (xKddX(xKddd X(xKdddX(xKddd X(xKddd (xKdd (xKdd (xKdd (xKdd ,(xKddh<(xKddd (xKdd (xKdd (xKdd ,(xKdd#X(xKdddAX(xKdddKX(xKdddX(xKddd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd. (xKdd$ (xKdd4 (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd' (xKdd (xKdd ,(xKdd{ (xKdd (xKdd` (xKdd (xKddy (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd( (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKddH (xKdd (xKdd ,(xKddC (xKdd (xKdd8 (xKdd (xKdd= (xKddb (xKdd (xKdd ,(xKdd (xKdd (xKdd (xKdd= (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd; (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd' (xKdd ,(xKdd; (xKdd ,(xKddR (xKdd (xKdd. (xKdd= (xKddG (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd> (xKdd (xKdd (xKdd (xKdd# (xKdd (xKdd (xKdd (xKdd' (xKdd ,(xKdd` (xKdd (xKddGh<(xKdddh(xKdddh(xKdddh(xKddd (xKdd ,(xKddTX(xKdddLX(xKdddMX(xKdddRX(xKddd} (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd' (xKdd (xKdd (xKdd" (xKdd (xKdd (xKdd5 (xKdd (xKdd (xKdd (xKdd5 (xKdd' (xKdd (xKdd ,(xKdd$ (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd6 (xKdd (xKdd (xKdd (xKdd (xKdd0 (xKdd (xKdd (xKdd* (xKdd (xKdd ,(xKddw (xKddl (xKdd* (xKdd (xKdd< (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKddGh<(xKddd (xKdd (xKdd# (xKdd (xKdd (xKdd (xKdd (xKdd (xKddC (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd% (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd) (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd ,(xKddW (xKdd= (xKddK (xKdd@ (xKdd? (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKddC (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKddHh<(xKddd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd' (xKdd ,(xKdd (xKdd5h<(xKddd$X(xKddd2X(xKdddX(xKdddX(xKddd (xKdd/ (xKddD (xKdd( (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd" (xKdd6 (xKdd3 (xKdd3 (xKdd+ (xKdd! (xKdd (xKdd (xKdd (xKdd' (xKdd ,(xKdd ,(xKdd (xKdd? (xKddr (xKddC (xKdd (xKdd (xKdd (xKdd (xKdd (xKdd I O a  @+ 2 ;@< ]N ,l Ky 1@,@ l ,@ l ,@ l ,,@ l S,@ l ,@ l ,@ l ',@ l ,@ l ,@ l ,@ l ',@ l ,@ l ,@ l ,@ l ,@ l ,@ l 7X XXX X,@ l ,@ l ,@ l ,@ l ,@ l !,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l :X1X0XMX8,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ;,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ',@ l ,@ l ;,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l N,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ',@ l ,@ l (,@ l ,@ l ,@ l ,@ l ,@ l ,@ l #,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ",@ l ,@ l ,@ l X?XX[Xg,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l >,@ l XXXX,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l <X$X)X\X3,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l a,@ l ,@ l !,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l I,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l 9,@ l ,@ l ',@ l ,@ l ,@ l ,@ l :XbXXX,@ l h,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l /,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l (,@ l ,@ l ,@ l ,@ l /,@ l @,@ l S,@ l ,@ l !,@ l ,@ l ,@ l 8,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l *,@ l #,@ l ,@ l ,@ l 3,@ l ",@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l J,@ l ,@ l X XX X,@ l ,@ l ,@ l ,@ l ,@ l h,@ l ,@ l ,@ l ,@ l #XAXKXX,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l .,@ l $,@ l 4,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ',@ l ,@ l ,@ l {,@ l ,@ l `,@ l ,@ l y,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l (,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l H,@ l ,@ l ,@ l C,@ l ,@ l 8,@ l ,@ l =,@ l b,@ l ,@ l ,@ l ,@ l ,@ l ,@ l =,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ;,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ',@ l ,@ l ;,@ l ,@ l R,@ l ,@ l .,@ l =,@ l G,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l >,@ l ,@ l ,@ l ,@ l #,@ l ,@ l ,@ l ,@ l ',@ l ,@ l `,@ l ,@ l Ghhhh,@ l ,@ l TXLXMXRX},@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ',@ l ,@ l ,@ l ",@ l ,@ l ,@ l 5,@ l ,@ l ,@ l ,@ l 5,@ l ',@ l ,@ l ,@ l $,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l 6,@ l ,@ l ,@ l ,@ l ,@ l 0,@ l ,@ l ,@ l *,@ l ,@ l ,@ l w,@ l l,@ l *,@ l ,@ l <,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l Gh,@ l ,@ l #,@ l ,@ l ,@ l ,@ l ,@ l ,@ l C,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l %,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ),@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l W,@ l =,@ l K,@ l @,@ l ?,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l C,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l Hh,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ',@ l ,@ l ,@ l 5h$X2XXX,@ l /,@ l D,@ l (,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ",@ l 6,@ l 3,@ l 3,@ l +,@ l !,@ l ,@ l ,@ l ,@ l ',@ l ,@ l ,@ l ,@ l ?,@ l r,@ l C,@ l ,@ l ,@ l ,@ l ,@ l ,@ l 0@ 0 -  ( ' 5 0D b .f @ @ *@ "@ *@ @ @  0 1P Sl'\0PH R \bailey, Reference: and love 724$z jl\!<.`dd|#:!x"t}#D߄tm4Ptddz#<2޺{#&\@A January 2003 dGMMddGMMddGMMd(xKddd+@+@]PG SeriesAlPG Entrance ExaminationsdGMMddGd(dGMMd+(xKddd+.@\t't'|! |!   8 8 JJ  FFZGd*ZGdZGd&ZGdZGd2ZGdZGd ZGdZGd%ZGdZGd9ZGdZGd/ZGd ZGd ZGdZGdFZGdZGd ZGdZGdZGd ZGdlZGd ZGdZGdEZGdZGd=ZGdZGdQZGdZGdEZGd ZGdlZGdZGd5ZGdZGd\ZGdZGdZGdZGd.ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGdOZGd ZGd ZGdZGdZGdZGd ZGd ZGdZGd ZGdZGdFZGdZGd1ZGdZGdDZGdZGdOZGd ZGdZGdZGdZGdCZGdZGd\ZGdZGdZGd ZGdZGdZGdZGdZGdZGdZGd ZGdZGd+ZGdZGd ZGdZGdZGdZGd ZGd ZGdZGdZGdZGd ZGdZGdZGdZGdEZGdZGd2ZGdZGd4ZGd ZGdAZGdZGdWZGdZGdZGd ZGdZGdZGdZGd6ZGdZGdBZGd ZGdZGdZGdHelvetica Ins"Hobo BTHoboDEERHollyweirdHomePlanningRHomePlanning2RHonda"HoratioDBolHoratioDLigHoratioDMedHorizon BT"HorndonDHouseholdRHumanst521 BT"Humanst521 Cn BT"Humanst521 Lt BT"Humanst521 UBd BT"Humanst521 XBd BT"Humanst521 XBdCn BT"Humanst531 Blk BT"Humanst531 BT"Humanst531 UBlk BT"Humanst970 BT"Humnst777 Blk BT"Humnst777 BT"Humnst777 Lt BT"HumstSlab712 Blk BTHumstSlab712 BTHuxleyVertical BT"HygieneRIceAgeDImperial BTImpress BTImpuls BTIncised901 Bd BT"Incised901 BdCn BT"Incised901 BT"Incised901 Ct BT"Incised901 Lt BT"Incised901 Nd BT"Incised901 NdIt BT"Industrial736 BTInformal011 Blk BT"Informal011 BT"IowanOldSt Blk BTIowanOldSt BTIrelandITC Officina Sans Book"ITC Officina Serif BookKabarettDKabel Bd"Kabel Bk BT"Kabel Dm BT"Kabel Md BT"Kabel Ult BT"KabelItcTEERKabelItcTEEDemRKabelItcTEEMedRKabelItcTEEUltRKaufmann Bd BTBKaufmann BTBKeypunchKeystrokeKhaki Two"KidnapRKidsKis BTKorinna BTKuenst480 Blk BTKuenst480 BTKunstlerschreibschDBolKunstlerschreibschDMedLandmarksRLandscapePlanningRLetterGotLCYBolRLetterGotLCYMedRLifeTEERLithos Regular"LubalinGraItcTEERLubalinGraItcTEEMedRLucidaSanTCYRMachineItcDEERMaximaCyrTCYLigComRMedicineRMicrogrammaDEEBolExtRCentScEmboss"Empire BT"EnglischeSchTEnglischeSchTDemBolEnglish111 Adagio BTBEnglish111 Presto BTBEnglish111 Vivace BTBEnglish157 BTBEngraversGothic BT"EngravrsRoman Bd BTEngravrsRoman BTEngrvrsOldEng Bd BTEngrvrsOldEng BTEnviroDEnviroDEEREras Bd BT"Eras Bk BT"Eras Contour"Eras Lt BT"Eras Md BT"Eras Ult BT"ErasItcPEEUltRErasItcTEERErasItcTEEDemRErasItcTEELigRErasItcTEEMedREwieDExotc350 Bd BT"Exotc350 DmBd BT"Exotc350 Lt BT"ExpoExPonto Regular"FestiveRFirenze"FlamencoDFlamencoInlDFlareserif821 BT"FlashDBolFlashDLigFlemishScript BTBFolioTEEBolConRFolioTEEMedRFoodRFranklinGotItcTEEBooRFranklinGotItcTEEDemRFranklinGotItcTEEHeaRFreehand471 BTFreehand521 BTBFreehand575 BTBFreehand591 BTBFreestyle Script"FreestyleScrDFreestyleScrDEERFrizQuadrata BT"FrizQuaItcTEERFurnitureRFuturaTEERFuturaTEEBolConRFuturaTEELigRFuturaTEELigConRFuturaTEEMedRFuturaTEEMedConRGaramond BookCondensedGaramond LightCondensedGaramondItcTEERGaramondItcTEEConRGaramondNo4CyrTCYLigRGaramondNo4CyrTCYMedRGaramondNo4TEELigRGaramondNo4TEEMedRGeographicSymbolsRGiddyup"GoudyOldStyTEERGoudyOldStyTEEExtBolRGreymantle MVB"HandelGotDBolHandelGotDLigHandelGothic BTHarlowDHarpoonHazelHehenHebTBolRHelv"Modern"Helvetica 55"ElegaGMilitaryRMilitaryIDRMinion CondensedMinion OrnamentsRMojo"MorseCodeRMurrayHilDEERMusicRMusicalSymbolsRMyriad Roman"Myriad Tilt"NauticalFlagsRNevisonCasDEERNicolasCocTEEBlaRNicolasCocTEERegRNimbusRomDCYRNimbusSanLCYRNimbusSanNo5TCYRNimbusSanNo5TCYMedRNueva BoldExtendedNueva RomanNuptialScriptNyxOCRA Alternate"OfficePlanningROuch"ParkAveDEERPeopleRPITARA-A01RELIGIOUSPITARA-A02RELIGIOUSPITARA-A03RELIGIOUSPITARA-A04RELIGIOUSPITARA-A05RELIGIOUSPITARA-A06RELIGIOUSPITARA-A07RELIGIOUSPITARA-A08RELIGIOUSPITARA-A09RELIGIOUSPITARA-A10RELIGIOUSPITARA-A11RELIGIOUSPITARA-A12RELIGIOUSPlantsRPoetica ChanceryIPompeia Inline"Postino ItalicRevuePEERSanvito LightSanvito RomanScienceRSemaphoreRSerifaDEERSerifaDEELigRSerpentineDEEBolRShapes1RShapes2RShuriken Boy"Sign LanguageRSignsRSouvenirItcTEEDemRSouvenirItcTEELigRSpaceRSports&HobbiesRSportsFiguresRSpumoni LPStars1RStars2RStencilDEERSymbolProp BTkRTechnologyRTektoMM_100 LT 250 CN"TektoMM_100 LT 564 NO"TektoMM_100 LT 850 EX"TektoMM_240 RG 250 CN"TektoMM_240 RG 850 EX"TektoMM_503 BD 250 CN"TektoMM_503 BD 488 NO"TektoMM_503 BD 850 EX"TimelessTCYLigRTms RmnRomanToolsRTracksRTransportationRUmbra BTUnivrstyRoman Bd BTUnivrstyRoman BTMediciUptight Neon"UtopiaVAG Rounded Lt"VAG Rounded Th"VanDijkDEERViva BoldExtraExtendedViva RegularWalkman-Chanakya-901"Walkman-Chanakya-Bd-Italix-901"Walkman-Chanakya-Boldx-901"Walkman-Chanakya-Italix-901"WeatherRWillowWoodtype Ornaments 1RZapfDingbats BToRMarlettLucida Console1Tahoma"Courier New1WingdingsArial Black"Comic Sans MSBImpact"Verdana"WebdingsWP Greek CenturyWP MultinationalA Courier1WP MultinationalB Courier1WP BoxDrawing1 WP Greek Courier1WP Hebrew DavidWP MultinationalA HelveWP MultinationalB HelveWP Phonetic"WP TypographicSymbolsWP IconicSymbolsAWP IconicSymbolsBWP MathAWP MathBWP MathExtendedAWP MathExtendedBWP Greek HelveWP JapaneseWP MultinationalA RomanWP MultinationalB RomanWP CyrillicAWP CyrillicBWP Arabic SihafaWP ArabicScript SihafaHaettenschweiler"Bookman Old StyleMonotype SortsGaramondMS OutlookBookshelf Symbol 1"Bookshelf Symbol 2Bookshelf Symbol 4"Bookshelf Symbol 5Albertus Extra Bold"Albertus Medium"Antique Olive"CG Omega"CG TimesClarendon CondensedCoronetBLetter Gothic1MarigoldBUnivers"Univers Condensed"Palatino-Bold ThPalatino-ItalicBook AntiquaDauphinFuturaBlack BTRFutura Md BT"Futura XBlk BT"Futura Lt BT"GoudyHandtooled BTRGoudyOlSt BTLithographLithographLightRMT ExtraOzHandicraft BTBPosterBodoni BTSerifa BTModernArial" !Bookshelf Symbol 3!Helvetica" !Palatino!Symbol!ZapfDingbatsR!Times!Arial Narrow"!Times New Roman!TektoMM_240 RG 564 NO"TektoMM"Aachen BTAachenDEEMedRAdLib BTAGaramondAldine401 BTAldine721 BTAldine721 Lt BTAlefbetAlexei Copperplate"AlgerianBasDAlgerianBasDEERAlgerianDAllegro BTRAlternateGothic2 BT"Amazone BTBAmelia BTAmericana BTAmericana XBd BTAmericana XBdCn BTAmericanText BTAmericanTypItcDEEBolRAmericanTypItcDEEMedRAmericanUncDAmeriGarmnd BTAmerigo BTAmerigo Md BTAmerType Md BTAnimals 1RAnimals 2RArchitectureArnoldBoeDArriba ArribaArrows1RArrows2RArrus Blk BTArrus BTArsisDEERegRArsisDRegAtlantic Inline"Aurora BdCn BT"Aurora Cn BT"AvantGarde Bk BT"AvantGarde Md BT"AvantGarGotItcTEERAvantGarGotItcTEEDemRAwardsRBakerSignet BTBBalloon Bd BTBalloon Lt BTBalloon XBd BTBalloonsRBangBankGothic Lt BT"BankGothic Md BT"BardBaskervilleOldFacDEERBauerBodDEERBauerBodni BdCn BTBauerBodni Blk BTBauerBodni BlkCn BTBauerBodni BTBauerBodni Titl BTBauhaus Hv BT"Bauhaus Lt BT"Bauhaus Md BT"BauhausITCEEHeaRBauhausItcTEEBolRBauhausItcTEEMedRBedrockBeehiveBellCent Add BT"BellCent BdList BT"BellCent NamNum BT"BellCent SubCap BT"BellCent NamNum BT"BellCent SubCap BT"Arial" !Bookshelf Symbol 3!Helvetica" !Palatino!Symbol!ZapfDingbatsR!Times!Arial Narrow"!Times New Roman!TektoMM_240 RG 564 NO"TektoMM"Aachen BTAachenDEEMedRAdLib BTAGaramondAldine401 BTAldine721 BTAldine721 Lt BTAlefbetAlexei Copperplate"AlgerianBasDAlgerianBasDEERAlgerianDAllegro BTRAlternateGothic2 BT"Amazone BTBAmelia BTAmericana BTAmericana XBd BTAmericana XBdCn BTAmericanText BTAmericanTypItcDEEBolRAmericanTypItcDEEMedRAmericanUncDAmeriGarmnd BTAmerigo BTAmerigo Md BTAmerType Md BTAnimals 1RAnimals 2RArchitectureArnoldBoeDArriba ArribaArrows1RArrows2RArrus Blk BTArrus BTArsisDEERegRArsisDRegAtlantic Inline"Aurora BdCn BT"Aurora Cn BT"AvantGarde Bk BT"AvantGarde Md BT"AvantGarGotItcTEERAvantGarGotItcTEEDemRAwardsRBakerSignet BTBBalloon Bd BTBalloon Lt BTBalloon XBd BTBalloonsRBangBankGothic Lt BT"BankGothic Md BT"BardBaskervilleOldFacDEERBauerBodDEERBauerBodni BdCn BTBauerBodni Blk BTBauerBodni BlkCn BTBauerBodni BTBauerBodni Titl BTBauhaus Hv BT"Bauhaus Lt BT"Bauhaus Md BT"BauhausITCEEHeaRBauhausItcTEEBolRBauhausItcTEEMedRBedrockBeehiveBellCent Add BT"BellCent BdList BT"BellCent NamNum BT"BellCent SubCap BT"aD+CX( ca0*CXr @B, Czcam3#hXChcam2#hX<#hX7#hX5#hX=#hXChn@B,Crcam9#hX7+hX>#hX7#hX)Ch: cC,Cca<9ChX@B<cc,CcaNCXecaDCXca0CXq@B,Ch @B7C@@xCc) C@ C C@B, Ccam7#hXCh cam9+hX2Chcam;#hX4ChqcamChcaZCcaZ C @B, Cca:7#XhCXcaNCX7caD.#XhCXca07#Xh CXR@B, Cz=#>#6#Cj@B,Cr7#,CcC,Cca<7+hXCh @B<ca:CXcaNCXcaDCXca0CX@B,(C @B.Co@@xCc)C@ CC@B, CCcamChcam Ch\ caZ CmcaZCcam Chcam.Ch cam%Ch cam-Ch| camChcaZCcaZ C5caZC camCh@B, CC:@B, Cz?#C#Cp@B,Cr7#CcC,CDca<*Ch @B<ca:CX9caNCXcaDCXca0CX?@B,2CT@B4#)C+ @@xCcuC@ C C@B, C8#C@B, Cca:3#Xh"CX caN3#Xh CXscaD3#XhCXca05#XhCX/@B, Cz:#"C @B,Cr:CCC(ca<;#hX3#hX6+hXCh@B<ca:CXlcaN CXcaDCXWca0CX @B,8C@BC@@xcamChcaZ C>camChcaZC camChscaZ C>cam#Chp caZ C>cam%ChW caZC cam Ch8caZ$Cp caZ CcaZCcaZCAcaZ3# C camCh2 caZCcaZ:C`caZ/CcaZCmcaZ-C caZ%C ca4Cca42CCc C@ C C@B, C Ccam6#hX-Ch cam ChVcamChjcam7ChAcaZ'C caZ&C caZ3+ C camChr @B, Cca:CX?caN0CXwcaDCXLca0*CX @B, Cz?#C cC,?c5#,%C @B,Cr8#5#6#:#=#9#:#)CcC,CTca<7#hX:#hX/Ch@@<ca:"CX caN(CX caD0CXca04#Xh"CX @B,3C4@BC @@xC@@@#"c C@ @@ CCC @@, C9#6#C}@B, Cca:%CXo caN(CX caD8#XhCXca08#Xh$CX @B, Cz8C@B,Cr=# CCC@"BardBaskervilleOldFacDEERBauerBodDEERBauerBodni BdCn BTBauerBodni Blk BTBauerBodni BlkCn BTBauerBodni BTBauerBodni Titl BTBauhaus Hv BT"Bauhaus Lt BT"Bauhaus Md BT"BauhausITCEEHeaRBauhausItcTEEBolRBauhausItcTEEMedRBedrockBeehiveBellCent Add BT"BellCent BdList BT"BellCent NamNum BT"BellCent SubCap BT"MThZGdZGdZGdZGdZGdZGd3ZGd ZGdZGdZGdZGdZGdZGd ZGd ZGdZGd ZGdZGdZGdZGd/ZGdZGdZGdZGd)ZGdZGd^ZGdZGd[ZGdZGdZGdZGdZGdZGd"ZGdZGd(ZGdZGd0ZGdZGdVZGd ZGd*ZGdZGdZGd ZGdZZGdZGdZGdZGdZGd ZGdZGd ZGdZGd%ZGdZGd(ZGdZGdVZGdZGd\ZGd ZGd8ZGdZGdFZGdZGd3  ,]K .HP LaserJet 2100 Series PCL 6HP LaserJet 2100 Series PCL 6LPT1:@@xGMMd(xKdddContents^tIndex ,^>;^>^=.^>X C:\PM6\RSRC\USENGLSHxA88dd0PP  db ..--__  DAdobe Compatibility CMSAdobe Compatibility CMSPageMaker 5.0 RGBDAdobe Compatibility CMS Adobe Compatibility CMSPageMaker 5.0 CMYK 1 0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-k  0pP0PP T 2 # '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-k0h0pP0PP U 3N#0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0hPp0PP V@MI  '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP WA@n0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP XB '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP YC0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP ZDO8U '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP [E0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP \cam&ch cCZcam"chV cCZcam/chCZcA@@<c<7#hX=#hX*Ch @B<Lca: CXcaN%CX caD9CXhca0/CX @B,LC@BLB#C@@xC C@B,L C5#7C@B,L Cca::#Xh CX caN3+Xh CX<caD8#XhCXLca03#XhCX@B,L Cz8#4C@B,LCr5CcamChcaZ1+ CjcaZ CC&camChcaZ2# C caZ-# CcaZCcamChcaZ CcaZ CC@@<C<ca<5#hX4#hX6#hXCh @B<ca:CXcaNCXcaDCXca0CX @B,#C @BB# C@@xCc)C@ CC@B, C4#8#8#>#C@B, Cca:4#XhCXBcaN1CXcaD6#XhCXca03+XhCX@B, CzcamChcaZCcaZ;#CcaZCcamChcaZ CcaZ CcaZCv@B,Crcam'Ch cam/Chy cC,C`ca<8#hX4#hX8#hX'Ch @B<ca: CX}caNCXcaDCX; ca0CX@B,)C @B+CN @@xc)C@ CC@B, CCcamChcam ChcamChcamCh1camChcamCh cam6+hX Chcam-Chcam3Ch@B, Cca:CXcaN9#Xh CXcaD2CXca04CX@B, CzAC@B,Cr5#"C C@ca<7+hX7#hX&Ch @@<ca: CX$caNCXcaD6CXhca03#XhCX@B,C2@BA#C@@xCcnC@ C C@B, C:#<#C$@B, CC:@B, Cz;#Cc:#,)C @B,Cr=#CcC,C(ca<6#hX8#hXCh @B<ca:CXcaNCX&caDCXca0#CX @B,C7 @BC#%C @@xCc C@ CCz@B, C/CP C-ca8#hX;#hX Chca9#hX.Ch ca4Ch`C!caChcaChca9+hXChca Chzc ,@ l h Oh ,@ l *h2h,@ l hX"X"X#X,@ l !,@ l \,@ l ,@ l ,@ l h hh hhhDh0hFirst symptom is loss of accommodation First sign is presence of keratin precipitates 160. A recurrent bilateral conjunctivitis occurring with the onset of hot weather in young boys with symptoms of burning, itching, and lacrimation with polygonal raised areas in the palpebral conjunctiva is: A. Trachoma. B. Phlyctenular conjunctivitis. C. Mucopurulent conjunctivitis. D. Vernal kerato conjunctivitis. Answer: D (Vernal kerato conjunctivitis) Ref: Basak 2nd edn, 104; Nema 4th edn, 121 Quality: Spotter Status: Repeat QTDF: All books Discussion Vernal conjunctivitis Called spring catarrh Bliateral Exogenous allergen Itching Ropy discharge Maxwell-Lyon sign Palpebral conjunctiva has cobble stone appearance (polygonal) Bulbar conjunctiva has Horner -Trantas spots Cornea has pseudogerantoxon with cupid bow outline Explanation A. Trachoma has follicles. B. Phlyctenular conjunctivitis is unilateral and itching is not marked. C. Mucopurulent conjunctivitis may not be recurrent. D. Vernal kerato conjunctivitis is the correct choice. Comments The history and signs point classically to vernal conjunctivitis Tips Sareoidosis may produce ORANGE, nodular, translucent lesions in folds of lower fornix. 161. A child has got a congenital cataract involving the visual axis, which was detected by the parents right at birth. This child should be operated: A. Immediately. B. At 2 months of age. C. At 1 year of age when the globe becomes normal sized. D. After 4 year when entire ocular and orbital growth become normal. Answer: A (Immediately) Ref: Parson 19th edn, 285; Kanski 4th edn, 177; SKBasak 2nd edn, 173 Quality: Spotter Status: Repeat QTDF: Parson Discussion Treatment is not required in cataract until the vision is considerably impaired. Visually significant cataract should be operated immediately. Explanation Self Explanatory Comments 2 to 4 months of age is the critical period for developing fixation reflex. Lamellar cataracts are operated after 4 years when entire ocular and orbital growth become normal. Tips Read the types of cataracts!! You are sure to get a question in this topic. 162. A lady wants LASIK surgery for her daughter. She asks for your opinion. All the following things are suitable for performing LASIK, except: A. Myopia of 4 diopters. B. Age of 15 years. C. Stable refraction for 1 year. D. Corneal thickness of 600 microns. Answer: B (Age of 15 years) Ref: Journals on LASIK ; Online Extension of the book Sure Success in PG, http://pgentrance.tripod.com Quality: Reader Status: New QTDF: Latest books Discussion Laser assisted in situ keratomileusis (LASIK) Indications 1. Approved range for myopic correction is 0.5 to 14.00 diopters (2 to 12 D; Parsons), with up to 5 diopters of astigmatism 2. Residual stromal bed thickness should be at least 250 mm (i.e. total corneal thickness of 550-600 mm) 3. Hyperopic corrections have been approved for +4.00 Contraindications 1. Unstable refractive error. 2. Age less than 21 years. 3. Active collagen vascular disease (especially in the presence of iritis or scleritis). 4. Pregnancy. 5. Presence of a pacemaker. 6. Any ongoing active inflammation of the external eye (eg, conjunctivitis, severe dry eye). 7. Refractive error outside the range of laser correction. 8. Keratoconus Patient selection for LASIK (preoperative workup) 1. Contact lens wear should be discontinued prior to the examination 3 days for soft contact lens wear 2 weeks for rigid gas permeable lenses. 2. A complete eye examination Manifest and cycloplegic refraction Slit lamp examination Dilated fundus examinationindirect ophthalmoscopy Corneal topography An estimate of scotopic pupil size is helpful in screening candidates that may be at risk for postoperative glare Procedure 1. Paint, drape, place speculum. 2. A suction ring placed on the eyeball elevates IOP to about 60 mmHg (temporary blackout of vision occurs). 3. The microkeratome advances and creates an epithelial flap, which is hinged usually nasally. 4. The flap is lifted and laser ablation of stroma done. Excimer Laser is used: Leave behind residual corneal thickness of at least 250 microns. Irrigate bed with saline and close the flap. No sutures. It sticks by itself. Use antibiotics and steroid drops for about 1 week. Enhancements Enhancement LASIK (i.e. repeat procedure) can be performed but usually after 3 months of table refraction. Super Vision Wavefront technology in LASIK aims to correct all aberrations of the eye to give vision beyond 6/6super vision. Explanation A. Myopia of 4 diopters is an indication. B. Age of 15 years is a contraindication. In fact, age less than 21 is condratindication. C. Stable refraction for 1 year is needed. D. Corneal thickness of 600 microns is needed. Comments Compilation by Dr.Ramgopal.MS Ophthal, author of Sure Success in PG at his website Tips More such useful topics are in his website http://pgentrance.tripod.com 163. The operation of plication of inferior lid retractors is indicated in: A. Senile ectropion. B. Senile entropion. C. Cicatricial entropion. D. Paralytic entropion. Answer: B (Senile entropion) Ref: Basak 2nd edn, 77; ,C(ca<6#hX8#hXCh @B<ca:CXcaNCX&caDCXca0#CX @B,C7 @BC#%C @@xCc C@ CCz@B, C/CP C-ca8#hX;#hX Chca9#hX.Ch6 ca4Ch`C!caChcaChca9+hXChca Chzc#X(xKddd ,(xKdd ,(xKddO x(xKdd2 (xKdd ,(xKdd (xKdd ,(xKddJX(xKddd5X(xKdddHX(xKdddSX(xKddd ,(xKddh(xKddd (xKdddO(xKddd(xKdddh(xKddd (xKddd(xKddd(xKddd ,(xKdd*h(xKddd2h(xKddd (xKddh<(xKdddX(xKddd"X(xKddd"X(xKddd#X(xKddd ,(xKdd! ,(xKdd      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxz{|}~+ x(xKdd1 (xKdd ,(xKdd (xKddh(xKddd h(xKdddh(xKddd h(xKdddh(xKdddh(xKdddDh(xKddd0h(xKddd6h(xKddd ,(xKddX(xKdddIX(xKddd6X(xKddd8X(xKddd ,(xKddA (xKdd ,(xKddW (xKddh<(xKdddX(xKdddX(xKddd:X(xKdddqh(xKddd ,(xKddLX(xKdddX(xKddd/X(xKddd.X(xKddd ,(xKddKh(xKddd*h(xKddd ,(xKddh(xKddd (xKdd?h<(xKddd (xKddX(xKdddX(xKdddX(xKddd ,(xKdd ,(xKdd x(xKdd x(xKdd x(xKdd x(xKdd (xKdd (xKdd ,(xKddPh(xKdddnh(xKdddrh(xKdddh(xKddd(xKddd#(xKddd ,(xKddMX(xKdddX(xKddd@X(xKdddEX(xKddd ,(xKdd (xKdd ,(xKddc (xKdd (xKddh<(xKdddYh<(xKdddX(xKdddX(xKddd"X(xKdddX(xKddd ,(xKdd ,(xKdd. x(xKdd (xKdd) (xKdd ,(xKdd (xKddh(xKddd#h(xKddd(xKddd(xKdddh(xKddd1h(xKddd(h(xKddd0h(xKdddh(xKddd(xKddd(xKddd(xKdddh(xKddd ,(xKdd (xKdd ,(xKdd (xKdd ,(xKddF (xKdd (xKdd0h<(xKdddX(xKdddX(xKdddX(xKdddX(xKddd ,(xKdd ,(xKdd ,(xKdd x(xKdd x(xKdd x(xKddC. Direct laser ablation using p ,@ l hRhh^hxhhMhhqh ,@ l LXX/X.X ,@ l Kh*h,@ l h,@ l ?h,@ l XXX,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l Phnhrhh# ,@ l MXX@XX&caDCXca0#CX @B,C7 @BC#%C @@xCc C@ CCz@B, C/CP C-ca8#hX;#hX Chca9#hX.Ch6 ca4Ch`C!caChcaChca9+hXChca Chzc"h(xKdddh<(xKdddX(xKddd)X(xKddd=X(xKddd3X(xKddd ,(xKdd ,(xKddF x(xKdd (xKdd ,(xKddl (xKdd ,(xKddIX(xKdddAX(xKdddUX(xKdddIX(xKddd ,(xKddl (xKdd ,(xKdd5 (xKddh(xKddd>(xKddd(xKdddh(xKdddU(xKddd:(xKddd(xKdddh(xKddd(xKddd(xKdddh<(xKdddX(xKdddX(xKdddX(xKddd"DAdobe Compatibility CMSAdobe Compatibility CMSPageMaker 5.0 RGBDAdobe Compatibility CMS Adobe Compatibility CMSPageMaker 5.0 CMYKfc//2cc@c.@@<.--f00%%((   @     @ @5     1  @1 @4< =    2 4da  @  9 9 @: :     +< @< < @= @c@BBEZGdZGd ZGdZGdZGdZGdZGdZGdZGd ZGdZGd ZGdZGd ZGdLZGddZGdZGdLZGdZGdZGdZGdZGdZGdZGdZGdZGd"ZGd ZGdZGdZGdZGdOZGd ZGdZGdZGdZGdZGdZGd ZGdZGdZGdZGd ZGdZGdZGd:ZGdZGd*ZGdZGdZGd8ZGdZGdZGd ZGdZGd\ZGdZGdZGd_ZGd=ZGdZGd3ZGdGZGd&ZGd,ZGd ZGd(ZGdZGd;ZGdZGdwZGd ZGdZGd#ZGdoZGdaZGd;ZGdZGdEZGdRZGd8ZGd ZGdZGdpZGd ZGdZGdyZGd ZGdZGd'ZGdZGdWZGdZGd(ZGdZGd,ZGd ZGdSZGdZGdHZGdRZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGdZGd ZGdZGd ZGdZGdZGd ZGdZGdGZGdZGdZGdZGdZGdJZGdZGdZGdZGdZGdZGdZGdZGdZGdAZGdZGdZGdZGd ZGdZGdZGdZGdZGdZGdZGdZGd ZGdZGdZGdZGd&ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdy CMSG,@ l 'h,@ l th3,@ l Gh&, h(;w ,@ l .h,@ l EhRh8h ,@ l ph ,@ l yh ,@ l ,X\X-X1X ,@ l S,@ l ,@ l H,@ l MhXXXX,@ l ,@ l ,@ l ,@ l ,@ l ,@ l (xKddd|(xKddd ,(xKddh(xKddd ,(xKdd (xKdd ,(xKdd (xKdd (xKdd (xKddh<(xKdddX(xKdddX(xKdddX(xKdddX(xKddd ,(xKdd ,(xKdd x(xKdd9 x(xKdd* x(xKdd (xKdd0 (xKdd ,(xKdd9 (xKdd ,(xKdd-X(xKddd?X(xKdddIX(xKddd$X(xKddd ,(xKdd (xKdd ,(xKddS (xKdd (xKddEh<(xKdddX(xKdddX(xKdddX(xKdddX(xKddd ,(xKdd ,(xKdd x(xKdd x(xKdd x(xKdd (xKdd& (xKdd ,(xKddh(xKdddRh(xKdddh(xKddd^h(xKdddxh(xKdddh(xKdddMh(xKdddh(xKddd9#hXaD+CX( ca0*CXr @B, Czcam3#hXChcam2#hX<#hX7#hX5#hX=#hXChn@B,Crcam9#hX7+hX>#hX7#hX)Ch: cC,Cca<9ChX@B<cc,CcaNCXecaDCXca0CXq@B,Ch @B7C@@xCc) C@ C C@B, Ccam7#hXCh cam9+hX1ChRcam;#hX4ChqcamChcaZCcaZ C @B, Cca:7#XhCXcaNCX7caD.#XhCXca07#Xh CXR@B, Cz=#>#6#Cj@B,Cr7#,CcC,Cca<7+hXCh @B<ca:CXcaNCXcaDCXca0CX@B,(C @B.Co@@xCc)C@ CC@B, CCcamChcam Ch\ caZ CmcaZCcam Chcam.Ch cam%Ch cam-Ch| camChcaZCcaZ C5caZC camCh@B, CC:@B, Cz?#C#Cp@B,Cr7#CcC,CDca<*Ch @B<ca:CX9caNCXcaDCXca0CX?@B,2CT@B4#)C+ @@xCcuC@ C C@B, C8#C@B, Cca:3#Xh"CX caN3#Xh CXscaD3#XhCXca05#XhCX/@B, Cz:#"C @B,Cr:CCC(ca<;#hX3#hX6+hXCh@B<ca:CXlcaN CXcaDCXWca0CX @B,8C@BC@@xcamChcaZ C>camChcaZC camChscaZ C>cam#Chp caZ C>cam%ChW caZC cam Ch8caZ$Cp caZ CcaZCcaZCAcaZ3# C camCh2 caZCcaZ:C`caZ/CcaZCmcaZ-C caZ%C ca4Cca42CCc C@ C C@B, C Ccam6#hX-Ch cam ChVcamChjcam7ChAcaZ'C caZ&C caZ3+ C camChr @B, Cca:CX?caN0CXwcaDCXLca0*CX @B, Cz?#C cC,?c5#,%C @B,Cr8#5#6#:#=#9#:#)CcC,CTca<7#hX:#hX/Ch@@<ca:"CX caN(CX caD0CXca04#Xh"CX @B,3C4@BC @@xC@@@#"c C@ @@ CCC @@, C9#6#C@B, Cca:%CXo caN(CX caD8#XhCXca08#Xh$CX @B, Cz8C@B,Cr=# CCC@Xqh(xKddd ,(xKddLX(xKdddX(xKddd/X(xKddd.X(xKddd ,(xKddKh(xKddd*h(xKddd ,(xKddh(xKddd (xKdd?h<(xKddd (xKddX(xKdddX(xKdddX(xKddd ,(xKdd ,(xKdd x(xKdd x(xKdd x(xKdd x(xKdd (xKdd (xKdd ,(xKddPh(xKdddmh(xKdddrh(xKdddh(xKddd(xKddd#(xKddd ,(xKddMX(xKdddX(xKddd@X(xKdddEX(xKddd ,(xKdd (xKdd ,(xKddc (xKdd (xKddh<(xKdddYh<(xKdddX(xKdddX(xKddd"X(xKdddX(xKddd ,(xKdd ,(xKdd. x(xKdd (xKdd) (xKdd ,(xKdd (xKddh(xKddd#h(xKddd(xKddd(xKdddh(xKddd1h(xKddd(h(xKddd0h(xKdddh(xKddd(xKddd(xKddd(xKdddh(xKddd ,(xKdd (xKdd ,(xKdd (xKdd ,(xKddF (xKdd (xKdd0h<(xKdddX(xKdddX(xKdddX(xKdddX(xKddd ,(xKdd ,(xKdd ,(xKdd x(xKdd x(xKdd x(xKddC,Cca<;#hX#Ch@B<ca:CXcaNCXcaDCXca0CXc@B,C @B2C@@xCc)C@ C C@B, Ccam6#hX6+hX%Ch cam7+hXChcam:#hX5+hXChcam9#hX"Ch cam9+hX5#hXChcam:#hX9+hX'Ch cam9#hXChcam:+hX=+hX Chcam;#hX3Chq@B, Cca:7#XhCXnCBcaN8#Xh6+Xh5CXFc| ,@ l h ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l hXXXX,@ l ,@ l ,@ l 9,@ l *,@ l ,@ l 0,@ l ,@ l 9,@ l ,@ l -X?XIX$X|,@ l EhXXXX,@ l ,@ l ,@ l ,@ l ,@ l ,@ l &,@ l 1 0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-k  0pP0PP T 2 # '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-k0h0pP0PP U 3N#0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0hPp0PP V@MI  '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP WAl0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP XB '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP YC0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP ZDO8U '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP [E90񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP \FX(xKddd ,(xKdd ,(xKddE x(xKdd0 (xKdd ,(xKdd (xKdd ,(xKdd (xKdd ,(xKdd (xKdd ,(xKddL (xKdd (xKddh<(xKdddX(xKdddX(xKddd#X(xKddd'X(xKddd ,(xKdd ,(xKdd x(xKdd x(xKddP x(xKdd (xKdd( (xKdd ,(xKdd; (xKdd'h(xKddd (xKddth(xKddd3 (xKddGh(xKddd&(xKddd,(xKddd h(xKddd((xKddd(xKddd;(xKddd(xKdddw(xKddd (xKdd.h(xKddd (xKddEh(xKdddRh(xKddd8h(xKddd (xKddph(xKddd (xKddyh(xKddd ,(xKdd,X(xKddd\X(xKddd-X(xKddd1X(xKddd ,(xKddS (xKdd ,(xKddH (xKddMh<(xKdddX(xKdddX(xKdddX(xKdddX(xKddd ,(xKdd ,(xKdd x(xKdd x(xKdd (xKdd ,(xKdd (xKddh(xKddd(xKddd(xKddd(xKddd(xKdddh(xKddd%(xKddd(xKddd2(xKdddh(xKddd(xKddd (xKdddA(xKddd(xKdddc(xKdddh(xKddd(xKddd(xKdddw0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP qMnI '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP  S (0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP   s; '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP $y0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP N+0a~ '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP O-t>0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP P. S '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP Q/A0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP R0 '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-k00Pp0PP SaD+CX( ca0*CXr @B, Czcam3#hXChcam2#hX<#hX7#hX5#hX=#hXChn@B,Crcam9#hX7+hX>#hX7#hX)Ch: cC,Cca<9ChX@B<cc,CcaNCXecaDCXca0CXq@B,Ch @B7C@@xCc) C@ C C@B, Ccam7#hXCh cam9+hX1ChRcam;#hX4ChqcamChcaZCcaZ C @B, Cca:7#XhCXcaNCX7caD.#XhCXca07#Xh CXR@B, Cz=#>#6#Cj@B,Cr7#,CcC,Cca<7+hXCh @B<ca:CXcaNCXcaDCXca0CX@B,(C @B.Co@@xCc)C@ CC@B, CCcamChcam Ch\ caZ CmcaZCcam Chcam.Ch cam%Ch cam-Ch| camChcaZCcaZ C5caZC camCh@B, CC:@B, Cz?#C#Cp@B,Cr7#CcC,CDca<*Ch @B<ca:CX9caNCXcaDCXca0CX?@B,2CT@B4#)C+ @@xCcuC@ C C@B, C8#C@B, Cca:3#Xh"CX caN3#Xh CXscaD3#XhCXca05#XhCX/@B, Cz:#"C @B,Cr:CCC(ca<;#hX3#hX6+hXCh@B<ca:CXlcaN CXcaDCXWca0CX @B,8C@BC@@xcamChcaZ C>camChcaZC camChscaZ C>cam#Chp caZ C>cam%ChW caZC cam Ch8caZ$Cp caZ CcaZCcaZCAcaZ3# C camCh2 caZCcaZ:C`caZ/CcaZCmcaZ-C caZ%C ca4Cca42CCc C@ C C@B, C Ccam6#hX-Ch cam ChVcamChjcam7ChAcaZ'C caZ&C caZ3+ C camChr @B, Cca:CX?caN0CXwcaDCXLca0*CX @B, Cz?#C cC,?c5#,%C @B,Cr8#5#6#:#=#9#9#)CcC,CTca<7#hX:#hX/Ch@@<ca:"CX caN(CX caD0CXca04#Xh"CX @B,3C4@BC @@xC@@@#"c C@ @@ CCC @@, C9#6#C@B, Cca:%CXo caN(CX caD8#XhCXca08#Xh$CX @B, Cz8C@B,Cr=# CCC@(xKdd@h=20(O3,@ l ,@ l fhhh:h*)V"h ,@ l X4X X.X ,@ l ,@ l ,@ l ,@ l ,@ l h&X,X4XZX,@ l +,@ l ,@ l ,@ l ,@ l d x(xKdd ,@ l hRhh^hxhhMhhqh ,@ l LXX/X.X ,@ l Kh*h,@ l h,@ l ?h,@ l XXX,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l ,@ l Phmhrhh      !"#$%&'()*+,-./012# ,@ l MXX@X@< /F/dec@c.@ .--@00%%@((   @     @ @5      @    < =    2 4@c  @  9 9 @: :     +< @< < @= BBKhurana, 341 Quality: Spotter Status: New Discussion Entropion is inward rotation of turning of the lid margin towards the globe. It can be congenital, spastic, cicatrical or senile entropion. 1. Congenital entropion: Rare Present since birth Management 3 Plastic reconstruction 2. Spastic entropion: Due to spasm of orbicularis oculi Management 3 Treatment of cause of spasm 3 Botulinum toxin 3. Cicatrical entropion: Most common in upper lid Due to 3 Trachoma, 3 Burns, 3 Pemphigus 3 Steven Johnson syndrome Management 3 Modified burrows 3 Joesche Arlts 3 Modified Ketessey 3 Resection of skin, muscle and tarsus 4. Senile entropion: Most common in lower lid Seen in elderly Management 3 Jones, Reeh and Wobig operationTucking or plication of inferior lid retractors 3 Modified Wheelers 3 Weiss 3 Blick Explanation 1. Plastic operations are done for senile ectropion. For spastic ectropion the cause is treated. 2. Senile entropion is managed with Jones, Reeh and Wobig OperationTucking or plication of inferior lid retractors, modified Wheelers, Weiss, Blick operations. 3. Cicatricial entropion is managed with modified burrows, Joesche Arlts, modified Ketessey, resection of skin, muscle and tarsus 4. Paralytic entropion is managed with plastic surgeries. Comments The question is one of the few where the question can be attempted (with a risk, of course) without knowing the subject, by careful analysis of choices. Tips You can see that senile appears 2 times and entropion 3 times. Now you consider yourself as the question setter and assuming senile ectropion to be the correct answer give three more choices. See whether these are the choices given in the Q, Paper. Proceed for the other three choices. Choice B stands out. But you cannot apply this method if the choices were. A. Senile ectropion. B. Senile entropion. C. Cicatricial ectropion. D. Cicatricial entropion. There analysis leaves you with 2-2 and 2-2. So the answer can be anything else. But our question paper had 2-1-1 and 3-1 telling that the answer probably has senile and also entropion. But I have to warn you that method is one of chance and can also fail. If you cannot understand what I have told you dont worry. There will be an online tutorial soon in www.targetpg.com about the strategies for attempting MCQs. 164. A patient is on follow-up with you after enucleation of a painful blind eye. After enucleation of the eyeball, a proper sized artificial prosthetic eye is advised after a postoperative period of: A. About 10 days B. About 20 days. C. 6-8 weeks. D. 12-24 weeks. Answer: C (6-8 weeks) Ref: Parson 18th edn, 311 deals with Proper Sized Prosthesis; Basak 2nd edn, 339 deals with Prosthesis Quality: Thinker Status: New QTDF: Parson 18th Edition Discussion An artificial eye of plastic should not be worn less than 2 weeks after excision. A small eye may be worn for an hour or two a day till the conjunctiva becomes used to the foreign body. Eight or nine weeks after the operation a full-sized eye may be worn; a plastic eye need only be taken and washed once a week. Explanation A. Anything should not worn about 10 days . B. A small eye is worn for an hour or two from about 20 days. C. A proper sized artificial prosthetic eye is advised after 6-8 weeks. D. 12-24 weeks is too long a time. Comments Even though most of the books recommend initiation of the prosthesis after 3 weeks, according to Parson, small prosthesis are worn after 3 weeks following surgery And a proper sized prosthesis is worn after 8 weeksSince our question also has the word proper, we go for choice C. Tips Be careful to the words, full, proper, definite, etc. in the question paper. 165. In a patient with AIDS chorioretinitis is typically caused by: A. Cytomegalovirus. B. Toxoplasma gondii. C. Cryptococcus neoformans. D. Histoplasma capsulatum. Answer: A (Cytomegalovirus) Ref: Harrison 15th edn, 185; Parson 19th edn, 257 Quality: Spotter Status: Repeat QTDF: Parson Discussion Cytomegalovirus (CMV) retinitis is an important cause of blindness in immunocompromised patients, particularly patients with advanced AIDS. One of the most devastating consequences of HIV infection is CMV retinitis. Patients at high risk of CMV retinitis (CD4+ T cell count <100/uL) should undergo an ophthalmologic examination every 3 to 6 months. The majority of cases of CMV retinitis occur in patients with a CD4+ T cell count <50/uL. Prior to the availability of HAART, this CMV reactivation syndrome was seen in 25 to 30% of patients with AIDS. CMV retinitis usually presents as a painless, progressive loss of vision. Patients may also complain of blurred vision, floaters, and scintillations. The disease is usually bilateral, affecting one eye more than the other. CMV infection of the retina results in a necrotic inflammatory process, and the visual loss that develops is irreversible. Intravitreal injections of cidofovir are generally avoided due to the increased risk of uveitis and hypotony. Explanation A. Cytomegalovirus causes chorioretinitis in 30 % of HIV Cases. (Harrison) B. Chorioretinitis due to toxoplasmosis can be seen alone or, more commonly, in association with CNS toxoplasmosis, but is less common than CMV chorioretinitis. C. Cryptococcus neoformans causes meningitis. D. Histoplasma capsulatum affects the lungs. Comments CMV retinitis may be complicated by rhegmatogenous retinal detachment. Therapy for CMV retinitis consists of intravenous ganciclovir or foscarnet, with cidofovir as an alternative. Combination therapy with ganciclovir and foscarnet has been shown to be slightly more effective than either ganciclovir or foscarnet alone in the patient with relapsed CMV retinitis. Tips P. carinii can cause a lesion of the choroid that may be detected as an incidental finding on ophthalmologic examination. These lesions are typically bilateral, are from half to twice the disc diameter in size, and appear as slightly elevated yellow-white plaques. 166. Fasanella Servan operation is specifically indicated in: A. Congenital ptosis. B. Steroid-induced ptosis. C. Myasthenia gravis. D. Horners syndrome. Answer: A (Horners syndrome) Ref: Kanski 4th edn, 39; SK Basak 2nd edn, 83; Khurana Quality: Spotter Status: New QTDF: ?? Discussion Fasanella Servan operation is a surgical procedure for management of ptosis. The upper border of tarsus is excised with the lower border of Mullers muscle and overlying conjunctiva aChca9#hX"Chw ca9Chfca Ch3Cca6#hX Chcasm#C casm)C+ caChcasm%C CcasmCcasm1+CcasmCKcasm8+5#C CcaCh/ ca;#hX0Ch$ca5#hX(Ch ca7ChCcam8#hX Chcam<#hXChcam5Ch C'cam5+hX8Ch Ccam8+hX7+hXChz@B, Cca:(CX caN:#XhCXcaD)CX ca0-CX @B, Cz6#C) @B,Cr2#CC$ca<9#hXCh@B<ca:CX\caNCXtcaDCXca0CXX@B,CW @B%CH @@xc) C@ @B, C:#@#CKcaChcaZCocaZCcaZ Cca4CcaChcaZ"CJ caZ Cca4Cca4CcaCh]caZCZcaZCca4 COca4Cca4 Cca4CcaZ Cca4Cca4C?ca4Cca4%C? caChFcaZCCcaZCcaZ Cca4/+#C` ca4CCca4Cca4C@B, Cca;+hX$Ch. ca7#hX=#hX,Ch ca9#hX6#hXChca7Ch@B, Cz9#@#!C @B,Cr?#5#>#=#@#<#9#?#>#9#;#5Cc4#,0#;CCCca<8#hX9#hX:#hXCh@B<ca:CXcaNCXcaD CXmca0CX!@B,CZ@BD##CG @@xCc] C@ CC@B, CB#;#=#=#:#Cs@B, Cca:)CX2 caN5#XhCXcaD<#Xh CXca0 CX{ @B, Cz:#@#=#=#%C @B,Cr?#C.cC,Cca<;#hXCh@B<ca:CXcaNCXcaDCXwca0CX5@B,C @B2C@@xCc)C@ C C@B, Ccam6#hX6+hX%Ch cam7+hXChcam:#hX5+hXChcam9#hX"Ch cam9+hX5#hXChcam:#hX9+hX'Ch cam9#hXChcam:+hX=+hX Chcam;#hX3Chq@B, Cca:6#XhCXnCBcaN7#Xh6+Xh5CXFcDAdobe Compatibility CMSAdobe Compatibility CMSPageMaker 5.0 RGBDAdobe Compatibility CMS Adobe Compatibility CMSPageMaker 5.0 CMYKDAdobe Compatibility CMS Adobe Compatibility CMSPageMaker 5.0 CMYK