APPG 2013; 001-020

1. In Dysphonia Plica Ventricularis 

(Ventricular Dysphonia) voice is produced by 
ventricular folds 

vocal cords 

aryepiglottic fold 

Epiglottis 

Ans A 

Dysphonia Plica Ventricularis (Ventricular Dysphonia) 

Here voice is produced by ventricular folds (false cords) which have taken over the function of true cords. Voice is rough, low-pitched and unpleasant. Ventricular voice may be secondary to impaired function of the true cord?such as paralysiS, fixation, surgical excision, or tumours.? 

Ventricular bands in these situations try to compensate?or assume phonatory function of true cords.?Functional type of ventricular dysphonia occurs in?normal larynx . Here cause is psychogenic. In this type,?voice begins normally but soon becomes rough when?false cords usurp the function of true cords. Diagnosis is?made on indirect laryngoscopy; the false cords are seen to?approximate partially or completely and obscure the?view of true cords on phonation. Ventricular dysphonia?secondary to laryngeal disorders is difficult to treat but?the function al type can be helped through voice therapy?and psychological counsellin

2.Lupus of the larynx mostly affects 

Posterior part 
Anterior part 

Subglottis 

Hypopharynx 

Ans B 

Syphilis affects the larynx and produces ulcers. These may involve almost *any portion but usually they are anterior, involving the epiglottis. They are often associated with syphilitic manifestations in the mouth. Tuberculosis affects the posterior portion of the larynx and the bulb-like swellings of the arytenoids are almost pathognomonic. Ulcers when they occur are most marked posteriorly. This affection is associated with a blanching of the mucous membrane of the mouth and the presence of a white frothy mucus, which will lead the laryn-gologist to suspect the existence of the disease before a view of the larynx is obtained.

3. Lateral soft tissue X-Ray of neck may show "Thumb sign" in 
acute epigiottitis 

retropharyngeal abscess 

laryngeal stenosis 

fractures of larynx 

Ans A 

In radiology, the thumbprint sign, or thumbprinting, is a radiologic sign found on a lateral C-spine radiograph that suggests the diagnosis of epiglottitis. The sign is caused by a thickened free edge of the epiglottis, which causes it to appear more radiopaque than normal, resembling the distal thumb 

4. Herpangina is caused by 
Coxsackie virus 

Herpes simplex 

Staphylococcus 

Fungus 

Ans A 

Herpangina, also called mouth blisters, is the name of a painful mouth infection caused by coxsackieviruses. Usually, herpangina is produced by one particular strain of coxsackie virus A (and the term "herpangina virus" refers to coxsackievirus A)[ but it can also be caused by coxsackievirus B or echoviruses.[2] Most cases of herpangina occur in the summer,[3] affecting mostly children. However, it occasionally occurs in adolescents and adults 

5. 'Recruitment phenomenon' is seen in one of the following conditions. 
Meniere's disease 

Otosclerosis 

Otitis media 

Mastoiditis 

Ans A 

Most patients with Ménière's disease (MD) reveal abnormal vestibular-evoked myogenic potentials (VEMPs) and the recruitment phenomenon, whereas most sudden deafness patients display normal VEMPs without the recruitment phenomenon 

6. Which of the following is called the "Gateway of tears" ? 
Killian's dehiscence 

Rathke's pouch 

Waldeyer ring 

Sinus of Morgagni 

Ans A 

Killian’s dehiscence is a potential triangular gap between the oblique fibers of thyropharyngeus and the transverse fibers of cricopharyngeus (Thyropharyngeus and cricopharyngeus are 2 parts of the inferior constrictor of pharynx) 

It is named after German ENT surgeon – Gustav Killian 

It is through this gap that the herniation of pharyngeal mucosa occurs in case of pharyngeal pouch (Zenker’s diverticulum) 

It is also called ‘gateway of tears‘ as it is a common site for perforation during oesophagoscopy

7. Cold-air caloric test is done with 
Dundas Grant tube 

Montgomery T tube 

Jackons tube 

Fuller's tube 

Ans A 

Clinical tests for vestibular functions 

Nystagmus 

Test for gaze evoked nystagmus 

Fistula test 

Siegalization 

Hennebert’s sign 

Fitzgerald Hallpike bithermal caloric test 

Canal paresis 

Directional preponderance 

Modified Kobrak test 

Dundas Grant Cold air caloric test 

Dix Hallpike manoeuvre 

Nystagmus in BPPV 

Epley’s manoeuvre 

Tripod fracture is usually referred to as a fracture of 

nasal bone 

Mandible 

Maxilla 
Zygoma 

Ans D 

Fractures of zygoma are the most common fractures of the upper cheek, the most common of which is the tripod fracture of zygomatic bone involving 3 separate breaks of bones of skull, through: 1. infraorbital foramen and canal to the infraorbital groove 2. zygomaticoparietal suture of lateral margin of orbit 3. zygomatic arch usually at its narrowest point, where the suture between the zygomatic process of temporal bone and temporal process of zygomatic bone occurs. 

10. Gelle's test is a popular test done for 

Presbycusis 

Serous otitis media 
Otosclerosis . 

Meniere's disease 

Ans C 

Gelles test was once a popular test to find out stapes fixation in otosclerosis, but now has been superceeded by tympanometry 

8. Early Laryngeal cancer which neither impaired cord mobility nor invaded cartilage or cervical nodes is treated by 

Chemotherapy 
Radiotherapy – ans/

Hemilaryngectomy 

Total laryngectomy

11. Aqueous flare in inclocyclifis is due to 

A. Platelets 

B. pigments 

C. RBCs 
D. Proteins 

Ans D 

• Aqueous flare is a pathognomonic sign of uveitis and is due to breakdown of the blood-ocular barrier with subsequent leakage of proteins into the anterior chamber. Aqueous flare is best detected using a very focal, intense light source in a totally darkened room. The passage taken by the beam of light is viewed from an angle. In the normal eye, a focal reflection is seen where the light strikes the cornea. The beam is then invisible as it traverses the almost protein- and cell-free aqueous humor in the anterior chamber. The light beam is visible again as a focal reflection on the anterior lens capsule and then as a diffuse beam through the body of the normal lens due to presence of lens proteins. If uveitis has allowed leakage of serum proteins into the anterior chamber then these will cause a scattering of the light as it passes through the aqueous. Aqueous flare is therefore detected when a beam of light joining the focal reflections on the corneal surface and the anterior lens capsule is visible traversing the anterior chamber. A slit lamp provides ideal conditions for detecting flare, however the beam produced by the smallest circular aperture on the direct ophthalmoscope held as closely as possible to the cornea in a completely darkened room and viewed transversely will also provide excellent results. The slit beam on the direct ophthalmoscope is not as intense and does not provide as many "edges" of light where flare can be appreciated most easily. Assessment of flare may be easier after complete pupil dilation due to the apparent dark space created by the pupil. Combined assessment of IOP and aqueous flare should be performed whenever glaucoma or uveitis is suspected because of the frequency with which these conditions co-exist. 

12. The following laser beam is used in LAS 1K (Laser-Assisted in Situ Keratomileusis) 
A. Excimer 

B. Argon 

C. Diode 

D. Krypton 

Ans A 

LASIK is a surgical procedure which combines a micro-keratome (an automated knife for shaving the cornea) and an Excimer Laser (an ultraviolet light beam) to reshape the cornea. 

13. Cobblelstone appearance of the palpebral conjunctiva is seen in 

A. Trachoma 
B. Spring Catarrh 

C. Ophthalmia nodosa 

D. Long term use of miotics 

Ans b 

Allergic conjunctivitis is suggested by bilateral itchy eyes, a history of atopy, and a ‘cobblestone’ appearance of the upper palpebral conjunctiva. 

• Signs of VKC can be described in three clinical forms. 

1. Palpebral form- Usually upper tarsal conjunctiva of both the eyes is involved. Typical lesion is characterized by the presence of hard, flat-topped papillae arranged in cobblestone or pavement stone fashion. In severe cases papillae undergo hypertrophy to produce cauliflower-like excrescences of 'giant papillae'. 

2. Bulbar form- It is characterised by dusky red triangular congestion of bulbar conjunctiva in palpebral area, gelatinous thickened accumulation of tissue around limbus and presence of discrete whitish raised dots along the limbus (Tranta's spots). 

Mixed form- Shows the features of both palpebral and bulbar types 

14. Subconjunctival haemorrhage freluently is seen in children with 
A. Whooping cough 

B. Measles 

C. Influenza 

D. Chicken pox 

Ans A 

Causes of Subconjunctival haemorrhage 

• Eye trauma 

• Congenital or acquired (coagulation disorder) 

• Diving accidents - Mask squeeze (volume inside in mask creates increased pressure with increased depth) 

• Head injury 

• Whooping cough or other extreme sneezing or coughing [1] [2] 

• Severe hypertension 

• LASIK 

• Acute hemorrhagic conjunctivitis (caused by Enterovirus 70 or Coxsackie A virus) 

• Leptospirosis 

• Increased venous pressure (e.g., extreme g-force, straining, vomiting, choking, or coughing) 

Subconjunctival hemorrhages in infants may be associated with scurvy (a vitamin C deficiency),] abuse or traumatic asphyxia syndrome 

15. Acute hydrops is seen in 

A. Keratoglobus 

B. Buphthalmos 

C. Keratoconus 

D. Bullous keratopathy 

Ans C 

Acute Corneal Hydrops 

CLINICAL DESCRIPTION: 

Corneal hydrops is an uncommon complication seen in patients with keratoconus. It is characterized by significant corneal edema resulting from a spontaneous rupture in Descemet's membrane. Clinical findings include dense stromal and epithelial edema with corneal protrusion, possible conjunctival hyperemia and irregular epithelium secondary to microcystic edema 

The location and area of the involved cornea is variable 

16. Ciliary staphyloma is due to 

A. Scleritis 

B. irido cyclitis 

C. degenerative Myopia 

D. choroiditis 

Ans a 

Ciliary staphyloma 

As the name implies, it is the bulge of weak sclera lined by ciliary body, which occurs about 2–3 mm away from the limbus. Its common causes are thinning of sclera following perforating injury, scleritis & absolute glaucoma. 

Posterior staphyloma 

In the posterior segment of the eye, typically diagnosed at the region of the macula, deforming the eye in a way that the eye-length is extended associated with myopia (nearsightedness). It is diagnosed by ophthalmoscopy, which shows an area of retinal excavation in the region of the staphyloma.

17. If you have to treat a patient with active trachoma all of the following drugs will be effective against Chlamydia, EXCEPT 

A. Azithromycin 

B. Ivermectin 

C. Rifampicin 

D. Erythromycin 

Ans C 

• Topical therapy regimes. It is best for individual ?cases. It consists of 1 percent tetracycline or 1 percent erythromycin eye ointment 4 times a day for 6 weeks or 20 percent sulfacetamide eye drops three times a day along with 1 percent tetracycline eye ointment at bed time for 6 weeks. The continuous treatment for active trachoma should be followed by an intermittent treatment especially in endemic or hyperendemic area. 

• Systemic therapy regimes. Tetracycline or erythromycin 250 mg orally, four times a day for 3-4 weeks or doxycycline 100 mg orally twice daily for 3-4 weeks or single dose of 1 gm azithromycin has also been reported to be equally effective in treating trachoma. 

• Combined topical and systemic therapy regime. It is preferred when the ocular infection is severe (TI) or when there is associated genital infection. It includes: (i) 1 per cent tetracycline or erythromycin eye ointment 4 times a day for 6 weeks; and (ii) tetracycline or erythromycin 250 mg orally 4 times a day for 2 weeks. 

• Ivermectin Inhibits Growth of Chlamydia trachomatis 

18. Angular conjunctivitis is typically due to "Moraxella lacunata" which is a 

A. Gram negative diplococci 

B. Gram positive diplococci 

C. Gram negative diplobacilli 

D. Gram positive diplobacilli 

Ans C 

Morax-Axenfeld diplobacillus or Moraxella lacunata is a rod-shaped, Gram negative, non motile bacteria, generally present as diploid pairs. They cause one of the commonest forms of catarrhal conjunctiviti 

19. Which one of the following lenses is manufactured from 

19 Hydroxyethylmethacrylate (HEMA) ? 

A. Hard lenses 

B. Gas permeable lenses 

C. Soft lenses 

D. None of the above 

Ans C 

More common monomers in contact lens materials include: 

??Methylmethacrylate (MMA), which contributes hardness and strength 

???Silicone (SI), which increases flexibility and gas permeability through the material's silicon-oxygen 

bonds but has the disadvantage of poor wettability???Fluorine (FL), which also adds a smaller degree of gas permeability and improves wettability and 

deposit resistance in silicone-containing lenses? 

??Hydroxyethyl-methacrylate (HEMA), the basic water-absorbing monomer of most soft lenses? 

??Methacrylic acid (MAA) and n vinyl pyrolidone (NVP) mono-mers, both of which absorb high amounts 

of water and are usually adjuncts to HEMA to increase lens water content? 

??Ethylene glycol dimethacrylate (EGDMA), a cross-linking agent that adds dimensional stability and stiffness but reduces water content 

Hydroxyethylmethacrylate or HEMA is the monomer that is used to make the polymer polyhydroxyethylmethacrylate. The polymer is hydrophobic; however, when the polymer is subjected to water it will swell due to the molecule's hydrophilic pendant group. Depending on the physical and chemical structure of the polymer, it is capable of absorbing from 10 to 600% water relative to the dry weight. Because of this property, it was one of the first materials to be successfully used in the manufacture of flexible contact lenses 

20 By using which one of the instruments corneal thickness can be best measured ? 

A. Optometer 

B. Ophthalmometer 

C. Ultrasonic Pachymeter 

D. Tensiometer 

Ans c 

A pachymeter is a medical device used to measure the thickness of the eye's cornea. It is used to perform corneal pachymetry prior to LASIK surgery, for Keratoconus screening, LRI surgery [8] and is useful in screening for patients suspected of developing glaucoma among other uses. Modern devices use ultrasound technology, while earlier models were based on optical principles. The ultrasonic Pachymeters traditionally have been devices that provide the thickness of the human cornea in the form of a number in micrometres that is displayed to the user. The newer generation of ultrasonic pachymeters.[9] work by way of Corneal Waveform (CWF).[10] Using this technology the user can capture an ultra high definition echogram of cornea,[11] think of it as a corneal A-scan. Pachymetry using the corneal waveform allows the user to more accurately measure the corneal thickness, have to ability to check the reliability of the measurements that were obtained, have the ability to superimpose corneal waveform[12] to monitor the change of patients cornea over time, and ability to measure structures within the cornea such as micro bubbles created in the cornea during femto-second laser flap cu