1 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

CLINICAL SUBJECTS HIGH YIELD POINTS INTERNAL MEDICINE, SURGERY, GYNAECOLOGY AND OBSTRITICS, PSYCHITORY, PEDIATRICS, ENT, OPTHOLMOLOGY AND DERMATOLOGY

OPTHOLOMOLGY 1. Unilateral painful red eye + dilated avoid pupil » Diagnose: Acute Congestive Glaucoma » Investigation: Schoid Tonometery , slit lamp examination, Fundoscopy » medical Rx: - For decrease production -Timolol drop, oral Acetazolamide - For increase drainage -Pilocarpine drop, IV mannitol » Surgical Rx: Laser Iridotomy 2. Unilateral painful red eye + vision loss+ preexisting Autoimmune disease history + constricted pupil + Talbot sign +ve  Anterior Uveitis 3. Bilateral red eyes  Acute Conjunctivitis 4. unilateral painful red eye + whitish spots in cornea  Acute Keratitis 5. unilateral painful red eye + dilated blood vessels that are moveable over sclera — Acute Episcleritis 6. unilateral painful red eye + dilated engorged blood vessels that are not moveable over sclera — Acute Scleritis 7. unilateral painless red eye + there is no loss of vision activity + no photophobia + no lacrimation — Sub- Conjunctival Haemorrhage 8. unilateral painless loss of vision + cherry red spots in macula — Central Retinal Artery Occlusion 9. unilateral painless loss of vision + stormy sunset appearance or angry looking retina — Central Retinal Vein Occlusion 10. unilateral painless loss of vision + curtain falling infront of eyes or clouds infront of my eyes + dull grey opaque retina that is balloning forward — Retinal Detachment 11. unilateral painless loss of vision + retina can’t be seen or there is absence of red reflex » Diagnose: Vitreous Haemorrhage » Rx: Vitrectomy + placement of vitreous gel 12. unilateral painful loss of vision + red desaturation + marcus gun pupil — Optic Neuritis 13. Gradual loss of B/L peripheral vision + temporal vision intact + optic disc cupping + tonometry shows raised IOP » Diagnose: Open Angle Glaucoma » Investigation: schoitz Tonometery , slit lamp examination, Fundoscopy » medical Rx: - For decrease production -Timolol drop, oral Acetazolamide

2 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

- For increase drainge -Pilocarpine drop, IV mannitol » Surgical Rx of choice: Trabeculotomy or Laser Tabeculoplasty 14. A 3 year old child + unilateral leucocoria — Retinoblastoma 15. Raised IOP since birth upto 2-4 years of age + tonometry shows raised IOP + enlarge eyeball, proptosis lacrimation, red eye, nystagmus » Diagnose: Buphthalmos » AKA: infantile/congenital glaucoma » Association: Neurofibromatosis, von reckling hausen syndrome and Struge-Weber-syndrome » Investigation: Slit lamp exam, schoitz tonometery » Surgical Rx: Goniotomy, Trabeculotomy, Trabeculectomy 16. old age + loss of central vision + degenerative pigments on fundoscopy » Diagnose: Senile Macular Degeneration » Rx is ineffective but Laser photocoagulation has tried 17. At puberty night blindness + later on total loss of vision+ fundoscopy shows deposition of blackish pigments — Retinitis Pigmentosa 18. Cataract is the most common cause of blindness in Pakistan 19. The thickest part of retina is — Fovea rim 20. Tear drainage is into lacrimal sac via— Canaliculus 21. The most common adverse effect of DM on eye is — Retinopathy 22. No accommodation Lesion at— Midbrain 23. 5 years old boy unilateral blindness tumor on CT with blue cells and which of the following gene involved — Retinoblastoma gene 24. Photoreceptors of retina carry — Decosahexaenoic acid 25. Optic disc is a vertical oval, with average diameter of — 1.5mm 26. Dilates the eye but doesn’t produce cycloplegic effect —Phenylephrine 27. Lens derived from — Surface ectoderm 28. Retinal pigment epithelium derived from Neuroectoderm 29. 1-year-old child source of oxygen for Atmosphere 30. German measles to mother in 5th month of pregnancy scenario effects on child — Congenital cataract 31. Regarding Trabecular meshwork — Greatest resistant at uveoscleral outflow (The trabecular meshwork is responsible for most of the outflow of aqueous humor.It has greatest resistance at uveoscleral outflow) 32. Most common congenital anomaly of lens — Ectopia lentis 33. Outermost layer of retina — Pigment epithelial layer 34. Scenario of eye surgery, occulocardiac reflex was activated. Which nerves were afferent n efferent — Trigeminal and vagus 35. Patient developed gradual loss of peripheral vision in 3 years. On examination he had bitemporal hemianopia — Pituitary adenoma

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36. Aqueous humor is produced by — Cilliary process 37. Ectopia lentis with dissecting aneurysm is seen in — Marfan syndrome 38. H/O cataract microphthalmia,iris and ciliary body anamolies are seen in — patau syndrome(Trisomy13) 39. In hypermetropic image is formed — Behind the retina 40. Lens needs continuous supply of — Aqueous and vitreous 41. Bruch"s membrane separates retina from — Choroid 42. Corneal transparency is maintained by intact — Endothelium 43. Drug increasing the IOP is — Ketamine 44. most common type of acquired cataract is senile cataract 45. Most common congenital cataract — Punctate cataract “AKA” Blue Dot cataract 46. Most common cataract in adults is — Cortical cataract 47. 70 yrs female diabetic. Difficulty in seeing distant objects. VA reduced in both eyes — Cataract 48. Boy with fracture arm after bout of fight with sister ( kuch is tarah tha) with Blue sclera — Osteogenesis imperfecta 49. Color Blindness due to — Cones defect 50. Early sign of Vitamin A deficient — Night blindness 51. Mother having measles, child at risk of — Cataract 52. Mother delivered a baby with cataract, cause — Measles 53. Most common visually significant congenital cataract Zonular or Lamellar cataract (MC type of congenital cataract associated with diminished vision) 54. Atropine is contraindicated in glaucoma 55. Most common complication of BRVO: Vitreous haemorrhage 56. Most common cause of unilateral proptosis in children: Orbital cellulitis 57. Most common cause of bilateral proptosis in children: Chloroma 58. Most common cause of unilateral & bilateral proptosis in adults: Thyroid ophthalmopathy 59. The first drug to be administered in a case of Acute acute angle closure glaucoma intravenous — Mannitol or oral Acetazolamide. 60. DOC for acute angle closure glaucoma is pilocarpine 61. Treatment of choice for acute angle closure glaucoma is Laser iridotomy 62. Most common complication of CRVO: Neovascular glaucoma 63. Neovascular glaucoma in CRVO is also called 100 day glaucoma 64. Most common cause of severe vision loss in diabetes: Vitreous Hemorrhage 65. Most common cause of vitreous haemorrhage in adult: Diabetes mellitus 66. Most common cause of vitreous haemorrhage in young adults: Trauma 67. The retina develop from neuro ectoderm 68. Most common cause of moderate vision loss in diabetes: Diabetic Maculopathy 69. Dendritic ulcers are pathogonomic of herpes simplex virus

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70. Steroids are contraindicated in dendritic ulcer 71. Nuclear cataract Associated with Rubella infection 72. Coronary cataract Develops at puberty 73. ICCE: (Intracapsular cataract extraction): Whole lens removed with intact capsule 74. ECCE: (Extracapsular cataract extraction): Lens removed, capsule left behind 75. Phecoemulsification: Whole lens removed with intact capsule 76. Phecoemulsification: Emulsifies lens nucleus and cortex by ultrasonic vibration 77. Most common intraocular malignancy in children: Retinoblastoma 78. Most common tumor of orbit/periorbitin children: Capillary hemangioma 79. Most common primary orbital malignancy in children Rhabdomyosarcoma 80. Most common cause of orbital metastasis in children: Neuroblastoma 81. Most common benign orbital tumor in adults: Cavernous hemangioma 82. Most common Eyelid tumor is: BCC 83. Most common tumor of lacrimal glands: Benign mixed tumor 84. Indirect ophthalmoscopy is the investigation of choice for retinal detachment 85. Diabetic retinopathy is the most common cause of blindness in adults aged 35–65 years old 86. Guanethidine is used in treatment of thyroid ophthalmopathy. 87. Test used for detection of Dry eye syndrome is Schirmer’s test 88. River blindness is due to Oncerchiasis volvolus, Transmitted by black fly, Mazotti test is helpful in diagnosis, Ivermectin is DOC 89. Commonest complication of topical steroids: Glaucoma 90. Rx Presbyopia — convex lenses 91. Rx Amblyopia — cover better eye 92. Rx Hypermetropia — convex lenses 93. Rx Myopia — concave lenses 94. Rx Trachoma — oral tetra or erythromycin 95. Repeated attacks of headache + Seeing haloes around light at night time + episode of blurred vision episode + increased IOP, Dark room test +ve — stage-ll angle closure glaucoma (intermittent stage) 96. sudden onset U/L Red Eye + painful vision loss + N&V, photophobia , headache lacrimation and Increase IOP, O/E; hazy cornea, Red/congested conjuctiva, shallow angle of ant, chamber + dilated pupil — Acute angle closure Glaucoma (Acute congestive Glaucoma) 97. persistent features of acute angle glaucoma + optic disc cupping on Retinoscopy — chronic angle closure glaucoma (chronic congestive Glaucoma) 98. Hypopyon — pus in anterior chamber , can be seen in anterior uveitis 99. DOC for anterior uveitis is steroid 100. Rx of anterior uveitis is — Hot fornentation + Atropine (pupillary dilator) + steroids + Abx if infectious & Rx underlying disease

5 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

101. cornea is — avascular structure 102. Glucose is provided by aqueous humor & O2 by air 103. Acute keratitis — Dendritic ulcer 104. complication of acute Scleritis is — scleromalacia perforans 105. Choroiditis — inflammation posterior uveal tract 106. Autoimmune disease + U/L painless loss of vision + greyish white raised patch on retina & vitrous opacities — Choroiditis (In late disease greyish white fibrous scar) 107. Argyle-Robertson’s pupil — Neuro syphillis 108. Glucose in lens is converted into Sorbitol by an enzyme Aldolase 109. Cotton wool spots — diabetic Retinopathy 110. Rx of choice of Diabetic Retinopathy — lesser photocoagulation 111. Senile Macular Degeneration— leading cause of blindness in developed countries 112. Four leading causes of blindness-developed countries 1) cataract 2) vitamin-A def 3) Onchoceriasis/trauma 4) senile macular degeneration 113. Congenital cataract — B/L Leuco-coria (White pupil) + Black opacity against Red-background 114. Punctate cataract or Dot-Opacities cataract a congenital cataract commonest in children 115. zonular cataract (congenital)— maternal vitamin-D deficiency 116. child + visual disturbance + B/L white pupil — congenital cataract 117. Most common senile cataract is — Cuniform cataract “wedge shaped all over cortex” (70%) 118. Cuniform cataract is cortical senile cataract present with white pupil (Leuco-coria) 119. Brown black pupil — Nuclear cataract is a type of senile cataract 120. Rx of choice for cataract is — Phaco-Emulsification 121. Eyes in case of Burns — wash with plenty of water 122. Eyes Burn with Phenol — should be washed with polyethylene Glycol 123. Trachoma is caused by chlamydia trachomatis 124. Rx of choice for trachoma — Tetracycline 125. Child+Eye turn inward + cover test +ve — Convergent squint (azotropia) 126. Most common squint is convergent quint 127. Bitot spots on palpable conjunctiva— Xero-Opthalmia due to vitamin A def 128. Entropion — in-turning of eyelid 129. Ectropion — out-turning of the eyelid 130. Hordeolum-Internum — infection of Meibomiam Gland ( Sabeceous gland) 131. Blepharitis — diffuse inflammation of eye lashes follicles 132. Causes of Blepharitis — staphylococcus aureus & Seborrhiec dermatitis

6 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

133. Pinguecula — Yellow degeneration nodules on conjunctiva 134. Pterygium — combination of multiple yellow degenerative nodules (pinguecula combine) 135. Dacro-Adenitis — acute inflammation of lacrimal gland, presented as painful swelling of upper temporal part of orbit 136. Dacro-Cystitis — acute inflammation of lacrimal sac, presented as painful swelling of inner canthus 137. Most common hyper-mature senile cataract — phagolytic glaucoma 138. Drug which is used in fundal examination and produce mydrisis and no cyclolagia — Phenylephrine 139. Loss of vision is the most common indication for cataract surgery 140. Amster grid chart is used to detect — macular disorder 141. most common complication of steroid use is — glaucoma (iatrogenic) 142. Schawalbe’s ring is the thickened peripheral margin of the Decement membrane of the cornea of eyes 143. in Wilson disease copper deposited in — Decement membrane 144. Most common ocular complication of deptheria is — isolated ocular muscle paralysis 145. Diagnosis of herpitic corneal ulcer “keratitis” (HSV) is made by — Rose bangal stain (Fluoresein dye test) 146. Most common systemic association of acute anterior uveitis is — Ankylosing spondylitis 147. Rx of choice for acute anterior uveitis— topical steroids 148. Tritanopia — Blue color blindness 149. Protanopia — Red color blindness 150. Deuteranopia — Green color blindness 151. Power of the eye is 60D (60 diopter) 152. Thickest layer of cornea is stormal layer and thinnest is endothelium 153. Color vision is due to cones 154. Campimeter is used to measure — Field of vision 155. Lympathic cyst is most common cyst of conjunctiva 156. Swimming pool conjunctivitis— chlamydia 157. Stye — inflammation of zeis’s gland 158. chalazoin is the infection of — meibomian gland 159. Argon laser is used in trabeculectomy 160. krypton laser use in — irridotomy 161. Thellium used in heart radiotherapy 162. Keratoconus is an indication for keratoplasty (Penetrating) 163. Maximum visual impairment occurs in central Leucoma 164. Rose Bengal staining demonstrates devitalised epithelial cells 165. In leucoma of cornea, the treatment of choice is penetrating keratoplasty 166. Copper is deposited in descemet's membrane in Wilson's disease (K Fring) KF Ring 167. Termination of Descemet's membrane is Ring of Schwalbe (Any Fungi) 168. Satellite lesion in keratitis occurs due to fungal infection

7 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

169. Dendritic ulcer is caused by Herpes simplex 170. Steroids are contraindicated in Acute keratitis causes -- Dendritic ulcer 171. Satellite nodule on a corneal ulcer is seen due to fungal infection 172. Corneal sensation is lost in Herpes simplex 173. Neisseria gonorrhoeae penetrates intact corneal epithelium 174. Pneumococcus causes ulcus serpens 175. Idoxuridine is used for treating herpetic keratitis 176. In Phlyctenular keratitis there is fascicular ulcer. 177. Green deposits in Descemet's membrane are seen in Wilson disease 178. Corneal opacity — Bowman membrane damage 179. Kerato-Ectasia — Thinning Of cornea 180. Kerato malacia — Ballooning Of cornea 181. Perforation of cornea — Loss of aqueous humor 182. hypotony of aqueous humor coming out known as corneal fistula 183. CRVO=angry looking retina 184. CRAO=Ischemic pale retina(cherry red spots) 185. Dull grey opaque Retina can be seen - Ballooning forward, curtain falling in front of my eye (cloud in front of eye) » Diagnose: Retinal deattchment » Rx for small breaks of retina: cryosurgery, Laser photocoagulation » Rx for large breaks of retina: Laser surgery , aspiration of vitreous gel, silicon scleral bulking & Retinopexy 186. Retinoblastoma association with patau and Down syndrome 187. Optic neuritis=Marcus gun pupil 188. Diabetic Retinopathy » Strict glycemic control » Laser photocoagulation 189. Snow flake cataract is seen in -- diabetes mellitus. 190. Sunflower cataract is seen in -- wilson's disease ( hepatolenticular degeneration ) 191. Munson's sign is seen in -- KERATOCONUS 192. Normal anterior chamber depth --> 2 to 3 mm ( 2.5 mm ) 193. Presbyopia is caused by -- loss of accomodation 194. The graph of the movement of eye is called -- electronystagmogram 195. Keratometer is used to assess the curvature of the cornea 196. Snellens chart is used to test -- vision 197. Length of the eye ball -- 24 mm 198. Commonest type of colour blindness -- PROTANOPES ( RED DEFECT )

8 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

199. Twilight vision is by -- rods 200. Commonest cause of keratitis in soft contact lens user --> acanthoameba 201. Strongest attachment of vitreous is - Base 202. Junction between retina & cornea is - Ora serrata 203. Levators of upper eyelid r - levator palpibra sup/Mullers/Frontalis 204. Muscles to close the Eyelid - Orbicularis 205. Celiary muscles constrict - Lens 206. Keratometry is - measurement of curvature of cornea 207. Pachymetry is to measure - thickness of the cornea 208. Refractometer is to measure - Retractive index of lens 209. Refractive error associated with divergent squint - Myopia 210. Cotton wool spots r seen in - T2DM/HTN 211. MC orbital tumour in children - Rhabdomyosarcoma 212. MC Brain tumour in children - Gliomas 213. MC cancer in children - Leukemia (ALL) 214. MC distant metastasis seen in retinoblastoma is - Bone. 215. In Rt.Homonomous hemianopia the MC site of lesion would be - Lt.optic tract 216. Pt has difficulty in walking downstairs probable muscle paralysed - Sup. Obl. 217. Hypopyon is due to - Fungal infection 218. Nummular keratitis is most commonly caused due to - Herpes zoster virus 219. Vossius ring r seen in - Trauma 220. Most potant antibiotic for trachoma treatment is - Azithromycin 221. Entropion is due to - Trachoma/Congenital/scarring/ageing/spasm. 222. Topical steroids cause - Glaucoma 223. Steroids r contraindicated in - herpetic corneal ulcer/chronic simple glaucoma 224. Pt with acute glaucoma the prophylactic Rx for other eye is - peripheral iridectomy 225. Subacute uveitis i glaucoma which drug should not be given - Pilocarpine 226. In a pt predisposed to glaucoma ,drug contraindicated is - atropine 227. Coloured halos r seen in - accomodation/narrow angle gaucoma/phakogenic glaucoma & 228. not seen in - steroid induced glaucoma 229. Large hemangioma of lid & cheek i glaucoma is seen in - sturge webers syndrome 230. Rx for malignant glaucoma - topical atropine / vitreous aspiration 231. Earliest change in glaucoma - Hazy cornea 232. Neovascular glaucoma is seen in - CRVO/diabetes 233. Coloured halos r found in - acute angle closure glaucoma/cataract/uveitis 234. Secondary glaucoma is seen in - IOL implantation/epidemic dropsy/CRVO 235. Medical treatment of Glaucoma is i - Pilocarpine

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236. Rx for malignant glaucoma is - vitreous aspiration 237. Rx for subacute glaucoma - peripheral iridectomy 238. Pain in absolute glaucoma is best relieved by - retrobulbar injection of alcohol 239. Secondry glaucoma following corneal perforation is due to - anterior synechia formation 240. In acute congestive glaucoma,best prophylaxis for the other eye is - Laser iridectomy 241. Fincham's test is used to differentiate - acute congestive glaucoma & cataract 242. 100 day glaucoma is seen in - central vein oclusion (CRVO) 243. Complication of operation of malignant glaucoma - retinal detachment 244. TOC in angle closure glaucoma - pilocarpine 245. DOC in chronic simple glaucoma in a young myopic - Timolol 246. MC complication of iridocyclitis - 2ry glaucoma 247. TOC for the other eye in open angle glaucoma - laser trabeculoplasty 248. TOC for other eye in angle closure glaucoma - laser iridotomy 249. Pupils are mid dilated & fixed in - acute congestive glaucoma 250. Commonest complication of topical corticosteroids - Glaucoma 251. Shape of pupil in glaucoma is - vertically oval 252. Eximer laser is used in - Glaucoma & correcting refractory errors 253. DOC in angle closure glaucoma - pilocarpine 254. TOC for congenital glaucoma i corneal ulcer - Trabeculectomy 255. Pt i acute bronchial asthma after treatment of glaucoma ,drug may be - Timolol 256. In hypertensive pt i glaucoma which is not used - Beta blockers 257. Pain while sitting in cinema in eye is seen in - acute angle closure glaucoma 258. Acute painfull red eye is seen in - glaucoma/uveitis/herpetic keratitis & not in conjunctivitis 259. Argon laser trabeculoplasty is used in - primary open glaucoma 260. Haab's sclera is seen in - Infantile glaucoma 261. Most important complicationof anterior chamber lenses - Glaucoma 262. DOC as tropical beta blocker in - open angle glaucoma 263. Congenital glaucoma is present as - photophobia 264. 6months old i large cornea,photophobia diagnosis is - congenital glaucoma 265. Ocular emergencies - CRAO,angle closure glaucoma,retinal detachment 266. Normal intra occular tension is - 15 to 22 mm/hg 267. Eye in the new born - Hypermetropic 268. Tears are produced in newborn after - 3 weeks 269. Sclerosis of bony orbit is seen in - Meningioma 270. Chorioretinitis is caused by - congenital toxoplasmosis 271. Ideal site for intra ocular lens implantation - in the lens capsule 272. Lens capsule is thinnest at - posterior

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273. Unilateral aphakia can be corrected by - spectacles/contact lens/intra ocular implants 274. Candle wax spots in the retina is seen in – Sarcoidosis 275. Sudden visual loss is due to - central retinal vein & artery occlusion/papillitis 276. Herbet's pits is seen in - Trachoma 277. Chalcosis - reaction due to copper of foreign body in the cornea 278. Spectacles are prescribed to patient with aphakia after - 6 weeks 279. Hypopyon is seen in - pneumococcal infection/fungal & gonococcal 280. What is tylosis - hypertrophy & dropping of eyelid 281. Bupthalmous-boys>girls,B/L eyes involved,autosomal recessive,Rx-trabeculectomy 282. Lens derives its nutrition from the - Aqueous 283. Dendritic ulcer is due to - Herpes simplex 284. Horner trantas spots are seen in- vernal conjunctivitis 285. Satellite nodules in the cornea are caused by - Fungus 286. Supra temporal lental subluxation is seen in - Marfan's 287. Toxic amblyopia is produced by - ethambutol 288. Optic foramen is located between - lesser wing & body sphenoid 289. Opthalmic nodosa is seen in - caterpillar hair in the eye 290. Mydriatic used in 6yr old child i squint - Atropine 291. Corneal reflex is lost in disease of opthalmic nerve 292. Trachoma can cause - trichiasis,entropion,blindness 293. Roth's spots in the fundus r seen n - bacterial endocarditis 294. Commonest causative organism of corneal ulcer - Staphylococci 295. Presence of kayser-fleischer ring is pathognomonic of - Wilson's disease 296. Kayser - fleischer ring has - copper deposits 297. Cylindrical lenses are used in - Astigmatism 298. Arcus senile is composed of - lipid deposits 299. Astigmatism is considered to be an - spherical abberation 300. Retinal detachment is seen in - DM,high myopia,Malignant melanoma 301. Earliest change noticed in hypertensive retinopathy - arteriolar spasm 302. Salmon patch of cornea is seen in - Interstitial keratitis 303. Image in Indirect opthalmoscope is - inverted-real-magnified 304. Eyepads r contraindicated in - purulent conjunctivitis 305. Enucleation is not indicated in – panopthalmitis 306. Amaurotic cat's eye reflex is seen in – Retinoblastoma 307. Commonest intra ocular tumour in children is – Retinoblastoma 308. Bitot's spots r seen in - Vit A deficiency 309. Length of the intra-orbital optic nerve is - 25mm

11 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

310. Bitemporal hemianopia indicates the lesion is at - Optic chiasma 311. Corneal ulceration is caused by injury to the - 5th cranial nerve 312. Anterior uveitis is seen in - RA, HLA B27,ankylosing spondylytis,Juvenile RA 313. Acute hemorhagic conjunctivitis is seen i - pneumococcus 314. Vossious ring is seen in - Anterior capsule 315. In webers syndrome there is - 3rd nerve palsy 316. Corneal nerves r visible in - leprosy & keratoconus 317. Corneal receives its nutrition from - corneal vassels/atmosphere/aqeous humour 318. Astigmatism is corrected by - cylindrical lens 319. Lacrimal duct opens at - inferior meatus 320. Commonest cause of vitreous hemorhage - Trauma 321. Size of the eyeball in myopia - bigger 322. Intra occular pressure increased with - succinyl choline 323. Feature of diabetic retinopathy - hard exudate 324. Earliest change in diabetic retinopathy - micro aneurysm 325. Commonest fungal lesion of eyelid is – candida 326. Retinoblastoma - autosomal dominant/treatment is enucleation/radiotherapy 327. Disease affects eye-juv.RA/wilsons dis./sjogren synd.leprosy 328. Presbyopia is - loss of elasticity of lens capsule/weakness of ciliary muscles/weakness of 329. suspensary ligament 330. Elevation of disc margins seen in- papilloedema 331. Uncrossed diplopia is seen in - Esotropia 332. Retinitis pigmentosa - night blindness/constriction of visual fields 333. Timolol - cause bradycardia/cause asthma 334. Bitemporal hemianopia can be due to - meningioma of sella diaphragmatica 335. Vitreous opacities may be due to - post.uveitis/hyaloid asteroids/high myopia 336. Pseudomembranous conjunctivitis is caused by - staphylococcus/streptococcus 337. Drug causing Bulls eye macula - chloroquin 338. primary deviation less than secondary deviation seen in- paralytic squint 339. Painless sudden visual loss is seen in - retrobulbar neuritis/retinal detachment/CRAO 340. Keratoconus is best treated with - contact lens 341. Contact lens is best used in - high myopia 342. Feature of tobacco amblyopia-B/L involvment/norm.fundus/ganglion cell degeneration 343. Field defect in tobacco amblyopia is - centro cecal 344. Centrocecal scotoma is seen in- Papillitis 345. Iris bombe occurs in - ring synechia 346. Sympathetic opthalmia is due to injury to - iris & ciliary body

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347. Examination of vitreous is best done by - slit lamp with contact lens 348. Thickness of cornea is measured by - Pachymeter 349. Keratometry is used in the measurement of - Curvature of cornea 350. IOL is contraindicated in - young diabetes/one eyed/over corneal dystrophy 351. Treatment of concomittant squint is - surgery/exercise/spectacles 352. MC tumour of lacrimal gland is - Benign mixed tumour 353. Cornea attains the size of adult cornea by which year - 1 yr 354. Retinal artery angiogram,the dye injected thru d - peripheral veins 355. Blue scelra is seen in - Osteogenesis imperfecta 356. Rubeosis iridis is most commonly seen in - Diabetes mellitus 357. Ropy discharge from eye is seen in - springh cataract 358. Metabolically active layer of cornea is - Endothelium 359. Interstitial keratitis is seen in - TB/leprosy/syphilis 360. Organism penetrates normal cornea is - Gonococcus 361. Ring scotoma is seen in - retinitis pigmentosa 362. Riders cataract is seen in- zonular cataract 363. Early feature of diabetic retinopathy is - micro aneurysm 364. Retinal detachment is preceeded by - floats & flash,high myopia,trauma 365. Lens develops from - ectoderm 366. Anisometropia - Refractive error 367. Visual loss is maximum in - Papillitis 368. Latest technique in cataract surgery is using - laser 369. Distance used in direct distant opthalmoscope is - 25cm 370. Aqeous flare is best demonstrated by - narrow beam of slit beam 371. Rx for uveitis & intra ocular tension – Atropine 372. Commonest type of congenital cataract - Zonular cataract 373. Earliest symptom of sympathetic opthalmitis - photophobia 374. Depth of anterior chamber of eye - 2-3mm 375. Angiography is IOC in - central serous retinopathy 376. Radial keratotomy is indicated in - Myopia 377. Yoke muscle for right superior rectus is - Left inferior oblique 378. Earliest symptom in corneal ulcer is - pain 379. Vortex vein drains to - uveal tract 380. Rx for aphakia is - posterior chamber IOL 381. MC type of Lid carcinoma is - Basal cell carcinoma 382. Constantly changing refractive error is seen in - Diabetic cataract 383. Ptosis with lid lag is seen in - myogenic ptosis

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384. DOC for acute irdocyclitis - Atropine 385. Shortest acting Mydriatic - Tropicamide 386. Accomodative squint is corrected by - spectacles/contact lens/ocular excercise 387. Periphery of retina is best visualised with - indirect opthalmoscope 388. Zonular cataract associated - IUGR/rickets/dental abnorms 389. Pseudo convergent squint is seen i - broad epicanthus 390. Action of right superior oblique muscle is - dextro depression 391. Dacryocystorhinostomy drainage is into - middle meatus 392. Pilocarpine is not used in young adults as it causes - cystic blebs of iris 393. Enlargement of blind spot is indicative of - papilledema 394. Earliest affected in papilledema is - color sense 395. Most severe papilledema is caused by - posterior cranial fossa tumour 396. Papilledema - hyperemia of optic disc/enlargement of blind spot/pupillary reflex normal 397. Angry sun appearance in fundoscopy is a feature of - papilledema 398. D-shaped pupil is seen in - iridodialysis 399. Sudden increase in blood sugar in diabetes cause - Myopia 400. Albinism - nystagmus/photophobia/refractory error 401. Visible retinal artery palsation seen in - Raised IOT 402. Painfull eye movement is a feature of Pallitis 403. Which part of orbicularis oculi is known as Horner's muscle - Muller's muscle 404. Fasiculer ulcer is present in moorens ulcer 405. Hirschberg test is used to detect - Squint 406. Resucitation time of human retina following ischaemia is - 1 to 2 hrs 407. Saccadic eye movements - may be vertical/torsional/may occur during sleep 408. Campimetry is used to measure - field charting 409. Esophoria is common in - hypermetropia 410. Lens has respiratory quotient of - 1 411. Physiological tone of ciliary muscle is about - one diopre 412. Normal PH of tears is - 7.5 413. Burow's operation is done for - epibulbar dermoids 414. Sling surgery should be avoided in case of ptosis i - poor bells phenonmenon 415. Wheelers operation is done for - entropion 416. Commonest indication of intraocular implant is - unilateral cataract 417. YAG laser is used in the Rx of - after cataract 418. MC occular complication in renal transplant - cataract 419. Cataract in newborn is Zonular 420. Diabetic cataract is due to accumulation of - sorbitol

14 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

421. Steroid cataract is posterior subcapsular 422. Cataract caused by intake of steroids - posterior subcapsular 423. Polychromatic lusture is seen in - posterior subcapsular cataract 424. Treatment for congenital cataract - needling & aspiration 425. After cataract is treated by - Nd-YAG laser 426. Second sight phenonmenon is seen in - Nuclear cataract 427. Recovery in cataract surgery is fastest i - phacoemulsification 428. Commonest cause of cataract - age related 429. Pediatric cataract is treated by - Discission 430. Polychromatic luster is seen in - complicated cataract 431. Most important factor in the prevention of endophthalmitis in cataract surgery - pre operative preparation with povidone-iodine 432. Developmental cataract is seen in - rubella/galactossemia/mongolian idocy/cretinism 433. Snow flake cataract is seen in - Diabetes 434. Parenteral steroids cause - cataract 435. Rosette cataract seen due to - Trauma 436. Sunflower cataract is seen in - chalcosis 437. Follicles are not seen in - spring cataract 438. Vision is diminished in day light in which type of cataract - central 439. Cobblestone appearance of conjunctiva is seen in - springh cataract 440. Cataract is seen in - galactosemia, cong.rubella, toxoplasmosis 441. Intense itching is a feature of - springh cataract 442. Zonular cataract - B/L,stationary,autosomal dominant,hypocalcemia 443. Commonest type of cataract in children - Lamellar cataract 444. Commonest type of cataract in adult - cortical cataract 445. True diabetic cataract are - snowflake cataract 446. Cataract is associated with - myotonic dystrophy 447. Cataract is found in - hypoparathyroidism/IDDM/myotonic dystrophy 448. MCC of blindness - Cataract 449. Oil drop cataract is seen in - Galactosemia 450. Blaskowicz operation is done for - ptosis 451. Type of laser used for capsulotomy is- YAG 452. YAG laser wave is - colourless 453. Sago grain follicles r characteristic features of - Trachoma 454. Anomaloscope is used to detect - colour blindness 455. Short posterior ciliary arteries numbers in - 20 456. Average volume of the Orbits is - 30cc

15 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

457. Most serious danger to the vision is - fracture through the optic foramen 458. Orange skin cornea results due to - Mustard gas 459. Refractive index of cornea is about - 1.37 460. In uraemic amaurosis the pupils are - dilated but react to light 461. Blind spot of Marotte is - Optic disc 462. Landolt's broken ring test is used for - recording visual acquity 463. Berlin's edema results due to - trauma to eye 464. Lens dislocation occurs in - marfans syndrome/homocystinuria/trauma 465. Adenoviruse causes - diarhea/parotid enlargement/kerato conjunctivitis 466. Maximum refractory power is to the - anterior surface to the cornea. 467. Snellens chart is used to test - vision 468. Colour vision is by - cones 469. Night blindness is due to - Vit A defeciency/retinitis pigmentosa/high myopia 470. EDTA is used in treatment of band shaped keratopathy 471. MC adverse effect on eye due to OCP usage - optic neuritis 472. Vitreous hemorhage in young adult indicates - Eales disease 473. Laser therapy for retinal disease laser affects which layer of retina - pigment layer 474. Maximum refractive index is for - anterior surface of cornea Distant direct opthalmoscopy is done at - 25cms 475. Rx of choice in amblyopis is - conventional occlusion 476. Photopthalmia is due to - UV rays 477. All visual reflexes are developed by - 1 year 478. Drooping of upper eyelid is called - Ptosis 479. Painful movement of eye is a feature of - retrobulbar neuritis 480. Vossiuous ring is seen in - lens concussion 481. Rx of choice in Aphakia is - IOL insertion 482. Most important cause of moderate visual loss in diabetic is - Maculopathy 483. Rx for photopthalmia is - patching & reassurance 484. DOC in CMV retinitis in AIDS pts is - Gancyclovir 485. Scintilating scotoma is seen in- Migraine 486. Panuveitis involves - Iris,ciliary body,choroid 487. Optic atrophy is caused by - Methyl alcohol 488. For transplantation cornea is preserved in - modified MK medium 489. Incidence of retained intraocular foreign bodies max i injuries due to-chisel&hammer 490. Vitreous hemorhage is seen in - SHT/T2DM/Eales disease/Trauma 491. Implantation of IOL is contraindicated in - corneal dystrophy 492. MC retinal change in AIDS - cotton wool spots

16 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

493. Common most type of colour blindness is - Deutanopes 494. Retinoscopy is used to visualise whole of - detecting errors of refraction 495. Rays of light from distant object are focussed in front of the retina in - Myopia 496. Photopthalmia is caused by - ultraviolet rays 497. Photopsia occurs in - choroiditis 498. Effective treatment in Trachoma - sulphanamides 499. Argon laser is used in - retinal detachment/retinal vein occlusion/eales disease 500. Photoretinitis is due to - Infrared rays 501. Magnification ofdirect opthalmoscope is - fifteen 502. Ptosis is due to involvment of - oculomotor.N 503. Total diopteric power of eye is - 58D 504. Ulcer serpens is caused by - pneumococcus 505. Paralysis of the 6th cranial nerve causes - uncrossed diplopia 506. TOC for photopthalmia - covering the eye 507. Black floaters in DM indicates - vitreous hemorhage 508. Moving floaters diagnosed by - Indirect opthalmoscope 509. Amslers grid is used in - Maculopathy 510. Berlin's edema is due to - Trauma 511. Binocular diplopia is seen n - Aphakia 512. TOC for high myopia is - contact lens 513. Aniseikonia is corrected with - contact lens 514. Cherry red spot is seen in - metachromatic leukodystrophy 515. Cherry red spot is due to - choroidal vascularity & pale retina 516. Enucleation - means removal of entire globe along with a portion of optic nerve 517. In mumps the most common lesion is - dacryoadenitis 518. Uveitis with raised IOT drug used is - 1% atropine 519. Pepper salt fundus is seen in - Rubella 520. Vossious ring is - circular pigment rim on the anterior capsule of the lens 521. Chloroquine in large doses causes - corneal deposits 522. Frills excission is done in - panopthalmitis 523. Uncrossed diplopia is seen in – Esotropia 524. White pupillary reflex - retinoblastoma/retinal detachment/endopthalmitis 525. Near point of a 5 year old child is - 5 cms 526. Angle of anterior chamber is visualised by - gonioscopy 527. Not an error of refraction is - presbyopia 528. Ptosis i orbicularis oculi palsy is seen in - Myasthenia gravis 529. Distant direct opthalmoscopy is done from a distance of - 25cms

17 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

530. Recurrent corneal erosions seen in - corneal dystrophy 531. Lansoprost acts by - increased uveoscleral outflow 532. Most sensitive part of eye is - fovea centralis 533. Anterior uveitis is seen in - ankylosing spondylitis 534. Retinal change in dropsy is - soft exudate 535. squint causes - deviation,confusion,diplopia 536. Lattice degeneration is seen in - Myopia 537. Orange skin cornea is seen in - siderosis 538. Astigmatism,lens used to correct the defect is - Hard lens 539. Salmon patch is seen in - interstitial keratitis 540. Which laser is used for treatment of myopia - Excimer laser 541. Patient with painless sudden loss of vision, o/e cherry red spot in fundus and cardiac murmur, diagnosis is - CRAO 542. 3month old infant was brought with profuse lacrimation, on pressure pus exudes from the 543. puncta, best line of management - massaging of sac and antibiotics 544. Sudden unilateral loss of vision with ill-sustained reaction of pupil with slight head ache & pain in orbit on looking upward diagnosis is - Retrobulbar neuritis 545. Patient with recent malarial illness presents in acute red eye cause could be - viral keratitis 546. Blunt trauma to eye with immediate loss of vision, O/E anterior chamber of eye is deep cause could be - dislocation of lens 547. In retinoblastoma after enucleation which tissue needs critical evaluation for systemic metastasis - optic nerve 548. All visual reflexes are developed by - 1 year 549. Traumatic dislocation of lens is diagnosed by - slit lamp examination 550. For a newborn baby with squint surgery should be done at - 3-4 yrs 551. MC occular problem is - Refractive error 552. Immediate restoration of vision is by- Phacoemulcification 553. Weakest wall of Human orbit is - Medial wall 554. Soft contact lens wearer developed pain & itching of eye and reticular pattern on corneal epithelium cause could be - Acanthamoeba Rx - polyhexamethylene biguanide 555. Length of the eyeball is - 2.4cms 556. Pt with head injury presents 6 hrs after with mild proptosis & scleral hyperemia diagnosis retro orbital hematoma 557. Ideal drug for hypertensive having uveitis - atropine 558. Pseudopapillitis is seen in - hypermetropia 559. IOL is mostly implanted in - posterior chamber 560. Differential diagnosis for cotton wool spots - AIDS / diabetic retinopathy

18 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

561. Amsler's grid is used to diagnose - Macular function 562. Diameter of the optic disc is - 1.5mm 563. Best diagnosis for BEST disease - EOG 564. MC sign of retinoblastoma - Leukokoria 565. Art's line is seen in - trachoma 566. Enucleation cannot be done in - Vitreous hemorhage 567. In fancon's disease,deposits in cornea are due to - cystine 568. Twilight vision is due to - Rods 569. Astigmatism is due to - irregularity of curvature of cornea 570. Unit of light remitted from a surface is - Lambart 571. Thinning of cornea occurs in - Keratoconus 572. Tear film is composed of - 3 layers 573. Which continues to grow in the lifetime - Lens 574. Retinal detachment is seen in - highmyopia/aphakia/chorodoitis & not in hypermetropia 575. Fundal picture in - myopia is - cystoid degeneration 576. Photopsia is characteristic of - Retinal detachment 577. Macular sparing is seen in affection of - Occipital lobe 578. Cornea melts without inflammation in which condition - keratomalacia 579. Safe stratergy has been developed for the control of - Trachoma 580. Commonest cause of low vision is - uncorrected refractive errors 581. In a patient with AIDS chorioretinitis is typically caused by - CMV 582. Difficulty in reading newspaper with rt.eye post gun shot injury to lt. eye likely to be sympathetic opthalmia 583. Artificial eye is adviced after enucleation in how many days - 20 days 584. Optic nerve injury may result in - loss of vision/dilatation of pupil/loss of light reflex 585. Blow out fracture of orbit involve - floor & medial wall 586. Diabetic retinopathy is treated with - strict glycemic control/antihypertensives/antioxidants/panphotocoagulation 587. Snow ball opacity in vitreous is seen in - sarcoidosis & pars planitis 588. Retinal detachment is investigated with indirect opthalmoscope/usg/gonioscope/triple mirror test 589. Substance used in IOL is - silicone & poly methyl methacrylate 590. Pt with orbital mass,anemia,hypergammaglobunemia,pt should be investigated to rule out multiple myeloma 591. Accomodation is maximum at the age of - 5yrs 592. Keratoconus - degenerative condition of cornea/sev.astigmatism,soft contact lens useful 593. Chalazion trreatment - incision & curettage,intra lesion steroid 594. Corneal epithelium is - startified squamous non keratinized

19 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

595. Thickness of cornea is measured by - pachymeter 596. Most adjuvant therapy in fungal corneal ulcer - atropine eye ointment 597. Aylt's line is seen in - Trachoma 598. Sub conjunctival hemorhage occurs in - trauma/pertusis/passive venous congestion 599. Commonest cause of loss of vision in non proliferative diabetic retinopathy macular edema 600. Avascular coat in eye is - cornea 601. Virus causing eye infection is - Adenovirus 602. Night blindness is seen in - high myopia/vit A def./retinitis pigmentosa & not in tobacco amblyopia 603. Superficial retinal hemorhages r situated in - nerve fibre layer 604. Depth of anterior chamber of eye is - 2.5mm 605. Uveitis is seen in - leprosy/ankylosing spondylosis,reiters syndrome 606. Anisometropia means -high difference of refractive errors between the two eyes 607. 1st symptom of optic nerve damage is -afferent pupillary defect 608. Retinal blood vessels r developed from - paraxial mesoderm 609. Lid separation of fetus in intrauterine life occurs at which month - 7 month 610. Indirect opthalmoscope will project - real image 611. Extra ocular muscle supplied by sympathetic nerve is - muller's muscle 612. Most prominent glial cell of retina is - muller cell 613. MC retrobulbar orbital mass in adults is - Cavernous hemangioma 614. Smooth muscle of the IRIS is developed from - Mesoderm 615. Crystalline lens derives its nutritions from - Aqeous & vitreous 616. Band shaped keratopathy is caused by - calcium 617. Soft contact lens is used in - high myopia 618. Adhesion of margins of two eyelids is called - ankyloblepheron 619. LASIK is used in - Myopia 620. Dellen is - localized thinning of peripheral cornea 621. Cataract  Blurry vision 622. Glaucoma  Tunnel like vision

DERMOTOLOGY POINTS 623. Butter fly rash is seen in - SLE 624. Icthyosis is associated with - AIDS,Hypothyroidism,Hodgkin's disease 625. Drug causing Acanthosis negricans - Nicotinic acid 626. Target/Iris lesions r seen in - Erythema multi forme

20 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

627. Causative agent of Chancroid - Hemophillus Ducrei 628. Important feature of psoriasis is - Silver scales 629. Most important in diagnosis of leprosy is - slit skin smears for AFB 630. As per WHO minimum duration of treatment for leprosy is - 12 months 631. Slit skin smear is negative in - Neuritic leprosy 632. Come dones are characteristic of - Acne vulgaris 633. Most common cause of pemphigus is - Pemphigus vulgaris 634. Lesions of childhood atopic derma located in - Cubital & Popliteal fossa 635. Melanocytes No. r reduced except - Albinism(vitiligo,piebaldism,hypopigmentation) 636. Increased incidence of vitiligo is found in - T2DM 637. In a patch of vitiligo - Melanocytes r absent 638. Vitiligo - genetic predisposition/PUVA(best)/Coaltar/Topical steroids 639. Sev itching over webs of fingers,> at night,l/e burrows - Scabies 640. Molluscum contagiosum is caused by - Virus 641. Fungus affecting hair is - Trichophyton/Microsporum 642. Apple jelly nodules are seen in - Lupus vulgaris 643. Scabies oral drug - Ivermectin 644. Keroin is a form of - Fungal infection 645. Most common cause of cellulitis is streptococcus pyogenes 646. Flag sign in Hair is charecteristic of - PEM 647. H.Ducreyi causes - Soft chancre 648. Mycosis fungoides is a - T-cell lymphoma 649. Alopecia areata - spontaneous recovery will occur within 3-6 months in major pts. 650. Cradle cap in babies is - seborrheic dermatitis 651. Leprosy will affect all organs except - Uterus 652. Freis test is diagnostic of - Lymphogranuloma venerium 653. Which is known as Gift spots - Leuconychia 654. Causative organism for common warts - Human papilloma virus 655. Acanthosis nigricans is most common due to carcinoma of - Colon 656. Most specific test for Syphilis - FTA-ABS 657. Photochemotherapy is useful in - Psoriasis 658. Skin condition treated with PUVA therapy is - psoriasis 659. Munro's micro abscess are seen in - Psoriasis 660. Treatment of psoriasis - PUVA/Methotrexate 661. Auspitz sign is found in - Psoriasis 662. Auspitz sign is seen in - plaque type psoriasis 663. Auspitz sign is characteristically seen n - Plaque psoriasis

21 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

664. Recurrent painful oro genital ulcers with arthritis is due to - Reiter's syndrome 665. Commonest cutaeneous eruption in SLE is - Erythema of light exposed area 666. Pitting of nails can be seen in - Alopecia areata 667. Young female c/o of genital wart the agent implicated is - Human papilloma virus. 668. Commonest veneral disease - Gonorrhoea 669. Tines versicolor is caused by - Malasia Furfur 670. Helitrope rash is seen on face in - Dermatomyositis 671. Lesions of pityriasis rosea are distributed mostly on - Trunk 672. PUVA therapy is used for - psoriasis/vitiligo/Atopic dermatitis 673. 5yrs/m with hypopigmented scaly macule on cheek some of his classmates also has it 674. probable diagnosis - Pityriasis Alba 675. 10yr child- hypopigmented multiple scaly patch in face diagnosis - Pityriasis alba 676. 3yrchild-eczematous dermatitis on extensor surface mother-BA - Atopic dermatitis 677. Mouth lesions r seen n - Lichen planus 678. Nail changes in psoriasis - Oncholysis/pitting/subungual hyperkeratosis 679. Burrow is scabies in the - Stratum corneum 680. Itch is disease is true for - Atopic dermatitis 681. Drug producing erythema nodosum is - Sulphonamides 682. Tzank test is +ve in-Pemphigusfoliacious,P.vegetans,P.vulgaris,senear usher syndrom 683. Tzank cell is a - Keratinocyte 684. Acantholytic bullae are found in - Burns 685. Bulla spread sign is seen in - Pemphigus vulgaris 686. DOC for dermatitis herpatiformis - Dapsone 687. DOC in Gonorrhoea is - Procaine penicillin 688. DOC in Chancroid - Erythromycin 689. Drug of choice in systemic candidiasis is - Amphotericin-B 690. DOC in ENL is - Steroids 691. DOC for pustular psoriasis - methotrexate 692. DOC for pustular psoriasis in pregnant lady is - Prednisolone 693. DOC for Herpes Zoster - Acyclovir 694. DOC for Granuloma venerium - Erythromycin 695. DOC for Tinea Unguam - Griseofulvin 696. DOC for systemic candidiasis - Amphotericin B 697. Koebners phenonmenon is seen in - Lichen planus 698. Most common type of scarring alopecia is - Androgenic 699. Patch test is done to document - Delayed type hypersensitivity 700. Mucosal lesion is common in - Lichen planus

22 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

701. Recurrent plaques on glans which heal with residual hyperpigmentation is-herpes gestationalis 702. Earliest sensation to be lost in Leprosy is - Thermal 703. Degeneration of Basal cells occurs in - Lichen planus 704. Sebaceous cyst r seen in - Gardeners syndrome 705. Abscess is not a primary skin lesion 706. Acne-on drug-presents withblue black pigmentation of nails cause-Tab.Minocycline 707. Most common side effect of retinoids - Skin rashes 708. Acne vulgaris is due to involvement of - Pilosebaceous glands 709. Apocrine gland - modified sweat gland,present in groin&axilla, 710. Rhinophyma (potato nose) is-Glandular form of acne rosacea/sebaceous gland 711. hypertrophy 712. Anagen phase of the hair indicates - phase of activity & growth 713. Female with diffuse alopecia suffered frm typhoid 4 months back diagnosis -Telogen effluvium 714. Correct sequence of cell cycle is - G0-G1-S-G2-M 715. Neither raised nor depressed is - Macule 716. Flat discoloration on skin as 1cm is called - Macule 717. Oil drop is seen in - psoriasis of nails 718. Felon is seen in - Nail bed 719. Tinea ungum affects - nail plate 720. Characteristic feature of atopic dermatitis - Pruritis 721. Secondary syphilis manifested by 722. painless lymphadenopathy/mucosal erosion/asymptomatic rash 723. Hypopigmented patches r seen in - Naevus anemicus 724. Fir tree type distribution is seen in - pityriasis rosea 725. Air-borne contact dermatitis is diagnosed by - patch test 726. Alopecia areata is treated by - Minoxidil 727. School of fish appearance is shown by - Haemophilus ducreyi 728. Cicatricial alopecia-DLE/Lichen planus/SLE 729. Non cicatrical alopecia - Psoriasis/Alopecia areata 730. Rain drop pigmentation is seen in - chronic Arsenic poisoning 731. Patch test is done for - Allergic contact dermatitis 732. Fluid filled in epidermis and dermis is called - Vesicle 733. Commonest site of Atopic dermatitis is - Ante cubital fossa 734. Berloque dermatitis is due to contact with: - Cosmetics 735. Least common site involvement in psoriasis is - CNS involvement 736. Civatte bodies are found in - Lichen planus 737. A washer man presents with thickness erosion & discoloration of web spaces of toes

23 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

738. diagnosis is - Candidiasis 739. Dhobi’s itch is - Tinea cruris 740. Spongiosis is seen in - Acute Eczema 741. Coin shaped eczema - Nummular Eczema 742. Atopic dermatitis is diagnosed by - Clinical examination 743. Commonest metal causing skin hypersensitivity - Nickel 744. MCC of allergic contact dermatitis in female - Detergents 745. Commonest cause of air borne contact dermatitis is - Parthenium grass 746. Pt gets recurrent urticaria while doing exercise & on exposure to sunlight cause is Cholinergic urticaria 747. Annular herald patch is seen in - P.Rosea 748. Nummular ring is caused due to - Idiopathic 749. Darrier's sign is seen in - urticaria pigmentosa 750. Pt with recurrent swelling on face & lips due to emotional stress cause is CI esterase inhibitor deficiency 751. Quincke's disease is popularly known as - Angioneurotic oedema 752. Bleeding spots seen on removal of scales in psoriasis is called as - Auspitz sign 753. 127.Ash leaf maculae is found in - Tuberous sclerosis 754. the important feature of psoriasis is - Scaling 755. Patch test is a type of - Delayed type hypersensitivity 756. Patch test is read after - 2 days 757. Morbilliform eruptions r seen in - Rubella/Measles 758. Koebner phenonmenon is present in - Psoriasis/Lichen planus/Warts 759. Which is pruritic - Lichen planus/sunburns/Pemphigoid/psoriasis 760. Characteristic feature of lichen planus is - Wickham striae 761. Lichen planus TOC - Systemic steroids 762. Psoralen-A is used in treatment of - Vitiligo 763. Row of Tomb stones appearance is seen in - Pemphigus 764. Commonest variety of Pemphigus - Pemphigus Vulgaris 765. Associated with Pemphigus - Thymoma/CLL/Myasthenia gravis/Atrophic gastritis 766. Blister formation in burn case is in - Subepidermal 767. Mucous lesions r seen n - Pemphigus 768. Intera cellular IgG deposition in epidermis s seen n - Pemphigus 769. 143.Increased level of IgE is seen in - Atopy 770. 144.Granular IgA deposits at dermal papilla r found n - Dermatitis herpetiformis 771. HLA associated with dermatitis herpatiformis - HLA B27 772. Pyoderma gangrenosum is seen in - Ulcerative colitis 773. Erythema nodosum is seen in- RA/PTB/Enteric fever/Leprosy 774. What can pt with gluten sensitive hypersensitivity consume as food -Rice,corn

24 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

775. Target or Iris lesion is seen in - Erythema multi forme 776. Causative organism of Molluscum contagiosum - Pox virus 777. Ballooning is characteristic of - Herpes Zoster 778. Acantholysis is characteristic of - Pemphigus vulgaris 779. Pt c/o abd pain i vomitting,psychiatric symt & visual hallucinationsIntermittant porphyria 780. Porphyria cutanea tarda can be treated by - Phlebotomy 781. Non palpable purpura is seen in - Amyloid/ITP/Drug induced vasculitis 782. Palpable purpura is seen n - HSP/Sr.Sickness/Wegners granulamatosis 783. Treatment for kawasaki's disease - IVIg 784. Lish nodule is seen in - von reclinghausens disease 785. IgA deposits on skin biopsy - Henoch schonlein purpura 786. Triad of Reiters syndrome include - Conjunctivitis/Urethritis/Arthritis 787. Defective DNA repair is associated - Xeroderma pigmentosa 788. Pseudo bubo is seen in - Donovanosis 789. Satellite lesions are seen in - Borderline tuberculoid leprosy 790. Dermatitis & Alopecia are due to defeciency of - Zinc 791. Tuberculoid leprosy is characterised by - Non caseating granuloma in nerve 792. Crocadile skin or sauroderma is seen in - Icthyosis vulgaris 793. Casal's necklace is caused by - pellagra 794. Rash n Measles occurs first n - Post auricular region 795. Erythema marginatum is seen in - Rheumatic fever 796. Commonest nerve involved in Leprosy is - Ulnar 797. Lupus vulgaris - Skin & Mucosa TB/Apple jelly nodules at root of nose 798. Acrodermatitis enteropathica - decreased Zinc level/autosomal recessive 799. Rose spot are seen in - Typhoid fever 800. Slapped cheek appearance is seen in - Erythema infectiosum 801. Phrynoderma - deficiency of - vitamin A 802. Virchows cells are seen in - Leprosy 803. Lepromin test is used for – prognosis 804. Features of Lepromatous leprosy - Saddle nose/Gynaecomastia/Mydriasis 805. Commonest fungal infection in female genitalia in diabetes is - Candida 806. Most potent anti leprotic drug is - Rifampicin 807. Permethrin is used in treatment of - Scabies 808. Leprosy do not involve - CNS 809. Leprosy affects all organs except - Uterus 810. In leprosy nerves commonly involved are - High ulnar,low median 811. Skin hazards of swimming are - Verrucae/M.marinum infection

25 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

812. Most common type of leprosy - TT 813. Commonest skin infection in children is - Impetigo contagiosa 814. Characteristic lesions of scabies is - Burrow 815. Honey colour crusts are characteristics of - Impetigo 816. Most common organism causing Tinea capitis - Microsporum 817. Athelet's foot - 4th toe web is involved/hyperthyroidism(+)/caused by Trichophyton 818. Tinea incognito is seen with - Steroid treatment 819. Treatment of Acne - 13 cis-retionol/Minocycline/Erythromycin 820. Multi drug therapy is given for - Leprosy 821. Tinea versicolor is caused by - Malassezia Furfur 822. Griseofulvin is useful in - T.capitis,T.cruris,T.Pedis 823. Treatment for T.Versicolor - clotrimazole/sod thiosulphate/miconazole/selenium sulphide 824. Safety pin appearance is shown by - Donovanosis granulomatis 825. Black dot ring worm is caused by - Trichophyton 826. Washerman i thickness erosion & discolouration of web spaces & toes -Candidiasis 827. Medically most important form of UV - UV-B 828. Rangeof light which causes max damage to skin - 290-360nm 829. Griseofulvin is not used in - T.Versicolor & Candida 830. Dhobi's Itch is - T.Cruris 831. Incubation period of scabies - 4 wks 832. Antidote for T.warfarrin - vit-k 833. Circlre of Hebra is associated with - Scabies 834. Vagabond's disease is - Pediculosis corporis 835. Impetigo contagiosa most commonly due to - Staphylococcus 836. Condylomata acuminata is caused by - HPV 837. LGV is caused by - Chlamydia trochamatis 838. Genital elephantiasis is caused by - Lymphogranuloma venerum 839. Sign of groove is found in - LGV 840. Frie's test is done in - LGV 841. DOC for LGV - doxycycline 842. DOC for Herpes Zoster - Acyclovir 843. DOC in primary syphilis is - Benzathine penicilline 844. Pseudo-isomorphic phenonmenon is shown by - Warts 845. Most severe form of scabies - Norwegian scabies 846. Chancroid is caused by - Hemophilus ducreyi 847. Most frequent cause of recurrent genital ulceration in sexually active male is Herpes genitalis 848. Ivermectin is indicated in treatment of - Scabies

26 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

849. Sabre tibia is seen in - syphilis 850. Acanthosis nigricans is indicative of internal malig/endocrine dis/Blooms synd/pigmentation of face & neck 851. Langerhans cells in skin are - Antigen presenting cells 852. Shagreen patch may be seen in - Tuberous sclerosis 853. Rodent ulcer is a type of - basal cell ca 854. Hypervitaminosis A is associated i - hair loss/dry skin/hypopigmentation/# bones. 855. Blue line on Gums r seen in - Acute monocytic leukemia 856. Escharotomy is done for - circumferential scars. 857. Leprosy does not affect - Uterus & ovary 858. Erythema multiforme is caused by - Virus 859. Systemic treat ment of Scabies - Ivermectin 860. Wasserman test is done for - syphilis 861. Protective from ultra violet rays - Melanocytes 862. Child born with nasal discharge & rash all over the body - Congenital syphilis 863. 25 yr GM with urticaria,recurrent skin infection,abd cramps & diarhea upon taking sea foods Atopic dermatitis 864. Male has painless ulcer 9 days after coitus i professional sex worker diag - Chancre 865. Multi bacillary leprosy is -12 months 866. Pauci bacillary leprosy is - 6 months 867. Silvery scaling is an important feature of - Psoriasis 868. Melasma is seen in - Face 869. Iron deficiency anemia - Koilonychias 870. Apple jelly nodules- lupus vulgaris 871. Butterfly rashes r seen n - SLE 872. Auspitz sign is seen n - Psoriasis 873. Row of Tomb stone appearance is seen in - Pemphigus 874. Kerion is a - Fungal infection 875. Anagen is the growth phase of - Hair 876. Ashleaf spots are seen in - Tuberous sclerosis 877. Honey colored crusting seen in which Disease – Impetigo 878. Gotrrons papule – Dermatomyositis 879. Facial angiofibroma/adenoma sebacium of Pringle -- Tuberous sclerosis 880. Brown spots under nail plate (oil spit) -- Psoriasis 881. Burrow is seen in  Scabies 882. Hyperpituitrism  Skin discoloration 883. SLE -- Butterfly rash

27 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

884. Liver cirhosis -- Spider angioma 885. Leprosy  Contracted face 886. Symmetrical Christmas tree skin lesion on back -- Pityriasis rosea 887. Hypopigmented anesthetic skin lesions -- Leprosy 888. Axillary freckling/crowe's sign -- Neurofibromatosis 889. Erythema cronicum migrans -- Lyme disease 890. Pink papule with central umbilication -- Molluscum Contagiosum 891. Casal's necklace is seen in -- Pellagra 892. Wickham stria -- Lichen planus

MEDICNINE & SURGERY POINTS 893. Myasthenia Gravis  descending muscle weakness, ptosis (drooping of eyelids). 894. Glioblastoma is the most common primary brain tumor in adults. 895. Astrocytoma is the most common brain tumor in children. 896. Medulloblastoma is the most common malignant brain tumor in children. 897. Most common fracture associated with Extra-dural hematoma (EDH) is Parietal bone 898. Most common source of bleeding in EDH is anterior division of middle meningeal artery. 899. the most sensitive test for SAH is Lumbar puncture 900. The “Gold standard” for evaluation of cerebral aneurysm is cerebral angiogram. 901. the most common site of Intracerebral hemorrhage is Putamen 902. site of Prostatic hyperplasia/BPH -- transitional periurethral zone 903. site of Prostatic carcinoma -- peripheral zone 904. Most common site of osteosarcoma -- Knee 905. Oligohydromnios can lead -- Potter Syndrome 906. Oligohydramnios -- Fetal compression --> Flattened facies and positional abnormalities of hands and feet 907. Adverse Effects of Systemic Corticosteroids: Osteoporosis, Cataracts, Adrenal suppression 908. The aqueduct is the most common site of stenosis --> Leads to hydrocephalus 909. Chocolate cysts seen in --> Endometriosis 910. Chocolate cysts tx with Danazole 911. Painless hematuria --> bladder cancer 912. Most common stones are calcium oxalate stones (75%) 913. Uncommon stone are Cysteine stones 914. Botulinum toxin increased flaccid paralysis 915. Tetanus toxin increased spastic paralysis 916. Roth's spot are seen in infective endocarditis 917. Koplik’s spot seen in  measles rubella 918. Best artery for coronary angiography  Femoral

28 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

919. Keyser Fleisher sign is seen in Wilson's disease 920. Negri bodies are most often found in hippocampus 921. Negri bodies are associated with rabies virus 922. Trousseau's sign is characteristic feature of tetany 923. Cullen’s sign is feature of  acute pancreatitis 924. Grey tender signs  acute pancreatitis 925. Virchow's node is present in --> carcinoma of stomach 926. Back water fever due to -- severe plasmodium Falciparum infection produces red urine 927. painless chancres is seen in: Syphilis 928. painful chancres is seen in Cancroid 929. Gonorrhea  green, creamy discharges and painful urination. 930. Chlamydia  milky discharge and painful urination. 931. Candidiasiswhite cheesy odorless vaginal discharges. 932. Trichomoniasis  yellow, itchy, frothy, and foul smelling vaginal discharges. 933. Unilateral proptosis followed by contralateral proptosis 24-48 hrs latter --> Cavernous sinus thrombosis 934. Heliotrope erythema of eyelids  Dermatomyositis 935. Battle's sign (retroauricular ecchymosis)  Basal skull fracture 936. Hellers operation  achalasia cardia 937. 2nd rat tail appearance ….achalasia cardia 938. Drug for Herpes zoster  foscarnet, acyclovir and valacyvlovir 939. Common presentation of large duct papilloma  nipple discharge 940. Most common vaginal infection in pregnant ladies -- candidiasis 941. Clue cells seen in -- bacterial vaginosis 942. Mass in posterior cranial fossa in child diagnosis -- medulloblastoma 943. Coffee bean sign seen in -- volvulus 944. Most common cause is isolated root dilation in  aortic regurgitation 945. Aortic regurgitation -- water hammer pulse 946. Microangiopathic hemolytic anemia seen in aortic stenosis 947. COPD -- Barrel chest 948. A young patient with angina at rest and ST-segment elevation with normal cardiac enzymes: Prinzmetal’s angina. 949. Parkinson’s disease --> pin-rolling tremors 950. Pneumonia -- Rusty color sputum 951. Pernicious anemia -- red beefy red tongue 952. Kawasaki disease -- Strawberry tongue 953. Cushing’s syndrome -- moon face appearance and buffalo hump 954. Tetany -- Muscle twitching face

29 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

955. Addison’s disease -- bronzelike skin pigmentation. 956. Appendicitis -- Rebound tenderness 957. Hepatitis -- Icteric (yellowish) sclera 958. Hyperthyroidism -- Exophthalmos(bulging of the eye out of the orbit). 959. Guillain-Barre Syndrome—ascending muscles weakness. 960. Typhoid fever -- Rose spot in the abdomen 961. Cholera -- Rice water stool 962. Asthma -- wheezing expiration 963. Bulimia nervosa  chipmunk facies (parotid gland swelling) 964. Down Syndrome  Single crease on Palm + protruding tongue 965. Angina—crushing, stabbing pain relieved by NTG. 966. Buerger’s Disease  intermittent claudication (pain at buttocks or legs from poor circulation resulting in impaired walking). 967. Diabetic Ketoacidosis  acetone breathe. 968. Russell's sign is seen in -- Purging behaviour 969. Ecthyma gangrenosum -- Pseudomonas aeroginosa septicemia 970. Stemmer sign (inability to pinch or pick up a fold of skin at the base of second toe) --> Lymphedema 971. Janeway lesions (painless erythematous palmar or plantar macules) --> Infective Endocarditis 972. Galactorrhea in man --> prolactinoma 973. New onset macroglosia in an Adult -- Amyloidosis 974. Strawberry gums -- Wegners granulomatosis 975. Hatchet face -- Myotonix dystrophy 976. Blue dot sign of scrotal skin -- Torsion of appendix testis OR epididymis 977. Calcified bladder resembling fetal head --> 420. Calcium oxalate monohydrate crystals in urine --> Ethyline glycol toxicity 978. Flat hexagonal crystals in urine -- Cystinuria 979. Figure 3 sign on CXR is seen in -- COA 980. Strawberry cervix (colpitis macularis) -- Trichomoniasis 981. Risus sardonicus is seen in --> Tetanus 982. Asymmetric tremor at rest -- Parkinson 983. Jaw claudication when chewing in adults -- Temporal arteritis 984. Thumb print sign is seen in -- Epiglottitis 985. Silver stool sign is seen in -- Cancer of ampulla of Vater 986. Dance's sign is seen in -- Intussusception 987. String of beads sign -- Small bowel obstruction 988. Corkscrew pattern on barium study -- Midgut volvulus 989. Double bubble sign is seen in -- Duodenal atresia

30 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

990. Currant jelly stool is seen in -- Intussusception 991. Mercedes Benz sign is seen in -- Gall stones 992. Blade of grass/flame sign is seen in -- Paget disease 993. Honda sign is seen in -- Insufficiency fracture 994. Periungual fibromas (koenen tumor) -- Tuberous sclerosis/bourneville's disease 995. Purple (violaceous abd stria wider than 1 cm) -- Cushing Syndrome 996. Palmar Xanthomas -- Type 3 hyperlipoproteinemia 997. Pulmonary Tuberculosis (PTB) -- low-grade afternoon fever. 998. Cholera -- rice-watery stool and washer woman’s hands (wrinkled hands from dehydration). 999. Malaria -- stepladder like fever with chills. 1000. Dengue -- Fever, rash, and headache. Positive Herman’s sign. 1001. Diphtheria -- pseudomembrane formation. 1002. Measles -- Koplik’s spots (clustered white lesions on buccal mucosa). 1003. Systemic Lupus Erythematosus—butterfly rash. 1004. Leprosy -- leonine facies (thickened folded facial skin). 1005. Appendicitis -- rebound tenderness at McBurney’s point. Rovsing’s sign (palpation of LLQ elicits pain in RLQ). Psoas sign (pain from flexing the thigh to the hip). 1006. Meningitis -- Kernig’s sign (stiffness of hamstrings causing inability to straighten the leg when the hip is flexed to 90 degrees), Brudzinski’s sign (forced flexion of the neck elicits a reflex flexion of the hips). 1007. Tetany -- hypocalcemia, [+] Trousseau’s sign; Chvostek sign. 1008. Tetanus -- Risus sardonicus or rictus grin. 1009. Pancreatitis -- Cullen’s sign (ecchymosis of the umbilicus), Grey Turner’s sign (bruising of the flank). 1010. Pancreatitis -- Blue discoloration preumblical area 1011. Pyloric Stenosis— olive like mass. 1012. Intussusception— Sausage-shaped mass. 1013. Multiple Sclerosis— Charcot’s Triad: nystagmus, intention tremor, and dysarthria. 1014. Deep vein thrombosis (DVT)—Homan’s Sign. 1015. Pulmonary embolism --> DVT 1016. Breast mouse is -- Fibroadenoma 1017. Trisomy 21 -- Down syndrome. (Age for Drinking is 21) 1018. Trisomy 13 -- Patau syndrome.(Age for Puberty in females is 13) 1019. Trisomy 18 -- Edward syndrome.(Age for voting in Election is 18) 1020. Increased alpha feto protein plus increased albumin = Anencephaly. 1021. DVT more common in popliteal vein but pulmonary embolism is through femoral veins. 1022. Investigation of DIC: D-dimers, FDPs, Platelet count and PT (except clotting time). 1023. Tracheostomy is done at 2nd tracheal ring by pulling the isthmus inferiorly. 1024. Treatment of hairsutism is Cyproterone Acetate.

31 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1025. CT pulmonary angiography is the best test to detect Pulmonary Embolism. 1026. Snow pattern on CXR --> silicosis 1027. Factors predisposing to digitalis toxicity are advanced age, hypoxia,hypokalaemia, hypomagnesaemia, hypercalcaemia, hypothyroidism, Amyloidosis and renal failure. 1028. The most common precipitating factor for digitalis toxicity is hypokalaemia. 1029. Diarrhoea and flushing, occurring separately or together, are the most frequent presenting features of carcinoid syndrome (approximately half of all patients). 1030. Hypertrophic cardiomyopathy is the single, most common cause of sudden death in young athletes. 1031. Basal cell carcinomas are the most common malignant skin tumour and are related to excessive skin exposure. 1032. The most common type of thyroid cancer is papillary cancer, which accounts for approximately 70% of all thyroid cancers 1033. A high white cell count with smear cells and mature lymphocytes > chronic lymphocytic leukaemia 1034. Infection is the commonest cause of death in multiple myeloma. 1035. Most specific tumor marker for prostate -- prostate specific antigen (PSA) 1036. Riased serum alkaline phosphatase indicated -- Paget’s disease / osteitis deformens 1037. Hot-tub-folliculitis is caused by -- Pseudomonas auregenosa 1038. Extra-Dural hematoma » cause: severe head trauma » Rupture middle meningeal artery » CT brain: Biconvex/lens shaped » ROC: Burr-Hole Craniotomy 1039. Sub-Dural hematoma » Cause: elderly , alcoholic » Rupture bridging vein (trivial/small scalp laceration) » CT brain: Concave/crescent shaped » ROC: Burr-Hole Craniotomy 1040. Sub-Arachanoid Hemorrhage » MCC Berry Aneurysm » C/F: Thunder clap headache “worst headache of life” » Additional: Neck stiffness, Sign Of meningeal irritation, 3rd CN Nerve palsy, Increased ICP » Ix: 1st line-CT brain 90% sensitivity, 2nd line-L/P: after 12h lowering of Increase ICP — xanthocromia » DOC: Nimodipine (cerebral vasospasm) » Ix aetiology: CT angiography 1041. Migraine Headache » Unilateral throbbing/pulsating headache, photophobia, phonophobia

32 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

» Duration: 4-72 hours » Triggers: Menses, OCP, stress, bright light, cheese, chocolate, caffeine » Rx Acute attack: 1st line - NSAIDs, 2nd line-Sumatriptane or Ergotamine » Prophylaxis Rx: 1st line - Propranolol, amitryptilline, 2nd line- valproic acid, flunarizine, verapamil, pizotifen » For acute attack pregnancy- Paracetamol & amitryptyliine for Prophylexis 1042. Cluster headache » Attack mostly at rest/night time » Sudden onset of severe pain in one eye (Unilateral periorbital headache) » Associated with ipsilateral lacrimation, conjunctivitis, ptosis » Duration: 15min - 3hours » Rx: Acute attack- 100% O2, Triptan » Prophylaxis: class-A: methysergide (Best drug but avoided due to retro peritoneal fibrosis), Class-B: verapamil, lithium, S/C steroid inj 1043. Tension headache (stress/work overload) » Leading cause of headache worldwide (40%) » B/L non-pulstile headache as tight band around head like pain » Worsen by stress & improve with massage » Rx: Relaxation & head massage » Drugs: anxiolytics, NSAID, Triptan 1044. Trigeminal Neuralgia » Paroxysm of intense shooting/firing/stabbing facial pain lasting for seconds (1-5min) » Tirggers: Brushing, shaving, eating, talking, washing » Ix: MRI base of skull for Sec. cause » Rx: carbamazepine (DOC) 1045. Benign intracranial Hypertension (BIH) » Known as Pseudotumor cerebri (Pt. Present with headache+ increased ICP but every thing is normal on CT » Cause: idiopathic » Associated with Cushing disease, SLE, PRV, CST, thyroid disease and drugs: tetracycline, steroids, OCPs » C/F: obese female 30’s, B/L diffuse headache, diplopia, vomiting » On F/E: pupiledema (Incr. ICP) » Rx: self-limiting conditions » Drugs: Acetazolamide 1046. Most common cause of ASOC & Fits worldwide — hypoglycaemia so should check BSL 1st & Rx Dextrose

33 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1047. Most common cause is dementia is — Alzheimer’s disease 1048. Illusion: False perception/ misperception of an actual external stimulus 1049. Delusion — Fixed false belief 1050. Hallucination — perception without an existing external stimulus (Abnormal sensation) 1051. Dementia — progressive decline of cognitive function intellect with memory loss 1052. Alzheimer’s disease » progressive forgetfulness » Pathology: Diffuse atrophy with enlarged ventricles + senile plaques + neurofibrillary tangles » Rx: Donepezil (anticholinestrase inhibitors) & Memantine (Anti-glutameneric/NMDA inhibitors) 1053. Multi-infact dementia (vascular dementia) » 2nd MCC dementia » H/O multiple stroke+dementia » Rx: same as stroke 1054. Lewy body dementia » Parkinsonism + early onset dementia + personality changes » Pathology: clumps of a-synuclein protein (Lewy bodies) 1055. Visual hallucinations + features of cognitive impairment — Lewy body dementia (Hallucination is prominent feature of LBD than Alzheimers. Again cognitive impairment goes more with LBD while prominent early memory loss symptom suggests Alzheimer’s) 1056. Pick disease — Frontotemporal dementia » Pathology: Round intraneuronal inclusion (pick bodies) » MRI/CT: frontotemporal atrophy 1057. Normal pressure hydrocephalus » classic triad: Dementia + Gait apraxia (ataxia) + urinary incontinence » CT/MRI: ventricular enlargement » Rx: surgical ventriculoperitoneal shunting 1058. Creutzfeld-Jakob Disease » progressive dementia + myoclonus (violent jerking of limbs) with visual disturbance (vertical gaze palsy) » Pathology: biopsy - prion protein » EEG shows pyramidal signs and periodic sharp waves. (Periodic complexes) » Ix: CSF electrophoresis, tonsillar & olfactory Nerve biopsy 1059. Dressing apraxia, agraphia and finger agnosia are features of — parietal lobe lesions 1060. In benign essential tremor there is no rest tremor but tremor occurs during movement of the affected limb 1061. nystagmus, loss of corneal reflex, hearing loss, balance problem are well known feature of — acoustic neuroma 1062. Hallpike maneovure is the preferred method to detect benign positional vertigo

34 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1063. H/O Bilateral vitreous haemorrhage + progressive ataxia — Von Hippel-Lindau syndrome 1064. In hypoglossal nerve palsy the tongue will be curved toward the damaged side, combined with the presence of fasciculations or atrophy 1065. Hemiplegia, homonymous hemianopia, dysphasia these are common features of mid cerebral artery stroke 1066. chronic alcohol abuse that leads to temporary or permanent — cerebellar damage 1067. loss of sensation on the tip of tongue and the inner aspect of the lip — Lingual nerve 1068. Ischemic stroke » cause: MC Atherosclerosis » C/F: Heaviness limb, slurred speech, FND without Incr. ICP » CT scan: Hypodense shadow (less grey area. » Rx: control RF, anti-thrombotic, anti-coagulant, anti-HTN, anti-platelet. 1069. Hemorrhagic stroke » cause: uncontrolled HTN » Sudden onset FND with incr. ICP features » CT scan: hyper-Intense shadow (more white area) » Rx: mannitol to decr. increase ICP, anti-epileptics for fits 1070. Features of anterior cerebral artery stroke » C/L legs weakness » Urinary incontinence » Memory loss » Behaviour change 1071. Features of middle artery stroke - C/L distal arm & trunk weakness only 1072. Tracheo-esophageal fistula » Dribbling and regurgitation after feed » Respiratory distress » Frothing & Bubbling at mouth 1073. Hirschsprung disease » Symptoms of bowel obstruction: abdominal distension, constipation » Child did not pass meconium at birth » Bilious vomiting and crying » Failure to thrive » Rectal biopsy (gold standard) 1074. Pyloric stenosis » Severe Abdominal pain » Non-Bilious vomiting » Current jelly stool 1075. Intussusception

35 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

» Bloody current jelly stool » abdominal distention » sausage shaped palpable mass in child screaming with severe abdominal pain » An empty RIF (Rt lower segment) 1076. Most common cause of intestinal obstruction in children: intussusception 1077. Esophageal atresia in child/infant first sign will be — Drooling of saliva 1078. Most common overall — ASD 1079. Most common in adults overall — ASD 1080. Most common in children overall — VSD 1081. Most common acyanotic overall — VSD 1082. Most common acyanotic in adults overall — ASD 1083. Most common cyanotic overall — TOF 1084. Most common cyanotic at Birth — transposition of great vessel 1085. Second most common at birth — tricuspid atresia. 1086. Cyanotic disease during first 24 hours — TOF 1087. 2nd most common tricuspid atresus. 1088. Most common congenital heart disease — VSD 1089. Most common acyanotic congenital heart disease — VSD 1090. Most common cyanotic congenital heart disease — TOF 1091. Most common type of ASD — Ostium secundum 1092. Most Common type of VSD — membranous VSD 1093. Eisenmenger complex is common in — VSD 1094. Common presentation of CoA » intermittent claudication » headache & dizziness » hypotension » dyspnea on exertion » weak pulse in femoral vessels 1095. Coarctation of aorta is common with — Turner syndrome 1096. Most common symptom of smal! bowel obstruction in a neonate: Bilious vomiting 1097. lsoprenaline should be ovoided in TOF as it causes peripheral pooling of blood 1098. Blalock Taussig shunt Between — Subclavian artery & Pulmonary Artery 1099. Pott's shunt Between — Descending aorta & Pulmonary Artery 1100. Waterston's shunt Between — Ascending aorta 1101. Boot shaped heart is seen in — TOF 1102. Eggs on side appearance — TGA 1103. surgical Rx of choice for TGA — Jantene arterial switch procedure

36 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1104. Murmurs of CHDs » Acyanotic heart disease with ejection systolic murmur: ASD, VSD, PDA, CoA » Pansystolic murmur at left sternal border — VSD » Continous (machinery) murmur — PDA 1105. Shortness of breath after fracture = Fat embolism 1106. Shortness of breath in deep sea drivers, chest injury = air embolism 1107. Shortness of breath after delivery or in pregnant lady = amniotic fluid embolism (sudden death) 1108. Shortness of breath on lying down = retrosternal goiter 1109. Female Shortness of breath after taking HRT/OCPs + Pulmonary thromboembolism 1110. Most common valve involved in Rheumatic Fever — mitral valve > Aortic 1111. Most common defect in Rheumatic Fever — mitral regurgitation 1112. Most common acquired heart disease in children’s— rheumatic carditis 1113. Most common major manifestation in Rheumatic Fever: Arthritis 1114. DOC for Rheumatic Fever — penicillin 1115. DOC in Penicillin allergic cases in Rheumatic Fever — Erythromycin 1116. DOC for prophylaxis of rheumatic carditis is — Benzathine penicillin 1117. Most common cause of hypertension in children — renal parenchymal disease, 1118. Most common cause of HTN among renal parenchymal diseases chronic glomerulonephritis > chronic pyelonephritis 1119. Most common cause af renovascular hypertension in children — renal artery stenosis 1120. Cyanotic CHD with left ventricle hypertrophy — Tricuspid atresia 1121. Left ventricle hypertrophy with central cyanosis is seen in — Tricuspid atresia 1122. Ebstein's anomaly is seen with intake of maternal — Lithium 1123. Recurrent chest infections are seen — ASD, VSD, PDA, TGA, TAPVR 1124. Most common cause of death in PDA is — CHF > infective endocarditis 1125. Anatomic closure of ductus arteriosus occurs: Between 10 to 25 days after birth. 1126. Functional closure of ductus arteriosus occurs: immediately (within 15hours) after birth 1127. Ductus arteriosus forms — Ligamentum arteriosum in post-natal life. 1128. Drugs used to maintain patency of PDA: prostagrandin E1, (misoprost, rioprostir). 1129. Closure of PDA is stimulated by: Prostaglandin inhibitors NSAIDs (most commonly indomethacin). 1130. Drug of choice for Acute migraine is Sumatriptan 1131. Drug of choice for Meningitis (Empirical therapy): Ceftriaxone + Ampicillin 1132. Drug of choice for S.Pneumonia meningitis is: ceftriaxone + Vancomycin 1133. Drug of choice for N.Meningitidis meningitis is: ceftriaxone + Ampicillin, Close contact should be given chemoprophylaxis: rifampicin for 2 days or one dose of 500mg azithromycin or IM 250mg Ceftriaxone 1134. Drug of choice for Tubercular meningitis: ATT 1135. Drug of choice for Fungal meningitis: Amphotericin B

37 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1136. Drug of choice for Syphilis: Benzathine Penicillin 1137. Drug of choice for Dermatitis herpetiformis is Dapsone 1138. Drug of choice for congenital adrenal hyperplasia – hydrocortisone 1139. Drug of choice for Bell's palsy/Facial nerve palsy – Corticosteroids + Acyclovir 1140. Drug of choice for Amoebic liver abscess – Metronidazole 1141. Drug of choice for malaria in pregnancy – Chloroquine 1142. Drug of choice for Anticoagulation in pregnancy – Heparin 1143. Drug of choice for DVT in pregnancy – Heparin 1144. Drug of choice for Eclampsia – Mg Sulphate 1145. Drug of choice for Pre eclampsia – Hydralazine , 2nd line Labetalol 1146. Drug of choice for Hypertensive emergencies in pregnancy -- Labetalol 1147. Drug of choice for Post Delivery uterine Bleeding – Ergometrine 1148. Drug of choice for Post Delivery uterine Bleeding with ATONY – Oxytocin 1149. Drug of choice for Ectopic pregnancy – Methotrexate 1150. Drug of choice for treatment of bacterial vaginosis during pregnancy – Metronidazole 1151. Drug of choice for Definitive treatment of severe preeclampsia -- Delivery of foetus 1152. Drug of choice for GI Bleed with CLD: Inj Terlipressin  Inj Octreotide 1153. Drug of choice for Trigeminal Neuralgia : Carbamazepine 1154. Drug of choice for acute bronchial asthma: salbutamol 1155. Drug of choice for COPD: Anticholinergic (Tiotropium, Ipratropium) 1156. Drug of choice for Methicillin-resistant Staphylococcus aurous (MRSA): Vancomycin 1157. Drug of choice for Vancomycin-resistant Staphylococcus aurous (VRSA): Linezolid 1158. Drug of choice for Amebiasis: Metronidazole 1159. Drug of choice for Giardiasis: Metronidazole 1160. Drug of choice for Trichomoniasis: metronidazole 1161. Drug of choice for Clostridium difficile: Metronidazole 1162. Drug of choice for diabetic nephropathy: ACE Inhibitors (captopril/Enalapril) 1163. Drug of choice for Bed wetting (Nocturnal enuresis): Imipramine 1164. Drug of choice for acute migraine: Sumatriptan 1165. Drug of choice for acute gout: NSAIDS 1166. Drug of choice for chronic gout: Allopurinol 1167. Drug of choice for cerebral edema: mannitol 1168. Drug of choice for decrease , increased intracranial pressure is: mannitol 1169. Drug of choice for decrease , increased intra-ocular pressure in emergency is: mannitol 1170. Drug of choice for acute hyperkalemia: calcium gluconate 1171. Drug of choice for Syphilis: Benzathine Penicillin 1172. Drug of choice for systemic fungal infection: Amphotericin-B

38 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1173. Drug of choice for scabies: 5% permethrin 1174. Drug of choice for head nits: Malathione 1175. Drug of choice for nodulocystic acne: Isotretinoin 1176. Drug of choice for Prevention osteoporosis: Bisphosphonate (Alendronate/Resodronate) 1177. Drug of choice for steroid induced osteoporosis: Bisphosphonate (Alendronate/Resodronate) 1178. Drug of choice for motion sickness: scopolamine (Hyoscine butyl bromide) 1179. Drug of choice for mountain sickness: Acetazolamide 1180. Drug of choice for Clindamycin induced pseudo-membranous colitis - metronidazole and alternative is Vancomycin 1181. Drug of choice for Absence seizures: Ethosuximide 1182. Drug of choice for Grandmal seizers (GTCS): Valproate 1183. Drug of choice for Partial seizure: carbamazepine 1184. Drug of choice for Seizure in pregnancy (Eclampsia): Magnesium Sulphate 1185. Drug of choice for Status Epilepticus: Lorazepam (IV), if not in option than IV Diazepam/Midazolam 1186. Drug of choice for Anaphylactic shock: Adrenaline (Epinephrine) 1187. Drug of choice for Distributive shock: Phenylephrine 1188. Drug of choice for Septic shock: nor-adrenaline (Nor-Epinephrine) 1189. Drug of choice for Diabetes mellitus Type 1: Insulin 1190. Drug of choice for Diabetes mellitus Type 2: Metformin 1191. Drug of choice for Diabetes Mellitus in Pregnancy/Gestational DM: Insulin 1192. Drug of choice for Diabetes mellitus in obesity: Metformin 1193. Drug of choice for Diabetic Ketoacidosis (DKA): Insulin (Crystalline regular insulin) 1194. Drug of choice for Hyperprolactinemia: Bromocriptine 1195. Drug of choice for hypothyroidism: Levothyroxine 1196. Drug of choice for reducing somatic manifestation of hyperthyroidism: Propranolol 1197. Drug of choice for Hyperthyroidism in pregnancy: Propylthiouracil (PTU) 1198. Drug of choice for making patient euthyroid before surgery: Potassium iodide 1199. Drug of choice for Bipolar disorder: Lithium carbonate > Valproate sodium 1200. Drug of choice for Obsessive Compulsive disorder: SSRIs (Fluoxetine) 1201. Drug of choice for Panic disorder: SSRIs 1202. Drug of choice for Panic attack: Benzodiazepine 1203. Drug of choice for Traveler's diarrhea: Diphenoxylate/ Norfloxacin 1204. Drug of choice for amoebic liver abscess: Metronidazole 1205. Drug of choice for HSV/Shingles: Acyclovir 1206. Drug of choice for malaria in pregnancy: Chloroquine 1207. Drug of choice for Pregnancy induced hypertension: Methyldopa (Recently Labetalol) 1208. Drug of choice for Drug Induced Parkinsonism (Haloperidol): Benzhexol, Procyclidine

39 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1209. Drug of choice for Post-operative vomiting – Ondansetron 1210. Drug of choice for Chemotherapy/Radiation induced vomiting: Ondansetron 1211. Drug of choice for Pulmonary edema: Furosemide 1212. Drug of choice for Ascites due to liver cirrhosis: Spironolactone 1213. Drug of choice for prinzmeatal angina: Nitroglycerin 1214. Drug of choice for AV nodal delay: Adenosine 1215. Drug of choice for atrial fibrillation: Digoxin 1216. Drug of choice for WPW: Procainamide 1217. Drug of choice for peptic ulcer: PPIs (omeprazole) 1218. Drug of choice for H.Pylori: PPIs + Amoxicillin + Clarithromycin (Triple therapy) 1219. Drug of choice for malignant hypothermia: Dantrolene 1220. Antidote for Acetaminophen toxicity: N-Acetylcysteine 1221. Antidote for Benzodiazepine overdose: Flumazenil 1222. Antidote for Isoniazid induce peripheral neuropathy: Pyridoxine B6 1223. Antidote for Heparin: Protamine sulfate 1224. Antidote for Warfarin: Delayed effect  Vitamin K, Immediate  FFP 1225. Antidote for Opioids overdose: Naloxone/Naltrexone 1226. Antidote for Organophosphates Poisoning: Atropine > pralidoxime 1227. Antidote for Digoxin (Digitalis): Digoxin-immune Fab 1228. Antidote for Magnesium Sulphate: Calcium gluconate 1229. Increases the risk of digoxin toxicity: Administration of quinidine 1230. Digoxin toxicity is caused by: Hypokalemia 1231. Digoxin toxicity causes: hyperkalemia 1232. Adverse effect of Digoxin: Hyperkalemia 1233. Digoxin toxicity is caused by: Hydrochlorothiazide 1234. Digoxin toxicity ECG: increase PR interval 1235. ECG changes in Hyperkalemia: Tall T wave 1236. ECG changes in hypokalemia: U wave 1237. ECG changes in myocardial infarction: ST segment elevation 1238. ECG changes in old myocardial infarction: Pathological Q wave 1239. Fixed splitting is seen in: ASD 1240. T-wave inversion may indicate: ischemia or recent MI 1241. Saw tooth appearance on ECG: Atrial flutter 1242. Triad of hypertension, bradycardia, and respiratory depression: Cushing reflex 1243. Most common site of atherosclerosis: Abdominal aorta 1244. Common cause of sudden death first few hours after MI: Arrhythmia 1245. Heart valve in IV drug abusers Endocarditis is: Tricuspid valve

40 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1246. Muffled heart sounds, elevated jugular venous pressure, and a fall in the systolic pressure known as Beck’s triad seen in: cardiac tamponade 1247. Most commonly affected valve in rheumatic fever is : mitral valve 1248. Most common cause of acute endocarditis (not damage valve) is: Staph. Aureus 1249. Most common cause of Sub-acute endocarditis (already damage valve): Strept Viridans 1250. Overall Most common cause of Endocarditis in IV drug abusers: Staph. Aureus 1251. Most accurate diagnostic test for infected endocarditis: Blood culture 1252. The enzyme of choice for diagnosing reinfarction in MI is: CK-MB 1253. Cardiac enzyme which is most specific after 6 hr of MI: Troponin I 1254. The Most sensitive as well as specific for MI is: Troponin 1255. Cardiac enzyme which is most specific: Troponin I 1256. Cardiac enzyme which is most sensitive: Troponin T 1257. Gold standard investigation in first 6 hr after MI: ECG 1258. What is the investigation for second MI after 1 week of previous MI: CK-MB 1259. The earliest lesion of atherosclerosis is: Fatty streak 1260. The most common cause of true aneurysm in aorta: Atherosclerosis 1261. The commonest cause of ascending aortic aneurysm: Hypertension 1262. Disarrangement of myofibrils is found in: Hypertrophic cardiomyopathy 1263. Most common cause of mitral stenosis is: Rheumatic heart disease 1264. Most common artery involved in myocardial infarction is: Left anterior descending coronary artery 1265. Most accurate diagnostic test for valvular heart diseases: Echocardiography 1266. Globular/flask shaped heart/ water bottled heart on CXR is seen in: Massive pericarditis 1267. Low voltage ECG is seen in: Massive pericarditis 1268. Most common cause of otitis externa is fungal i.e. otomycosis. 1269. Most common organism causing malignant otitis externa = Pseudomonas 1270. Most common cause of acute supporative otitis media Streptococcus pneumoniae > H. influenzae 1271. Pneumatic otoscopy is the gold standard for the diagnosis of otitis media with effusion. 1272. Most common extracranial complication of CSOM: Mastoiditis 1273. Most common abscess associated with mastoiditis–post aural subperiosteal abscess 1274. Most common Intracranial complication of CSOM- Meningitis 1275. Most common nerve involved in CSOM—Facial Nerve 1276. Throat infection causes Ear infection through: Eustachian tube 1277. Cholesteatoma is commonly caused by: Attico-antral perforation31 1278. Treatment of choice in central (safe) perforation is: conservative management > myringoplasty 1279. Inferior meatus open in — Nasolacrimal duct 1280. Middle meatus open in — Frontal sinus, (which opens via fronto nasal duct), Maxillary sinus, Anterior ethmoidal sinus

41 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1281. Superior meatus open in — Posterior ethmoidal sinus 1282. Sphenoethmoidal recess open in Sphenoid sinus 1283. Little’s Area — Most common site for epistaxis in children and young adult 1284. Location of Little’s Area — Anteroinferior part of the nasal septum 1285. Septoplasty is the procedure of choice for DNS 1286. In children, chronic stridor is due to congenital lesions, mostly due to laryngomalacia. 1287. In children acute stridor is mostly due to acute upper respiratory tract infection. 1288. In adults stridor is uncommon chronic stridor may indicate laryngeal carcinoma. 1289. Rhadomyosarcoma » MC malignant tumor of nasopharynx in children » MC site is the Orbit (the head and neck region) 1290. Nasopharyngeal Ca: » EBV is responsible » MC nerve involve is » MC in southern states of China, Taiwan and Indonesia. » Most common manifestation is upper neck swelling due to cervical lymphadenopathy » Most common cranial nerve palsy in nasopharyngeal carcinoma is V CN » Most common lymph node involved jugulodigastric (upper deep cervical) lymph node. » Unilateral serous otitis media is seen » Treatment of choice radiotherapy » Metastasized to cervical lymph node 1291. Nasopharyngeal CA most commonly arises from fossa of rosenmuller in lateral wall of nasopharynx. 1292. Genetically Nasopharyngeal CA is most common in China 1293. Most common histological type of nasopharyngeal CA – SCC 1294. Treatment of choice (TOC) for nasopharyngeal fibroma – Surgery 1295. TOC for nasopharyngeal carcinoma – Radiation 1296. TOC for advanced carcinoma – Chemotherapy + Radiation 1297. Peri-Tonsillar Abscess (Quinsy) » Abscess formation in peri-tonsillar space (space b/w capsule of tonsils & superior constrictor Muscles) » Commonest site: Upper pole of tonsil » Feature: inflamed Red-Congested tonsils with U/L enlargement + Thick muffled voice “hot potato voice” » ROC: I&D —> C&S Of abscess » IV systemic antibiotics » Procedure: Interval Tonsillectomy 1298. Retro-Pharyngeal Abscess » abscess formation b/w Bucco-pharyngeal fascia & preverteberal fascia

42 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

» R/F: penetrating injury, throat infection » O/E: Bulge in Post. Pharyngeal wall covered with muco-pus » Rx: Tracheostomy » ROC: I &D —> C&S Of abscess » IV Systemic antibiotics 1299. Para-Pharyngeal Abscess » abscess formation in para-pharyngeal space » Space b/w base of skull & hyoid bone » R/F: penetrating injury, throat infection » O/E: External swelling (Bulge) in Lat.Part of neck behind angle of mandible » Rx: Tracheostomy » ROC: I&D —> C&S Of abscess » IV Systemic antibiotics 1300. Position of patient during tonsillectomy: Rose position 1301. Position of patient after tonsillectomy: Lateral position to avoid any aspiration 1302. Method of performing tonsillectomy: Dissection and snaring method 1303. MC complication of tonsillectomy: Haemorrhage 1304. Average blood loss during tonsillectomy: 50 to 80 ml 1305. Average blood loss during Adenoidectomy: 80 to 120 ml 1306. MCC of bleeding during tonsillectomy: Paratonsillar vein (Dennis Browne vein) 1307. MC arterial cause of bleeding during tonsillectomy → Tonsillar branch of facial artery (called as artery of tonsillar hemorrhage) 1308. MC symptom adenoid hypertrophy — B/L nasal obstruction 1309. Rhinolalia clausa: It is toneless voice with no nasal component (loses nasal quality) 1310. Infection of submandibular space is called — Ludwig angina 1311. Rhinopyema — sebaceous gland hypertrophy 1312. Systemic sclerosis — Raynods phenomena, pulmonary involvement, oesophageal dysmotility are suggestive of systemic sclerosis 1313. Limited systemic sclerosis: Raynaud’s phenomena, telangiectasia, sclerodactyly indicates to the dx of CREST syndrome or Limited systemic sclerosis 1314. Takayasu-Arthritis » Young female + repeated attacks of dizziness, faintness, syncope, blurred vision » Arm claudication + cyanosis and Reynaud’s phenomenon » Hallmark: B/L absent brachial and radial pulse » IOC: Aortography 1315. Poly-Arthritis Nodusa (PAN) » Pathology: Necrotizing inflammation of medium size vessels , associated e HBV

43 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

» C/F: mesenteric infarction/ischemia (70%), CVS: IHD/MI (80%), CNS: stroke neuropathies (70%), Renal infarction (80%) -LCO death, Skin purpuric rash (80%), Testicular swelling (50%) » Ix: Skin biopsy - Necrotizing inflammation of medium size vessels, » Alternate Ix-Renal/Mesenteric angiography —> vasculitis » After Dx of PAN Always check: HbsAg » Rx: Pulse steroid therapy inj M.P » Check HBV if +ve Entacavir if -ve oral prednisolone + cyclophosphamide 1316. Microscopic Polyangitis » Pathology: Necrotizing inflammation of medium size vessels , true variant of P.A.N » Difference from P.A.N: pulmonary involvement (infiltrate on CXR), G.N (proteinuria) & P-ANCA +ve so this features absent in PAN » Ix: Skin biopsy - Necrotizing inflammation of small size vessels » Lab: P-ANCA positive » Rx: Pulse steroid therapy inj M.P » oral prednisolone + cyclophosphamide 1317. Giant cell arthritis (GCA)/Temporal Arthritis » C/F: Age >55 + Unilateral headache, scalp tenderness upon combing + jaw claudication +/- transient loss of vision (Amaurosis Fugax) » Associated with poly-myalgia rheumatica (PMR) » 1st line Ix: ESR increased » Ix of choice: biopsy of temporal artery » If dx in doubt on biopsy & involvement as patchy - Segmental T. A biopsy » Biopsy reveal: Non-Caseating Granuloma » DOC: high dose steroid + PPIs & bisphosphonate to prevent steroids complication 1318. Sudden, severe pain in the left half of her skull + pain around her jaw + increase ESR— GCA/Temporal Arthritis 1319. Age >55 + Right sided headache + pain around her jaw +/- loss of vision — GCA/Temporal Arthritis 1320. 1st line investigation for GCA is — to check ESR 1321. Ix of choice for temporal arthritis/GCA — biopsy of temporal artery 1322. Drug of choice for GCA — high dose steroid 1323. In GCA - Low dose aspirin is increasingly being recommended for people with a history of giant cell arteritis. It has been found to be effective in preventing complications of giant cell arteritis, such as heart attacks or stroke 1324. Poly-myalgia rhematica (PMR) » C/F: Age >70, U/L headache+ after morning stiffness + tender some joints + diff in climbing stairs & combing hair » Rx: steroids

44 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1325. Systemic Lupus Erythematous (SLE) » Butterfly rash (ac. Cutaneous lupus) » Discoid rash (ch. Cutaneous lupus) » Arthritis & photosensitivity » Lupus nephritis (proteinuria,RBC cast) » Lupus cerebritis (ASOC/Fits) » Ix: anti-ds DNA most specific, ANA most sensitive » Rx: 1326. Polymyositis: Proximal muscle weakness (inability to climb the stairs) + raised CPK points towards 1327. Osteoarthritis: Stiffness and pain of right hip increasing as the day progresses, nodules in hands (Hebarden or Bouchard’s nodes) 1328. Seronegative arthritis: » Patient with Chronic diarrhea, mouth ulcers and skin tags, Low back pain, visual problem, morning stiffness, raised ESR and CRP, low Hb » There is a well-known association between IBD and seronegative arthritis (chronic diarrhoea mouth ulcer and skin tags features of IBD) 1329. Ankylosing Spondylitis: » Young male (15-30y) with back pain + early morning spinal stiffness » O/E: Tenderness Of spine/sacro-iliac joints » Additional: Enthesitis - Tretz syndrome(heel, chest & foot pain), Extra-Articular: Uveitis, ILD, AR » Progression:progressive stiffening for spine, loss of spinal movements, neck-hyper extension & eventually kyphosis » Gene: HLA-B27 (95%) +ve lab » Lab: CRP/ESR+ve, RA-factor -ve » Ix: MRI shows increased signal in sacroiliac joints and vertebrae, X-Ray shows syndesmophyte (interspinous ligament calcification) & Bamboo spine (multiple vertebral fusions) & square shape vertebral body » Rx: Adalimumab (TNF blockers) » Systemic steroids should be avoided due to risk osteoporotic spinal frx 1330. Psoriatic arthropathy: » Presents with a red, hot, swollen, metatarsal phalangeal joint, sarcoilitis and onycholysis » Psoriatic arthritis initially can affects the toes very similar to gout. 1331. Wegener’s granulomatosis: ARF and recurrent epistaxis and hemoptysis + C-ANCA +ve (most specific) 1332. Bachet’s Syndrome » Recurrent Oral, corneal & genital ulcer not responding to medical Rx + Arthritis + purpuric rashes, neuropathies » Gene: HLA-B5 (B51)

45 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1333. Anticentromere would be present in limited scleroderma & CREST syndrome 1334. Anti- Scl 70 would be present in diffuse scleroderma 1335. Anti-DSDNA would be positive in SLE, along with Anti-Ro. 1336. Anti- Ro is also positive in Sjogren’s syndrome and scleroderma. 1337. Anti Jo1 antibody - Polymyositis 1338. Juvenile Rheumatoid Arthritis (JRA) » Age <16, Swinging Fever, Salmon-colored pink skin rash, Arthritis » Ix: ANA & RA factor -ve, very high ferritin » Rx: NSAIDs, MTX 1339. Psoriatic Arthritis » H/O Psoriasis skin ulcer (Silvery scales - Auspitz sign & Koebner phenomena) » DIP involvement » Sausage-shaped digits (dactylitis), Arthritis mutilans » Nail pitting & onycholysis » Most common cancer in women in the world is breast cancer » Most malignant type of CA breast: Inflammatory breast cancer » Most common site of CA breast: Upper outer quadrant (left breast >right) » Thiazides diuretics may increase uric acid levels in blood causing precipitating gout and joint fluid may show uric acid crystals » Alcoholic drinks can raise the level of uric acid in the blood leading to gout 1340. Joint finding in rheumatoid arthritis » Boutonniere deformity: Flexion of the PIP hyperextension of DIP » Swan neck deformity: Extension of the PIP with flexion of the DIP » Baker’s cyst (outpocketing of synovium at the back of the knee) » MCP swelling and pain » C1/C2 cervical spine subluxation 1341. Most common site of metastasis of breast cancer is Bone (Osteolytic deposits in Lumbar vertebra >Femur >Thoracic vertebra >Rib >Skull) 1342. Most common benign tumor of female breast: fibroadenoma (breast mouse) 1343. Excision is the treatment of choice for fibroadenoma (breast mouse) 1344. Most common cause of greenish discharge: Duct ectasia 1345. Most Common cause of blood-stained nipple discharge: Duct papilloma 1346. Bleeding from nipple is seen in: Duct ectasia, Ductal papilloma and CA breast 1347. A 25-years old female complains of discharge of blood from a single duct in her breast. The most appropriate treatment is: Microdochectomy 1348. Best diagnostic method for breast lump is: Biopsy 1349. A 45-years old woman presents with a hard and mobile lump in the breast. Next investigation is: FNAC

46 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1350. Most common site of metastasis from breast carcinoma: lumber vertebra 1351. First investigation of breast cancer is: FNAC 1352. Best and diagnostic investigation of breast cancer: Biopsy 1353. Hormonal Therapy in Carcinoma Breast: Tamoxifen is DOC in both pre-menopausal and post-menopausal patients 1354. Drug of choice for galactorrhea is: Bromocriptine 1355. Most common thyroid malignancy is: Follicular carcinoma 1356. Bone metastasis is common in which thyroid tumor: Follicular carcinoma 1357. Carcinoma thyroid with blood borne metastasis is: Follicular and Medullary carcinoma 1358. Most common site of metastasis of medullary carcinoma of thyroid: Liver 1359. Medullary carcinoma of thyroid Spread is both lymphatic and hematogenous 1360. Dancing carotid is seen in: Thyrotoxicosis and Aortic regurgitation 1361. Most common symptom of retrosternal goiter: Dyspnea at night 1362. Vocal cord palsy in thyroid surgery is due to injury to: Recurrent laryngeal nerve 1363. Sistrunk’s operation is done in: Thyroglossal cyst 1364. Most common site of thyroglossal cyst: Subhyoid 1365. Isthmus of thyroid gland overlies the: 2nd and 3rd and 4th tracheal cartilage 1366. Most sensitive and specific test for thyroid function: TSH 1367. Most common cause of liver abscess: E. coli 1368. Most common benign tumor of liver is: Hemangioma 1369. Pyogenic Liver Abscess in Children most common cause: Staph. aureus 1370. Most common complication of ERCP is acute pancreatitis 1371. First investigation in acute pancreatitis: USG 1372. Investigation of choice for acute pancreatitis: CECT 1373. Most sensitive test for acute pancreatitis: Amylase 1374. Most specific test for acute pancreatitis: Lipase 1375. Poor prognostic factor in a patient with acute pancreatitis: Leucocytosis >20,000/µL 1376. Most common causes of death due to acute pancreatitis: Infection 1377. Gold standard investigation for chronic pancreatitis: ERCP 1378. Most common complication of pseudocyst: Infection 1379. Most common cause of pancreatic pseudocyst: Hemorrhage 1380. Steatorrhoea is seen in chronic pancreatitis, not in acute pancreatitis. 1381. Most common symptom of CA head of pancreas: Jaundice 1382. Diagnostic investigation in carcinoma pancreas: MDCT 1383. Most common tumor of pancreas is: Ductal adenocarcinoma 1384. Most common site for carcinoma pancreas is: Head 1385. Bad prognostic factor in acute pancreatitis: hypocalcemia

47 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1386. Shock is clinically best assessed by: Urine output 1387. Neurogenic shock is characterized by: Hypotension and bradycardia 1388. Compensatory mechanism in a patient with hypovolemic shock: Decreased cutaneous blood flow 1389. Hypotension is the MC cause of death in septic shock 1390. Cardiac output is decreased in septic shock, leading to hypotension 1391. Beck’s triad for cardiac tamponade: Hypotension, distant heart sounds, and JVD. 1392. Most common site of hypertrophic scar is presternal area 1393. Hypertrophic scar common in flexor surfaces 1394. Most common site of keloid is extensor surfaces, common site is sternum 1395. Keloid is due to proliferation of immature fibroblasts 1396. Initial treatment of keloid is intralesional steroids 1397. The most common peripheral aneurysm involves the popliteal artery 1398. The most common nerve affected in thoracic outlet syndrome is ulnar Nerve 1399. Pre-operative blood should be transfused if Hb is less than 8gm/dl 1400. Blood is colloid solution 1401. A patient with haemophilia may need factor Vlll transfusion pre-operatively 1402. Factor ll, Vll, lX, and X is vitamin k dependent factors 1403. Transfusion reactions in unconscious patient are identified by hypotension, tachycardia, urticarial rash and bronchospasm 1404. Group O negative is universal donor 1405. Group AB positive is universal recipient haemolytic transfusion reactions are identified by direct coomb’s test 1406. One unit of fresh blood arises the Hb% concentration by 1gm% 1407. Most common blood transfusion reaction is febrile non-hemolytic transfusion 1408. Beta-HCG is a tumor marker of Choriocarcinoma 1409. Use of chemotherapy after surgery/radiotherapy is called adjuvant chemotherapy 1410. Crystalloid fluids are the first line choice for fluid resuscitation in the presence of hypovolemia, hemorrhage, sepsis, and dehydration. 1411. Examples of crystalloids fluids are: Ringer lactate, normal saline, Glucose solution, Dextrose with N.S, hypertonic saline 1412. Examples of colloids fluids are: Albumin, Blood replacement, Dextrans, gelatine and hydroxyethyl starch 1413. Colloid are hypertonic solution and decrease cerebral and pulmonary edema 1414. Crystalloids are maybe isotonic/hypertonic and can precipitate cerebral edema 1415. Ideal colloid solution is albumin 1416. Colloid increase intravascular volume 1417. Dextrose 5% in water, 0.9% N/S and R/L is isotonic solution 1418. 5% Dextrose in half N/S, 5% Dextrose in N/S and Dextrose 10% in water is hypertonic solution

48 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1419. 0.45% N/S is hypotonic solution 1420. Fluid of choice for gastric outlet obstruction is normal saline 1421. Fluid of choice within 1st 24hr of burn patient is Ringer lactate 1422. Fluid of choice within after 24hr of burn patient is colloids 1423. Fluid of choice liver and Renal failure is colloids 1424. Fluid of choice in DKA, Brain injury and hypochloremic metabolic alkalosis is Normal saline 1425. Fluid of choice for hyponatremia is N/S and hypertonic saline 1426. Fluid of choice in cerebral and pulmonary edema is hypertonic saline 1427. Fluid of choice in intestinal obstruction and intraoperative fluid management is R/L 1428. Neurogenic shock is characterized by hypertension and bradycardia 1429. Hypovolemic shock is charactirized by hypotension, tachycardia, acidosis and oliguria 1430. Plasma expender are used in septic shock 1431. Most common coaglupathy in surgical patient is thrombocytopenia 1432. CO2 gas is commonly used in laparoscopy 1433. Intra-abdominal pressure during laparoscopy is 10-15 mmHg 1434. Most common type of shock is hypovolemic shock 1435. Best suture for hernia surgery is prolene (blue color) 1436. Best suture for circumcision is plain catgut suture 1437. Best suture for closing midline abdomen incision is polydioxane (PDS) > Prolene 1438. Suture removal duration for Eyelid, eyebrow, nose, lip and face is 3-5 days 1439. Suture removal duration for scalp suture is 6-8 days 1440. Suture removal duration for chest and abdomen suture is 8-10days 1441. Suture removal duration for ear suture is 10-14days 1442. Suture removal duration for Back, Extremities, Hand and foot/sole is 12-14 days 1443. The best treatment of contaminated wound of legs is Debridement and antibiotics 1444. Decubitus ulcer is pressure ulcer also known as pressure sore and bed sore, most common site is ischium 1445. Most common cause of cellulitis is streptococcus 1446. Carbuncle is treated by incision and drainage 1447. Hyperkalemia (K+ >5.5mmol/L), ECG shows Tall peaked T wave and sholud he treated with calcium gluconate, insulin with Dextrose, for severe Bicrabonate and peritoneal dialysis 1448. Hypkalemia (K+ <3.5mmol/L) ECG shows prominent U wave, should be treated with oral KCL (Mild) Intravenous KCL (Severe) 1449. Hypercalcemia ( S/Ca >5.5 meq/L), treatment include: diuresis, calcitonin, bisphosphonate, glucocorticoid or even dialysis 1450. Hypocalcemia (S/Ca <4.5 meq/L), treatment include: Vitamin-D+ IV Ca gluconate and thiazide 1451. Hypernatremia (plasma Na+ >145 mmol/L), treatment include water intake and correct cause

49 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1452. Hyponatremia (plasma Na+ <135 mmol/L), treatment include: Fluid and salt restriction, Diuretics and hypertonic saline 1453. Investigation of choice for acute appendicitis is CT/MRI abdomen 1454. Investigation of choice for acute cholecystitis is USG 1455. Most accurate investigation for acute cholecystitis is HIDA scan (MTB) 1456. Treatment of choice for acute cholecystitis is laparoscopic cholecystectomy 1457. Hallmark feature of chronic cholecystitis is Rokitansky-Aschoff sinus 1458. Proclein gallbladder is risk factor for gallbladder cancer 1459. Major risk factor for carcinoma of gallbladder is cholecystitis 1460. Investigation of choice for Acute diverticulitis and diverticular diseases is CT abdomen 1461. Most common cause of colonic bleeding is diverticulosis 1462. In 95% cases the source of lower GI bleeding is colon 1463. Most common cause of lower GI bleeding in peadiatric age group is Intussusception 1464. Most common cause of intussusception in Children is Payer patch hypertrophy/ Lymphoid hyperplasia(Viral infection) 1465. Intussusception is the most common cause of intestinal obstruction in children’s under 3 years of age 1466. Most common cause of intussusception in Adults is Intraluminal mass or tumor 1467. Most common cause of bowel obstruction is volvulus 1468. Most common cause of lower GI bleeding in young adults is Meckel’s Diverticulum 1469. The first investigation for lower GI bleeding is per rectal examination followed by Proctoscopy and endoscopy 1470. Most common cause of acute pancreatitis in Pakistan is Gallstones 1471. Most common cause of acute pancreatitis in western is alcohol 1472. Most common symptoms of chronic pancreatitis is abdominal pain 1473. Commonest injury in blunt abdominal is spleen 1474. Investigation of choice for acute pancreatitis or for every pancreatic injury is CT abdomen 1475. Gold standard test for chronic pancreatitis is ERCP 1476. Most common type of pancreatic carcinoma is adenocarcinoma 1477. Pancreatic carcinoma is adeno CA arising from pancreatic ducts 1478. Major risk factor for pancreatic CA is smoking and chronic pancreatitis 1479. Obstructive jaundice with pale stool and palpable gallbladder associated with tumors that arise in the head of the pancreas (Most common location) 1480. Trousseau syndrome (migratory thrombophlebitis) is seen in 10% of patient with Carcinoma of pancreas.. 1481. Trousseau syndrome is present as swelling erythema and tenderness in the extremities 1482. Tumor marker for pancreatic CA is CA19-9 1483. Procedure of choice for pancreatic CA is Whipple procedure 1484. First line test for cholelithiasis is USG abdomen

50 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1485. Gold standard test for cholelithiasis is HIDA scan 1486. Gold standard test for choledocolithisis (stone in common bile duct) is ERCP > MRCP 1487. Treatment of choice for choledocolithisis is ERCP 1488. Jaundice + pruritis/itching + clay colored stools + xanthomas is choledocolithisis 1489. Swinging fever with chills and rigors + pain right hypochondriac + jaundice is known as Charcot triad seen in acute ascending cholangitis 1490. Treatment of choice for mesenteric infarction or ischemia is urgent laparotomy 1491. First line test for renal colic, bladder colic and ureteric colic X-Ray KUB, alternative is USG KUB 1492. Investigation of choice for renal colic, bladder colic and ureteric colic is Spiral CT abdomen, alternative is Intravenous urogram (IVU) 1493. Most common causing agent of spontaneous bacterial peritonitis is E-Coli 1494. Most common cause of peritonitis in children is streptococci 1495. Investigation of choice for peritonitis is erect abdominal X-Ray (gas/air under diaphragm) 1496. Treatment of choice is urgent laprotomy 1497. Investigation of choice for small and large bowel obstruction is Erect abdominal Xray 1498. Goiter/Enlarged thyroid isthmus: neck lump which moves upward on swallowing but do not moves upward on protruding tongue 1499. Thyroglossal cyst: Neck lump which move upward on swallowing and protrusion of tongue 1500. Neck mass with trans Illuminate brightly is cystic hygroma, Diagnosis is confirmed by CT or MRI, and treatment is by excision of the mass. 1501. Torsion of testes: acute painful testicular swelling, O/E lifting scrotum will make pain worse 1502. Acute epidido-orchitis: acute painful testicular swelling, O/E lifting scrotum will make pain better 1503. Varicocele: inguino-scrotal lump, testes feels like Bag of worms 1504. Hydrocele: inguino-scrotal lump with examination transilluminabillity postive 1505. Procedure of choice for hernia is Lichenstein repair 1506. Test for differentiation of direct vs indirect hernia is Ring-Occlusion test 1507. Commonest hernia in children and young Male is Indirect inguinal hernia 1508. Commonest hernia in old age is direct inguinal hernia 1509. Most common hernia in young female is femoral hernia 1510. Commonest peadiatric hernia is umbilical hernia 1511. Richter’s hernia: any hernia which do not have peritoneum but having only bowel loops 1512. Incisional hernia is a post-operative hernia caused by previous surgical operation or trauma 1513. Benign prostatic hyperplasia arises from transitional zone 1514. Prostate carcinoma (prostate adeno CA) arises from peripheral zone 1515. Screening test for prostatic carcinoma is PSA (prostate specific antigen) 1516. Investigation of choice prostatic adeno CA is Excision biopsy 1517. History of trauma/fracture + severe leg pain + absent pulses is compartment syndrome

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1518. Treatment for compartment syndrome is removal plaster of paris, urgent Fasciotomy 1519. Procedure of choice anal fissure is lateral internal sphincterotomy (LIS) 1520. Prolapse during defecation but spontaneously reduced is 2nd degree haemorrhoid 1521. Prolapse during defecation but require manual reduction is 3rd degree haemorrhoid 1522. Permanently prolapsed outside is 4th degree haemorrhoid 1523. Treatment of 2nd and 3rd degree haemorrhoid is rubber band ligation + inj sclerotherapy with 5% phenol in almond oil 1524. Treatment of 4th degree haemorrhoid is haemorrhoidectomy (excisional or stapled) 1525. Haemorrhoid bleeding mostly from submucosal rectal venous plexus which is formed by superior and inferior rectal veins 1526. Most common complication after haemorrhoidectomy/ano-ractal surgery is urinary retention 1527. Pulmonary embolism is from deep vein thrombosis (DVT) 1528. First line investigation for pulmonary embolism is V/Q scan 1529. Investigation of choice for pulmonary embolism is CT pulmonary angiogram (CTPA) 1530. Investigation of choice for pulmonary embolism in pregnancy is V/Q scan 1531. Drug of choice for pulmonary embolism and DVT in pregnancy is Heparin 1532. Most common type of lung CA in non-smokers is adenocarcinoma 1533. Most common type of lung CA in smokers is Squamous cell CA 1534. Most common type of lung CA associated with Superior vana-caval syndrome is small cell lung CA 1535. Most common site of metastasis of lung CA is Liver 1536. Paraneuplastic syndrome are most commonly seen with small cell lung carcinoma 1537. Most common endocrine organ involve in carcinoma of lung is adrenal 1538. Ectopic ACTH is seen in small cell lung carcinoma which causes hypokalemia and Cushing syndrome 1539. Eaton-Lambert syndrome is seen in Small cell lung carcinoma 1540. Most aggressive lung carcinoma: Small cell lung carcinoma 1541. Small cell lung CA is also known as Oat cell cancer 1542. Small cell lung carcinoma is bronchogenic carcinoma 1543. Small round lymphocyte like (oat cells) with central nucleus is seen in small cell CA of lung 1544. Ectopic PTH is seen in squamous cell CA of lung which causes hypercalcemia and hypophophatemia 1545. Gynaecomastia is seen in large cell CA of lung 1546. Commonest benign bone tumour is: Osteochondroma 1547. “Soap bubble” appearance on x-ray: Giant cell tumor 1548. Sun-ray appearance is on x-ray is seen in: osteosarcoma 1549. Onion skin appearance in bone: Ewing sarcoma 1550. Most common site of appendix is: Retrocecal 1551. Most common primary for bone metastases: Breast >Prostate 1552. Liver abscess (space occupying lesion caused by: E-histolytica

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1553. Biliary tract-cholangiocarcinoma is caused by : Clonorchis sinensis 1554. Triad of Ovarian fibroma, ascites and hydrothorax is seen in Meig’s syndrome 1555. Ovarian cancer marker is CA 125 1556. Fried egg appearances seen in seminoma 1557. Yolk sac tumor marker is AFP 1558. Gastro-intestinal malignancy that metastasize to ovaries: Krukenberg tumor 1559. Most common cause of acute mastitis is staph aureus 1560. Stomach cancer associated with Blood group A 1561. Patient presents with type 2 diabetes mellitus. Most likely complication in limb will be: Wet Gangrene 1562. Warts is caused by Human papilloma virus 1563. Rodent ulcer is seen in Basal cell carcinoma 1564. Basal Cell Carcinoma (BCC), which has a very low metastatic potential 1565. Squamous Cell Carcinoma (SCC) can metastasize and grow rapidly 1566. Marjolin’s Ulcer: Squamous cell carcinoma in scar/burn/long-standing ulcer 1567. A 16-year-old female has firm, rubbery mass in right breast moving with palpation: Fibroadenoma 1568. A 16-year-old female has firm, rubbery mass in right breast is 8 cms in diameter: Giant fibroadenoma 1569. A 30-year-old female has history of bilateral breast tenderness related to menstrual cycle with lumps coming and going: Fibrocystic disease 1570. A 30-year-old female has bloody discharge from nipple. No other palpable masses are seen: Intraductal papilloma 1571. A 30-year-old lactating mother has red, hot, tender mass with fever and leukocytosis: Breast abscess 1572. A 55-year-old woman has 3.5 cm hard mass in her left breast with ill-defined borders and not mobile. The skin overlying has orange peel appearance: Breast carcinoma 1573. A 60-year-old has headaches not responding to medications. She had undergone modified radical mastectomy 1 year back: Brain metastasis from breast carcinoma 1574. Cystic Hygroma is commonly arising in the neck, these fluid-filled lesions of lymphatic origin, lymphangioma 1575. Most common site of cystic hygroma is: Posterior triangle of neck 1576. Most common site of Branchial Cyst is upper part of neck at junction of upper anterior border of sternomastoid 1577. Thyroid tumor associated with MEN II: Medullary carcinoma 1578. Most common anterior mediastinal mass: Thymoma 1579. Most common middle mediastinal mass: Bronchogenic cyst 1580. Most common posterior mediastinal mass: Neurogenic tumor 1581. Most common malignant mass of mediastinum: Lymphoma 1582. Most Common Site larynx cancer is: Glottis

53 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1583. Barrett’s esophagus is that it may lead to the development of low-grade dysplasia, highgrade dysplasia, or esophageal adenocarcinoma. 1584. Most Common site of gastric ulcer: Lesser curvature 1585. Most Common site of duodenal ulcer: Duodenal cap 1586. Most Common site of carcinoma stomach: Antrum 1587. Most Common site of Zollinger-Ellison syndrome: Pancreas 1588. Curling’s ulcer: GI ulcers in severe burns 1589. Cushing’s ulcer: GI ulcers in head injury 1590. Most Common malignant tumor of appendix is Carcinoid, Adenocarcinoma of appendix is rare. 1591. Most colorectal cancers, regardless of etiology, arise from adenomatous polyp 1592. Most Common site of colorectal cancer: Rectum 1593. Most Common site of colorectal cancer in colon: Sigmoid colon 1594. Most Common type of colorectal cancer: Adenocarcinoma 1595. Most Common site of Typhoid ulcer: Terminal ileum (payer pitches) 1596. Most Common site of Tuberculous ulcer: Terminal ileum 1597. Most Common site of Crohn’s disease: Terminal ileum 1598. Most Common site of Gallstone ileus: Terminal ileum 1599. Most Common site of Ulcerative colitis: Rectum 1600. Most Common site of Amebic colitis: Sigmoid colon 1601. Most Common site of Volvulus: Sigmoid colon 1602. Most Common site of Diverticulae: Sigmoid colon 1603. Referred abdominal pains to right shoulder: Biliary colic 1604. Referred abdominal pains to Groin: Renal colic 1605. Referred abdominal pains to periumbilical to right iliac fossa: Appendicitis 1606. Referred abdominal pains to Back: Pancreatitis 1607. Referred abdominal pains to back/ tearing pain: Ruptured aortic aneurysm 1608. Referred abdominal pains to Knee: Hip pain 1609. Murphy’s sign is seen in: Acute cholecystitis 1610. Kehr’s sign is seen in: Splenic rupture ectopic pregnancy rupture 1611. Cullen’s sign and Grey-Turner’s sign is seen in Retroperitoneal hemorrhage (hemorrhagic pancreatitis, abdominal aortic aneurysm rupture) 1612. Antihypertensive for a diabetic patient with proteinuria: ACEI. 1613. Treatment for ventricular fibrillation: Immediate cardioversion. 1614. Virus associated with aplastic anemia in patients with sickle cell anemia: Parvovirus B19. 1615. First-line medication for status epilepticus: IV benzodiazepine 1616. Rigidity and stiffness with unilateral resting tremor and masked facies: Parkinson’s disease.

54 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

PSYCHIATORY POINTS

1617. Duration of symptoms for Brief Psychotic disorder: > 1 day, but < 1 month 1618. Duration of symptoms for schizophreniform disorders: > 1 month, but < 6 months 1619. Duration of symptoms for Duration of symptoms: > 6 months 1620. Most common type of schizophrenia is: Paranoid schizophrenia 1621. Illusion: Misinterpretation of stimuli arising from external object 1622. Delusions: fixed, false beliefs/ False unshakable belief not amenable to reasoning 1623. Delusion is a disorder of thought 1624. Hallucinations: Perception without an external stimulus 1625. Depersonalization: An alteration in perception to self 1626. Derealization: An alteration in perception to external world 1627. Delusion of persecution: someone wants to harm me 1628. Grandiose type delusions or hallucinations is seen in Paranoid schizophrenia 1629. ‘Tactile’ hallucinations are seen in cocaine abuse 1630. the most common form of hallucination in schizophrenics is: ‘Auditory’ hallucinations 1631. visual hallucinations are the most common type of hallucination 1632. visual hallucinations is seen in alcohol withdrawal (i.e., delirium tremens) 1633. visual hallucinations are seen in temporal lobe lesion 1634. Early onset and bad prognosis: Hebephrenic Schizophrenia/ Disorganized schizophrenia 1635. Schizophrenia with late onset, best prognosis: Catatonic Schizophrenia 1636. Schizophrenia with worst prognosis: Simple Schizophrenia 1637. First symptoms to start treatment in schizophrenia is: Auditory hallucination 1638. Patient with schizophrenia. She is overweight and suffers from type 2 DM. She is concerned about her medications and asks for advice. Most suitable drug is: Aripiprazole 1639. Acute treatment and maintenance for schizophrenia: antipsychotics (haloperidol, Risperidone, olanzapine; clozapine if refractory 1640. Earliest extra-pyramidal side-effect of anti-psychotic is acute dystonia are sudden contraction of a muscle group such as Torticollis, Trismus, Laryngeal spasms and Occulogyric crisis (sudden up-rolling of eyeballs) 1641. Most common extra-pyramidal side-effect of anti-psychotic is acute akathisia “sense of restlessness, objective signs (fidgeting, pencing around)” 1642. Treatment of choice in acute dystonia: Benztropine, Trihexyphenidyl or IM promethazine 1643. Drug for Neuroleptic malignant syndrome (elevated temperature, muscle rigidity, increased CPK and myoglobinuria): Dantrolene or dopamine agonist (bromocriptine, amantadine)

55 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1644. A patient recently diagnosed with schizophrenia is started on haloperidol. Within a few hours he develops muscle stiffness. His eyes roll upward and he cannot move them down. The most likely diagnosis: acute dystonia 1645. Drug of choice for panic disorder is SSRIs (Fluoxetine, paroxetine, and sertraline) 1646. Drug of choice for panic attack is Benzodiazepine (Alprazolam/Bromazepam) 1647. Claustrophobia: fear of Closed spaces 1648. Respiratory alkalosis is seen in Hysterical hyperventilation 1649. Sudden "loss of memory" or "blackouts" related to painful or humiliating experience is seen in Dissociative disorders 1650. EEG recording clearly differentiate attacks of pseudoseizures and epileptic seizures 1651. Beta blockers (e g atenolol or propanolol) are used for performance anxiety such as stage fright. They are given 30 minutes to 1 hour before performance. 1652. Treatment of phobias: Expose individuals to their feared objects moving from l - provoking (Systematic desensitization) 1653. Obsessive Compulsive Disorder (OCD): Combination of obsessions and compulsions, typically affect the individual’s level of functioning 1654. Obsessions: Thoughts that are intrusive, senseless, and distressing, thus increasing anxiety, Includes fear of contamination 1655. Compulsions: Rituals such as counting and checking done to neutralize thoughts, Time consuming and tends to lower anxiety 1656. Treatment of choice of Obsessive compulsive disorder is: SSRIs such as fluoxetine, paroxetine, sertraline, citalopram, or fluvoxamine 1657. Drug of choice for acute stress disorder is: SSRIs (fluoxetine, paroxetine, sertraline, citalopram etc..) 1658. Drug of choice for post-traumatic stress disorder is: SSRIs (fluoxetine) 1659. Treatment of choice for post-traumatic stress disorder is: Cognitive behavioral therapy 1660. Excessive anxiety and worry about most things, lasting > 6 months: Generalized Anxiety Disorder (GAD) 1661. Drug of choice for Generalized Anxiety Disorder (GAD) is: SSRIs 1662. Flumazenil is a benzodiazepine antagonist, used as antidote for benzodiazepine overdose 1663. Hypochondriasis: Patients believe that they have some specific disease despite constant reassurance 1664. Somatization disorder: Patients must have at least 4 Pain, 2 GI, 1 sexual and 1 Pseudoneurological symptom 1665. Body Dysmorphic Disorder: Patients believe that some part of the body is abnormal, defective, or misshapen 1666. Factitious Disorder: Individual fakes an illness to get attention and emotional support in patient role. Either psychological (Hallucinations, delusions, depression, and bizarre behavior) or physical illness (Abdominal pain, fever, nausea, vomiting, or hematomas) 1667. Factitious Disorder Formerly known as Münchausen syndrome, commonly seen in females

56 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1668. Factitious disorder by proxy, caretaker fakes signs and symptoms in another person. Usually a child in order to assume the sick role by, in order to assume the sick role by proxy as the caregiver 1669. Malingering: Conscious production of signs and symptoms for an obvious gain, such as Avoiding work Evading criminal prosecution/Achieving financial gain 1670. Narcolepsy: Excessive daytime sleepiness and Abnormalities of REM sleep 1671. Sudden muscle tone loss (Cataplexy) is the pathognomonic feature of narcolepsy 1672. La belle indifference: An inappropriately cavalier patient attitude in the face of serious symptoms; classically associated with conversion disorder 1673. Dreaming and Nightmares occurs in: REM Sleep 1674. penile/clitoral tumescence occur in : REM Sleep 1675. sleepwalking, night terrors, and bedwetting occur in Stage-3 of NREM Sleep 1676. Deeper sleep is seen in: Stage-2 of NREM Sleep 1677. Light sleep is seen in: Stage-1 of NREM Sleep 1678. Deep sleep is characterized by loss of : Vascular tone 1679. REM sleep characterized by loss of: Muscular tone 1680. Fugue: Purposeful travel or bewildered wandering while in amnesic state 1681. Déjà vu: Sensation of feeling of familiarity. Seen in temporal lobe epilepsy 1682. Increased Dopamine levels: Schizophrenia 1683. decreased Dopamine levels: Parkinson’s 1684. Decreased acetylcholine (Ach): Dementia 1685. Increased Noradrenalin/Norepinephrine: Mania and Anxiety 1686. Decreased 5HT, Noradrenalin/Norepinephrine: OCD 1687. Decreased GABA: Epilepsy 1688. Decreased Serotonin: Depression 1689. Retrograde Amnesia is characterized by an inability to remember events prior to the onset of disease, with preservation of the ability to form new memories 1690. Anterograde Amnesia is characterized by an inability to register and form lasting memories of new or present events. 1691. Attention Deficit Hyperactivity Disorder (ADHD): Poor attention span or Easy Distractibility, Hyperactivity and Impulsivity 1692. Methyl phenidate is used in treatment of ADHD 1693. Amphetamines cause paranoid Schizophrenia 1694. Senseless giggling and mirror gazing are seen in Hebephrenic schizophrenia 1695. Dramatic self-mutilation in schizophrenia is called von Gogh Syndrome 1696. Amenorrhea is the feature of anorexia nervosa

57 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1697. A 42-year-old lecturer in history says that she was fired from her job because she worked too hard and made her Head of Department look lazy. She says that when the same thing happened in a previous job, she filed a lawsuit against that company: Paranoid Personality Disorder 1698. On an OPD visit the parents of a 22-year-old man say that they are concerned about him because he has no friends and spends most of his time hiking in the woods. You examine him and find that he is content with his solitary life: schizoid Personality Disorder 1699. An oddly dressed 30-year-old woman says that she likes to walk in the woods because the animals communicate with her. She says that she never goes out after 6 PM however, because they are ‘dangerous hours’. She has few friends: schizotypal Personality Disorder 1700. A 23-year-old man comes to your office dressed in yellow color and a cap lined with red satin. He reports that his mild sore throat felt like ‘a hot poker’ when he swallowed and says that he feels so warm that he must have a fever of at least 106°: Histrionic Personality Disorder 1701. A 33-year-old man basically a student with poor economic and academic career asks you to that he is the richest man on earth and that he is the most learnt person around. He says that he is ‘better’ than your other patients: Narcissistic Personality Disorder 1702. A 30-year-old man says that he had set fire to the school he studied. He has often been unemployed and has been arrested for stealing and robbery several times: Antisocial Personality Disorder 1703. A 20-year-old graduate tells you that because she was afraid to be alone again, she tried to commit suicide after a man with whom she had two dates did not call her again. After your interview, she tells you that all of the other doctors she has seen were horrible and that you are the only doctor who has ever understood her problem: Borderline Personality Disorder 1704. A 30-year-old woman who works as a tutor lives with her elderly mother and rarely socializes. She reports that when coworkers ask her to join them for dinner, she refuses because she is afraid that they will not like her: Avoidant Personality Disorder 1705. A 33-year-old man reports that each night he washes his hands at least 6 times after dinner. He checks his door at least 7 times before going to sleep and checks the night lamp frequently: Obsessive compulsive Personality Disorder 1706. A 28-year-old woman says that her brother accompanies her everytime she leaves her home and on her marriage would take him along with her to her new house and she says that she cannot decide anything of her own and everyday decisions her brother decides for her: Dependent Personality Disorder 1707. Three years back a woman suffered during an earthquake and she was successfully saved. After recovery she has nightmares about the episode and she also gets up in the night and feels terrified. The most probable diagnosis is: Post-traumatic stress disorder 1708. A 36-year-old woman with a 16 years history of vague and chronic physical complaints. She says that she has always been in pain and has pain in abdomen, chest, legs, etc. sick but that her doctors have not been able to identify her problem: Somatization Disorder

58 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1709. A 22-year-old female experiences a sudden loss of vision, after a fight with her husband but appears unconcerned (‘la belle indifference’). She reports that the onset of her blindness, she saw her child going to the street: Conversion Disorder 1710. A 48-year-old man says that he has been ‘ill’ for most of his life. He has attended multiple doctors but is angry with most of them because they ultimately referred him to mental health clinicians. He now fears that he has pancreatic cancer reports are normal. Many of his previous ‘illnesses’ also seem to be amplified responses to normal physical sensations: Hypochondriasis 1711. A 22-year-old woman seeks plastic surgery for her nose which is normal. She rarely meets her friends: Body dysmorphic disorder 1712. A young lady presented with repeated episodes of excessive eating followed by purging by use of laxatives, which is the most appropriate diagnosis: Bulimia nervosa 1713. Drug of choice for nocturnal enuresis/ Sleep Enuresis: Imipramine > Desmopressin 1714. Acrophobia: Fear of heights 1715. Agoraphobia: Fear of entering open or crowded places 1716. A 28-year-old apprehensive patient presented in casualty to a resident with a history of sudden palpitation, sensation of impending doom (a feeling of heart sinking/Dil dhoobna) and constriction in his chest. This lasted for about 10–15 minutes after which he become all right the diagnosis is likely to be: Panic attack 1717. Most common Psychiatric disorder in Pakistan is: Depression 1718. Most common cause for suicide is depression 1719. Most common type of post purpureal pshycosis is depression 1720. A 22-year-old male from Karachi, suffers from decreased sleep, increased sexual activity, excitement and spending excessive money for last 8 days. The diagnosis is: Mania 1721. Wernickes encephalopathy: Global confusion+ ophthalmoplegia+ Ataxia 1722. Korsakoff’s Psychosis: Confabulations+ Amnesia 1723. Drug of choice for opioid overdose: Naloxone 1724. Drug used in alcohol withdrawal is: Chlordiazepoxide and Diazepam 1725. Drug used in opium withdrawal is: Methadone and clonidine 1726. Capgras syndrome: Patient sees a familiar person as a stranger. Delusion of doubles. 1727. Cotard’s syndrome: Delusion that one has lost everything (possessions, strength and even organ such as heart). Thinks that his bowels are rotting and he will never pass tools again. 1728. Kleine Levin syndrome (sleeping beauty syndrome): Hypersomnia, Hyperphagia and Hyper sexuality due to involvement of Amygdala 1729. Drug of choice for Kleine Levin syndrome: Modafinil 1730. Drug of choice for acute mania: Lithium 1731. Drug of choice for Prophylaxis of mania: Lithium 1732. Most common side effect in Direct Electro convulsive therapy (ECT) is T4-T8 spine fracture 1733. Most common side effect of Modified Electro convulsive therapy (ECT) is retrograde amnesia

59 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1734. drug which is used for long-term maintenance in opioid addiction: Methadone 1735. Naltrexone is used in opioid addiction: To Prevent relapse 1736. A 19-year-old boy suffering from chronic schizophrenia is put on Haloperidol in the dose of 20 mg/day. A week after the initiation of medication, the patient shows restlessness, fidgety, irritability and cannot sit at one place. The most appropriate treatment strategy is: Addition of beta blocker 1737. A 42-year-old male with a past history of a manic episode presents with an illness of 1-month duration characterized by depressed mood, anhedonia and profound psychomotor retardation. The most appropriate management strategy is prescribing a combination of: Antidepressants and mood stabilizers 1738. Confabulation is defined as the unconscious filling of gaps in memory by imagined or untrue experiences that the patient believes are true, even though they are not based on facts. It is associated with organic pathology. 1739. Magical thinking is a form of thinking in which thoughts, words, or actions assume power, such as causing or preventing events. It is typical for the preoperational phase of thinking in children. 1740. Ideas of influence constitute a type of delusion in which a person believes that he or she is being controlled by another person or external force. 1741. Ideas of reference are delusions in which a person has a false belief that others (including people on TV or radio) are talking about him or her. In a broader sense the behavior of others refers to one self, other persons, or objects that have special significance and meaning. 1742. Concrete thinking is described as literal thinking that shows a lack of understanding of the nuances of meaning. These individuals lack the ability to use metaphors. 1743. Abstract thinking refers to the ability to appreciate nuances of meaning and the ability to use metaphors and hypotheses appropriately. 1744. Blocking is a disturbance in thought form, characterized by an abrupt interruption in the train of thought before the thought is finished. After a pause, the person is unable to recall what was being said. 1745. Drug of choice for Tourette’s syndrome is: Haloperidol 1746. Drug of choice for Haloperidol induced tremors is: anticholinergic (Procyclidine, Benztropine, Benztropine) 1747. Drug of choice for insomnia – Eszopiclone (clonexa in Pak), zolpidem, zoleplon 1748. Drug of choice for Bipolar disorder (Manic depressive psychosis) – Lithium carbonate 1749. Drug of choice for Body dysmorphic disorder – SSRIs (Fluoxetine) 1750. Drug of choice for Suicidal depression – Electroconvulsive Therapy (ECT) 1751. Drug of choice for sleep walking – Carbamazepine 1752. DOC For Rapid cycling Bipolar disorder – Sodium valproate 1753. DOC For Attention Deficit Hyperactivity Disorder (ADHD) – Methylphenidate (amphetamine) 1754. Drug of choice Narcolepsy - modafinil or Methylphenidate 1755. Drug of choice Somatization disorder – Amitriptyline or citalopram 1756. Drug of choice Depression with acid peptic disease – Doxepin

60 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1757. DOC For Generalized Anxiety Disorder (GAD) – Benzodiazepines > Buspirone 1758. Drug of choice for Borderline Personality Disorder – SSRIs (Fluoxetine) 1759. Drug of choice for Phobias - MAO inhibitors, Paroxetine 1760. Drug of choice for Delusional disorder – Antipsychotics (Haloperidol/Risperidone) 1761. Drug of choice for the Management of antipsychotic-induced akathisia is beta-blocker 1762. Drug of choice for Smoking cessation – Bupropion 1763. Drug of choice for Tardive dyskinesia – Diazepam 1764. Common mood stabilizers/anticonvulsants include: Lithium carbonate, valproate, Lamotrigine and Carbamazepine 1765. Side effects of Antipsychotics: Sedation, Orthostatic hypotension, Tardive dyskinesia, acute dystonia 1766. Side effects of Clozapine: Agranulocytosis 1767. Side effects of Trazodone: priapism in adolescent boys, orthostatic hypotension 1768. Side effects of Nortriptyline (TCAs): Torse de pointe arrhythmia/QT prolongation 1769. Side effects of Mirtazapine: weigh gain and sedation 1770. Side effects of venlafaxine: hypotension 1771. Side effects of Phenelzine: hypertensive crisis 1772. Side effects of Lithium: Polyuria leading to diabetic nephrogenic Insipidus, Limb hypoplasia (pregnancy), hypernatremia, hyperthyroidism, tremors 1773. Drug induced parkinsonism (Rigidity, tremors and bradycardia) should be treated with anticholinergic (Procyclidine, Benztropine, Benztropine)

GYNAECOLOGY & OBSTRITICS POIN TS

1774. Primary causes of third-trimester bleeding: Placental abruption and placenta previa. 1775. Medication given to accelerate fetal lung maturity: Betamethasone or dexamethasone × 48 hours. 1776. The most common cause of postpartum hemorrhage: Uterine atony. 1777. Treatment for postpartum hemorrhage: Uterine massage; if that fails, give oxytocin. 1778. A patient fails to lactate after an emergency C-section with marked blood loss: Sheehan’s syndrome (postpartum pituitary necrosis). 1779. Vaginal bleeding at 18 weeks’ gestation; no products expelled, cervical OS open: Inevitable abortion. 1780. Vaginal bleeding at 18 weeks’ gestation; no products expelled, cervical OS closed: Threatened abortion. 1781. Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C: Asherman’s syndrome. 1782. A 35-year-old man has recurrent episodes of palpitations, diaphoresis, and fear of going crazy: Panic disorder 1783. Hematuria, hypertension, and oliguria: Nephritic syndrome. 1784. Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, and edema: Nephrotic syndrome.

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1785. Most common site of ectopic pregnancy is: fallopian tube 1786. Chorio carcinoma: honey combing on CXR (metastatic nudules) 1787. Treatment of choice for Chorio carcinoma: Methotrexate 1788. Most common cause of carcinoma of cervix is: HPV 16 and 18 1789. Painless vaginal bleeding: placenta previa 1790. Drug of choice for hypothyroidism in pregnancy is: HRT- thyroxin 1791. Drug of choice for hyperthyroidism in pregnancy is: propylthiouracil 1792. Drug of choice for cerebral malaria in pregnancy is: Artemether 1793. Trophoblast give rise to placenta 1794. The uterine blood flow at term is 500 -750 ml/min 1795. Utero placental blood flow at term = 450-650 ml/min 1796. Feto placental blood flow =400 ml/min 1797. The folds of Hoboken are found in the umbilical cord 1798. Fetal blood loss in abnormal cord insertion is seen in Vasa previa 1799. Decidual space is obliterated by 16th week 1800. The finding of a single umbilical artery on examination of the umbilical cord after delivery is an indicator of considerably increased incidence of major malformation of the fetus. 1801. Uteroplacental circulation is established on 10-12 days after fertilization 1802. Feto placental circulation is established 21 days post fertilization 1803. Longest part of the fallopian tube is ampulla 1804. Narrowest part of fallopian tube is interstitial portion 1805. Complete failure of fusion of the Mullerian duct leads to uterus didelphys 1806. Paramesonephric duct develop into uterus 1807. Fertilized ovum reaches the uterine cavity in 3 days 1808. Protective bacterium in normal vagina is Lactobacillus 1809. The main source of physiological secretion found in the vagina is cervix 1810. Uterine-cervix ratio upto 10 years of age is 1:2 1811. The epithelial lining of cervical canal is high columnar 1812. Nabothian follicles occur in erosion of cervix 1813. Vaginal defence is lost after 10 days of birth 1814. Ovary is attached to the posterior layer of the broad ligament by mesovarium 1815. To diagnose uterus didelphys, procedure of choice is MRI 3, which is better than D-USG 1816. The most important indication for surgical repair of a bicornuate uterus is habitual abortion 1817. SRY gene is located on the short arm of Y chromosome 1818. Progesterone Is produced by granulosa luteal cells 1819. The risk of thromboembolism increases in pregnancy because of increased hepatic production of clotting factor: Fibrinogen increases

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1820. Highest cardiac output in pregnancy is after delivery 1821. Lactose is present normally in the urine of a pregnant women in the third trimester and lactation 1822. During foetal life maximum growth is caused by Insulin 1823. HCG is secreted by Syncytiotrophoblast cells 1824. In normal pregnancy character of vagina is ↑ed number of lactobacilli 1825. Hormone responsible for decidual reaction and Arias stella reaction in ectopic pregnancy is Progesterone 1826. Schwangershaft protein is the other name of Pregnancy specific beta1 glycoprotein 1827. Most sensitive for detecting hCG is Fluorescent Immuno Assay (FIA) 1828. Decreasing sensitivity for detecting hCG is FIA>RIA>ELISA = RRA (radioreceptor assay> IRMA (Immunoradiometric ) 1829. Placental sign denotes spotting on the expected date of period in early pregnancy 1830. Fetal kidneys start producing urine by 3 months 1831. Fetal stage starts at 9weeks 1832. The foetal circulation is first intact and functional, separated from maternal circulation at the age of 21 days 1833. Lifespan of the fetal RBC approximates 80 days 1834. In the embryonic phase, the erythropoiesis is first demonstrated in the primitive mesoderm 1835. Fetal sex can be detected by USG at 14 weeks 1836. Oxygenated blood from the placenta reaches the fetal heart in utero via Ductus venosus 1837. Ligamentum teres is formed after Obliteration of the ductus venous 1838. Insulin identified in fetal pancreas by 9-10 weeks but secretion begins at 12 weeks 1839. Glucagon identified in fetal pancreas by 8 weeks but secretion after birth 1840. Urine production by fetus at term is 27ml/hr, 1841. 1st stimulant for production of testosterone from fetal kidneys is hCG 1842. Main product of fetal adrenal gland is DHEA-S 1843. Best timing of transabdominal chorionic villous biopsy is 10-13 weeks 1844. Increased nuchal translucency at 14 weeks of gestation is seen in Down syndrome 1845. The best marker for neural tube defect is acetyl cholinesterase 1846. Hydrocephalus is best detected antenatal by ultrasonography 1847. Consequence of maternal use of cocaine is cerebral infarction 1848. Heparin do not cross placenta 1849. Vasopressor of choice in pregnancy is Phenylephrine 1850. Propylthiouracil can be given safe in pregnancy: 1851. The use of Misoprostol during pregnancy can lead to Möbius syndrome 1852. HCG is produced from Syncitiotrophoblast 1853. Cephalhematoma does not vary in tension with crying

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1854. An abnormal attitude is illustrated by face presentation 1855. The smallest diameter of the true pelvis is interspinous diameter 1856. The shortest diameter of fetal head is bimastoid diameter (7.5cm) < bitemporal (8.0cm) 1857. Shortest diameter is obstetric conjugate 1858. Longest diameter of fetal skull is mento vertical (14cm) > submentovertical (11.5cm) 1859. Critical obstetric conjugate for trial of labour is 10.0 cms 1860. Most important diameter of pelvis during labor is inter spinous diameter. 1861. Best method of detecting CPD is Trial of labor> pelvic assessment 1862. One ala of sacrum absent – NAEGELE’S PELVIS 1863. Both ala of sacrum absent – ROBERT PELVIS 1864. Cardinal movements of labour are engagement → descent → flexion → internal rotation → extension → external rotation → expulsion 1865. Sensitivity of uterine musculature is enhanced by estrogen and inhibited by progesterone 1866. Assessment of progress of labour is best done by partogram 1867. During active labour cervical dilatation per hour in primi is 1.2 cms / hr 1868. Living ligature of the uterus is middle layer of myometrium 1869. Bag of membrane ruptures after full dilatation of cervix 1870. Ritgen maneuver is done in delivery of head in normal labour. using one hand to apply upward pressure against the perineum, and the other hand on the fetal occiput to control the expulsion of the fetal head 1871. Post-term pregnancy is that which continues beyond 294 days 1872. Pain in early labour is limited to dermatomes is T10 - L1 1873. Bandl's ring is also called as retraction ring 1874. Perineal tear should be repaired immediately 1875. Percentage of women who deliver on EDD is 4% 1876. Uterine contractions are clinically palpable when intensity is more than 10 mm Hg 1877. Pudendal nerve block – nerve roots blocked are S2 S3 S4 1878. The advantage of ventouse extraction is that it can be applied without full dilatation of cervix 1879. Vento use in the 2nd stage of labour is contraindicated in premature fetus 1880. In heart disease, prophylactic forceps is applied at head station of +2 1881. An absolute indication for LSCS in case of a Heart disease is co-arctation of Aorta 1882. Not a Contraindication of vaginal delivery after previous Caesarean: Breech presentation in previous pregnancy 1883. ARM is contraindicated in Hydramnios – controlled ARM can be done 1884. Level of anesthesia in caesarean is T4 1885. Ideal time to conceive after caesarean is 18 months (minimum time = 6 months) 1886. The incidence of Placenta previa increases by two fold after LSCS

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1887. Singers Alkali denaturation test is done with Fetal Hb 1888. A positive "Stall worthy’s sign" is suggestive of low lying placenta 1889. Expectant management in a case of placenta praevia is MacAfee and Johnson regime 1890. Classification of severity of abruption is by PAGE’s classification 1891. Most common cause of postpartum hemorrhage is uterine atony 1892. Atonic uterus is more common in multigravida 1893. B Lynch suture is applied on uterus 1894. True about placenta accreta is seen in cesarean scar 1895. Minimum duration between onset of symptoms and death is seen in PPH 1896. A patient after delivery goes into shock - most probable cause in PPH 1897. A patient after delivery goes immediately into shock – most probable cause is uterine inversion 1898. A patient after delivery goes into unexplained shock - most probable cause is Amniotic fluid embolism 1899. In PIH an impending sign of eclampsia is visual symptoms 1900. Antihypertensives is not safe in pregnancy: ACE inhibitors/Enalapril 1901. Drug of Choice for severe Preeclampsia is Labetalol 1902. Earliest sign of Mg toxicity is depression of deep tendon reflexes 1903. Endothelial dysfunction is related to preeclampsia 1904. Criteria now removed to differentiate between mild & severe pre eclampsia- proteinuria, oliguria , IUGR 1905. MC hematological finding in PLH is decreased platelet count . 1906. MC type of eclampsia - Antepartum eclampsia 1907. Eclampsia with worst prognosis – Antepartum eclampsia 1908. MC MRI finding in eclampsia – subcortical white matter edema 1909. MC cause of death in eclampsia- intracranial bleeding 1910. Persistence of diastolic notch in uterine Artery Doppler beyond 24 wks is predictive of PIH 1911. Low dose Aspirin is given to prevent pre – eclampsia in high risk pregnancies only . (from 12 WKS onwards). 1912. Calcium supplementation for pre- eclampsia prevention is recommended only for women who are calcium deficient. 1913. In a pregnant female with BP > 150 /100 mm Hg, a protein / creatinine ratio of > 0.30 suggests pre – eclampsia. 1914. According to Hellin's law chances of twins in pregnancy are 1 in 80 1915. Most common type of twin pregnancy is both vertex 1916. Twin peak sign seen in diamniotic dichorionic 1917. In twin discordance the differences in the two twins should be 25% with the larger twin as index 1918. Second twin has more chances of developing polycythemia(LQ) 1919. Blood chimerism is maintained by monochorionic dizygotic twins 1920. In super fecundation there is fertilization of 2 ova released at same time, by sperms released at intercourse

65 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

on 2 different occasions 1921. A double headed monster is known as a dicephalus 1922. Absolute proof of monozygosity is determined by DNA finger printing 1923. Embryo reduction of multiple pregnancy is done at 11-13 weeks 1924. Uncomplicated dichorionic twins – deliver at 38 wk (DCDA) 1925. Uncomplicated monochorionic diamniotic twins – Deliver at 37 wk(MCDA) 1926. Uncomplicated triplets – Deliver at 35 wk 1927. Monochorionic → caesarean section at 32 – 34 wks after giving corticosteroids 1928. Most common cause of first trimester abortion is chromosomal abnormalities Aneuploidies 1929. Commonest cause of first trimester abortion is Trisomy > monosomy X 1930. Most specific chromosomal anomaly a/w abortions – monosomy > trisomy 16 1931. MC cause of RPL → Idiopathic 1932. Mc chromosomal anomaly a/w RPL → balanced reciprocal translocation 1933. Recurrent abortion in 1st trimester, investigation of choice karyotyping 1934. Anti progesterone compound RU-486 is effective for inducing abortion if the duration of pregnancy is 63 days 1935. For medical termination of pregnancy, consent should be obtained from the female partner 1936. Suction evacuation can be done up to 15 weeks 1937. Abembryonic gestation – mean gsac diameter → 20 mm and no embryo seen 1938. MSD > 20 mm & no fetal pole OR CRL > 7 mm & no CA → high probability of non viable pregnancy → Repeat scan after 7 days to confirm 1939. CRL >= 10 mm & no CA → embryonic death /missed abortion 1940. In the fallopian tube, ectopic pregnancy will have longest survival in the interstitium 1941. The cause of fetal death in ectopic pregnancy is postulated as vascular accident 1942. In ectopic pregnancy decidua is shed as decidua vera 1943. Medical treatment of ectopic pregnancy is contraindicated in the presence of fetal heart activity 1944. Indications of medical management in ectopic pregnancy size <4cms (if CA absent) & size <3.5cm (if CA present) 1945. Diagnostic criteria for primary abdominal pregnancy is stud ford criteria 1946. Highest risk of ectopic pregnancy is with h/o previous ectopic pregnancy > h/o tubal surgery 1947. MC risk factor for ectopic is PID (chlamydia) 1948. All contraceptives reduce absolute risk of ectopic 1949. But failure of contraception leads to ectopic gestation, max chances with sterilization failure> IUCD >POP 1950. Least chances with OCPs 1951. Amongst IUDs, max chances with Progestasert > Mirena>cut 1952. The highest incidence of Gestational Trophoblastic Disease is in Asia 1953. Follow up in a patient of H mole is done by Serum Beta-HCG monitoring

66 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1954. Snow storm appearance on USG is seen in Hydatidiform mole 1955. Treatment of the lutein cyst in Hydatiform mole is Suction evacuation 1956. A case of Gestational Trophoblastic Neoplasia belongs to high risk group if disease develops after full term pregnancy 1957. Most common site for metastasis in choriocarcinoma is lungs 1958. Choriocarcinoma commonly metastasize to lungs 1959. The ideal treatment for metastatic choriocarcinoma in the lungs in a young women is chemotherapy 1960. Most common gestational trophoblastic disease following H. Mole is invasive mole 1961. Molar pregnancy is diagnosed in 1sttrimester 1962. Hydatidiform - mole is characterized histologically by hydropic degeneration of the villous stroma 1963. The advantages of hysterectomy in molar pregnancy are chances of pulmonary embolization are minimal 1964. Hydatidiform mole is principally a disease of chorion 1965. Risk of recurrence of H mole in future pregnancy is 1-4% 1966. Percentage of complete moles progressing to persistent GTN is 15-20% 1967. Choriocarcinoma is differentiated from invasive mole (chorio-adenoma destruens) by the absence of villi structure on histological examination of the lesion 1968. p57 kip 2 staining is negative in complete mole but positive in partial mole (it’s a paternally imprinted gene, which is maternally expressed. Absence of maternal genes in androgenic complete moles means this gene cannot be expressed in complete moles) 1969. Cut-off value of cervical length at 24 weeks of gestation for prediction of preterm delivery is 2.5 cm 1970. On TVS ‘ U’ shape of cervix indicates preterm labour 1971. The drug that inhibits uterine contractility and cause pulmonary edema is Ritodrine 1972. Drug given to reduce uterine contractions during preterm labour with least side effects is Nifedipine 1973. Rupture of membrane is said to be premature when it occurs at prior to 1st stage of labour 1974. Blood will interfere with the nitrazine test for detecting ruptured membranes because it is alkaline 1975. Post term labour is seen in anencephaly 1976. Saffron colored meconium is seen in post maturity TB 1977. In a pregnant woman of 28 weeks gestation IUD is earliest demonstrated on X-ray by gas in vessels – ROBERT SIGN 1978. Cause of death in breech delivery in intracranial hemorrhage 1979. The most likely complication of IUD is Hypofibrinogenemia 1980. Treatment for intrauterine death at 36 weeks is waiting for spontaneous expulsion 1981. Antibiotics don’t have any role in preterm labor unless membranes are also ruptured 1982. Progesterone helps in preventing preterm labor but cannot be used as tocolytic 1983. MC cause of post term pregnancy is wrong dates 1984. Fetal fibronectin > 50 ng/ml in cervicovaginal discharge beyond 22 wks of gestation & before rupture of membranes is predictive of preterm labor

67 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

1985. SPALDING SIGN – comes one week after fetal death in utero 1986. Amniotic fluid is mainly produced by fetus 1987. The pH of amniotic fluid is 7.1 to 7.3 1988. Oligohydramnios is seen in renal agenesis 1989. Cleft palate is associated polyhydramnios 1990. Amount of liquor is maximum at 36-38 weeks 1991. Golden colour amniotic fluid is seen in Rh incompatibility 1992. The major contribution of the amniotic fluid after 20 weeks of gestation is fetal urine 1993. Amniotic fluid at 38 weeks in normal pregnancy is 800 cc 1994. MC cause of mild oligohydramnios - Idiopathic 1995. MC cause of mild polyhydramnios - Idiopathic 1996. MC cause of severe oligohydramnios – Renal anomalies 1997. MC cause of severe polyhydramnios – gross congenital anomalies GIT anomalies (cleft Lip & palate ) > NTDs 1998. Best diagnostic test for cholestasis of pregnancy is Bile acid 1999. Intrahepatic cholestasis treatment in pregnancy is Ursodiol 2000. At 38 wks, pregnancy with cholestasis be terminated 2001. Highest transmission of hepatitis B from mother to fetus occurs if the mother is infected during IlIrd trimester 2002. PIH decreases GFR 2003. Retention of urine in a pregnant woman with retroverted uterus is most commonly seen at 12-16 weeks 2004. In pregnancy, the most common cause of transient- diabetes insipidus is severe preeclampsia 2005. Treatment of ovarian cyst in postpartum patient is, immediate removal 2006. Dermoid cyst is most prone to undergo torsion during pregnancy 2007. Treatment of Red degeneration of fibroid in pregnancy is analgesics 2008. Metronidazole is the best drug of choice for treatment of bacterial vaginosis during pregnancy 2009. Only observation is the emergency management of bleeding vulvar varices during pregnancy 2010. Colposcopy is the procedure of choice in a woman with 12 weeks pregnancy and atypical pap smear 2011. Max risk of maternal mortality is with hepatitis E 2012. Max risk of perinatal transmission is with hepatitis B 2013. Max transmission of hepatitis B occurs at the time of delivery 2014. If hepatitis B in Ist trim, MTP is not recommended 2015. Hepatitis B in pregnancy not an indication for Caesarean 2016. Breast feeding is not contraindicated in case of hepatitis 2017. According to WHO, anemia in pregnancy is diagnosed, when hemoglobin is less than 11.0 gm% 2018. Serum ferritin is most sensitive for the detection of iron depletion in pregnancy 2019. Total amount of iron needed by the fetus during entire pregnancy is: 300 mg

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2020. With oral iron therapy, rise in Hb% can be seen after 3 weeks 2021. Formula used for estimation of the total iron requirement is 4.4 x body weight (kg) x Hb deficit (g/dl) 2022. 2500 mg iron is the amount a patient can tolerate at a time given intravenously 2023. Ideal / best contraceptive for sickle cell women is progesterone only contraceptive ( implants, injections, pills 2024. IUGR is defined when birth weight is below the tenth percentile of the average of gestational age 2025. Best parameter for ultrasound evaluation of IUGR is abdominal circumference 2026. Birth weight of a baby can be increased by cessation of smoking 2027. A large baby is born with which complication in pregnancy is gestational diabetes 2028. Congenital infection in fetus with minimal teratogenic risk is HIV 2029. Most common cause of intrauterine infection is Cytomegalovirus 2030. Congenital anomalies are most severe in: Rubella infection (max risk in 1st trimester) 2031. Blood dyscrasias is commonly seen in a fetus with congenital CMV infection 2032. The drug of choice in treatment of typhoid fever in pregnancy is Ceftriaxone 2033. Transmission of herpes is maximum in during parturition 2034. DOC for syphilis in pregnancy is Penicillin 2035. During pregnancy HIV transmission occurs mostly during during labour 2036. Most common cause of HIV infection in infant is perinatal transmission (peripartum > intrapartum) 2037. Nevirapine is given to prevent HIV transmission from mother to child: 2038. CS elective will decrease transmission to baby in case of an HIV +ve pregnant woman true is 2039. Toxoplasmosis is not transmitted to the baby at delivery 2040. Cesarean section is preferred in Herpes 2041. Regarding listeriosis in pregnancy mode of Transmission of infection is sexual 2042. Absent fetal risk if rubella infection is beyond 20 weeks 2043. MC single defect which occurs with rubella is sensory neural hearing loss 2044. After rubella vaccine , pregnancy is contraindicated for 1 month 2045. CMV never leads to heart defects in fetus 2046. MC time for toxoplasma infection is 3rd trimester 2047. But fetus is most severely affected in toxoplasma if infection is in Ist trimester 2048. Triad of toxoplasma infection is intracerebral calcification, chorioretinitis & hydrocephalus 2049. Rate of transmission of toxoplasma to fetus is maximum in the 3rd trimester 2050. Late hyperglycemia in pregnancy is associated with Macrosomia 2051. Most sensitive screening test in diabetic mothers for congenital malformation is HbA1C (Glycosylated hemoglobin) 2052. Polycythemia is seen in the infant of a diabetic mother 2053. Complication seen in fetus of a diabetic mother is B cell hyperplasia

69 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2054. Best test for fetal maturity in a diabetic mother is Phosphatidyl glycerol 2055. The one measurement of fetal maturity that is not affected by a 'bloody tap' during amniocentesis is Phosphatidyl glycerol 2056. Fasting Blood sugar should be maintained in a pregnant diabetic female as 70 -100 mg% 2057. Gestational diabetes is diagnosed by Glucose tolerance test (GTT) 2058. Glycosuria during routine investigation of antenatal visit indicates that there is need for Glucose tolerance test 2059. Hb A1c levels <6.5% = no greater risk of malformation than non diabetic mothers 2060. MC system involved in congenital malformation in diabetic females = CVS >CNS 2061. MC congenital anomaly = VSD > NTD 2062. Most specific anomaly = Caudal regression syndrome 2063. MC CVS finding in babies of diabetic mother = HOCM (Hypertrophic Cardiomyopathy). 2064. This is not an anomaly but a finding 2065. Most specific cardiac anomaly seen = Transposition of great arteries 2066. Gestational diabetes mellitus is not a/w increased risk of congenital anomalies & abortions 2067. The commonest cause of breech presentation is prematurity 2068. Best method to deliver arms in breech is Lovset's method 2069. The complication that can occur with internal podalic version for transverse lie is uterine rupture 2070. The commonest cause of occipito-posterior position of fetal head during labour is android pelvis 2071. In brow presentation, presenting diameter is mento vertical 2072. Incidence of cord prolapse is least in Frank breech 2073. In an after coming head, the occiput is perforated during delivery 2074. The most common form of fetal traumatic injury incurred during breach extraction is intracranial hemorrhage 2075. In a case of direct occipitoposterior position, face to pubis delivery, most commonly encountered problem is complete perineal tear 2076. Blood in urine in a patient in labour is diagnostic of obstructed labour 2077. Transverse lie in labor or in early labor, liquor adequate and no C/I for vaginal delivery = Do ECV 2078. Transverse lie in late or active labor or with ruptured membranes = Do CS 2079. MC cause of unstable lie is idiopathic > placenta previa > polyhydramnios 2080. MC location of placenta in unstable lie is fundal 2081. Primigravida with breech is a relative indication for CS 2082. Primigravida with breech + any complication or high risk factor = prefer CS 2083. Signs of heart disease in pregnancy is diastolic murmur 2084. Maximum strain of parturient heart occurs during immediate postpartum 2085. In Eisenmenger syndrome, maternal mortality during pregnancy is found to be the highest 2086. Normal pregnancy can be continued in Wolf-Parkinson-White syndrome

70 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2087. Most common heart disease associated with pregnancy is mitral stenosis 2088. Tubectomy in a heart patient who has recently delivered is best done after 1 week 2089. Patients with organic heart disease in pregnancy, most commonly die following delivery 2090. Heart disease with max risk of maternal mortality is Eisenmenger syndrome. 2091. MC cause of material mortality in heart disease is mitral stenosis 2092. MC time of heart failure = immediate postpartum > intrapartum > 28-32 weeks of pregnancy 2093. Best time for cardiac surgery in MS is 14-18 weeks 2094. Surgery of choice is Balloon valvuloplasty 2095. If valves calcified – valve replacement required – to be done ideally before conception 2096. Hydatidiform mole is not an absolute contraindication of oral contraceptive pill 2097. Mechanism of action of spermicide is disrupting cell membrane and motility 2098. Dysmenorrhea is not a side effect of oral contraceptives 2099. Emergency contraception is contraception provided to unprotected intercourse 2100. Hepatic adenoma has been associated with the use of oral contraceptives 2101. Lowest dose of ethinyl estradiol used in combination contraceptive is 10 µg – Lo Loestra 2102. Micronized progesterone can be given by oral and vaginal routes 2103. In a young female of reproductive age, an absolute contraindication for prescribing oral contraceptive pills is impaired liver function 2104. The most common complication of IUCD is bleeding 2105. Most commonly removed/resected parts of loop in tubectomy include isthmus 2106. The intra-abdominal pressure during laparoscopy should be set between 10-15 mmHg 2107. Mifepristone and misoprostol can be used for induction of abortion for a maximum of up to 9 weeks of amenorrhea 2108. IUCD having the longest life span is Cu T380A 2109. The contraception of choice for a newly married healthy couple is OC pills 2110. Norgestimate in OC pills has an advantage of reducing acne and hirsutism 2111. Ideal contraception for lactating mother is Progestogen-only pills (POPs) 2112. Mifepristone is used in fibroid uterus 2113. Low-dose oral contraceptive pills contains desogestrel 2114. Contraception with least failure rate is Implanon 2115. Minimum effective dose of EE in OCPs = 10 µg 2116. Ovulation return within 3 months of withdrawal of (OCP) drug in 90% cases 2117. Most effective method of emergency contraception = CuT IUCD 2118. But this is not the Ideal EC pill since it requires a doctor for insertion as compared to the pill. Hence its most effective but not the ideal 2119. Most commonly used emergency contraception = LNG (I pill) 2120. Least failure in sterilization is with unipolar cautery

71 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2121. Best method in HIV patients = IUCD + Barrier 2122. Most effective method of sterilization in female = modified Pomeroy’s method 2123. The findings of a single umbilical artery on examination of the umbilical cord after delivery is an indicator of considerably increased incidence of major malformations of the fetus 2124. Complications of polyhydramnios include placental abruption, uterine dysfunction, and postpartum hemorrhage 2125. Least vital capacity is seen in Trendelenburg position 2126. Drug contraindicated during pregnancy is Captopril 2127. Vaccine contraindicated in pregnancy is rubella 2128. In Sheehan's syndrome, the most effective drug is Corticosteroid 2129. Posterior urethral valve in the fetus is a cause of oligohydramnios 2130. Stilbestrol administered during pregnancy can produce vaginal adenocarcinoma in teenage 2131. Cerebral infarction is seen with maternal use of cocaine 2132. Primary postpartum hemorrhage is most commonly caused by uterine atony 2133. Excessive intake (hypervitaminosis) of Vitamin A is associated with increased risk of congenital malformations 2134. During foetal life, maximum growth is caused by Insulin 2135. Commonest cause of perinatal mortality is infection 2136. In ovarian cycle increased levels of LH are due to increased Estrogen 2137. In 40 days of menstrual cycle the ovulation occurs at 26th day 2138. The ovarian cycle is initiated by FSH 2139. Corpus luteum functions maximally without an implantation for 9 days 2140. Maximum function of corpus luteum occurs 8 days after ovulation 6. 2141. The earliest morphological evidence of ovulation on endometrial biopsy is basal vacuolation 2142. Pulsatile GnRH is used for managing anovulatory infertility 2143. Maturation Index on vaginal cytology is a diagnostic method for evaluating the endocrine status of cervix 2144. Vaginal cytology for hormonal changes is best taken from lateral wall 2145. Cornification index or eosinophilic index indicates estrogen effects 2146. The production of cervical mucus is stimulated by estradiol 2147. Ferning of cervical mucus depends on estrogen 2148. Clomiphene citrate is antiestrogen 2149. Clomiphene citrate is indicated in Stein - Leventhal syndrome 2150. True about clomiphene citrate is Enclomiphene has antiestrogenic affect 2151. The most serious complication of clomiphene therapy for induction of ovulations is hyperstimulation syndrome 2152. Danazol is used in the treatment of cyclical mastalgia 2153. The probable source of Relaxin is ovary

72 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2154. Granulosa cells produces estrogen with the help of the enzyme aromatase 2155. SERM used for contraception = Ormeloxifene 2156. S/E of clomiphene for which it should be immediately stopped is visual symptoms 2157. MC Androgen produced by ovary = Androstenedione 2158. Most potent androgen = Dihydrotestosterone 2159. Androgen produced only by adrenal = DHEA – sulfate 2160. Strawberry vagina is seen in Trichomonas vaginalis 2161. Clue cells are seen in bacterial vaginosis 2162. Non-gonococcal urethritis is caused by Chlamydia 2163. During laparoscopy, the preferred site for obtaining cultures in a patient with acute PID is fallopian tubes 2164. Asymptomatic carriage of gonococcal infection in female is commonly seen in endocervix 2165. Gonococcal vaginitis occurs in infants 2166. Chlamydia cannot be detected by wet film: 2167. The most sensitive method for detecting cervical chlamydia trachomatis infection is polymerase chain reaction 2168. Drug of choice for Chlamydia in pregnancy is Azithromycin 2169. Creamy fishy odor is caused by Gardnerella 2170. Most common site for genital tuberculosis is fallopian tube 2171. Most common route of transmission of endometrial tuberculosis is hematogenous 2172. Salpingitis/Endosalpingitis is best confirmed by Hysteroscopy and Laparoscopy 2173. Cause of infection in tuberculous fallopian tube is hematogenous spread from a primary focus 2174. Most common pregnancy outcome following treatment of genital tuberculosis is ectopic pregnancy 2175. The LEAST chance of PID is seen with the use of condom 2176. Gold standard for diagnosis of PID is diagnostic laparoscopy 2177. Posterior colpotomy is done in pelvic abscess 2178. Endosalpingitis is best diagnosed by Laparoscopy: Avoid hysteroscopy 2179. MC vaginitis in pregnant women – Candidiasis 2180. MC cause of PID in virgin female – Tuberculosis 2181. Amsel’s criteria is used for bacterial vaginosis 2182. Complete failure of fusion of the Mullerian duct leads to Uterus didelphys 2183. Paramesonephric duct develop into uterus 2184. To diagnose uterus didelphys, procedure of choice MRI > 3D-USG 2185. The most important indication for surgical repair of a bicornuate uterus is habitual abortion 2186. Vaginal atresia is associated with uterine atresia 2187. Ideal age for repair of vaginal agenesis is before marriage 2188. Ovary develop from genital ridge 2189. Transverse vaginal septum corresponds to external os

73 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2190. Rokitansky Kuster Hauser syndrome is associated with vaginal atresia 2191. Bicornuate uterus is due to incomplete fusion of paramesonephric duct 2192. Unicollis bicornis means two uterine cavities with one cervix 2193. SRY gene is located on short arm of Y chromosome 2194. Gartner’s cyst can be differentiated from cystocele by the absence of impulse on coughing 2195. MC cause of primary amenorrhoea is gonadal dysgenesis (Turner’s syndrome) 2196. MC cause of hirsutism= Idiopathic > PCOS 2197. Clitoromegaly is defined if clitoris is > 10mm. 2198. Modified Ferriman Gallwey score > 8 means hirsutism is present 2199. Percentage of PCOS patients having diabetes = 10% 2200. Percentage of PCOS patients having Impaired glucose tolerance = 35% 2201. DOC for hirsutism is OCPs 2202. MC congenital anomaly of uterus is septate uterus 2203. MC anomaly causing abortion = septate uterus 2204. MC anomaly a/w infertility = septate uterus 2205. MC anomaly with renal anomalies = Unicornuate uterus 2206. Best reproduction outcome seen in Arcuate uterus 2207. The sequence of development of puberty in girls is growth spurt, thelarche, Pubarche, peak height velocity & lastly menarche. 2208. The first visible sign of puberty in girls is breast budding 2209. Medication used in treatment of idiopathic central precocious puberty is Gn RH analogues 2210. Precocious puberty associated with bony dysplasia and cafe au lait spots in skin is seen in Mc Cune Albright syndrome 2211. During sexual differentiation in males primitive Gonads differentiate into testis due to the presence of SRY gene 2212. Most common cause of ambiguous genitalia in a female child is congenital adrenal hyperplasia 2213. Most common cause of female pseudohermaphroditism is congenital adrenal hyperplasia 2214. The treatment for a case of Virilizing adrenal hyperplasia is cortisone 2215. Best prenatal treatment for CAH is Dexamethasone 2216. High testosterone levels is a feature of testicular feminization syndrome 2217. In Testicular Feminization syndrome, Gonadectomy is indicated, after puberty (16-18 years) 2218. Pure gonadal dysgenesis will be diagnosed in the presence of bilateral streak gonads 2219. Androgen insensitivity syndrome ovaries functions normally 2220. Normal size but non-functioning uterus is usually associated with uterine synechiae 2221. Ambiguous genitalia with no palpable gonad in inguinal area and XX karyotype – most likely diagnosis is congenital adrenal hyperplasia. 2222. Pulsatile release of GNRH ( initially at sleep ) is responsible for pubertal development.

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2223. Menopause is diagnosed by FSH > 40 IU/L 2224. Ethinyl estradiol is not a natural estrogen. 2225. Post-menopausal endometrial thickness is 1-3 mm 2226. Norepinephrine and serotonin are the neurotransmitters which trigger hot flushes. 2227. Main indication for prescribing HRT is hot flushes 2228. The cutoff point serum estradiol level for the diagnosis of ovarian failure is 20 pg/ml 2229. DOC to treat decreased libido in menopausal females is androgens. 2230. Selective serotonin reuptake inhibitors (SSRIs) is most useful for the treatment of premenstrual syndrome 2231. The presentation of Asherman syndrome typically involves hypomenorrhea 2232. The investigation of choice in a 55-year-old postmenopausal woman who has presented with postmenopausal bleeding is fractional curettage 2233. Period of amenorrhea followed by massive bleeding is seen in premenopausal women with metropathic hemorrhagica 2234. Most common cause of postmenopausal bleeding is carcinoma cervix 2235. Halban’s Disease is due to persistent corpus luteum 2236. Metropathia hemorrhagica is best treated by progesterone 2237. Swiss cheese pattern of endometrium is seen in metropathia hemorrhagica 2238. Most common source of vicarious menstruation is nose 2239. Endometriosis is commonly associated with bilateral chocolate cyst of ovary 2240. Pain in endometriosis correlates with the depth of invasion 2241. Best investigation to establish the diagnosis of endometriosis is laparoscopy 2242. Most accepted theory of endometriosis is Sampson’s theory of retrograde menstruation and implantation 2243. Recurrence rate of endometriosis after medical therapy is 30-50% 2244. Red degeneration of fibroid occurs most commonly in 2nd trimester 2245. In a pregnant woman with red degeneration, management is conservative treatment 2246. In leiomyoma of uterus Squamous metaplasia does not occur 2247. Percentage of myomas which undergo sarcomatous transformation is 0.5% 2248. The common complication of fibroid uterus in pregnancy is red degeneration 2249. Sarcomatous changes is the rarest modification in a fibroid uterus 2250. To start with all fibroids ARE INTRAMURAL 2251. Calcareous degeneration occurs most commonly subserous fibroids 2252. Uterine fibromyoma is associated with endometriosis, follicular cysts of ovary, endometrial hyperplasia and endometrial cancer 2253. Treatment of red degeneration of fibroid during pregnancy is analgesics 2254. Least common complication of fibroid is malignancy 2255. Most common type of uterine polyp is mucous polyp 2256. Drug not helpful in induction of ovulation is progesterone

75 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2257. Spinnbarkeit phenomenon is due to elasticity of cervical mucus 2258. The commonest Indication of IVF is abnormality of fallopian tube 2259. Asherman's syndrome is due to curettage 2260. Cryptomenorrhea is seen in imperforated hymen 2261. The presentation of Asherman syndrome typically involves Hypomenorrhea 2262. The most common cause of primary amenorrhea is ovarian dysgenesia 2263. Gonococcal infection in female is commonly found in endocervix 2264. In IUCD, the organism causing infection is Actinomyces 2265. The drug of choice for bacterial vaginosis is Metronidazole 2266. The most sensitive method for detecting cervical Chlamydia trachomatis infection is Polymerase chain reaction 2267. Gonococcal infection spreads by Involvement of adjacent structures 2268. Gonococcal infection in a female is commonly found in the endocervix 2269. Normal menstrual blood loss is 80ml 2270. Enclomiphene is anti-estrogenic 2271. Fern test is due to the presence of NaCl under estrogenic effect 2272. Anti hormonal substance used to induce ovulation is Clomiphene citrate 2273. Fallopian tube dysmotility is seen in Kartagener syndrome 2274. Best Investigation to assess tubal patency is Laparoscopic chromtubation 2275. Post coital test (PCT) is done for cervical receptivity (detecting antisperm antibodies) 2276. According to WHO criteria, the minimum normal sperm count is 20 million/ ml 2277. Aspermia is the term used to describe absence of semen 2278. In azoospermia, the diagnostic test which can distinguish between testicular failure and obstruction of Vas deferens is the estimation of testosterone 2279. In vitro fertilization is indicated in tubal pathology 2280. Aspiration of sperms from testes is done in TESA 2281. In semen banks, semen is preserved at low temperature using liquid nitrogen 2282. The major contribution to the human seminal fluid is from seminal vesicles 2283. Max semen inseminated in IUI=0.5 ml 2284. Most important semen parameter for ICSI is sperm morphology 2285. MC cause of B/L cornual block on HSG is cornual spasm 2286. First test to assess tubal patency is hysterosalpingography 2287. Polar bodies are not preferred for PIGD as it cannot detect paternal defects 2288. MC fibroid causing infertility is sub mucous fibroid 2289. Stress incontinence is a common symptom of prolapse of uterus 2290. Most common cause of vesicovaginal fistula in developing countries is obstructed labor 2291. Retention of urine in a pregnant woman with a retroverted uterus is seen at 12-16 weeks

76 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2292. Stress incontinence is best corrected by bladder neck suspension 2293. Retention of urine in a pregnant woman with retroverted uterus is seen in 12-16 weeks 2294. Most common site of injury to ureter is where it crosses uterine A 2295. Burch colposuspension for Stress incontinence has highest success rate at the end of 5 yrs 2296. Most useful investigation for VVF is Cystoscopy 2297. Most important support of pelvic viscera is levator ani muscle 2298. Most important ligament support of uterus is the cardinal ligament 2299. Decubitus ulcer is due to venous congestion in the prolapse 2300. Baden walker halfway system, reference point for classification of prolapse is the hymen 2301. In POPQ classification, reference point is hymen 2302. Most common vaginal carcinoma is squamous cell carcinoma 2303. In a case of vaginal carcinoma of stage III, there is involvement of the pelvis 2304. Common differential diagnosis of verrucous carcinoma is condylomata accuminata 2305. Brachytherapy is used in Stage Ib Ca cervix 2306. Characteristic feature of carcinoma fallopian tube is watery discharge 2307. Sentinel biopsy is most effective in vulval ca 2308. The most common site of vulval cancer labia majora 2309. Endometrial hyperplasia is seen in PCOD 2310. Long-term tamoxifen therapy may cause endometrium Ca 2311. Endometrial carcinoma is predisposed by diabetes mellitus, hypertension and obesity 2312. The most malignant endometrial carcinoma is Clear cell carcinoma 2313. Investigation of choice in a 55-years-old post menopausal woman who has presented with postmenopausal bleeding is endometrial biopsy. Gold standard is fractional curettage (Preferably with Hysteroscopy) 2314. Carcinoma endometrium with positive superficial inguinal lymph node status is classified as stage IV 2315. Metropathia hemorrhagica can cause endometrial cancer 2316. Therapeutic conization is indicated in microinvasive carcinoma 2317. MC agent responsible for Ca cervix is HPV 16 2318. HPV associated with adenocarcinoma of cervix is Type 18 2319. Most common type of human papilloma virus causing Ca cervix are 16 and 18 2320. Virus associated with cancer cervix is HPV 2321. MC Site of Ca Cervix is transformation zone 2322. Earliest symptom of carcinoma cervix is irregular vaginal bleeding 2323. In microinvasive cervical cancer, most common treatment is simple hysterectomy 2324. M/C site of metastasis of Ca cervix is lymph nodes 2325. Most common ovarian tumor in less than 20 years is germ cell tumour 2326. Dysgerminoma is the most radiosensitive ovarian tumors

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2327. According to WHO classification of ovarian tumours, Brenner tumor of ovary belongs to epithelial tumours 2328. Ovarian tumours commonly arise from epithelium 2329. Brenner’s tumor resembles fibroma 2330. Masculinizing tumors of the ovary arrhenoblastoma 2331. The most common pure germ cell cancer of the ovary dysgerminoma 2332. Pain of ovarian carcinoma is referred to medial surface of thigh 2333. Meig's syndrome is associated with fibroma 2334. The most common complication of an ovarian tumor is torsion 2335. Most common ovarian cyst to undergo torsion is benign cystic teratoma 2336. The pseudomyxoma peritonei occurs as a complication of the mucinous cyst adenoma (ovary) 2337. Attacks of flushing and cyanosis occur in carcinoid tumors of ovary 2338. Reinke's crystals are found in hilus cell tumor 2339. Schiller-duval bodies are seen in endodermal sinus tumor: 2340. In a case of Dysgerminoma of ovary, serum lactic dehydrogenase is likely to be raised 2341. CA -125 is a tumor marker for carcinoma ovary 2342. Ca-125 is a sensitive marker. Its specificity increases in postmenopausal women. 2343. Placental alkaline phosphatase is marker of Dysgerminoma 2344. Marker for granulosa cell tumor is Inhibin 2345. Bilateral germ cell tumour is dysgerminoma 2346. Ovarian tumor likely to involve the opposite ovary by metastasis granulosa cell tumor 2347. Most common ovarian tumour in pregnancy is dermoid cyst 2348. The maturation index on vaginal cytology is a diagnostic method for evaluating the endocrine status of cervix 2349. Vaginal cytology for hormonal change is best taken from Lateral wall 2350. Cornification index or eosinophilic index indicates estrogenic effect 2351. Hysteroscopy means visualization of uterine cavity 2352. Best gas used for creating pneumoperitoneum at laparoscopy is CO2 2353. Laparoscopy is best avoided in patients with COPD 2354. Laparoscopy is contraindicated in Peritonitis 2355. Goniometer is used for urethrovesical angle 2356. Feature of post ovulatory endometrium on ultrasound is prominent posterior enhancement 2357. Luteal phase defect is best diagnosed by endometrial biopsy 2358. Corpus luteum cyst occurs due to HCG 2359. Sexual maturity is attained early in precocious puberty 2360. Menstruation is defined as precocious if it starts before the child reaches the age of 10 years 2361. Post menopausal estrogen production is due to peripheral aromatization of androstenedione

78 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2362. Hydatidiform mole is associated with Lutein cyst 2363. Metastasis of choriocarcinoma most commonly goes to the lungs 2364. Point of distinction between partial mole to complete mole is partial mole is triploid 2365. A case of Gestational Trophoblastic Neoplasia belongs to high-risk group if disease develops after full term pregnancy 2366. Chemotherapy is indicated in gestational trophoblastic disease in persistent increase in β−HCG after evacuation 2367. The treatment of the lutein cyst in H. mole is suction evacuation 2368. Snow storm appearance is seen in complete molar pregnancy 2369. In Leiomyoma of uterus, least likely change to occur is sarcomatous change 2370. Mifepristone is useful for the treatment of fibroids 2371. Methotrexate is used in management of ectopic pregnancy 2372. Call Exner bodies are seen in Granulosa cell tumour 2373. Increase in maternal serum AFP is seen in renal agenesis 2374. The PAP smear is used largely for screening carcinoma cervix 2375. Pap smear in pregnancy is routine as a part of screening 2376. Carcinoma cervix extends to the lateral pelvic wall in Stage III 2377. Long-term use of tamoxifen causes endometrial carcinoma 2378. Most common cause of cervical wart is HPV 11 2379. The best investigation to diagnose carcinoma cervix in early stages pap smear 2380. Most common site of metastasis in Choriocarcinoma is the lung 2381. Management of CIN III is LEEP conization 2382. Ca125 is elevated in what50 % of stage 1 epithelial ovarian cancer 2383. Treatment of Ca Cervix IIIB include concurrent chemoradiation 2384. Cervical cancer III B treatment is intracavitary radiation + external beam radiation+ chemotherapy 2385. Treatment for stage IIb to III of cervical cancer is Chemotherapy + Radiotherapy 2386. Most commonly Krukenberg tumor is due to carcinoma of stomach 2387. Brenner’s tumor is malignant 2388. The ovarian tumor which is most likely to be associated with virilization is Sertoli-Leydig cell tumor 2389. Largest tumour of the ovary is mucinous cystadenoma 2390. MC functional cyst of ovary is Follicular cyst 2391. Rupture of ovarian cyst MC seen with corpus luteal cyst 2392. Hemorrhage in cyst MC seen with serous cystadenoma 2393. Dash and dot appearance on USG is seen in dermoid cyst of ovary 2394. MC ovarian cancer a/w endometrial cancer is endometrioid cancer 2395. MC ovarian cancer a/w endometriosis is clear cell cancer 2396. IVP showing hydronephrosis in cervical cancer confined to cervix is stage III

79 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2397. MC variety of cancer cervix is large cell keratinizing 2398. MC cause of postmenopausal bleeding – senile endometritis 2399. Ovarian tumor seen in digenetic gonads is dysgerminoma 2400. Germ cell malignancy with the best prognosis is dysgerminoma

EAR, NOSE & THROAT (ENT) POINTS

2401. Hot potato voice is known to occur in: Peritonsillar abscess (quinsy) 2402. Bull neck is seen in: Tonsillar diphtheria 2403. Ostiomeatal complex consist of: Uncinate process 2404. Traetment of choice for maxillary sinusitis and antro-choanal polyp is: Cald-well luc procedure 2405. The narrowest position of the nasal cavity is located at: Nasal valve 2406. Rinne tuning fork test negative,Weber test lateralize to poor ear,the diagnosis is: Conductive hearing loss 2407. The transmitter induced allergic rhinitis is: IgE 2408. The episode of allergic rhinitis has an intense correlation with the activation of: Mast cell 2409. allergic rhinitis is: Type-1 HSR 2410. Meniere’s disease: episodic attacks of tinnitus, hearing loss, aural fullness, and vertigo lasting minutes to hours (Classic triad Sensoreneuronal Hearing loss + tinnitus + vertigo) 2411. Meniere’s Disease is Characterized by » Episodic vertigo (accompanied by nausea vomitting and vagal disturbances like abdominal cramps, diarrhea and bradycardia) » Fluctuating deafness of sensorineural type » Fluctuating tinnitus. » Aural fullness. » Emotional disturbances, headache and anxiety. 2412. Pulsatile tinnitus is seen in glomus jugulare, AV shunts, aneurysms, stenotic arterial lesions. It may also occur in secretory otitis media 2413. Carharts’ notch and Schwartz’s sign are seen in otosclerosis 2414. Decompression of endolymphatic sac (and not fallopian canal) is done in Meniere’s disease. 2415. Decompression of Fallopian canal is done in traumatic facial nerve palsy. 2416. Electrocochleography is the gold standard investigation for diagnosis in Meniere's disease. 2417. Noise induced hearing loss and trauma to labyrinth leads to SNHL. 2418. Travelling in air plane, leads to ear ache and temporary conductive hearing loss. 2419. Stapes abnormal at oval window will lead to conductive hearing loss. 2420. Ideal tuning fork for testing hearing - 512 Hz. 2421. Gelle’s test - Test for bone conduction.

80 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

» Positive in normal persons and sensorineural deafness. » Negative in otosclerosis. 2422. Screening test for detecting hearing loss in infant is Otoacoustic emission 2423. Investigation of choice in assessing hearing loss in neonate: Brainstem evoked response audiometry (BERA) 2424. Rhinnes positive means AC > BC; it is seen in normal persons or those having SNHL. 2425. Rinne test positive in both ears indicates either hearing is normal or there is SNHL. 2426. Down sloping audiogram (meaning higher frequencies affected more) is seen in: Presbycusis and Noise induced hearing loss 2427. Upsloping audiogram (i.e. lower frequencies affected more) is seen in: Meniere Disease (Early stages) 2428. U-shaped on audiogram is seen in: Congenital SNHL 2429. Carhartz notch (dip at 2000 Hz) on audiogram is seen in: Otosclerosis 2430. Hair cells are damaged mainly: Cochlear SNHL 2431. Lesion is of 7th nerve or its central connections: Retrocochlear SNHL 2432. A 35 years old pregnant female complained of hearing loss, which was aggravated during pregnancy. This patient is most probably suffering from otosclerosis, which is more common in females and aggravated

during pregnancy. Type As tympanogram is seen in otosclerosis 2433. Cold water induces nystagmus to Opposite side whereas Warm water to Same side (mnemonic: COWS) 2434. Caloric test is used to test vestibular function/labyrinthine function. So nystagmus induced by it is vestibular in origin. Vestibular nystagmus has both fast (of cerebral origin) and a slow component (of vestibular origin) 2435. Vertical nystagmus means vertical displacement of the eye, not side to side nystagmus when attempting upward or down ward gaze. As defined vertical nystagmus always indicates brainstem dysfunction 2436. Fitzgeraled Hallpike Bethernalcaloric test: the lateral semicircular canal (SCC) is stimulated (tested) (horizontal) by irrigating cold (30°C) and warm water (44°C) in the external avditoy canal warm 2437. Myringitis granulosa is associated with impacted wax, long standing foreign body or external ear infection. 2438. Herpes zoster oticus also known as Ramsay Hunt syndrome. It is herpetic vesicular rash on the cochlea, external auditory canal or pinna with lower motor neuron palsy of the ipsilateral facial nerve. It may be accompanied by anesthesia of face, giddiness and hearing impairment due to involvement of 5th and 8th nerve. 2439. Hemorrhagic external otitis media: (Otitis externa hemorrhagia) is caused by influenza virus. » Characterised by formation of haemorrhagic bullae on tympanic membrane. » Clinical features: severe pain and blood stained discharge. » Treatment: Analgesics + antibiotics. 2440. Gold standard for diagnosis of malignant otitis externa is technetium 99 scan 2441. Most common organism causing malignant otitis externa = Pseudomonas

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2442. Presence of a painful lesion in the external ear with the evidence of granulation tissue and associated cranial nerve palsies (VII nerve) in a diabetic (or immunocompromised) patient do not leave any doubt about a diagnosis of malignant otitis externa 2443. Malignant otitis externa—can cause destruction of tissues of canal, pre and postauricular region by various enzymes like leuthinase and hemolysis. Infection can spread to skull base and jugular foramen causing multiple cranial palsies in which most common is facial nerve palsy. 2444. Keratosis Obturans is also known as canal wall cholesteatoma. 2445. Keratosis Obturans (Primary canal cholesteatoma): accumulation of a large plug of desquamated keratin in the external auditory meatus 2446. Organism causes Acute suppurative otitis media (ASOM): Streptococcus pneumoniae (Most common), H. influenzae (2nd most common) 2447. most common intracranial complication of suppurative otitis media: meningitis 2448. MRI is the IOC in extradural, Bezold and cerebral abscess. CT is the IOC in cases of coalescent mastoiditis. 2449. Cerebral abscess is seen twice as frequently as cerebellar abscess and Most common site of cerebral abscess is Temporal lobe 2450. 'Ring sign' on CT scan (hypodense area surrounded by an area of edema) is seen in brain/cerebellar abcess 2451. A 3 year old child presents with fever and earache. After a course of antibiotic, his condition is still not relieved. What is the next step in management: Myringotomy with grommet insertion 2452. Most common cerebellopontine angle tumour is: Acoustic neuroma, 2nd most is meningioma 2453. Cerebellopontine angle tumor produces: Tinnitus, Deafness, Absent corneal reflex and Trigeminal neuralgia 2454. Acoustic neuroma commonly arise from: Inferior vestibular nerve 2455. In acoustic neuroma cranial nerve to be involved earliest is: 5th nerve 2456. The earliest symptom of acoustic nerve tumor is: Sensory neural hearing loss 2457. Earliest sign seen in Acoustic neuroma is: Reduced corneal reflex. 2458. Acoustic neuroma cause retrocochlear type of SNHL as it damages 8th nerve. 2459. Most common benign tumor of external canal—Exostosis. 2460. Most common benign tumor of middle ear—Glomus tumor. 2461. Exostosis are most common in divers, swimmers and hence also called as surfers ear. 2462. Best test for testing vestibular function - Caloric test 2463. To detect threshold of hearing - Audiometry 2464. In tuberculosis - central perforation is seen 2465. In CSOM - Marginal perforation 2466. In Atrophic rhinitis obstruction is caused by – Crusting 2467. The only Abductor of vocal cords - posterior crico arytenoid 2468. MCC of Deviated nasal septum - Birth trauma SOC - Septoplasty

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2469. MC Antrochoanal polyp in children - Maxillary sinus 2470. Glossopharyngeal nerve supplies - Stylopharangeus muscle 2471. Rhinoplasty done for - DNS 2472. Vertigo is defined as - Subjective sense of imbalance 2473. Sinuses open in middle meatus - Frontal/Anterior/Maxillary sinus 2474. MC malignancy seen in which paranasal sinus – Maxillary 2475. MCC of bacterial sinusitis in age less than 3 yrs-ethmoid sinusitis 2476. MCC of bacterial sinusitis in age more than 3yrs - Maxillary sinusitis 2477. MCC of unilateral mucopurulent nasal discharge in child is - Foreign body in nose 2478. Clear watery discharge with history of trauma - CSF rhinorhea 2479. Clear nasal discharge - allergic rhinitis 2480. Unilateral foul smelling nasal discharge - foreign body must be excluded 2481. MC form of facial nerve palsy - Bell’s palsy 2482. TOC for cholesteatoma - modified radical mastoidectomy 2483. Potts puffy tumour of the nose is seen in - chronic frontal sinusitis 2484. MC type of temporal bone fracture is - longitudinal 2485. MCC of epistaxis in adult female - Nose picking 2486. First & most common symptom of otomycosis - Pruritis 2487. MCC of CSF rhinorhea is - Trauma 2488. MC organism causing Ludwigs angina - streptococcus 2489. Submucus fibrosis is an oral premalignant lesion caused by - chewing pan masala 2490. Gold standard IOC for Menire's disease - Electrocochleography 2491. Carhart's notch is seen in otosclerosis at - 2000Hz 2492. Treatment of ethmoid polyposis - Topical steroids 2493. MC complication of unsafe CSOM - Meningitis 2494. Most vestibulo toxic drug is - Streptomycin 2495. MC site of # mandible is - subcondylar region 2496. MC site for laryngeal cysts - True vocal cord 2497. Most common ossicle damaged in ear disease is - Incus 2498. TOC in nose bleeds in your children is - nasal pinching 2499. Noise induced hearing loss is seen at - 4000Hz 2500. MC nerve injured in Thyroid surgeries - superior laryngeal nerve 2501. Perichondritis of pinna - cauliflower ear,singapore ear,caused by - Pseudomonas 2502. Type of maxillary Ca associated i soft wood workers - Squamous cell Ca 2503. Laryngeal cancers r mostly - squamous cell carcinomacommonest symp. For 2504. laryngeal ca - Hoarsness of voice 2505. MC bone to undergo # in neck injuries - Hyoid bone

83 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2506. MCC of acquired sensoneural hearing loss - Meningitis 2507. MC nerve injured in maxillary bone # is - Infraorbital nerve 2508. Nose develops from - fronto nasal process 2509. Swallowing of caustic agents is more dangerous as it causes - Liquifactive necrosis 2510. MC site of foreign body esophagus - just below cricopharyngeus 2511. Most predominant organism causing CSOM - Proteus 2512. Earliest symptom of Ca larynx – Hoarseness 2513. Epithelial lining of True vocal cords - Startified squamous epithelium 2514. CSF Otorhea due to fracture of - petrous part of temporal 2515. Immunoglobulins seen in nasal secretions - Ig A 2516. Immunoglobulins cross the placenta - Ig G 2517. Ototoxic drugs r - kanamycin/streptomycin/gentamycin/vincristine 2518. Unilateral nasal obstruction in a child is most often due to - foreign body 2519. Myringitis bullosa is caused by - virus 2520. Life threatening complication is seen in - B/l complete choanal atresia 2521. Hard elongated swelling n tonsilar fossa post tonsillectomy-elongated styloid process 2522. Lump in throat not interfering i swallowing - globus hystericus 2523. Myringotomy is done in the postero inferior quadrant of d tympanic membrane 2524. Colour of tympanic membrane in otosclerosis is - pearly white 2525. Cauliflower ear is due to - hematoma of the auricle 2526. Cricothyroid is supplied by the - superior laryngeal nerve 2527. TOC for otosclerosis - stapedectomy 2528. Multiple perforations of the tympanic membrane is characteristic of 2529. tuberculous otitis media 2530. Sinus not present at birth is - frontal 2531. Commonest cause of suppurative otitis media is - Pneumococcus 2532. Grommet tube is used in - Glue ear 2533. Treatment of cholesteatoma - radical mastoidectomy 2534. Maggots in the nose can be removed by - Instillation of chloroform 2535. Recurrent epistaxis & unilateral nasal mass in young boys is seen i 2536. juvenile naso pharyngeal fibroma 2537. Main blood supply of the tonsils is - facial artery 2538. Ca presents i hoarseness early - Glottic 2539. Rx of cholesteatoma of the middle ear in 6yr old - modified radical mastoidectomy 2540. Acoustic neuroma commonly affects - 8th cranial nerve 2541. Earliest symptom of acoustic neuroma is - deafness 2542. Investigation of choice for 1cm of Acoustic neuroma - MRI scan

84 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2543. Commonest occurence of acoustic neuroma is in - superior vestibular nerve 2544. In acoustic neuroma earliest ocular finding is - loss of corneal reflex 2545. Acoustic neuroma commonly arise from - superior vestibular nerve 2546. Maxillary sinus has a communication with the - middle meatus 2547. Dangerous type of ear refers to - attic granulations 2548. Tonsils develop embryologicaly from - second pharyngeal pouch 2549. In gradenigo's triad there is a - abducent nerve palsy 2550. Tonsillectomy is done after - 6weeks,-of an attack of quinsy 2551. Paramount function of the larynx is - protection of lower respiratory tract 2552. Otomycosis is commonly caused by - Aspergillus 2553. Commonest site of epistaxis is - Little's area 2554. Commonest organism causing quinsy is - streptococci 2555. Otosclerosis mostly affects - stapes 2556. Lancinating pain around the tonsills during eating is indicative of glossopharyngeal neuralgia 2557. Commonest cause of laryngeal stenosis - high tracheostomy 2558. Dysphagia for fluids but not for solids is seen in - achalasia cardia 2559. Rat tail appearance of barium swallow is suggestive of - esophageal Ca 2560. Secondary hemorhage after tonsilectomy commonly occurs after - 6days 2561. Submucous resection done in deflected nasal septum 2562. Polyp which has mulbery appearance & bleeding on touch is due to -rhinosporiodisis 2563. Antrochoanal polyps originate in - maxillary sinus 2564. Nerve supply for external auditory meatus - vagus/auriculotemporal nerve 2565. Ramsay hunt syndrome is characterized by - herpes zoster of geniculate ganglion 2566. Treatment of multiple papilloma of the larynx is - excision with cautery 2567. Commonest post-op complication of tonsillectomy is - hemorrhage 2568. Control of hemorrhage after adenoidectomy is by - post nasal pack 2569. Live insect trapped in the auditory canal can be killed by - Ether 2570. Commonest complication of mastoidectomy is - facial palsy 2571. Commonest cause of deafness in childhood is - CSOM 2572. Commonest complication of CSOM - conductive deafness 2573. 8yr old child with B/L conductive deafness, diagnosis is - Glue ear 2574. MCC of B/L conductive loss in 8yrs child - otitis media with effusion 2575. Defect MC occurring in congenital rubella - deafness 2576. High risk criteria for development of deafness in newborn 2577. birth asphyxia/bact.meningitis/congenital infections 2578. MCC of unilateral deafness in children is - Measles 2579. Triad of Meniers disease - deafness, vertigo, tinnitus

85 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2580. Commonest cause of deafness in children under 12 yrs - secretory otitis media 2581. Rhinne's test positive means the ear - sensory neural deafness 2582. Sensori neural deafness postnatally is due to - noise/trauma to head 2583. Trotter's triad is seen in - nasopharyngeal carcinoma 2584. Persistant CSF rhinorhea is seen in - anterior cranial fossa # 2585. Arnolds nerve is a branch of - vagus nerve 2586. Le fort's # involves - zygoma/maxilla/nasal bones & not mandible 2587. Which collagen disease most commonly affects the oesophagus - scleroderma 2588. High tracheostomy is indicated in - Ca larynx 2589. Unsafe otitismedia in child with fever,convulsions diagnosis-temporal lobe abscess 2590. Peritonsillar absces is - Quinsy 2591. Epistaxis in elderly pt is commonest in - Hypertension 2592. Myringoplasty is plastic repair of - Tympanic membrane 2593. Rhinosporidiosis is due to - Fungus 2594. Vasodilator of the internal ear is - Nicotinic acid 2595. Menierr's disease is associated with - cochlear deafness 2596. Rhinosporidiosis is - fungal granuloma / surgery is Rx 2597. Nasal allergy due to - pale edematous mucosa/DNS/eosinophills in discharge 2598. Recurrent epistaxis in a 15yr/f common cause - hematopoetic disorder 2599. Laryngeal mirror is warmed before use by placing - glass surface on the flame 2600. Function of the nasal cavity is - warming,moistening,filtration 2601. Trachea begins at the level of - lower border of cricoid 2602. Rupture of ear drum may occur at the noise level above - 160db 2603. CSF rhinorhea is due to # of - cribriform plate 2604. CSF otorhea occurs in trauma of - petrous temporal bone 2605. Black colour patch in the mouth is seen in - vincent's angina 2606. Singers nodule is due to - voice abuse 2607. Rhinolith - deposition of calcium around foreign body in nose 2608. MC indication for tracheostomy is - foreign body aspiration 2609. Young's operation is done for - atropic rhinitis 2610. Rx of traumatic rupture of tympanic membrane-no active treatment/conservative 2611. ASOM is treated using - Penicillin 2612. Labyrinthine artery is a branch of - anterior inferior cerebellar artery 2613. Stapedius is supplied by - facial nerve 2614. Rhinne's test -ve is seen in - CSOM 2615. Commonest organism causing Acute tonsillitis in children - streptococcus 2616. Most immediate treatment in CSF rhinorhea is - prophylactic antibiotics & x-ray

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2617. Nasal mucosa is supplied by - mainly ext.carotid artery 2618. Throat pain radiating to the ear post tonsillectomy is due to persistant infection/injury to 9th nerve 2619. Bulla ethmoidalis is seen in - middle meatus 2620. Most reliable landmark in otoscopy is - handle of malleus 2621. Acute epiglotitis is due to - hemophilus 2622. Tonsills reach their maximum size by - 5yrs 2623. A crooked nose is due to - Deviated tip & septum 2624. Cholesteatoma - erodes bone , bluish tympanic membrane 2625. DOC for acute epiglotitis in children - ampicillin 2626. Signet ring shape - cricoid cartilage 2627. Apple jelly nodules on the nasal septum are found in cases of - Lupus vulgaris 2628. Complications of sinus disease - cavernous sinus thrombosis 2629. Commonest complication of pediatric tracheostomy is - pneumothorax 2630. An U shaped audiogram suggests - congenital deafness 2631. Attacks of vertigo in children over 6 yrs r often associated with - seizure disorders 2632. Commonest benign intramural tumour of the oesophagus - Leiomyoma 2633. TOC for pus in the middle ear,when under tension - Myringotomy 2634. Submucosal resection is indicated in – DNS with obstruction 2635. Local anaesthetic used for nasal surgery - cocaine paste & xylocaine 2636. Cervical oesophagus receives it blood from - inferior thyroid artery 2637. Absolute bone conduction test is shortened in - perceptive deafness 2638. Father of micro surgery of the ear is - zollener 2639. Laryngo fissure is - opening the larynx in midline 2640. Valsalva manuere generates about - 20-40 mmhg of pressure 2641. Endoscopy is contraindicated in - Aortic aneurysm 2642. Organ of corti is arranged along the inner edge of - basilar membrane 2643. Pain of migraine head ache is due to - dilatation of cranial arteries 2644. Frequent symptom of cancer of nasopharynx is - mass in the neck 2645. Cody tack operation is done for - Meniere's disease 2646. Meniere's disease is characterised by - deafness, tinnitus, vertigo 2647. Most frequent cause of respiratory allergy is - House dust 2648. Destruction of right labyrinth causes nystagmus to - left side 2649. Commonest cause of hoarseness of voice in elderly man more than 3 months duration: Ca larynx 2650. Common cold is caused primarily by - Viruses 2651. 186.Nasopharyngeal Ca presents as - Mass 2652. Vestibule presents in - larynx,pharynx,nose 2653. Kiss ulcer of larynx is due to - Tuberculosis

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2654. The only Abductor of vocal cords - posterior crico arytenoid 2655. MC site for laryngeal cysts - True vocal cord 2656. Lesion of vocal cord dangerous to life - b/l abductor paralysis 2657. Mouse-nibbled appearance of vocal cord - TB 2658. MC location of vocal nodule - anterior 1/3 & posterior 2/3 junction 2659. MCC of vocal cord palsy - total thyroidectomy 2660. Granuloma of vocal cords is mostly due to - vocal abuse 2661. Epithelial lining of True vocal cords - Startified squamous epithelium 2662. Precancerous lesions in the vocal cord is - Leukoplakia 2663. Tensors of the vocal cord is - cricothyroid/internal portion of thyoarytenoid 2664. Commonest cause of unilateral vocal cord palsy is - Trauma 2665. Cause for contact ulcer in vocal cords is - vocal abuse 2666. MCC of unilateral left vocal cord palsy - Ca thyroid 2667. Reinke's edema is seen in - edges of vocal cords 2668. Angiofibroma of nose is common in- young males 2669. Thyroid carcinoma i neck nodes is seen in - papillary ca 2670. Commonest lymph node to enlarge in acute tonsillitis is - Jugulo-digastric 2671. Fungus causing otomycosis most commonly is - aspergillus fumigatus 2672. Mastoid tip appears at the age of - 2yrs 2673. A pt hears better in noise diagnosis is - Paracusis 2674. Bony septal perforation occurs in - syphillis 2675. Prolonged & repeated use of nasal decongestant leads to-Rhinitis medicamentosa 2676. TOC of traumatic rupture of tympanic membrane - conservative 2677. Common cause of eustachian tube disease is - Adenoids 2678. Prolonged exposure to noise levels > following may impair hearing permanently 100decibals 2679. MCC of acquired sensoneural hearing loss - Meningitis 2680. Noise induced hearing loss is seen at - 4000Hz 2681. Commonest cause of hearing loss in children is - chronic adhesiv otitis media 2682. Malignant otitis externa is caused by - P.aeruginosa 2683. MCC of bacterial sinusitis in age less than 3 yrs-ethmoid sinusitis 2684. MCC of bacterial sinusitis in age more than 3yrs - Maxillary sinusitis 2685. Potts puffy tumour of the nose is seen in - chronic frontal sinusitis 2686. Sinusitis in children is commonest in - maxillary sinus 2687. Periodic head ache is seen in - frontal sinusitis 2688. Ethmoidal sinusitis is more common in - Wood workers 2689. Most definitive diagnosis of sinusitis is - proof puncture 2690. Stridor is caused by - hypocalcemia/epiglotitis/laryngeal tumour

88 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2691. Commonest cause of stridor in a newborn is - Laryngomalacia 2692. Cause of stridor in newborn-cystic hygroma/a vascular ring/laryngo malacia 2693. Laryngeal stridor in children is caused by - laryngomalacia & foreign body 2694. 3 month old infant with intermittant respiratory stridor since 10 days - laryngomalacia 2695. Max. Stridor is seen in - B/L incomplete paralysis 2696. Rx for Ca larynx with stridor - planned tracheostomy 2697. Stridor in adults is most commonly caused by - malignancy 2698. Ideal treatment for rhinosporidiosis - excision with cautery at base 2699. IDDM pt presents with septal perforation of nose with brownish black discharge probable diagnosis is - Mucor mycosis 2700. TOC for anterochoanal polyp in a 10yr child - intranasal polypectomy 2701. Child with otitis media not responding to tab.ampicillin comes with bulging membrane with dull look 2702. TOC is - Myringotomy 2703. Cone of light is formed by - handle of malleus 2704. Facial nerve palsy due to trauma TOC is - Decompression 2705. Threshold for bone conduction is decreased & that of air conduction is increased in disease 2706. of - Middle ear 2707. Commonest presentation of Nasopharyngeal Ca is - Cervical adenopathy 2708. Schwartz operation is called - cortical mastoidectomy/simple mastoidectomy 2709. Schwartz sign is seen in - otosclerosis 2710. Narrowest part of middle ear - Mesotympanum 2711. Material used in tympanoplasty - temporalis fascia 2712. Inner ear is present in which bone - petrous part of temporal bone 2713. Hyperaccusis - normal sounds are heard as loud & painfull 2714. Cahart's notch is characteristically seen at - 2000Hz(2khz) 2715. In blast injury MC organ affected - Eardrum 2716. Pulsatile otorhea is seen in - ASOM 2717. Commonest cause of deafness is - Wax 2718. Mc evans triangle is the landmark for Mastoid antrum 2719. Commonest site of ivory osteoma - fronto-ethmoidal region 2720. Allodynia is - increased perception of painful stimulus 2721. Atrophic rhinitis - females-50-60yrs of life-anosmia 2722. Rhinosporidiosis - bleeding polyp-oral dapsone usefull-excision i knife is Rx 2723. Bells palsy not responded to steroid,further Rx - surgical decompression 2724. 10yr old boy having sensory neural deafness,not benefited by hearing aids further Rx: cochlear implant 2725. 40db compared to 20db is - 10times 2726. Hiatus semilunaris is present in - Middle meatus

89 GOLDEN POINTS FROM CLINICAL SUBJECTS DR. ASIF ALI KHAN Email: [email protected]

2727. Tone decay test is done for - neural deafness 2728. MC complication of acute otitis media in children is - deafness 2729. Ground glass appearance on x-ray is seen in- septal angiofibroma 2730. In pure tone audiogram,the symbol X is used to mark - Air conduction in left ear 2731. Latest Rx in BPPV is - Intra labrynthine streptomycin 2732. Choana is - posterior nares 2733. Griesingers sign is seen in - lateral sinus thrombosis 2734. Prussack's space is situated in - Epitympanum 2735. FESS - Functional endoscopic sinus surgery 2736. Direction of water jet while doing syringing of ear should be - posterio-inferior 2737. Contraindications to tonsillectomy r - submucus fibrosis,bleeding disorders,polio 2738. Larynx in neonate -funnel shaped,cricoid narrowest part,epiglottis omega shaped 2739. FESS s indicated in - allergic polyps,frontoethmoidal mucocoele,maxillary polyp 2740. Pneumatic bones - maxilla,ethmoid,mastoid 2741. Collar stud abscess is seen in - TB lymphadenitis 2742. Septoplasty s indicated n – DNS with nasal obstruction,OSA 2743. Adenotonsillectomy contraindications - <3yrs/polio/hemophilia/URTI 2744. Endoscopic nasal surgery indicated in - chronic sinusitis 2745. Inferior turbinate is a - separate bone 2746. Laryngo fissure is - opening the larynx in midline 2747. Commonest site of origin of nasopharyngeal Ca - tonsillar bed 2748. Ear is sensitive to which frequency of sound - 500-3500Hz 2749. TB otitismedia-multiple perforations/pale granulations/thin odourless fluid 2750. Palatal myoclonus is seen in - cerebellar infarction 2751. Steeple sign is seen in - croup 2752. Craniofacial dissociation is seen in - Le forts-3 fracture 2753. Complication of Total thyroidectomy - hoarseness/airway obstruction/hemorhage 2754. Ceruminous glands present in the ear are - modified apocrine glands 2755. Maxilla achieves max.size at - 2ry dentition 2756. Surface area of tympanic membrane - 70msquare 2757. Cauliflower ear is - perichondritis in boxers