Which college you are in?

In which year are you currently in?

A 40 years old male presented with history of two episodes of sudden onset fits over the past three days. The patient has been having headache for the last one month or so which responds to Paracetamol. MRI scan of brain level 4 active cortical parenchymal cysticerci. A diagnosis of neurocysticercosis was made. He was treated with Albendazole. However another drug was administered 2 days prior and 15 days thereafter albendazole administration. Name this drug.

(a)  

Red eye is the cardinal sign of ocular inflammation. Solve the following clinical algorithm for diagnosis of this common eye complaint.

QUESTION A - This disease also shows reduction in redness on adding 10% phenylephrine. Name the inflammation.

(a)  

Red eye is the cardinal sign of ocular inflammation. Fill the following clinical algorithm for diagnosis of this common eye complaint.

QUESTION B - Associated runny nose and pharyngitis can be seen in this disease. Identify the disease.

(a)  

A 16-year male patient reported to the OPD with a swelling skull at the left parietal region of 1-month duration. He gave a history of trauma at the same site 1 month back. Post trauma there was no history of loss of consciousness, vomiting or bleeding from ear or nose. Examination revealed a 5 cm diameter swelling. No punctum was noticed. The swelling was non-tender. The overlying skin was normal. Systemic examination revealed no abnormality. Aspirate revealed approximately 7-8 ml thin blood stained fluid. Direct smears and centrifuged deposit were prepared.

X-ray skull (lateral view) showing a well defined lytic lesion in the left parietal bone and left parieto-occipital region

Photomicrograph of aspirate cell block showing large histiocytes with prominent groove (arrow) and numerous eosinophils (arrowhead 400 x)

Electron micrograph showing racquet shaped birbeck granules in the cytoplasm (arrow) (14000X).

QUESTION - DIAGNOSIS.

(a)  

A 55-year-old male patient was referred to the outpatient department for severe loss of vision in the left eye (LE) for 5 days. It was also associated with an intermittent headache, facial pain, and left-sided nasal blockage. He was diagnosed as CRAO in the LE by a local ophthalmologist and referred for further management.

Current medical history revealed poorly controlled type 2 diabetes. His random blood sugar level was 398 mg/dl, urine glucose was 4+, but urine ketone was negative.

A magnetic resonance imaging (MRI) scan of the brain and orbit showed enhancing soft tissue in the left ethmoid sinus eroding the fovea ethmoidalis and lamina papyracea with soft-tissue extension into the left orbit involving medial and inferior recti muscles and surrounding the optic nerve. Posteriorly, this soft tissue was seen to occupy the orbital apex and superior orbital fissure and infiltrating into the left cavernous sinus, causing its thrombosis.

The patient underwent emergency functional endoscopic sinus surgery with debridement of the sinuses. He was started on subcutaneous insulin and amphotericin B (liposomal) with the monitoring of the serum electrolytes and the renal functions. The patient showed a dramatic clinical response.On last controlled visit there was complete resolution of the mass in the left frontal region but his LE remained blind, with complete ptosis and total ophthalmoplegia.

(a)  

Two brothers, both Caucasian and native to South Africa, of non-consanguineous parents were referred to the retinal clinic The elder brother, aged 43, was myopic and developed night blindness and peripheral visual field loss at six years of age. Following clinical examination and electrodiagnostic testing in South Africa a diagnosis of retinitis pigmentosa (RP) was made. On further questioning he mentioned that he had always had "unusual" feet. Examination showed abnormal 2nd and 3rd toes with a short 4th metatarsal. Neurological assessment including clinical examination and electrophysiology revealed an unremarkable CNS examination with peripheral examination showing normal symmetrical reflexes and sensation with normal gait and no evidence of ataxia. A blood sample was sent for biochemical analysis, showing serum phytanic acid levels which were raised at 297 μm/L (normal range: 0–15 μm/L) with pristinate and very long chain fatty acids being within normal limits.Phytanic acid accumulated within the body due to an abnormality in a mitochondrial enzyme phytanic acid α-hydroxylase.The younger brother, aged 38, had also been diagnosed with RP in South Africa at around the same time as his elder sibling. There were no other family members with abnormal toes or with any other significant medical or ocular history.

Q.Mention the metabolic disorder presenting as retinitis pigmentosa and along with the type of inheritance seen in this disease.

(a)  

A young woman present to the ENT OPD with complains of a sensation of lump in the throat indicating the region of cricoid cartilage(fig.1) as the site of discomfort and is not associated with nasal symptoms of post-nasal discharge or chronic rhinitis where frequent swallowing predisposes and accentuates discomfort. She consistently replies that saliva is the problem and the symptom occurs between meals.

On a Barium swallow spasm of cricopharyngeus is seen where the barium column is “nipped”(fig.2).No other significant findings.

QUESTION - DIAGNOSIS

Cue- Young female - think of psychosomatic disorders from ENT.

(a)  

What is A?

(a)  

What is B?

(a)  

What is A?

(a)  

What is B?

(a)  

What is Test "A"?

(a)  

What is B?

(a)  

What is A?

(a)  

What is B?

(a)  

What is A?

(a)  

What is A?

(a)  

What is B?

(a)  

What is A?

(a)  

What is B?

(a)