Contents

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 AIIMS New Pattern 2019 Model Questions��������������������� 3–5

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 Day 1 of
Chapter 1- Trauma���������������������������������������������������������������������������������������������������������������� 7–66
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Chapter 2- Peripheral Nerve Injury������������������������������������������������������������������������������������������67–90
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 Day 2
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Chapter 3- Sports Injury������������������������������������������������������������������������������������������������������ 92–118

Chapter 4- Musculoskeletal Infections���������������������������������������������������������������������������������� 119–136
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Chapter 5- Bone Tumors���������������������������������������������������������������������������������������������������� 138–167

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Chapter 6- Pediatric Orthopedics���������������������������������������������������������������������������������������� 168–209

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Chapter 7- Arthritis���������������������������������������������������������������������������������������������������������� 211–240
Chapter 8- Metabolic Bone Diseases������������������������������������������������������������������������������������ 241–261

 Day 5
Chapter 9- Spine�������������������������������������������������������������������������������������������������������������� 263–295
Chapter 10- Miscellany and Revision������������������������������������������������������������������������������������� 296–318
Chapter 11- Final Recall������������������������������������������������������������������������������������������������������ 319–328
 t h a l m ology in 5 D
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 AIIMS New Pattern 2019 Model Questions������������������ 333–335

 Day 1

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Chapter 12 Embryology, Anatomy and Physiology of the Eye������������������������������������������������������337–344

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Chapter 13 Eyelids�������������������������������������������������������������������������������������������������������������345–355

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Chapter 14 Conjunctiva������������������������������������������������������������������������������������������������������356–370
Chapter 15 Cornea------------------------------------------------------------------------------------------------------------ 371–387

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 Day 2
Chapter 16
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Lens����������������������������������������������������������������������������������������������������������������389–405
Chapter 17 Uvea���������������������������������������������������������������������������������������������������������������406–418
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Chapter 18 Glaucoma���������������������������������������������������������������������������������������������������������419–433
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Chapter 19 Vitreous�����������������������������������������������������������������������������������������������������������435–439
Chapter 20 Sclera��������������������������������������������������������������������������������������������������������������440–444
Chapter 21 Retina�������������������������������������������������������������������������������������������������������������445–471
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Chapter 22 Neuro-ophthalmology and Squint��������������������������������������������������������������������������473–495

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Chapter 23 Orbit, Trauma and Intraocular Tumors��������������������������������������������������������������������496–512

Chapter 24 Lacrimal Apparatus��������������������������������������������������������������������������������������������513–519

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Chapter 25 Optics and Refraction�����������������������������������������������������������������������������������������521–539
Chapter 26 Community Ophthalmology���������������������������������������������������������������������������������540–543
Chapter 27 Instruments������������������������������������������������������������������������������������������������������544–547
Chapter 28 Miscellaneous���������������������������������������������������������������������������������������������������548–550
 o laryn gology in 5
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 AIIMS New Pattern 2019 Model Questions������������������ 555–559

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Chapter 29 Anatomy of Ear��������������������������������������������������������������������������������������������������561–581
Chapter 30 Physiology of Ear�����������������������������������������������������������������������������������������������582–588
Chapter 31 Assessment of Hearing Loss���������������������������������������������������������������������������������589–607

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Chapter 32 Hearing Loss�����������������������������������������������������������������������������������������������������608–616
Chapter 33 Assessment and Disorders of Vestibular Function�����������������������������������������������������617–628

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Chapter 34 External Ear Diseases������������������������������������������������������������������������������������������629–639
Chapter 35 Middle Ear Disorders, CSOM and Cholesteatoma������������������������������������������������������640–665

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Chapter 36 Otosclerosis and Meniere’s Disease�����������������������������������������������������������������������666–676
Chapter 37 Facial Nerve and Its Disorders�������������������������������������������������������������������������������677–684
Chapter 38 Tumors of Ear ���������������������������������������������������������������������������������������������������685–693
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Chapter 39 Miscellaneous���������������������������������������������������������������������������������������������������694–702

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Chapter 40 Anatomy and Physiology of Nose and Paranasal Sinuses���������������������������������������������704–717

Chapter 41 Disease of External Nose, Septum and Sinusitis �������������������������������������������������������718–735
Chapter 42 Granulomatous Disease, Polyp and Foreign Body������������������������������������������������������736–744
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Chapter 43 Epistaxis and Rhinitis������������������������������������������������������������������������������������������745–753

Chapter 44 Tumors of Nose and Paranasal Sinuses�������������������������������������������������������������������754–762
Chapter 45 Miscellaneous���������������������������������������������������������������������������������������������������763–774
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Chapter 46 Anatomy and Diseases of Pharynx, Adenoids and Tonsils��������������������������������������������776–791

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Chapter 47 Head and Neck Space Infections����������������������������������������������������������������������������792–800

Chapter 48 Tumors of Pharynx���������������������������������������������������������������������������������������������801–814
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Chapter 49 Anatomy and Physiology of Larynx�������������������������������������������������������������������������816–824
Chapter 50 Laryngeal Paralysis, Congenital Lesions, Stridor and Diseases of Larynx������������������������������825–844
Chapter 51 Tumor of Larynx������������������������������������������������������������������������������������������������845–856
Chapter 52 Diseases of Oral Cavity and Esophagus�������������������������������������������������������������������857–867
Chapter 53 Diagnostic and Operative ENT������������������������������������������������������������������������������868–877

 Day 5
Chapter 54 Final Recall�������������������������������������������������������������������������������������������������������879–884
Chapter 55 Instruments������������������������������������������������������������������������������������������������������885–890
 Recent Pattern Questions 2019
 Orthopedics

1. Which part of scaphoid fracture is most susceptible to 6. Identify the condition as shown:
avascular necrosis? A. Brodie abscess
A. Distal 1/3rd B. Middle 1/3rd B. Osteoid osteoma
C. Proximal 1/3rd D. Scaphoid Tubercle C. Intracortical hemangioma
2. Which of the following attitude will be seen in a patient with D. Chondromyxoid fibroma
posterior dislocation of hip? 7. What should be the most likely diagnosis of this 65 year old

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A. Flexion, Abduction, Internal rotation lady presents with backache and following radio-graph of
B. Flexion, Adduction, Internal rotation the spine shown in image: 
C. Flexion, Abduction, External rotation
D. Flexion, Adduction, External rotation

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3. Foot drop is caused by injury to which nerve involvement:
A. Femoral nerve 

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B. Tibial nerve
C. Common peroneal nerve
D. Sciatic nerve

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4. Identify the condition as shown:

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A. Osteoporosis B. Spondylolisthesis
C. Spondylolysis D. Discitis
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8. Scissor gait is seen in which of the following condition: 

A. Polio B. Cerebral palsy
C. Hyperbilirubinemia D. Hyponatremia
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Ans. 9. Painful arc syndrome pain is felt during? 

A. Mid abduction B. Initial abduction
1. C C. Full range of abduction D. Overhead abduction
2. B A. Brodie abscess
B. Osteoid osteoma
3. C
 Ophthalmology
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4. A C. Intracortical hemangioma
5. D D. Chondromyxoid fibroma 10. A 3 year old child is presenting with drooping of upper
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6. A 5. Which statement is incorrect about the pathology shown in lid since birth. On examination, the palpebral aperture
7. B the image: height is 6 mm and with poor levator palpebrae superioris
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8. A function. What is the procedure recommended?

9. B A. Observation
10. C B. Fasanella Servat operation
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11. A C. Frontalis Sling surgery

12. B D. Mullerectomy
11. The dosage of Vitamin A in keratomalacia in a 2 year old
boy who is 12 kg weight is:
A. Vitamin A :2 lakh I U, oral, 1st, 2nd and 14th day
B. Vitamin A :1 lakh I U, oral, 1st, 2nd and 14th day
C. Vitamin A :2 lakh I U, oral, 1st, 2nd and 3rd day
D. Vitamin A :1 lakh I U, oral, 1st, 2nd and 3rd day
12. Intravenous Mannitol is indicated in:
A. Primary Open angle glaucoma
A. Tumor arise from epiphyseal to metaphyseal region B. Acute angle closure attack
B. Tumor has distinct margin C. Normal tension glaucoma
C. Eccentric lesion D. Sympathetic ophthalmitis
D. Chemotherapy is the treatment of choice
 AIIMS New Pattern 2019
Model Questions

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Single Best Answer Type

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C. ‘Foamy’ physaliferous cells
D. ‘Alphabet soup’ pattern
1. Which of the following correctly describes the pattern of E. ‘Herringbone’ pattern

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inheritance for the corresponding condition? F. ‘Lacey’ osteoid
A. Achondroplasia – autosomal Recessive. G. ‘Clock face’ pattern
B. Osteogenesis imperfecta type 1 – autosomal recessive. H. ‘Chicken wire’ calcification
C. Sickle cell anaemia – autosomal recessive.
D. Hypophosphataemic rickets – X-linked recessive.
of I. ‘Biphasic’ pattern
Which one of the options above is most applicable to
each of the following statements?
E. Duchene’s muscular dystrophy – X-linked dominant.
Each option may be used once, more than once or not
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Ans. C. Sickle cell anaemia – autosomal Recessive.
at all.
x As a very general rule of thumb autosomal dominant
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I. A 9-year-old boy presents with painless bowing of the

disorders cause structural defects whereas autosomal
tibia. On examination he has mild tenderness over
recessive defects are physiological. In orthopaedics,
the most prominent aspect of the anterior surface of
X-linked hypophosphataemic rickets is the only X-linked
the tibia. His radiographs show an anterior eccentric
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dominant condition to be aware of.

lesion confined to the anterior cortex of the tibia. A
2. A biopsy taken from an Achilles tendon, 5 days after procurvatum deformity of the tibia is noted.
rupture treated in plaster, would show a predominance II. A 62-year-old female presents with pain and
of which collagen subtype? swelling in her left arm. The patient is noted to have
A. I. B. II.
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exophthalmus. Radiographs show a lytic lesion in the

C. III. D. IV. humeral diaphysis with well-defined margins.
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E. X. III. A 12-year-old boy presents with 2 months of increasing

Ans. C. III. pain in his right shoulder. It is particularly bad at night.
He lacks full abduction and external rotation because
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There are several collagen types, including:

x Type I collagen is the predominant form in bone and of pain. Radiographs reveal a well-circumscribed
fibrocartilage epiphyseal lytic lesion with a thin rim of sclerotic bone.
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x Type II collagen is found in articular cartilage Ans. I. d. ‘Alphabet soup’ pattern. II. a. ‘Birbeck’ granules.
x Type III collagen is produced in the proliferative phase III. h. ‘Chicken wire’ calcification.
of tendon and ligament healing Osteofibrous dysplasia is a rare, benign fibro-osseous
x Type IV collagen forms the bases of cell basement lesion that occurs in children, almost exclusively confined
membranes to the anterior cortex of the tibia. The characteristic
x Type X collagen is found in mineralizing cartilage in histological feature is of fibroblastic proliferation surro-
endochondral ossification unding woven bone which gives an appearance of an
‘alphabet soup’ or ‘Chinese letters’. This feature is also seen
Extended Matching Questions in fibrous dysplasia, but the key differentiating feature is
osteoblastic rimming of the woven bone which is only seen
in osteofibrous dysplasia.
3. Histological features of bone tumours Langerhans’ cell histiocytosis (LCH) is a spectrum of
A. ‘Birbeck’ granules diseases of the reticuloendothelial system that includes:
B. ‘Storiform’ pattern Eosinophilic granuloma (monostotic LCH)
 1
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Trauma

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High Yield Facts

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ഩ&ŽƌĞĂƌŵ&ƌĂĐƚƵƌĞƐ͗DĞĐŚĂŶŝƐŵŽĨ/ŶũƵƌLJ
Monteggia fracture Fall on outstretched hand with forced pronation of forearm

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Nightstick fractures Direct trauma to the ulna along its subcutaneous border
Galeazzi fractures Direct trauma to the wrist on the dorsolateral aspect or

Reverse Galeazzi fractures

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Fall onto an outstretched hand with forearm pronation
Fall onto an outstretched hand with forearm supination
Essex-Lopresti injury Longitudinal force on the outstretched hand with the elbow in extension.
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Colles fracture Fall on outstretched hand with wrist in dorsiflexion and forearm in pronation.
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Smith fracture Fall onto a flexed wrist with forearm fixed in supination
(Reverse Colles Fracture)
Barton fracture Fall onto a dorsiflexed wrist with the forearm fixed in pronation
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Chauffeure’s fracture Compression of the scaphoid against the styloid with the wrist in dorsiflexion and
(Hutchinson fracture) ulnar deviation.

d>ϭ͗ഩŝƐůŽĐĂƚŝŽŶŽĨsĂƌŝŽƵƐ:ŽŝŶƚƐ
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Joint Direction of dislocation Methods of reduction

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Hip Posterior (90%): trauma to the flexed knee (e.g. dashboard injury) with the hip in • Allis method
varying degrees of flexion: • Stimson gravity technique
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• If the hip is in the neutral or slightly adducted o posterior dislocation without • Bigelow’s method
acetabular fracture. • Reverse Bigelow’s method
• If the hip is in slight abduction o posterior dislocation and fracture of the
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posterior rim of the acetabulum.

Anterior (10%): External rotation and abduction of the hip
Shoulder Anterior (90%): • Traction-countertraction
• Indirect force (MC): Abduction and external rotation of shoulder • Hippocratic technique
• Direct: Anteriorly directed impact to the posterior shoulder (rare). • Stimson gravity technique
Posterior (10%): Electric shock or convulsive mechanisms • Milch technique
Inferior (rare): hyperabduction of the shoulder • Kocher maneuver
Elbow Posterior / Posterolateral 90%: combination of elbow hyperextension, arm Longitudinal traction and flexion of
abduction, and forearm supination. the elbow with gentle pressure on
Anterior: A direct force on the posterior forearm with the elbow in a flexed olecranon
position.

contd...
 Triple O

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A B C

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ORTHOPEDICS

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&ŝŐ͘ϵ͗ഩA͘,ƵŵĞƌƵƐĨƌĂĐƚƵƌĞƚƌĞĂƚĞĚǁŝƚŚƉůĂƟŶŐ͖B͘Tension band wiring of patella; C͘Cerclage wiring of patella; D͘Open fracture treated
ǁŝƚŚĞdžƚĞƌŶĂůĮdžĂƟŽŶ͖E͘Oblique fracture treated with lag screws; &͘Supracondylar fracture treated with K wires; G͘ůĂƐƟĐŶĂŝůŝŶŐĨŽƌ
pediatric long bone fractures; ,͘Tibial intramedullary nail; /͘Ilizarov apparatus (for limb lengthening)
 Chapter 1 | Trauma

Chapter at a Glance
37
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ORTHOPEDICS
 Chapter 1 | Trauma

Image-Based Questions 39

1. A 24 year old man sustained the fracture shown in the 3. What is your diagnosis?
x-ray below. The nerve most likely to be injured is

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A. Monteggia B. Smith
C. Colles D. Galeazzi

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4. Identify the type of fracture shown in the photograph

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A. Ulnar nerve
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B. Median nerve
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C. Radial nerve
D. Musculocutaneous nerve
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2. Eponym for fracture shown in below X-ray is

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A. Transverse B. Spiral
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C. Oblique D. Comminuted
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5. Most common nerve affected in condition shown in

this photograph is
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ORTHOPEDICS

A. Monteggia fracture B. Colle’s fracture A. Radial N B. Ulnar N

C. Galeazzi fracture D. Smith’s fracture C. Median N D. Axillary N
 Triple O

42 Answers off Image-Based

g Questions
1. C. Radial Nerve (Apley and Solomon’s Concise System of Orthopedics and Trauma, page 371)
The radiograph shows a fracture shaft of humerus. The nerve most likely to get damaged is radial nerve, as this nerve is very
close to the shaft of humerus.

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Holstein-Lewis fracture
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Holstein Lewis Syndrome: Entrapment of radial nerve between fragments in the oblique fracture of distal third of humerus.
Radial nerve, which is fixed to proximal fragment by lateral intermuscular septum, is trapped between fragments when closed
reduction is attempted.
2. A. Monteggia fracture (Apley and Solomon’s Concise System of Orthopedics and Trauma, page 385)
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The radiograph shows a fracture of proximal part of ulna and dislocation of head of radius (disruption of upper radioulnar joint).
This is called Monteggia fracture dislocation.
Treatment of Monteggia fracture
x Acute fractures: In children – Closed reduction and Plaster cast
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x In adults: ORIF with plate. Radial head reduces spontaneously.

ld, malunited fractures: ORIF with plate for ulna fracture and radial head excision.
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3. D. Galeazzi (Apley and Solomon’s Concise System of Orthopedics and Trauma, page 385)
x The x-ray shows a fracture at the junction of middle and distal third of shaft of radius.
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x The distal radio ulnar joint is disrupted.

x Galeazzi fracture is treated by ORIF with plating.
x Without ORIF, the functional recovery will not be good.
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x That is why, this is grouped under Fractures of Necessity.

Fractures of Necessity
x Neck of femur fracture
x Lateral humeral condyle fracture
ORTHOPEDICS

x Galeazzi fracture
4. D. Comminuted
Multiple fractured fragments are present.
5. A. Radial N (Apley and Solomon’s Concise System of Orthopedics and Trauma, page 371)
The picture shows wrist drop. It is due to radial nerve palsy.
6. C. Anterior shoulder dislocation (Apley and Solomon’s Concise System of Orthopedics and Trauma, page 367,
(Maheswari’s Essential Orthopedics, 5th Edition, page 90)
x The glenoid is empty and the head of humerus is lying below the corocoid process.

11
General Orthopedics
z Wolff’s law: Bone remodels in response to mechanical
stress.
z (In areas of high stress o Bone mass increased; In areas
of less stress o low bone mass)
z Heuter-Volkmann’s law: Excessive compression
inhibits physeal growth; distraction (i.e. tension) across
z
the physis accelerates growth.
Major mineral content of the bone is Calcium
hydroxyapatite.
z Maximum weight which can be applied for skin traction
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is 4-5kgs.
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z Maximum weight limit for Skeletal traction is 20 kgs.
z Alkaline phosphatase is elevated in Rickets, Paget’s
disease.
Scurvy affects the bone by deficient formation of osteoid
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z z
matrix.
z Unmineralized bone matrix is known as Osteoid.
z Osteon (Haversian system) is the basic structural unit
of bone.
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z Haversian canal is the central longitudinal canal of
concentric lamellae of osteon.
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z Volkmann’s canal is horizontal canal connecting
periosteal and endosteal surfaces.
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z Periosteum is attached to the bone by Sharpe’s fibers.
z Periosteum is thick in children.
z Major collagen in bone is Type I collagen.
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z Type of collagen present in cartilage is Type II.
z All long bones are formed by Enchondral ossification
except Clavicle.
z Most common bone fracture during birth is clavicle
fracture.
z Last step in healing of fractures is remodelling.
z Action of intramedullary ‘K’ nail is three-point fixation.
z Ilizarov method works in the principle of Distraction
osteogenesis. (It is the generation of new bone in
response to gradual increases in tension.)
z Arthrotomy (means opening a joint) is used in synovial
biopsy, drainage of a haematoma or an abscess, remove a
loose body or damaged structures such as torn meniscus.
5
Final Recall
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z SACH foot means Solid Action Cushion Heel. It is an
artificial foot prosthesis used in leg amputation.
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z Jaipur foot was designed by PK Sethi.
z Tourniquet Pressure: about 150 mm Hg above the
systolic pressure is recommended for the lower limb
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surgeries and 100 mmHg above systolic is for the upper
limb surgeries.
z Pulsed electromagnetic field stimulation (PEMF), Low-
of intensity pulsed ultrasound (LIPUS) are some of the
noninvasive biophysical methods used to promote
fracture healing in delayed union and non-union.
z Autogenous bone graft is the standard graft substance
used in the management of non-union.
Trauma
Polytrauma: defined as injury to at least two organ
systems that cause a potentially life-threatening
condition. Injury Severity Score (ISS) > 16.
z A direct impact on the bone will produce a transverse
fracture pattern.
z The most serious complication of pelvic fracture is Hy-
povolemic shock.
z Complete displacement of articular (joint) surface is
called as Dislocation.
z Partial displacement is called as Subluxation.
z Recurrent dislocation is seen in Shoulder and patella-
femoral joint.
z Apprehension test is positive in recurrent dislocations.
z Habitual dislocation is seen in Ligamentous laxity.
z Straddle fracture is bilateral pubic ramus fracture.
z Malgaigne’s fracture is fracture of pubic rami with
fracture of ipsilateral sacroiliac region.
z Morel-Lavelle lesion is subcutaneous degloving injury
of lateral thigh, usually seen pelvic fractures.
z Judet view of X ray is useful to evaluate the acetabular
fractures.
z Kocher–Langebeck approach is a posterior approach to
do ORIF of posterior acetabular fractures.
z Watson-Jones approach is anterolateral approach to hip
to hip surgeries.
 1

AIIMS New Pattern 2019

Model Questions

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le
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Single Best Answer Type
(Usual Type of Question We Get)

T
D. The IOP decrease with usage of topical steroids is
1. The most common congenital cataract affecting the known as steroid responsiveness
vision is:
A. Blue dot cataract
B. Sutural cataract
of E. It is the only modifiable risk factor in Glaucoma
Ans. A. a, c, e – True b, d – False (A K Khurana's
C. Anterior pyramidal cataract Comprehensive Ophthalmology, 7th edition, pg.no 231)
s
D. Zonular cataract Mark True/false after each statement
x Imbert – Fick principle is the principle for applanation
ge

Ans. D. Zonular cataract (A K Khurana's Comporehensive tonometer.

Ophthalmology, 7th edition, pg.no 189) x Steroid responsiveness – IOP increases with the
x Lamellar cataract/ zonular cataract/ rider’s cataract
prolonged usage of steroids (6 weeks).
is the most common visually significant congenital
Pa

cataract. 4. Which statements are true / false regarding Sympathetic

x In blue dot cataract vision remains normal. Ophthalmitis?
A. Blunt injury at the site of ciliary body is the main cause
2. Horner Tranta’s spot is seen B. Injured eye is called as sympathising eye; Other eye –
A. Trachoma exciting eye
e

B. Paratrachoma C. Enucleation is the only treatment of choice available

C. Vernal keratoconjunctivitis for all the cases
pl

D. Trachoma dubium D. Dalen Fuch’s nodules are the characteristic Pathological

Ans. C. Vernal keratoconjunctivitis (A K Khurana's features seen in sympathetic ophthalmitis.
m

Comprehensive Ophthalmology, 7th edition, pg.no 80 E. Earliest sign of sympathetic ophthalmitis is mutton fat
Keratic precipitates.
Sa

Ans. A. D – True B, C, E– False (A K Khurana's

Multiple True –False Types
3. Which statements are true or false regarding intraocular
pressure
A. The normal IOP is between 10-21mmHg
B. The best way to measure IOP is by Applanation
Tonometer which has Total internal reflection as
principle.
C. Diurnal Variation of more than 8 mmHg is diagnostic of
POAG
Comporehensive Ophthalmology, 7th edition, pg.no 456)
x Bilateral granulomatous panuveitis after penetrating
trauma with prolapsed uvea
x Injured eye – exciting eye; normal fellow- sympathizing
eye
x Dalen fuch’s nodules – granulomas between Bruch’s and
RPE
x Earliest symptom: Loss of accommodation
x Earliest sign: Retrolental flare and cells
x Enucleation of the injured eye within 10 days only in
eyes with a hopeless visual prognosis.
x Treatment: Topical and systemic steroids.
 Triple O

8. Arrange the following post op complications of cataract

334 Match the Following Type surgery in the order of occurrence
a. Bullous keratopathy
b. Cystoid macular edema
5. Match the Antiglaucoma medications with their adverse c. Striate Keratopathy
effects. d. Bacterial Endophthalmitis
1. Beta blockers — a. Cystoid macular edema
A. c o d o b o a B. a o c o b o d
2. Latanoprost — b. Respiratory depression
C. c o d o a o b D. a o b o c o d
3. Dorzolamide — c. Heart block
4. Brimonidine — d. Endothelial dysfunction Ans. A. c o d o b o a (A K Khurana's Comprehensive
Ophthalmology, 7th edition, pg. no 219 – 221)

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e. Cataract
f. Loss of accomodation x Striate keratopathy o Immediate post op complication.
A. 1 - d, 2 - c, 3 - b, 4 - a Corneal edema due to instrumentation.
B. 1 - c, 2 – a, 3 – d, 4 – d x Bacterial endophthalmitis o usually presents 48 – 72

le
C. 1 - e, 2 - c, 3 – d, 4 – f hours after surgery.
D. 1 – c, 2 – d, 3 – a, 4 – e x Cystoid macular edema o 2–3 months after surgery
x Bullous keratopathy o late post op complication

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Ans. B. 1 - c, 2 – a, 3 – d, 4 – e (A K Khurana's Comprehensive
Ophthalmology, 7th edition, pg.no 469)
x Beta blockers — asthma, cardiac block Multiple Completion Type
x Latanoprost — lengthening of eyelashes, uveitis, macular

T
edema 9. True statements about Convex lens is /are :
x Dorzolamide — Endothelial dysfunction, sulpha allergy a. Convex lens is thick in the centre and thin at the
x Brimonodine — causes respiratory depression in
children.
of periphery
b. An object held close to the lens, appears minified
c. When a convex lens is moved, the object seen through
6. Match the clinical condition with the cause
it moves in the opposite direction.
s
  Siderosis — a. Facial nerve palsy
d. Used to correct myopia
  Chalcosis — b. Intraocular Iron foreign
ge

A. a, b, c B. a, c
body
C. a, b, c, d D. a, c, d
  Neurotrophic keratitis — c. Intraocular Copper
foreign body Ans. B. a, c (A K Khurana's Comprehensive Ophthalmology,
  Neuroparalytic keratitis — d. Trigeminal nerve palsy
Pa

7th edition, pg.no 28)

e. Blunt trauma Convex Lens
f. Methanol poisoning
x Convex lens is thick in the centre and thin at the
A. 1 – e, 2 – c, 3 – b, 4 – a
periphery
B. 1 – b, 2 – c, 3 – d, 4 – a
x Magnification of images
e

C. 1 – b, 2 – c, 3 – a, 4 – f
x When the lens moves, the object seen through it moves
D. 1 – c, 2 – b, 3 – d, 4 – a
pl

in the opposite direction.

Ans. B. 1 – b, 2 – c, 3 – d, 4 – a (A K Khurana's Comprehensive
Uses
Ophthalmology, 7th edition, pg.no 585, 118)
x
m

x Siderosis – Intraocular iron foreign body Hypermetropia

x Chalcosis – Intraocular copper foreign body x Aphakia
x Neurotrophic keratitis – Trigeminal nerve palsy x Presbyopia
Sa

x Neuroparalytic keratitis – Facial nerve palsy x +90 D /+78D in slitlamp fundus examination
x +20 D in indirect ophthalmoscope
Seqeuntial Arrangement Type
OPHTHALMOLOGY

10. Which statement is/are true about Retinal detachment?

a. Hypermetropia is commonly associated with retinal
7. Arrange the sequence of events in Non healing corneal detachment
ulcer b. Grey pupillary reflex is seen
a. Descematocele b. Pseudocornea c. Tractional Retinal detachment is characterized by
c. Staphyloma d. False cornea convex configuration
d. Shaffer’s sign is a very good indicator of visual prognosis
A. a o b o c o d B. a o c o b o d
C. a o d o b o c D. c o a o d o b A. b only B. a, b, d
C. c, d D. b, c, d
Ans. C. a o d o b o c (A K Khurana's Comprehensive
Ophthalmology, 7th edition, pg.no 104) Ans. A. b only (A K Khurana's Comprehensive
Ophthalmology, 7th edition, pg.no 309)
 1 1
12 Embryology, Anatomy and
Physiology of the Eye

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Embryology of Eye z Neural crest cell migration forms the corneal stroma, iris
stroma and trabecular meshwork. (Anterior chamber

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z The eye is developed from the nuero ectoderm, surface formation)
ectoderm, mesoderm (mesenchyme) and neural crest z Mesoderm forms the extra ocular muscles, blood vessels
cells. and the sclera.
z Endoderm# has no role in ocular embryology.

T
d> ϭ͗ഩOcular Embryogenesis – Time Line

Gestational Ocular Structure Formed

Ocular Embryology of
Age Embryology
The neural tube gives rise to Prosencephalon, Mesen- 22ND day Grooves are called OPTIC
cephalon and Rhombencephalon. PIT#
s
25th day Forming OPTIC VESICLES#
ge

th
4 week LENS PLATE# – develops from
the surface ectoderm#
EMBRYONIC FISSURE#
– through which hyaloid
Pa

Mescecephalon (Midbrain) vessels reach the anterior

Rhombencephalon (Hindbrain) segment
z At 22nd day of gestation, on either side of the Diencephalon One month LENS PIT & LENS VESICLE #
a groove appears called OPTIC GROOVE/PIT. forms
e

z The Optic Groove out pouches to form the OPTIC Lens vesicle invaginate into
the optic vesicle to form the
pl

VESICLE.
OPTIC CUP #
z Once the optic vesicle reaches the surface ectoderm, the
ectoderm thickens to form the LENS PLATE. 7th week Migration of First wave: Formation of
m

z The lens plate invaginate into the optic vesicle to form Neural crest cells Corneal and Trabecular
#
the LENS PIT and detaches from the surface ectoderm occur. endothelium#.
Sa

forming the LENS VESICLE. Second wave: Formation of

z When the lens plate invaginates into the optic vesicle, it corneal stroma#.
becomes double layered THE OPTIC CUP. OPTIC CUP Third wave: Formation of Iris
stroma#.
has two layers
 The outer layer differentiates into the retinal
pigmentary epithelium. 5th month Photoreceptors
 The inner layer differentiates into the remaining 9 differentiate
inner layers of the retina. 6th month Nasolacrimal
 There is a potential subretinal space in between system becomes
these layers. patent
z Embryonic Fissure: INFERO NASAL GAP# in the Optic 8th month Hyaloid vessels
Cup which allows the hyaloid artery to reach the inner disappear
chamber of the eye. Closure is complete after 7 weeks.
 Triple O

342 Image-Based Questions

1. The structure shown in this picture is developed 2. Sutures present in the picture is present in which
from part of the nucleus

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le
rip
A. Embryonic B. Infantile

T
A. Mesoderm B. Neuroectoderm C. Juvenile D. Fetal
C. Surface ectoderm D. Neural crest
of
3. Cause for the defect shown in this picture
s
ge
Pa
e

A. Prematurity
pl

B. Persistent pupillary membrane

C. Failure of embryonic fissure to close
m

D. None
Sa

Answers off Image-Based

g Questions
OPHTHALMOLOGY

1. C. Surface ectoderm (Parson 22nd edition Pg.no 6)

Structure marked is lens, it is derived from surface ectoderm
2. D. Fetal (AK Khurana 7th edition, Pg.no 185)
Structure marked is Y suture. It is present in fetal nucleus.
3. C. Failure of embryonic fissure to close (AK Khurana 7th edition, Pg.no 154)
Defect shown in this picture is Iris Coloboma.
Supracondylar fracture of humerus o Malunion oCubitus varus
 Chapter 16 | Lens

RECENT UPDATES 399

z Anterior lenticonus#: ^ĞĞŶŝŶůƉŽƌƚƐLJŶĚƌŽŵĞ#, characterized
by progressive sensory neurĂl ĚeĂĨness͕ renĂl ĚiseĂse͕ retinĂl
ĨlecŬs ĂnĚ Ɖosterior ƉolLJŵorƉŚous corneĂl ĚLJstroƉŚLJ
z Posterior lenticonus#: Seen in Lowe syndrome#. Most cases
are unilateral and sporadic.
z DicrosƉŚeroƉŚĂŬiĂ#: Small and spherical lens is seen in
DĂƌĨĂŶ ĂŶĚ tĞŝůůůͲDĂƌĐŚĞƐĂŶŝ ƐLJŶĚƌŽŵĞƐ͕ ,LJƉĞƌůLJƐŝŶĞŵŝĂ
z Femtosecond laser assisted cataract surgery. Laser is used
ƚŽ ŵĂŬĞ ĐŽƌŶĞĂů ŝŶĐŝƐŝŽŶƐ͕ ĐĂƉƐƵůŽƌƌŚĞdžŝƐ ĂŶĚ ĚŝǀŝĚĞ ƚŚĞ
nucleus into smaller pieces.
z Optical coherence biometry for accurate measurement of
IOL power.
z ƐƉŚĞƌŝĐ/K>ƚŽŝŵƉƌŽǀĞƚŚĞĐŽŶƚƌĂƐƚƐĞŶƐŝƚŝǀŝƚLJ͘
z dŽƌŝĐ/K>͗dŽĐŽƌƌĞĐƚƉƌĞͲĞdžŝƐƚŝŶŐĂƐƚŝŐŵĂƚŝƐŵ
Toric Multifocal IOL: To correct both pre op astigmatism

O
z
and familial Ectopia lentis at pupillae.
z DicroƉŚĂŬiĂ#: Small lens is seen in Lowe syndrome. ĂŶĚ ŶĞĂƌ ĂŶĚ ĚŝƐƚĂŶƚ ǀŝƐŝŽŶ͘ ;DƵůƚŝĨŽĐĂů /K> ŝƐ ĂůƐŽ ĐĂůůĞĚ
ĂĐĐŽŵŵŽĚĂƚŝǀĞ/K>Ϳ͘

le
Image-Based Questions

rip
1. A 5 year old child brought for defective vision and 3. To treat the condition shown in this picture, which

T
his clinical photograph is shown below of the following is used

of
s
ge
Pa

A. Argon laser
A. Coraliform cataract B. Excimer laser
B. Lamellar cataract C. Frequency double NdYAG laser
C. Blue dot cataract D. NdYAG laser
e

D. Sutural cataract
pl

2. A 60 years diabetic patient underwent cataract 4. Identify the condition shown in this picture
m

surgery five days back and presented with pain,

defective vision and his clinical photograph is shown
below. What is the most probable diagnosis
Sa

OPHTHALMOLOGY

A. Subluxation of lens
A. Fungal endophthalmitis
B. Disslocation of lens
B. Fungal keratitis
C. Anterior lenticonus
C. Bacterial endophthalmitis
D. Posterior lenticonus
D. Choroiditis
 Chapter 22 | Neuro-ophthalmology and Squint

d>ϭϱ͗ഩůŝŶŝĐĂůĨĞĂƚƵƌĞƐŽĨǀĂƌŝŽƵƐƚLJƉĞƐŽĨELJƐƚĂŐŵƵƐ

PHYSIOLOGICAL NYSTAGMUS
487
Types Clinical Features Site of Lesion
ŶĚWŽŝŶƚELJƐƚĂŐŵƵƐ • &ŝŶĞũĞƌŬLJŶLJƐƚĂŐŵƵƐŝŶĞdžƚƌĞŵĞƐŽĨŐĂnjĞ͘
• dŚĞĨĂƐƚƉŚĂƐĞŝƐŽŶƚŚĞĚŝƌĞĐƟŽŶŽĨŐĂnjĞ͘
KƉƚŽŬŝŶĞƟĐELJƐƚĂŐŵƵƐ • :ĞƌŬLJŶLJƐƚĂŐŵƵƐŝŶĚƵĐĞĚďLJŵŽǀŝŶŐƌĞƉĞƟƟǀĞ • WĂƌŝĞƚŽͲŽĐĐŝƉŝƚŽƚĞŵƉŽƌĂůƌĞŐŝŽŶĐŽŶƚƌŽůƚŚĞƐůŽǁ
ƚĂƌŐĞƚƐ ;ƉƵƌƐƵŝƚͿƉŚĂƐĞ͘
• &ƌŽŶƚĂůůŽďĞĐŽŶƚƌŽůƚŚĞƌĂƉŝĚƐĂĐĐĂĚŝĐƉŚĂƐĞ
sĞƐƟďƵůĂƌELJƐƚĂŐŵƵƐ • ĞƐƚƌƵĐƟǀĞůĞƐŝŽŶƐŝŶĚƵĐĞŶLJƐƚĂŐŵƵƐƚŽƚŚĞ • ůƚĞƌĞĚŝŶƉƵƚĨƌŽŵƚŚĞǀĞƐƟďƵůĂƌŶƵĐůĞŝƚŽ

O
ŽƉƉŽƐŝƚĞƐŝĚĞη ŚŽƌŝnjŽŶƚĂůŐĂnjĞĐĞŶƚĞƌƐ͘
• /ƌƌŝƚĂƟǀĞůĞƐŝŽŶƐƉƌŽĚƵĐĞĨĂƐƚƉŚĂƐĞŝŶƚŚĞƐĂŵĞ
ĚŝƌĞĐƟŽŶη

le
• CALORIE TEST
COWS
^LJƌŝŶŐŝŶŐCŽůĚǁĂƚĞƌŝŶŽŶĞĞĂƌo OƉƉŽƐŝƚĞƐŝĚĞ

rip
ŶLJƐƚĂŐŵƵƐ
WĂƌŵǁĂƚĞƌo SĂŵĞƐŝĚĞŶLJƐƚĂŐŵƵƐ
CUWD

T
^LJƌŝŶŐŝŶŐCŽůĚǁĂƚĞƌŝŶďŽƚŚĞĂƌƐo UƉǁĂƌĚŐĂnjĞ
^LJƌŝŶŐŝŶŐWĂƌŵǁĂƚĞƌŝŶďŽƚŚĞĂƌƐo DŽǁŶǁĂƌĚŐĂnjĞ
PATHOLOGICAL NYSTAGMUS
of
CONGENITAL • WĞŶĚƵůĂƌƚLJƉĞŶLJƐƚĂŐŵƵƐη
• ĂŵƉĞŶĞĚďLJĐŽŶǀĞƌŐĞŶĐĞĂŶĚŶŽƚƉƌĞƐĞŶƚĚƵƌŝŶŐ
ƐůĞĞƉ
s
• dŚĞƌĞŝƐƵƐƵĂůůLJŶƵůůƉŽŝŶƚͲƉŽƐŝƟŽŶŽĨŐĂnjĞŝŶǁŚŝĐŚ
ŶLJƐƚĂŐŵƵƐŵŝŶŝŵĂůĂŶĚĐŽŵƉĞŶƐĂƚŽƌLJŚĞĂĚƉŽƐƚƵƌĞ
ge

ŵĂLJĚĞǀĞůŽƉ͘
UPBEAT NYSTAGMUS • dŚĞǀĞƌŵŝƐŽĨĐĞƌĞďĞůůƵŵŽƌƚŚĞďƌĂŝŶƐƚĞŵη
• WŚĞŶLJƚŽŝŶƚŽdžŝĐŝƚLJη
Pa

DOWN BEAT • WŽƐƚĞƌŝŽƌĨŽƐƐĂůĞƐŝŽŶĂƚƚŚĞůĞǀĞůŽĨ&ŽƌĂŵĞŶ

NYSTAGMUS DĂŐŶƵŵη
REBOUND • ŚĂŶŐĞƐƚŚĞĚŝƌĞĐƟŽŶŽĨƚŚĞŶLJƐƚĂŐŵƵƐǁŝƚŚ • ĞƌĞďĞůůĂƌůĞƐŝŽŶη
NYSTAGMUS ƐƵƐƚĂŝŶĞĚŐĂnjĞ
e

^ʹ^t • KŶĞĞLJĞĞůĞǀĂƚĞƐĂŶĚŝŶƚŽƌƚƐĂŶĚŽƚŚĞƌĞLJĞ • dŚĞŚŝĂƐŵĂŽƌƚŚĞdŚŝƌĚǀĞŶƚƌŝĐůĞη

pl

NYSTAGMUS ĚĞƉƌĞƐƐĞƐĂŶĚĞdžƚŽƌƚƐ
BRUNS NYSTAGMUS • ŽĂƌƐĞŚŽƌŝnjŽŶƚĂůŶLJƐƚĂŐŵƵƐŝŶŽŶĞĞLJĞĂŶĚĮŶĞ • ĞƌĞďĞůůŽƉŽŶƟŶĞĂŶŐůĞƚƵŵŽƌƐηĞŐ͕͘ĐŽƵƐƟĐ
m

ŚŝŐŚĨƌĞƋƵĞŶĐLJǀĞƐƟďƵůĂƌŶLJƐƚĂŐŵƵƐŝŶŽƚŚĞƌĞLJĞ ŶĞƵƌŽŵĂ͘
'sK< • EŽŶLJƐƚĂŐŵƵƐŝŶƚŚĞƉƌŝŵĂƌLJƉŽƐŝƟŽŶ͕ŝƚĂƉƉĞĂƌƐ • ůĐŽŚŽůŝŶƚŽdžŝĐĂƟŽŶ͕ĂƌďŝƚƵƌĂƚĞƐ͕ĞƌĞďĞůůĂƌĂŶĚ
ǁŚĞŶƚŚĞĞLJĞƐůŽŽŬƚŽƚŚĞƐŝĚĞ͘ ďƌĂŝŶƐƚĞŵůĞƐŝŽŶ
Sa

NYSTAGMUS
dy/Ez^d'Dh^ • /ŶƚĞƌŶƵĐůĞĂƌKƉŚƚŚĂůŵŽƉůĞŐŝĂ
D/EZ͛^Ez^d'Dh^ • ZŽƚĂƚŽƌLJŶLJƐƚĂŐŵƵƐ
OPHTHALMOLOGY

• ^LJŶĚƌŽŵĞƐĂƐƐŽĐŝĂƚĞĚǁŝƚŚĂďĚƵĐĞŶƚŶĞƌǀĞƉĂůƐLJĂƌĞ͗
ƒ Foville: /ŶǀŽůǀĞƐĚŽƌƐĂůƉŽŶƐ͕ĐŚĂƌĂĐƚĞƌŝnjĞĚďLJŝƉƐŝůĂƚĞƌĂůŝŶǀŽůǀĞŵĞŶƚŽĨĐƌĂŶŝĂůŶĞƌǀĞƐϱ͕ϲ͕ϳ͕ĂŶĚϴ͕,ŽƌŶĞƌƐLJŶĚƌŽŵĞ
ĂŶĚŚŽƌŝnjŽŶƚĂůŐĂnjĞƉĂůƐLJ͘
ƒ DillĂƌĚͲ'Ƶďleƌ: >ĞƐŝŽŶĂƚƚŚĞůĞǀĞůŽĨƉLJƌĂŵŝĚĂůƚƌĂĐƚ͕ŝƉƐŝůĂƚĞƌĂůĂďĚƵĐĞŶƚƉĂůƐLJ͕>DEĨĂĐŝĂůƉĂůƐLJĂŶĚĐŽŶƚƌĂůĂƚĞƌĂů
ŚĞŵŝƉůĞŐŝĂ͘
 1

AIIMS New Pattern 2019

Model Questions

O
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done which were normal and been referred to ENT.
Single Best Answer Type diagnostic nasal endoscopy showed a polypoidal mass

1. A 20-year-old female presenting with vertigo on
suddenly changing his head, lasting for few seconds,
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which was not pinkish and it did not bleed, so he was
shifted to OT and biopsy was taken, which showed
presence of mikulicz cells and russell bodies. His nasal

T
choanae was free, his sinus cavities were free. What is
Diagnosis? your diagnosis?
A. BPPV
Ans. E. Rhinosceroma
B. Vertebrobasilar insufficiency of x Mikulicz cells and Russell bodies on pathology o
C. Vestibular migraine
features of rhinoscleroma
D. Central etiology
CASE 2:
Ans. A. BPPV
s
The question states o patient gets an episode of vertigo on A 40-year-old female came to OPD with history of nasal
ge

sudden turning & lasting for seconds, not associated with
aural or neural symptoms
2. The pathognomonic sign/test for CSF rhinorrhea?
Pa
bleeding. On examination she had a pinkish polypoidal
mass in her right nasal cavity and it was vascular, so
biopsy was done in OT and CT was taken, she gave a
history of taking bath in lakes in her village and most of

A. Halo sign
B. Target sign her colleagues also had faced this same issue.
C. Beta 2 transferrin analysis Diagnosis?
D. Beta trace protein Ans. A. Rhinosporidiasis
x Presence of a polypoidal vascular mass with history of
Ans. C. Beta 2 transferrin analysis
bathing in contaminated water o rhinoscleroma
e

The pathognomonic test for CSF rhinorrhea o BETA 2

transferrin analysis.
pl

4. Theme – Hearing loss

m

Answer option list o

Extended Matching A. Otomycosis
B. Otosclerosis
Sa

C. Presbyacusis
3. Theme – granulomatous conditions of nose:
D. Noise induced hearing loss
Answer option list:
E. Serous otitis media
A. Rhinosporidiosis
F. Ossicular discontinuity
B. Stewarts granuloma
G. Acute suppurative otitis media
C. Potts puffy tumour
D. Mucocele CASE 1:
E. Rhinoscleroma A 7-year-old boy was brought by parents with complaints
F. Lupus vulgaris of not responding to sounds on called. His school
CASE 1: teachers have also complained of child's inattentiveness
in academics. He has a open mouth breathing and
A 34-year-old male presented in OPD with nasal block.
snoring at night. He had no history of ear pain or ear
He had episodes of headache and facial pain. He is
discharge. On examined his tympanic membrane was
heading from Delhi. He was admitted in hospital for fever
intact and bulging. Audiogram was done which showed
a month back following which several investigations
1 1
29
Anatomy of Ear

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le
High Yield Facts

rip
• Incisura terminalis: Area between tragus and crus of helix devoid of cartilage —Used as an endaural
approach in surgery of external auditory canal or mastoid.

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• External auditory canal length: 24 mm.
• Tympanic membrane: Normal colour is pearly grey, mobile and maximum mobility at periphery.
• Cone of light: The central part of pars tensa is tented inwards at the level of tip of malleus and is
of
called umbo. A bright cone of light can be seen radiating from tip of malleus to the periphery in the
anteroinferior quadrant.
• Hitzelberger’s sign: Hypoesthesia of posterior meatal wall in Acoustic neuroma.
s
• Crus commune: Non ampullated ends of posterior and semicircular canals unite to form a common
channel.
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• Endolymphatic duct: Connects scala media to epidural space.

• Cochlear aqueduct: Connects scala tympani with subarachnoid space.
• Donaldson’s line: This is surgical landmark for endolymphatic sac; it passes through horizontal bisecting
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the posterior canal. Sac is situated inferior to it.

• Boxer’s ear’: Pinna is made up of yellow elastic cartilage which is vascular on lateral side, adherent to
perichondrium, injury causes necrosis of cartilage.
• Bill’s bar: It is a vertical crest of bone, which divides superior compartment of the internal acoustic meatus
into anterior compartment for facial nerve and posterior compartment for superior vestibular nerve.
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Fig. 1:ഩ^ƚƌƵĐƚƵƌĞŽĨĞĂƌ
 Chapter 29 | Anatomy
my of Ear

Multiple
p Choice Questions
1. Endolymph secreted by:
A. Basilar membrane
B. Reissners membrane
C. Stria vascularis
D. Tectorial membrane
2. The center for stapedial reflex is
573
(Recent Pattern 2018) 12. Which of the following nerves has no supply to the
auricle (AI 12)
A. Lesser occipital
B. Auriculotemporal nerve
C. Auricular branch of vagus
(AIIMS Nov 16) D. Tympanic branch of glossopharyngeal nerve

O
A. Superior olivary complex 13. Vertical crest of bone in the internal acoustic meatus is
B. Medial geniculate body known as (AIIMS 11)
C. Superior colliculus A. Cog B. Bill's bar

le
D. Lateral lemniscus C. Falciform crest D. Subiculum
3. Nerve supply of ear lobule is contributed by: 14. Pinna develops from (AIIMS May11)
A. Greater auricular nerve (AIIMS Nov 15) A. 1st pharyngeal arch

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B. Auriculotemporal nerve B. 1st and 3rd pharyngeal arch
C. Lesser occipital C. 1st and 2nd pharyngeal arch
D. Auricular branch of vagus D. 2nd pharyngeal arch

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4. The derivation of otic placode is: (Recent Pattern 2016) 15. Anterior part of tympanic cavity contains (PGI May 11)
A. Ear ossicles A. Promontory
B. Tympanic membrane B. Pyramid
C. Mastoid
D. Cochlea
5. The following is not a derivative of first arch
of C. Processus cochleariformis
D. Tensor tympani
E. Bony part of pharyngotympanic tube
(Recent Pattern 2016) 16. Endolymph in the inner ear (AIIMS May 10)
s
A. External canal B. Pinna A. Is a filtrate of blood serum
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C. Mastoid D. Cochlea B. Is secreted by Stria Vascularis

6. The following is a derivative of first pouch C. Is secreted by Basilar membrane
A. External auditory meatus (Recent Pattern 2016) D. Is secreted by hair cells
B. Auditory tube 17. Infection of CNS spreads in inner ear through
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C. Tonsil (AIIMS May 10, Nov 10, May 11, AI 09,

D. Mastoid antrum Recent Pattern 16)
7. The function of stria vascularis is (Recent Pattern 2016) A. Cochlear aqueduct
A. Endolymph secretion B. Endolymphatic sac
B. Perilymph secretion C. Vestibular aqueduct
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C. CSF secretion D. Hyrtle’s fissure

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D. Cortilymph secretion 18. Which of the following attain adult size before birth
8. Boundaries of Facial recess are all except (AIIMS May 13) (AIIMS Nov 2010, Recent Pattern 07,09)
A. Chorda Tympani A. Ear ossicles B. Maxilla
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B. Facial nerve C. Mastoid D. Parietal bone

OTORHINOLARYNGOLOGY
C. Stapedius tendon 19. True about Eustachian tube (PGI Nov 10)
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D. Short process of incus A. Length is 36 mm in adult and 1.6-3 mm in child

9. Perilymph is produced by (Recent Pattern 2013) B. Higher elastin content in adults
A. Scala vestibule C. Angulated in infants
B. Reisner’s membrane D. More horizontal in adults
C. Spiral ligament capillaries 20. Hair cell of organ of corti is supported by (PGI Nov 09)
D. Stria vascularis A. Deiter cell B. Onodi cell
10. The length of external auditory canal is C. Hensen cell D. Hallar cell
(Recent Pattern 2016) E. Bullar cell
A. 24 mm B. 36 mm 21. What is the type of joint between the ear ossicles (AI 08)
C. 12mm D. 42 mm A. Fibrous joint
11. The Eustachian tube makes a degree of: B. Primary cartilaginous joint
(Recent Pattern 2016) C. Secondary cartilaginous joint
A. 60 degree B. 45 degree D. Synovial joint
C. 25 degree D. 50 degree
 Triple O

78. Organ of Corti is situated in (Recent Pattern 2015) 81. Bill’s island is (Recent Pattern 13)
576 A. Utricle B. Saccule A. Thin plate of bone over sigmoid sinus
C. Basilar membrane D. External ear B. Thin plate of bone over jugular bulb
79. Promontory is formed by (Recent Pattern 2016) C. Thin plate of bone in anterior wall of middle ear
A. Facial nerve B. Ossicles D. Tympanic membrane
C. Jugular bulb D. Basal coil of cochlea 82. Depolarization of cochlea is due to:
80. False about Sinus tympani (Recent Pattern 2016) A. Potassium influx
A. Lies between oval and round window B. Potassium efflux
B. Present in anterior part of middle ear C. Sodium influx
C. Present Above subiculum D. Sodium efflux
D. Present below Ponticulus

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Answers with Explanations
p

le
1. C. Stria vascularis (Dhingra's 7/e p 12)

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Endolymph – inner ear fluid – similar to intracellular fluid
a. Rich in potassium
b. Secreted by stria vascularis of cochlea
c. And dark cells of utricle & saccule

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d. Endolymph absorbed by endolymphatic sac in
subarachnoid space
2. A. Superior olivary complex (Dhingra's 6/e p 24, 5/e p 30) of
Acoustic reflex: It is based on the fact that a loud sound,
70-100 dB above the threshold of hearing of a particular
ear, causes bilateral contraction of the stapedial muscles
s
which can be detected by tympanometry. Tone can be
delivered to one ear and reflex picked from the same or the
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contralateral ear. The reflex arc involved is:

The Greater auricular nerve supplies most parts of medial
surface of pinna and only posterior part of the lateral
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surface. The ear lobule is supplied both medially and

laterally by greater auricular nerve. (In picture the area
supplied by greater auricular nerve can be identified by
applying thumb over lateral aspect and rest four fingers on
medial aspect).
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4. D. Cochlea (Dhingra's 6/e p 12, 5/e p 14)

pl

x Auricle: From six tubercles around 1 st brachial cleft.

x External auditory meatus: 1 st brachial cleft.
m

Tympanic Membrane
x
OTORHINOLARYNGOLOGY

Outer epithelial layer: Ectoderm.

3. A. Greater auricular nerve (Dhingra's 6/e p 4, 5/e p 5)
x Middle fibrous layer: Mesoderm.
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x Inner mucosal layer: Endoderm.

x Malleus and incus: 1st arch.
x Stapes: 2nd arch.
x Foot plate and annular ligament: Otic capsule.
x Auditory placode and Otocyst: Endolymphatic sac and
duct, utricle, saccule, semicircular ducts, cochlea.
5. D. Cochlea (Dhingra's 6/e p 12, 5/e p 14)
Refer previous answer.
6. A. External auditory meatus
(Dhingra's 6/e p 12, 5/e p 14)
The external auditory meatus is derived from 1st pouch
while tonsil and tympanic tube is derived from 2nd pouch
and mastoid antrum from 1st and 2nd arch.
1
32
Hearing Loss

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High Yield Facts

rip
• Closure of oval window has 60 dB hearing loss.
• Ossicular interruption with intact drum has 54 dB loss.

T
• Henebert’s sign: A positive fistula sign in absence of a fistula due to fibrous adhesions between stapes
footplate and membraneous labyrinth.
• Meniere’s Syndrome with episodic vertigo, fluctuating hearing loss, tinnitus, aural fullness - a picture
simulating Meniere’s disease.
of
• A frequency of 2000-3000 Hz causes more damage than lower and higher frequencies in noise trauma.
• A noise of 90 dB SPL, 8 hours a day for 5 days per week is maximum safe limit recommended by Ministry of
s
Labour.
• The audiogram of noise induced hearing loss shows a typical notch at 4 KHz, for both air and bone
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conduction.
• Carbogen is a combination of 5% carbon dioxide with 95% oxygen.
• Stinger test is done for non organic hearing loss.
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• Bone anchored hearing aid is the treatment of choice for management of single sided deafness.
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d>ϭ͗ഩDifference between conductive hearing loss and dA> Ϯ:ഩCondition for hearing loss
sensorineural hearing loss
Condition Loss
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Conductive hearing loss Sensorineural hearing loss

TM perforation 10-40 dB
• Low frequencies affected • More often involving high
Complete obstruction of ear canal 30 dB
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more
• Audiometry: BC better than
AC with air bone gap greater
the air-bone gap, more is
the CHL
• Loss is not more than 60dB
• Speech discrimination is
good
Hearing Loss in Various Pathology
Note: Ossicular disruption with intact TM causes more loss
than with perforated TM.
frequencies
• Audiometry: No air-bone
gap
• Difficulty in hearing in the
presence of noise
• Loss may exceed 60dB
• Speech discrimination poor
Ossicular disruption with TM perforation 38 dB
Ossicular disruption with intact TM 54 dB
Closure of oval window 60 dB
Conductive Hearing Loss
Congenital Causes of Conductive Hearing Loss
z Meatal atresia
z Fixation of stapes foot plate
z Fixation of malleus head
z Ossicular discontinuity
z Congenital cholesteatoma.
 Chapter 32 | Hearing
ing Loss

Acquired Cause of Conductive Hearing Loss Middle ear: Perforation of TM, serous otitis media,

External ear: Wax, foreign body, furuncle, benign or mali-

hemotympanum, benign or malignant mass in middle ear, 609
trauma to ossicular chain, Chronic Suppurative Otitis Media
gnant tumors of canal. (CSOM), cholesteatoma, otosclerosis, adhesive otitis media,
Tympanosclerosis, retracted TM.

Congenital Sensory Neural Hearing Loss

dAL ϯ͗ഩ Syndromes associated with hearing loss

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Syndrome /Inheritance Features Onset/Type HL
Waardenberg’s syndrome (AD) • White forelock Congenital
• Heterochromia iridis SNHL
• Vitiligo

le
• Dystopia cathorum
Usher syndrome (AR) • Retinitis pigmentosa Delayed

rip
• Night blindness SNHL
Jervell and Lange-Neilson’s syndrome (AR) • Repeated syncopal attacks Congenital
• Prolonged QT interval SNHL

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Alport syndrome • Hereditary progressive GN Delayed
(AD or X-linked) • Corneal dystrophy Progressive SNHL

dysostosis) (AD) • Coloboma of lower lid

of
Treacher-Collins syndrome (mandibulofacial • Antimongoloid palpebral fissures

• Hypoplasia of mandible and malar bones

Congenital
Conductive

• Malformed pinna and meatal atresia

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• Malformed malleus incus (stapes
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normal)
Crouzon’s syndrome (AD) • Frog eyes, Hypertelorism Congenital
(craniofacial dysostosis) • Parrot beak nose Conductive or mixed
• Mandibular prognathism
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• Mental retardation
Apert’s syndrome (AD) • Syndactyly Congenital, Conductive (stapes fixation)
• Features of Crouzon’s syndrome
Klippel-Feil syndrome (AR) • Short neck Congenital
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• Fused cervical vertebrae SNHL or mixed

• Spina bifida
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• Atresia of ear canal

Stickler’s syndrome (AD) • Small jaw Delayed
m

• Cleft palate Conductive or SNHL

OTORHINOLARYNGOLOGY
• Myopia, Cataract
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• Juvenile onset arthritis

Van der Hoeve’s syndrome • Osteogensis imperfecta (h/o fractures) Delayed
• Blue sclera CHL, SNHL or mixed
Pierre-Robin sequence • Micrognathia SNHL or conductive
• Glossoptosis
• Cleft plate
Goldenhar’s syndrome (facio-auriculo- • Facial asymmetry Mixed or conductive
vertebral dysplasia or oculo-auriculo – • Low set ears
vertebral [OAV] syndrome) • Atresia of ear canal
• Preauricular tags
• Cardiac abnormalities
• Hemi vertebrae in cervical region
• Epibulbar dermoid
• Coloboma or upper lid