Syncytium

SYNCyTIUM 3rd year MBBS Companion
An Initiative by IMA MSN Kerala

Topic wise distribustion of KUHS
Question papers from 2014 - 2021
• Community Medicine I
• Community Medicine II
IMA MSN Kerala
• Ophthalmology
• ENT
* This is an interactive PDF, Tap on any of the blue

links to navigate to the corresponding section
Syncytium
Published By
Indian Medical Association
Medical Students Association , Kerala
Editors
Athul S Kumar
[Pushpagiri Institute of Medical Sciences] - Editor in Chief
Aravind Baburaj
[KMCT Medical College]- Associate Editor
Mithra Thampi
[KMCT Medical College] - Associate Editor
Adithya Krishna Shaji

[Sree Narayana Institute of Medical Sciences] - Contributing Editor
Kritharth Tandon
[PK Das Medical college] - Contributing Editor
Content
Vinoj V
[Dr. Somervell Memorial CSI Medical College] - Community Medicine
Devu R Krishna
[Al Azhar Medical College] - ENT
Alenta Merin Babu

IMA MSN Kerala
[Pushpagiri Institute of Medical Sciences] - Ophthalmology
Aby Suresh
[DM WIMS]- Community Medicine
Gouri Sunil
[Karuna Medical College]- Community Medicine
Compiled by
Vishnu Gopan
State convener, IMA MSN Kerala
[GMC Trivandrum]
Tap here to Give Feedback

and Suggestions
Community
Medicine
Paper I
IMA MSN Kerala
* There is no clear cut division of topics between Paper 1 and Paper 2 in PSM;
The questions may overlap in each questions paper, we have attempted to
segregate the overlaped questions from differrent topics to a common heading
- ‘Others’
1
Syncytium - Community Medicine
Concept of Health and Occupational Health &

Diseases Genetics
Hospital Waste
Management, Health
Nutrition and Health
Information & Basic
Medical Statistics
Principles of
Epidemiology &
Demography and
Epidemiological
Family Planning
methods, Screening for
diseases
Environment and Rch and Health of
Health Elderly
Medicine & Social
IMA MSN Kerala
Sciences,
Others
Communication for
Health Education
Answers to List the following
2
Concept of Health and Diseases
Problem - 5 Marks
1. With reference to the ‘levels of prevention’, describe the ‘modes of intervention’ [2018 R]
Short Note - 4 Marks

1. Levels of prevention of a disease [2020]
2. Modes of intervention under primary prevention of disease [2021-S]
3. Contribution of John Snow to public health in the 1850s [2019-S]
4. Iceberg phenomenon of disease [2015 R]
Diffrentiate - 2 Marks
1. Quality-adjusted life years (QALY) and disability-adjusted life years (DALY) [2017-S]
Substatiate - 2 Marks
1. Specific protection is an important component of primary prevention [2014-R]
2. The “Germ theory of disease” takes a one sided view on causation [2015-R]
3. Primary health care is the method of choice for achieving health for all. [2016-R]
List - 2 Marks
1. Components of an epidemiological hypothesis [2015-R]
2. Indicators of “health” [2015-R
3. Methods of health promotion [2015-S , 2017-S]
4. Indicators used in the calculation of physical quality of life index [2015-S]
5. Indicators of physical quality of life index [2021-S]
6. Indicators used in the calculation of human development index [2014-S] IMA MSN Kerala
3
Problem - 5 Marks
1. Prepare a diet chart for a pregnant woman in 2nd trimester having anemia. [2014-R, 2015-R,
2016-R]
2. As a medical officer of PHC, what are the strategies you will plan to prevent and control
iron deficiency anaemia in children in your area. [2015-R]
3. As a medical officer of a primary health centre what are the steps that you will undertake
to prevent and control anemia among pregnant mothers in your area. [2017, 2015-S]
4. As a primary health centre medical officer, how will you prevent nutritional blindness among
children in the primary health centre area. [2016-R]
5. As a medical officer in a primary health centre how will you control vitamin A deficiency
in your area. [2019-R]
6. In a small remote village in a predominantly agrarian community, a large proportion of the
children under five years of age are found to be malnourished. You are asked to address a
group consisting of parents of the children regarding measures to improve their nutritional
status. List and describe the measures which you would suggest. [2019-S]
7. As a programme officer, what interventions will you take for prevention and control of
neuro lathyrism. [2021-S]

1. Vitamin A prophylaxis programme. [2015-S]
2. Neurolathyrism. [2016-S, 2018-S]
3. Dietary goals recommended by WHO experts. [2014-S]
4. Causes of low birth weight. [2015-S]
5. Micro nutrients. [2016-R]
6. Mid-Day meal scheme. [2017-R, 2019-S]
7. Iodine deficiency disorder. [2020]
8. Beneficiary and benefits of Integrated Child Development Service scheme [2021-S]
9. Assessment of dietary intake [2018 R]
IMA MSN Kerala
1. Food pyramid and food plate. [2015-S]
2. Polished rice and parboiled rice. [2018-R]
3. Fortification and enrichment of foods. [2018-S]
4. Codex alimentarius and the agmark standards. [2019-R]
5. Breast milk and cow milk. [2021-S]
6. Surveillance and monitoring [2019-R]
1. Vitamin A supplement is given to a child recovering from measles. [2017-R]
2. Egg protein is considered as reference protein. [2021-S]
3. Vitamin A prophylaxis during Measles rubella (MR) vaccination [2020]
4
List - 2 Marks
1. Iodine deficiency disorders. [2018-S]
2. Nutritional status assessment methods in children. [2021-S]
Dermography and Family Planning

1. Postconceptional contraceptives. [2014-R]
2. Third generation IUCDs. [2014-S]
3. Couple protection rate. [2015-R, 2017-R]
4. Lactation amenorrhea method. [2015-S]
5. Medical termination of pregnancy Act. [2017-S, 2018-R]
6. Pearl index. [2018-S]
1. Early expanding stage and late expanding stage in the demographic cycle. [2014-S, 2015-S]
2. General fertility rate and total fertility rate. [2017-S]
3. Gross reproduction rate and net reproduction rate. [2018-R]
1. Socio economic development is the best method of contraception. [2016-R]
List - 2 Marks
1. Stages of demographic cycle. [2014-R, 2019-S]
2. Indications of Medical termination of pregnancy. [2016-R]
3. Methods of natural family planning. [2017-S]
4. Hormonal contraceptives. [2019-R]
5.
6.
FOUR measures of fertility. [2019-S]
Non contraceptive health benefits of hormonal oral contraceptive pill. [2021-S]
IMA MSN Kerala
7. Specific protection methods [2014 S]
Environment and Health
Essay - 10 Marks
It is said that ‘no single method of control’ will adequately address the problem of
mosquitos in all areas. In this regard, classify the different methods of the integrated
approach to vector control and describe clearly each method with specific reference to
mosquitos. [2018-R]
5
Problem - 5 Marks
1. There is mosquito menace reported in the primary health centre area where you are
working. What steps will you take for the vector control. [2016 S]
2. The Warden of a hostel brings a child to you with scabies. What advice will you
give to the Warden in managing the case. [2017 R]
3. A sample of water was taken from a house tap and sent for analysis. The chemical
analysis showed lead level to be 0.16mg/L. Comment on the quality of water, the
impact on health and give remedial measures. [2019 R]
4. An educational camp for 250 people is expected to be organized in a village. How
do you arrange temporary toilet facility for these people as a medical officer of this
area. [2020]
5. Steps of conducting well water disinfection during an outbreak of gastroenteritis
[2021 S]
6. The incidence of all mosquito borne diseases are increasing in your PHC area, as the
medical officer of the PHC how will you apply the levels of prevention to reduce the
incidence and control the situation. [2019 S]
7. As a medical officer how do you prevent and control mosquito borne disease outbreaks in
your area. [2020]
8. Steps of conducting well water disinfection during an outbreak of gastro enteritis. [2021]

1. Effects of noise exposure. [2014-S, 2016-R, 2017-R]
2. Biological effects of radiation. [2015-S]
3. Soakage pit. [2016-R]
4. Lead poisoning. [2017-R]
5. Effects of heat stress on humans. [2019-S]
6. Precautions in collecting a sample of water for bacteriologic examination. [2019-S]
7. Fly control measures. [2017-S,2019-R,2014-R]
8. Plumbism. [2014-R]
9. Active surveillance for malaria. [2014-R]
10. Noise pollution [2016-R]
IMA MSN Kerala
1. Definitive host and intermediate host in malaria. [2016-R]
2. Anopheles and aedes mosquito. [2015-R]
3. Trans-ovarian and trans-stadial transmission of diseases. [2017-S]
4. Sandflies and mosquitos. [2019-S]
5. Shallow well and deep well. [2021-S]
1. Insecticide treated bed nets are the most effective method of protection
against mosquitoes. [2017-S]
2. Manure pits solve the problem of disposal of refuse in rural areas. [2016-S]
3. Dumping as a method of solid waste disposal should be outlawed. [2018-R]
4. “Green belts” are established between industrial and residential areas. [2019-S]
5. Free residual chlorine should be 0.5 mg/L at the end of chlorination of water. [2021-S]
6
List - 2 Marks
1. Vectors of malaria and their breeding places. [2017 S]
2. Biological effects of radiation. [2021 S]
3. Steps in water purification on a large scale. [2016 R]
4. Indicators of air pollution. [2016 R]
5. Louse borne diseases. [2016 S]
6. Indices of thermal comfort. [2016 S]
7. Tick borne diseases. [2019 R]
8. Direct transmission of infectious diseases. [2019 R]
9. The classification of insecticides used in public health. [2019-S]
10. .Enumerate methods to prevent air pollution [2018 R]
11. Indicators of air pollution [2018 S]
Medicine and Social Sciences, Communication

for Health Education
1. Approaches to health education. [2015-R]
2. Problems of nuclear families. [2019-S]
3. Barriers of communication [2017-S]
4. Functions of the ‘family. [2017-R]
5. Principles of ‘health education’. [2018-R]
6. Medical social work. [2019-R]
7. Acculturation. [2021-S]
8. Cultural factors that affect health [2016-S]
1. Health education and health propaganda. [2014-R, 2019-R, 2020]
2. Didactic method and socratic method in communication. [2016-S]
3. Nuclear family and Joint family. [2020]
IMA MSN Kerala
1. Social classification based on occupations has limitations. [2015 R]

2. It is the responsibility of the family to socialize the “stream of new-born barbarians”.
[2017 S]
3. Medio-social worker is an important part of the health team. [2014 S]
List - 2 Marks
1. Group approach in health communication. [2016-S]
2. Two advantages and disadvantages of a nuclear family. [2017-R]
3. Barriers of communication [2020]
4. Functions of a family [2020]
5. Indicators used in computing Kuppusamy scale [2017 R]
6. Functions of the family in health & disease [2015 S]
7. Health promotion methods [2017 S]
7
Occupational health and Genetics
Problem - 5 Marks
1. Suma aged two years with Down’s syndrome is the only child to her parents who bring
her to you for advice. How will you proceed to manage considering various levels of
prevention. [2016 S]
2. Occupational health hazards are increasing in the industrial area coming under your PHC.
As a medical officer what are the steps you will take to control the situation. [2018 R]
1. Occupational hazard [2020 R]

2. Control of bagassosis [2019 R]
3. Genetic counselling [2020 R, 2017 S]
4. Ergonomics [2016 R]
5. Hazards of agricultural workers [2015 R]
6. Causes of sickness absenteeis [2014 S]
7. Medical benefits under ESI scheme [2015 S]
8. Benefits of ESI scheme [2014 R]
9. Prevention of occupational diseases [2016 S]
10. Genetic Counseling [2016 R]
1. Pre-employment medical check and periodic medical check [2014 S]

2. Pre-placement and periodic examination [2017 R]
3. Prospective and retrospective genetic counseling [2015 R]
4. Bagassosis and byssinosis [2019 S]
5. Eugenics and euthenics [2021]
IMA MSN Kerala
1. Personal protective equipment is the last resort in preventing occupational
diseases . [2015 S]
List - 2 Marks
1. Benefit under ESI Act [2017 R & S]

2. Occupational hazards among agricultural workers [2018 R]
3. Organic pneumoconiosis [2015 S]
4. Four chromosomal disorders related to sex chromosomes [2018 R]
8
Hospital waste management, Health information & Basic medical Statistics
1. Measures of dispersion [2015 R]

2. Record linkage [2016 S]
3. Health hazards of health-care waste [2017 S]
4. Standard normal curve[2020 R]
1. Incineration and inertization [2016 S]
1. Sharp wastes must be disposed in blue puncture proof containers. [2019 R]
List - 2 Marks
1. Enumerate four measures of dispersion [2019 S, 2021 S]
2. Sampling methods [2016 S, 2017 S]
3. Characteristics of a ‘standard normal curve’ [2018 R]
4. Biomedical wastes that SHOULD NOT be incinerated [2018 R]
5. Sources of health care wastes [2018 S]
6. Sources of health information. [2019 R , 2020]
7. The kinds of biomedical waste disposed in BLUE/WHITE TRANSLUCENT
containers [2019 S]
8. Tests of significance [2020 R/S]
Principles of Epidemiology & Epidemiological methods,

Screening for diseases IMA MSN Kerala
Essay - 10 Marks
1. A third year MBBS student during his clinical posting observed that many patients had
leukoplakia in the oral cavity. He wanted to find the risk factors for leukoplakia. Answer the
following:
i)State the objectives of the study
ii)What is the study design used and why
iii)State the methods of study
iv)State the methods of analysis [2014 R]
v)What sort of errors can creep in (2+2+3+2+1=10)
OR {Case Control}
9
Sunaina is a recent MBBS graduate who is working as a medical officer in a primary

health centre. There have been a number of cases of fever from a nearby village. The
villagers suspect it is because of contaminated water in the overhead tank that supplies
parts of the village. She decides to investigate. Answer the following:
i)What type of study design should she use.
ii)What are the steps of such a study. [2015 S]
iii)How she will analyze the data, that she has gathered. (2+4+4=10)
OR
Final MBBS students observed that, cases of cervical cancer are admitted to the
gynecology department of teaching hospital in which they are posted. They wanted to find
out the risk factors. Answer the following:
i)What type of study they have to undertake.
ii)What is the objective of the study.
iii)Mention the methodology. [2016 R]
iv)How to analyze the data. (1+2+4+3=10)
OR
In the primary health centre where you are the medical officer, there are more number of
low birth weight babies being born. You want to find out without much delay whether
maternal anemia can be the associated risk factor. Answer the following:
i)What type of study design can you plan
ii)What are the steps of such a study
iii)How do you minimize the bias of the study [2019 R]
iv)How will you determine the association (2+4+2+2)
2. Sanjana is a recent MBBS graduate who is working as a medical officer in a primary

health centre. There a number of patients present to her with signs of jaundice. A local
traditional medical practitioner tells her about the usefulness of a special plant in the
treatment of jaundice. She decides to test plant. Answer the following:
IMA MSN Kerala
i)What type of study design should she use

ii)What are the steps of such a study [2014 S]
iii)How she will analyze the data that she has gathered (2+4+4=10)
{Cohort Study}
OR
As a medical officer recently recruited in a primary health centre, you find that there is a
cotton mill in your area and its workers utilize your health services. You want to
investigate whether their health is affected by the work environment.
i)What type of study design will you use
ii)What are the steps of such a study [2016 S]
iii)How can you analyze the data that you have collected (2+4+4=10)
OR
Dr. Meera is a medical officer in a primary health centre. Dengue is rampant in the region.
patient brings her a strip of capsules given to him by a local health practitioner who
10
claims that a course of this medication will prevent thrombocytopenia. Dr. Meera decides to
test the medication. Answer the following:
i)What type of study design she should use and why
ii)Describe in brief the steps of the study [2017 S]
iii)How will she analyze the data that she has gathered (2+4+4=10)
OR
A drug company has produced a new formulation of zinc in the form of a sweetened
beverage which they claim has the ability to reduce the duration and severity of diarrhea
in children below five years of age. 25 ml of the beverage has to be given to children
below the age of one and 50 ml for those one to five years of age, in a once-daily dosage.
They request you to assist with preparing an outline for a study which they wish to do to
demonstrate the efficacy of the beverage. Answer the following:
i)What is an appropriate study design for this study and why
ii)List and briefly describe the steps of the study design chosen by you.
iii)List and briefly describe TWO ethical considerations which might need to be addressed in
performing this study. (2+6+2)
[2019 S]
OR
i)Define epidemiology.
ii)What are the types of epidemiological studies designed to explore disease etiology.
iii)Discuss in detail ‘framework’ and ‘steps’ in conducting the cohort study. [2020]
iv)Mention the merits and demerits of cohort study. (2+2+4+2)
OR
In a study to assess the relationship between birth weight and infant mortality,700 babies
among 5500 weighed below 2500 grams at birth. They were followed up till they
completed their first birthday. Of the 500 infants deaths registered, 350 occurred among babies
with normal birth weight.
i)What type of study is this.
ii)What are the steps of conducting this study.
IMA MSN Kerala
iv)Construct 2 x 2 table for the for the data in the question. [2021 S]
v)Write three advantages and disadvantages of this study. (2+4+2+2)
3. 10 students residing in your medical college hostel have been admitted to the hospital in
the last 4 days with Jaundice. Answer the following:
i)Is it an “epidemic”. Mention its reasons in support your answer
ii)How will you investigate the above.
iii)State the likely aetiological factors for the above occurrence with reasons [2015 R]
iv)List the preventive measures you will take, to prevent further occurrences (2+4+2+2=10
{Epidemiological
OR Investigation}
The district hospital reports a confirmed case of anthrax from one of the villages in your
primary health center and you are instructed to investigate it. Answer the following.
i)Describe the steps you take for the investigation.
11
ii)How will you manage the case? [2017 R]

iii)What are the preventive measures (5+3+2)
4. A primary health center reports episodes of fever and swelling following a routine
immunization of children and you are required to investigate the matter. Answer the follow-
ing.
i)How will you determine that this is in fact an adverse event following
immunization(AEFI).
ii)How will you proceed with the investigations. (3+7)
[2018 S]
Problem - 5 Marks
1. As a medical officer of a primary health centre what are the steps that you will take to
investigate the outbreak of food-poisoning following a village festival. [2014-S, 2017-S]
2. As a medical officer of primary health centre, how will you ensure adequate immuniza-
tion coverage among under fives in the PHC area. [2014-R]
1. Bradford Hill’s criteria for judging causality [2018-R]

2. Criteria for screening [2019-R]
3. Disinfection [2019-R]
4. Concept of lead time in screening [2021-S]
1. Infection and infestation [2014-R]

2. Epidemic and endemic disease. [2014-R]
3. Isolation and quarantine [2014-S, 2016-S, 2018-S, 2019-S]
4. Active and passive immunization. [2015-R]
5. Droplet infection and droplet nuclei [2015-S]
IMA MSN Kerala
6. Incidence and prevalence of a disease. [2016-R, 2018-R]

7. Source and reservoir of infection. [2017-R]
8. Odds ratio and relative risk. [2018-S]
9. Screening test and diagnostic test [2020]
1. Immunization against killer diseases of the childhood is cost effective. [2014-R]

2. Herd Immunity does not protect against tetanus [2017-R]
3. Experimental studies are faced with more ethical issues than case control studies. [2018-R]
4. Intramuscular injections are avoided if poliomyelitis outbreak is suspected [2018-S, 2019-S]
12
List - 2 Marks
1. Steps in a case-control study [2014-S, 2017-R]
2. Methods of health promotion [2015-S, 2015-R, 2017-S]
3. Uses of mass screening [2014-R]
4. Importance of carrier state. [2014-R]
5. Uses of epidemiology [2014-R]
6. Host factor in morbid condition. [2014-R]
7. Criteria for judging causality [2014-S, 2015-R]
8. Components of an epidemiological hypothesis [2015-R]
9. Objectives of descriptive epidemiology. [2016-R]
10. Indirect transmission of infectious diseases. [2016-S]
11. Measures of evaluating a screening test. [2018-S]
12. Objectives of descriptive epidemiology. [2016-R]
13. Steps in cohort study [2015 R, 2017 R]
14. Types of Screening [2015 R]
RCH and Health of Elderly
Problem - 5 Marks
1. A mother brings her 2 years old daughter with complaints that the child is “not
eating enough”. How will you manage the case. What advice will you give to the
mother. [2018-S]
2. What are the critical factors that you will consider, when taking the history of a
40 years old male whose BMI is 28.5, who presents to you at an annual medical
check-up conducted by his company [2014-S]
3. What are the critical factors that you consider when taking the history of a 43
years old woman who has presented to you with 8 weeks of amenorrhea. What
advice you would give her. [2015-S]
4. In a community health center what steps can be taken by the health care workers
to address adolescent health problems of the area. [2017-R]
5. What advice will you give to a group of pregnant mothers on how to take care of
themselves during pregnancy. [2018-S]
IMA MSN Kerala
1. Causes of infant deaths in India [2018-S]

2. “High Risk” pregnancy [2018-S]
3. Use of Growth chart in planning [2018-S]
4. “At Risk” infant [2017-R]
5. Uses of growth chart [2021]
1. Demand feeding and exclusive breastfeeding [2017-R]
13
1. Exclusive breastfeeding is imperative for the young infant. [2014-S]

2. Immunization against tetanus is imperative for the pregnant woman. [2015-S]
3. Growth chart is an educational tool to the mother. [2016-S]
4. Exclusive breast feeding is the best for an infant up to 6 months. [2019-R]
5. ORS is the treatment of choice in children with acute diarrhea. [2018-S]
List - 2 Marks
1. Beneficiaries under the integrated child development services scheme [2018 R]
Others

1. Emporiatrics [2016-S]
1. In network analysis, critical path method is considered as largest path of the net work
[2020 R]
List - 2 Marks
1. Drugs used in category II of tuberculosis treatment

IMA MSN Kerala
14
Principles of epidemiology and epidemiological methods
1. Steps in case control study

-Selection of case and control
-matching
-measurement of exposure
-analysis and interpretation.
2. Steps in cohort study

-selection of study subject
-obtaining data on exposure
-selection of comparison groups
-follow up
-analysis
3. Uses of mass screening

-case detection
-control of disease
-research purpose
-educational opportunities.
4. Importance of carrier state

-they are less infectious and cases
-there are more dangerous than cases since they can escape recognition and continue to live a
normal life among population or community
-Carriers readily infect the habitable individuals over a wide area and longer period of time under
favourable conditions
5. Uses of epidemiology
-To study historically the Rise and fall of disease in the population

-Community diagnosis
-Planning and evaluation
IMA MSN Kerala
-Evaluation of individual risk and chances
-Syndrome identification
-Completing the natural history of disease
-Searching for causes and risk factor
6. host factor in morbid condition

-A host of a subsistence and lodging for a pathogen
-level of immunity
-Genetic makeup
-level of exposure
-State of Health and overall fitness of the host can determine the effect of a disease or
organism will have on it.
7. Criteria for judging casualty

-Temporal Association
-Strength of association
-Specificity of association
15
-Consistency of association
-Biological plausibility
-Coherence of association
8. Components of an epidemiological hypothesis

-Possible source of infection
-Causative agent
-Possible methods of spread
-Environmental factors which enabled the spread
9. Objectives of descriptive epidemiology
-To make the best use of observation on individuals or populations exposed to suspected factors
or die disease.
-Observing the distribution of disease or health related characteristics in human population
-Identify the characteristics with which the disease seem to be associated.
10. Indirect transmission of infectious disease

-Vector-borne via water food ice blood serum plasma or other biological products such as tissue and
organs
-Vector-borne mechanical transmission biological transmission
-Airborne droplet nuclei dust
-Formite borne
-Unclean hands and fingers
11. Measures of evaluating a screening test

-sensitivity
-specificity
-predictive value of a positive test
-predictive value of a negative test
-percentage of false negative
-percentage of false positive
IMA MSN Kerala
12. Direct transmission of infectious disease

-direct contact
-droplet infection
-contact with soil
-inoculation into skin or mucosa
-transplacental
13. Types of screening

-mass screening
-high risk or selective screening
-multiphasic screening
-multipurpose screening
-opportunistic screening
16
1. Advantages of dietary fibre

-Reduced incidence of CHD by reducing cholesterol level
-Reduce post prandial cholesterol level in blood
-It adds bulk to the food, favours satiety, increases transit time of food in the gut
-An active substrate in large intestine for release of important functional components like
organic acid nutraceuticals
-Reduces chances of diabetes
2. Iodine deficiency disorders

-Goitre
-Hypothyroidism
- normal intelligence,delayed motor milestones mental deficiency
hearing defects, speech defects
-Strabismus
-nystagmus
-Spasticity
-neuromuscular weakness
-Endemic cretinism
-Intrauterine death
3. Nutritional status assessment methods in children

-Clinical examination
-Anthropometry
-Biochemical evaluation
-Functional assessment
-Assessment of dietary intake
-Viral and health statistics
-Ecological studies
4. Food intoxicants
-Neurolathyrism
-Aflatoxins
-Ergot
IMA MSN Kerala
-Epidemic dropsy
-Endemic ascites
-Fusarium toxins
5. Test for Pasteurization of Milk

-Phosphatase test
-Standard plate count
-Coliform count
Demography and family planning
1.Stages of demographic cycle

-First stage-high stationery
-Second stage- early expanding
-Third stage- late expanding
-Fourth Stage- low stationary
17
2.Indications of MTP
-Medical where continuation of the pregnancy might endanger the Mother's life or cause
Grave injury to her physical or mental health
-Eugenic where there is a substantial risk of of the child being born with serious handicaps due
to physical or mental abnormalities.
-Humanitarian where pregnancy is the result of rape
-Socio economic where actual or reasonably foreseeable environment could lead to risk of
injury to the health of mother
-Failure of contraceptive devices
3. Indicators used in computing Kuppuswamy scale

-Education of head of family
-Occupation of head of family
-Family income per month
4. Four measures of fertility

-Birth rate
-General fertility rate
-General marital fertility rate
-Age specific fertility rate
-Total fertility rate
-Total marital fertility rate
-Gross reproduction rate etc.
Genetics
1. Chromosomal disorders related to sex chromosome.

-Klinefelter syndrome
-Turner syndrome
-x y y syndrome
IMA MSN Kerala
-super females
Contraceptives
1. Oral pills
-Combined pills, progesterone only pill, post coital pill, once a month (long acting pill),
male pill
2. Depot slow release formulation

-injectables
-subcutaneous implant
-vaginal rings
3. Non contraceptive health benefits of hormonal are contraceptive pill
-Protection against benign breast disorders including;

-Fibrinolytic disease and fibroadenoma.
-Ovarian cyst
-iron deficiency anaemia
18
-pelvic inflammatory disease
-ectopic pregnancy
-ovarian cancer
4. Natural methods of family planning

-abstinence
-coitus interruptus
-safe period
-basal body temperature method
-cervical mucus method
-symptothermic method
-breastfeeding
5. Advantages of condom
-easily available
-safe and inexpensive
-easy to use and do not require medical supervision
-no side effects
-light compact and dispersible provides protection not only against pregnancy but also against
ENVIRONMENT AND HEALTH
1.BIOLOGICAL EFFECTS OF RADIATION

*Somatic
a) immediate
-radiation sickness
-acute radiation syndrome
b)delayed
-Leukemia
-Carcinogenesis
-Foetal developmental abnormalities
-Shortening of life
*Genetic
IMA MSN Kerala
-Chromosome mutations
-point mutations
2.STEPS IN WATER PURIFICATION IN LARGE SCALE

*Storage
*Filtration
-Slow sand/Biological filters
-Rapid sand/Mechanical filters
*Disinfections
3.INDICATION OF AIR POLLUTION

*Sulphur dioxide
*Smoke,soiling index
*Grit and dust measurements
*Coefficient of HAZE
*Air pollution index
19
4.LOUSE BORNE DISEASES

*Pediculosis
*Epidemic typhus
*Relapsing fever
*Trench Fever
5.INDICES OF THERMAL COMFORT

*Air temperature and humidity
*cooling power
*effective temperature
*Corrected effective temperature
6.TICK BORNE DISEASES

* Hard tick
-Tick typhus (Rocky mountain spotted fever)
-Viral encephalitis (Russian spring summer encephalitis)
- viral fever (Colorado tick fever)
-Tularemia
-Viral haemorrhagic fever(KFD in India)
-Tick paralysis
-Human babesiosis
* Soft tick
-Q Fever
-Relapsing fever
-KFD (Kyasanur Forest Disease)
7. THE CLASSIFICATION OF INSECTICIDES USED IN PUBLIC HEALTH

*Stomach poisons: paris green,sodium fluoride
*Fumigants: Hydrogen cyanide,Methyl bromide
*Contact poisons:
-Natural:Pyrethrum,Rotenone
-Synthetic:
IMA MSN Kerala
+organo-chloride compound-DDT,HCH
+organo-phosphorus: Diazinon,Chlorthion
+carbamates:Carbaryl,pyrolan
+Repellents: indalone,Dimethyl phthalate
+Synthetic pyrethroids: Resmethrin,pothrin
8. CONTROL MEASURES AGAINST NOISE INDUCED HEARING LOSS

* Careful planning of cities
*Control of vehicles
*Improve acoustic insulation of buildings
*Industries and railways-control of noise source
*Protection of exposed persons
*Legislation
*Education
9. MONITORING OF AIR POLLUTION

*Sulphur dioxide
*Smoke or soiling index
20
*Grit and dust measurement
*Coefficient of HAZE
*Air pollution index
10.Enumerate methods to prevent air pollution

● Containment : Prevention of escape of toxic substances
● Replacement: Increase use of electricity, solar power generation etc
● Dilution: Establishment of green bells between industrial and residential areas
● Legislation
● International action
Medicine and social service
Communication of health service
1.Group approach in health communication

Lectures
Demonstrations
Discussion methods
○ group discussion
○ panel discussion
○ workshop
○ symposium
○ conferences
○ seminars
○ role play
2.Two advantages of and disadvantages of nuclear family advantage:

Advantages:
intimate relationship between husband and wife
● privacy among family members is good disadvantage :
Disadvantages:

●
child rearing will be difficult
bonding between children and grandparents will not be present
IMA MSN Kerala
3. Barriers of communication physiological - difficulties in hearing expression
● psychological - emotional disturbances, neurosis, levels of Intelligence or comprehension
difficulties.
● Environmental: Noise, invisibility, congestion.
● Cultural: Illiteracy, levels of knowledge and understanding ,customs,beliefs,religion,attitudes,
economics and social class difference
4. Functions of family in health

● Child recurring
● Socialization
● Personality formation
● Case of dependent adults
● Stabilization of adult personality
● Family susceptibility of disease
● Problems in families
21
● Broken family
CONCEPT OF HEALTH AND DISEASE
1. ICEBERG PHENOMENON
● It gives a better idea of the progress of a disease from its subclinical stages to overt or appar
ent disease than the familiar spectrum of disease
● Submerged position of ice berg represents the hidden mass of disease{sub-clinical case,
carier-undiagnosed case}
● Floating tip represent what the physician sees in his practice
2.Indicators of health
● Mortality indicators
● Morbidity indicators
● Disability rates
● Nutritional status indicators
● Health care delivery indicators
● Utilization rates
● Indicators of social and mental health
● Environmental indicators
● Health policy indicators
● Indicators of quality life
● Other indicators
3.Methods of health promotion

● Health education
● Environmental modifications
● Nutritional interventions
IMA MSN Kerala
● Lifestyle and behavioral changes
4.Indicators used in calculation of physical quality of life index

● Infant mortality
● Life expectancy at age 1
● Literacy
5.Morbidity indicators
● Incidence and prevalence
● Notification rates
● Attendance rates at out-patient departments, health center
● Admission, readmission and discharge rates
● Duration of stay in hospitals
● Spells of sickness or absence from work or school
6.Physical quality of life Index

It consolidates three indicators
● Infant mortality
22
● Life expectancy at age 1
● Literacy
● For each component, the performance of individual countries is placed on a scale of
0-100,where
0 = worst performance
100 = best performance
7.Millenium Development Goals

Goal1: Eradicate extreme poverty and hunger
Goal 4: Reduce child mortality
Goal 5: Improve maternal health
Goal 6: Combat HIV/AIDS, malaria and other diseases.
Goal 7: Ensure environmental sustainability
Goal 8: Develop a global partnership for development
9.Specific protection methods

● immunization
● chemoprophylaxis
● use of specific nutrients
● protection against occupational hazards
● protection against carcinogens
● Avoidance of allergens
Control of specific hazards in general environment
Control of consumer product quality & safety of foods, drugs , cosmetics
Protection against accidents
10. components of an epidemiological hypothesis

● possible source of infection
● causative agent
● possible modes of spread
● environmental factors favoured spread of disease
Health information and basic medical statistics

IMA MSN Kerala
1.Tests of significance:
● Standard error of mean
● standard error of proportion
● standard error of difference
● standard error of difference between two proportions
2. Sampling method :
● simple random sample
● systematic random sample
● stratified random sample
3. Characteristics of a standard normal curve

● smooth bell shaped curve
● its symmetrical
● total area of the curve is 1
● mean is zero
● standard deviation is 1
23
● mean median and mode all coincide
BIOSTATISTICS
Enumerate four measures for depression
● The range
● The mean or average deviation
● The standard deviation
● Variance
OTHERS
Beneficiaries under the integrated child development services scheme
● Pregnant women
● Nursing mothers
● Other women 15-45 years
● Children less than 3 years
● Children in age group 3-6
● Adolescent girls 11-18 years
Drug used in category II of tuberculosis treatment

● Rifampicin
● Isoniazid
● Pyrazinamide
BIOMEDICAL WASTE MANAGEMENT
1.Biomedical wastes that should not be incinerated

● Glass wares
● Metallic body implants
● Sharp waste including metals
● Contaminated waste which are recyclable
IMA MSN Kerala
2. Sources of health care wastes

● Private hospitals
● Government hospitals
● Nursing homes
● Mortuaries
● Animal houses
● Physician's office / clients
● Dentist's office /clients
● Laboratories
● Research organisations
● Dispensaries
3.The kind of biomedical waste disposed in blue/white translucent containers

White:
Waste sharps including metals-needles, syringes with fixed needles, needles from needle tip cutter
or burner scalpels, blades.
Blue:
● Glassware - Broken or discarded, contaminated, glass including vail ampoules
24
● Metallic body implants
OCCUPATIONAL HEALTH AND DISEASES
1.Organic pneumoconiosis
Bagassosis to cane fibre
Tobacossis to tobacco
Byssinosis to cotton dust
Farmer’s lung to hay or grain dust
2. Benefits under ESI act
Medical benefit
Sickness benefits
Maternity benefit
Disable benefit
Dependant's benefit
Funeral expenses
Rehabilitation allowance
3.Occupational hazards among agricultural workers.
Zoonotic diseases – Brucellosis, anthrax, leptospirosis

Accidents
Toxic hazards – insecticides, fertilisers
Physical hazards-extreme conditions such as temperature humanity solar radiation etc
Respiratory diseases-exposure to dust of grain, rice husks, coconut fibre
SOCIOLOGY
1.Indicators used in computing Kuppuswamy scale.

Education of head of family
Occupation of head of family
Family income per month
IMA MSN Kerala
25
Community
Medicine
Paper II IMA MSN Kerala
* There is no clear cut division of topics between Paper 1 and Paper 2 in PSM; The questions
may overlap in each questions paper, we have attempted to segregate the overlaped questions
from differrent topics to a common heading - ‘Others’ 1
Communicable Diseases
• Respiratory Infections • Zoonosis
• Intestinal Infections • Surface Infection
• Arthropod Borne
• Emerging & Remerging
Infections
Diseases
Non-communicable
Health Planning
diseases, Disability,
Management
Rehabilitation
Mental Health, Behavioral
RCH and Health of Elderly Health problems & Health
Education
Biomedical Waste
Health legislation and
Management and
International Health
IMA MSN Kerala
Occupational Health
Health Care Delivery National Health
System and Urban Health Programmes & NRHM
Disaster Management Others
Answers to List the Following
2
Communicable diseases
Respiratory Infections
Essay - 10 Marks
1. Sujatha is an 18 months old girl who is brought to you with a history of cough and
breathing difficulty over the past three days. Answer the following: [2014 R]
i) What are the danger signs that you would ask or look for. {ARI}
ii) How would you classify the disease and on what basis. (3+5+2=10)
iii) How would you treat the child if there is at least one general danger sign.
OR
Maria, 2 months old infant is brought to you with a history of cough and difficulty in
breathing for the past three days. As the medical officer of the PHC,
i) What are the danger signs that you would ask or look for [2019 R]
ii) How would you classify the disease and on what basis
iii) How would you treat the child if she has no pneumonia
OR
A child of 2 years was brought with fever of one week duration associated with
worsening cough for the past 2 days. On examination, the child was febrile with
respiratory rate of 50 breaths per minute with chest in drawing. [2019 S]
i) How will you classify this condition
ii) Explain the standard treatment protocol for this condition
iii) Explain the vaccines available for preventing this condition as per national (2+4+4)
immunization schedule
2. Rama a 27 years old daily wages labourer is having cough of three weeks duration.
Answer the following:
i) List the criteria of diagnosis.
ii) How will you initiate the treatment in this case.
{TB}
[2014 S] IMA MSN Kerala
iii) List the objectives of the programme for control of this disease (2+4+2+2=10)
iv) When we will state that, control of disease is achieved
OR
A man aged of fifty years comes to outpatient department with H/o cough, irregular
fever,chest pain and at times hemoptysis for the past 2 months. Answer the following:
i) What are the possible causes.
ii) How will you diagnose this case. [2016 R]
iii) State the method of managing the patient (2+2+4+2=10)
iv) State the objective of the management
OR
Srikrishna a 36 years old man has been diagnosed to have pulmonary tuberculosis. His 5
years old daughter Neethu is brought to you with a history of cough. As the medical
[2017 R]
3
officer of the PHC, (3+4+3=10)

i) How would you confirm the diagnosis of tuberculosis in the child?
ii) If diagnosed positive, what is the regimen that you would follow to treat the child?
iii) If negative, what are the next steps to be taken?
3. A lady brings her 2 years old daughter to the urban health centre, stating that the girl had
developed a fever and a peppery rash on her face. You examine and diagnose this as a
case of measles. On inquiry, the mother states that she has migrated from a far-away
state and her child has not received any immunizations. Answer the following: [2021 S]
i) How will you plan the child immunization {Measeles}
ii) Outline health problems faced by migrants in an urban area. (2+4+4)
iii) Describe the strategy for measles elimination in India
Problem - 5 Marks
1. Suma 6 years old child is studying in a school of your PHC area. She presents with fever
of 3 days duration. On examination you find maculo-papular rashes and some vesicles.
The lesions are well distributed all over the trunk as medical officer how will you manage
the situation
OR
An unusually high number of cases of fever with rash have been reported from 3 villages
in the jurisdiction of a sub centre area. Outline the steps you would take to investigate
this outbreak. [2014 R, 2018 S]
2. A 3 years child was brought with fever and rashes on the body. The child was partially
immunized. How will you diagnose and manage the case. [2015 R]
3. Four months old Priya is brought to the primary health center with fever and cold for
3 days. She is alert and her respiratory rate is 58/min. Grunting is present. How will you-
classify her diagnosis and what treatment will you give. [2016 S]
4. A truck driver with HIV may have developed tuberculosis chest. What problems do you
anticipate in the diagnosis and management of the case. [2017 S]
5. Krishnan aged 28 years comes to the PHC with sputum positive tuberculosis. How
IMA MSN Kerala
would you categorize and treat him. What advices will you give to his family. [2020 R]
1. Assessment and classification of acute respiratory infections in children under five

years of age as per the current national programme. [2021 R]
2. Directly observed treatment short course plus in tuberculosis [2015 R]
3. Clinical features of the different stages of measles and complications of measles[2018 R]
4. Drug resistant tuberculosis [2021 S]
5. Pentavalent vaccine [2021 S]
4
1. Measles and Chicken pox [2019 S]

2. Small Pox and Chicken Pox [2017 R]
3. Antigenic Shift & Antigenic Drift [2015 R, 2017 R, 2019 S]
4. Rubella & measeles [2015 S]
1. DOTS strategy can reduce the burden of tuberculosis. [2016 S]

2. AIDS is reviving the old problem of tuberculosis [2017 R]
3. It was possible to eradicate smallpox globally[2018 S]
4. Tuberculosis is a social disease with a medical aspect[2019 R]
List - 2 Marks
1. First and second line drugs against tuberculosis[2018 R]
Intestinal Infections
Essay - 10 Marks
1. Susheela is an 18 months old girl who is brought to you with a history of diarrhea for the past
two days. Answer the following:
i) What are the danger signs that you would ask or look for.
ii) How would you classify the disease and on what basis.
iii) How would you treat the child if she is unable to drink fluids offered to her. (3+5+2=10)
[2015 S]
Problem - 5 Marks
{Diarrhea} IMA MSN Kerala
1. Rashmi a 4 years old who is attending the anganwadi is brought to your PHC with history
of 7-8 episodes of loose stools. On examination her systolic BP is 80mm Hg. How will you
manage the case.[2014 S]
OR
Many cases of diarrhea are reported to a primary health centre. List how will youinvestigate
and how will you categories individual cases. What is the treatment plan and what are the
preventive measures [2016 R]
2. As medical officer of the PHC, what are the strategies you will plan to ensure eradication of
poliomyelitis from your area.[2014 S]
5

1. Oral rehydration solution [2016 R]
2. Laboratory diagnosis of cholera [2016 S]
3. Hepatitis B vaccination for health care workers [2017 R]
1. Ancylostoma duodenale and Necator americanus [2019 R]

2. Salk and Sabin vaccines [2018 R]
3. Staphylococcal food poisoning and salmonella food poisoning [2016 R]
1. Live polio vaccine is still used in India [2017 S]

2. Cholera is both an epidemic and endemic disease [2017 S]
3. Prevention of hookworm infestation strategies include wearing of slippers [2018 S].
List - 2 Marks
1. Steps in the investigation of food poisoning [2019 R]
2. Carriers in Typhoid [2018 S]
Arthropod Borne Infection
Essay - 10 Marks
1. Asha a 6 years old child is brought to the primary health center with fever for 3 days and
tourniquet test is positive indicating probable case of dengue. What investigations will you do.
IMA MSN Kerala
How will you manage. As a medical officer what actions will you take to control the disease in
the community. [2016 (2+4+4=10) {Dengue} S]
2. As a medical officer in a primary health center of a high risk area for malaria, what are the
indicators that will help you to prepare a plan of action against malaria. What are the strategies
you will follow for prevention and control of malaria. What is the chemotherapy for severe
and complicated malaria. [2020 (3+5+2) {Malaria} R]
Problem - 5 Marks
1. Cases of fever with severe joint pains, diagnosed as chikungunya fever, are reported from
a ward in a town. Outline the steps you would take to control the disease and prevent
spread. [2021 S]
2. Increasing number of falciparum malaria cases are reported from your PHC area over the
past two months . As the medical Officer of the PHC how will you tackle this situation ?
[2017 R]
3. Many cases of malaria are reported in a primary health centre area. How will you investi-
gate. What are the malariometric indices you take to analyze and manage the situation.
[2015 R]
6
1. Malariometric indices [2021 S]
2. Treatment of resistant malaria [2017 S]
3. Mass drug administration for control of filariasis [2017 S]
1. Vivax and falciparum malaria [2014 R, 2019 R]

2. Active and passive surveillance of malaria [2014 S]
1. Integrated vector management is an effective strategy for malaria control [2015 R]

2. Mass therapy is essential for the control of filariasis [2015 S]
Zoonosis
Essay - 10 Marks
1. A mother brings her 8 years old son with history of stray dog bite to the community-
medicine clinic. The wound is lacerated and bleeding. As the medical officer
• What all history will you ask
• How will you manage the case {Rabies} [2017 S]
• What are the pre-exposure and re-exposure strategies (2+4+4)
Problem - 5 Marks
IMA MSN Kerala
1. If there is an outbreak of plague in your Primary Health Centre area what measure will
to take for the prevention and control of the disease. [2019 S]
2. Sasikumar, 26 years old man comes to you with a history of an unprovoked attack by a
dog. On examination you find multiple bite marks and bleeding from some wounds. As
medical officer how will you manage the situation? [2019 R]
1. Post exposure prophylaxis for category II animal bite [2014 R]
2. Post exposure prophylaxis for category III animal bite [2015 S]
3. Blocked flea [2017 R, 2018 S]
4. Japanese encephalitis vaccine [2018 S]
5. Vaccination regimes for post exposure prophylaxis in rabies [2018 S]
List - 2 Marks
1. Signs of Leptospirosis [2019 S]
7
Surface Infection
Essay - 10 Marks
1. A 10 years old boy studying in a primary school had hypopigmented patches at the back
detected during school health check up. Answer the following:
What are the probable causes
i) How will you diagnose the condition.
ii) What are the tests you perform. {leprosy}
iii) How will you manage this case. [2015 R]
Problem - 5 Marks
1. You have been asked to speak to a group of truck drivers regarding the prevention of
HIV infection. Briefly describe the issues which you will cover in your session. [2018 S]
2. Suresh is a 26 years old man who comes to you with a history of urethral discharge for
the past 2 weeks. As Medical Officer how will you manage the situation. [2015 S]
1. Treatment of multibacillary leprosy in a child aged 12 years [2014 R]

2. Treatment of paucibacillary leprosy in adults [2015 S]
3. Treatment of multi-bacillary leprosy in adults [2017 R]
1. Lepromatous and Tuberculoid Leprosy [2015 R]
2. Type I & Type II Lepra reaction [2018 S]
1. Blanket treatment is essential for the control of trachoma [2014 R]
IMA MSN Kerala
List - 2 Marks
1. Deformities in Leprosy [2014 R]
Emerging & Re-emerging Diseases
1. Emerging & Re-emerging diseases [2016 R]
8
Non - Communicable diseases, Disability, Rehabilitation
Essay - 10 Marks
1. Describe about hypertension under the following headings:

a) Classification of hypertension by blood pressure levels.
b) Current magnitude of hypertension in India,
c) Classification and description of the risk factors for hypertension
d)Approaches recommended by the WHO for prevention of hypertension
[2018] (2+2+3+3)
Problem - 5 Marks
1. There has been reports of increased incidence of mortality due to coronary
artery disease in your area. What steps will you take to manage the situation in your area
[2016 R]
2. Survey done in your PHC area reveals increasing number of cardiovascular diseases in
the population. As the Medical Officer of the PHC, prepare an action plan to address this
problem [2017 R]
3. As an epidemiologist if you are asked to measure the burden of coronary heart disease in
the community, how will you estimate the burden. [2019 S]
4. A group of 40-year old software professionals have invited you to address them on how to
prevent cardiovascular disease, since they have heard that it is the leading cause of death
in India. Describe the outline of your session with them on this topic. [2021 S]
5. Describe how palliative care for cancers can be provided at home with partnership
between health care workers and relatives of the patient. [2017 S]
6. As the medical officer of a primary health centre you are asked to prepare a project to
control diabetes in the area. Describe your project. [2019 R]

1. Tracking of BP [2014 S]
2. Assessment of obesity [2019 S]
3. Primary prevention of rheumatic heart disease [2016 S]
4.
5.
Primary level of prevention of hypertension
Screening for Breast Cancer [2021 S]
[2020 R/S]
IMA MSN Kerala
1. Disability and handicap [2014 S]
2. Type I and type II diabetes mellitus [2015 R]
1. Checking blood pressure is the single most useful test in identifying individuals at risk of
developing coronary heart disease [2017 R]
9
List - 2 Marks
1. Risk Factors of DM [2014 S]

2. Indicators of Obesity [2016 R, 2018 R, 2020 R]
3. Modifiable Risk Factors in HTN [2016 S]
4. Human Factors in Accident Formation [2017 R]
5. Environmental factors in accident causation [2019 R]
6. The complications of diabetic mellitus [2019 S]
RCH and Health of Elderly
Essay - 10 Marks
1. You are the medical officer in a primary health centre located in a remote rural-
community. A pregnant lady presents to you, claiming to be 6 months pregnant,
this is her first visit to a health centre. In this context, answer the following
questions:
i) List and briefly describe the components of essential obstetric care.
ii) List and briefly describe the components of birth preparedness.
iii) How could this lady benefit from the provisions of the janani suraksha
yojana scheme? (3+3+4) [2018 S]
Problem - 5 Marks
1. As the medical officer of a PHC you are asked to prepare a project to improve the
nutritional status of the children in the schools under your jurisdiction. Describe your
project. [2015 S]
2. Eighteen years old Anisha a primi gravida comes with 4 months amenorrhea for check
up. How will you proceed with clinical examination and management. [2016 S]
IMA MSN Kerala
3. Sumitha has delivered a term baby of birth weight 2kg in a PHC. As a medical officer how
will you assess the health and provide immediate neonatal care. [2020 R]

1. Baby friendly hospital initiative. [2015 R]
2. Health programs of the elderly [2016 R]
3. Adolescent Health [2016 R]
4. Child Trafficing [2018 R]
5. Social problems of elderly [2018 S]
10
1. Neonatal mortality rate and infant mortality rate [2018 R]

2. Adult Health Care and Geriatric Health Care [2020 R]
1. ‘Under five mortality rate’ is a good index of social development of the country [2014 S]
2. “Active aging” is necessary in the Kerala scenario now [2021 S]
3. Breast milk is the ideal food for babies till six months of age [2021 S]
List - 2 Marks
1. Indicators of maternal and child health care [2017 S]
Biomedical Waste Management & Occupational Health
1. Pre-placement examination and periodic examination in occupational health

[2020 R]
List - 2 Marks
1. Control measures against industrial cancer [2014 R]

2. Salient features of factories act [2015 R]
3. Biomedical waste management in a hospital set up [2015 R]
4. Categorisation of Biomedical waste in India. [2021 R]
IMA MSN Kerala
11
Health Care Delivery system & Urban Health
Problem - 5 Marks
1. As the medical officer of a PHC you are asked to prepare a project to im-
prove the services of the anganwadis under your jurisdiction. Describe your
project protocol. [2014 R]

1. First referral unit [2014 S]
2. Health care delivery system in India [2015 R]
3. Functions of PHC [2017 S]
4. ASHA [2017 S]
5. Services provided at a health sub centre [2018 R]
6. Principles of PHC [2020 R]
7. Services provided at health sub center [2018 R]
1. Asha and Anganwadi worker [2016 R]
1. ASHA is a good example of community participation [2014 S]
2. Appropriate technology is suitable for health care in developing countries [2015 R]
List - 2 Marks
1. Facilities under CGHS [2014 R]

2. Job responsibilities of female health worker [2015 S]
3. Functions of a Sub Center [2016 R]
4. Elements of a PHC [2019 S, 2016 S, 2018 R, 2018 S]
IMA MSN Kerala
5. Functions of PHC [2017 R]

6. Job Responsibilities of a Male health worker [2019 R]
7. Govt. Health care delivery institutions [2021 S]
8. Government health care delivery institutions from village to district level [2021 S]
12
Disaster Management
1. Disaster mitigation [2014 S]

2. Disaster Cycle [2017 R]
3. Triage in disaster management [2019 S, 2020 R]
1. What is to be done:during the floods and after the floods in disaster management
[2016 S]
2. Disaster mitigation and disaster preparedness [2018 R]
1. Disaster increases Communicable Diseases [2019 R]
List - 2 Marks
1. Disaster management after earthquake [2016 R]

2. Steps in disaster management [2018 S]
3. Components of a Disaster Cycle [2020]
Health Planning Management
1. Cost effective analysis and cost bebefit analysis [2019 S, 2020 R, 2021 S]
2.
3.
Monitoring and evaluation [2014 R, 2019 R]
Programme evaluation and review technique and critical path method [2016 S]
IMA MSN Kerala
4. Objective and goal in health planning [2014 S, 2015 S]
1. In network analysis, Critical Path Method is considered as the longest path of the network.
[2019 S]
2. Recommendations of the Bhore committee are still relevant [2018 R]
List - 2 Marks
1. Steps in the planning cycle [2014 R, 2016 R, 2018 S, 2020 R, 2021 S]
2. Steps in evaluation of health services [2015 S, 2017 R]
3. Behavioural methods of management [2018 S]
4. Quantitative methods in the management of health services [2019 R]
13
Mental Health, Behavioral Health Problems & Health Education

1. Warning signs of poor mental health [2014 S]
2. Barriers of communication [2019 S]
1. Health education and propaganda [2017 R]
1. Life skills education in schools is essential for mental health of the child
and academic performance. [2020]
List - 2 Marks
1. Methods of mass communication [2017 S]

2. Mental health services [2016 S]
3. Warning signs of poor mental health [2017 R]
Health Legislation & International Health

1. Functions of UNICEF [2020 R]
2. Functions of voluntary health agencies [2019 R]
IMA MSN Kerala
1. The world health organization establishes and promotes international standards in

the field of health. [2018 R]
List - 2 Marks
1. Functions of the world health organization [2014 S, 2019 R]
2. Role of voluntary organizations in health care [2015 S]
3. Responsibilities of world health organization [2016 S]
4. Services provided by United Nations Children’s Fund (UNICEF) [2019 S]
5. Functions of non-government organizations (NGOs) in health [2021 S]
6. List four international health agencies [2021 S]
14
National Health Programmes & NRHM
Problem - 5 Marks
1. Janani suraksha yojana [2018 R]

2. Integrated disease surveillance project [2018 R]

1. National guinea worm eradication programme [2014 R]
2. Antiretroviral therapy centre [2015 R]
3. Vision 2020: the right to sight [2016 S, 2017 S]
4. Package of services under National AIDS Control Programme(NACP- IV) [2016 S]
5. Adolescent friendly health services(AFHS) [2016 S]
6. Kishori Shakti Yojana [2017 R]
7. Janani Suraksha Yojana [2019 R]
8. Syndromic approach to STDs [2019 S, 2018 R]
9. Suraksha clinic [2020 R]
10. Adoloscent Reproductive and Sexual Health Programme (ARSH) [2019 S]
11. Behavior change communication in malaria [2014 R]
12. Anti-malaria month campaign [2015 S]
13. Malaria control strategy in areas where annual parasite incidence is more than two [2018]
14. Prevention of Parent To Child Transmission [2014 S]
15. Essential package of prevention of parent to child transmission (PPTCT) of HIV [2017 R]
16. National programme for the health care of the elderly. [2019 R]
17. New initiatives under National Tuberculosis Control Programme (RNTCP)
18. Tobacco control legislation [2015 S]
1. Surveillance has to be improved if annual blood examination rate is less than10% in

an endemic area for malaria [2016 S]
Diffrentiate - 2 Marks IMA MSN Kerala

1. Drug distribution centres and fever treatment depots under the national vector
borne disease control program (NVBDCP), for malaria control [2018 S]
List - 2 Marks
1. Parameters of malaria surveillance [2017 S]

2. Objectives of HIV sentinel surveillance [2019 S]
3. Obstetric care in RCH phase II [2020 R]
4. Structure for Vision 2020 [2014 R]
5. Causes of avoidable blindness in India [2018 R]
15
Syncytium
Syncytium-
- Community
Opthalmology
Medicine
Others

1. Iodine deficiency disorder [2016 R]
2. Symptoms of drug addiction [2014 S]
3. Vitamin A prophylaxis [2016 R]
4. Nutritional anemia [2015 R]
5. Factors encouraging counterfeit drugs [2014 R, 2019 R]
1. Eugenics and euthenics [2015 S]
2. Disinfection and sterilization [2017 S]
3. Control and elimination of disease [2017 S]
4. Sewage and sullage [2017 S]
5. Mosquitos of the genus anopheles and genus culex [2018 S]
6. First, second and third generation intra uterine contraceptive devices [2021 S]
7. Neurolathyrism and aflatoxicosis [2021 S]
8. Kwashiorkar and marasmus [2014 R]
9. Street Virus and Fixed Virus in Rabies [2016 R]
1. Fluorine is a double edged sword [2014 R]

2. Goitrogens are an important reason for iodine deficiency in India [2015 S]
3. Oral contraceptives are best suited for nulliparous women [2019 S]
4. Oral contraceptives are avoided in a breast cancer patient. [2020 R]
List - 2 Marks
1. Vaccines to be administered in the first year of life [2018 S]

2. Advantages of condoms [2017 S]
3. Tests of pasteurization of milk [2017 S]
IMA MSN Kerala
4. Physical quality of life index [2016 R]

5. Natural methods of family planning [2015 S]
6. Control measures against noise induced hearing loss [2015 S]
7. Millennium development goals [2015 R, 2016 S]
8. Food toxicants [2015 R]
9. Morbidity indicators [2015 R]
10. Conditions for medical termination of pregnancy [2014 R]
11. Ways of acculturation [2014 R]
12. Source of Infection & Reservoir [2016 R]
16
Communicable diseases
I.Respiratory diseases
1.First and second line drugs against TB:
i. First line drugs:
a. Rifampicin
b. INH
c. Streptomycin
d. Pyrazinamide
e. Ethambutol
ii. Second line drugs:
a. Fluoroquinolones
b. Ethionamide
c. Capreomycin
d. Kanamycin & Amikacin
e. Cycloserine
f. Thioacetazone
g. Macrolides
h. Bedaquiline
II.Intestinal Infections:
1. Carrier’s in Typhoid:
a. Temporary/Convalescent- Excrete bacilli for 6-8 weeks
b. Excrete bacilli for more than 1 year
2. Steps in the investigation of food poisoning:

a. Secure complete list of people invaded and and their history.
b. Laboratory investigations. (phage typing)
c. Animal experiments.
d.
e.
Blood for antibodies. (for retrospective diagnosis)
Environmental study. IMA MSN Kerala
f. Data analysis. (food specific attack rate)
III. Arthropod Borne Infections:
1. Parameters of Malaria Surveillance:

a. Animal Parasite Incidence (API)
b. Animal Blood Examination Rate (ABER)
c. Animal Falciparum Incidence (AFI)
d. Slide Positivity Rate (SPR)
e. Slide Falciparum Rate (SFR)
17
Syncytium- Opthalmology
IV. Zoonosis:
1. Signs of Leptospirosis and it’s symptoms:

There are two clinical types:-
 Anicteric Leptospirosis:
a. Fever and chills
b. Myalgia
c. Conjunctival suffusion
d. Headache
e. Renal, pulmonary manifestation
f. Haemorrhagic tendencies
 Icteric Leptospirosis:
a. Jaundice
b. Fever and Myalgia
c. Headache
d. Conjunctival suffusion
e. Acute Renal Failure
f. Nausea, vomiting, diarrhoea
g. Abdominal pain
h. Hypotension an LPd circulatory collapse
2. Vectors illustration of Malaria and Breeding Places:

• Anopheles stephenii and Anopheles minimus – Overhead tanks and wells
• Anopheles fluviatilis – Moving water
• Anopheles sudaicus – Brakish water
V. Surface Infections:
1. Deformities in Leprosy:
a. Face:
• Mask face, facesfacies leonina
IMA MSN Kerala
• Lagophthalmos, loss of eyebrows and eyelashes

• Corneal ulcers and opacities
• Perforated nose and depressed nose
• Ear deformities (nodules and elongated lobules)
b. Hand:
• Claw hand, wrist drop, ulcers, swollen hand
c. Feet:
• Plantar ulcers, foot chop, swollen foot
d. Other deformities:
• Gynaecomastia
• Perforation of palate
2. Objectives of HIV Sentinel Surveillance:

a. To determine the level of HIV infection among general as well as high risk population.
b. To understand the trend of HIV epidemic.
c. To understand the geographical spread of HIV infection and to identify. emerging pockets.
d. To estimate HIV prevalence and HIV burden in society.
18
Non Communicable Diseases
1. Risk factors for Diabetes mellitus:

a. Overweight and Obesity
b. Physical Inactivity
c. Maternal Diabetes
d. Sedentary lifestyle
e. Diet
f. Alcohol
g. Malnutrition
h. Stress
2 Indiactors of Obesity:
a. Body weight –
• Broca’s
• BMI
b. Skinfold thickness
c. Waist circumference
d. Waist-hip ratio
e. Measurement of total body water
f. Measurement of total body potassium
g. Measurement of body density
3. Criteria for Obesity Assessment:

a. Body weight –
• Brola’s
• BMI
b. Skinfold thickness
c. Waist circumference
d. Waist-hip ratio
e. Measurement of total body water
f.
g.
Measurement of total body potassium
Measurement of body density
IMA MSN Kerala
4. Modifiable risk factors of HIV:
a. Obesity
b. Salt intake
c. Saturated fat
d. Dietary fibre
e. Heart rate
f. Physical Activities
g. Environmental stress
h. Socio-economic status
i. Oral contraceptives usage
19
5. Human factors in Accident Causation:

a. Age
b. Sex
c. Education
d. Medical conditions -
• Sudden illness
• Heart attack
e. Fatigue
f. Psycho-social factors -
• Lack of experience
• Impulsiveness
g. Lack of body protection -
• Helmets and Safety belts
6. Environmental factors in Accident Causation:

a. Relating to road –
• Defective, narrow roads
• Defective layouts of crossroads and speed breakers
• Poor lighting
b. Relating to vehicle:
• Excessive speed
• Old, poorly maintained
c Bad whether:
• Inadequate enforcement of existing laws
d. Mixed traffic:
• Slow and fast moving pedestrians and animals
7. Complications of Diabetes mellitus:

a. Blindness
b. Kidney failure
c. Coronary thrombosis
d. Gangrene of lower extremities etc.
IMA MSN Kerala
8. Safety measures to prevent Accidents:

a. Data collection
b. Safety education
c. Promotion of safety measures
d. Prevention of alcohol and other drugs
e. Elimination of causative factors
f. Enforcement of laws
20
RCH & HEALTH OF ELDERLY
1 Indications of maternal &child health care

-maternal mortality ratio
-mortality in infancy &childhood
-prenatal mortality rate
-neonatal mortality rate
-post-neonatal mortality rate
-infant mortality rate
-1-4-year mortality rate
-under 5 mortality rate
-child survival rate
2 obstetric care in RCH-Phase 2

a. essential obstetric care
• Institutional delivery
• Skilled attendance at delivery
b. emergency obstetric care
• Operationalising first referral unit
• Operationalising PHC & CHC for round the clock delivery system
Health care delivering system &urban health
1.facilities under CGHS

• OPD treatment including issue of medicines
• Specialist consultation at polyclinic/govt hospitals
• Indoor treatment at government &empanelled hospitals
• Investigations at government &empanelled diagnostic centres
• Cashless facilities
• Paediatric services
• Domiciliary visits
• Family welfare services
2.job responsibilities of female health workers

IMA MSN Kerala
• Maternal &child health [register &provide care]
• Family planning [distribute contraceptive]
• MTP [Identify the needy & refer]
• Nutrition [malnutrition identification & treatment]
• UIP [immunising pregnant &all infants]
• Non-communicable disease [prevention &detection]
• Vital events [report birth &death]
• Record keeping
• Treatment of minor ailments
• Team activities [clean sub centre, staff meeting]
21
3.functions of a subcentre
• Maternal health
• Child health
• Counselling
• Adolescent health care
• Water quality monitoring
• Promotion of sanitations
• Disease surveillance
• National health program implantation
4.elements of PHCare
• E-Education of health problem & method of prevention
• L-locally endemic disease prevention & control
• E-essential drugs-provision
• M-maternal & child health care
• E-expanded immunisation against infectious disease
• N-Nutrition & promotion of food supply
• T-treatment of common disease & injuries
• S-sanitation facility & adequate safe water supply
5.principle of PH Care
• Equitable distribution
• Community participation
• Intersectoral coordination
• Appropriate technology
6.Job responsibility of health worker male

• In national health program implementation.
Example: NVBDCP, uprosy eradication program etc
• Communicable disease [identify &notify]
• Environmental sanitation [chlorinate water]
• Nutrition [identify LBW & identify]
IMA MSN Kerala
• Vital events [birth & death reportries]

• Record keeping
7.government health care delivery institutes from village to private level

Primary health centre
sub centres
Community health centres
Rural hospitals
District hospital
22
Disaster management
1. Steps in disaster management

• Response
• Preparedness
• Mitigation
2.disater management after earthquake

• Obey authority instructions
• Do not go back into damaged buildings
• Give first aid to injured
• Do not go simply to look at the stricken areas
• Keep emergency packages &radio near at hand
• Make sure that water is safe to drink
3.components of a disaster cycle

-Recovery phase after a disaster
Response
Rehabilitation
Reconstruction
-Risk reduction phase before disaster
Mitigation
Preparedness
IMA MSN Kerala
23
Ophthalmology
IMA MSN Kerala
1
Anatomy and
Optics and Refraction
Physiology of Eye
Diseases of
Diseases of Cornea
Conjunctiva
Diseases of Sclera Diseases of Uveal Tract
Diseases of Lens Glaucoma
Diseases of VitreousDiseases of Retina
Occular Motility and
Neuro-ophthalmology
Strabismus
Disorders of Lacrimal
Disorders of Eyelid
Apparatus
Disorders of Orbit Occular injuries

IMA MSN Kerala
Systemic &
Occular Therapeutics Community
Opthalmology
Answers to list the
Following
2
Anatomy and Physiology of Eye
Draw and label
1. Angle of anterior chamber (2016 S Q 7,2018 R Q 7)

2. Cross section of Human Eyeball (2019 R Q 7)
Optics And Refraction

Short Notes
1. Astigmatism (2014 R Q 3,2018 S Q 3)

2. Myopia (2015 R Q 3,2017 R Q 3,2019 R Q 1)
3. Hypermetropia (2015 S Q 3)
4. Sturm’s Conoid (2020 R Q 2)
Draw and label
1. Sturm’s conoid(2016 R Q 6,2019 S Q 6)
Answer Briefly
1. Cycloplegia(2020 R Q 9)
2. Aphakia(2014 S Q 10, 2016 R Q 9)
3. Types of astigmatism(2016 S Q 9)
4. Sturm’s conoid(2021 S Q 10)
Give Precise Answers
1. Name four methods to correct myopia(2014 S Q 15)

2. Mention two surgical procedures to correct myopia (2015 S Q 16,2017 R Q 16)
Diseases Of Conjunctiva IMA MSN Kerala

Short Notes
1. Pterygium(2016 S Q 2)
2. Trachoma(2019 S Q 2)
3. WHO classification of Trachoma(2020 R Q 3)
Answer Briefly
1. Pterygium(2015 R Q 8)
2. Ophthalmia neonatorum(2015 S Q 8,2017 R Q 8)
3. Phlycten(2017 R Q 11)
4. WHO classification of trachoma(2016 R Q 8)
5. Membranous conjunctivitis(2016 R Q 10)
6. Angular conjunctivitis(2018 S Q 9)
7. Sub-conjunctival hemorrhage(2018 R Q 8)
8. Phlyctenular conjunctivitis(2019 R Q 11)
3
Disease of Cornea
Essay
A fifty-years-old man presented to the eye department with history of pain and
redness of the eye of 7 days duration. He gave history of injury to the eye with a
plant material while working in the farm. Answer the following:
• What is the probable diagnosis.
• Describe the clinical features of the condition.
• What are the investigations you order.
• How do you treat this condition.
• Enumerate the complications
(2014 S Q 1)
OR
An agricultural worker presents with sudden painful loss of vision in right eye following
injury with vegetative matter. Answer the following:
• What is the most probable diagnosis
• What are the clinical features of the condition
• What are the ocular investigations you should do
• How will you manage the case
• What are the probable complications
Fungal Corneal Ulcer (2018 S Q 1)
Short Essay
1. Clinical features of fungal keratitis(2014 R Q 2)

2. Management of fungal keratitis(2015 S Q 4)
3. Keratoconus(2014 S Q 2,2019 R Q 5)
4. Viral keratitis(2017 S Q 5)
5. Management of bacterial keratitis(2015 R Q 5)
6. Mooren’s ulcer(2016 R Q 2,2020 R Q 5)
IMA MSN Kerala
7. Dendritic ulcer(2016 S Q 5)
8. Management of bacterial Keratitis(2017 R Q 4)
Draw and Label
1. Draw a cross section of Cornea (2014 R Q 7,2017 R Q 7)
Answer briefly
1. Spring catarrh(2014 R Q 8,2017 S Q 9)

2. Staphyloma(2015 S Q 11,2017 R Q 10)
3. Band keratopathy(2016 R Q 12)
4. Leucoma(2018 R Q 12)
5. Preservation methods of donor cornea(2017 S Q 8)
6. Munson sign(2019 R Q 10)
7. Indications of keratoplasty(2019 S Q 9)
8. Anterior staphyloma(2019 S Q 12)
9. Clinical features of fungal corneal ulcer(2021 S Q 9)
10. Enumerate the indications of keratoplasty with one example for each(2021 S Q 12)
4
1. Two types of Keratoplasty(2020 R Q 14)

2. Name two fungi which can infect cornea (2016 S Q 16)
3. Two organisms penetrating intact corneal epithelium(2017 S Q 13)
4. Mention two organisms causing hypopyon corneal ulcer(2019 R Q 14)
5. Mention two clinical signs of keratoconus(2021 S Q 15)
Diseases Of Sclera
Answer Briefly
1. Scleritis(2015 S Q 9)
2. Episcleritis(2018 S Q 10)
3. Discuss types and causes of scleritis(2021 S Q 11)
Diseases Of Uveal Tract
Essay
1. Patient complaining of pain, redness, blurring of vision in one eye, with history of
repeated similar attacks, associated with small joint pains. Answer the following:
• What is your more probable diagnosis

• What is the differential diagnosis
• How will you confirm the diagnosis
• How will you manage the case. Uveitis (2015 S Q 1)
Short Notes
1. Phthisisbuibi(2018 R Q 3)
2. Occlusio pupillae(2018 R Q 5)
3. Granulomatous Uveitis(2020 R Q 4) IMA MSN Kerala
Answer Briefly
1. Keratic precipitates(2018 S Q 8)
2. Heterochromia(2019 R Q 9)
1. Name four causes of loss of vision in iridocyclitis(2014 S Q 13)

2. Name four features of granulomatous iridocyclitis(2016 S Q 13)
3. Two features of granulomatous uveitis(2017 S Q 16)
4. Two features of iridocyclitis(2019 S Q 15)
5
Diseases of Lens
Essay
1, Patient presents with a history of gradual painless progressive loss of vision

in both eyes with a vision of counting fingers 2½ meters. Lens appears grayish
white in colour with iris shadow. Answer the following:
• How do you classify
• Mention differential diagnosis.
• How will you manage the case IMMATURE CATARACT (2019 R Q 1)
2. An elderly patient complains of gradually progressive painless loss of vision in both

eyes. His best corrected visual acuity is 3/60 both eyes. Fundus examination is normal
both eyes. Answer the following:
1. Mention the most probable diagnosis

2. What are the investigations you should do
3. How will you confirm the diagnosis
4. How do you manage the case
5. Enumerate the complications of surgery SENILE CATARACT (2019 S Q 1)
3. A 65 years old male with a history of an uneventful cataract surgery right

eye, 6 months ago, with good postoperative visual recovery, has now presented with
painless progressive diminution of vision in the right eye. Answer the following
Questions:
• What is the diagnosis
• What is the differential diagnosis?
• List the early and late postoperative complications of cataract surgery.f
IMA MSN Kerala
• Describe in detail the etiopathogenesis, clinical features and management of any one
of these. AFTER CATARACT/ SECONDARY CATARACT/ PCO (2021 S Q 1)
Short Note
1. Complicated cataract(2015 S Q 2)
2. Phacoemulsification(2018 S Q 4)
3. Congenital cataract(2017 S Q 2)
Answer Briefly
1. Ectopia Lentis(2020 R Q 12)

2. Nuclear cataract(2020 R Q 10)
3. Zonular cataract(2014 S Q 9)
4. IOL power calculation(2014 R Q 9)
5. After cataract(2017 S Q 12)
6
1. Mention two causes of subluxation of lens.(2015 R Q 16)

2. Mention two syndromes associated with ectopia lentis(2017 R Q 15)
3. Name different types of intraocular lenses(2016 R Q 16)
4. Mention two syndromes associated with cataract(2018 R Q 15)
5. List four types of congenital cataract(2021 S Q 16)
GLAUCOMA
Essay
1. 60 years old patient presented with sudden onset of pain, redness in one eye and
headache, with decreased vision since six months, with past history of cataract surgery in other
eye. Answer the following:
• What are the differential diagnosis
• How will you manage the case. (2014 R Q 1) (Lens Induced Glaucoma)
2. Patient complaining of gradual loss of vision and frequent change of presbyopic

glasses. Answer the following:
• How will you manage the case (2017 R Q 1) (Primary OAG)
3. Female patient complaining of sudden painful blurring of vision in one eye with shallow
anterior chamber in both eyes. Answer the following:
• What is the probable diagnosis
• What are the necessary ocular investigations to confirm the diagnosis
• what are the precautions to be taken for the other eye”.
IMA MSN Kerala
• What is the precaution to be taken for the other eye
(2017 S Q 1) (Angle Closure Glaucoma)
Short Notes
1. Buphthalmos(2015 S Q 5,2014 S Q 5)
2. Absolute glaucoma(2016 R Q 4)
3. Congenital glaucoma(2017 R Q 5)
4. Lens induced glaucoma(2018 R Q 2,2018 S Q 2)
Draw and Label
1. Field changes in primary open angle glaucoma(2019 S Q 7)
7
Answer Briefly
1. Glaucoma flecken(2020 R Q 8)
2. Neovascular glaucoma(2014 S Q 11)
3. Field changes in open angle glaucoma(2015 R Q 9)
4. Phacolytic glaucoma(2016 S Q 8)
5. Iridectomy(2018 R Q 10)
1. Mention two causes of dilated pupil(2015 R Q 14)

2. Mention two causes for tubular vision(2015 S Q 14,2017 R Q 14)
3. Name 4 topical antiglaucoma drugs (2018 S Q 13)
4. Mention two surgical procedures for angle closure disease(2019 R Q 16)
Diseases Of Vitreous
Essay
1. 60 years old female patient with type II diabetic mellitus since 12 years, presents to OPD
with complaining of sudden painless loss of vision in one eye. Answer the following:
• How will you manage the case. (2015 R Q 1) VITREOUS HEMORRHAGE
Answer Briefly
1. Asteroid hyalosis(2015 S Q 10,2017 R Q 9)

IMA MSN Kerala
1. Name four causes of vitreous hemorrhage(2016 S Q 15)
Diseases Of Retina
Short Notes
1. Diabetic retinopathy(2014 S Q 4,2019 R Q 4)
2. Retinoblastoma(2016 R Q 5)
3. Diabetic retinopathy(2017 R Q 2)
4. Retinal detachment(2017 S Q 4,2019 S Q 5)
5. Leucocoria(2019 R Q 3)
6. Discuss the etiology and clinical features of ischemic
central retinal vein occlusion(2021 S Q 5)
8
Draw and Label
1. Pseudorosettes(2020 R,S Q 7)
2. Fundus picture of central retinal vein occlusion(2014 R Q 6)
3. Fundus picture of hypertensive retinopathy(2015 R Q 6,2018 S Q 6)
4. Fundus picture of diabetic retinopathy(2015 S Q 6)
5. Fundus picture of retinitis pigmentosa(2017 R Q 6,2019 R Q 6)
6. Normal fundus(2018 R Q 6)
Answer Briefly
1. Enucleation(2014 R Q 11)
2. Hypertensive retinopathy(2016 R Q 9)
3. Fundus picture in central retinal artery occlusion(2016 S Q 10)
4. Enucleation(2016 S Q 12)
5. Enumerate the principles of management of rheumatogenous
retinal detachment(2021 S Q 8)
1. Two types of retinal detachment(2020 R Q 13)

2. Mention two causes of sudden loss of vision (2014 R)
3. Mention two syndrome associated with retinitis pigmentosa(2015 S Q 15)
4. Two differential diagnosis of leukocoria(2017 S Q 15)
5. Two indications for enucleation(2019 S Q 13)
NEURO OPHTHALMOLOGY
Short Note
1. Papilloedema(2016 S Q 4)
2. Optic neuritis(2019 S Q 3)
3. Define amblyopia. Discuss the clinical features and management(2021 S Q 3) IMA MSN Kerala
Draw and Label
1. Light reflex pathway(2016 R Q 7)

2. Draw the visual pathway and the field defect due to lesions at each level along the visual
3. pathway(2016 S Q 6)
4. Visual pathway(2017 S Q 6,2021 S Q 7)
Answer briefly
1. Optic atrophy(2020 R Q 11)

2. Horner’s syndrome(2015 S Q 12)
3. Marcus gunn pupil(2017 S Q 11)
9

1. Name two causes of Papilloedema (2016 R Q 13)
2. Name four types of optic atrophy(2016 S Q 14)
3. Mention two causes of toxic amblyopia(2018 R Q 14)
OCULAR MOTILITY AND STRABISMUS
Draw and label
1. Uniocular extra-ocular movements(2020 R,S Q 6)
Answer Briefly
1. Toxic ambylopia(2018 S Q 12)

2. Diplopia(2019 R Q 12)
Give Precise Answer
1. Two causes of uniocular diplopia(2018 S Q 14, 2019 R Q 15)

2. Enumerate the grades of binocular vision(2021 S Q 13)
DISORDERS OF EYELID
Short Notes
1. Ectropion(2014 R Q 4)
2. Lagophthalmos(2015 R Q 2)
3. Blepharitis(2018 S Q 5)
IMA MSN Kerala
Draw and Label
1. Cross section of upper eye lid(2015 S Q 7,2017 S Q 7)
Answer Briefly
1. Senile entropion(2014 S Q 12)

2. Blepharitis(2015 R Q 12)
3. Chalazion(2018 R Q 11)
4. Ptosis(2019 S Q 10)
10
1. Types of acquired ptosis (2020 R Q15)

2. Classify ptosis(2016 R Q 14)
3. Name two surgeries to correct senile ectropion(2016 R Q 15)
4. Mention two surgical types of tarsorrhaphy(2018 R Q 16)
DISORDERS OF LACRIMAL APPARATUS
Essay
1. A 40-years-old female presented with watering and discharge from right eye of 6 months
duration. On examination she had a swelling near the medial canthus of the eye. Answer the
following:
• How do you manage the patient
• Enumerate the causes of epiphora
• Enumerate the investigations.
• Enumerate the complications if not treated
(2016 R Q 1)
OR
Patient presents with a history of watering with mucopurulent discharge for the last six
months in the right eye. Regurgitation test positive. Answer the following:

• Describe the anatomy
• How do you confirm the diagnosis
• What are the complications
• How will you manage the condition
(2018 R Q 1) CHRONIC DACRYOCYSTITIS

Short Note
IMA MSN Kerala
1. Congenital dacryocystitis(2014 R Q 5)
2. Chronic dacryocystitis(2017 S Q 3)
Draw and Label
1. Lacrimal drainage apparatus(2014 S Q 7,2015 R Q 7,2018 S Q 7)
Answer Briefly
1. Congenital dacryocystitis(2016 S Q 11,2019 S Q 11)
1. Mention two absolute indications for dacryocystectomy(2014 R Q 13)

2. Mention two tests for dry eye(2021 S Q 14)
11
DISORDER OF ORBIT
Essay
1. A fifty-years-old female patient presented to the eye department with history of pain,
redness, protrusion of the eye, double vision of 2 days duration. She also had fever.
• What is the probable diagnosis.

• Describe the clinical features
• What are the investigations you order.
• How do you treat the patient
• Enumerate the complications
(2016 S Q 1) ORBITAL CELLULITIS
Draw and label
1. Cavernous sinus and its connections(2014 S Q 6)

2. Spaces of the orbit(2021 S Q 6)
1. Mention two important causes of bilateral proptosis(2015 R Q 13)

2. Two causes of orbital cellulitis(2018 S Q 15)
3. Two causes of proptosis(2019 S Q 16)
OCULAR INJURIES
Essay
IMA MSN Kerala
1. A man was hit on his right eye by cricket ball while playing. On examination his vision
was 6/6 both eyes. He had binocular diplopia and periorbital ecchymosis with crepitus in
right eye. Answer the following questions:
• What type of ocular trauma he encountered

• Two causes of diplopia probable in this patient
• Two other clinical signs likely in this patient
• Four causes of decreased vision following blunt trauma to eye
• How will you manage this patient
(2020 R Q 1) BLUNT TRAUMA CLOSED GLOBE INJURY
12
Short notes
1. Chemical injuries involving the eye(2019 S Q 4)
Answer Briefly
1. Hyphaema(2015 R Q 10)
Give precise answers
1. Two ocular features in blunt trauma(2018 S Q 16)

2. Name four retinal findings following a blunt trauma to the eye.
(2014 S Q 16)
OCULAR THERAPEUTICS
Short notes
1. Atropine(2016 R Q 3)
2. Latanoprost(2016 S Q 3)
3. Classify anti glaucoma drugs. Discuss the mechanism of action and
side effects of each group with examples(2021 S Q 4)
Answer Briefly
1. Atropine(2014 R Q 10)
2. Timolol maleate(2014 S Q 8)
Give Precise Answer
1.
2.
3.
Mention two hyper osmotic agents(2014 R Q 15)
Mention the uses of lasers in ophthalmology(2015 R Q 15)
Mention two miotics(2015 S Q 13)
IMA MSN Kerala
4. Mention two beta-blockers used in glaucoma(2017 R Q 13)
5. Mention two antiviral agents(2018 R Q 13)
6. Two uses of atropine eye drops(2017 S Q 14)
7. Two topical antifungal drugs(2019 S Q 14)
8. Mention two mydriatics(2019 R Q 13)
13
SYSTEMIC AND COMMUNITY OPHTHALMOLOGY

Short notes
1. Ocular manifestations of vitamin A deficiency(2014 S Q 3)

2. Vitamin A deficiency(2015 R Q 4)
3. Discuss WHO classification of xerophthalmia(2021 S Q 2)
Answer briefly
1. Legal blindness(2014 R Q 12)

2. NPCB(National programme for control of blindness)(2015 R Q 11,2018 S Q
11)
3. Bitot’s spot(2017 R Q 12,2019 R Q 8)
4. Vitamin A deficiency(2017 S Q 10)
5. Vision 2020(2019 S Q 8)
Give Precise Answer
1. Two signs of Vitamin A deficiency (2020 R Q 16)

2. Mention four causes of nyctalopia/night blindness(2014 R Q 16,2014 S
Q 14)

IMA MSN Kerala
OPTICS AND REFRACTION

1.Name four methods to correct myopia
- Laser in situ keratomileusis, Radial keratotomy, contact lenses, spectacles
2. Name two surgical procedures to correct myopia

- Radial keratotomy
- Laser in situ keratomileusis
DISEASES OF CORNEA
1. Two types of keratoplasty
- Auto keratoplasty
- Allo keratoplasty
2.Two organisms penetrating corneal epithelium
- Neisseria gonorrhoeae
- Neisseria meningitidis
14
3.Name two fungi that can infect the cornea.
- Aspergillus fumigatus
- Candida
4.Mention two organisms causing hypopyon corneal ulcer.

- Pneumococci
- Staphylococci
5.Mention two clinical signs of keratoconus.

- Central/ paracentral stromal thinning
- Apical protrusion of anterior cornea.
DISEASES OF UVEAL TRACT

1.Two features of iridocyclitis.
- Photophobia
- blepharospasm
2. Name four causes of loss of vision in iridocyclitis.

- Induced myopia due to ciliary spasm
- corneal haze
- aqueous turbidity
- Vitreous haze
3.Two features of granulomatous uveitis.

- Iris nodules
- Mutton fat keratic precipitates
4.Name four features of granulomatous iridocyclitis

- Nodular lesions in fundus
- Mild aqueous flare
-
-
Mutton fat keratic precipitates
Iris nodules IMA MSN Kerala
DISEASES OF LENS
1.Mention the syndromes associated with cataract
- Down syndrome
- Lowe's syndrome
2. Name different types of intraocular lenses.
-BASED ON METHOD OF FIXATION
- Anterior chamber IOL
- Iris supported lenses
- Posterior chamber lenses
-ON THE BASIS OF MATERIAL
- Rigid IOL
15
- Foldable IOL
- Rollable IOL
-BASED ON FOCUSING ABILITY
- Unifocal IOL
- Multifocal IOL
- Accommodative IOL
- Extended depth of focus IOL
-APHAKIC v/s PHAKIC REFRACTIVE IOLs
-SPECIAL FUNCTION IOLs
- Toric IOL
- Aspheric IOL
- Aniridia IOL
3.Name two syndromes associated with ectopia lentis.

- Marfan syndrome
- stickler syndrome
4. Mention two causes of subluxation of the lens.

- Partial rupture of the zonules
- Unequal stretching of the zonules
5. List four types of congenital cataract

- Congenital capsular cataract
- Polar cataract
- Congenital nuclear cataract
- Generalised cataract
GLAUCOMA
1.Mention two causes of dilated pupil.
- Primary angle closure glaucoma
- Phacomorphic glaucoma
IMA MSN Kerala
2.Mention two causes for tubular vision.

- Terminal stage of advanced glaucomatous field defect.
- Advanced stage of retinitis pigmentosa.
3.Mention 2 surgical procedures for angle closure disease.

- Trabeculectomy
- prophylactic laser iridotomy
- laser iridotomy
4. Name 4 topical antiglaucoma drugs

- Betaxolol
- Brimonidine
- Latanoprost
- Pilocarpine
16
DISEASES OF VITREOUS
1.Name four causes of vitreous hemorrhage.
- Retinal tear
- Trauma to eye
- Blood dyscrasias
- Neoplasms
DISEASES OF RETINA
1.Mention two syndromes associated with retinitis pigmentosa
- refsum's syndrome
- cockayne’s syndrome
2. Two types of retinal detachment.

- Tractional retinal detachment
- Exudative retinal detachment
3.Two indications for enucleation.

- Retinoblastoma
- Malignant melanoma
4.Mention two causes for sudden loss of vision.

- Retinal detachment
- Central Retinal vein occlusion.
5. Two differential diagnosis of leucocoria

- Congenital cataract
- Coloboma of the choroid
NEUROOPHTHALMOLOGY
1. Name four types of optic atrophy

IMA MSN Kerala
- Primary optic atrophy
- Consecutive optic atrophy
- Glaucomatous optic atrophy
- Post neuritic optic atrophy
2. Name two causes of pappiledema

- Neuroretinitis
- Papillophlebitis
17
OCCULAR MOTILITY & STRABISMUS

1.Name two causes of toxic amblyopia
- Excessive tobacco smoking
- Alcohol consumption
2. Two causes of unilocular diplopia

- Subluxated clear lens
- Double pupil
3.Enumerate the grade of binocular vision

- Grade I - Simultaneous macular perception
- Grade II - Fusion
- Grade III - Stereopsis
DISORDERS OF EYELID
1. Mention two surgical types of tarsorrhaphy
- Temporary tarsorrhaphy
- Permanent tarsorrhaphy
2.Classify ptosis
Congenital ptosis and Acquired ptosis
3. Name two surgeries to correct senile ectropion

- Medial conjunctivoplasty
- Kuhnt szymanowski
4.Types of acquired ptosis

- Simple congenital ptosis
- Congenital ptosis with associated weakness of superior rectus muscle
- Blepharophimosis syndrome
- Congenital synkinetic ptosis
IMA MSN Kerala
DISORDERS OF LACRIMAL APPARATUS

1. Mention two absolute indications for dacryocystectomy
- Too old patient
- Markedly shrunken and fibrosed sac
2.Mention two tests for dry eye

- Schirmer-I test
- Tear film break-up
DISORDERS OF ORBIT
1.Mention two important causes of bilateral proptosis
- Osteitis deformans
- Acromegaly
18
2.Two causes of orbital cellulitis
- Exogenous infection eg: penetrating injury
- Extension of infection from neighbouring structures like paranasal sinuses
OCCULAR INJURIES
1. Four retinal findings following blunt trauma to the eye
- Berlin's edema
- Retinal hemmorhage
- Choroidal detachment
- Traumatic choroiditis
OCCULAR THERAPEUTICS
1.Mention two antiviral agents
- Acyclovir
- Ganciclovir
2.Two uses of atropine eyedrops

- Mydriasis & Cycloplegia
- Amblyopia therapy
3.Mention the uses of lasers in ophthalmology

- Correction of after cataract- YAG laser
- Management of Central retinal vein Occlusion
- Photodynamic therapy, Retinal detachment
- Central serous chorioretinopathy
- LASIK surgery in correction of the myopia
4. Mention two beta blockers used in glaucoma

- Timolol
- Betakolol
IMA MSN Kerala
5.Mention two miotics
- Pilocarpine
- Phsyostigmine
6. Mention two mydriatics

- Atropine
- Homatropine
7. Two topical antifungal drugs

- Nystatin
- Amphotericin B
19
8.Mentiontwo hyperosmotic agents

- Glycerol
- Mannitol
SYSTEMATIC & COMMUNITY OPHTHALMOLOGY

1. Name four causes of night blindness OR Name four causes of nyctalopia
- Vitamin A deficiency
- Oguchis disease
- Familial congenital night blindess
- Congenital high myopia
2.Two signs of Vitamin-A deficiency

- Night blindess
- Bitots spots
IMA MSN Kerala
20
IMA MSN Kerala
1
ENT
Syncytium - ENT
Nose and Paranasal Air

Ear
Sinuses
Pharynx Tonsil
Larynx Trachea
Oral Cavity and Salivary
Oesophagus
Glands
Operative Surgery Appendices
IMA MSN Kerala
Head & Neck Space

Clinical Methods
Infections
Answers to List the Following
2
Syncytium - ENT
Nose and Para Nasal Air Sinues
Essay - 10 Marks
1. A two years old child brought to the outpatient department with complaints of nasal
obstruction, foul smelling unilateral nasal discharge for past one month. Answer the
following:
• What are the causes for unilateral nasal obstruction
• What is the etiology of Choanal Atresia?
• What are the investigations to be done {infected foregin body}
• Discuss the treatment of this child [2015 S]
(1+2+2+2+3=10)
2. Enumerate the causes of epistaxis. Discuss the management of sudden, profuse nasal
bleed in an adolescent male. (3 +7) [2018 R]
Short note - 3 Marks

1. Septal abscess [2014-R]
2.Rhinosporidiosis [2014-S]
3.Treatment for rhinosporidiosis [2015-S]
4. Nasal polyposis [2015-R]
5.Allergic rhinitis [2016-S]
6.Treatment for allergic rhinitis [ 2017-S]
7. Nasal bone fractures. [Q3 2017-S]
8. Clinical differences between antrochoanal and ethmoidal polyp [2018-S]
9. Allergic fungal sinusitis [Q2 2019-R]
10. Aetiopathology of chronic sinusitis with nasal polyposis [2019-S]
11.Treatment of atrophic Rhinitis [2020-S]
12. Etio-pathology of sino-nasal polyposis [2018-R]
13. Osteo-meatal complex [2016-R]
14. Type II Le fort fracture [2019-S]
Draw and label - 2 Marks

1.
2.
Constituents of nasal septum
Framework of nasal septum
[2014-R]
[2018-S]
IMA MSN Kerala
3. Blood supply of nasal septum [2014-S, 2015R]
4. Lateral Wall of Nose [2016-S, 2017-R]
5. Kiesselbach’s Plexus [2019-S]
6. Osteomeatal Complex [2018-R]
Answer Briefly - 2 Marks

1. Allergic fungal rhino-sinusitis [2014-S]
2. Investigations in a case of CSF rhinorrhea [2015-R]
3. Medical management of atrophic rhinitis. [2016-R]
4. Rhinoscleroma [2016-R]
5. Air-conditioning function of nasal cavity [2018-S]
6. Fracture nasal bone -diagnosis and management [2019-R]
7. Rhinosporidiosis – diagnosis and management.[2019-R]
8. Differences between antrochoanal and ethmoidal polyp[2021-S]
9. Cottle’s test[2017-S]
10. Osteomeatal complex[2016-S]
3
Give precise Answer - 1 Mark
1. Name four arteries supplying little’s area[Q16 2014-S]
2. Four surgical treatments for atrophic rhinitis.[Q13 2015-R]
3. Four causes for bilateral nasal obstruction in a child [Q15 2016-S]
4. Four complications of acute sinusitis[Q14 2016-S]
5. Woodruff ’s Plexus[Q14 2017-S]
6. Function of turbinates[Q15 2018-R]
7. Causes of Rhinitis medicamentosa [Q15 2018-S]
8. Antrochoanal polyp.[Q15 2019-R]
9. Little’s area[Q14 2020-R]
10. Two types of nasal bone fracture[Q13 2021-S]
11. Two techniques to manage posterior nasal bleeding. [Q16 2021-S]
12. Pott’s puffy tumor[Q16 2019-R]
13. One antihistamine medication with its per day dosage [Q14 2019-S]
Ear
Essay - 10 Marks
1. OTOSCLEROSIS-
A 38 years old female patient coming with progressive hearing loss and occasional
tinnitus with no history of ear discharge. Tuning fork tests reveal a bilateral similar
conductive hearing loss. There is family history of hardness of hearing. Answer the
following:
i)What is the probable diagnosis
ii) Describe the clinical features of this condition
iii) Enumerate non-suppurative causes of conductive hearing loss.
iv) What investigations are to be done
v)Discuss the treatment.
[2015-R]
OR
A 25 years old female presented with progressive hearing loss worsening after preg-
nancy. On examination of the ear, tympanic membranes are normal. Answer the following:
i) What is the most probable diagnosis
IMA MSN Kerala
ii) Describe the clinical features of this condition
iii) Describe the audiometric finding
iv) What is the nonsurgical treatment of this condition
v) Mention the surgical treatment of the condition and list four
complications of the surgery.
[2016-S]
OR
A 30 years old female patient presents to the ENT OPD with complaints of
gradually progressing hearing loss in both ears, for the past 5 years. She gives the
history of hearing loss worsening during pregnancy. On examination, her
tympanic membranes are normal. Tuning fork tests show negative rinne in both
ears and Weber lateralized to the right ear. Answer the following:
i)What is the most likely diagnosis
ii)Mention two relevant investigations and the expected findings in each
iii)Mention four differential diagnosis
4
Syncytium - ENT
iv) How will you treat this patient

v) Mention four complications of the surgical procedure used to treat this
patient.
[2019-S]
2. CSOM
A 45 years old male, presented with chronic intermittent scanty purulent foul
smelling ear discharge in right ear for past 15 years and progressive hardness
of hearing for 5 years. On examination of the right ear, tympanic membrane
revealed an attic perforation- presently with right sided facial nerve palsy.

i)What is the most probable diagnosis
ii)Describe the aetiopathology
iii) Describe the clinical features
iv)What investigations will you do
v)How will you treat this patient
[2016-R]
Short note - 3 Marks

1. Labyrinthitis [2014-R]
2. Ototoxicity [2014-R, 2014-S]
3. Rinne’s Test [2014 S]
4. Treatment of Meniere’s Disease {OR} Management of Meniere’s Disease [2014-S, 2015-S]
5. Aural Polyp [2016-S]
6. Management of Otosclerosis [2017-R]
7. Clinical features and Treatment of Otosclerosis [2021-S]
8. Otogenic Brain abscess [2017-R]
9. Bell’s Palsy [2017-S]
10. Treatment of Bell’s Palsy [2021-S]
11. Clinical Features of attico-antral type of chronic suppurative otitis media [2018-R]
12. Management of malignant otitis externa [2018-S]
IMA MSN Kerala

13. Etio-pathology of cholesteatoma[2018-S]
14. Internal auditory meatus [2019-R]
15. Acoustic neuroma [2019-R]
16. BPPV and its management [2019-R]
17. Hearing evaluation of a deaf child [2020]
18. Discuss treatment of otogenic facial palsy [2020]
Draw and label - 2 Marks

1. Stapes[2017-R]
2. Mastoid Air Cell [2017 S]
3. Draw a diagram of the auditory pathway[2015-R]
4. Draw a diagram of the medial wall of the middle ear[2015-S]
5. Draw a diagram of organ of corti and label its parts[2016-R, 2019-R, 2021-S]
6. Right tympanic membrane [2016-S, 2017-R, 2018-S]
7. Draw a diagram of ossicular chain[2017-S]
8. Medial wall of the tympanic cavity[2018-R]
9. Membranous Labyrinth[2017-S]
10. Left Tympanic membrane [2020]
5
ANSWER BRIEFLY [2MARKS]
1. MC EVEN TRIANGLE[2014-R, 2016-S]

2. Presbycusis[2014-R]
3. Grommet[2014-R, 2014-S]
4. Audiometric findings in otosclerosis[2014-S]
5. Objective tinnitus[2014-S]
6. Bat ear[2015-R]
7. Sudden sensory-neural hearing loss[2015-S]
8. Otomycosis[2015-S, 2021-S]
9. Theories of hearing[2015-S]
10. Surgical treatment of Meniere’s disease[2016-R]
11. Cerumen[2016-R, 2019-R]
12. Malleus[2016-S]
13. Noise induced hearing loss[2017-R]
14. Cholesteatoma[2017-R]
15. False negative Rinne[2017-R, 2018-S]
16. Management of Bezold’s abscess[2017-S]
17. Pre auricular sinus[2017-S]
18. Schwabach test.[2017-S]
19. Pure tone audiogram findings in stapedial otosclerosis[2018-R]
20. Functions of middle ear[2018-R]
21. Clinical features of lateral sinus thrombophlebitis[2018-R]
22. Epley’s maneuver[2018-S]
23. OAE – What is it. What is its use[2019-R]
24. Pure tone audiogram and speech audiogram findings in Meniere’s disease[2019-S]
25. Cardinal signs of acute coalescent mastoiditis[2019-S]
26. Causes of referred otalgia[2019-S]
27. Fistula test [2020]
28. Weber’s test[2000]
29. Lignocaine in ENT[2021-S]
GIVE PRECISE ANSWER[1 MARKS ]

1. Korner’s septum and its importance [2014-R]
2. Bat ‘s ear and how it is corrected [2014-R]
IMA MSN Kerala
3. Four causes of conductive hearing loss[2014-R] [SA SUB Question 2015-R]
4. Tympanic plexus[2014-S]
5. What is Schwart’z sign and its clinical importance[2014-S, 2017-S]
6. What is false negative Rinne test[2015-S]
7. Boundaries of facial recess[2015-S]
8. Four causes for referred otalgia[2016-R]
9. Two indications for cochlear Implant.[2016-R]
10. Two conditions producing positive Hennerbert’s sign[2016-S, 2018-R]
11. Gradinego’s syndrome[2017-R, 2017-S]
12. Boundaries of Mac - Ewen’s triangle[2017-S, 2020]
13. Tympanometry showing normal middle ear function.[2018-R]
14. Griesinger’s sign[2018-S]
15. Rinne’s test[2019-R]
16. Functions of cerumen[2019-S]
17. Tympanometry finding in serous otitis media[2019-S]
18. Two features of tuberculous otitis media[2021-S]
19. Treacher Collins syndrome[2020]
20. Keratosis Obturans Treatment [2016 R] 6
Syncytium - ENT
PHARYNX
ESSAY
I)JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
i) A 16 years old male presented with progressive nasal obstruction and sudden onset
of painless profuse bleeding from nose. Nasal examination reveals pinkish mass seen in
the right nasal cavity and nasopharynx. Answer the following:
• Describe the clinical features of this condition
• What are the investigations to confirm the diagnosis
• What is the spread of this condition
• How will you treat this condition (1+2+2+2+3=10) [2014-R]
OR
ii) A 16 years old boy brought to the casualty with severe spontaneous bleeding from the nose. He also
gives the history of progressive nasal obstruction for the past 6 months. Answer the following:
• Discuss the etiology(1+2+2+2+3=10) [2017-R]
OR
iii) A 13 years old boy came to the OPD with torrential bleeding from the right nasal cavity.
He gives a history of a similar episode of profuse, unprovoked bleeding from the right nasal
cavity 6 months back, when the bleeding stopped by itself. Post nasal examination revealed a
smooth, lobulated pink swelling blocking the choana. Answer the following:
• Discuss the etiopathogenesis of the condition
• Mention four relevant investigations and the expected findings in each
IMA MSN Kerala

• Discuss the treatment options for this patient [2021 S]
DRAW AND LABEL [2MARKS]

1.Draw a diagram of Waldeyer’s ring.[2020]
ANSWER BRIEFLY[2MARKS]
1.ADENOID FACIES [2015-R]
GIVE PRECISE ANSWERS [1 MARK]
1. Constituents of Waldeyer’s ring [2014-R]

2. Boundaries of pyriform fossa [2015-R]
3. Keratosis pharyngis[2018-S]
4. Boundaries of pyriform fossa.[2020]
7
TONSIL
Short Notes[3MARKS]
1. Vincent’s angina[2014-R]
2. Complications of tonsillectomy[2016-S]
3. Management of secondary hemorrhage following tonsillectomy.[2020]
Draw and label [2 MARKS]
1) BLOOD SUPPLY OF TONSIL

i) Draw a diagram showing the blood supply of tonsil[2016-R,2019-R]
OR
ii) Blood supply of palatine tonsil [2021-S]
2) TONSILLAR BED
i) Draw the diagram showing structures in tonsillar bed[2017-S]
ANSWER BRIEFLY [2 MARKS]

1) Complications of tonsillectomy [2014-R]
2) REACTIONARY BLEEDING FOLLOWING TONSILLECTOMY- CAUSES AND

TREATMENT
i) Reactionary hemorrhage following tonsillectomy-causes and treatment [2015-R]
OR
ii) Management of post-tonsillectomy reactionary hemorrhage [2019-S]
3)Cardinal signs of chronic tonsillitis [2018-S]
GIVE PRECISE ANSWER [1 MARK]
1. Four causes for white membrane over tonsil. [2015-R]

2. One antibiotic used in Acute Tonsillitis with its dosage [2018-R]
3. Two causes of membrane over palatine tonsil. [2021-S]
IMA MSN Kerala
8
Syncytium - ENT
LARYNX
Essay
1. CARCINOMA LARYNX
A 55 years old man presented with progressive hoarsness and neck swelling since two
months with stridor since one day. Answer the following:
• Describe the clinical features of this condition
• How will you investigate the condition
• How does the lesion spread
• What is the treatment of this condition [2014-S]
OR
A 55 years old man, known smoker and alcoholic came to the casualty with stridor. He
also gives a history of hoarseness for the last three months. Answer the following:
• What are the causes of stridor in an adult patient
• What are the investigations to be done in this patient and mention the expected find-
ings in each
• Discuss the treatment options for this patient [2020]
2. STRIDOR
Classify and enumerate the causes of stridor in a child. Discuss the etiology, clinical fea-
tures
and management of acute retropharyngeal abscess [2018-S].
OR
Mention about the differential diagnosis of sudden onset stridor and discuss about
the investigations & management. [2019-R]
Short Notes[3MARKS]
IMA MSN Kerala
1 Cartilages of larynx[2015-R]
2 Causes of stridor in children[2016-R]
3 Etiopathogenesis and clinical features of vocal nodule[2019-S]
4 Unpaired laryngeal cartilages[2021-S]
Answer Breifly [2MARKS]
1. Reinke’s edema[2014-R, 2017-R]

2. Puberphonia[2016-R]
3. Vocal cord polyp[2016-S]
4. Rhinolalia aperta[2017-S]
9
5. Cardinal Signs of Tuberculous Laryngitis[2018-R]
6. Functions of larynx[2019-S]
7. Rhinolalia clausa[2020]
8. Laryngomalacia[2016-S]
Give precise Answers[1MARKS]
1. Four causes for left recurrent laryngeal nerve palsy[2015-R]

2. Vocal nodule.[2015-S, 2017-R, 2019-R]
3. Ventricle of the larynx[2018-S]
TRACHEA
Short Notes[3MARK]
1. Complications of tracheostomy [2015-S, 2018-R]

2. Indications of tracheostomy [2018-S, 2021-S]
Answer Briefly[2MARKS]
1. Management of foreign body bronchus[2018-R]
OESOPHAGUS
Give Precise Answers[1MARKS]
1. Define plummer vinson syndrome [2015-S]
OR
Features of plummer vinson syndrome.[2019-R]
ORAL CAVITY AND SALIVARY GLANDS

Answer Briefly[2MARKS]
1. Oral sub mucous fbrosis[2015-S] IMA MSN Kerala
2. Pre malignant conditions of oral cavity[2020]
Draw and label[2MARKS]

1. Taste buds[2015-S]
Operative Surgery
Short Answers[3MARKS]
1. Septoplasty[2017-R]
2. Complications of adenoidectomy[2017-R]
10
Answer Briefly[2MARKS ]
1. Myringotomy[2015-R]
2. Cortical mastoidectomy[2015-S]
3. Modified radical mastoidectomy[2017-R]
4. Radical mastoidectomy[2020]
5. Complications of mastoidectomy[2021-S]
Give Precise Answers [1MARKS]

1. Four major complications of FESS[2014-S]
2. Four complications of SMR operation.[2016-R]
3. Four complications of septoplasty[2016-S]
APPENDICES
Short Notes [3MARKS]
1. Tracheostomy tubes.[2017-S]
Answer Briefly [2MARKS]
1. Laryngopharyngeal reflux[2018-S]
2. Portex tracheostomy tube[2014-S]
3. Boundaries of Trautmann triangle [2017 R]
CLINICAL METHODS
Give Precise Answer[1MARK]

1. Laryngeal crepitus [2017-R, 2019-S]
HEAD AND NECK SPACES INFECTIONS
IMA MSN Kerala

Short Notes[3MARK]
1. Retropharyngeal abscess[2015-R][SA SUB QUESTION 2018-S]

2. Peri tonsillar abscess[2016-R]
3. Para pharyngeal space[2016-S, 2018-R]
4. Ludwig’s angina[2019-S]
Answer Briefly
1. Quinsy [2021-S]
11
Syncytium - ENT

NOSE AND PARA-NASAL AIR SINUSES
1. Name four arteries supplying littles area
Anterior ethmoidal Artery
Septal branch of superior labial artery
Septal branch of sphenopalatine artery
Greater palatine artery
2. 4 surgical treatments for atrophic rhinitis

Youngs operation
Modified Youngs operation
Narrowing of Nasal Cavity.
Submucosal injection of Teflon paste
Section and medial displacement of lateral wall of nose
Insertion of fat, cartilage, bone or Teflon strip under the mucoperiosteum of the floor and
lateral wall of nose and the mucopericondrium of the septum
3. 4 causes for the bilateral nasal obstruction in a child

Nasal polyp
Congenital atresia of nares
Acute rhinitis
Allergic rhinitis
4. 4 complications of acute sinusitis

Osteitis osteomyelitis
Orbital Cellulitis or abscess
Meningitis
Fistula formation
Chronic sinusitis.
IMA MSN Kerala
5. Woodruffs plexus
It’s a plexus of veins situated inferior to posterior end of inferior turbinate
Its site of posterior epistaxis in adults
6. Function of turbinates
They warm the air we breathe
Humidify the air as it passes through the nose
Directing of air
Guard opening of sinues
Mucous layer of the turbinates assist in filtering the particles such as dust and pollen
Guard NLD and Hasners valve
7. Causes of rhinitis medicamentosa

• Topical deconyestant nasal drops cause rebound phenomenon
• Their excessive usage cause rhinitis
• Treatment- By withdrawal of nasal drops, Short course of systemic steroid therapy.
8. Antrochoanal polyp
• Arise from the mucosa of axillary maxillary antrum near its accessory
12
Comes out of it and grows in the choana and nasal cavity
• Cause nasal allergy coupled with sinus infection
9. Little’s area
Its present in the anterior part of the nasal septum, just above the vestibule
4 arteries
• Anterior ethmoidal A
• Septal branch of superior labial A
• Septal branch of sphenopalatine A
• Greater palative A
Anastomose here to form a vascular plexus ‘Kisselbachs plexus’
10. Two types of nasal bone fracture

Dispersed :
• Due to frontal blow
• Lower part of nasal bone which is thinner, easily gives way.
• Severe frontal bone = Open book fracture
Angulated:
• Lateral Blow
• Unilateral depression of nasal bone
• Fracture both nasal bone and septum with nasal bridge deviation
11. Two techniques to manage posterior nasal bleeding

• Posterior nasal packing
• TESPAL
12. Potts puffy tumor

• Its seen in osteomyelitis of frontal bone due to acute infection of Frontal sinus
• Pus may form externally under the periosteum as soft doughy
Swelling= Potts puffy tumor
Treatment- Large dose of antibiotics
Drainage of abscess
IMA MSN Kerala

Trephining of frontal sinus through the floor.
13. One antihistamine medication with its per dosage

Dimenhydrinate
25-50mg 4-6 hrs adult
Children 6-12 yrs 12.5-25mg 4-6 hrs
Children 4-6 yrs 6.25-12.5mg 4-6 hrs
Children and infants upto 4 yrs. Not recommended
Ear
1. Korners septum and its importance
• Mastoid develops from squamous and petrous bones
• The petrosquamosal suture may persist as a bony plate- the korners septum
Separating squamosal cells from deep petrosal cells
Surgically imp; - Cause difficulty in locating the centrum and deeper cells
- Lead to incomplete removal of diseases at mastoidectomy
13
Syncytium - ENT
2. Bats ear and how its corrected

• Abnormally protruding ear
• Concha is large with poorly developed antihelix and scapha
• Correction-Surgical after 6 years of age.
3. 4 causes of conductive hearing loss

• Meatal atresia
• Perforation of tympanic membrane
• Disruption of ossicles; trauma to ossicular chain
• Fixation of ossicles
4. Tympanic Plexus
Lies on promontory
Formed by ; Tympanic branch of glossopharyngeal and sympathetic fibres from plexus round the
internal carotid artery.
5. What is Schwarts sign and its clinical importance

A reddish hue seen on the promontory through tympanic membrane
• Indicative of active focus with increased vascularity
• Diagnostic indicator of otosclerosis.
6. What is false negative Rinne test?

• Seen in severe unilateral sensorineural hearing loss
• Patient does not perceive any sound of tuning fork by air conduction but responds to bone
conduction testing, this response to bone conduction is from opposite ear because of transcranial
transmission of sound.
7. Boundaries of facial rececs

• Also called posterior sinus
• Its depression in the posterior wall of lateral to the pyramid
IMA MSN Kerala
Bound- Medial: vertical part of VIIth N

Lateral: Chorda tympani
Superior:(Above) fossa incuslis
8. 4 causes of referred otalgia
Via Vth CN Dental-caries tooth, apical abscess

Oral cavity-Benign or malignant ulcerative lesions of oral cavity or tongue
Via IXth CN- Oropharynx- Acute tonsilitis, peritonsillar abscess
Base of tongue-Tb or malignancy
Elongated styloid process
Via Xth CN- malignancy or ulcerative lesions of vallecula, epiglottis
Via C2 and C3 spinal nerve- Cervical spondylosis, carve spine
14
9. 2 indications for cochlear implant
• Bilateral severe to profound sensorineural hearing loss
• Little or no benefit from hearing aids
10. 2 conditions producing positive Hennerberts sign

• Congenital syphilis
• Menieres disease
11. Grandinegos syndrome

• It’s the classical presentation in petrositis(intratemporal complication of otitis media)
• Consists of - External rectus palsy (VIth N palsy)
-Deep seated ear or retro- orbital pain (Vth N involvement)
-Persistent ear discharge
12. Boundaries of Mac-Ewans triangle

• Temporal line
• Posterior superior segment of bony external auditory canal
• Line drawn as a tangent to external canal.
13. tympanometry showing normal middle ear function

Page no :27 diagram
14. Griesinger’s sign

It is oedema over the mastoid and is seen in lateral sinus thrombosis. It is due to
thrombosis of mastoid emissary vein impending venous drainage and thus causing oedema over
the mastoid .
15. Rinne’s test: clinical test of hearing

• Air conduction of ear is compared with its bone conduction. (method)
• Rinne’s test is called positive when AC is longer or louder than BC – Normal person/sen-
sory neural hearing loss.
• A negative Rinne’s test BC>AC – conductive deafness
16. Functions of cerumen

• Protective function
IMA MSN Kerala
• Lubricates the ear canal.
• Entraps any foreign material that happens to enter the ear cannal.
17. tympanometry finding in serous-otitis media

Page no: 27 diagram
18. 2 features of tuberculosis otitis media

• Painless ear discharge
• Perforation
19. Treacher Collins syndrome

• Mandibulofacial dysostosis
• Congenital disorder – AD inheritance
Features: coloboma of lower lid
Microtia pinna and meatal atresia
Malformed and malleus and incus
15
Syncytium - ENT
PHARNYX
1. Constituents of Waldeyer’s ring
• Nasopharyngeal tonsil or the adenoids
• Palatine tonsils or simply the tonsils
• Lingual tonsil
• Tubal tonsil( in fossa of Rosenmuller)
• Lateral pharyngeal bands
• Nodule (in posterior pharyngeal wall)
2. Boundaries of pyriform fossa

• It lies on either side of the larynx and extend from pharnyngoepiglottic fold to the upper
end of oesophagus
• Lateral: thyroid membrane and cartilage
• Medial: aryepiglottic fold, posterolateral surfaces of arytenoid and cricoid cartilages.
3. Keratosis pharyngis
• Benign condition characterised by horny excrescences on the surface of tonsil ,pharyngal
wall or lingual tonsils appearing as white or yellowish dots.

Excrescences:
results due to hypertrophy and keratinisation of epithelium
Does not require any specific treatment
TONSIL
1. 1 antibiotic used in acute tonsillitis with its dosage
Penicillin for 10 days
2. 10 cause of membrane over tonsil - use mnemonic “AL VITAMINS”

IMA MSN Kerala
Diphtheria
Vincent angina
Membranous tonsillitis
candiditis
Leukemia
Aphthous Ulcer
Infectious Mononucleosis

LARNYX
1. 4 causes for recurrent laryngeal nerve palsy
• Thyroid disease
• Thyroid surgery
• Accidental trauma
• Cervical lymphadenopathy
2. Vocal nodules
• Singer’s or screamer’s nodule
• Symmetrical
16
• Position ;free edge of vocal cord ,junction of ant 1/3 and post 2/3
• Results due to vocal trauma –speaks in unnatural low tone for prolonged period
3. Ventricle of the larynx

• Sinus of larynx
• Deep elliptical space b/w vestibular and vocal folds ,also extending a short distance
above and lateral to vestibular fold
OESOPHAGUS
Plummer Vinson syndrome
• Features: dysphagia, iron deficiency ,glossitis ,angular stomatitis ,koilonychia, ach-
lorhydria
• There is atrophy of mucus membrane of the alimentary tract – barium swallow ->
web(post cricoid region) esophagoscopy also
shows web appearance.
• Affects females> 40 years
• t/t : anaemia corrections oral parental iron
B12 and B6 deficiency should be corrected
Dilation of webbed area of oesophageal bougies
Operative surgery
1. 4 major complications of FESS
• Orbital haemorrhage
• Loss of vision
• Diplopia
• CSF leak ,meningitis
2. 4 complications of SMR operation

• Bleeding
• Septal abscess
IMA MSN Kerala

• Perforation
• Septal hematoma
3. 4 Complications of septoplasy
• Bleeding
• Septal hematoma and abscess
• Septal perforation
• Supratip depression
Clinical methods
1. Laryngeal crepitus
It is felt by examiner when the larynx is moved from side to side with a slight posterior
pressure.
When absent, it is a clinical sign of mass in the retropharyngeal space or hypopharnyx.
17

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SYNCyTIUM 3rd year MBBS Companion

An Initiative by IMA MSN Kerala

* This is an interactive PDF, Tap on any of the blue

Adithya Krishna Shaji

Alenta Merin Babu

[Pushpagiri Institute of Medical Sciences] - Ophthalmology

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Concept of Health and Occupational Health &

Short Note - 4 Marks

Nutrition and Health

Short Note - 4 Marks

Dermography and Family Planning

Short Note - 4 Marks

Environment and Health

Short Note - 4 Marks

Medicine and Social Sciences, Communication

1. Social classification based on occupations has limitations. [2015 R]

Occupational health and Genetics

Short Note - 4 Marks

1. Occupational hazard [2020 R]

1. Pre-employment medical check and periodic medical check [2014 S]

1. Benefit under ESI Act [2017 R & S]

Short Note - 4 Marks

1. Measures of dispersion [2015 R]

Principles of Epidemiology & Epidemiological methods,

Sunaina is a recent MBBS graduate who is working as a medical officer in a primary

2. Sanjana is a recent MBBS graduate who is working as a medical officer in a primary

i)What type of study design should she use

ii)How will you manage the case? [2017 R]

Short Note - 4 Marks

1. Bradford Hill’s criteria for judging causality [2018-R]

1. Infection and infestation [2014-R]

6. Incidence and prevalence of a disease. [2016-R, 2018-R]

1. Immunization against killer diseases of the childhood is cost effective. [2014-R]

RCH and Health of Elderly

1. Causes of infant deaths in India [2018-S]

1. Demand feeding and exclusive breastfeeding [2017-R]

1. Exclusive breastfeeding is imperative for the young infant. [2014-S]

1. Beneficiaries under the integrated child development services scheme [2018 R]

Short Note - 4 Marks

1. Drugs used in category II of tuberculosis treatment

Principles of epidemiology and epidemiological methods

1. Steps in case control study

2. Steps in cohort study

3. Uses of mass screening

4. Importance of carrier state

6. host factor in morbid condition

7. Criteria for judging casualty

8. Components of an epidemiological hypothesis

9. Objectives of descriptive epidemiology

10. Indirect transmission of infectious disease

11. Measures of evaluating a screening test

12. Direct transmission of infectious disease

13. Types of screening

1. Advantages of dietary fibre

2. Iodine deficiency disorders

3. Nutritional status assessment methods in children

5. Test for Pasteurization of Milk

Demography and family planning

1.Stages of demographic cycle