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A. Written paper: 60 marks (paper I 60 + papers II 60 = 120 marks)
General concepts of health & disease,
Disease screening
Epidemiology of communicable (including childhood diseases like ARI, diarrhoea, VPDs) &
non-Communicable diseases
Health information
Environmental health
Disaster management
Maternal & child health
Nutrition & health
Social & behavioural sciences as relevant to community health
Occupational health
Health education & communication including counseling
Health planning & management
Health care delivery.
B. Viva: 10 marks
C. Practical: 30 marks
i. Epidemiological exercise = 5 marks
ii. Statistical exercise = 5 marks
iii. Problem solving exercise = 10 marks
iv. Project work = 5 marks
v. Family study exercise = 5 marks
D. Internal assessment: 40 marks (theory 30+ practical 30)


Group A
1. What are the characteristics of ideal indicator? Enumerate the morbidity indicators. Describe briefly the Infant
mortality rate and case fatality rate.
2. Enumerate diseases under National Vector Borne Disease Control Programme (NVBDCP). Write down a brief
note on integrated vector control. Describe in brief the national drug policy 2014 on Malaria.
1. Enlist the types of epidemiological studies. Discuss the importance of incubation period in epidemiological
studies. Describe different time trends in disease occurrence.
2. Name two important chemicals of health significance present in ground water of West Bengal. Describe in brief
the health effects and control measures of any one.
1. Epidemiology. How can you estimate the disease risk in a case control study? What are the biases in case control
study including the process of elimination as applicable.
2. Enumerate the levels prevention and different modes of intervention in each level. Discuss the levels of
prevention in context to diabetes.
1. What do you mean by indicators of health? Write down the different disability rates with example. What is the
concept of disability limitation?
2. Discuss in brief the strategies under the National Vector Borne Disease Control Programme (NVBDCP) for
prevention and control of vector borne diseases. Write down general guidelines for treatment of uncomplicated
malaria as per National Drug Policy on malaria 2013
1. Describe the salient features of different types of time trends in disease occurrence with suitable examples. What
are the different possible changes that you should keep in mind while interpreting time trends.
2. Describe the natural history of disease. Discuss briefly the different levels of prevention and modes of
intervention as applied to pulmonary tuberculosis.
1. What do you mean by multifactorial causation of disease? Describe with suitable examples.
2. What is sampling? What are the different types of sampling? Describe them briefly with their advantages and
1. What are the different types of epidemic? How will you investigate an epidemic of fever in a block?
2. What are the risk factors of coronary heart disease (CHD)? Discuss preventive strategies of CHD.

1. Enumerate the determinants of health. How do socioeconomic conditions act as one of the determinants of health?
2. Enlist major causes of blindness in India. Outline the strategies adopted for control of blindness under National
1. Define epidemiology. Enlist the different epidemiological studies. Explain briefly the merits and demerits of case
control and cohort studies.
2. Illustrate how the levels of prevention and the modes of intervention can be applied in poliomyelitis.
1. Define epidemiology. Classify epidemiological studies. Mention briefly the important differences between case
control and cohort studies.
2. Enumerate the cancers most commonly found in India. What are the early warnings signs of cancer? Describe
some preventive measures of cancer cervix.
1. Define screening. How does it differ from diagnostic test? Describe the criteria of screening.
2. Enumerate different modes of intervention under levels of prevention. Discuss. in brief, the levels of prevention
in relation to leprosy.
1. Enumerate the functions of primary health centre. What are the services provided by subcentre?
2. Mention the causes and detrimental effects of nutritional anaemia. Describe the measures undertaken to combat
anaemia among adolescents according to national programme.
1. Enumerate the objectives of school health pregremme. Briefly mention the different components under the
2. Enlist the disorders caused by iodine deficiency. What are the strategies to control iodine deficiency in India?
1. Define malnutrition. How will you assess the quality of protein? Name the nutritional programme currently
available in India. Discuss any one of them.
2. What are the eligibility criteria for enrolment in ESl Scheme? Write in brief the benefits available under ESI
scheme during and after working tenure. What are the services available under medical scheme?
1. What do you mean by essential obstetric care? What are the services delivered under essential obstetric care
according to RCH-II programme? What is the importance of maternal death review?
2. Define ‘Factory’ under Indian Factories act 1948. Write in brief the provisions recommended in Indian Factories
Act 1948 to protect health of workers.

1. Define maternal mortality ratio and maternal mortality rate. Describe the important cultural and social factors
affecting infant mortality.
2. What are the health problems of adolescent? Mention the national programs concerning improvement of
adolescent health. Outline the important health educational messages for benefit of an adolescent girl.
1. Enumerate different components of ICDS programme.
2.Name the types of occupational hazards. Describe the different medical measures to prevent occupational
1. Enumerate the 4 major nutritional problems in India. Discuss in brief, methods of nutritional assessment of Under-
5 children in a community.
2. Discuss the 3-tier system of Health Care Delivery in your state. What are the reforms made to give better service
to people? Discuss the role of PPP in efficient delivery of health services.
1. Enumerate the principles of primary health care. How is it delivered in rural India?
2. What is malnutrition? Discuss its prevention strategies in terms of different levels of prevention.
1. Enumerate types of family. Describe the stages of family cycle. Discuss the role of family in health and disease.
2. Define ergonomics. Discuss the importance of preplacement examination with suitable examples
1. Define social security. Discuss briefly any one social security measure in India.
2. Enumerate fertility indicators. What do you mean by NRR = 1? Write in brief advantages and disadvantages of
contraceptive methods which an eligible couple should adopt in different phases of their reproductive life to achieve
‘small family norm’
1. What is pneumoconiosis? Enumerate the different types of causative factor for the respective type of
pneumoconiosis. Enumerate the benefits provided under ESI Act. Describe one benefit under ESI Act which is
relevant to pneumoconiosis.
2. How RCH programme differs from CSSM programme? Describe briefly the package of services under RCH Programme.


1. A 35 years sedentary obese man with smoking habit is found to have blood pressure of 126/100 mm. of Hg. How
will you classify this blood pressure? Describe the management with special emphasis on diet of the person.
2. In a block several cases of Dengue are reported for last one month. How Dengue can be diagnosed? What
measures do you like to suggest for its control and prevention?
3. Many school students in your block are found suffering from reduced ability to see the board-work by the teachers
in class room. As BMOH, how will you manage the situation?
1. A sputum positive pulmonary TB patient was found sputum smear positive after 5 months of treatment with
category 1. What is your inference about the case? What is the next line of management as per RNTCP?
2. A six month old child was brought by the mother at OPD, presented with loose stools for more than three times
and vomiting from last night. On examination. the child was found restless and drinking eagerly. Classify diarrhoea.
Outline the management. What information you want to make the mother aware of the situation?
3. Significant no. of cases of jaundice was reported from an urban locality. As a public health expert how will you
investigate it and what remedial measures will you suggest for the problem?
1. Mention the modes of transmission of HIV/AIDS. Explain the role of high risk group in HIV transmission.
Outline the strategies undertaken in National program to reduce transmission from high risk group.
2. A recent public demonstration has occurred in a Block primary health Centre about the disposal of biomedical
waste contaminating water body by the side of the hospital. As a BMOH of that hospital, what measures would you
like to adopt for proper waste management of your hospital.
3. In Kolkata and its suburbs, a few cases of dengue are being reported for last one month. How dengue can be
diagnosed? What measures do you like to suggest for its control.
1. What do you mean by essential hypertension? What is its prevalence in lndia? What are the risk lactors for it?
What preventive measures should you take to reduce prevalence and complication due to hypertension?
2. What do you mean by disaster? What are the common causes of disaster? As a BMOH of a cyclone prone
block how will you proceed for preparedness to tackle the impending disaster in your block?
3. After having dinner with fried rice, egg curry and salad in a hostel, 20 students complained of vomiting and
diarrhoea at midnight and another 15 students reported the same complaints in the morning. How will you
investigate the outbreak and take control measures?
1. Rising trends in the occurrence of diabetes has been observed throughout lndia. Describe the epidemiological
determinants of diabetes. Describe the methods of primary prevention of type 2 diabetes.
2. A person was bitten by a dog in the street. The bite was single and on the face. What is the category of bite?
Outline the management of the case. What is pre-exposure prephylaxis?
3. What are the functions of a BPHC? Mention the national programs under a BPHC. What is ‘Record linkage and
what is ‘Tracking of Beneficiaries’ under MCH care?


1. Describe shortly the epidemiology and clinical presentation of dengue fever. Write the measures to be taken to
control dengue outbreak in a town.
2. What are the early signs of cancer? Describe in brief the epirlmnlnlngy of oral cancer and its primary levels of
3. Define ‘Safe and Wholesome water’?. Discuss the different tests for the bacteriological surveillance of drinking
1. A man comes to your health centre with lacerated injury of both legs caused by the bite of a dog about an hour
ago. Discuss steps of management. Suggest measures for minimising the risk of human rabies in the area.
2. Name the different types of waste generated in your hospital. Suggest measures for their safe disposal as per
national and state level rules. What is the importance of waste tracking?
3. Immunisation rate in your district has fallen to 50%. How would you investigate to find out the reason? How
would you concurrently try to increase the immunisation rate?
1. A 2 year old child presented with history of frequent passage of loose stool for 2 days, irritability, excess thirst
and skin turgor going back slowly. Classify the condition with proper justification in accordance with national
programme guidelines. Outline the management of the child.
2. A 30 year old man, attended OPD with more than 5 hypopigmented patches on different parts of the body. Write
down the diagnosis. Outline the management of the case as per National guideline.
3. Enumerate different health hazards likely to occur during and following flood. As a BMOH, describe your
preparedness plan to mitigate such hazards in future.
1. A 25 year old man reported in medical OPD with high fever, chills and retroorbitai pain. Outline the diagnosis,
case management and community intervention as per national guideline.
2. A 10 years old child reported with dog bite on call region in casualty OPD within 2 hours of bite. As CMO
suggest measures to prevent rabies in this child.
3. A 7 days old baby is brought to your CPU with excessive cry, refusal of feeds and convulsions. Discuss the
diagnosis, case management and preventive strategies as per national immunisation program.
1. Your BPHC is situated by the side of a busy highway. Cases of road traffic accidents are common. Describe the
measures you would take as BMOH to reduce the problem.
2. Give a brief account of epidemiology of kalaazar. Briefly outline the strategies of control of kalaazar. Enumerate
the causes of resurgence of kala-azar.
3. A child bitten by a street dog on hands and fingers was brought to the casualty ward of medical college with’n an
hour of bite. As a MOI/C what measures will you suggest to prevent rabies in this case?
1. The BMOH reported large number of cases clinically suspected to be Dengue. He also referred two cases to
district hospital and suspected an outbreak has occurred. As a BMOH how will you investigate and control the
2. What are the danger signals of cancer? Outline the epidemiology of oral cancer and methods of its prevention in to community.

3. A 2 years old child with history of passing watery stool every 2-3 hours, who is restless with dry mouth a sunken
eyes has been brought to the subcantre. How the health worker assess, classify and manage the case? What advice
should give to the mother for prevention of occurrence of such condition in future?
Paper II
1. A 28 years old mother with children aged 4 year and 1 year, has come to you for family planning advice. Describe
different methods of contraception that can be offered to her with merits and demerits.
2. Describe different types of Pneumoconiosis. As a medical officer of a coal mine, what measure you like to adopt
to prevent Pneumoconiosis?
3. A recently delivered (2 weeks back) mother has come for check up. Mention the components of post natal check
up. What might be the post natal complications? What measures can be taken to improve post natal care at
community level?
1. What is balanced diet? Enumerate different nutritional problems prevalent in lndia. How primary prevention
plays an important role in prevention of protein energy malnutrition.
2. In a block of West Bengal recent statistics showed lower rate of institutional delivery, As a health administrator
of the block what measures you like to adopt for improving institutional delivery of your block.
3. Enumerate different methods of diet survey. Briefly describe the methods you have applied to assess the
nutritional status in your ‘Family programme’.
1. What do you mean by neonatal mortality? Why it is so important? Write in brief the components of Essential
New-born Care with special reference to breastfeeding.
2. What are the average populations catered in relation to health -in a village. subcentre, PHC, BPHC or CHC? Who
serves at the level of subcentre? What are the activities carried out at BPHC/CHC?
3. Immunisation drop outs and left outs are found to be quite high for consecutive years in a block. Mention the
possible reasons and outline the measures that can be adopted by the health administrator in that block to improve
the situation.
1. Define sex ratio. What are the factors behind decline sex ratio in India? What are the measures adopted to correct
the situation?
2. Write the national sociodemographic goals for 2015? Outline the steps for evaluation of family Planning
3. Define ‘Low Birth Weight’. What is its prevalence in India and the target to achieve? What measures would you
like to adopt as BMOH to reduce the Low Birth Weight in your block.
1. Cases of AEFl are being reported from subcentres of a block. Due to apprehensions among people, dropouts for
immunisation are also increased. How the AEFl are classified mention with examples. Describe important health
managerial functions / measures need to be undertaken to address and overcome the problem in that block.
2. Many cases of silicosis were reported from a pottery and ceramic industry. As an industry health officer, what
measures will you recommend for prevention and control of the problem?


3. In a block of Nadia district the couple protection rate is much less in comparison to neighbouring blocks. What
are the social causes of poor couple protection rate and what measures you will take up as a BMOH to improve the
1. Mention the packages of services under RCH programme. Outline as to how the services are provided through
different levels health care facilities available in a block.
2. In a block 40% of eligible couples are protected by modern contraceptive methods. As BMOH outlines the
interventions to improve the situation.
3. Maternal mortality ratio in a block is found to be persistently high. As a BMOH outline the :
i. Investigation procedure to find out the causes of maternal mortality and
ii. Interventions to be adopted to reduce the MMR.
1. There is sudden rise of infant mortality in a block. What are the measures you would like to adopt to reduce lMR
in the block?
2. Enumerate the different vector borne diseases. Describe the principle of vector control programme according to
existing national control programme.
3. What is a disaster? What are the different aspects of disaster management. Outline the management aspects of
disaster impact in a flood prone area.
1. Percentage of fully immunised children is very low while drop out and left out rates are unexpectedly high in
your block. What measures you will adopt as a BMOH to improve the situation.
2. Proportion of institutional delivery is very low in your district. There is also poor utilisation of JSY, referral
transport and Ayushmati Scheme. What steps you would like to take as a CMOH to improve the situation?
3. Define health education. How it differs from BCC? Briefly outline the different health educational measures to
prevent cervical cancer in a block as a BMOH.
1. IMR is high in your block. As a BMOH suggest measures to improve the situation.
2. Prepare an action plan to conduct an IEC campaign in your block to reduce anaemia among pregnant women.
3. Enumerate different types of food toxicants. Suggest measures to control epidemic dropsy in your area.
1. Proportion of LBW babies in your block is very high. As a BMOH, what action will you take to tackle the
2. Outline your plan of action as BMOH to reduce the health hazards due to flood in your flood prone block.
1. A 25 year old mother with 2 children aged 5 year and 1 year, has come to the OPD for family planning advice.
Discuss different methods of contraception that can be offered to her with merits and demerits.
2. Few cases of NNT is reported from a block of a district. As BMOH what measures will you take to prevent its
further occurrence?
3. Large no. Of PEM cases among Under 5s have been identified in your block. What social factors are responsible
for it? Name the nutritional programmes currently available in India. Describe briefly any one of them.

Vaccination in disaster.
Indoor air pollution.
Sanitation barrier.
Multiphasic screening
Modifiable risk factors of hypertension
Types of ventilation
Bacterial indicators of drinking water quality
Cancer registry
Laboratory network under RNTCP
Triple blinding in epidemiological studies
Measures of dispersion
Types of sampling
Health hazards of ionising radiation
Bacteriological surveillance of water quality
Principles of biomedical waste management
Preventable blindness
Preventive services offered by your medical college and hospitals
Disaster preparedness
Principles of chlorination of water
lntradermal rabies vaccination
Biological treatment of sewage
Normal curve
Statistical averages
Chemotherapy of multibacillary leprosy
Integrated vector management
Interpretation of false negatives of a screening test

Human development index
Hazards of noise pollution
Sanitary land-fill
Sources of health information
Standard normal curve
Hepatitis B vaccine
Water-borne diseases
Biological transmission of disease
BCG vaccine (Bacille Calmette and Guerin)
Indicators of air pollution
Quality of life
Risk factors of diabetes
Biological transmission
Disaster preparedness
Family physician.
Standard Normal curve.
Sources of health information.
Indian Redcross
Endemic fluorosis
Social stress
Pasteurisation of milk
Principles of primary health care with examples
Facility based newborn care
Food safety

Role playing
Geriatrics health problems
Juvenile delinquency
Social mobilisation
Modifiable risk factors of hypertension
Non-government organisation
Sickness absenteeism
Village health and nutrition day (VHND)
Juvenile delinquency
Central government health scheme
Health problems of geriatrics
Measures of dispersion
Health insurance scheme
Child labour
Pre-placement examination
Spectrum of iodine deficiency disorders
Unmet need for family planning
Voluntary health agencies
Principles of primary health care
Common home made oral rehydration solutions
Healthy life styles
Channels of communication
Health problems of geriatrics
Elements of primary health care
Indian Redcross
Interpretation of ICDS growth chart
Intersectoral coordination

Injection safety is important for the recipient, provider and community – Justify.
Zinc is given with ORS in treatment of ‘Diarrhea’- justify.
Data carry little meaning when considered alone.
Screening and diagnostic test differ.
Sterilisation and disinfection are not synonymous.
Majority of blindness can be prevented Explain.
Biomedical waste should be segregated at source.
Carriers though less infectious are epidemiologically dangerous.
Quarantine and isolation are not synonymous Explain.
Triage approach can provide maximum benefit in disaster situation-justify.
Integrated vector control management is the most effective method of vector control justify.
The census is an important tool of health information explain.
Cohort studies are not always prospective Explain.
Screening test and diagnostic test are not synonymous Justify.
Sputum smear examination is the method of choice for case finding in TB Explain.
BMI is the best of all indices of obesity.
ICTC should be supported by ART/Link ART centre Explain.
Prioritisation is an important step in health planning Explain why?
Sensitivity and specificity of a screening test is inversely related -justify.
For small sample median is a better measure of central tendency than mean, why?
Screening and case finding are not synonymous Explain.
Carriers are more dangerous than cases -justify.
Overcrowding can influence health -justify.
Hepatitis B infection should be considered more dangerous than HIV infection Justify.
All influenza pandemics were caused by influenza virus A and not by B or C Explain.
Lung cancer can be controlled by primary preventive measures justify.
RNTCP gives priority on detection of new smear positive cases Explain.
WHO definition of ‘Health‘ has defects Explain.

HIV is a behavioural disease explain.
Vitamin A supplementation is necessary after measles infection-give reasons.
AEFI include events beyond side effects of vaccines explain.
Sanitation barrier aims at breaking the transmission cycle of faecal-borne disease explain.
Role of pretest counselling for HIV/AIDS is useful explain.
Sentinel surveillance of disease is better than periodic mass screening explain.
Carrier stage of a disease is not amenable to control explain.
Role of IPV in polio eradication.
Submerged part of the disease ice-berg has immense importance to an epidemiologist explain.
Syndromic management of STD is the most appropriate approach in India justify.
Carriers are more dangerous than cases justify
lndia is yellow fever receptive area Explain.
The tem source and reservoir are not always synonymous explain with suitable example.
Live vaccines are more potent immunising agent than killed vaccine Explain.
Discuss health hazards of immunisation.
Discuss active surveillance in malaria.
Cost effectiveness analysis is best suitable than cost benefit analysis in health sector.
ORS is an example of appropriate technology.
Family performs many functions: Explain.
Parboiled rice is nutritionally superior to milled rice.
Supplementary and therapeutic nutrition are different
FRU can reduce MMR -Explain
Importance of genetic counselling in preventing genetic disorders.
Use of auto-disable syringe in national immunisation programme has several advantages.
Prioritisation is an important step in health planning Justify.
Community participation is essential for success of a health programme.
India is in third stage of demographic cycle-explain.
Significance of a false positive screening test.

Feedback is very important in health planning.
Apart from growth monitoring growth chart has many other uses -explain.
Primordial prevention is a subset of primary prevention justify.
NRR is regarded as a superior method to GRR for measuring population growth -justify.
Social security measures have a great role in preventing health problem explain with examples.
Accessibility cannot be equated with acceptability of health services justify.
Explain why family is considered as an epidemiological unit.
Population pyramid is important for public health.
Food additives and food adulteration are not synonymous Explain.
Interpersonal communication is better than mass media for advocacy purpose Explain.
’Equittable distribution of health services” an important principle of primary health care justify.
Cost effective analysis and cost benefit analysis are not synonymous -explain.
Cangaroo care.
Short term high dose of Vit. A is useful for prevention of xerophthalmia.
lDD is a social and preventable problem.
Fluorine is often called two-edged sword Explain.
Revised lCDS growth chart currently in operation differ from the earlier one -explain.
Parboiled rice is nutritionally superior to milled rice explain.
Prioritisation is an important step in health planning Explain why?
Periodical examination is effective in prevention of occupational diseases justify.
ASHA links health care delivery with community -Explain.
Networking with voluntary health agencies play an important role in health care delivery
Institutional deliveries can reduce maternal mortality to a great extent explain.
Growth chart can play multiple roles explain.
FRU will reduce MMR Explain.
Subcentre is considered as pivot of health care delivery system in rural areas Explain.
Use of growth chart is a quick methodology for identification at under nutrition justify.
Management consists of four basic activities explain.
Problems at industrialisation.
Different aspects of school health service
Medical care and health care are not synonymous.
Primary health care is basically the responsibility of the state.




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Marks Distribution
Total Marks 100 Pass Marks 50
Theory: 40 Marks
Pre & Para clinical subject
Group A Long question (No alternative): 10 Marks
Operative and Clinical question
Group B Short notes (Two out of three): 10 (5×2) Marks
Group C Long questions (One out of two): 10 Marks
Group D Short notes (Two out of three): 10 (5×2) Marks
Oral: 10 Marks
[Oral questions, Instruments, X-ray & other imaging]
Practical: 30 Marks
[Long case, Short case]
Internal Assessment: 20 Marks


Sorted Questions

1. Describe the anatomy of lacrimal apparatus with a labelled diagram. Enumerate the causes of
watering of eye. [2018]
2. Describe a schematic diagram of pupillary light reflex. Mention the drugs acting on pupil.
3. Describe anatomy and physiology of lens. What is mechanism of accommodation? [2016]
4. Discuss the theories of Aqueous Humour formation, circulation and drainage. [2015]
5. Describe the anatomy of the upper eyelid with a labelled diagram. [2014]
6. Describe the anatomy of physiological lens. What is the mechanism of accommodation?
7. Describe the pathway of light reflex with diagram. [2012]
8. Describe the anatomy of conjunctiva. [2011]
9. Discuss pupillary reactions with special reference to their basis and clinical significance.
10. Describe the origin, insertion, nerve supply and action of extra ocular muscles. [2009]


1. Describe symptoms, signs and management of acute attack of angle closure glaucoma. [2018]
2. A 65 years old patient presented with gradual painless dimness of vision in both eyes during
last 2 years. Discuss the differential diagnosis and management. [2018] {Hint: D/D- Senile
cataract, POAG, Age related macular degeneration, Diabetic retinopathy, Presbyopia, Degenerative
myopia, Retinitis pigmentosa}
3. What is Keratoplasty? What are types? How will you collect the donor cornea and how will
you preserve it? [2017] {Hint: Keratoplasty = Corneal transplantation}
4. Enumerate the postoperative complications of cataract surgery. Briefly outline the treatment
of any one of them. [2017] {Hint: Most common late complication of ECCE is posterior capsular
5. What is chronic dacryocystitis? Describe the steps of dacryocystorhinostomy. [2016] {HintDacryocystitis = inflammation of lacrimal sac}

6. How do you prepare a patient before cataract operation? How to predict the outcome of
cataract surgery? [2016]
7. Describe in brief the management of a case of a bacterial corneal ulcer. How would you treat
a non-healing ulcer? Enumerate the complications of corneal ulcer. [2015]
8. What are causes of seeing rainbow halo around light? Describe the management of one such
case having severe pain in the eye. [2015] {Hint: Causes of rainbow halo include Angle closure
glaucoma, Immature cataract & Mucopurulent conjunctivitis; out of these acute attack of angle closure
glaucoma is extremely painful}
9. Enumerate the possible causes of sudden painful dimness of vision in a 35 years old female
patient. Briefly discuss the signs, symptoms and management of any one of the cause. [2014]
{Causes include Acute attack of angle closure glaucoma, Acute keratitis, Acute Iridocyclitis, Orbital apex
syndrome, Chemical or thermal burn etc.}
10. A 7 years old boy was hit by a cricket ball in one eye. Enumerate possible damage in each of
the ocular structures expected in such a case. Describe the options for treatment to each
injury. [2014] {Hint: Blunt trauma}
11. A patient comes with Rainbow haloes. How do you diagnose the case? [2013] {Hint:
Differentiated by Fincham’s stenopaeic slit test, irrigating discharge etc.}
12. Enumerate the causes of night blindness. Write down the clinical features and management of
Vitamin A deficiency. [2013] {Hint: Causes include Vitamin-A deficiency/ xerophthalmia, Retinitis
pigmentosa, High myopia, Open angle glaucoma, Nuclear cataract etc.}
13. What are the causes of red eye? Write in brief about their differential diagnosis with
management. [2012] {Hint: Causes of red eye include Conjunctivitis, Keratitis, Acute iridocyclitis, Acute
angle closure glaucoma, Episcleritis, Scleritis, Subconjunctival haemorrhage etc.}
14. Describe the effect of blunt trauma on the eye. [2012]
15. Same as 8. [2011]
16. Describe the signs, symptoms and management of acute iridocyclitis. [2011] {Hint: Iridocyclitis
= anterior uveitis}
17. How would you diagnose a case of open angle glaucoma and follow up such a patient? [2010]
18. Write down the causes of gradual painless loss of vision and their management. [2009]
19. What is intraocular pressure? Mention conditions where intraocular pressure is low. [2009]
{Hint: Causes of hypotony include Chronic uveitis, Recent penetrating injury, Wound leak, Post-surgical
(e.g. trabeculectomy), Choroidal detachment, Retinal detachment etc.}



1. Myopia [2015, 2009], Pathological Myopia [2014, 2011], Treatment of myopia [2018]
2. Hypermetropia [2012]
3. Presbyopia [2017]
4. Vernal Conjuctivitis [2011], Clinical features of vernal keratoconjunctivitis [2013]
5. Phlyctenular conjunctivitis [2017]
6. Red eye [2010]
7. Pterygium [2015], Management of recurrent pterygium [2017]
8. Bacterial Corneal Ulcer [2012]
9. Hypopyon corneal ulcer [2016]
10. Removal of corneal foreign body [2013]
11. Paracentesis [2016]
12. Indications of keratoplasty [2009], Eye banking and keratoplasty [2015]
13. Staphyloma [2016, 2012]
14. Keratic precipitates [2018, 2009]
15. Endophthalmitis [2018]

16. Panophthalmitis [2014]
17. Evisceration [2014, 2012]
18. Hypermature cataract [2009], Morgagnian Cataract [2011]
19. Capsulotomy in cataract extraction [2011]
20. SICS [2013]
21. Biometry [2018, 2012]
22. Early postoperative complications following cataract surgery [2009]
23. Posterior capsular opacification (PCO) [2017]
24. Buphthalmos [2017]
25. Field changes in Primary Open Angle Glaucoma [2015]
26. Phacolytic glaucoma [2016]
27. Trabeculectomy [2014]
28. Vitreous haemorrhage [2010]
29. Diabetic Retinopathy [2011]
30. Retinoblastoma [2016]
31. Enucleation [2018, 2011]
32. Binocular Vision [2013]
33. Management of estropia in a 2 year old [2010]
34. Entropion [2013]
35. Symblepharon [2014]
36. Epiphora [2015]
37. Syringing of the Lacrimal passage [2012]
38. Acute Dacryocystitis [2013]
39. Symptoms, signs and management of a case of chronic dacryocystitis [2010]
40. Dacryocystorhinostomy [2009]
41. Alkali burn of eye [2018]
42. Anti-glaucoma drugs [2016]
43. Side effects of topical corticosteroids [2010]


44. Use of laser in eye [2014]
45. Nutritional blindness [2017]
46. Vision 2020 [2015]
47. Various methods of determination of visual acuity [2010]

N.B. Chapter division is based on “Comprehensive Ophthalmology by A K Khurana”




Click in this link below to download.

Download PDF

Marks Distribution



Group A Pre and Para Clinical Subjects (No Alternative) – 10 Marks
Group B Problem Based Question (One out of Two) – 10 Marks
Group C Short Notes (Two out of Three) – 10(5×2) Marks
Group D Answer in Brief (Two out of Three) – 10(5×2) Marks
[Flying Oral, Instruments, X-Ray and Other Imaging]
[One Long Case, One Short Case]



Questions –

For Group A & B

1. Describe anatomy of the Middle Ear Cavity. [2009]
2. What is middle ear cleft? Describe the anatomy of medial wall of the middle ear with
diagram. [2013]
3. Describe the anatomy of medial and posterior wall of middle ear. Describe the
relation of facial nerve in medial and posterior wall. [2011]
4. A middle aged male reported with bilateral conductive deafness with intact tympanic
membrane. How will you diagnose and manage the case? [2016]
5. Describe the etiology, clinical features and management of acute suppurative otitis
media. [2018]
6. Describe the aetiopathology, clinical feature, management of otitis media with
effusion. [2014]
7. Define Cholesteatoma. Describe the pathogenesis and management of the C.S.O.M.
with cholesteatoma [2017]
8. A middle aged patient presents in the ENT OPD with intermittent mucopurulent
discharge from one ear. How will you investigate & treat the case? [2015]
9. Describe the intratemporal course of the facial nerve. Enumerate the intratemporal
branches of the facial nerve and their site of origin. What is Bells Palsy? [2018]

10. A 65 years old male presents with pain in Right Ear. How will you investigate the
case? [2014]
11. Describe the lateral wall of the nose. Mention its surgical importance. [2015]
12. Describe the anatomy of Nasal septum. [2012]
13. Illustrate with diagram the constituents of Nasal Septum and its vascular supply.
Describe the surgical importance of little’s area. [2016]
14. Write a note on deviated nasal septum and its effect on the ear. [2010]
15. A male patient 15 years of age presented with H/O recurrent sever epistaxis and
nasal obstruction. What is your provisional diagnosis? How will you manage the
case? [2017]
16. A young adult presented with left sided nasal polyp. Give their differential diagnosis.
Outline the management of antro-choanal Polyp. [2012]
17. A 17 year old male presented with history of recurrent profuse epistaxis for last one
year. What are the probable causes? Give an outline of relevant investigations and
management of the patient. [2011]
18. A 65 years old male presents with epistaxis. How will you manage this case? [2010]
19. Describe the anatomy of Maxillary Antrum and functions of nose. [2014]
20. Describe the clinical features, treatment and complications of acute tonsillitis. [2016]
21. Describe the etiology, clinical features and management of Acute Follicular
Tonsillitis. [2013]
22. A 10yr old child presents with a patch in the tonsil with fever. How would you
examine the patient? What will be treatment? [2015]
23. Outline the clinical features and management of patches over Tonsil in short. [2018]
24. An 8 year old child presented with patch over the tonsil and adjoining region.
Discuss the differential diagnosis. [2009]
25. Describe the clinical feature, complication and management of acute Peritonsillar
abscess. [2012]
26. Describe the clinical features, investigation and management of Acute
Retropharyngeal abscess. [2017]
27. Draw a neat labelled diagram of larynx as seen on indirect laryngoscopy. Describe
briefly the levels and groups of lymph node in the neck. Describe the pre-epiglottis space and its significance. [2010]

28. A 65 yrs old male presented with Hoarseness of voice for last 3 months. How will you
investigate the case to arrive at a diagnosis? [2013]
29. A 60 year old male presented with hoarseness of voice for one month. How will you
investigate the case? [2011]
30. Discuss the mechanism of deglutition. [2009]

1. MacEwen’s triangle (suprameatal) [2015]
2. Absolute Bone Conduction test [2015]
3. Ototoxic drugs [2018]
4. Fistula test [2014]
5. Caloric test [2012]
6. Circumscribed otitis externa [2010]
7. Malignant otitis externa [2013, 2011]
8. Foreign Body Ear [2012]
9. Cholesteatoma [2015]
10. Masked mastoiditis [2009]
11. Lateral sinus thrombosis [2018]
12. Cahart’s notch [2016]
13. Facial nerve palsy of sudden onset [2010]
14. Osteo-mental complex [2017, 2013, 2011]
15. Dangerous area of nose [2017, 2015]
16. Atrophic Rhinitis [2018, 2009]
17. Rhinolith [2016]
18. C.S.F. Rhinorrhoea [2014]
19. Maxillary sinus [2012]
20. Waldeyer’s ring [2016]
21. Adenoid facies [2009]
22. Clinical features and management of Juvenile Nasopharyngeal Angiofibroma [2010]
23. Diagnosis of Diphtheria [2017]
24. Peritonsillar abscess/ Quinsy [2016, 2014, 2010]
25. Retropharyngeal abscess [2018]
26. Acute Retropharyngeal Abscess [2015, 2013]
27. Obstructive sleep apnoea [2013]

28. Safety muscle of larynx [2016]
29. Acute epiglottitis [2014]
30. Laryngomalacia [2010]
31. Nerve supply of Larynx [2018]
32. Vocal nodule [2014, 2009]
33. Functions of Tracheostomy [2015]
34. Complications of Tracheostomy [2017, 2013, 2011]
35. Oesophageal strictures [2012]
36. Plummer-Vinson syndrome [2016, 2011]
37. Cardiospasm [2009]
38. Coin in Oesophagus [2017]
39. Branchial cyst [2017]
40. Myringotomy [2011]
41. Myringoplasty [2010]
42. Antral puncture [2012]
43. Caldwell-luc operation [2009]
44. Indications of Caldwell-Luc’s operation [2013]
45. Complications of S.M.R operation [2014]
46. Difference between Septoplasty and SMR operation [2011]
47. FESS [2018]
48. Indications of Tonsillectomy [2012]
N.B. Chapter division is based on “Diseases of Ear, Nose and Throat by Dhingra & Dhingra”.

Adrenaline in Anaphylactic Shock and Other Drugs for it

Adrenaline in Anaphylactic Shock and Other Drugs for it

  • What is adrenaline?
    Adrenaline, or epinephrine, is a catecholamine secreted by the adrenal medulla and is one of the hormones released during stressful situations. Other catecholamines synthesised in the body are noradrenaline (norepinephrine) and dopamine. Structurally it contains a 3,4-dihydroxybenzene group.

The principal catecholamines of the body are formed by hydroxylation and decarboxylation of the amino acid, tyrosine. Adrenaline is formed by methylation of noradrenaline, which is formed from tyrosine in neurons secreting catecholamines. Enzyme phenylethanolamine-N-methyltransferase (PNMT) catalyses this reaction and is found in the brain and adrenal medulla.
The normal level of free epinephrine in plasma is about 30 pg/mL (0.16 nmol/L).

The adrenal medulla has receptors which when sympathetically stimulated by norepinephrine release epinephrine into the blood stream.

Mechanism of action
Adrenaline acts by stimulating adrenergic receptors. It has non-selective action and hence stimulates all adrenergic receptors:
• Alpha-1
• Alpha-2
• Beta-1
• Beta-2
• Beta-3

On binding to these receptors they stimulate formation of cyclic AMP which brings about further actions.

Physiologic actions
Epinephrine exerts sympathomimetic effects on the body.
• Heart: it has cardiac stimulant actions and causes increase in contractility, heart rate and cardiac output
• Blood vessels: it mediates vasoconstriction in the skin, mucous membranes and viscera ( alpha action) but dilatation in the liver and skeletal muscles (beta-2 action) with a net rise in the systolic blood pressure
• Respiratory system: adrenaline causes bronchodilation and also inhibits the release of allergic mediators from mast cells
• Hyperglycemia
• Initiation of lipolysis

Therapeutic uses
Generally this drug is used in emergency situations like the following:
1. Anaphylactic shock
2. Bronchospasm
3. Cardiopulmonary arrest
Besides the above mentioned scenarios adrenaline may also be used, in low concentrations (1:100000 parts), to increase the duration of local anaesthesia.

Use in anaphylactic shock
Anaphylactic shock
​Anaphylactic shock is an immediate type of hypersensitivity (type I) reaction. This occurs in response to exposure to an allergen to which the body has been hypersensitised and hence an unwanted, dangerous reaction occurs. Typical symptoms include a rash, nausea, vomiting, difficulty in breathing and shock.
​The best route for administration is the intramuscular route and the best site for injection is the anterolateral aspect of the middle one-third of the thigh. (An IV route is not preferred because it has a greater risk of causing harmful side effects since adrenaline is very potent even in small amounts.)
The usual dose for adults is 0.5 mg IM (i.e. 0.5 mL of 1:1000) adrenaline.
​Mechanism of action
​Action of adrenaline in anaphylaxis is basically a manifestation of its physiologic actions. It induces vasoconstriction which reduces the erythema of rashes.
Bronchodilating effect relieves dyspnoea.
Perhaps the most important effect of adrenaline here is the inhibition of mast cells which play an active part in anaphylaxis. As a result mediators of allergy, such as histamine, serotonin, are not released and the reaction is controlled.
Other drugs
Apart from adrenaline, nowadays several other drugs have emerged for treating a case of anaphylaxis.
Antihistamines (such as diphenhydramine and hydroxyzine) are one such choice. These act by blocking the H1 receptors of histamine which plays an important role in the reaction. Sometimes a combination of H1 and H2 blockers may also be used. However these have to be continued for 2-3 days after the attack.
​Inhaled beta-2 agonists (such as albuterol) may also be used. They act by relaxing the bronchial smooth muscles and thus reducing dyspnoea. These are administered to patients who appear with wheezing.
Glucocorticoids (such as methylprednisolone) prevent inflammation by suppressing the migration of polymorphonuclear leucocytes and fibroblasts, decreasing capillary permeability and stabilising lysosomes at the cellular level.
​Lesser used drugs include glucagon and dopamine which help in relieving symptoms. But these are used in adjunct with epinephrine and not alone. Dopamine may be used alone but requires high doses.

What is Multiple sclerosis? And what its treatment?

What is Multiple sclerosis? And what its treatment?

What is Multiple sclerosis:


Multiple sclerosis also known as Disseminated sclerosis is the most common CNS demyelinating  disease. The usual age onset is 20 to 40 years. In this disease there is recurrent attack of focal degenerative neurological disorders with predilection for involvement of the spinal cord , optic nerve and brain. The early attack is like a single symptom or sign ; most commonly optic neuritis followed by recovery.

Prevalence in India:

In India MS is a very common neurological disorders. There is about 1 million case in every year.


  1. Genetic susceptibility.
  2. Infectious agent.
  3. Immunologic mechanism.


The hallmark of multiple sclerosis is the presence of many scattered discreat areas of demyelination termed plaques. Grossly plaques are grey pink , swollen , sharply defined , usually bilateral areas in the white matter .

In histopathologic features; plaques are made up of accumulated lymphocytes and macrophages arround the sites where demyelination is already started. In addition there is loss of oligodendrocytes and presence of reactive astrocytes and lipid laden microglia ( macrophages).


  1. Stiffness and spasms in muscles.
  2. Depression.
  3. Epilepsy.
  4. Bowel and bladder problem.

Treatment of Multiple sclerosis:

As disease become progressive, remission become infrequent and incomplete. The drugs are used mainly for prolongation of life and delay disease progression.  In march ; 2017 FDA approved first drug for multiple sclerosis; that is OCRELIZUMAB.

  • Disease modifying drugsAs MS is a autoimmune disease ; causes immune destruction of myelin sheath. These drugs work by curbing the immune system . They also reduce the number of flare-ups….include –
  1. Glatiramer.
  2. Interferon beta 1b.

Both cut down the number of flare-up and slow down the advance of MS –

  1. Daclizumab.
  2. Dimethyl fumarate.
  3. Interferon beta 1a
  4. Ocrelizumab
  5. Peginterferon beta 1a

The interferons are considered as very safe drugs for treating MS. Sometimes self injection can cause redness, warmth, itching and dimpling of skin.

Other Adverse effect of interferons are-

  1. Flu like symptoms – aches, chills,fatigue , fever.
  2. Increase risk of infections due to lowering down of white blood cell count and also decrease immunity.

In relapsing case of MS ; drugs like Teriflunomide causes sideeffects like nausea , hair loss.

Another drug Aubagio ; is detected as” BLACK BOX” warning by FDA due to its serious side effects

  1. Hepatitis or other liver disease.
  2. And may cause serious teratogenic effect if prescribed for pregnant women.

Gilenya ; another drug causes –

  1. Headache.
  2. Leucoencephalopathy.
  3. Cough.
  • For the treatment of Flare-ups:
    1)High dose of steroides are given intravenously.
    2)Another technique is plasmapheresis.
  • For the Treatments of other symptoms:
    1) For muscle stiffness and spasms: muscle relaxant Beclofen or sedative like clonazepam or diazepam.
    2)Fatigue: Amantidine.
    3) Depression: antidepressants like leupropion or fluoxetine or sertraline.
    4) bladder problem:oxybutynin.

Except the above drug therapy the doctor can give advise to have a little exercise and moderate walking everyday. It can relief from the symptoms of MS and gives a comfortable feeling to the patients.

How to lose belly fat in one month – very effective way

How to lose belly fat in one month – very effective way

Belly fat is more than just a nuisance that makes your clothes feel tight.

Fat inside the belly area is also termed visceral fat, and it is seriously harmful.

This type of fat is a major risk factor for type 2 diabetes and heart disease, to name a few.

Many health organizations use BMI (body mass index) to classify weight and predict the risk of metabolic disease. However, this is misleading.


People with excess belly fat are at an increased risk, even if they look thin on the outside Although losing fat from this area can be difficult, there are several things you can do to reduce excess abdominal fat.



We all have a Fascination for Muscles and Strength. Whether we want to be stronger, look like Superman or just get rid of that annoying belly bulge.


How to lose belly fat is still one of the most commonly searched health and fitness topics of all time.

That why today.

I’m going to show exactly how to lose that stubborn stomach and start carving a sexy stomach

And it’s all Backed by science.

Before we talk about methods for blasting away belly fat. Let’s talk about what causes it.

And if you want to see our video about – “How to Lose Belly Fat in 1 Month” – Click Here or Check at the end of the article.

There are 5 main causes to an pesky belly bulge.


1. Overeating

Kind of obvious , but has to be said.


The main culprit of belly fat is consuming too much calories leading conversion of unnecessary calories into stomach fat, Leading to weight gain and stomach fat.


So , it is really necessary to have a daily nutrition plan.


2. Sugar –

Eating foods that contains a sugar is the number one contributor to belly fat.

High sugary foods such as candies, donuts, cake, sodas and other sugar-laden foods and drinks are to be blamed for belly fat.

If you eat these foods often, you will gain belly fat whether you exercise or not.

Sugar is you number one enemy.


There are other types of sugar, that many peoples are not aware of that are equally dangerous as sucrose or regular table sugar.

Fructose or fruit sugar are dangerous too if consumed in large quantities. Fewer fruits contains high amount of fructose level like bananas, cherries and mangoes. So, eat those in fewer moderations.


3. Hormonal imbalances

Especially high amount of stress hormone cortisol have been found to be directly linked to higher abdominal fat.

Other hormonal issues are also been linked with slow weight loss and difficulty for the body to properly uptake nutrients.

So, it’s just as important to get hormones in check as it is to make sure your nutrition is aligned.

4. Bloating –

Missed by lots of Health and fitness professionals , bloating certainly Does not help with belly Fat. This is usually caused by high sodium intake, excessive carbohydrate intake, and even be sign of food intolerance.


5. Alcohol intake –

Studies have shown that certain types of alcohol are directly correlated with stubborn belly fat.

And if your goal is to lose fat, cutting down on alcohol intake is a simple solution that really works.


So, here’s how to lose belly fat Fast and its actually backed by science!!!


1. Start eating right type of food-


Try eating food that has low carbohydrate level and low Sugar Contents.Look for food that is rich in vitamins and minerals and low in fat and calories.Chow down on fibre rich foods.


Studies have show there is a direct relation between fibre intake and reduction of belly fat.

Type of fibre you want to focus on is viscous fibre. Viscous fibre binds with the water and slows down the digestive process hence reduces cravings.


Its can be found in – beans, vegetable and whole fruits.


d. Make some of these foods part of your daily diet – watermelon, orange, beans, strawberries, limes, peas, grapefruit and leafy vegetables like – spinach, kale, cabbage and broccoli.


e. Eat more of these fats – a study done by Swedish scientists shows a strange result.


Those ate more polyunsaturated lost more visceral fat, lost more weight and gain more lean muscles than those who ate other fats.


Poyunsaturated fat can be found in – fish, nuts and seeds.

2. Cut down the “sugar” from diet–

Plenty of studies have shown how sugar increases belly fat, causes cravings and is ultimately “terrible” for the body.


Cut it out of your diet.

3. Reduce your salt intake –

High salt intake in an average diet causes stored water weight and lots of belly bloat.


Reducing salt intake to between 1500mg and 2300mg will usually result in an immediate reduction in belly bloat.


4. High intensity interval training (HIIT) –

HIIT is one of the most effective workouts to burn fat faster. You only need to work for 30 minutes a day, and as short as 10 to 15 minutes can do.


For instance, start jogging “as fast as you can” on the treadmill for 10 seconds followed by 12 seconds of slower jogging. Do as much repetition as you can for 1 to 3 minutes.


5. Sleep well and avoid stress –

Getting at least 7 hours of sleep each night very good for your health.


When you lack sleep you of get irritated. And you will be in stress. When you are stressed your body craves for sugary food and increases cravings and will make you gain belly fat.

A good night sleep and less stress in your life will help you lose belly fat.

6. Add Apple Cider Vinegar to your diet –

Apple cider vinegar is uniquely effective for losing belly fat.


Its ability to control blood sugar and carve appetite is also AWESOME…


Studies have shown that those who take 1 to 2 tablespoon daily have a Significant decrease in visceral fat than those who do not.


7. Take a long daily walk –

Walking is a part losing weight is often underrated. But you will be surprised of how much fat you burn walking 30 minutes every day.


Walk everyday if you can it is more effective. A long walk is not a targeted belly fat routine but don’t forget that when you start losing weight, it will start coming off everywhere.


8. Stay hydrated –

Drink 7 to 8 glasses of water to help your body burn fat efficiently.

If you want to increase your appetite for water try flavoured water infused with lemon, cucumber and mint.


Water has no calories and it will keep you full .when you feel full you are less likely to look for for snacks or something to quench your hunger.


Drinking a lot of water is the number one of the things you should do to daily lose belly fat.

Watch our Full Video on – “How To Lose Belly Fat in 1 Month” – HERE .

These things you must know about Male and Female Epispadias

These things you must know about Male and Female Epispadias

Epispadias is a rare congenital abnormality that involves the opening of the urethra. It can occur in male as well as in female.
In Male – The urethra opens in the top of the penis rather than the tip.


In Female – The urethral opening is towards the clitoris or even in the belly area.

Frequency – It occurs more commonly in males than in females, with a prevalence of 1 case in 10,000 – 50,000 persons.
The male to female ratio is 2.3 : 1

Epispadias from Front View
Epispadias from Front View

Etiology – There are more than one hypothesis about epispadias.
1. Defective migration of paired primordia of  the genital tubercle that usually fuse on the midline to form the genital tubercle at the fifth week of embryonal development.
2. Another hypothesis relates the defect to the abnormal developement  of the cloacal membrane.
Classification – Usually Epispadias are of three types.
1. Glandular – Malformation affects the distal part of the urethra.
2. Penile – Entire penile urethra is affected, with an external meatus on the dorsal shaft of the penis.
3. Complete or Penopubic type – total deficiency of the dorsal wall of the urethra.

How epispadias are diagnosed ?
Epispadias is most often noticed at birth during physical examination. If the defect is mild, it might not be detected at first.
In some cases, it might not be noticed until the child has been toilet trained and presents with urine leak. This is most common eith girls.

Epispadias from Lateral View
Epispadias from Lateral View

Treatment – Surgery is the treatment of choice for epispadias.
The main goals of the treatment are –
1. Make sure the penis works properly
2. Make the penis of a good length.
3. Fix bends in the penis ( dorsal bend and chordae)
4. Make the penis look normal
5. If the bladder and bladder neck are affected, surgery will be needed to make sure that the child can control his urine
6. Surgery might also be needed to preserve fertility.

Cyclopia – One Eyed Baby – Proboscis above eyes

Cyclopia – One Eyed Baby – Proboscis above eyes

Cyclopia is a rare form of holoprosencephaly. The synonyms for Cyclopia are cyclocephaly or synophthalmia.

Cyclopia is a congenital birth defect and a rare one,occurring in an incidence of 1 in 200 miscarriages. Cyclopia is not confined only to the human species but may occur in animals too (1 in 16,000 born animals).

Presentation –

The baby usually has one eye (commonly called as One-eyed baby) located in the forehead at the site of what should have been the root of the nose. There’s a missing nose or a small non-functional nose called Proboscis (a tubular appendage) present above the eye on the forehead or on the back . Most such embryos get naturally aborted or are stillborn upo


Causes –

Genetic causes or toxins can misdirect the embryonic forebrain dividing process. One such alkaloid toxin thought to be responsible is Cyclopamine, found in the plant Veratrum californicum (false hellebore).

Cyclopamine Drug Causing Cyclopia
Cyclopamine Drug Causing Cyclopia

Humans may ingest this plant by mistake considering it as hellebore which is an unrelated plant and recommended as a natural treatment for vomiting,cramps and poor circulation quite common in the early months of pregnancy .
Certain proteins are inappropriately expressed causing the brain to stay whole rather than dividing into two separate hemispheres. This leads to the foetus having one optic lobe and one olfactory lobe resulting in the typical malformations of Cyclopia.


Genetic basis –

The sonic hedgehog (SHH) gene regulator is involved in the separation of the single eye field into two bilateral fields. Mutation of the SHH gene results in Cyclopia, a single eye in the center of the face .

A baby Having Cyclopia
A baby Having Cyclopia

Holoprosencephaly is a cephalic disorder in which the prosencephalon (the part from which the forebrain develops) fails to completely separate into two hemispheres. Normally the forebrain develops and the face also begins to form around the fifth and sixth weeks of human pregnancy. If the embryo’s forebrain fails to divide to form bilateral cerebral hemispheres (the left and right halves of the brain), it results in defects in the development of the face and in brain structure and function. In very severe cases of prosencephaly , the malformations turn out to be so serious that the babies usually die before birth . However in less severe cases,the baby may be born with almost normal brain development but there are defects in the development of face i.e., eyes,nose or lip.

Some cases of Cyclopia have been found in farm animals such as horses, sheep, pigs and even in some chickens. In such cases, the nose and the mouth fail to form or the nose grows from the roof of the mouth causing obstruction to the airflow after birth.

What is Sacrococcygeal Teratoma

What is Sacrococcygeal Teratoma

What is Sacrococcygeal Teratoma?

Sacrococcygeal Teratoma
Figure. Sacrococcygeal Teratoma 

Sacrococcygeal Teratoma is the Teratoma of the Tailbone. Teratoma means a tumor made up of several different tissues like bone, skin, hair or muscle typically occurring in the testicle, ovary or tailbone.

How it looks?
Fetal SCT may be completely internal –
may push and displace other oragns internally.
At Birth – visible lump or mass under skin top of the buttock crease (can be seen in the picture). It feels like a hard boiled egg.

  • What are the other tumors developed at the Sacrococcygeal region?
  • extraspinal ependymoma,
  • ependymoblastoma,
  • neuroblastoma and
  • rhabdomyosarcoma.

Important Points:

  • The most commonly diagnosed fetal teratomas are sacrococcygeal teratoma
  • Sacrococcygeal Teratoma is developed from Primitive Streak
    It is mostly occur in children (female>male)
  • In prenatal Ultrasound external component is found to be cyst filled cavity.
  • Most of the internal SCT is not detected even when it is large and cover most of the pelvis as Bony pelvis conceals it from detection. Displacement of pelvic organ like urinary bladder helps in detection.

So the preferred tretment of SCT is surgery.
If the SCT is small we should approch through the perineum. In case of large, we should also approch through the abdomen.
Usually resection of the coccyx and some part of the sacrum is needed. So, muscles and ligaments attached to those part should be reattached i.e. reconstruction of the posterior perineum is required. If it is not done it may lead to peritoneal hernia.
if coccyx is not removed it causes recurrence of teratoma and metastatic cancer.

  • Types of SCT?
    There are 4 types of SCT on the basis of extent of the tumor inside or outside the body.
  • Altman type I — entirely outside,
  • Altman type II — mostly outside
  • Altman type III — mostly inside
  • Altman type IV — entirely inside;

Significance of the Altman typing is that more the tumor remains outside the body, labour and delivery gets more complicated.

Altman type can change over time.

  • Complications
    Complication in mother
  • During pregnancy – Mirror syndrome
  • During Delivery – Cesarean Section / Mechanical Dystocia