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MEQ2010
A full term pregnant lady presented with the
complaints of nasal blocking, sneezing, facial pain for
the past 8 months. What is the ddx and MX ?
Vasomotor rhinitis, allergic rhinitis, sinusitis
Ix : occipitomental xray, skin prick testing, rigid
endoscopy of the nose
Mx : reassurance, topical nasal steroid, systemic
antihistamine(loratadine), topical ipratropium will
control rhinorrhea
mother bring a child to an A&E department and the
child (3 years old) accidentally ingested a coin while
playing with his brother. What are the symptoms and
signs and MX for this patient?
Stridor, cyanosis, tachypnoe, use of accessory musle,
pallor, sweating, breathlessness, tachycardia,
intercostals and sternal recession, Chocking ,coughing
Mx : secure airway, then ix xray, examination,
Heimlich menouvre (compression pf upper abdomen)
but if fail endocopy and tracheostomy will be
necessary
Treat underlying causes
Massive blood transfusion: definition? 2 situations
that itll occur?complications? if an amount greater
than 50% of patients blood volume is replaced
rapidly, the transfusion is deemed massive. e.g. 5
units/hr in 70kg adult .
def : replacement of an individual of entire blood
volume more than 10min within 24hr
fracture : pelvic n femur: AAA rupture
Complication : platelet decreadse, calcium deceresas,
clotting factor decrese, hyperkalaemia, hypothermia

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5.

A guy of football player was having a continous

anterior right shoulder dislocation.
What are the pain relief and anaesthethics that you
would give: what drugs? Dosage? Route?
Brachial plexus block: 1.5 to 2% lignocaine with
adrenaline or 0.375 to 0.5% bupivacaine or 0.5 to
0.75% ropivacaine may be used.
Supraclavicular techniqueInterscalene approach (cervical approach)
Axillary approach
Morphine , IM, adult:10mg
A lady with chronic renal failure need to undergo
emergency appendicectomy. What are the basic
investigations routine (must do in this patient) and
what muscle relaxant you would give to her? ( state
why the reason)
FBC, BUSE AND CREATININE , ABG, ECG
Atracurium , spontaneous degrade (Hoffman
degradation)

6.

What are the basic monitoring requirements in a

patient who would undergone general anaesthesia?
Pulse oximetry, capnogram, ecg, urine output,
noninvasive blood pressure, vapour analyzer if
anaesthetic machine used
Clinically : patient colour, chest expansion, surgical
field

7.

A patient presented with failure to abduct the right

eye. What are the causes of it?
Malignancy(NPC), paralysis of the lateral rectus
Ms, CST
TRAUMA
Ischaemic at the pons area

8.

Anatomy of the retina and give symptoms on retina

detachment: loss of vision, floaters, flashes, visual
field defect, shower and curtain
10. Signs and symptoms and causes of posterior
uveitis
- blurring of vision, dim vision
- circumcorneal injestion
- post synaechia
- cell and falres
- iris nodules
- hypopyon
11. A patient present with covering the right
eye(pain), pressing on the stomach, feel nauseated.
What is your diagnosis and give 4 other symptoms
and signs for it.
Ddx: acute congestive glaucoma
Ss: frontal headache, nausea n vomiting, epigastic
pain, red eye, Very vague, non specific, Headache,
Eye pain/discomfort, Halos, Blurry vision, Focussing
problems
Takes a while for the patient to become suspicious.
Total loss of vision in one eye may remain un-noticed
in some patients:
RAPD, Tonometry high IOP >21mm Hg
Fundoscopy Optic nerve may be:
Cupped > 0.3 disc,Pale or atrophic, Visual field,
Constricted, tunnel vision, Paracentral scotoma,
Angles open
12. Mastoiditis: definition, signs and symptoms, Mx.
- inflammation of tha mastod air cells
- pain at post auricular area, throbbing, otorrhea,
oincreasing deafness
- sign: pyrexia, temderness over mastoid antrum ,
swelling post auricular, pinna is push down n forward,
TM perforated with ear discharging or bulging
Mx : WBC, pus culture, CT SCAN show opacity of an
air cell coalescene
Admit hospital, iv antibiotic, broad spectrum is guided
by sensitivity results, cortical mastoidectomy

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MEQ 2007
List five possible complications of oxygen therapy.
Hypoventilation
Absorption atelectasis
Pulmonary toxicity
Retrolental fibroplasia
Oxygen convulsion
Fire hazard & explosion
List two measures to prevent regurgitation in
emergency operation. List two measures if aspiration
occurs.
Cricoid pressure application (Sellicks maneuver)
presses the cricoid cartilage against the cervical
vertebrae and so compresses the lumen of the
pharynx
Prevents regurgitation into the pharynx during
induction
Rapid sequence induction
Nasogastric tubes should be left open and suction
applied b4 starting anesthesia
List five properties of an ideal inhalational agent.
Classify local anaesthesias. Describe the
complications of lignocaine.
Describe blood supply of the eye.
Describe the sympathetic pathway to the eye.
List five possible causes of cataract.
Senile, Rubella, Toxicity (steroid), Trauma,
Malnutrition(vit d d), Metabolic(diabetes)

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A 6 years old girl have positive toxoplasma antibody

test. List 5 ocular manifestations of Toxoplasmosis:
Hazy vision, floaters, eye red and painful, creamy
focus and inflammatory cells at margin of old
chorioretinal scar

3.

CVP
(a) What are the indications for CVP? (2.5)
A boy with left thigh injury. He has fever. BP 80/30, PR
135 per minute. CVP is 7 mmHg despite 2 fluid
challenge tests done.
(b) What is your interpretation of the CVP? (1)
(c) What is your diagnosis? septicemic shock
(d) What drug you would like to give? (1)
-antibiotic ,inotrope

4.

What is the management of tubotympanic type of

CSOM?
8. A 23 years old pregnant lady come to ENT clinic,
complained of nasal blockage for 6 months.
(a) What are the 6 questions you would like to ask?
(3)
-ask the 4s of nose symptoms (swelling, sleep
problem, smell problem, sneezing)
-ask allergy: - itchiness, any attack before
- hyaluronic acid increase: hormonal induced
(b) What is the provisional diagnosis?vasomotor
rhinitis

List the possible causes of lid abnormality.

Blepharitis, Chalazion, Internal n external hordeulum
Ectropian, Ptosis, Entropian

11. List three causes of epitaxis. Outline the

management.
Local : spontaneous, trauma, post operative, tumor,
hereditary telangeictasia,
General : cvs(hpt, mitral stenosis), coagulation or
vessel defect( hemopjilia, thrombocytopenia,
leukeimia)
Fever : thyphoid fever n influenza
12. Describe five indications for tracheostomy.
Relief of upper airway obstruction
Protection of tracheo-bronchial tree
facilitate tracheal toilet
Treatment of respiratory insufficiency : to reduce dead
space, to institute IPPR
List 5 possible causes of cranial nerve 7 palsy

Upper motor neuron : stroke, intracranial

tumor, multiple sclerosis

A man with blisters on the cornea. List 5 types of

cornea dystrophy.
Anterior : cogan microcytic, meesman, schnyder
Stromal : lattice 1,11, 111 , granular 1, 11,111
macular
Posterior : fuchs endothelial, posterior polymorpheous

2.

Describe the levels of diabetic retinopathy.

Background retino: micro, hard
exudates,hemorrhag(supe-flame, deep-blot n dot)
Pre ploriferative- soft exudates
Proliferative : neovascularisation

10. Categorise the complications of chronic suppurative

otitis media.
Intracranial: meningitis, cerebellar abscess, temporal
abscess, csthrom,
Cranial : petrositis, labyrinthitis, facial palsy
Extracranial: mastoiditis,mastoid abscess, bezolds
abscess.

Lower motor neuron : bell palsy, trauma,

tumor (parotid tumor, acoustic neuroma),
middle ear suppuration, ramsay hunt
syndrome, gullaine barre syndrome,
sarcoidosis

(c) What are the possible signs you can see?

-swelling of inferior turbinate, pale color, and septum
pink, nasal discharge.

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9. What are the withholding criteria for CPR?Dr Lilys

ethic
Patient has signed DNR
Irreversible death- rigor mortis, decapitation,
dependent lividity
No physiological benefit, vital function has deteriorate
Eg: CCF NYHA Stage IV
Decompensated Cirrhotic liver
Uremic, not amenable for dialysis
Advanced mets
Anoxic encephalopathy
Sepsis, shock
Irreversible resp failure
In delivery room, neonatal resuscitation
Gestational week < 23 weeks, <400g
Trisomy 21
anencephaly
10. A 18 month old boy diagnosed with
laryngomalacia. You are writing case report.
(a) What you would like to write in case report
regarding clinical picture? inspiratory stridor. stridor
increased by supine position
(b) How you would manage?

12. A man was transfused with packed red cell. He

then complain of flank and chest discomfort. He also
has nausea and vomiting. Outline your plan of
management.
acute hemolytic reaction
management :

k.
l.

Write briefly about the classification of America

Society of Anesthesia and state out the
mortality.
Description
Perioperativ
e mortality
rate (%)
1 A normal healthy patient
0.06-0.08
2 Mild systemic diseases, no
0.27-0.4
functional limitations (eg mild
DM, controlled HPT)
3 Moderate systemic diseases, with 1.8-4.3
some functional limitation (MI,
angina)
4 Severe systemic diseases, with a
7.8-23
constant threat to life, and
functionally incapacitating (CCF,
ARF)
5 Moribund, who is not expected to
9.4-51
survive within 24 hours
6 Brain dead, organ for harvesting
E Emergency procedure

- stop transfusion
- check identity and name on unit
- tell hematology
- send unit
- do FBC, BUSE, clotting, culture and
urine(hemoglobuniria)
- keep iv line 0.9 saline

List five complications of spinal anesthesia.

a) Hypotension due to sympathetic blockade
b) Nausea and vomiting, usually associated with
hypotension
c) Dyspnoea, hypopnoea due to ascending muscle
paralysis
d) Bradycardia
e) Headache- low pressure and high pressure
f) Backache
g) Retention of urine
h) Meningitis
i) Paralysis of 6th cranial nerve
j) Transient lesions of cauda equina

a.
b.
c.
d.
e.
f.
g.

h.
i.
j.

Describe five characteristics of non depolarizing

muscle relaxant.
Do not cause muscular fasciculation.
Relatively slow onset (1-5min)
Reversed by neostigmine and other
anticholinesterases.
Effects reduced by adrenaline and acetylcholine.
Potentiated by volatile agents.
Acidosis increases duration and degree of
nondepolarizing block.
Briefly describe the procedure used for central
venous catheter insertion.
-Seldinger technique
Position the patient flat, with 1 pillow. Head-down tilt
may help if volume depleted.
Wash hands, don a gown and sterile gloves.
Clean the area with iodine solution and apply sterile
drapes.
Assemble the catheter, and flush all the lumina with
saline.
Identify the insertion point: 1 cm below the junction of
the medial third and lateral 2/3 of the clavicle. Nick
the skin with a scalpel.
Using a green needle inject 5-10mL of 1-2% lidocaine
under the skin and into the subcutaneous tissues,
down to the clavicle.
Using the introducer needle, and an appropriate
syringe, partly filled with saline, puncture the skin and
advance the needle to the clavicle. Once hit the
clavicle, move the needle under the clavicle and aim
for opposite sternoclavicular joint. Aspirate as
advance the needle and should be able to cannulate
the subclavian vein.
Remove the syringe, keeping the needle still and
insert the guide-wire. Remove the needle over the
wire.
Feed the dilator over the wire.
Remove the dilator and feed the catheter over the
wire.

Feed the catheter into the vein, remove the wire and
check that blood can be aspirated through each
lumen.
Flush each lumen and then stitch the catheter in
place.

Briefly write about ocular melanoma

Introduction
-uveal melanomas usually presents from middle-age
onwards (40-70 years).
-malignant melanoma may also be seen in the ciliary
body and iris but by far the greatest number (80%)
are found in the choroid.
Symptoms
-the presence of a melanoma may be detected as a
coincidental finding during ocular examination.
-Advanced cases may present with a visual field
defect or loss of acuity.
Signs
-a raised, usually pigmented, lesion is visible at the
back of the eye.
Investigations
-the patient is investigated for systemic spread.
-An ultrasound of the eye is useful.

List five systemic causes of retinal detachment

Diabetes
Tumors (eg, breast cancer, melanoma)
Angiomatosis of the CNS
Sickle cell disease
Leukemia
Eclampsia
Prematurity
List five causes of third nerve palsy
Nuclear
Basilar
-vascular (DM, HPT,
-aneurysm (posterior
GCA)
communicating artery)
-demyelination (MS)
-Raised ICP/DM
-tumor
Intracavernous
Intraorbital
-CST(Vitt+DM)
-vascular/trauma
Fascicular

-webers
-Benedicts
Describe briefly stages of hypertensive
retinopathy.
Grade 1: Mild narrowing or sclerosis of retinal
arterioles (silver wiring)
Grade 2: Generalised and localised narrowing of
arterioles, moderate or marked sclerosis of retinal
sclerosis of retinal arterioles with exaggeration of
arteriolar reflex and arteriovenous compression (AV
nicking)
Grade 3: Retinal edema, cotton wool spots, retinal
haemorrhage superimposed on sclerotic vessels
Grade 4: Diffuse retinal and optic disc edema
(malignant hypertension)

Le Fort III

Fracture across
frontozygomatic suture line,
entire orbit and nasal bridge
(craniofacial separation)

-motion is se
suture (crani
-may have a
at the cribrif
edema, or le
dish-face de
lack of sagitt
causing it to
spherical.

How would you manage the patient with

chronic suppurative otitis media (tubotympanic
type)
Conservative treatment
-aural toilet and local antibiotics when the discharge
is active
Surgical treatment
- To improve/retain hearing: repair of tympanic
membrane (Myringoplasty) or repair of middle ear
structures (tympanoplasty).
- Elimination of the adjacent foci of infection.
(tonsillectomy and adenoidectomy)

List five organic causes of hoarseness of voice.

1. Congenital
-laryngeal web
-laryngeal malacia
2. Traumatic
-vocal nodules
-vocal polyp
-chronic laryngitis
-intubation trauma
3. Infective
-viral, bacterial, fungal and tuberculosis laryngitis
4. Tumour
Briefly describe the layers of retina .A patient
-Benign: papilloma, haemangioma
with retinoschisis
-Malignant: squamous cell carcinoma
5. Metabolic:
Vitreous
-Hypothyroidism
Nerve fibre layer
fibers from ganglion cells traversing
the
-juvenile
retina to leave the eyeball at the
optic rheumatoid arthritis
6. Neurologic
disk.
Ganglion cell layer
Nuclei of the ganglion cells and-stroke
displaced
-myaesthenia gravis
amacrine cells
-muscular dystrophy
Inner plexiform layer
axons of bipolars (and amacrines),
7. Allergic: environmental exposure
dendrites of ganglion cells
Inner nuclear layer
Nuclei of horizontal, bipolar
CSP MEQ (2008)
cells
Outer plexiform layer
rod and cone axons, horizontal 1. A man presented to the A2E department after an
accident with 2 hours history of epistaxis, nasal
dendrites, bipolar dendrites
obstruction, and crooked nose.
Outer (Receptor)
cell bodies of rods & cones
a. outline your management
nuclear layer
b. what
are the possible complications that follows
Inner and outer
contains inner and outer segments
of the
segments of
rod and cone photoreceptors. case like this?
2. Outline your management for a medium size
photoreceptors
perforated
eardrum due to chronic suppurative
Retinal pigment
supporting cells for the neural portion
of
otitis media.
epithelium (RPE):
the retina
3. Causes of chronic laryngitis.
Choroid
Habitual shouting, False use of voice
Smoking, Spirit, URTI
Explain briefly about types of Le Forte
4. Mallampati classifications.
fractures and the clinical presentations of each.
6. Classify the local anaesthetics and give 2 example
for each. Describe briefly on local toxicity.
Type
Description
Clinical presentations
7. A man was transfused with packed red cell.
Le Fort I
Tooth bearing portion
-Motion at the
of complain
the anterior
Helevel
then
ofnasal
flank and chest discomfort.
separated from upper
spine withoutHe
simultaneous
motion
also have nauseaof
and vomiting. Outline your
maxilla
anterior maxilla
plan of management.
-may be associated
with of
gingival
9. Anatomy
eyeball.
crepitation. 10. signs and symptoms of anterior uveitis.
Le Fort II
Fracture across orbital floor
-motion of the
pyramid
the
12.nasal
procedure
of along
eyeball
retrieval.
and nasal bridge (pyramidal
medial orbit rims.
fracture)
-may have midface flattening and
elongation. MEQ
-often associated
infraorbital
1. Mx ofwith
CSOM,
attico antral type
paresthesias.
2. Indicatins ( 5) of tonsillectomy

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6.

Epidural anesthesiae ; definitions and complications

3 bottle system for chest drainage; describe bottle
A,B, C , advantages (2) and how to generate negative
pressure in bottle C.
Contra indications for enteral feedings
Causes of trigeminal neuralgia

7.

Penetrating injury to left eye; anatomy of cornea and

possible sequelae after injury.
8. Rapid sequence induction, describe steps by steps.
9. Eye retrieval process
10. AIDS manifestations of eye