The Correct Answer is D


Student's t-Tests

"Student" (real name: W. S. Gossett [1876-1937]) developed statistical methods to solve problems stemming from his employment in a brewery. Student's t-test deals with the problems associated with inference based on "small" samples: the calculated mean (X_avg) and standard deviation () may by chance deviate from the "real" mean and standard deviation (i.e., what you'd measure if you had many more data items: a "large" sample).

More Info

The correct Answer is C

'Vision 2020: The Right to Sight’ is a global campaign with the objective of liminating avoidable blindness by the year 2020. The World Health Organization (WHO) in collaboration with various international, non-governmental and private organisations launched it worldwide on February 18,1999.

Strategies for implementing Vision 2020

1. Control and prevention of major blinding diseases and disorders: Cataract, Trachoma, Onchocerciasis, Childhood Blindness, Refractive Errors and Low Vision have been identified as immediate priorities based on the burden of blindness they represent and the feasibility and affordability of interventions to prevent and treat them.

2. Training of human resources: Adequately trained human resources are a key factor for
achieving the goals of Vision 2020. Training will need to be provided to ophthalmologists, refractionists, and managers of national/regional prevention of blindness programmes. In India
the target is to have one ophthalmologist per 50,000 population from the present ratio of 1
per 100,000.

3. Strengthening the existing eye care infrastructure:
In the global scenario it is clear that the current infrastructure has to be significantly increased in terms of eye hospitals, beds, equipment and manpower. While establishing new infrastructure the issues of accessibility and coverage can be addressed by the following factors:
-Location
-Range of service
-Barriers to access
-Utilisation

4. Use of appropriate and affordable technology:
Rapid advances are being made in the field of ophthalmology in the diagnosis and treatment of eye diseases. The same is happening in the specific focus area of Vision 2020, which are cataract, trachoma, childhood blindness, refractive errors and low vision. Here the challenge in “Technology” is not so much innovating but adapting the new developments to the local economies in a cost-effective manner. Initiatives that aim at transfer of technology so that manufacturing of high quality equipment and consumables at low cost by developing countries will be supported and promoted by Vision 2020. So the whole challenge is really in technology management.The technology management has to have a comprehensive approach and the various elements in such an approach are listed below:

- Making it affordable
- Developing skills in using them
- Infrastructure for new technologies
- Developing commercial infrastructure
- Community awareness

Reference:Vision 2020: The Global Initiative for Right to Sight, R.D. Thulasiraj, R. Muralikrishnan, Lions Aravind Institute of Community Ophthalmology, Madurai

The correct Answer is A

Angioneurotic edema (angioedema)—subcutaneous edema, usually from an allergic reaction to food or drugs

Etiology of Anaphylaxis

IN-HOSPITAL

• Latex
• Antibiotics (especially intravenous)
• Intravenous immune globulin
• Radiocontrast dye

OUTSIDE OF HOSPITAL

• Food (peanut, tree nuts, shellfish, milk, egg)
• Insect sting (Hymenoptera, fire ants)
• Oral medications (penicillins)
• Exercise (including food-associated)
• Idiopathic

The correct Answer is C


What is glue ear?

Glue ear is a very common condition affecting children. It is also called ‘otitis media with effusion’, which means the middle ear contains fluid. It occurs when a sticky fluid (glue) builds up inside the ear. This can affect hearing because the parts of the middle ear cannot move freely, although the level of hearing loss is mild to moderate, rather than severe or profound.

If the child keeps having glue ear, Myringotomy with tube may be advised, where a ventilation tube called a grommet is inserted temporarily into the eardrum.

The Correct Answer is B

A grommet is a small bobbin-shaped tube used to keep open the incision made in the ear drum as a ventilation of secretory otitis media. It acts as a ventilation tube by allowing the Eustachian Tube to recover its normal function.

A period of watchful waiting is the best management strategy for children with otitis media with effusion. Grommets should only be considered for patients satisfying defined criteria. Patients and parents should be advised of the risk of potential harm e.g. tympanosclerosis.

Children with hearing impairment should have a period of at least 6 months of watchful waiting from the onset of the symptoms.

Grommet should only be considered if
A - glue ear persists, and the child (3 years or over) also suffers from one of the followings:

1. Recurrent acute otitis media with more than 5 times per year.
2. Evidenced delay in speech development
3. Educational or behavioural problems attributable to persistent hearing impairment, with a hearing loss of at least 25dB particularly in the lower tones (low frequency loss
4. A second disability, such as Down’s syndrome
5. Severe collapse of the eardrum

Or

B. the child has had at least 5 occurrences of acute otitis media in the last year with additional complications such as perforations, persistent discharge, febrile convulsions, sensorineural deafness or cochlear implantation.

Or

C. for children aged 2 years, the child has:

• OME with prolonged effusion (6 months or longer);
• AND measured hearing loss;
• AND disability attributable to hearing loss (delay in speech development or other problems).

Combine adenoidectomy and grommet insertion if the child has nasal symptoms on top of otitis media with effusion


References:

1. Cochrane Database of Systematic Reviews 2005, Issue 1: Grommets for hearing loss associated with otitis media with effusion. Lous J, Burton MJ, Felding JU, Ovesen T, Rovers MM, Williamson I. Available online at: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001801/frames.html
2. BMJ Clinical Evidence: Otitis media with effusion (available online at: http://www.clinicalevidence.com/ceweb/conditions/ent/0502/0502.pdf, free registration required)

The Correct Answer is C

Otosclerosis is a primary disease of the otic capsule and the ossicles. It is not known to occur outside the human temporal bone. It is characterized by a progressive hearing loss that may be conductive, sensorineural, or mixed. Histologically, it is seen as abnormal resorption and then deposition of bone in the labyrinthine capsule and middle ear. Otosclerosis is an important cause of auditory and, to a lesser extent, vestibular symptoms, and both can be treated effectively in most cases.

The patient with otosclerosis typically presents with a history of slowly progressive hearing loss that is often bilateral and asymmetric. The hearing loss usually presents between the ages of 15 and 45. It occurs approximately twice as often in women than in men. In 70% of patients there is a family history of deafness. Younger patients often have a more rapid progression of the hearing loss. It is often rapidly progressive during pregnancy and in women on estrogen therapy.

Audiology

The key test in the diagnosis of otosclerosis remains the audiogram. The audiological manifestations of otosclerosis are as distinctive as they are varied. Characteristic abnormalities appear on tympanometry, acoustic reflexes, and the pure-tone audiogram.

The tympanogram is a graphic representation of the change in acceptance of sound energy through the middle ear as a function of air pressure.

• The most typical case is the presence of a normal, type A typanogram. As the disease progresses the height of the peak decreases and you can eventually obtain a type
  

  As

  tympanogram.

Acoustic reflex morphology is a very sensitive indicator of otosclerosis. In contrast to the normal configuration in which middle ear compliance is reduced for the duration of a stimulus, in otosclerois there is a characteristic diphasic response or “on-off” phenomenon. With this response there is an increase in compliance at both the onset and termination (“offset”) of the sound stimulus. Forty percent of the normal population can have a brief compliance increase at the onset of a stimulus but the offset increase (at the termination of the signal) is virtually pathognomonic of early stapedial fixation. It is often seen in the first 5 years of disease progression but is rarely seen in otosclerosis of 10 years or longer. This “on-off” response can often be seen prior to the development of a detectable air-bone gap. Advancing stapedial fixation affects both the ipsilateral and contralateral acoustic reflexes.

Pure tone audiometry is always a part of the assessment and a gradually progressive low-frequency conductive hearing loss is first seen. As the sclerosis worsens and the footplate becomes fixed, a mass effect is added to the audiogram. This results in a stabilization of low-frequency thresholds, with worsening in the high frequencies and a gradual widening of the air-bone gap. The configuration changes from upward sloping to flat. Complete stapes fixation will give a maximum conductive hearing loss of 60 to 65 dB HL as long as there is not progression of the disease to involve the cochlea. Usually though, there is development of cochlear otosclerosis, and the loss becomes mixed or sensorineural. High frequencies are more severely affected at this point.

The audiometric hallmark of stapes fixation is the Carhart notch, characterized by elevation of bone conduction thresholds of approximately 5 dB at 500 Hz, 10 dB at 1,000 Hz, 15 dB at 2,000 Hz, and 5 dB at 4,000 Hz. It is important to realize that the Carhart notch is a mechanical artifact, not a true representation of cochlear reserve. Commonly, one can obtain “overclosure” of the air-bone gap after stapedectomy with postoperative air-conduction thresholds lower than preoperative bone-conduction thresholds.

The correct answer is C.

If dihydropyridines are used alone, they may actually aggravate angina. Vasodilation caused by dihydropyridines is followed by a reflex increase in contractility and heart rate. Beta blockers are commonly given to combat such undesirable effects.