OSPE (Ophthalmology) for FCPS, FRCOphth, MS & DO Examinee.Anisur Rahman
1) I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. I am now working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh.
These OSPE are dedicated to the postgraduate student who are decided to builds their carrier in ophthalmology. I hope that they will be benefitted if they solve these OSPE
The term ‘‘aniseikonia” comes from the Greek words ‘‘an” (not) ‘‘is” (equal) & ‘‘eikon” (icon or image) so aniseikonia is a binocular condition in which the apparent sizes of the images seen with the two eyes are unequal.
Whenever refractive ametropias in the two eyes of a person are different (i.e., when there is an anisometropia), the corrected retinal images of the two eyes, and consequently the two visual images, differ in size.
This condition has been termed aniseikonia
Optical aniseikonia
Retinal aniseikonia
Cortical aniseikonia
Eyelid Tumours: A swelling of a part of eyelid generally without inflammation caused by an abnormal growth of tissue.
Types:
Benign &
Malignant
Benign tumors:
Epithelial tumors
Melanocytic tumors
Adnexal cystic lesions
Sweat gland origin
Hair follicle origin
Miscellaneous lesions
Vascular Tumours
Neural Tumours
Malignant tumors:
OSPE (Ophthalmology) for FCPS, FRCOphth, MS & DO Examinee.Anisur Rahman
1) I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. I am now working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh.
These OSPE are dedicated to the postgraduate student who are decided to builds their carrier in ophthalmology. I hope that they will be benefitted if they solve these OSPE
The term ‘‘aniseikonia” comes from the Greek words ‘‘an” (not) ‘‘is” (equal) & ‘‘eikon” (icon or image) so aniseikonia is a binocular condition in which the apparent sizes of the images seen with the two eyes are unequal.
Whenever refractive ametropias in the two eyes of a person are different (i.e., when there is an anisometropia), the corrected retinal images of the two eyes, and consequently the two visual images, differ in size.
This condition has been termed aniseikonia
Optical aniseikonia
Retinal aniseikonia
Cortical aniseikonia
Eyelid Tumours: A swelling of a part of eyelid generally without inflammation caused by an abnormal growth of tissue.
Types:
Benign &
Malignant
Benign tumors:
Epithelial tumors
Melanocytic tumors
Adnexal cystic lesions
Sweat gland origin
Hair follicle origin
Miscellaneous lesions
Vascular Tumours
Neural Tumours
Malignant tumors:
bilateral potentially blinding condition in which obstruction to aqueous outflow is brought about solely by closure of angle by peripheral iris One eye is usually affected before the other
INTRODUCTION
ETIOLOGY
RISK FACTORS
PATHOPHYSIOLOGY
CLASSIFICATION
CLINICAL FEATURES
DIAGNOSTIC MEASURES
MANAGEMENT
Medical
Surgical
Nursing
CONCLUSION
BIBLIOGRAPHY
POST TEST
Glaucoma types, Pathogenesis, Diagnosis and TreatmentPranatiChavan
Glaucomas are ocular disorders characterized by changes in the optic nerve head (optic disk) and by loss of visual sensitivity and field.
There are two major types of glaucoma: open-angle glaucoma, which accounts for most cases and closed-angle glaucoma.
Glaucoma and dgharia of bgf vfcvf vf .pptxmekulecture
Under normal conditions, only approximately 1 mL of the 125 mL of glomerular filtrate that is formed each minute is excreted in the urine.
The other 124 mL is reabsorbed in the tubules.
This means that the average output of urine is approximately 60 mL/hour… approximately 1.5L urine per day.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
acute intra-ocular pressure rise
1. ACUTE INTRA OCULAR PRESSURE RISE BY DR/MOHAMED ABDEL-AZIZD SUPERVISOR PROF.DR/KHALED HANAFY
2. Increased eye pressure can lead to optic nerve damage and vision loss. this can happen immediately or gradually depending on the level of eye pressure.
3.
4. pigmentary glaucoma . A – gonioscopy revealing pigment accumulation in the trabecular meshwork B – UBM showing iris concavity; C – Iris transillumination defects; D – Krukenberg's spindle
8. Advanced anterior segment neovascularization with ectropion uveae Neovascular Glaucoma choroidal detachment B - scan
9. ciliary body melanoma : ( A ) EOE is noted superonasally, with an associated sentinel vessel . ( B ) coloured photograph shows the ciliary body melanoma superonasally . ( C ) UBM demonstrating the ciliary body mass with a small area of scleral thickening corresponding to the EOE . ( D ) B - scan ultrasound with a dome - shaped mass corresponding to the melanoma .
10. Features of this syndrome: _Recurrent episodes of mild cyclitis _Uniocular involvement _Duration of attack varying from a few hours to several weeks _Corneal edema with a few keratic precipitates. _Normal IOP between episodes _IOP usually is elevated (40-60 mm Hg) _IOP is related to the duration of uveitis but NOT to the degree of uveitis Glaucomato cyclitic crisis
13. _The acute rise in intraocular pressure ( IOP ) is related to red blood cells and their byproducts clogging the trabecular meshwork. _Glaucoma is more likely to develop with total hyphema or after rebleeding Red cell glaucoma hyphema from blunt trauma
14.
15.
16. Signs of phacomorphic glaucoma include the following: _High intraocular pressure ( IOP ) - Greater than 35 mm Hg _Mid-dilated, sluggish, irregular pupil _Corneal edema _Injection of conjunctival and episcleral vessels _Shallow central anterior chamber ( AC) _Lens enlargement and forward displacement _Unequal cataract formation between the 2 eyes
17. Medical Care _Medical treatment of phacomorphic glaucoma is aimed at rapidly reducing the IOP to prevent further damage to the optic nerve, to clear the cornea, and to prevent synechiae formation. _ Initial management should address the acute nature of the angle closure and include beta-blockers, alpha 2-adrenergic agonists, and carbonic anhydrase inhibitors. _Miotics can worsen the secondary angle closure attack by increasing irido-lenticular contact.
18. _Laser iridectomy sometimes relieves the acute angle-closure attack, but the AC remains shallow. _ These eyes are susceptible to repeated attacks of angle closure; therefore, cataract extraction should be performed if the AC does not deepen after laser iridectomy. Secondary management _begins with laser iridotomy to relieve the pupillary block.
19. N:B. On initial puncture of the capsule on an intumescent lens, an increased risk of a tear extending to the equator exists. One method for dealing with this possibility is using a needle on a syringe to aspirate the liquefied cortex as the capsule is punctured. N:B. Because of the increased risk of complications during cataract extraction, deepening of the AC with pars plana vitreous tap has been suggested (Dada et al.,2007).
20. Acute angle closure is defined as at least 2 of the following symptoms : ocular pain, nausea / vomiting, and a history of intermittent blurring of vision with halos; and at least 3 of the following signs : IOP greater than 21 mm Hg, conjunctival injection, corneal epithelial edema, mid - dilated non reactive pupil, and shallower chamber in the presence of occlusion. predispose individuals to AACG . These include shallower anterior chambers, thinner ciliary bodies, a thinner iris, anteriorly situated thicker lens and a shorter axial eye length. A narrow angle has the most devastating consequences.
22. Emergency Care _The treatment of acute angle - closure glaucoma ( AACG ) consists of IOP reduction, suppression of inflammation, and the reversal of angle closure . _ Once diagnosed, the initial intervention includes acetazolamide, a topical beta - blocker, and a topical steroid .
23. _Topical steroids decrease the inflammatory reaction and reduce optic nerve damage . _Addressing the extraocular manifestations of the disease is critical . This includes analgesics for pain and anti-emetics for nausea and vomiting . _ Placing the patient in the supine position may aid in comfort and reduce IOP . It is also believed that, while supine, the lens falls away from the iris decreasing pupillary block .
24. After the initial intervention, the patient should be reassessed . Reassessment includes evaluating IOP, evaluating adjunct drops, and considering the need for further intervention, such as osmotic agents and immediate iridotomy . Approximately 1 hour after beginning treatment, pilocarpine, a miotic that leads to opening of the angle, should be administered every 15 minutes for 2 doses .
25. No standard rate of reduction for IOP exists; however, Choong et el identified a satisfactory reduction as IOP less than 35 mm Hg or a reduction greater than 25% of presenting IOP . If the IOP is not reduced 30 minutes after the second dose of pilocarpine, an osmotic agent must be considered . An oral agent like glycerol can be administered in non diabetics . In diabetics, oral isosorbide is used to avoid the risk of hyperglycemia associated with glycerol .
26. Patients who are unable to tolerate oral intake or do not experience a decrease in IOP despite oral therapy are candidates for IV mannitol . _When medical therapy proves to be ineffective, corneal indentation ( CI ) can be used . any smooth instrument can be used to perform this procedure . _Laser peripheral iridotomy ( LPI ) , performed 24-48 hours after IOP is controlled, is considered the definitive treatment for AACG .