Please help! Mr. A built a shopping mall in Mumbai at the request of Mr. B, a civic corporater. Mr. C accepts a one-time payment of Rs. 250000. The suggestion of Mr. C has been accepted by Mr. A. Explain your answer to the question about the agreement.The Textile unit needs 10,000 paper cones per day from a contractor. He learns he can produce 25,000 sheets of paper a day when he starts a production run. A cone costs 2 paise to hold in stock for a year, and Rs.18 to set up a production run. There are 300 working days in the factory every year.

Answer all questions.

Question 1.

How would you treat optic neuritis?

Question 2.

After two episodes of optic neuritis, one affecting each eye and 2 months apart, confirmed to be demyelinating in nature by visual evoked potentials, could a diagnosis of multiple sclerosis be reached in the absence of periventricular lesions on the MRI?

Question 3.

While assessing the pupillary reflexes, the consensual light reflex is really difficult to see in the other eye. Are there any tips for that?

Question 4.

Is it clinically significant to examine the consensual light reflex? If there is a lesion of the IIIrd cranial nerve of the unilluminated eye to impair the consensual response, this will be clear by the other symptoms and signs of the IIIrd cranial nerve palsy on that eye. If there is a lesion of the optic nerve of the unilluminated eye, the patient will not have a direct light reflex of that eye when examining its own direct reflex. I am not sure how the IIIrd cranial nerve can lose only its parasympathetic fibres. It is difficult to see the unilluminated pupil when light is not directly shining on it.

Question 5.

Should every patient with trigeminal neuralgia be given an MRI of the brain?

Question 6.

Is carbamazepine more effective than phenytoin in the treatment of trigeminal neuralgia? Would this patient need a higher dose of carbamazepine, and what is the upper limit?

Question 7.

Is gabapentin effective in the treatment of trigeminal neuralgia?

Question 8.

What medication is best used for the treatment of carbamazepineresistant trigeminal neuralgia? Question 9.

What are the common causes of recurrent lower motor facial nerve palsy?

Question 10.

In a case of facial nerve palsy, what is the value of preserved taste sensation? Does its preservation exclude upper motor affection and/or nuclear lesion or is it localized between the facial canal and the cerebellopontine angle?