ENT and Eyes

Question 1

What are the symptoms of anterior uveitis?

Answer 1

acutely painful red eye that worsens over several days
photophobia
blurred vision
headache
small irregular pupil
ciliary flush

Question 2

What are the risk factors for anterior uveitis?

Answer 2

ankylosing spondylitis
reactive arthritis
ulcerative colitis, Crohn’s disease
Behcet’s disease
sarcoidosis: bilateral disease may be seen

Question 3

How is anterior uveitis managed?

Answer 3

Cycloplegic eye drops, e.g. atropine - dilates pupils, relieving pain and photophobia
Steroid eye drops
Analgesia
Methotrexate for chronic uveitis

Question 4

what are the risk factors for episcleritis?

Answer 4

mostly idiopathic
IBD
rheumatoid arthritis

Question 5

what are the features of episcleritis?

Answer 5

red eye
classically painless, may have mild pain/irritation
watering, mild photophobia
50% of cases are bilateral

Question 6

how can episcleritis be differentiated from scleritis?

Answer 6

scleritis usually painful
phenylephrine drops: eye redness improves with these drops in episcleritis
in episcleritis, injected vessels are mobile when gentle pressure is applied to sclera

Question 7

how is episcleritis managed?

Answer 7

conservative
artificial tears may be used

Question 8

What is rhinosinusitis?

Answer 8

Inflammation of the linings of the nasal passages and the paranasal sinuses

Question 9

What are the risk factors for rhinosinusitis?

Answer 9

Atopy: hay fever, asthma
Nasal obstruction, e.g. septal deviation or nasal polyps
Recent local infection, e.g. rhinitis or dental extraction
Swimming
Smoking

Question 10

What are the features of rhinosinusitis?

Answer 10

Nasal obstruction (‘mouth breathing’)
Nasal discharge
Post-nasal drip - may produce chronic cough
Facial pain/pressure - worse on bending forwards
Cough, myalgia, sore throat, anosmia

Question 11

What are the red flag symptoms for rhinosinusitis?

Answer 11

unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis

Question 12

What are the complications of rhinosinusitis?

Answer 12

Meningitis
Cavernous sinus thrombosis
Peri-orbital cellulitis
Abscess

Question 13

How is rhinosinusitis managed?

Answer 13

Symptoms <5 days: paracetamol, nasal saline irrigation and decongestants
Symptoms >10 days: topical steroids and antibiotics should be considered

Question 14

what is glaucoma?

Answer 14

optic nerve damage due to raised intraocular pressure - caused by blockage in aqueous humour trying to leave the eye

Question 15

what are the features of Ramsay Hunt syndrome?

Answer 15

auricular pain
facial nerve palsy
vesicular rash around the ear
vertigo, tinnitus

Question 16

how is Ramsay Hunt syndrome treated?

Answer 16

oral aciclovir and corticosteroids

Question 17

what are the stages of hypertensive retinopathy?

Answer 17

Grade 1 = Silver Wiring
Grade 2 = AV Nipping
Grade 3 = Flame Haemorrhages and Cotton Wool Exudates
Grade 4 = Papilloedema

Question 18

what are the features of vestibular schwannoma?

Answer 18

vertigo
sensorineural hearing loss (unilateral and progressive) - bilateral vestibular schwannomas are seen in neurofibromatosis type 2
tinnitus
headache, nausea, vomiting
facial weakness or numbness

Question 19

how is vestibular schwannoma investigated?

Answer 19

audiometry
MRI of cerebellopontine angle (gold standard)

Question 20

what is orbital cellulitis?

Answer 20

infection affecting the fat and muscles posterior to the orbital septum
usually caused by spreading upper respiratory tract infection
medical emergency, high mortality rate

Question 21

what are the risk factors for orbital cellulitis?

Answer 21

childhood
previous sinus infection
recent eyelid infection/insect bite on eyelid (periorbital cellulitis)
ear or facial infection

Question 22

what are the features of orbital cellulitis?

Answer 22

redness and swelling around the eye
severe ocular pain
visual disturbance
proptosis (bulging of eyes)
ophthalmoplegia/pain with eye movements
eyelid oedema and ptosis

Question 23

what organisms commonly cause orbital cellulitis?

Answer 23

Streptococcus
Staphylococcus aureus
Haemophilus influenzae B

Question 24

how is orbital cellulitis investigated?

Answer 24

FBC (elevated WBC, raised inflammatory markers)
ophthalmologic assessment (decreased vision, afferent pupillary defect, proptosis)
CT with contrast
blood culture and microbiological swab

Question 25

how is orbital cellulitis managed?

Answer 25

admit to hospital for IV antibiotics

Question 26

what are the types of epistaxis?

Answer 26

anterior bleed: often has visible source of bleeding, insult to Kiesselbach’s plexus
posterior bleed: more profuse, originate from deeper structures

Question 27

what are the causes of epistaxis?

Answer 27

trauma
insertion of foreign bodies
bleeding disorders: immune thrombocytopaenia
juvenile angiofibroma: benign tumour that is highly vascularised, seen in adolescent males
cocaine use
hereditary haemorrhagic telangiectasia
granulomatosis with polyangiitis

Question 28

how is epistaxis managed first line?

Answer 28

first aid measures - patient sits forward with their mouth open (reduced risk of aspiration of blood)
pinch cartilaginous area of nose firmly
this should be done for at least 20 minutes
give topical Naseptin - contraindicated with peanut allergy

Question 29

how is epistaxis managed if first-line measures don’t work?

Answer 29

nasal cautery using silver nitrate packs if bleeding can be visualised
otherwise, nasal packing
admit to hospital if posterior bleed suspected
final: sphenopalatine ligation in theatre

Question 30

what are the features of vestibular neuronitis?

Answer 30

post-viral infection
recurrent vertigo attacks lasting hours or days
nausea and vomiting
horizontal nystagmus
no hearing loss or tinnitus

Question 31

what are the features of viral labyrinthitis?

Answer 31

vertigo, which is exacerbated by movement
nausea and vomiting
sensorineural hearing loss - may be unilateral or bilateral
tinnitus
preceding or concurrent symptoms of viral infection

Question 32

what are the features of bacterial conjunctivitis?

Answer 32

sore, red eyes
purulent discharge
eyes may be ‘stuck together’ in the mornings

Question 33

what are the features of viral conjunctivitis?

Answer 33

serous discharge
URTI
preauricular lymph nodes