Opthalmology & ENT

Question 1

Management of epistaxis

Answer 1

• Resus if needed
• Apply pressure and tilt head forwards for 15 mins
• Find bleeding point and use silver nitrate cautery
• if not bleeding point refer to ENT
• If bleeding continues, use anterior nasal pack fro 24 hours
• If still bleeding use posterior nasal pack

Question 2

Symptoms and Management of acute angle closure glaucoma

Answer 2

Symptoms: Nausea, vomiting, red eye, pain, headache, mid-dilated pupil, haloes around bright lights, blurred vision- unilateral symptoms

Management: Beta blockers - Timolol, Miotics - pilocarpine, carbonic anhydrase inhibitors

Admit to monitor IOP

Peripheral iridectomy once IOP is controlled

Question 3

Neck lump red flags

Answer 3

• Weight loss
• Night sweats
• Fever
• Dysphagia
• Hoarseness
• Dysphonia
• Sore throat

Question 4

Differentials for gradual loss of vision

Answer 4

• Cataract
• Macular degeneration
• Glaucoma

Question 5

Differentials for ear discharge

Answer 5

• Otitis externa
• Chronic suppurative otitis media
• Cholesteatoma
• CSF otorrhoea

Question 6

Ototoxic drugs

Answer 6

• Gentamicin
• Streptomycin
• Vancomycin
• Quinines
• Chemotherapy

Question 7

Differentials for nasal blockage

Answer 7

• Septal deviation
• Chronic rhinosinusitis
• Allergic rhinosinusitis
• Chronic rhinosinusitis with nasal polyps
• Viral URTI

Question 8

Investigations after loss of vision history

Answer 8

• Eye examination (including visual fields, acuity, reflexes, eye movements)
• Fundoscopy
• ESR and temporal artery biopsy
• Tonometry
• MRI is MS suspected

Question 9

Investigations after hearing loss history

Answer 9

• Neurological and Ear exmination (Rinne’s and Weber’s)
• Otoscopy
• Pure tone audiometry
• Medication review

Question 10

Differentials for a red eye

Answer 10

• Conjunctivitis
• Subconjunctivial hemorrhage
• Infectious keratitis
• Anterior uveitis
• Episcleritis
• Scleritis
• Acute glaucoma

Question 11

Sore throat history

Answer 11

• History of sore throat (duration, onset, progression, relieving and aggravating factors)
• ENT symptoms (coryzal symptoms, dysphagia, hoarseness, cough, neck lumps, ear pain)
• Systemic symptoms (fatigues, weight loss, loss of appetite, rash, abdo pain, headache, shortness of breath)

Question 12

Most common type of cataract

Answer 12

Nuclear

Question 13

Differentials for diplopia

Answer 13

• Myasthenia gravis
• 3rd, 4th, and 6th nerve palsies
• Any cause of raised ICP
• Alcohol intoxication

Question 14

Differentials for hearing loss

Answer 14

Conductive: Ear wax, otosclerosis, cholesteatoma, tumour, glue ear

Sensorineual: Meniere’s, presbycusis, noise induced, acoustic neuroma, medications, post- infectious

Question 15

Causes of Congenital cataracts

Answer 15

• Genetic mutation (autosomal dominant)
• Chromosomal abnormalities (Down syndrome, Edward syndrome)
• Metabolic disorders
• Intrauterine infections (Rubella, CMV, Varicella)

Question 16

Red flags in red eye history

Answer 16

• Visual loss
• History of trauma
• Haloes around bright lights
• Discharge or itchiness
• Recent urinary symptoms (burning or discharge)
• Joint pain or rashes

Question 17

Nasal blockage history

Answer 17

Duration
Onset\Timeline
Variation throughout the year
Unilateral or bilateral
History of trauma
Nasal symptoms: discharge, post nasal drip, sneezing, facial pain, epistaxis, sense of smell
Previous nasal surgery
Allergies

Question 18

DVLA rules regarding visual acuity

Answer 18

Must be better than 6/12 corrected with both eyes

Question 19

Risk factors for retinal detachment

Answer 19

• Trauma

- Myopia

Question 20

Complications of untreated retinopathy of prematurity

Answer 20

• Retinal detachment

- Vitreous hemorrhage

Question 21

Investigations after a red eye history

Answer 21

• Eye examination (including visual fields, acuity, reflexes, eye movements)
• Fundoscopy
• Tonometry
• Swabs for culture/PCR
• Gonioscopy
  CXR, syphilis serology, HLA- B27 for complex uveitis

Question 22

DVLA rules regarding first seizure/epilepsy diagnosis

Answer 22

First seizure: Stop driving until seizure free for 6 months

Epilepsy diagnosed: Stop driving until seizure free for 1 year

Question 23

Differentials for acute loss of vision

Answer 23

• Retinal detachment
• Retinal artery occlusion
• Retinal vein occlusion
• Temporal arteritis
• Optic neuritis
• CVA

Question 24

Symptoms and management of anterior uveitis

Answer 24

Symptoms: Pain, blurred vision, red eye, photophobia, increased lacrimation, features of systemic disease

Management: urgent referral; prednisolone drops, cyclopentolate to dilate pupil and prevent adhesions

Question 25

Sore throat differentials

Answer 25

- Acute pharyngitis (common cold) - Tonsilitis (viral or bacterial) - Peritonsilar abscess (quinsy) - Glandular fever

Question 26

DVLA rules after TIA/Stroke

Answer 26

Stop driving for 1 month

Question 27

Red flags in loss of vision history

Answer 27

- Sudden loss of vision - Red eye - Headache - Flashes or floaters - Weakness

Question 28

Neck lump history differentials

Answer 28

- Malignancy (SCC, salivary gland tumour, lymphoma) - Infection (EBV, CMV, TB - Thyroid (nodule, goitre) - Inflammatory (sarcoidosis) - Vascular (carotid aneurysm)

Question 29

Differentials for dizziness/vertigo

Answer 29

- Acute labrynthitis - Acoustic neuroma - BPPV - Meniere's disease - Ototoxicity - Ramsay Hunt Syndrome

Question 30

Features of orbital cellulitis

Answer 30

- Lid swelling - Fever - Diplopia (limited upgaze) - Painful eye movements - Proptosis

Question 31

Features of retinoblastoma

Answer 31

- White pupil (leucocoria) - Absent red reflex -

Question 32

DVLA guidelines for glaucoma

Answer 32

Advised to inform DVLA who will then arrange their own specific tests

Question 33

Driving rules with diplopia

Answer 33

Must advise the DVLA and stop driving - Group 2 drivers cannot drive

Question 34

Management of diplopia

Answer 34

Refer to orthoptist - Patch - Temporary prism - Permanent prism