Otorhinolaryngology and Ophthalmology: Sensory Organs in Focus
Core concepts
ENT and ophthalmology questions reward systematic anatomy and pattern recognition. In ENT, know the anatomy of the ear and the distinction between conductive and sensorineural hearing loss, confirmed by tuning fork tests. Understand the approach to vertigo - peripheral versus central features - and the management of epistaxis by site. Learn the red flags of head and neck disease: hoarseness lasting beyond three weeks, unilateral nasal obstruction, and a neck lump. Know the complications of otitis media and sinusitis.
In ophthalmology, master the causes of a red eye and how to separate benign from sight-threatening: keratitis, acute angle-closure glaucoma, uveitis and endophthalmitis are emergencies, while conjunctivitis is usually not. Understand the physiology of aqueous flow and the principles of glaucoma management. Learn the presentation of retinal detachment, central retinal artery occlusion, and diabetic retinopathy. Test visual acuity and fields before anything else.
Traps
Examiners exploit the patient with a painful red eye and reduced vision - a red flag - versus the comfortable red eye with normal vision. Do not confuse vertigo with presyncope or disequilibrium. Watch for questions where the answer is urgent referral rather than a specific drug.
Rule of thumb
In the red eye, pain plus reduced vision plus photophobia means an emergency until proven otherwise. In vertigo, the presence of neurological signs points to a central cause.
Worked example
A patient has a painful red eye, haloes around lights, a fixed mid-dilated pupil and a hard globe. This is acute angle-closure glaucoma; management is urgent ophthalmology referral with intraocular pressure-lowering treatment, not topical antibiotics.