ENT, Ophthalmology and Sensory Conditions
What this domain tests
Red flags in the eye, ear, nose and throat, and the decisions that must happen today rather than at routine review.
Core rules
- The painful red eye. A contact lens wearer with pain, photophobia or reduced vision needs same-day ophthalmology assessment for microbial keratitis. Acute angle closure - severe pain, haloes, headache, vomiting, a fixed mid-dilated pupil - is an emergency.
- Sudden painless loss of vision suggests a vascular event and needs immediate assessment. Sudden floaters with flashes requires same-day review to exclude retinal tear or detachment.
- Epistaxis. Pinch the soft part of the nose and lean forward for 10–15 minutes; cautery or packing if it persists. Consider anticoagulants and hypertension. Recurrent unilateral bleeding in an older adult warrants nasendoscopy.
- Sore throat. Use FeverPAIN or Centor to guide antibiotics; most are viral. Refer for recurrent tonsillitis meeting documented frequency criteria, or for quinsy if there is trismus, a hot potato voice or uvular deviation.
- Hoarseness lasting more than three weeks, especially with smoking, needs urgent laryngeal assessment.
- Otitis externa is treated with topical antibiotic or antiseptic drops after clearing debris; avoid drops if the tympanic membrane may be perforated unless a licensed formulation is used.
- Sudden sensorineural hearing loss is an emergency - urgent ENT referral, as steroids within days improve outcome.
Worked example
A 44-year-old soft contact lens wearer presents with a painful red right eye and photophobia since yesterday. You advise lens removal, do not prescribe topical antibiotics, and refer to ophthalmology the same day. The reasoning: contact lens-related keratitis is sight-threatening and needs a corneal scrape and specialised treatment.
Traps
- Treating a contact lens red eye with chloramphenicol.
- Missing acute angle closure because the patient reports vomiting.
- Prescribing antibiotics for a viral sore throat without using a scoring tool.
- Dismissing hoarseness as reflux after three weeks.