Otorhinolaryngology and Ophthalmology
These items test the red-flag eye and ear presentations that must be recognised and referred, plus hearing assessment and common ENT infections.
Core rules
- Acute otitis media: bulging red drum, fever, earache; treat with amoxicillin, and give analgesia.
- Chronic suppurative otitis media: persistent discharge through a perforation; keep the ear dry; refer for surgery if cholesteatoma is suspected.
- Hearing tests: Rinne compares air and bone conduction; Weber lateralises to the affected side in conductive loss and to the better ear in sensorineural loss.
- Epistaxis: Little's area is the commonest site; pinch the nose and lean forward. Posterior bleeding needs packing and referral.
- Acute angle-closure glaucoma: painful red eye, haloes, nausea, fixed mid-dilated pupil and high intraocular pressure. Treat with pilocarpine, acetazolamide, hyperosmotic agents and laser iridotomy.
- Corneal ulcer: painful red eye with fluorescein uptake - urgent referral; never start steroids.
Worked example
A 60-year-old has sudden severe eye pain, blurred vision with haloes, nausea and a hard eye with intraocular pressure of 50 mmHg. This is acute angle-closure glaucoma. Give topical pilocarpine, intravenous or oral acetazolamide, analgesia and an osmotic agent, then arrange laser peripheral iridotomy.
Traps
- Prescribing steroid drops for a corneal ulcer.
- Using mydriatics in angle-closure glaucoma.
- Missing sudden painless visual loss, which suggests retinal artery occlusion.
- Treating a discharging ear with repeated antibiotics instead of referring for cholesteatoma.