ENT and Ophthalmology: Red Flags and Emergencies
What this domain tests
The section tests red-eye diagnosis, sudden vision loss, glaucoma, retinal disease, hearing loss, vertigo, epistaxis, otitis, and upper airway obstruction. Red flags distinguish clinic cases from emergencies.
Core rules
- Painful red eye with halos, mid-dilated pupil, hazy cornea, and high intraocular pressure suggests acute angle-closure glaucoma.
- Dendritic corneal ulcer is herpes simplex keratitis; topical steroids are contraindicated.
- Chemical eye injury needs immediate copious irrigation before detailed examination.
- Sudden sensorineural hearing loss is an emergency treated with urgent steroids.
- Epistaxis: sit upright, lean forward, pinch the soft part of the nose for 10–15 minutes, and assess for posterior bleeding.
Worked example
A 60-year-old has severe eye pain, blurred vision, coloured halos, a mid-dilated pupil, and a hazy cornea. The likely diagnosis is acute angle-closure glaucoma. Give immediate topical beta-blocker, pilocarpine after IOP reduction, and intravenous acetazolamide, and arrange ophthalmology review for definitive laser peripheral iridotomy. The reasoning is that the angle is blocked, so lowering IOP and relieving the block are priorities.
Traps
Giving steroids for a dendritic ulcer; missing giant cell arteritis in an elderly patient with headache and visual loss; prescribing antibiotics for viral conjunctivitis; delaying irrigation in chemical injury; treating vertigo as a psychiatric symptom without examining nystagmus.
Exam strategy
In ENT and ophthalmology, first decide whether the condition threatens vision or airway, then choose the time-critical treatment.