ENT + Ophthal

Question 1

Sudden onset sensironeural hearing loss -> Rx

Answer 1

Prednislone 60mg daily for 7-14days
Most causes idiopathic
Need MRI to exclude vestibular schwannoma

Question 2

Croup mild-mod treatment

Answer 2

1st line - pred 1mg/kg single dose
2nd line - dex 0.15mg.kg
Observe for 30mins in clinic

Question 3

Severe croup Rx

Answer 3

Nebulised adrenalinee 0.1% solution, 5ml. Rpt after 30mins if no improvement
PLUS
Pred 2mg/kg, with rpt 24hrs
or Dex 0.6mg/kg

Question 4

LR6 SO4 O3 ??

Answer 4

Eye movements
- lateral rectus, 6th (abducens)
- superior oblique (down+out) , 4th (trochlear)
- others, 3rd (oculomotor)

Question 5

DDX of 3 months nasal congestion, loss of smell + facial pain (6)

Answer 5

• Chronic rhino-sinusitis
• Allergic rhinitis
• Rhinits Medicamentosa (overuse of nasal decongestants)
• Cluster headaches
• nasal foreign body
• nasopharyngeal carcinoma

Question 6

Hx features in acute angle closure glaucoma (5)

Answer 6

1. Decreased vision from affected eye
2. Halos around lights
3. Headache
4. Severe eye pain
5. Nausea+vomiting

Question 7

Examination findings in acute angle closure glaucoma (5)

Answer 7

1. Poor pupillary reaction
2. Mid dilated pupil
3. Reduced visual acuity
4. Conjuctival injection or erythema
5. Cloudy cornea

Question 8

Pt presents with severe right sided headache + eye pain. Eye is red, and he complains of reduced vision in this side ? Dx + Mx (6)

Answer 8

Acute angle closure glaucoma
1. Arrange urgent ambulance transfer to hospital for ophthlamology review
2. Ondansetron PO
3. Morphine IM
4. Keep in supine position
5. Keep NBM
6. Avoid eye patching (will dilate eye

Question 9

Finding that is marked, and likely Dx

Answer 9

Peri-limbic injection -> think anterior uveitis
Usually spared in conjunctivitis

Question 10

16yoF presents with few days of bilateral red eyes, dry + itchy. OE cobblestone pattern on close examination of conjuctiva
?Dx and treatment (5)

Answer 10

Allergic conjunctivitis
Rx
1. Azelastine eye drops (antihistamine + mast cell stabliser)
2. Avoid rubbing eyes
3. Discontinue contact lens use
4. Cool compresses
5. refrigerated artificial tears

Question 11

16yoF with few days of bilateral red eyes. OE follicular pattern on close exam of conjunctiva
?Dx

Answer 11

Follicular pattern assoc with viral conjuctivitis
NB: different to cobblestone

Question 12

2 features and underlying diagnosis

Answer 12

1. Exudates
2. Haemorrhages

Both features of diabetic retinopathy
- can progress with neovascularisation

Question 13

Age that orbital (post-septal) cellulitis is higher risk?
+ differentiating factors for orbital (3)

Answer 13

<4yo is higher risk
Symptoms of orbital
- systemic features
- pain on eye movements
- visual loss

Question 14

First line Abx for spreading odontogenic infection without severe disease (1+2)

Answer 14

1. Metronidazole BD 5/7
   PLUS Phenoxymethylpenicillin QID for 5/7
   2nd line - Aug DF
   Penicllin allergy - oral clindamycin TDS 5/7

Question 15

DDx of monocular vision loss (5)

Answer 15

1. TIA/CVA
2. Giant cell arteritis
3. Acute angle-closure glaucoma
4. Migraine
5. Optic neuritis

Question 16

DDx of red eye (8)

Answer 16

1. Episcleritis
2. Scleritis
3. Conjunctivitis - bacterial, viral, allergic
4. Corneal abrasion or FB
5. Acute angle-closure glaucoma
6. Uveitis
7. Photokeratitis
8. Bacterial Keratitis (think contact lens)

Question 17

Progressive conductive hearing loss in 20-30yo, with Fhx of similar

Answer 17

Otosclerosis