ENT/Ophthalmology

Question 1

What are concerning features in paeds AOM?

Answer 1

Systemically unwell
Any acute complications
< 3 months old
<6 months and febrile
Ottorrhoea
<2yrs with bilateral infections

Question 2

What are the acute complications in AOM? (5)

Answer 2

Meningitis
Mastoiditis
Intracranial abscess
Sinus thrombosis
Facial nerve palsies

Question 3

What are the concerning features for orbital cellulitis? (3)

Answer 3

Proptosis
RAPD
Restriction of eye movements or associated diplopia

Question 4

What is an RAPD?

Answer 4

A pupil that constricts more to consensual rather than direct light.

Seen in unilateral optic nerve or retinal disease. E.g. optic neuritis

Question 5

What are the clinical signs of optic neuritis? (6)

Answer 5

Painless unilateral vision loss over hours to days
Central scotoma
RAPD
Painful eye movements
Fundoscopy - mild optic disc swelling
Red desaturation (MS)

Gold standard Ix - MRI with gadolinium

Question 6

What are the causes of optic neuritis?

Answer 6

MS
DM
Infections E.g. syphylis
Medications E.g. Ethambutol

Question 7

Risk factors for MS (5)

Answer 7

Smoking
Autoimmune ds.
EBV/infectious mononucelosis prev.
Obesity in childhood (esp. females)
Northern hemisphere (low vitD)

Question 8

Giant cell arthritis - features and risk factors

Answer 8

Usually in women over 50yrs
- new onset headache
- temporal art tenderness, thickening, or nodularity
- visual disturbance (loss, diplopia, change to colour)
- scalp tenderness
- intermittent jaw claudication
- features of PMR
- Systemic st - fever, fatigue, wt loss

Rx prednisolone 40-60mg PO
Or 0.5-1mg methylpred IV if visual loss

Question 9

Which patients with OM are more likely to benefit from abx?

Answer 9

Discharging perforation
<2yrs and B/L OM
Systemically unwell
Underlying vulnerability

Back up prescription can be given if no improvement in 3/7