ENT & Ophthalmology

Question 1

What are the common ENT conditions presenting to the emergency department?

Answer 1

Epistaxis

Earache

Question 2

How should epistaxis be assessed?

Answer 2

A-E
-estimate blood loss
Examine the nose

Question 3

What is the immediate first-aid for epistaxis?

Answer 3

Lean forward
Pinch fleshy part of nose for 10mins
Apply ice pack to bridge of nose

Question 4

How is epistaxis managed?

Answer 4

First-aid
IV access (FBC, U&E, coag, G&S)
Remove clots
Apply anaesthetic/vasoconstrictor spray
Cauterise
   -silver nitrate/diathermy
Ant vaseline packing +/- balloon
Ligation of sphenopalatine aa
   -last resort, in theatre

Question 5

What is the most common cause of URTI in children?

Answer 5

Acute otitis media

Question 6

What are the sx of acute otitis media?

Answer 6

Hearing loss
Pain
Otorrhoea
Pyrexia
Systemic disturbance

Question 7

What are the signs of acute otitis media?

Answer 7

Red, bulging TM

Possible perforation

Question 8

What are the potential complications of acute otitis media?

Answer 8

Facial nn palsy
Labyrinthitis
Intercranial infections

Question 9

What are the management options of acute otitis media?

Answer 9

1st line = Amoxicillin
Myringotomy
-if fails to resolve OR neurological sequelae

Question 10

What are the common Ophthalmological conditions presenting to the emergency department?

Answer 10

Corneal FB
Ocular pain
Sudden visual loss

Question 11

How should a corneal FB be managed?

Answer 11

Apply topical anaesthetic
Fluorescein stain
Evert eyelid
IF EMBEDDED IN CORNEA GET SENIOR HELP

Question 12

What are the differentials for ocular pain?

Answer 12

Discomfort - conjunctivitis, thyroid eye disease, dry eye, blepheritis
Pain on eye movement - optic neuritis
Pain around eye - giant cell arteritis, orbital cellulitis
Severe pain - ant uveitis, bacterial keratitis, AAC glaucoma, scleritis/episcleritis

Question 13

What are the sx of optic neuritis?

Answer 13

Pain on eye movement
Loss of vision over days
-especially colour e.g. red desaturation

Question 14

What are the sx of ant uveitis?

Answer 14

Severe pain
Photophobia
Blurred vision
Red eye
Synechiae

Question 15

What are the sx of bacterial keratitis?

Answer 15

Severe pain
Blurred vision
Hypopyon

Question 16

What are the sx of acute angle closure glaucoma?

Answer 16

Severe pain
Red eye
Blurred vision
Photophobia
Headache
Nausea

Question 17

What are the sx of scleritis/episcleritis?

Answer 17

Severe pain
Red eye
Intense pain
Blurred vision (w/ scleritis)
Tenderness (w/ episcleritis)

Question 18

How is ant uveitis managed?

Answer 18

Topical steroids
Mydriatics
Antibiotics

Question 19

How is bacterial keratitis managed?

Answer 19

Topical antibiotics

Question 20

How is acute angle closure glaucoma managed?

Answer 20

IV acetazolamide
Topical pilocarpine (every 5mins)
Topical B-blockers

Question 21

How is scleritis/episcleritis managed?

Answer 21

Scleritis = systemic steroids
Episcleritis = topical NSAIDs

Question 22

What are the common causes of sudden, painful visual loss?

Answer 22

Angle closure glaucoma
Uveitis
Optic neuritis
Giant cell arteritis

Question 23

What are the common causes of sudden, painless visual loss?

Answer 23

Ischaemic optic neuropathy
Retinal artery/vein occlusion
Retinal detachment 
AMD
Vitreous haemorrhage
Intracranial disease