Ophthalmology + ENT

Question 1

Uveitis symptoms and management

Answer 1

Anterior Uveitis:
Acutely painful red eye, decreased vision
Synechiae = iris adherence to cornea or lens (Seen on slit lamp examination)
Flare = leukocyte accumulation, HYPOPON may form (pus seen as white fluid level)
PHOTOPHOBIA
CONSTRICTED OR NON-REACTIVE DILATED PUPIL
TEARING
OPTIC DISC swelling and macular oedema may occur

Differentials = acute angle closure glaucoma(patients typically older than 40!!, patients may see Halos around lights, eye will be DILATED)

Associated w autoimmune systemic diseases

Posterior Uveitis:
Painless, floaters/flashers, lacrimation, decreased visual acuity

Steroid and Cycloplegic(a.g atropine) eye drops

+ management of underlying disease
Infectious causes = urgent specialty consultation

Question 2

What are the differenr stages of diabetic retinopathy and how are they managed?

Answer 2

Background retinopathy

• hard exudates, microaneurysms, blot haemorrhages
• glyceamic control

Pre-prolifereative

• cotton wool spots/soft exudates
• pan retinal photocoagulation

Proliferative

• visible new vessels
• pan retinal photocoagulation

Pre-proliferative with macular oedema
- anti VEGF injection = aflibercept, ranibizumab, bevacizumab

Question 3

Optic neuritis
Symptoms
Investigations
Management

Answer 3

subacute or acute onset of pain in the eye worse with eye movements
Reduced colour vision
RAPD
Vision loss- central scotoma - described as seeing through cloud/fog

MS = RF

MRI optic nerve

Methylprednisolone and prednisolone

Question 4

scleritis symptoms

Answer 4

Dark red eyes
Severe eye pain especially with eye movement
50% associated with systemic disease especially RA

Episcleritis is similar. It can cause irritation but importantly NO PAIN

Question 5

Visual field defects

Answer 5

Go through diagram

Question 6

Obstructive sleep apnea
Symptoms
Investigations
Management

Answer 6

Chronic snoring, excessive daytime sleepiness, insomnia

1st line = polysomnography = AHI ≥15 episodes/hour or AHI ≥5 with symptoms or comorbidities

CPAP
Upper airway surgery if discrete anatomical lesions present

Question 7

BPPV
Symptoms
Investigation
Management

Answer 7

Vertigo from bppv - <30s
Nausea, imbalance, lightheadedness - may persist longer
Absence of neurological or otological symptoms

Suggestive history + a positive Dix-Hallpike manoeuvre(unilateral delayed onset torsional nystagmus) or a positive supine lateral head turn

Repositioning maneuvers - Epley manoeuvre is best

Question 8

Tonsillitis
Symptoms
Management

Answer 8

Fever >38
Pain on swallowing
Tonsillar exudate (in bacterial causes)

Sore throat, cough, swelling of neck glands may occur

Usually viral and resolve on own
Antibiotics

Question 9

Rhinosinusitis
Symptoms
Management

Answer 9

Purulent nasal discharge
+ nasal obstruction or facial pain/pressure/fullness
<10 days = viral cause
< 4 weeks = bacterial cause or if they worsen after initial improvement

Antibiotics if bacterial

Differentials - Allergic and non allergic rhinitis

Question 10

Menieres disease
Symptoms
Investigation

Answer 10

sudden onset of vertigo, hearing loss(low frequencies), tinnitus, and sensation of fullness

Audiological tests

Question 11

Scleritis symptoms

Answer 11

Painful eye movement 
Eye pain which is boring and aching 
Deep pink colour to the eye 
Visual acuity preserved to late 
Associated with rhuematoid arthritis and other systemic symptoms