Master Eye & ENT
for PMDC NLE Step 1

Core Concepts

Eye:

• Glaucoma: Optic neuropathy characterized by progressive damage to the optic nerve, often associated with increased intraocular pressure (IOP), leading to irreversible visual field loss.
• Cataract: Opacification of the natural lens of the eye, causing painless, progressive vision loss.
• Retinal Detachment: Separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE), a medical emergency.
• Macular Degeneration: Leading cause of irreversible central vision loss in the elderly, affecting the macula.
• Conjunctivitis: Inflammation of the conjunctiva, presenting as "red eye." Can be bacterial, viral, or allergic.

• Otitis Media (AOM): Acute infection of the middle ear, commonly viral or bacterial.
• Otitis Externa: Inflammation/infection of the external auditory canal, often called "Swimmer's Ear."
• Meniere's Disease: Inner ear disorder causing spontaneous episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness.
• Benign Paroxysmal Positional Vertigo (BPPV): Most common cause of vertigo, triggered by specific head movements, due to otoconia displacement in the semicircular canals.
• Acute Sinusitis: Inflammation of the paranasal sinuses, typically viral, but can be bacterial.
• Pharyngitis/Tonsillitis: Inflammation of the pharynx/tonsils, most commonly viral, but Group A Streptococcus (GAS) is an important bacterial cause.

Clinical Presentation

• Glaucoma:
  • Primary Open-Angle Glaucoma (POAG): Often asymptomatic until late stages (peripheral vision loss).
  • Acute Angle-Closure Glaucoma (AACG): Sudden severe eye pain, blurred vision, halos around lights, nausea/vomiting, fixed mid-dilated pupil.
• Cataract: Gradual, painless blurring of vision, glare, halos around lights, reduced night vision.
• Retinal Detachment: Sudden onset of flashes of light (photopsia), new floaters, a "curtain" or "shadow" obscuring part of the visual field.
• Macular Degeneration: Gradual loss of central vision, distortion of straight lines (metamorphopsia).
• Conjunctivitis:
  • Bacterial: Purulent discharge, eyelids stuck together upon waking, usually unilateral.
  • Viral: Watery discharge, often bilateral, associated with URTI symptoms.
  • Allergic: Itching, watery discharge, often bilateral, associated with other allergy symptoms.
• Acute Otitis Media (AOM): Ear pain (otalgia), fever, irritability, hearing loss, often preceded by URTI.
• Otitis Externa: Ear pain worsened by touching the tragus or pulling the pinna, ear discharge, itching, ear canal swelling.
• Meniere's Disease: Episodic vertigo (20 mins to hours), fluctuating low-frequency sensorineural hearing loss, tinnitus, aural fullness.
• BPPV: Brief (seconds to minutes) episodes of vertigo triggered by head position changes (e.g., lying down, turning in bed).
• Acute Sinusitis: Facial pain/pressure, nasal congestion/discharge, post-nasal drip, headache, reduced sense of smell. Symptoms lasting >10 days or worsening after 5-7 days suggest bacterial.
• Strep Pharyngitis: Sudden onset sore throat, fever, absence of cough, tonsillar exudates, anterior cervical lymphadenopathy.

Diagnosis (Gold Standard)

• Glaucoma: Tonometry (IOP), Gonioscopy (angle assessment), Optic disc/RNFL OCT (optic nerve damage), Visual field testing (field loss).
• Cataract: Slit-lamp examination revealing lens opacities.
• Retinal Detachment: Dilated fundoscopy.
• Macular Degeneration: Amsler grid, Dilated fundoscopy, Optical Coherence Tomography (OCT).
• Conjunctivitis: Clinical diagnosis; cultures rarely needed.
• AOM: Otoscopy showing bulging, erythematous tympanic membrane (TM) with absent/impaired mobility and sometimes fluid behind TM.
• Otitis Externa: Otoscopy showing inflamed, edematous ear canal, often with discharge.
• Meniere's Disease: Clinical criteria (episodic vertigo, documented SNHL, tinnitus/fullness).
• BPPV: Dix-Hallpike maneuver eliciting vertigo and nystagmus.
• Acute Sinusitis: Clinical diagnosis. CT scan typically reserved for recurrent/chronic cases or complications.
• Strep Pharyngitis: Rapid Antigen Detection Test (RADT) and/or throat culture.

Management (First Line)

• Glaucoma:
  • POAG: Topical prostaglandin analogs (e.g., Latanoprost).
  • AACG: Immediate IOP reduction (topical beta-blockers, alpha-agonists, pilocarpine, systemic acetazolamide), followed by peripheral iridotomy.
• Cataract: Surgical extraction (phacoemulsification) with intraocular lens implantation.
• Retinal Detachment: Surgical repair (pneumatic retinopexy, scleral buckle, vitrectomy).
• Macular Degeneration:
  • Dry AMD: Lifestyle modification, antioxidant vitamins (AREDS formulation).
  • Wet AMD: Anti-VEGF injections (e.g., Ranibizumab, Aflibercept).
• Conjunctivitis:
  • Bacterial: Topical antibiotics (e.g., Moxifloxacin, Erythromycin ointment).
  • Viral: Supportive care (cold compresses, artificial tears).
  • Allergic: Topical antihistamine/mast cell stabilizer (e.g., Olopatadine).
• AOM: Amoxicillin. Watchful waiting for mild cases in older children.
• Otitis Externa: Topical otic fluoroquinolones (e.g., Ciprofloxacin/dexamethasone).
• Meniere's Disease: Dietary salt restriction, diuretics (e.g., Hydrochlorothiazide/triamterene).
• BPPV: Epley maneuver.
• Acute Bacterial Sinusitis: Amoxicillin-clavulanate.
• Strep Pharyngitis: Penicillin V or Amoxicillin.

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