Question Easy: 👀 A 45-year-old man presents to the GP with sudden onset of painless vision loss in his right eye. Fundoscopy reveals a cherry-red spot at the fovea and a pale retina. What is the most likely diagnosis?
A) Retinal detachment
B) Central retinal artery occlusion
C) Central retinal vein occlusion
D) Age-related macular degeneration
E) Diabetic retinopathy
Question Medium: 👂 A 30-year-old woman attends the ENT clinic with tinnitus and sensorineural hearing loss in her left ear, along with facial paresis. MRI shows a mass at the cerebellopontine angle. What is the most likely diagnosis?
A) Acoustic neuroma (vestibular schwannoma)
B) Ménière’s disease
C) Labyrinthitis
D) Otosclerosis
E) Cholesteatoma
Question Hard: 👃 An 8-year-old child is brought to A&E with epistaxis that won’t stop despite pinching the nose and applying cold compresses. On examination, bright red blood is seen oozing from the anterior part of the nasal septum. What is the most effective first-line treatment that should be considered for this persistent case according to current UK guidelines?
A) Nasal packing
B) Silver nitrate cautery
C) Electrocautery
D) Systemic tranexamic acid
E) Antifibrinolytic nasal spray
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: The sudden onset of painless vision loss with a cherry-red spot at the fovea is a classic sign of central retinal artery occlusion. It occurs due to a blockage in the retinal artery, leading to ischemia. Immediate treatment is essential to attempt to restore blood flow and prevent permanent vision loss, but prognosis is generally poor.
Question Medium Answer: A
Question Medium Explanation: The symptoms and MRI findings are indicative of an acoustic neuroma, also known as a vestibular schwannoma. This benign tumour on the vestibulocochlear nerve can cause hearing loss, tinnitus, and sometimes facial nerve involvement due to its location at the cerebellopontine angle.
Question Hard Answer: B
Question Hard Explanation: For persistent anterior epistaxis, NICE guidelines suggest first attempting chemical cautery with silver nitrate when the bleeding site is clearly identified. This is typically done after simple first aid measures have failed and is more effective than nasal packing for clearly identified anterior bleeds.
Medical fact of the day: 👃 The sense of smell, or olfaction, is the only one of the five senses that has a direct connection to the brain through cranial nerve I (the olfactory nerve). It does not relay through the thalamus as the other senses do, which is why smells can trigger vivid memories and emotions.
Quote of the day: “In the world of healing, every small step toward understanding brings us closer to the miracle of care.” 🌟