**Question Easy:**
A 25-year-old woman presents to the GP with complaints of sudden, painless loss of vision in her left eye, which she noticed upon waking up this morning. She reports no trauma or previous ocular problems. An afferent pupillary defect is noted on the left with fundoscopy revealing a pale retina and a cherry-red spot at the macula. What is the most likely diagnosis?
A) Retinal detachment
B) Central retinal artery occlusion
C) Optic neuritis
D) Diabetic retinopathy
E) Age-related macular degeneration
**Question Medium:**
A 60-year-old man complains of gradually worsening hearing loss in his right ear over the past year. He also notes occasional tinnitus and a sensation of fullness in the same ear. On otoscopic examination, there is a visible oblique light reflection, with no signs of infection or fluid. Tympanometry reveals Type As tympanogram, and audiometry shows conductive hearing loss. What is the likely diagnosis?
A) Acoustic neuroma
B) Otitis media with effusion
C) Otosclerosis
D) Presbycusis
E) Cholesteatoma
**Question Hard:**
A 45-year-old woman presents with intermittent episodes of vertigo, hearing loss, tinnitus, and a feeling of pressure in her left ear. These episodes last for several hours and are so severe that she often has to lie down. She denies any recent infections or trauma. Audiometry reveals low-frequency sensorineural hearing loss in her left ear. Which of the following is the most appropriate initial management?
A) High-dose oral corticosteroids
B) Low-salt diet and diuretics
C) Vestibular rehabilitation exercises
D) Surgical decompression
E) Antibiotic therapy
**Explanations & Answers:**
**Question Easy Answer:** B
**Question Easy Explanation:** Central retinal artery occlusion (CRAO) is characterised by sudden, painless vision loss, often noticed upon waking, with classic findings of a pale retina and a cherry-red spot at the macula due to the obstruction of blood flow to the retina. This is an ophthalmic emergency and requires immediate attention based on NICE guidelines.
**Question Medium Answer:** C
**Question Medium Explanation:** Otosclerosis is a condition involving abnormal bone growth in the middle ear, typically affecting the stapes bone, leading to conductive hearing loss, tinnitus, and a sensation of fullness. The Type As tympanogram and audiometry findings are consistent with otosclerosis, which is also backed by NICE and NHS guidelines.
**Question Hard Answer:** B
**Question Hard Explanation:** Meniere’s disease is characterised by episodic vertigo, fluctuating sensorineural hearing loss (initially low-frequency), tinnitus, and aural fullness. NICE guidelines recommend a low-salt diet and diuretics as initial conservative management to reduce fluid retention in the inner ear and alleviate symptoms.
**Medical fact of the day:** Did you know that the human eye can distinguish approximately 10 million different colours? This incredible capability is due to the cone cells in our retina, which are sensitive to varying wavelengths of light!
**Quote of the day:** “In the hustle of healing, remember to find a moment for your own peace. Every act of care is an act of courage. 🌟”