Question Easy:
A 45-year-old woman presents with sudden onset unilateral flashing lights and visual floaters. She also reports a shadow descending across her field of vision. What is the most likely diagnosis? 🚨
A) Migraine
B) Retinal detachment
C) Conjunctivitis
D) Glaucoma
E) Diabetic retinopathy
Question Medium:
A 32-year-old man comes in with progressive hearing loss over the past few months. On examination, his tympanic membrane appears normal, and Rinne’s test shows air conduction is greater than bone conduction bilaterally. Weber’s test lateralizes to the right ear. What is the most likely diagnosis?
A) Otosclerosis
B) Sensorineural hearing loss on the left
C) Ménière’s disease
D) Chronic otitis media
E) Presbycusis
Question Hard:
A 33-year-old woman presents with episodes of vertigo, tinnitus, fluctuating hearing loss, and a sensation of fullness in her right ear. Her symptoms are episodic and last for several hours. Which of the following medications is recommended by NICE as first-line treatment for her condition?
A) Betahistine
B) Meclizine
C) Diazepam
D) Amoxicillin
E) Prednisolone
Explanations & Answers:
Question Easy Answer:
B) Retinal detachment
Question Easy Explanation:
Retinal detachment is characterised by symptoms such as sudden onset flashing lights, floaters, and a shadow or curtain descending across the field of vision. Immediate referral to an ophthalmologist is warranted. Guidance from NICE emphasises the urgency of assessment to prevent permanent vision loss.
Question Medium Answer:
B) Sensorineural hearing loss on the left
Question Medium Explanation:
In sensorineural hearing loss, air conduction remains greater than bone conduction on Rinne’s test. Weber’s test localizes to the better (right) ear when there is sensorineural loss on the opposite side. The patient’s presentation of progressive hearing loss with a normal tympanic membrane helps to rule out conductive causes.
Question Hard Answer:
A) Betahistine
Question Hard Explanation:
Betahistine is commonly used and recommended by NICE as a first-line treatment for Ménière’s disease. It helps to reduce the frequency and severity of vertigo attacks. Other medications like meclizine and diazepam may be used for symptom control but are not first-line treatments according to current guidelines.
Medical fact of the day:
Did you know that Age-related macular degeneration (AMD) is the leading cause of severe vision loss in people over 50 in the UK? Early detection and lifestyle changes can significantly slow its progression.
Quote of the day:
“Every patient you see is a reminder of why you chose this path. Continue to make a difference, one step at a time.” 💡💖