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LE2 Flashcards

1
Q

The following conditions may cause sudden visual loss except
a. Amaurosis fugax
b. Anterior ischemic optic neuropathy
c. Retinal detachment
d. Cataract

A

d. Cataract

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2
Q
  1. The following conditions can cause anisocoria except
    a. Herniation
    b. CN II paralysis
    c. NOTA
    d. Horner syndrome
A

b. CN II paralysis

Anisocoria refers to a condition where the two pupils of the eyes are of unequal size. The optic nerve (CN II) is responsible for vision, not pupil size. Pupil size and reaction are mainly governed by the sympathetic and parasympathetic pathways involving CN III (oculomotor nerve). Thus, CN II paralysis wouldn’t typically cause anisocoria. The other options can be associated with anisocoria. (NOTA usually means “None Of The Above,” and if “Homer syndrome” is a typo and you meant “Horner’s syndrome,” then Horner’s syndrome can indeed cause anisocoria.)

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3
Q
  1. The afferent arm of the pupillary light reflex
    a. Optic nerve
    b. Trochlear nerve
    c. Abducens nerve
    d. Oculomotor nerve
A

a. Optic nerve

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4
Q
  1. 40 year old female with 2 month history of headaches and blurring of vision. On fundoscopy, the following is noted. What is your most likely diagnosis
    a. Central retinal artery occlusion
    b. Optic neuritis
    c. Retinal detachment
    d. Papilledema
A

d. Papilledema

Rationale:
Papilledema is swelling of the optic disc due to increased intracranial pressure. The clinical symptoms of headaches and blurred vision combined with fundoscopic findings of swollen optic disc would be most consistent with papilledema. The other options provided have distinct clinical and fundoscopic presentations different from the scenario described.

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5
Q
  1. Which of the following is a painful, idiopathic inflammatory orbital syndrome?
    a. Carotid-cavernous fistula
    b. Grave’s ophthalmopathy
    c. Orbital pseudotumor
    d. Orbital cellulitis
A

c. Orbital pseudotumor

Rationale:
Orbital pseudotumor, also known as idiopathic orbital inflammation, is a painful inflammatory condition of the orbit without a known cause. It is not associated with systemic disease and is not infectious. The inflammation can involve any structure within the orbit.

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6
Q

A 24 y/o female consulted for right eye proptosis. She was involved in a vehicular crash 2 weeks prior. On examination, there was noted of proptosis and chemosis of the left eye, with limited extraocular movements. There was also note of bruit on auscultation. What will be the definitive management for the patient?
a. Observation
b. Steroid therapy
c. Endovascular technique/intervention
d. Antibiotic treatment

A

c. Endovascular technique/intervention

Rationale:
The presentation described suggests a carotid-cavernous fistula (CCF). CCFs can occur traumatically, as might be the case following a vehicular crash. Symptoms of a CCF include proptosis (bulging of the eye), chemosis (swelling of the conjunctiva), decreased eye movement, and a bruit that can be heard over the eye or orbit. The definitive management for a traumatic CCF is typically endovascular intervention to close off the abnormal connection between the carotid artery and the cavernous sinus.

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7
Q

Which of the following is consistent with subconjunctival hemorrhage?
a. Associated with severe pain
b. May be caused by increased venous
pressure
c. Usually resolves after 6 months with intensive pharmacologic treatment
d. Usually presents with purulent discharge.

A

b. May be caused by increased venous pressure

Subconjunctival hemorrhage can be caused by factors that increase venous pressure, such as sneezing, coughing, or heavy lifting. It is typically painless and often resolves on its own within a few weeks without treatment.

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8
Q

Considered as transient ischemic attack of the retina:
a. Anterior ischemic optic neuropathy
b. Amaurosis fugax
c. Papilledema
d. Optic neuritis

A

b. Amaurosis fugax

Amaurosis fugax is often described as a transient loss of vision in one eye, usually lasting just a few minutes, and is considered a type of transient ischemic attack (TIA) of the retina.

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9
Q

A 57 y/o female previously diagnosed with rheumatoid arthritis consulted for dry red eyes with concomitant burning sensation. What is the most likely diagnosis?
a. Herpes zoster
b. Allergic conjunctivitis
c. Orbital cellulitis
d. Keratoconjunctivitis sicca

A

d. Keratoconjunctivitis sicca

Keratoconjunctivitis sicca, commonly referred to as dry eye syndrome, is often associated with autoimmune conditions like rheumatoid arthritis. It presents with dry, red eyes and a burning sensation.

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10
Q

a. Right superior quadrantanopia
b. Right homonymous hemianopia
c. Left homonymous hemianopia
d. Left superior quadrantanopia

A

a. Right superior quadrantanopia

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11
Q
  1. Which of the following is the most common cause of sensorineural hearing loss in adults?
    a. Labyrinthitis
    b. Menieire’s disease
    c. Presbycusis
    d. Radiation exposure
A

c. Presbycusis

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12
Q

A 30-year old female came into your clinic complaining of partial hearing loss with feeling of fullness on the left ear. He has a history of colds for the last 5 days and fever for the last 2 days. On examination, you noticed an intact, erythematous and bulging tympanic membrane. Which of the following measures will prevent hearing loss in this patient?
a. Prompt antibiotic coverage
b. Immediate cranial CT scan
c. Immediate tympanoplasty
d. Immediate hearing test to isolate the type of hearing loss

A

a. Prompt antibiotic coverage

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13
Q
  1. Which of the following is consistent with hyperthyroidism
    a. Weight gain
    b. Dry puffy face
    c. Cold skin
    d. Tremors
A

d. Tremors

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14
Q
  1. During confrontation test, you note that your patient has bitemporal hemianopia. Which structure is most likely affected?
    a. Occipital lobe - (total homonymous hemianopia)
    b. Optic radiation - (homonymous hemianopia)
    c. Optic nerve - (scotoma)
    d. Optic chiasm - (bitemporal hemianopia)
A

d. Optic chiasm - (bitemporal hemianopia)

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15
Q
  1. When the right eye looks up and out, which of the following extraocular muscles is tested?
    a. Superior oblique
    b. Superior rectus
    с. Inferior rectus
    d. Inferior oblique
A

b. Superior rectus

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16
Q
  1. Which of the following will present with masked like fascie, decreased blinking and a characteristic stare?
    a. Parkinson’s disease
    b. Nephrotic syndrome
    c. Hyperthyroidism
    d. Myxedema
A

a. Parkinson’s disease

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17
Q
  1. Which of the following findings is not characteristic of a cranial nerve III palsy?
    a. Limited eye adduction
    b. Miotic pupil
    c. Pupil is deviated down and out
    d. Ptosis
A

b. Miotic pupil

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18
Q
  1. A 40 year old male developed a doubling of vision progressively over 5 months. Confrontation test revealed the following. Which structure is most likely affected?
    a. Both optic nerves
    b. Left optic radiation
    c. Right occipital lobe
    d. Optic chiasm
A

d. Optic chiasm

If the confrontation test showed a bitemporal hemianopia (loss of the outer half of the visual field in both eyes), the most likely affected structure would be:

Rationale:
Bitemporal hemianopia is classically associated with lesions of the optic chiasm, often due to conditions such as pituitary tumors pressing on the chiasm.

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19
Q
  1. Which of the following is consistent with Horner’s syndrome?
    a. Small irregular pupils that do not accommodate
    b. Mydriasis
    c. Impaired extraocular muscle movement
    d. Anhidrosis
A

d. Anhidrosis

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20
Q
  1. Normal features of the optic disc, except?
    a. Physiologic cup horizontal diameter is less than half of the disc diameter
    b. Yellowish white central physiologic cup
    c. White optic disc
    d. Blurred nasal portion
A

c. White optic disc

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21
Q
  1. Which fibers of the optic nerve cross at the optic chiasm?
    a. Nasal fibers of the optic nerve
    b. There is no crossing of fibers occurring at the level of the optic chiasm
    c. Both nasal and temporal fibers
    d. Temporal fibers of the optic nerve
A

a. Nasal fibers of the optic nerve

Rationale:
At the optic chiasm, the nasal (or medial) retinal fibers from each eye cross to the opposite side. These fibers carry visual information from the temporal (or lateral) visual fields of each eye. In contrast, the temporal (or lateral) retinal fibers do not cross and continue on the same side. This arrangement allows for binocular vision and depth perception.

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22
Q
  1. A 50 year old female consults for blurring of vision. Visual acuity test using Snellen chart revealed 20/40 on the right eye which improved upon pinhole test. What is the most likely diagnosis?
    a. Intracranial tumor
    b. Error of refraction
    c. Optic neuritis
    d. Presbyopia
A

Answer: b. Error of refraction

Rationale:
When visual acuity improves with the use of a pinhole test, it typically indicates a refractive error. The pinhole acts as a tool to eliminate peripheral rays of light, allowing only the central rays to enter the eye, which helps correct for refractive errors like myopia, hyperopia, or astigmatism. The fact that the vision improved upon pinhole testing suggests that the blurring is due to a refractive error rather than a pathological process affecting the retina or optic nerve.

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23
Q
  1. How many cardinal directions of gaze are tested during EOM testing?
    a. Six
    b. Five
    с. Four
    d. Seven
A

a. Six

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24
Q

24.
The distance by which a patient should hold the jaeger chart during visual acuity examination
a. 20 feet
b. 20 inches
c. 14 inches
d. 2 feet

A

c. 14 inches

Rationale:
The Jaeger chart is used to test near vision. It is typically held at a distance of 14 inches from the patient’s eyes during the examination. This standard distance allows for a consistent assessment of near visual acuity.

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25
Q

Which of the following is consistent with a cranial nerve VI palsy
a. esotropia
b. Difficulty in eye adduction
c. exotropia
d. Eye deviated down and out

A

a. esotropia

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26
Q

The following are true of tuning forks except
a. If you have to perform these tests with a single fork, pick the 512 Hz
b. To set the tuning fork into vibration, strike it against a firm surface like tabletops
c. Tests done with these include rinne’s and weber’s
d. To set the tuning fork into vibration, strike it against firm surface like your elbow

A

b. To set the tuning fork into vibration, strike it against a firm surface like tabletops

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27
Q

To straighten the ear canal, pull the pinna (<3 y.o)
a. Downward, backward and away from the head
b. Downward, forward and away from the head
c. Upward, backward and away from the head
d. Upward, forward and away from the head

A

a. Downward, backward and away from the head

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28
Q

To straighten the ear canal, pull the pinna (>3 y.o)
a. Downward, backward and away from the head
b. Downward, forward and away from the head
c. Upward, backward and away from the head
d. Upward, forward and away from the head

A

c. Upward, backward and away from the head

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29
Q

In unilateral conductive hearing loss, sound is heard in which ear?
a. Both ears are affected
b. The good ear
с. The impaired ear

A

с. The impaired ear

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30
Q

How is conductive hearing loss reported in the rinne’s test
a. BC>AC
b. Lateralizes to the good ear
c. Lateralizes to the bad ear
d. AC>BC

A

a. BC>AC

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31
Q
  1. Vertigo is described as:

a. Unsteadiness or imbalance when walking, specially in older patients
b. None of the above
c. A spinning sensation accompanied by nystagmus and ataxia
d. A near faint from “feeling faint or lightheadedness”

A

c. A spinning sensation accompanied by nystagmus and ataxia

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32
Q

A 45 year old male with a one (1) year history of ear fullness only on the right ear, occasional blood streaked nasal discharge and a right lateral neck mass should make you suspicious of which condition?
a. Nasal polyp
b. Recurrent tonsillitis
c. Nasopharyngeal carcinoma
d. Adenoid hypertrophy

A

c. Nasopharyngeal carcinoma

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33
Q

A patient diagnosed with oropharyngeal squamous cell carcinoma complains of otalgia. Which cranial nerves are most likely involved?
a. VII and IX
b. V and VII
c. IXandX
d. VandX

A

a. VII and IX

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34
Q

Non-healing lesions/masses in the oral cavity need to be biopsied when they have been present for at least how many days?
a. 21 days
b. 14 days
c. 7 days
d. 28 days

A

b. 14 days

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35
Q

When one uses the otoscope, it is important to remember to:
a. Use the largest-sized aural speculum that
can fit the patient’s ear canal
b. Use the smallest-sized aural speculum that can fit the patient’s ear canal
c. Aural speculum size appropriate for the age of the patient
d. Use the middle-sized aural speculum that can fit the patient’s ear canal

A

a. Use the largest-sized aural speculum that
can fit the patient’s ear canal

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36
Q

When performing anterior rhinoscopy, it is important to remember that when you remove the nasal speculum from the patient’s nostrils:
a. None of the above
b. The nasal speculum must be closed
c. It does not matter whether the nasal speculum is opened or closed
d. The nasal speculum must be opened

A

d. The nasal speculum must be opened

When removing the nasal speculum from the patient’s nostrils, it should be opened to prevent pinching or causing discomfort to the nasal tissues.

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37
Q

Characteristic of sensorineural hearing loss:
a. They have trouble understanding speech
b. Results from problems in the outer ear
c. Results from problems in both outer and middle ear
d. Noisy environments make hearing better

A

a. They have trouble understanding speech

Sensorineural hearing loss typically affects the inner ear or the auditory nerve. Patients with this type of hearing loss often have difficulty understanding speech, especially in noisy environments.

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38
Q

When examining the oral cavity, the gag reflex can be elicited when the tongue depressor touches that sensitive structure/s
a. None of the above
b. Posterior pharyngeal wall
c. Tonsillar area
d. Posterior third of the tongue
e. All of the above

A

e. All of the above

The gag reflex is a protective reflex to prevent choking and aspiration. Touching the posterior pharyngeal wall, the tonsillar area, or the posterior third of the tongue can elicit the gag reflex.

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39
Q
  1. Unilateral foul-smelling nasal discharge in children is usually due to:
    a. Foreign body
    b. Nasal polyp
    c. Papillomas
    d. Sinusitis
A

a. Foreign body

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40
Q

How do you differentiate nasal polyps from turbinates?
a. Polyps have a “peeled grape” appearance
b. Polyps decrease in size when a decongestant is administered intranasally
c. Touching a nasal polyp with a probe is painful for the patient
d. All of the above

A

a. Polyps have a “peeled grape” appearance

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41
Q

While palpating both sides of the neck of a 60 year old female, the patient fainted. What possibly happened?
a. The patient was probably hungry
b. The examiner palpated both sides of the neck at the same time, evoking cardiac syncope followed by orthostatic hypotension
c. The examiner palpated both sides of the neck at the same time, evoking a carotid body reflex with vasovagal syncope
d. The examiner palpated both sides of the neck at the same time, evoking a carotid sinus reflex with vasovagal syncope.

A

d. The examiner palpated both sides of the neck at the same time, evoking a carotid sinus reflex with vasovagal syncope.

The carotid sinus is a baroreceptor located in the carotid bifurcation. When it’s excessively stimulated, it can cause a reflex drop in heart rate and blood pressure, leading to a vasovagal syncope. This is why clinicians are cautioned not to massage or palpate both carotid sinuses at the same time.

42
Q

Hoarseness persisting for more than ___ weeks requires further evaluation
a. 2 weeks
b. 1 week
c. 4 weeks
d. 3 weeks

A

a. 2 weeks

43
Q

The following are visible structures during anterior rhinoscopy except for which structure?
a. Superior turbinate
b. Inferior turbinates
c. Middle turbinates
d. Anterior portion of the nasal septum

A

a. Superior turbinate

44
Q

Lymph nodes are said to be enlarged if they are how many cm in size?
a. 2
b. 4
c. 1
d. 3

A

a. 2

45
Q

Which case indicates a possible infectious etiology for enlarged lymph nodes?
a. Irregular-shaped, non-tender with ulceration
b. Firm, non-tender and non-movable
c. Warm, erythematous and tender on palpation
d. Solf-pulsatile and non-tender

A

c. Warm, erythematous and tender on palpation

46
Q

Enlargement of supraclavicular nodes on the left suggest which pathology?
a. HIV
b. LYMPHOMA
c. METASTATIC NODE FROM AN ABDOMINAL MALIGNANCY
d. LEUKEMIA

A

c. METASTATIC NODE FROM AN ABDOMINAL MALIGNANCY

Enlargement of the left supraclavicular lymph node (often referred to as Virchow’s node) is classically associated with metastasis from an abdominal malignancy, especially from the stomach, though other malignancies can also spread to this node.

47
Q
  1. Generalized Lymphadenopathy is suggestive of multiple causes except for:
    a. LEUKEMIA
    b. GOITER
    с. LYMPHOMA
    d. HIV
A

b. GOITER

48
Q
  1. An ominous high-pitched musical sound from sever subglottic or tracheal obstruction:
    a. Hoarseness
    b. Stertor
    c. Wheezing
    d. Stridor
A

d. Stridor

Rationale for the choices:

a. Hoarseness: Refers to a change in the pitch or quality of the voice. It results from disorders of the vocal cords, but not necessarily from an obstruction.

b. Stertor: Refers to noisy breathing that occurs during inhalation. It’s often caused by an obstruction in the nasal passage or pharynx and produces a snoring-like sound.

c. Wheezing: A high-pitched continuous sound, often heard on exhalation, due to narrowing of the lower airways, commonly seen in conditions like asthma.

d. Stridor: A high-pitched, musical sound caused by an obstruction in the upper airway, most often heard during inhalation. It’s a sign of a potential emergency, especially if it occurs suddenly, as it indicates significant narrowing or obstruction in the trachea or larynx and can lead to complete airway obstruction.

49
Q
  1. The Stensen’s duct opens in which area?
    a. In the buccal mucosa near the second lower premolar
    b. In the buccal mucosa near the upper second molar
    c. In the buccal mucosa near the upper second premolar
    d. In the buccal mucosa near the lower second molar
A

c. In the buccal mucosa near the upper second premolar

Rationale:
The Stensen’s duct is the main excretory duct of the parotid gland. It traverses over the masseter muscle, turns medially at the anterior border of the masseter, and penetrates the buccal fat. It then opens into the oral cavity in the buccal mucosa opposite the upper second premolar. The location of its opening is important clinically, especially in cases of sialolithiasis (stones in salivary duct) or infections. The other options (a, b, d) incorrectly identify the location of the Stensen’s duct opening in relation to the dental anatomy.

50
Q
  1. A pulsating neck mass is suggestive of what condition
    a. Goiter
    b. Malignancy
    c. Vascular mass
    d. Infected lymph node
A

c. Vascular mass

51
Q
  1. How is sensorineural hearing loss reported in Rinne’s test?
    a. BC>AC
    b. Lateralizes to the bad ear
    c. Lateralizes to the good ear
    d. AC>BC
A

d. AC>BC

52
Q
  1. The following are true of tuning forks except:
    A. To set the tuning fork into vibration, strike it against a firm surface like your elbow
    B. If you have to perform these tests with a single fork, pick the 512 Hz
    C. To set the tuning fork into vibration, strike it against a firm surface like tabletops
    D. Tests done with these include Rinne’s and Weber’s
A

C. To set the tuning fork into vibration, strike it against a firm surface like tabletops

53
Q
  1. To straighten the ear canal, pull the pinna _____.
    A. upward, backward and away from the head
    B. upward, forward and away from the head
    C. downward, forward and away from the head
    D. downward, backward, and away from the head
A

A. upward, backward and away from the head

54
Q
  1. In unilateral conductive hearing loss, sound is heard in which ear?
    A. the good ear
    B. the impaired ear
A

B. the impaired ear

55
Q
  1. How is conductive hearing loss reported in the Rinne’s test?
    A. AC>BC
    B. BC >AC
    C. Lateralizes to the good ear
    D. Lateralizes to the bad ear
A

B. BC >AC

56
Q
  1. Vertigo is described as:
    A. A near faint from “feeling faint or lightheadedness”
    B. Unsteadiness or imbalance when walking, specially in older patients
    C. A spinning sensation accompanied by nystagmus and ataxia
    D. None of the above
A

C. A spinning sensation accompanied by nystagmus and ataxia

57
Q
  1. A 45 year old male with a one (1)-year history of ear fullness only on the right ear, occasional blood streaked nasal discharge and a right lateral neck mass should make you suspicious of which condition?
    A. Adenoid hypertrophy
    B. Nasal polyp
    C. Nasopharyngeal carcinoma
    D. Recurrent tonsillitis
A

C. Nasopharyngeal carcinoma

Rationale:
The presentation described – right ear fullness, occasional blood-streaked nasal discharge, and a right lateral neck mass in a 45-year-old male – is highly suggestive of nasopharyngeal carcinoma (NPC). NPC is known to present with these types of symptoms due to the tumor’s location in the nasopharynx, which can block the Eustachian tube leading to ear symptoms, cause epistaxis or bloody discharge, and metastasize to cervical lymph nodes causing a neck mass.

A. Adenoid hypertrophy is more common in children and would not typically present with bloody nasal discharge or a neck mass.
B. Nasal polyps can cause nasal obstruction but are not typically associated with ear fullness, bloody discharge, or neck masses.
D. Recurrent tonsillitis would primarily present with sore throat and may lead to swollen tonsils, but it wouldn’t typically cause ear fullness, bloody nasal discharge, or a neck mass.

58
Q
  1. A patient diagnosed with oropharyngeal squamous cell carcinoma complains of otalgia/ear pain. Which cranial nerves are most likely involved?
    A. V and VII
    B. IX and X
    C. VII and IX
    D. V and X
A

C. VII and IX

59
Q
  1. Non-healing lesions/masses in the oral cavity need to be biopsied when they have been present for at least how many days?
    A. 7 days
    B. 14 days
    C. 21 days
    D. 28 days
A

B. 14 days

60
Q
  1. When one uses the otoscope, it is important to remember to:
    A. Use the smallest-sized aural speculum that can fit the patient’s ear canal
    B. Use the middle-sized aural speculum that can fit the patient’s ear canal
    C. Use the largest-sized aural speculum that can fit the patient’s ear canal
    D. Aural speculum size does not matter, as long as you do not injure the patient’s ear canal
A

C. Use the largest-sized aural speculum that can fit the patient’s ear canal

61
Q
  1. When performing anterior rhinoscopy, it is important to remember that when you remove the nasal speculum from the patient’s nostrils:
    A. The nasal speculum must be opened
    B. The nasal speculum must be closed
    C. It does not matter whether the nasal speculum is opened or closed
    D. None of the above
A

A. The nasal speculum must be opened

62
Q
  1. Characteristic of sensorineural hearing loss:
    A. They have trouble understanding speech
    B. Noisy environments make hearing better
    C. Results from problems in the outer ear
    D. Results from problems in both outer and middle ear
A

A. They have trouble understanding speech

63
Q
  1. When examining the oral cavity, the gag reflex can be elicited when the tongue depressor touches what sensitive structure/s:
    a. Posterior third of the tongue
    b. Posterior pharyngeal wall
    c. Tonsillar area
    d. All of the above
A

d. All of the above

64
Q
  1. Unilateral foul-smelling nasal discharge in children is usually due to:
    a. Papillomas
    b. Foreign body
    c. Nasal polyp
    d. Sinusitis
A

b. Foreign body

65
Q
  1. How do you differentiate nasal polyps from turbinates?
    A. Polyps decrease in size when a decongestant is administered intranasally
    B. Polyps have a “peeled grape” appearance
    C. Touching a nasal polyp with a probe is painful for the patient
    D. All are correct
A

B. Polyps have a “peeled grape” appearance

66
Q
  1. While palpating both sides of the neck of a 60 year old female, the patient fainted. What possibly happened?
    A. The examiner palpated both sides of the neck at the same time, evoking a carotid sinus reflex with vasovagal syncope
    B. The examiner palpated both sides of the neck in different time, evoking a carotid body reflex with vasovagal syncope
    C. The patient was probably hungry
    D. The patient just fell asleep
A

A. The examiner palpated both sides of the neck at the same time, evoking a carotid sinus reflex with vasovagal syncope

Palpating both carotid sinuses simultaneously can stimulate the carotid sinus reflex, which can lead to vasovagal syncope and cause the patient to faint. It’s a reason why care should be taken not to compress both carotid sinuses at the same time.

67
Q

16 The following are visible structures during anterior rhinoscopy except for which structure?
A. with vasovagal syncope
B. vasovagal syncope
C. anterior portion of the nasal septum
D. superior turbinate

A

D. superior turbinate

68
Q

17 hoarseness persisting for more than _____weeks require further evaluation
A. 1
B. 2
C. 3
D. 4

A

B. 2

69
Q
  1. Lymph nodes are said to be enlarged if they are how many cm in size?
    A. 1
    B. 2
    C. 3
    D. 4
A

B. 2

70
Q
  1. Which case indicates a possible infectious etiology for enlarged lymph nodes?
    A. warm, erythematous and tender on palpation
    B. firm, non-tender and non-movable
    C. irregularly-shaped, non-tender with ulceration
    D. soft, pulsatile and non-tender
A

A. warm, erythematous and tender on palpation

71
Q
  1. Enlargement of a supraclavicular node on the left suggests which pathology?
    A. HIV
    B. lymphoma
    C. leukemia
    D. metastatic node from an abdominal malignancy
A

D. metastatic node from an abdominal malignancy

72
Q
  1. Generalized lymphadenopathy is suggestive of multiple causes except for:
    A. HIV
    B. lymphoma
    C. leukemia
    D. goiter
A

D. goiter

73
Q
  1. An ominous, high-pitched musical sound from severe subglottic or tracheal obstruction:
    A. Stridor
    B. Hoarseness
    C. Wheezing
    D. Stertor
A

A. Stridor

74
Q
  1. The Stensen’s duct opens in which area?
    A. in the buccal mucosa near the upper second molar
    B. in the buccal mucosa near the upper second premolar
    C. in the buccal mucosa near the lower second molar
    D. in the buccal mucosa near the lower second premolar
A

B. in the buccal mucosa near the upper second premolar

Rationale:
The Stensen’s duct is the main excretory duct of the parotid gland. It traverses over the masseter muscle, turns medially at the anterior border of the masseter, and penetrates the buccal fat. It then opens into the oral cavity in the buccal mucosa opposite the upper second premolar. The location of its opening is important clinically, especially in cases of sialolithiasis (stones in salivary duct) or infections. The other options (a, b, d) incorrectly identify the location of the Stensen’s duct opening in relation to the dental anatomy.

75
Q
  1. A pulsating neck mass is suggestive of what condition?
    A. Malignancy
    B. Infected lymph node
    C. Vascular mass
    D. goiter
A

C. Vascular mass

76
Q
  1. How is sensorineural hearing loss reported in the Rinne’s test?
    A. AC>BC
    B. BC>AC
    C. Lateralizes to the good ear
    D. lateralizes to the bad ear
A

A. AC>BC

77
Q
  1. 70 year old male with sudden onset, persistent visual loss on the left. On funduscopy, the following is noted (see pic below). What is your diagnosis?
    A. Papilledema
    B.Amaurosis fugax
    C.Central retinal artery occlusion
    D. Optic neuritis
A

C.Central retinal artery occlusion

78
Q
  1. Which of the following physical examination findings is not observed in corneal injury/abrasion?
    A. Watery discharge
    B. Erythema or ciliary injection
    C. Pupils not reactive to light
    D. Decreased visual acuity
A

C. Pupils not reactive to light

79
Q
  1. A 30 y/o male consulted for left eye proptosis. He was involved in a vehicular crash 2 weeks prior. On examination, there was noted of proptosis and chemosis of the left eye, with limited extraocular movement. There was also note of bruit on auscultation. What will be the definitive management for the patient?
    A. Endovascular technique/intervention
    B. Antiobiotic treatment
    C. Steroid therapy
    D. Observation
A

A. Endovascular technique/intervention

80
Q
  1. The following conditions may cause ptosis except
    A. myasthenia gravis
    B. myopathies
    C. old age
    D. tumors affecting the parasympathetic trunk
A

D. tumors affecting the parasympathetic trunk

81
Q
  1. Which of the ff is consistent with subconjunctival hemorrhage?
    A. may be caused by increased venous P
    B. usually present with purulent discharge
    C. associated w/ severe pain
    D. usually resolves after 6 mo. w/ intensive pharmacologic management
A

A. may be caused by increased venous P

82
Q
  1. The following findings are consistent with acute angle closure glaucoma except
    A. Severe eye pain
    B. Decreased visual acuity
    C. Miotic pupil
    D. Increased intraocular pressure
A

C. Miotic pupil

83
Q
  1. A 57 y/o female previously diagnosed with rheumatoid arthritis consulted for dry red eyes with concomitant burning sensation. What is the most likely diagnosis?
    A. Keratoconjunctivitis sicca
    B. Allergic conjunctivitis
    C. Orbital cellulitis
    D. Herpes zoster
A

A. Keratoconjunctivitis sicca

84
Q
  1. 21 y/o male presented with jaundice, ascites and hallucinations. On eye exam, the following was noted (see pic). The following statements about this condition are true except
    A. it is due to abnormal iron transport and metabolism
    B.it is due to abnormality in chromosome 13
    C. neurologic manifestations may include tremor and problems in speech
    d. It is autosomal recessive
A

A. it is due to abnormal iron transport and metabolism

Kayser-Fleischer Ring

based on the clinical presentation of a 21-year-old male with jaundice, ascites, hallucinations, and presumed findings on eye exam, it sounds like the condition in question might be Wilson’s disease.

Wilson’s disease is a genetic disorder causing abnormal copper transport, leading to copper buildup in the body. This isn’t related to iron.

85
Q

34Possible causes of conductive hearing loss except
A. Impacted cerumen
B. Otosclerosis
C. Presbycusis
D. Cholesteatoma

A

C. Presbycusis

Presbycusis refers to age-related sensorineural hearing loss, not conductive hearing loss. The other options (A. Impacted cerumen, B. Otosclerosis, D. Cholesteatoma) are potential causes of conductive hearing loss.

86
Q
  1. Which of the following is the most common cause of sensorineural hearing loss in adults?
    A. Presbycusis
    B. Radiation exposure
    C. Labyrinthitis
    D. Meniere’s disease
A

A. Presbycusis

87
Q
  1. A 30-year old female came into your clinic complaining of partial hearing loss with feeling of fullness on the left ear. He has a history of colds for the last 5 days and fever for the last 2 days. On examination, you noticed an intact, erythematous and bulging tympanic membrane. Which of the following measures will prevent hearing loss in this patient?
    A. Prompt antibiotic coverage
    B. Immediate tympanoplasty
    C. Immediate cranial CT scan
    D. Immediate hearing test to isolate the type of hearing loss
A

A. Prompt antibiotic coverage

The presentation suggests acute otitis media, which is an infection of the middle ear. Intact, erythematous, and bulging tympanic membrane are typical signs of this condition. Prompt antibiotic treatment can help resolve the infection and prevent complications, including hearing loss.

88
Q
  1. Which of the following is consistent with HYPOthyroidism?
    A. Exophthalmos
    B. Warm moist skin
    C. Weight loss
    D. Tremors
A

C. Weight loss

89
Q
  1. Which of the following instructions/statements is/are incorrect during finger
    wiggle test/confrontation test?
    A. None of the above
    B. “Look straight into my eye”
    C. “Look at my fingers at the periphery”
    D. “Cover one of your eyes”
A

C. “Look at my fingers at the periphery”

During the confrontation test, the patient should be instructed to focus on the examiner’s eyes (or a fixed point on the examiner’s face) while the examiner wiggles their fingers or uses some form of stimulus in the patient’s peripheral vision. Asking the patient to look at the fingers in the periphery would defeat the purpose of testing peripheral vision.

90
Q
  1. When the right eye looks down and out, which of the following extraocular muscles are tested?
    A. Inferior rectus
    B. Superior oblique
    C. Inferior oblique
    D. Superior rectus
A

D. Superior rectus

91
Q
  1. Which of the following will present with masked like fascie, decreased blinking and a characteristic stare?
    A. Hyperthyroidism
    B. Myxedema
    C. Parkinson’s disease
    D. Nephrotic syndrome
A

C. Parkinson’s disease

92
Q
  1. Which of the following findings during ophthalmoscope exam is indicative of increased intracranial pressure?
    A. Exudates
    B. Neovascularization
    C. Papilledema
    D. Optic atrophy
A

C. Papilledema

93
Q

A. Left homonymous hemianopia
B. Left homonymous superior quadrantanopia
C. Right homonymous superior quadrantanopia
D. Left homonymous inferior quandrantanopia

A

B. Left homonymous superior quadrantanopia

94
Q

A. Right optic nerve
B. Right optic tract
C. Optic chiasm
D. Left geniculocalcarine radiation

A

B. Right optic tract
(Left Homonymous Hemianopsia)

95
Q
  1. Which of the following is consistent with Horner’s syndrome?
    A. Mydriasis
    B. Small irregular pupils that do not accommodate
    C. Impaired extraocular muscle movement
    D. Anhydrosis
A

D. Anhydrosis

Horner’s syndrome is characterized by miosis (constricted pupil), ptosis (drooping of the upper eyelid), and anhidrosis (lack of sweating) on the affected side of the face.

96
Q
  1. A 50 year old female presents with sudden severe headache and diplopia. On primary gaze, you noted that the right eye is down and out. Which of the following is most likely affected?
    A. Oculomotor nerve
    B. Lateral rectus
    C. Abducens nerve
    D. Trochlear nerve
A

A. Oculomotor nerve

The classic presentation of an “eye that is down and out” is indicative of a dysfunction of the oculomotor nerve (cranial nerve III).

The oculomotor nerve innervates the majority of the extraocular muscles: superior rectus, inferior rectus, medial rectus, and inferior oblique. Additionally, it provides parasympathetic fibers to the pupil. When there’s a dysfunction of the oculomotor nerve, the unopposed actions of the lateral rectus (abduction or “out”) and superior oblique (depression or “down”) muscles lead to the eye being positioned “down and out.”

Given the provided options, the most likely affected is:

A. Oculomotor nerve

97
Q
  1. Normal features of the optic disk, except:
    A. White optic disc
    B. Blurred nasal portion
    C. Yellowish-white central physiologic cup
    D. Physiologic cup horizontal diameter is less than half of the disc diameter
A

A. White optic disc

98
Q

47 Which fibers of the optic nerve cross at the optic chiasm?
A. There is no crossing of fibers occurring at the level of the optic chiasm
B. Both nasal and temporal fibers
C. Temporal fibers of the optic nerve
D. Nasal fibers of the optic nerve

A

D. Nasal fibers of the optic nerve

99
Q
  1. A 50 year old female consults for blurring of vision. Visual acuity test using Snellen chart revealed 20/40 on the right eye which improved upon pinhole test. What is the most likely diagnosis?
    A. Presbyopia
    B. Optic neuritis
    C. Intracranial tumor
    D. Error of refraction
A

D. Error of refraction

100
Q
  1. How many cardinal directions of gaze are tested during EOM testing?
    A. five
    B. Seven
    C. Six
    D. four
A

C. Six

101
Q
  1. The distance by which a patient should hold the Jaeger chart during visual acuity examination
    A. 2 feet
    B. 20 inches
    C. 20 feet
    D. 14 inches
A

D. 14 inches

MED 1 (13 decks)

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