EENT practice

Question 1

Which type of fracture is most common?
a) Medial wall
b) Lateral wall
c) Orbital roof
d) Orbital floor

Answer 1

d) Orbital floor

(orbital floor & medial wall are most thin)

Question 2

A pt presents after a baseball injury with a unilateral depressed globe with diplopia and an upward gaze, and ipsilateral cheek numbness. On palpation you note subcutaneous emphysema. What is the test of choice to evaluate the extent of their injury?

a) MRI
b) CT scan
c) Ultrasound
d) PE is sufficient

Answer 2

b) CT scan

(pt has orbital blowout Fx)

Question 3

Which of the following treatments are appropriate for the patient from the previous question? (baseball injury/ orbital blowout Fx). Select all that apply.
a) Nasal decongestant
b) Cold compress
c) Antibiotics
d) Emergency ophthalmology consult

Answer 3

a) Nasal decongestant
b) Cold compress
c) Antibiotics
d) Emergency ophthalmology consult

Question 4

A contact lens wearer presents with unilateral photophobia, tearing, and blepharospasm. They think they got sand in their eye at the beach when they weren’t wearing their contacts (but they usually wear them daily). You do fluorescein staining and don’t see a FB, but do note a 2mm corneal abrasion. Which antibiotics are appropriate treatments?

a) Sulfacetamide
b) Ciprofloxacin
c) Ofloxacin
d) Gentamycin
e) Erythromycin

Answer 4

b) Ciprofloxacin
c) Ofloxacin
d) Gentamycin

Question 5

Which two are appropriate empiric Txs for corneal ulcers? Select two
a) Gentamycin
b) Erythromycin
c) Moxifloxacin
d) Gatifloxacin

Answer 5

c) Moxifloxacin
d) Gatifloxacin

Question 6

A pt presents with sudden acute, painless, blackened vision in their right eye. They said that before this started they noted an increase in floaters. During your physical exam, when moving your pen light from their left eye to their right eye, the right eye dilated (instead of constricted). You note a displaced retina flapping around on fundoscopic exam. While you’re consulting with the ophthalmologist for emergency surgery, what should you instruct the patient to do?

a) Remain supine with head turned toward the right
b) Remain supine with head turned toward the left
c) Remain vertical with head tilted downward
d) Remain vertical with head tilted upward

Answer 6

a) Remain supine with head turned toward the right

Question 7

What is the #1 cause of legal blindness in older adults?
a) DM
b) HTN
c) Aging
d) Drug toxicity

Answer 7

c) Aging

Question 8

A pt has been experiencing bilateral progressive central vision loss. During your vision tests you note metamorphopsia. Mottling, drusen deposits, and hemorrhages are seen on fundoscopic exam. What is the Tx for the most likely Dx?

a) Age-Related Eye Diseases Study compound
b) Intravitreal vascular endothelial growth factor (VEGF) inhibitors + Laser therapy

Answer 8

b) Intravitreal vascular endothelial growth factor (VEGF) inhibitors + Laser therapy

(pt has wet macular degeneration bc of the hemorrhages; AREDS compound is for dry MD)

Question 9

Your pt is experiencing sudden, monocular, painless, vision loss. Fundoscopy shows retinal pallor, arteriolar narrowing, and perifoveal atrophy (cherry red spot). What is the most common root cause of their condition being described?

a) Retinal artery detachment
b) Acute-angle glaucoma
c) Thoracic artery atherosclerosis
d) Carotid artery atherosclerosis

Answer 9

d) Carotid artery atherosclerosis

(pt has Central Retinal Artery Occlusion)

Question 10

Which are appropriate to Tx a pt with Carotid artery atherosclerosis? Select all that apply
a) 100% oxygen
b) Ocular massage
c) Emergency referral
d) Acetazolamide
e) Sulfacetamide

Answer 10

a) 100% oxygen
b) Ocular massage
c) Emergency referral
d) Acetazolamide

Question 11

T/F: Most people with amaurosis fugax have complete recovery within an hour

Answer 11

True

Question 12

Diffuse arteriolar narrowing, AV nicking, and copper/silver wiring are characteristic of _________ retinopathy
a) Diabetic
b) Hypertensive

Answer 12

b) Hypertensive

(Diabetic = Microaneurysms, retinal hemorrhages, Neovascularization (if proliferative))

Question 13

A pt with a Hx of DM and dyslipidemia is experiencing sudden, monocular, painless vision loss; their vision is severely blurred. Fundoscopy revealed extensive retinal hemorrhages, dilated veins, and exudates, so you realize this is not an emergency.

Which of the following are correct abt the Tx of this condition? Select all that apply
a) Addresses the macular edema that is caused by the RVO
b) First line is intravitreal VEGF inhibitors
c) 2nd line is intravitreal steroids
d) Acetazolamide should be given to decrease IOP
e) Surgical photocoagulation is an option

Answer 13

a) Addresses the macular edema that is caused by the RVO
b) First line is intravitreal VEGF inhibitors
c) 2nd line is intravitreal steroids
e) Surgical photocoagulation is an option

(Central Retinal Vein Occlusion)

Question 14

For both diabetic and hypertensive retinopathy, dilated ophthalmoscopic examinations should be done at least ______________
a) Every 3 months
b) Every 6 months
c) Annually
d) Every 2 years

Answer 14

c) Annually

Question 15

Open-angle glaucoma: Which Tx both decreases aqueous humor production and increases outflow?
a) Timolol drops (beta blocker)
b) Acetazolamide oral (carbonic anhydrase inhibitor)
c) Latanaprost drops (prostaglandin analog)
d) Pilocarpine drops (cholinergic)
e) Brimonidine drops (alpha agonist)

Answer 15

e) Brimonidine drops (alpha agonist)

(Timolol + Acetazolamide just decr production
Latanaprost + Pilocarpine just incr output)

Question 16

T/F: Normal IOP doesn’t exclude glaucoma, and both increased IOP or incr cup to disc ratio don’t necessitate glaucoma

Answer 16

True

Question 17

Which are preferred (and not contraindicated) in acute-angle glaucoma?
a) Timolol drops
b) Acetazolamide (oral or IV)
c) Epinephrine
d) Atropine

Answer 17

a) Timolol drops
b) Acetazolamide (oral or IV)

Question 18

Orbital cellulitis is defined as infection of the tissues _________ to the orbital septum
a) Anterior
b) Posterior

Answer 18

b) Posterior

Question 19

IV vancomycin + metronidazole + ceftriaxone or cefotaxime should be used for what?
a) Diabetic retinopathy
b) Acute angel closure glaucoma
c) Orbital cellulitis
d) Dacryocystitis

Answer 19

c) Orbital cellulitis

(Dacryocystitis = IV vancomycin and ceftriaxone if severe)

Question 20

A pt presents to urgent care complaining of eyelid pain. On PE you note meibomian gland inflammation, as well as swelling, eyelid crusting, and discharge. What is the first line Tx?

a) Warm compress, eyelid scrubbing with baby shampoo
b) Topical abx: bacitracin, erythromycin, or other topical ophthalmic abx
c) Oral abx: doxycycline, tetracycline, azithromycin
d) Any of the above

Answer 20

a) Warm compress, eyelid scrubbing with baby shampoo

(Pt has anterior and posterior Blepharitis; B is second line, C is third line)

Question 21

You note an acute painful erythematous eyelid nodule on a pt presenting with eyelid pain, and you recognize this as a local infection of the meibomian gland that should first be treated with a warm compress for 48hrs. What is the most likely organism causing this?
a) Pseudomonas
b) E. Coli
c) S. epidermidis
d) S. aureus

*Bonus: Tx? What may it lead to?

Answer 21

d) S. aureus

Pt has a Hordeolum (“Stye”)

Antibiotics if secondary infection develops, such as Preseptal (periorbital) cellulitis (infection of tissue anterior to orbital septum)
>Less serious than orbital cellulitis and causes septal pain, swelling, erythema, may be confused w styes

Question 22

What is defined as an indurated granuloma (usually due to meibomian obstruction) with minimal irritation (or no Sxs)?
a) Chalazion
b) Stye
c) Blepharitis
d) Entropion

Bonus: Tx?

Answer 22

a) Chalazion

(Tx w Warm compress and referral to ophthalmology for excision or steroid injection if not improving after weeks)

Question 23

Your pt is experiencing both their eyes “glued shut” on waking up. They do not wear contacts, so which of the following is a possible Tx?
a) Erythromycin (topical)
b) Moxifloxacin (topical)
c) Gatofloxacin (topical)
d) Ofloxacin (topical)

Answer 23

a) Erythromycin (topical)

(pt has Bacterial Conjunctivitis, the rest are options better for contacts users)

Question 24

A pt was recently prescribed ethambutol and is experiencing unilateral painful loss of vision (esp. color vision). They have a central scotoma (blind spot) and you note an afferent pupillary defect. On fundoscopy you note optic disc swelling/blurring.

What is the main Tx?
a) Erythromycin (topical)
b) Acetazolamide should be given to decrease IOP
c) Ofloxacin (topical)
d) IV methylprednisolone, then PO steroids

Answer 24

d) IV methylprednisolone, then PO steroids

(pt has optic neuritis)

Question 25

A 22 y/o pt is experiencing recent-onset otalgia/ pressure with mild hearing impairment. Their temperature is 102.5, and on pneumotoscopy their TM mobility is limited. How should you Tx them? a) Amoxicillin b) Amoxicillin-clavulanate c) Ofloxacin (topical) d) Vancomycin

Answer 25

b) Amoxicillin-clavulanate (PT has AOM, so amoxicillin only is only an option for kids)

Question 26

With which diagnoses is it specified in the powerpoint that you should keep their ear dry? Select all that apply a) Acute Otitis Media b) Chronic Otitis Media c) Otitis Externa d) Acute Sinusitis

Answer 26

b) Chronic Otitis Media c) Otitis Externa

Question 27

Which was NOT mentioned to be a common cause of acute sinusitis? Bonus: Tx? a) Rhinovirus b) Influenza c) Parainfluenza d) Strep pneumo e) Staph Aureus

Answer 27

e) Staph Aureus (this is a chronic cause) Acute Tx: Supportive care, if severe (fever, etc) or >10 days, 1st line is amox and 2nd is doxy.

Question 28

Your pt with Acute Pharyngitis due to Strep has had a mild reaction to penicillin in the past. What should you give them? a) Penicillin b) Cephalosporin c) Azithromycin d) Clindamycin

Answer 28

b) Cephalosporin (azithromycin or clindamycin should be used if severe rxn)

Question 29

Which are most commonly due to a viral cause? Select all that apply a) Laryngitis b) Acute Pharyngitis c) Acute Sinusitis d) Otitis Externa

Answer 29

a) Laryngitis b) Acute Pharyngitis c) Acute Sinusitis

Question 30

Which is a second line Tx for thrush (oral candida)? a) Nystatin rinse b) Clotrimazole lozenge c) Miconazole buccal tablet d) PO fluconazole

Answer 30

d) PO fluconazole (the rest are first line)

Question 31

List the GABHS Centor criteria

Answer 31

Tonsillar exudate, tender ant. cervical LAD, fever, absence of cough Centor 0 or 1: no testing need, treat with supportive measures Centor 2: rapid test, if negative treat with supportive measures Centor 3: rapid test, if negative then throat culture (supportive measures in the meantime) Centor 4: treat with antibiotics without testing