ENT

Question 1

What is the immediate treatment for alkaline chemical burns to the eye?

Answer 1

Irrigation for at least 30 minutes until pH is normal, remove particulate matter, then cycloplegic drops, 0.5% erythromycin ointment QID, and pain management

Question 2

What bacteria cause ophthalmia neonatorum and in what timeframe?

Answer 2

N. gonorrhoeae appears 2-4 days after birth; Chlamydia appears 5-15 days after delivery

Question 3

What is the empiric treatment for ophthalmia neonatorum?

Answer 3

Ceftriaxone IM 50 mg/kg, topical polymyxin B, saline washes, and topical erythromycin ointment

Question 4

What are the classic symptoms of conjunctivitis?

Answer 4

Redness, foreign body sensation, lid swelling, eye crusting, drainage. NO photophobia, NO visual loss

Question 5

How do you differentiate pterygium from pinguecula?

Answer 5

Pterygium: wedge-shaped tissue extending ONTO the cornea from nasal side. Pinguecula: white/yellow tissue NEXT TO cornea, doesn’t extend onto it

Question 6

What are 4 causes of superficial punctate keratitis (SPK)?

Answer 6

UV burns, conjunctivitis, topical drug toxicity, contact lens use, dry eyes, blepharitis, minor trauma

Question 7

What is Hutchinson’s sign in herpes zoster?

Answer 7

Vesicles on the tip of the nose indicating nasociliary branch involvement, associated with 76% risk of ocular involvement

Question 8

How do you differentiate hordeolum from chalazion?

Answer 8

Hordeolum: eyelid margin involvement, staph infection. Chalazion: obstructed meibomian gland with NORMAL lid margin

Question 9

What are the key features of orbital cellulitis vs periorbital cellulitis?

Answer 9

Orbital: proptosis, painful EOM movements, diplopia, visual changes. Periorbital: limited to eyelid, no vision/movement problems

Question 10

What is the pathophysiology of acute angle closure glaucoma?

Answer 10

Pupillary block - lens and iris touch, stopping aqueous humor flow from posterior to anterior chamber, causing iris to bulge forward and obstruct trabecular meshwork

Question 11

List 7 therapies for acute angle closure glaucoma

Answer 11

1. Timolol 2. Pilocarpine 3. Acetazolamide 4. Head of bed 30 degrees 5. Anti-emetics 6. Analgesics 7. Prednisolone (TPAa mnemonic)

Question 12

What are 10 causes of acute painless visual loss?

Answer 12

CRAO, CRVO, retinal detachment, vitreous hemorrhage, posterior vitreous detachment, hemianopsia, pituitary tumor, macular degeneration, ischemic optic neuropathy, toxic causes

Question 13

What are 8 risk factors for central retinal artery occlusion?

Answer 13

HTN, cardiac disease, diabetes, collagen disease, vasculitis, valvular heart disease, sickle cell disease, glaucoma

Question 14

What is the emergency treatment for CRAO?

Answer 14

Digital ocular massage, inhaled carbogen, timolol drops, acetazolamide, consider IV tPA (controversial)

Question 15

What are 6 risk factors for retinal detachment?

Answer 15

Age >45, male gender, myopia, trauma, previous retinal detachment, family history

Question 16

What is the classic presentation of optic neuritis?

Answer 16

Progressive monocular vision loss over hours to days with ocular PAIN on eye movement, +RAPD, age 15-45

Question 17

What are the signs of temporal arteritis?

Answer 17

Weight loss, fever, jaw pain, scalp tenderness, malaise, headache, elevated ESR, age >50, history of PMR

Question 18

What are the classic visual field defects for chiasmal vs post-chiasmal lesions?

Answer 18

Chiasmal: bitemporal hemianopsia. Post-chiasmal: homonymous hemianopsia (left occipital lesion = right bilateral visual field loss)

Question 19

What is Anton’s syndrome?

Answer 19

Bilateral blindness with normal pupillary reflexes, bilateral occipital lesions, and denial of blindness

Question 20

Which pupils are problematic in light vs dark in anisocoria?

Answer 20

Light setting: problem pupil is the LARGER one. Dark setting: problem pupil is the SMALLER one

Question 21

What is Horner’s syndrome triad?

Answer 21

Ipsilateral ptosis, miosis, and facial anhidrosis with dilation lag up to 15 seconds

Question 22

What are the fundoscopic findings of papilledema?

Answer 22

Swelling of optic nerve head, blurring of disc margins, hyperemia, loss of physiologic cupping

Question 23

What is the #1 cause of binocular diplopia?

Answer 23

Palsy of cranial nerves 3, 4, or 6

Question 24

Define acute, chronic, and recurrent otitis media

Answer 24

Acute: infection signs with effusion. Chronic: chronic discharge from perforated TM. Recurrent: >3 episodes in 6 months or >4 in 1 year

Question 25

What are the two components required for AOM diagnosis?

Answer 25

1. Signs/symptoms of middle ear inflammation (bulging TM, erythema, otalgia, fever) 2. Middle ear effusion (opacity, lack of mobility, air-fluid level)

Question 26

What are the intracranial complications of otitis media?

Answer 26

Meningitis, epidural abscess, brain abscess, lateral sinus thrombosis, cavernous sinus thrombosis, subdural empyema

Question 27

How do you differentiate otitis externa from malignant otitis externa?

Answer 27

Malignant OE: immunocompromised patients, cranial nerve involvement, ill-appearing, high mortality, needs IV cipro 6-8 weeks

Question 28

What is Ramsay Hunt syndrome?

Answer 28

Herpes zoster oticus: ipsilateral facial paralysis, ear pain, and vesicles in auditory canal/auricle (CN 7 and 8 involvement)

Question 29

What defines sudden sensorineural hearing loss?

Answer 29

Idiopathic hearing loss >30dB, ENT emergency, usually 40s-50s, treat with steroids and antivirals (limited evidence)

Question 30

How do you interpret Weber and Rinne tests?

Answer 30

Weber: sound louder in affected ear = conductive loss. Rinne: bone > air conduction = conductive loss, air > bone = normal or sensorineural

Question 31

Name 10 causes of epistaxis

Answer 31

Trauma, infections, nose picking, allergies, low humidity, polyps, foreign body, HTN, anticoagulants, pregnancy

Question 32

What is the difference between anterior and posterior nosebleeds?

Answer 32

Anterior: Little's area/Kiesselbach's plexus, treat with cautery/packing. Posterior: requires foley balloon with traction, antibiotics

Question 33

What are the inflammatory causes of neck masses?

Answer 33

Adenitis (strep/staph), viral (HIV, EBV, HSV), fungal, parasitic, cat-scratch disease, tularemia, sialadenitis, thyroiditis

Question 34

What are the congenital causes of neck masses?

Answer 34

Brachial cleft cyst, thyroglossal duct cyst, dermoid cyst, cystic hygromas, torticollis, thymic masses, teratomas

Question 35

What is sialolithiasis and how is it treated?

Answer 35

Stone in salivary gland (85-90% submandibular). Treat with massage/heat, sialagogues, antibiotics if infected, lithotripsy

Question 36

What is the treatment for UV keratitis?

Answer 36

Cycloplegic drops, topical broad spectrum antibiotics, PO analgesics. Symptoms resolve in 24 hours

Question 37

What bacteria commonly cause bacterial conjunctivitis?

Answer 37

Strep pneumoniae, H. influenzae, Staph, Moraxella, Neisseria gonorrhoeae, Klebsiella, Pseudomonas

Question 38

What is the key difference between viral and bacterial conjunctivitis?

Answer 38

Viral: watery to purulent discharge, pre-auricular lymphadenopathy. Bacterial: purulent discharge, no lymphadenopathy

Question 39

What are the signs of dacryocystitis?

Answer 39

Pain, tenderness, swelling, erythema over lacrimal sac due to nasolacrimal duct obstruction, caused by Staph aureus

Question 40

What is blepharitis and how is it treated?

Answer 40

Thickened, red eyelid margins with blood vessels. NOT infection, just inflammation. Treat with eyelid hygiene, warm compresses

Question 41

What are the key features of third nerve palsy?

Answer 41

Ptosis, unable to turn eye inward/upward, mydriasis. Causes: diabetes (ischemic), orbital mass/tumor

Question 42

What are the key features of fourth nerve palsy?

Answer 42

Diplopia worse with downgaze, head tilt opposite way. Causes: trauma, vascular disease (aneurysm)

Question 43

What are the key features of sixth nerve palsy?

Answer 43

Most common, esotropia worse with lateral gaze, head turn toward paretic side. Causes: increased ICP, aneurysm, MS

Question 44

What is the difference between ADIE's pupil and third nerve palsy?

Answer 44

ADIE's: poor accommodation, young women, reduced DTRs, 1% pilocarpine causes constriction. Third nerve: EOM dysfunction, ptosis, diplopia

Question 45

What is the classic triad for acute angle closure glaucoma symptoms?

Answer 45

Sudden severe eye pain, blurred vision with halos around lights, nausea/vomiting

Question 46

What are the risk factors for acute angle closure glaucoma?

Answer 46

Anatomically small/shallow anterior chambers, age 55-70, triggered by pupil dilation events

Question 47

What is the difference between central and branch retinal artery occlusion?

Answer 47

CRAO: painless vision loss over seconds, cherry red spot, prominent RAPD. BRVO: painless, 'blood and thunder' appearance

Question 48

What antibiotics are used for otitis externa?

Answer 48

Polymyxin B + neomycin + hydrocortisone 4x/day OR ofloxacin/ciprofloxacin + steroid 2x/day (better compliance)

Question 49

What is the treatment for malignant otitis externa?

Answer 49

Oral or IV ciprofloxacin for 6-8 weeks (excellent bone penetration), CT/MRI imaging, may need hyperbaric oxygen

Question 50

What are the treatment options for posterior epistaxis?

Answer 50

Foley balloon with traction, pack both nares, antibiotics (Keflex/Amox-Clav), leave 2-5 days, refractory cases need IR

Question 51

What is the most common cause of neck masses by category?

Answer 51

Inflammatory: adenitis. Congenital: thyroglossal duct cyst. Neoplastic: depends on age (lymphoma in young, carcinoma in older)