ENT

Question 1

With chemical ophthalmic burns, what is the initial management?

Answer 1

sterile (if possible) irrigation for at least 30 minutes

Question 2

What physical exam finding is most concerning for a blow out orbital fracture?

Answer 2

inability of the patient to look up due to an entrapment of the infraorbital nerve and musculature

Question 3

What diagnosis is associated with a curtain being drawn over the eye from top to bottom?

Answer 3

Retinal detachment

Question 4

what is the prognosis for retinal detachment?

Answer 4

80% will recover spontaneously, 15% require treatment, 5% will never recover

Question 5

What is the major worrisome side effect of long term or high dose chloroquine use?

Answer 5

Macular degeneration

Question 6

What is the leading cause of irreversible central visual loss?

Answer 6

Macular degeneration

Question 7

What is the biggest risk factor for macular degeneration?

Answer 7

Age > 50

Question 8

Patient presents with a gradual loss of central vision with wavy distorted remaining vision, unilaterally. Diagnosis?

Answer 8

Macular degeneration

Question 9

How do you differentiate central retinal artery occlusion from giant cell arteritis?

Answer 9

GCA: fever, HA, jaw claudication

Question 10

What is associated with unilateral visual loss/blurriness and a “blood and thunder” retina on fundoscopic exam?

Answer 10

Central retinal vein occlusion

Question 11

What is the leading cause of blindness in the US?

Answer 11

diabetic retinopathy

Question 12

Differentiate Macular degeneration from cataracts

Answer 12

Cataracts: usually bilateral, intact peripheral vision, non distorted

Question 13

Describe a typical patient with open-angle glaucoma

Answer 13

African American with diabetes < 40 years old

Question 14

What type of glaucoma is most common?

Answer 14

open-angle glaucoma

Question 15

Patient presents with circumlimbal injection, seamy cornea, fixed mid-dilated pupil, decreased visual acuity and tearing. Patient has vomited once. Diagnosis? Treatment?

Answer 15

angle-closure glaucoma - anhydrase inhibitor (acetazolamide) + topical B-blocker + systemic diuresis (mannitol)

Question 16

What are the typical pathogens in orbital cellulitis?

Answer 16

S. pneumoniae, S Aureus, H. Flu and Gram-negatives

Question 17

9 yo F p/w ptosis, eyelid edema, exophthalmos, purulent conjunctivitis and fever. She has decreased EOM and sluggish pupil. She reports having had cold symptoms for the 2 previous weeks. Work up? Likely Dx? Tx?

Answer 17

CT for extent of infection, Orbital Cellulitis, IV abx for total 2-3 week course, initially nafcillin + flagyl or clinda

Question 18

Conjunctivities with intracellular gram-negative diplococci seen on smear. What is the organism?

Answer 18

N. Gonorrhea

Question 19

Blue sclera

Answer 19

osteogenesis imperfecta

Question 20

Weber: lateralization to affected ear, Rinne: Bone>Air on affected side - What type of hearing loss?

Answer 20

Conductive

Question 21

Weber: lateralization to the unaffected ear (better hearing), Rinne: air > bone in both ears - what type of hearing loss?

Answer 21

sensorineural

Question 22

What is the most common etiology of sensorineural hearing loss?

Answer 22

Presbycusis - gradual impairment of higher sound frequencies occurring with increasing age

Question 23

Pt presents with episodic vertigo over the past week, lasting several minutes, unilateral hearing loss and tinnitus. On exam caloric testing reveals loss of nystagmus on the side with hearing impairment. Diagnosis?

Answer 23

Meniere disease

Question 24

What is the primary treatment of Meniere’s disease?

Answer 24

diuretics (acetazolamide) and low-sodium diet

Question 25

What are the most common ototoxic medications?

Answer 25

Aminoglycoside abx (mycins), lasix, chemotherapy

Question 26

Child with h/o ear infections p/w painless ear discharge - what is the diagnosis? Likely PE findings? Tx?

Answer 26

Likely chronic otits media, perforated TM, will need abx drops/tubes

Question 27

What is the differential of antibiotics for acute sinusitis?

Answer 27

10-14 days of symptoms - Amox or for PCN all Macrolides/Bactrim/Doxy -> Amp -> fq

Question 28

What are the diagnostic criteria for strep throat? (4)

Answer 28

Fever > 100.4, tender anterior cervical lymphadenopathy, lack of cough, pharyngotonsillar exudate

Question 29

Patient presents with painless white oral plaques, next step?

Answer 29

biopsy - likely leukoplakia 5% risk of SCC

Question 30

Differentiate epiglottitis from peritonsilar abscess

Answer 30

No physically identifiable swelling or intra oral erythema in epiglottitis - just difficulty swallowing and/or breathing

Question 31

What medication should be avoided in patients with allergic rhinitis, nasal polyps and asthma?

Answer 31

aspirin can cause bronchospasm