ENT

Question 1

herpes keratitis

Answer 1

SEVERE eye pain, photophobia, blurred vision
fernlike lines in corneal surface (using black lamp)
EMERGENCY=blindness

Question 2

acute angle closure glaucoma

Answer 2

elderly, severe eye pain, n/v, “halos”. exam: dilated oval shaped pupil, cloudy cornea, “cupping”. EMERGENCY

Question 3

cholesteatoma

Answer 3

cauliflower like growth with foul smelling ear discharge
hearing loss
hx of otitis media, not concerous by may effect CN 7

refer

Question 4

battle sign

Answer 4

bruise behind the ear (mastoid) area after recent trauma
indicates skull fracture
look for clear golden discharge
Emergency

Question 5

clear fluid from nose or ear

Answer 5

sign of skull fracture
test fluid with urine dipstick=glucose (CSF)

emergency

Question 6

cavernous sinus thrombosis

Answer 6

hx of sinus injection with SEVERE headache/fever,

Question 7

peritonsillar absess

Answer 7

severe sore throat, odonophagia (painful swallowing), truisms (jaw tightening), “hot potato”, uvula displaced, fever.

Refer to ED fro incision and drainage

Question 8

diptheria

Answer 8

swollen “bulls neck”

posterior pharynx coated with gray/yellow psudomembrane, very contagious. ED

Question 9

normal eye findings

Answer 9

veins larger than arteries

Question 10

leukoplakia

Answer 10

on the tongue, may be cancerous, high risk in tobacco users

Question 11

apthous stomatitis ( canker sores)

Answer 11

painful shallow ulcers of soft tissue

Question 12

geographic tongue

Answer 12

map like appearance on tongue
patches may move
soreness with acidic/spicy foods
benign

Question 13

torus palatinus

Answer 13

benign

bony protuberance midline on the hard palate

Question 14

fishtail or split uvula

Answer 14

benign

may be a sign of occult cleft lip

Question 15

nystagmus

Answer 15

few beats on extreme lateral gaze that resolves when back to midline .

VERTICAL nystagmus is ALWAYS abnormal

Question 16

papilledema

Answer 16

swollen optic disc

secondary to bleeding, brain tumor, abscess, pseudo tumor cerebri

Question 17

hypertensive retinopathy

Answer 17

silver/copper wire arterioles

Question 18

diabetic retinopathy

Answer 18

microaneurysms caused by neovascularization (new arteries in the retina fragile)

On funduscopic exam, cotton wool spots, flame hemorrhages (similar lesions are also caused by the alpha-toxin of Clostridium novyi), and dot-blot hemorrhages.

Question 19

cataracts

Answer 19

opacity of the cornea

chronic steroid can cause

Question 20

allergic rhinitis

Answer 20

blue tinged or pale/swollen boggy nasal turbinates

Question 21

koplik spots

Answer 21

measles

small red papules with blue/white centers inside the cheeks by the lower molars

Question 22

hairy leukoplakia

Answer 22

elongated papilla on the lateral tongue, HIV injection caused by EBV

Question 23

leukoplakia of the tongue

Answer 23

bright white plaque caused by chewing tobacco or chronic infection ( rule out cancer)

Question 24

nystagmus

Answer 24

horizonal is normal, vertical his not

rule out strabismus

Question 25

abnormal vision test

Answer 25

2 line difference between each eye

Question 26

test for color blindess

Answer 26

ishihara chart

Question 27

vision test if illiterate

Answer 27

tumbling E chart

Question 28

legal blindess

Answer 28

20/200 or visual field

Question 29

normal rinne test

Answer 29

air conduction > bone conduction ( can hear longer in front of the ear than on mastoid bone)

Question 30

herpes keratitis

Answer 30

look for herpetic rash not eh side of the temple/tip of the nose (rule out shingles) of CN 5 The trigeminal nerve (the fifth cranial nerve, or simply CN V) is a nerve responsible for sensation in the face and certain motor functions such as biting and chewing. It is the largest of the cranial nerves.

Question 31

corneal abrasions

Answer 31

appear linear line on back lamp ( fernlike for herpes keratitis) flush out with saline, if unable to remove refer if corneal abrasion, use topical antibiotic (erythro, plytrim). do NOT patch eye. f/u in 24 hours

Question 32

hordeolum (stye)

Answer 32

``` painful bacterial infection of a hair follicle of the eyelid antibiotic drops (sulfa or erythromycin gtts), warm packs ```

Question 33

chalazion

Answer 33

chronic inflammation of the meibomian gland (sweat gland) of the eyelids "PAINLESS" nodule to the upper eyelid, benign tx: if nodule enlarges or does not resolve in a few weeks, biopsy to r/u squamous cell cancer.

Question 34

pinguecula

Answer 34

yellow triangular thickening of the bulbar conjunctiva caused by UV damage A pinguecula (above) is a yellowish patch or bump on the conjunctiva, near the cornea. It most often appears on the side of the eye closest to the nose. It is a change in the normal tissue that results in a deposit of protein, fat and/or calcium. It is similar to a callus on the skin.

Question 35

pterygium

Answer 35

yellow triangular thickening of the conjunctiva that extends to the cornea on the nasal or temporal cornea du to UV. A pterygium (also known as surfer's eye or farmer's eye) is a triangular-shaped growth of fleshy tissue on the white of the eye that eventually extends over the cornea. This growth may remain small or grow large enough to interfere with vision. A pterygium can often develop from a pinguecula.

Question 36

subconjuctival hermorrhage

Answer 36

blood trapped under conjunctiva and sclera, resolves within 1-3 wks. watchful waiting

Question 37

primary open angle glaucoma

Answer 37

gradual >IOP, >22mm hg dt lbokcage of the drainage of aqueous humor. CN2 can be permanently damaged (glaucoma, 60-70%) most common in elderly, AA gradual change in peripheral first. if shoes "cupping"- refer tx: BB gtts Betimol (timolol) side effects: fatigue/depression, bradycardia contraind: heart block, heart failure, copy/astham/emphysema

Question 38

closed angel glaucoma

Answer 38

SUDDEN blockage, increase IOP causing ischemia and permanent CN 2 damage ie: elder with sudden headache and eye pain, sees halos, n/v objective: fixed, mid dilated cloudy pupil. oval shaped. REFER ED

Question 39

anterior uveitis (iritis)

Answer 39

inflammation of the iris refer to opthamalogist higher risk with autoimmune; RA, lupus, anklosing spodylitis, etc. complains of red sore eyes, no discharge

Question 40

age related macular degeneration

Answer 40

higher risk in smokers gradual damage to the macula treatment: refer pt is given AMSLER grid (focus on central dot and view grad 12" from eye). check daily or weekly "areds" formula ocular vitamins (Antioxidents and zinc)

Question 41

sjorgrens syndrome

Answer 41

autoimmune. 3 months, gritty eyes (keratoconjuntivitis sicca). swollen salivatory glands OTC tear substitute eye gtts, refer

Question 42

belpharitis

Answer 42

chronic condition, inflammation of base of eyelashes, redness, crusting tx: baby shampoo until resolved. or erythromycin gtts

Question 43

allergic rhinitis

Answer 43

chronic nasal congestion, clear mucus post nasal drip, cough worse in supine. objective: blue tinged or pale boggy nasal turbinates mucus clear tx: flonase, decongestants, zyrtec, avoid dust mite allergies complications: acute sinusitis acute otitis media

Question 44

rhinitis medicamentosa

Answer 44

prolonged use of topical nasal decongestants (>3 days) causes rebound.

Question 45

epistaxis

Answer 45

tilt head forward and apply pressure, use afrin prn, nasal packing, antibiotic prophylaxis for staph/strep prn. posterior nose bleeds refer to ED

Question 46

strep throat

Answer 46

acute infection of the pharynx B. streptocuccus gram + group A classic example: acute onset of pain on swallowing, mild submandibular nodes, no rhinitis, pharynx pink/red, afebrile, tonsillar exudate, pettechiae on the palate Tx: throat culture and sensitivity (C&S) or rapid strep test first line: PCN QID x 10 days salt water gargles, throat lozenges repeat culture if high risk: hx of mitral valve or valve surgery pcn allergy: azithromyzin ( zpack) x 5 days levo x 10 days ( contraindicated if

Question 47

acute otitis media

Answer 47

acute infection middle ear organisms: S. pneumoniae, h. influenza, m. catarrhalis classic ex: ear pain (otalgia), popping nose, hx of cold/allergies.

Question 48

bullous myringitis

Answer 48

AOM but causes more PAIN | blisters (or bulla) on tempanic membrane, hearing closs

Question 49

tx for AOM

Answer 49

amoxicillin gold standard for all age groups or 2nd line augmenting, ceftin, cefzil (use 2nd line if antibiotic use in past 3 mos, no response to amoxicillin, or severe AOM (high fever, severe pain). if allergic to PCN: azithro, bacterium, levo (>18 yo dt risk of tendinitis/achilles tendon rupture complications: meningitis ( positive brudzinski or kerning sign)

Question 50

otitis externa ( swimmers ear)

Answer 50

bacterial infection of the skin of the external ear canal p. aeruginosa s. aureus external ear pain, swelling, green discharge "ear pain with tragus". tx: cortisporin otic suspension qid x 7 days. keep water out of ear. if recurrent, prophylaxis is otic domeboro (boric) or alcohol and vinegar (vosol)

Question 51

mono

Answer 51

``` EPV 15-24yo triad; fatigue, pharyngitis, lymphadenopathy stomach pain ( dt splenomegaly) objective: cbc (>50% lymphocytes) Positive mono spot tender cervical nodes, tonsils inflamed ``` Tx: abdomen US if splenomegaly no contact sports 4-6 wks avoid amoxicillin if patient has strep throat ** keep checking lymphocytes until normal**

Question 52

cheilosis

Answer 52

skin fissures corner of the mouth | apply topical antibiotic

Question 53

tx for otitis externa

Answer 53

corisporin otic drops | otitis externa = pseudomonas

Question 54

if pt has used antibiotics in the past 3 months

Answer 54

do nOT use amox | use augmenting of ceftin

Question 55

PCN allergy

Answer 55

use macrolides, sulfa (avoid cephalosporins if true PCN allergy)

Question 56

weber and rinne test which CN

Answer 56

8 (acoustic)

Question 57

most common cerumen tx

Answer 57

carbamide peroxide