HEENT

Question 1

4 cardinal symptoms of rhinosinusitis

Answer 1

1) anterior/posterior nasal mucopurulent drainage
2)nasal obsrtuction/congestion
3) facial pain/pressure
4) hyposmia/anosmia

Question 2

chronic vs acute rhinosinusitis. Bacterial vs viral rhinosinusisti

Answer 2

chronic rhinisunusitis is inflammtation of the nasal passage & paranasal sinus last >12 weeks.
Acute rhinosinusitis last <4 weeks
–>Viral last less than 10 days
–>bacterial last greater than 10 day and follows a viral URI (worsening of symptoms)

Question 3

What is the treatment for bacterial rhinosunusitis

Answer 3

amoxicillin or augmentin

Question 4

Physical exam findings of allergic rhinitis

Answer 4

pale boggy nasal mucosa w hypertrophic tubinates.
cobblestone appearace of posterior pharyngeal wall

allergic shiner: dark dsicoloration under eye
allergic nasal crease: transverse crease from upward wiping

Question 5

Treatment for allergic rhinitis

Answer 5

1) intranasal steroids (fluticasone, mometasone)
2) anti-histamine (cetirizine, , loratadine )
3)Intranasal decongestant (Oxymetazoline nasal spray, phenylephrine (Sudafed PE)) only use for 5 days

Question 6

What is rhinitis medicamentosa

Answer 6

rebound nasal congestion with intranasal decongestant use >5 days

Question 7

What is aphthous ulcers

Answer 7

small painful sore in the mouth that is often triggered by trauma.

Question 8

Aphthous ulcers presentation

Answer 8

lip, cheek or under tongue.
painful Ulcer: fibrous membrane cap (yellowish-white or gray), well-defined margins with a red halo.

Question 9

What is blepharitis?

Answer 9

Inflammation of the eyelid margins cauinf eye redness, irritation, FB sensation.
FLAKING AND CRUSTING of eyelids & lashes

Question 10

What is the most common cause of blepharitis?

Answer 10

Staphylococci

Question 11

treatment of blepharitis

Answer 11

warm compress, wash w baby shampoo. topical abx if refractory

Question 12

What is cholesteatoma

Answer 12

keratinizing squamous epithelium cell grows in the middle ear.
primarily affect children

Question 13

Presentation of cholesteatoma

Answer 13

foul-smelling otorrhea
conductive hearing loss

growth can destroy osscile, lead to facial nerve paralysis & temporal bone erosion.

Question 14

Diagonisis of cholesteatoma

Answer 14

CT of the temporal bone.
surgery ( mastoidectomy) is indicated

Question 15

anterior nose bleed site

Answer 15

kiesselbach’s venous plexus.

Question 16

posterior nose bleed

Answer 16

sphenopalatine artery

Question 17

treatment for anterior nosebleeds

Answer 17

Nasal decongestant (will cause vasoconstriction): Afrin, oxymetazoline, phenylephrine.

Silver nitrate stick for chemical cautery

Question 18

viral conjunctivitis is cause by

Answer 18

it is the most contagious conjunctivitis caused by adenovirus. spread by direct contact

Question 19

Bacterial conjuctivitis is cuased by

Answer 19

adults: staph aureus
Children: Strep pneumo

Question 20

presentation of viral conjuctivitis

Answer 20

1) start unilaterally then bilaterally
2) pink or red conjunctiva
3) clear watery, stringy discharge
4) preauricular LAD

Question 21

viral vs bacterial vs allergic conjuctivitis discharger

Answer 21

viral: watery & stringy
Bacterial: purulent, white, yellow/green discharge
allergic: watery, mucous discharge.

Question 22

Bacteral Conjunctivitis presentation

Answer 22

1) unilateral
2) thick mucopurulent discharge
3) Crusting, difficulty opening eye in AM.

Question 23

treatment for Bacteral Conjunctivitis

Answer 23

symptomatic management + macrolide eye drops

cipro if eye contact wearer.

Question 24

Allergic Conjunctivitis presentation

Answer 24

1) bilateral eye itching
2) watery or stringy
3) conjunctiva edema

Question 25

Allergic Conjunctivitis treatment

Answer 25

antihistamine drops: topical naphazoline/pheniramine

Question 26

scrape/sratch injury on the corneal epithelium

Answer 26

corneal abrasion

Question 27

Diagnosis of corneal abrasion

Answer 27

fluorescein staining

Question 28

tx corneal abrasion

Answer 28

erythromycin drops

Question 29

A serious infection affecting multple layers of the cornea that is seen in contact lens wearers

Answer 29

corneal ulcer

Question 30

Physical exam finding of corneal ulcer

Answer 30

round or irregular ulcer w white hazy base.

Question 31

corneal ulcer diagnosis

Answer 31

slit-lamp w/ fluorescein staining

Question 32

Management for corneal ulcer

Answer 32

1) topic cipro for pseudomonas coverage 2) cyclopentolate for pain 3) emergent ophthalmology referral

Question 33

a larger triangular fibrovascular wedge in the conjuctival tissue

Answer 33

pterygium develops due to chronic UV light exposure. starts medially(nose then growth laterally) cause irritation and foreign body sensation conservative management

Question 34

an infectious obstruction of the nasolacrimal duct (inferomedial region)

Answer 34

dacryocystitis erythema, edema, warmth & pain of medial cathus of the eye + purulent discharge.

Question 34

a 58-year-old woman presents to the emergency department with a 3-day history of increasing pain, redness, and swelling in the inner corner of her left eye. She also reports some purulent discharge from the same eye. She denies any vision changes or trauma. On physical examination, you note localized erythema, warmth, and swelling over the medial canthal area of her left eye. Her visual acuity is normal.

Answer 34

dacryocystitis

Question 35

inflammation of lacrimal (tear-producing) glands usually caused by bacteria or a virus that initiates the inflammation (supratemporal)

Answer 35

Dacryoadenitis

Question 36

triad of acute angle closure glaucoma

Answer 36

injected conjunctiva, steamy (cloudy) cornea, and fixed dilated pupil

Question 36

Tonometry showing IOP >30 is diagnosistic for

Answer 36

acute angle closure glaucoma cupping of the optic nerve may occur

Question 37

1st line treatment for open angle glaucome

Answer 37

prostaglandins (Iatanoprost, travoprost)

Question 37

Acute narrow angle-closure glaucoma

Answer 37

Acetazolamide IV is the first-line agent - decrease IOP by decreasing aqueous humor production Topical beta-blockers (ex. timolol) reduces IOP without affecting visual acuity Miotics/cholinergics (ex. Pilocarpine, Carbachol) Peripheral iridotomy is the definitive treatment

Question 38

Trauma causes blood to collect in the anterior chamber of the eye

Answer 38

Hyphema ->eye-shield, pain drops & steriod drops

Question 39

treatment for papilledema

Answer 39

acetazolamide to decrease IOP

Question 40

a 62-year-old male who arrives for his follow-up visit for chronic central visual loss. He describes a phenomenon of wavy or distorted vision that has deteriorated rather quickly. The patient is frustrated because he “just can’t drive anymore,” and he is “having difficulty seeing words when he reads.” When looking at a specific region of the Amsler grid, he reports a dark “spot” in the center, with bent lines. On the fundoscopic exam, you note areas of retinal depigmentation along with the presence of yellow retinal deposits.

Answer 40

Macular degeneration: gradual painless central vision loss. ->metamorphopsia (distortion on amsler grid) ->dry macular degeneration (mc): gradual macula atropy (drusen bodies = yellow retinal deposits)

Question 41

zinic & antioxidant vitamin

Answer 41

dry age-related macular degeneration

Question 42

VEGF inhibitors (e.g., bevacizumab)

Answer 42

Wet age-related macular degeneration

Question 43

true or false laryngitis is alway viral in nature with hoarseness following an URI

Answer 43

True consider squamous cell cancer if it last >2 wks tx w vocal rest

Question 44

teardrop-shaped growths partially obstructing the nasal passages

Answer 44

nasal polyps -> topical nasal corticosteroids

Question 45

Peritonsillar abscess presentation

Answer 45

1) muffles hot potato voice 2) trismus (difficulty opening mouth) 3) deviation of uvula associated with anterior cervical LAD will have a hx of sore throat

Question 46

Centor score for strep pharyngitis

Answer 46

1. Absence of a cough 2. exudates 3. fever (> 100.4 F) 4. cervical lymphadenopathy 3 out 4 = rapid strep test