HEENT

Question 1

Anterior chamber closes, blocking aqueous outflow and causing sudden-onset buildup of pressure in the eye

Answer 1

acute angle closure glaucoma

Question 2

Acute angle-closure glaucoma is usually spontaneous, but sometimes it’s triggered by meds. What are some examples of drugs that can do this?

Answer 2

antihistamines, anticholinergics (decongestants, atropine), alpha-1 agonists
** for this reason, the above meds are C/I in acute angle-closure glaucoma **

Question 3

Older woman w/ sudden onset of headache, ocular pain, nausea, vision loss. PE: red conjunctiva, fixed mid-dilated pupil, corneal opacity. TX?

Answer 3

topical BBs > acetazolamide, pilocarpine

Question 4

Degeneration of the optic nerve due to chronic increased intraocular pressure, causing slow progressive loss of peripheral vision

Answer 4

open-angle glaucoma

Question 5

Open-angle glaucoma causes peripheral or central vision loss?

Answer 5

peripheral

Question 6

PE: optic cup-disc ratio > 0.5, pale optic disc. TX?

Answer 6

topical prostaglandins

Question 7

Unilateral painful eye with photophobia and ciliary flush (injection around the limbus). +/- hypopyon.

Answer 7

anterior uveitis

Question 8

Causes of central scotomas (vision loss/changes)

Answer 8

macular degeneration, multiple sclerosis, drug-induced optic neuropathy (bilateral), hydroxychloroquine retinopathy

Question 9

Drusen and wavy distortions of straight lines

Answer 9

macular degeneration (dry)

Question 10

MCC amaurosis fugax

Answer 10

atherosclerotic emboli from the ipsilateral carotid artery (causes retinal artery occlusion & ischemia)

Question 11

Acute onset of floaters and “curtain” being pulled across the peripheral visual field (often 2/2 trauma or tripping)

Answer 11

retinal detachment

Question 12

Painless progressive vision loss bilaterally. Difficulty with nighttime driving.

Answer 12

cataracts

Question 13

Loss of red light reflex (white reflex) is caused by

Answer 13

opacities on the lens – cataracts (MC) or retinoblastoma/other tumor

Question 14

Sudden painless unilateral vision loss. PE: optic disc edema, venous dilation, retinal hemorrhages, cotton wool spots.

Answer 14

central retinal vein occlusion

Question 15

cherry red spot

Answer 15

central retinal artery occlusion

Question 16

retinal detachment TX

Answer 16

surgery

Question 17

Gradual painless vision loss with headaches. PE: hard exudates, flame hemorrhages, AV nicking, cotton wool spots

Answer 17

hypertensive retinopathy

Question 18

macular edema, cotton wool spots, microaneurysms, neovascularization, retinal hemorrhages

Answer 18

diabetic retinopathy

Question 19

Genetic condition that causes loss of photoreceptors

Answer 19

retinitis pigmentosa

Question 20

13y/o M presents with difficulty seeing at night, progressive peripheral vision loss. PE: retinal vessel attenuation, optic disc pallor

Answer 20

retinitis pigmentosa

Question 21

Repeated episodes of amaurosis fugax in ONE eye. Next steps?

Answer 21

duplex US of the neck (likely retinal artery occlusion)

Question 22

Pt presents w/ a thin flat layer of blood in the conjunctiva after rubbing his eyes aggressively. No pain or vision changes. TX?

Answer 22

no tx needed for subconjunctival hemorrhage

Question 23

Young woman w/ unilateral central vision loss, pain with EOM, “washed out” color vision. +RAPD. TX?

Answer 23

steroids – likely optic neuritis

Question 24

TX for preseptal vs orbital cellulitis

Answer 24

preseptal = PO abx
orbital = IV abx

Question 25

MCC of preseptal vs orbital cellulitis

Answer 25

preseptal = local trauma orbital = spreading infx (dental, sinus, preseptal cellulitis)

Question 26

Pt presents w/ R eyelid swelling and erythema. Limited EOM due to pain. 2 weeks ago he scratched his eye when he tripped and fell. Next steps?

Answer 26

CT w/ contrast (suspicious for orbital cellulitis)

Question 27

Pt reports a "gush of fluid" sensation following blunt orbital trauma. +RAPD and decreased vision in that eye. Next steps?

Answer 27

emergency ophthalmology consult & place eye shield in the meantime. pt will eventually get tetanus IM, IV abx, CT eye, and probably need surgery for open globe injury.

Question 28

What findings are associated w/ open globe injury?

Answer 28

teardrop pupil, RAPD, decreased visual acuity, low IOP

Question 29

Painless rubbery erythematous nodule on the eyelid

Answer 29

chalazion

Question 30

TX for persistent chalazion

Answer 30

REFER TO OPHTHALMOLOGY, could be cancer

Question 31

Bright red focal nodule on the conjunctiva. +FB sensation. TX?

Answer 31

no tx for episcleritis (self-limiting) - can use topical lubricants for grittiness

Question 32

Pt w/ PMHX of SLE presents w/ a severely painful, dark red sclera. Reports a burning sensation, worsened to the touch. TX?

Answer 32

PO prednisone and immunosuppressants (anterior scleritis)

Question 33

Shortly after starting a new medication, pt develops reduced color perception and bilateral central vision loss without pain. PE shows optic disc edema. What drugs can cause this?

Answer 33

ethambutol, linezolid

Question 34

Uh oh! Orbital trauma!! When should I get a CT scan?

Answer 34

- severe eye pain - pain w/ EOMs or limited EOM - decreased visual acuity - suspected intraocular FB - cannot examine eye fully - evidence of fracture on exam

Question 35

MC organism for necrotizing/malignant otitis externa

Answer 35

Pseudomonas

Question 36

T/F: necrotizing/malignant otitis externa is life-threatening

Answer 36

T

Question 37

Elderly pt with PMHX of DM presents w/ severe ear pain worse w/ sleeping and chewing. Exam shows purulent otorrhea with granulation tissue along the ear canal and unilateral facial drooping. ESR is high. TX?

Answer 37

IV FQ or other antipseudomonal (necrotizing/malignant otitis externa)

Question 38

Pt presents w/ temporal headaches, pain in the jaw worse w/ chewing, and episodes of amaurosis fugax. No hx of HTN or HLD. TX?

Answer 38

HIGH DOSE STEROIDS (while waiting for bx results - this is suspicious for GCA)

Question 39

Conditions associated w/ unilateral painless vision loss or blurriness

Answer 39

- retinal detachment - retinal artery occlusion/ischemia (MC) - giant cell arteritis

Question 40

Unilateral facial pain and spongy swelling (from the preauricular area extending to the mandible) that is worse w/ eating. TX?

Answer 40

something sour (sialolithiasis)

Question 41

17y/o M presents for evaluation of his ear after he got hit in the head during a wrestling match. PE: tender fluctuant mass on the anterior pinna. TX?

Answer 41

I&D immediately and apply pressure dressing (auricular hematoma, may develop into cauliflower ear)

Question 42

MCC epiglottitis

Answer 42

HIB

Question 43

T/F: both systemic and topical steroids is RF for early onset cataracts

Answer 43

T - so ie DM, radiation/sun exposure

Question 44

TX for hyphema (usually 2/2 blunt trauma)

Answer 44

admit for observation with: - HOB elevation, eye shield, serial IOP - cycloplegic drops - ophthalmology referral

Question 45

Unilateral hearing loss with unsteady gait and imbalance. No vertigo.

Answer 45

vestibular schwannoma / acoustic neuroma

Question 46

Meniere's DZ & labyrinthitis both present w/ vertigo and unilateral hearing loss. What is the main difference b/t the two?

Answer 46

Meniere is RECURRENT episodes of vertigo. Labyrinthitis is one prolonged episode that could last days.

Question 47

What should you always consider in a young child w/ unilateral purulent, malodorous nasal discharge without any other sick sxs

Answer 47

FB impaction

Question 48

Clear unilateral rhinorrhea w/ a normal nasal exam is suspicious for

Answer 48

CSF leak - get imaging or nasal endoscopy, both w/ intrathecal contrast

Question 49

T/F: CSF rhinorrhea can be treated outpt if mild

Answer 49

NO - admit always due to high risk of meningitis

Question 50

Pale optic disc indicate

Answer 50

optic nerve atrophy

Question 51

GCA may present similarly to TMJ: headache and jaw pain worsened w/ chewing. What is the main difference?

Answer 51

GCA is almost always >50y/o and has high ESR

Question 52

Red painful eye with ciliary flush, hypopyon, and erythema nodosum

Answer 52

sarcoid * anterior uveitis is also associated w/ IBD, ankylosing spondylitis, RA, SLE, etc.

Question 53

Strep throat is group A or B strep?

Answer 53

GAS

Question 54

1st line TX for strep

Answer 54

amoxicillin or PCN x 10d (finish full course to prevent rheumatic heart disease)

Question 55

1st line TX for strep if anaphylactic to PCNs

Answer 55

zpak or clinda

Question 56

Mono and strep throat both present w/ exudative tonsillitis. What is a PE finding that can differentiate the two (lymph nodes)?

Answer 56

mono is POSTERIOR lymphadenopathy strep is ANTERIOR lymphadenopathy

Question 57

T/F: Both leukoplakia and SCC do not scrape off oral mucosa

Answer 57

T

Question 58

TX for persistent leukoplakia

Answer 58

biopsy to check for malignant transformation (SCC)

Question 59

p24 antigen is for

Answer 59

HIV testing (4th gen)

Question 60

MC organism bacterial sinusitis

Answer 60

HIB

Question 61

MC organism otitis media

Answer 61

strep pneumo ** if concurrent conjunctivitis, HIB more likely

Question 62

Visual acuity should be taken at every peds physical starting at age

Answer 62

4

Question 63

TX for corneal abrasion in a contacts wearer

Answer 63

FQ or aminoglycoside with 24-hr f/u to eval for ulcer development

Question 64

T/F: RPA is more common in young children

Answer 64

T

Question 65

MCC Ludwig angina (submandibular abscess); presents with submandibular and lingual swelling

Answer 65

dental infection

Question 66

Infant has cyanosis with feeding. It improves with crying. Most likely

Answer 66

choanal atresia

Question 67

Rock hard eyeball and severe swelling of the periorbital area following blunt trauma. TX?

Answer 67

lateral canthotomy (orbital compartment syndrome)

Question 68

Sialadenosis is benign noninflammatory swelling of the salivary glands due to

Answer 68

chronic alcohol use or malnutrition

Question 69

SXS of vit D deficiency (scurvy)

Answer 69

bleeding gums, gingivitis, dental caries, xerostomia

Question 70

Amblyopia is a complication of untreated strabismus - what is the tx?

Answer 70

eye patch the stronger eye or topical cycloplegics (ie. atropine) the stronger eye

Question 71

MC organism of mastoiditis

Answer 71

strep pneumo

Question 72

mastoiditis TX

Answer 72

IV abx & middle ear drainage (via tympanostomy or mastoidectomy)

Question 73

Presbyopia (age-related nearsightedness) is caused by

Answer 73

loss of lens elasticity

Question 74

After successful tx of otitis media, pt develops serous otitis media. TX?

Answer 74

none necessary, watchful waiting

Question 75

Name some ototoxic meds (cause sensorineural hearing loss)

Answer 75

aminoglycoside, loop diuretics, salicylates,

Question 76

What should pts w/ dry macular degeneration do to lower risk of progression to wet macular degeneration?

Answer 76

- smoking cessation - zinx/antioxidant vitamins

Question 77

Pt with 2-yr hx of drusen and some mild central scotomas suddenly develops worsening vision loss. He is a smoker. PE shows neovascularization and new hemorrhages on fundoscopy. TX?

Answer 77

VEGF inhibitors (now has wet macular degeneration)

Question 78

T/F: in children, strep throat should be confirmed with rapid test or throat culture before giving abx

Answer 78

T - although empiric tx while culture is pending is OK

Question 79

MC S/E of intranasal steroids

Answer 79

epistaxis

Question 80

Pt presents w/ a wedge-shaped fibrovascular tissue on the medial conjunctiva, extending laterally onto the cornea. She lives in FL. DX?

Answer 80

pterygium

Question 81

Painless yellow raised lesion on only the medial conjunctiva. No corneal involvement. DX?

Answer 81

pinguecula