HEENT

Question 1

Fluorescein dye “fern like” CN V. Abrupt onset of pain

Answer 1

Herpes keratitis

Question 2

Round/Irregular

Answer 2

Corneal Abrasions

Question 3

Acute/severe halos, cupping optic nerve, cloudy cornea, mid-dilated oval pupil. ER STAT.

Answer 3

Acute Angle-closure glaucoma

Question 4

CN2 gradual changes in peripheral vision LOST FIRST, then second central vision. Pressure 8 - 21

Answer 4

Primary Open Angle Glaucoma

Question 5

Elderly- night vision issues, extreme glare. Opaque lens. Absent red reflex.

Most common cause of blindness in developing countries

Tx: cataract surgery with IOL –intraocular lens implantation

Answer 5

Cataracts

Question 6

Painless loss of “central vision” reports straight lines appear curved. Periphery is preserved. Give asmler grid.

Answer 6

Age-Related Macular Degeneration

Question 7

Floaters, curtain, flashes of light. Painless. EXAM

Answer 7

Retinal Detachment

Question 8

cauliflower, foul-smell, hearing loss. If erodes bones in face affects CN VII. ENT - SURGERY

Answer 8

Cholesteatoma

Question 9

Aphthous stomatitis: painful shallow ulcers heal 7-10 days.

Tx: Magic mouthwash.

Answer 9

Canker sores

Question 10

Optic disc swollen w/ blurred edges due to increased ICP

Answer 10

Papilledema

Question 11

• Copper/silver wire arterioles.
• AV nicking (mild retinopathy).
• Retinal Hemorrhages.

Answer 11

Hypertensive Retinopathy

Question 12

• Cotton wool spots (moderate retinopathy)
• micro-aneurysms.
• RETINAL HEMORRHAGES (CENTER OF EYE APPEAR ORANGE RED)

Answer 12

Diabetic Retinopathy

Question 13

“clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars”. Rubeola and Measles. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash. EXAM

Answer 13

Koplik Spots

Question 14

Lateralization to good ear. Rinne- AC > BC.

Answer 14

Sensorineural:

Question 15

Lateralization to bad ear. Rinne- BC > AC.

Answer 15

Conductive:

Question 16

Tunning fork midline. CN 8 (acoustic). EXAM

Answer 16

Weber:

Question 17

Painful swollen red warm abscess Tx: hot compress erythromycin, dicloxacillin.

Answer 17

Hordeolum

Question 18

Middle ear. Usually S. pneumo. (others: h influ, mor catarrhalis). Popping, muffled, afebrile or low-grade, TM can rupture blood and pus on pillow on awakening with relief of ear pain. “erythematous TM” bulging or retracting. Decreased mobility.

Answer 18

Acute Otitis Media

Question 19

1st line Amoxicillin (first line),

Augmentin,

Omnicef, Ceftin, Levaquin.

Answer 19

Acute Otitis Media - Tx

Question 20

Ear pressure, popping, muffled hearing, chronic allergic rhinitis, sterile serious fluid is trapped in the middle ear. TM should NOT BED RED. TM may bulge or retract.

Answer 20

Otitis Media with Effusion

Question 21

Oral decongestants, steroid nasal spray, treat like allergies. Usually Painless.

Answer 21

Otitis Media with Effusion - Tx

Question 22

Pseudomonas aeruginosa. (other- S. aureus). External ear pain- d/c itching, hearing loss, tragus, green d/c.

Tx: Corticosporin, Cipro drops EXAM

Answer 22

Otitis Externa (swimmers’ ear)

Question 23

Sensorineural loss without lateralization. Involves the inner ear. Symmetrical progressive. Human speech lost first. AGING ADULT EXAM

Answer 23

Presbycusis

Question 24

“stringy; increased tearing” PO antihistamines. Type I sensitivity. Typically, bilateral. Rhinitis and allergic shiner

Answer 24

Allergic Conjunctivitis

Question 25

Animals/hides/hair/wool. Lesions begin as papule that enlarges quick 24-48h develops necrosis and ulceration (sort of like a spider bite recluse) Tx: Doxy, Cipro, Levaquin.

Answer 25

Anthrax

Question 26

Painful lump hurts more with eating (by jaw) aka calculi or salvary stones. Usually in sub mandibular gland aka whartons; duct.

Answer 26

Sialolithiaisis

Question 27

VERTIGO TINNITUS, HEARING LOSS

Answer 27

Meinier’s disease

Question 28

Tx: Epley’s Maneuver - Nystagmus should be horizontal (if vertical, check EOMs and refer)

Answer 28

BBPV DX: Dix Hallpike

Question 29

Unilateral facial pain or upper molar pain, **\*worse with bending over,** \*purulent nasal discharge, s/s over 10 days Tx: Augmentin (if already watched/waited 10 days)

Answer 29

Rhinosinusitis

Question 30

S/S: FFPL (Fever, Fatigue, Pharyngitis, Lymphadenopathy-Posterior Cervical) **Enlarged spleen** - hold activity until resolved (US) **4 – 6 wks** Dx: Monospot (**aka heterophile** antibody test) (positive 2-3 weeks in) US to check for if condition has resolved

Answer 30

MONO

Question 31

Answer 31

Copper/silver wire arterioles.

Question 32

Answer 32

AV nicking (mild retinopathy

Question 33

Answer 33

Retinal Hemorrhages.