EENT #1

Question 1

Symptoms of an acoustic neuroma

Answer 1

• Unilateral sensorineural hearing loss

- Tinnitus, vertigo, facial numbness, facial paresis

Question 2

Diagnostic imaging for Acoustic Neuroma

Answer 2

• MRI (imaging of choice)

- Audiometry is the lab of choice

Question 3

Management of acoustic neuroma

Answer 3

Surgery or focused radiation therapy

Question 4

Pathophysiology of acute angle closure glaucoma

Answer 4

Decreased drainage of aqueous humor via trabecular meshwork and canal of Schlemm in patients with pre-existing narrow angle or large lens

Question 5

True or False: Acute angle closure glaucoma is the leading cause of preventable blindness in the US

Answer 5

True

Question 6

Precipitating factors for acute angle closure glaucoma attack

Answer 6

Mydriasis (dilation), dim lights, sympathomimetics, anticholinergics

Question 7

Symptoms of acute angle closure glaucoma

Answer 7

• Sudden onsets of severe, unilateral ocular pain
• Halos round lights and loss of peripheral vision
• N/v, headache
• Conjunctival erythema, cloudy cornea, mid-dilated and fixed pupil

Question 8

Diagnostics for acute angle closure glaucoma

Answer 8

• Increased IOP > 21 mmHg

- Fundoscopy: optic disc blurring or cupping

Question 9

Treatment for acute angle closure glaucoma

Answer 9

• Acetazolamide with Topical BB (Timolol) without affecting visual acuity
• Definitive: Iridotomy

Question 10

MCC of acute otitis media (SMH)

Answer 10

Strep Pneumo (MC); GABHS
Moraxella Catarrhalis
H. Influenzae

Question 11

Symptoms of AOM

Answer 11

• preceded by URI
• Fever, otalgia, ear tugging in infants, conductive hearing loss
• Bulging and erythematous TM with effusion
• Decreased TM mobility (most sensitive)

Question 12

What is the definitive diagnostic for AOM for recurrent cases

Answer 12

Tympanocentesis for a sample of fluid for culture

Question 13

If the TM perforates, what symptoms present?

Answer 13

Rapid relief of pain + otorrhea (usually heals in 1-2 days)

Question 14

Treatment for AOM

Answer 14

Amoxicillin (1st line) x 10-14 days

• Augmentin or Cefaclor second line
• Azithromycin if PCN allergy

Question 15

Acute sinusitis, if bacterial, is caused by

Answer 15

Strep Pneumo

Question 16

Acute sinusitis, if viral, is caused by

Answer 16

Rhinovirus, influenza, and parainflueza

Question 17

Symptoms of acute sinusitis

Answer 17

• Facial pain or pressure worse with bending or leaning forward
• Headache
• Purulent nasal discharge
• Worsening symptoms after period of improvement
• Malaise
• Nasal congestion

Question 18

Diagnostic of choice, if needed, for acute sinusitis

Answer 18

CT scan

Question 19

However, diagnostic that is gold standard for acute sinusitis is

Answer 19

Biopsy or aspirate

Question 20

If sinus radiographs are ordered for acute sinusitis, what view is most helpful?

Answer 20

Water’s View

Question 21

Treatment for acute sinusitis

Answer 21

Decongestants, analgesics, antihistamines, mucolytics, nasal lavage

Question 22

However, in acute sinusitis, if symptoms are present for _______, or if they have worsening symptoms, you can start ABX. What are the ABX that you can start?

Answer 22

10-14 days

• Augmentin
• Second line is Doxycycline

Question 23

What is the MCC of pharyngitis (acute tonsillitis)

Answer 23

Viral (Adenovirus, Rhinovirus, EBV)

However, bacterial is also a cause. Group A Strep (Strep Pyogenes) is the MC bacterial cause

Question 24

Treatment for acute tonsillitis

Answer 24

Symptomatic, warm fluids, saline gargles, topical anesthetics, lozenges

Question 25

If the acute tonsillitis is due to S. Pyogenes, you should use what ABX?

Answer 25

Amoxicillin

Question 26

MCC of permanent legal blindness and vision loss in older adults

Answer 26

Macular degeneration

Question 27

Symptoms of macular degeneration

Answer 27

Bilateral, progressive central vision loss. - Metamorphopsia (blurred lines) - Micropsia (objects are smaller in affected eye)

Question 28

Risk factors for Macular degeneration

Answer 28

Age > 50 Caucasians Females Smokers

Question 29

Fundoscopic exam for macular degeneration (dry and wet)

Answer 29

Dry: Drusen bodies (small yellow-white spots on retina) Wet: New, abnormal vessels that cause retinal hemorrhaging and scarring

Question 30

Management of Dry Macular Degeneration

Answer 30

- Zinc and Vitamins A & C | - Amsler grid monitoring at home

Question 31

Management of Wet Macular Degeneration

Answer 31

Intravitreal VEGF inhibitors (Bevacizumab) | -Laser photocoagulation

Question 32

Symptoms of allergic rhinitis

Answer 32

- Clear, watery rhinorrhea - Pale or boggy turbinates - Nasal polyps - Cobblestone mucosa of conjunctiva - Allergic Shiner - Allergic Salute

Question 33

Treatment for allergic rhinitis

Answer 33

- Intranasal corticosteroids - Intranasal glucocorticoids (Mometasone, Fluticasone) if nasal polyps - Decongestants

Question 34

What is the risk with decongestants?

Answer 34

Intranasal decongestants used > 3-5 days can cause rhinitis medicaments (rebound congestion)

Question 35

What is Amaurosis Fugax?

Answer 35

-Transient monocular vision loss with complete recovery due to retinal emboli or ischemia

Question 36

Symptoms of Amaurosis Fugax

Answer 36

Vision loss descending over visual field described as a curtain or shade, that lifts up and resolves within 1 hour

Question 37

Fissures at the side of the mouth

Answer 37

Angular Cheilitis

Question 38

bacterial conjunctivitis causes

Answer 38

- Staph A (MC) - Strep Pneumo - H. Influenzae - M. Catarrhalis

Question 39

Symptoms of bacterial conjunctivitis

Answer 39

-Purulent discharge, lid crusting (eye stuck shut in the morning), conjunctival erythema, no visual changes

Question 40

Treatment for bacterial conjunctivitis

Answer 40

-Erythromycin ointment

Question 41

However, for a contact lens wearer for bacterial conjunctivitis, what should you cover for and what ABX should you use?

Answer 41

Pseudomonas -Topical Ciprofloxacin or Ofloxacin

Question 42

with a bitemporal hemianopsia, where would you expect a lesion to be?

Answer 42

Lesion of optic chiasm

Question 43

Risk factors for cataracts (lens opacification/thickening)

Answer 43

- Aging - Smoking - Glucocorticoid use - DM - Trauma - UV light

Question 44

Symptoms of cataracts

Answer 44

- Absent red reflex, opaque lens - Painless, slow progressive vision loss over years - Difficulty driving at night, reading signs