EENT

Question 1

What is the presentation of acute otitis media?

Answer 1

• Otalgia
• Bulging of tympanic membrane
• Marked erythema
• Fever
• May experience conductive hearing loss

Question 2

What is the first-line treatment for acute otitis media in patients 2 years and older without recent antibiotic use?

Answer 2

Amoxicillin 45mg/kg twice a day for 5 to 7 days

Question 3

How should acute otitis media be treated in patients under 2 years or with recurrent AOM?

Answer 3

Antibiotic treatment for 10 days

Children <2 years old, those with recurrent AOM, or with a perforated tympanic membrane should receive 10 days of antibiotic treatment (typically amoxicillin). Older children with mild AOM and intact tympanic membranes may be treated for 5–7 days instead.

Question 4

How is acute otitis externa treated?

Answer 4

• Clean out ear canal if debris present
• Place a wick if patient has significant swelling
• Ear drops (options include combinations of the following: fluoroquinolones, glucocorticoids, aminoglycosides)

Question 5

True or False:

Neomycin can be used in cases of acute otitis externa with a perforated tympanic membrane.

Answer 5

False

Question 6

What is the typical presentation of bacterial conjunctivitis?

Answer 6

• Purulent discharge (yellow, white, or green)
• Typically unilateral, though can be bilateral

Question 7

What is the recommended treatment for bacterial conjunctivitis in contact lens wearers?

Answer 7

Topical fluoroquinolones

Question 8

Fill in the blank:

______ conjunctivitis is characterized by itchy eyes and watery discharge, generally bilateral.

Answer 8

Allergic

Question 9

What are the indications for urgent ophthalmology referral in conjunctivitis?

Answer 9

• Decreased visual acuity
• Severe mucopurulent discharge
• Unable to open eye
• Rapidly progressing, or lasting extended weeks to months
• Conjunctivitis in a newborn

Question 10

What is the presentation of a hordeolum?

Answer 10

• Painful swelling or nodule on the eyelid
• May be internal (meibomian gland) or external (eyelash follicle)

Question 11

How is a chalazion typically treated if it persists beyond 2 months?

Answer 11

Refer to ophthalmologist for possible incision and drainage (I&D)

Question 12

What are the risk factors for subconjunctival hemorrhage?

Answer 12

• Anticoagulation therapy
• Trauma
• History of coughing or vomiting
• Hypertension
• Diabetes

Question 13

What are the recommended treatment options for a corneal abrasion in non-contact lens users?

Answer 13

Erythromycin and sulfacetamide ophthalmic ointment

Question 14

What is the initial management step for epistaxis?

Answer 14

Evaluate patient for any airway or hemodynamic compromise

Question 15

What are the indications that rhinosinusitis is bacterial?

Answer 15

• Onset with high fever
• Purulent nasal discharge for <4 weeks
• Severe nasal congestion
• Facial pain for at least 10 days
• Symptoms improve and then worsen

Question 16

What is the first-line treatment for bacterial pharyngitis caused by Group A Streptococcus?

Answer 16

Penicillin V 500mg 2 to 3 times a day for 10 days

Question 17

What is the presentation of infectious mononucleosis?

Answer 17

• Fever
• Pharyngitis
• Lymphadenopathy (generally posterior chain)
• Fatigue
• Splenomegaly can occur

Question 18

What is the most important management step in epiglottitis?

Answer 18

Get emergency airway assistance

Question 19

Fill in the blank:

Acute otitis externa is also known as ______.

Answer 19

swimmer’s ear

Question 20

What type of hearing loss is associated with the inner ear?

Answer 20

Sensorineural hearing loss

Question 21

What is the Weber test used for?

Answer 21

To determine if conductive or sensorineural hearing loss is present

Question 22

Fill in the blanks:

In the Rinne test, normal results show ______ conduction greater than ______ conduction.

Answer 22

air, bone

Question 23

What is presbycusis?

Answer 23

Progressive, symmetric hearing loss over years in the elderly

Question 24

What is the presentation of conjunctivitis?

Answer 24

• Pruritic, red eyes
• Discharge

Question 25

What is a **subconjunctival hemorrhage**?

Answer 25

Bright red blood, sharply demarcated area of the eyeball, surrounded by normal conjunctiva

Question 26

What is the treatment for a **hordeolum**?

Answer 26

* Warm/moist compress for 5-10 mins BID to QID * Discontinue eye makeup during recovery

Question 27

What is the **difference** between a hordeolum and a chalazion?

Answer 27

A hordeolum is painful and may be internal or external, while a chalazion is painless and caused by obstruction of a sebaceous gland.

Question 28

What is the treatment for **blepharitis**?

Answer 28

* Warm compresses to lid for 5-10 mins, 2 to 4 times a day * Lid massage * Artificial tears * Bacitracin or erythromycin ophthalmic ointment, up to 4x a day, up to 1 month

Question 29

What is the diagnostic method for **corneal abrasion**?

Answer 29

Using fluorescein dye stain after topical anesthetic

Question 30

What are the treatment options for a **corneal abrasion in contact lens users**?

Answer 30

Fluoroquinolone eye drops or gentamicin ophthalmic ointment

Question 31

What is a **pterygium**?

Answer 31

Yellow, triangular thickening of the conjunctiva that extends across the cornea surface on the nasal side

Question 32

What is the presentation of **arcus senilis**?

Answer 32

Gray or white visible arc, above and below the outer part of the cornea, may become a complete ring

Question 33

What are the risk factors for **acute angle-closure glaucoma**?

Answer 33

* Family history * Age >60 years * Female gender * Hyperopia * Certain medications such as some anticholinergic agents, some antihistamines, some diuretics

Question 34

What is the leading cause of **vision loss** in individuals **over 50 years** of age?

Answer 34

Age-related macular degeneration | (AMD)

Question 35

What is the treatment for **rhinosinusitis with bacterial presentation**?

Answer 35

Amoxicillin or amoxicillin-clavulanate

Question 36

What is **epistaxis**?

Answer 36

Nosebleed

Question 37

What is the **most common type** of nosebleed?

Answer 37

Anterior nosebleed ## Footnote Anterior nosebleeds occur in the Kiesselbach's plexus and are generally more common and non-concerning.

Question 38

What are the treatment options, besides tamponade, for an **anterior nosebleed** if it can be visualized?

Answer 38

Cautery and nasal packing if cautery is unsuccessful ## Footnote Never cauterize both nares to avoid septal necrosis.

Question 39

What should be done if **nasal packing is unsuccessful** in stopping a nosebleed?

Answer 39

Suggests a posterior bleed and should be referred to the ER for management ## Footnote Brisk bleeding despite proper packing techniques indicates a posterior nosebleed, which is more difficult to manage and can cause hemorrhage.

Question 40

# Fill in the blank: The most common bacterial cause of pharyngitis is \_\_\_\_\_\_.

Answer 40

Group A Streptococcus | (GAS) ## Footnote Bacterial pharyngitis is commonly caused by GAS, presenting with fever, sudden onset of sore throat, tonsillar exudates, and tender lymph nodes.

Question 41

What is the first-line treatment for **bacterial pharyngitis** caused by Group A Streptococcus?

Answer 41

Penicillin for 10 days ## Footnote Alternative treatments include amoxicillin, cephalexin, or azithromycin/clindamycin if there is a penicillin allergy.

Question 42

Which virus causes **infectious mononucleosis**?

Answer 42

Epstein-Barr virus ## Footnote Infectious mononucleosis mainly occurs in adolescents and young adults, presenting with fever, pharyngitis, lymphadenopathy, and fatigue.

Question 43

What is a **potential complication** of infectious mononucleosis related to the spleen?

Answer 43

Splenomegaly and rarely splenic rupture ## Footnote Patients should avoid contact sports for 3-4 weeks to reduce the risk of splenic rupture and confirm resolution with ultrasound before resuming sports.

Question 44

What is the most important management step for **epiglottitis**?

Answer 44

Managing the airway ## Footnote Epiglottitis can progress to airway obstruction, and emergency airway assistance is crucial.

Question 45

# True or False: Direct visualization should be attempted in a patient with suspected epiglottitis.

Answer 45

False ## Footnote Direct visualization should not be attempted; instead, keep the patient upright and deliver supplemental oxygen while deferring plain radiographs.