HEENT

Question 1

With sensorineural hearing loss, the Rinne test findings would be?

Answer 1

Normal: AC>BC

Question 2

With conductive hearing loss, Rinne test findings would be?

Answer 2

BC>AC

Question 3

Pt complains of acute onset severe eye pain, photophobia and blurred vision in one eye. The Fluorescein exam shows fern like lines in the corneal surface. What disorder do you suspect?

Answer 3

Herpes Keratitis

Question 4

Round corneal abrasions noted in the center are common with this type of keratitis?

Answer 4

Contact Lens-related

Question 5

Treatment for Keratits/corneal abrasion that is not Herpetic would include coverage for what organism? And which abx are recommended?

Answer 5

Pseudomonas: cirpofloxacin, ofloxacin, or Polytrim (trimethoprim-polymixinB)

Question 6

What is the treatment for Hordeolum?

Answer 6

Warm compresses 5x a day for 10 min.

Systemic Abx if infection has spread into preseptal cellulitis

Question 7

This eye condition is caused by excessive UV exposure resulting in thickening of conjunctiva extending across the cornea generally on nasal or temporal side of the eye?

Answer 7

Pterygium

Question 8

Primary open-angle glaucoma presents with pressures above -___?

Answer 8

22

Question 9

Primary open-angle glaucoma typically develops slowly and is often insidious in the early stages? T or F

Answer 9

True

Question 10

Common treatment of primary open-angle glaucoma are?

Answer 10

Timolol 0.5% (beta-blocker)

Latanoprost (Xalatan): topical prostaglandin ey

Question 11

Patient presenting with sudden onset severe unilateral eye pain, blurred or loss of vision, halos around lights, frontal headache w/ N/A is suspected to have what disorder?

Answer 11

Primary Angle-Closure Glaucoma, a medical emergency

Question 12

The limbus is what?

Answer 12

The area between the cornea and sclera

Question 13

Persons with autoimmune disorders such as RA, lupus, ankylosis spondylitis, and sarcoidosis are at risk for what eye disorder?

Answer 13

Anterior uveitis (Iritis)

Question 14

What helps to differentiate bacterial conjunctivitis from anterior uveitis (iritis)?

Answer 14

Lack of purulent drainage with anterior uveitis

Question 15

What area of the eye is responsible for central vision?

Answer 15

Macula

Question 16

Gradual (or sudden) painless loss of central vision in one or both eyes of a smoker is concerning for?

Answer 16

Macular degeneration

Question 17

The pt complaint of dry, gritty eyes who is using OTC tear solutions more that 3 times a day who is found to have dry mouth and poor dentition is suspected to have?

Answer 17

Sjorgren’s syndrome

Question 18

Patient has complaint of red, dry and itchy eyes with crusting and flaking at lash border is diagnosed with blepharitis. What is the treatment?

Answer 18

Mild diluted soap scrub (Johnson’s baby shampoo), warm compresses 2-4 times a day. Erythromycin solution 2-3 times a day may be indicated.

Question 19

Entropion is the ____ turning of the Lowe eyelid?

Answer 19

Inward

Question 20

Ectropion is the ____ of the lower eye lid?

Answer 20

Outward and downward retraction

Question 21

Atope is _____?

Answer 21

History of allergic reactions

Question 22

Pt exam reveals pale and boggy nasal turbinates, posterior pharynx with thick yellow to clear mucus, and dark under eye circles. What are these findings suggestive of?

Answer 22

Allergic rhinitis

Question 23

What is the recommended treatment for allergic rhinitis?

Answer 23

First line: elimination of allergen, nasal steroids (flucitasone). Adding nasal antihistamines (azelastine), oral decongestants (in adults) and 2nd generation antihistamines if failure to improve.

Question 24

Prolonged use of what common nasal sprays causes rhinitis medicamentosa?

Answer 24

Afrin

Question 25

Prolonged use of nasal decongestant sprays can cause what condition?

Answer 25

Rhinitis medicamentosa

Question 26

What are the risks of untreated GABHS?

Answer 26

Scarlet fever (strawberry tongue and sloughing of the skin Acute rheumatic fever (heart valve and joint involvement) PTA Post-streptococcal glomerulonephritis (abrupt onset proteinurea w/ HTN & edema)

Question 27

What are the most common pathogens in OM?

Answer 27

Strep pneumoniae H. Influenzae Morexella

Question 28

Bullous myringitis presents with and how is it treated

Answer 28

Conductive hearing loss and sx similar to OM but more painful. Bullae (blisters) on TM. Treatment: amoxicillin 500mg tie x 5-7 (up to 10) days but may move to augment or omnicef if unresponsive.

Question 29

Otitis Media w/ Effusion (serous otitis media) appears as?

Answer 29

Bulging or retracted TM w/o erythema. Fluid generally appears amber. Is common after bout of AOM.

Question 30

What is the treatment for OM w/ effusion?

Answer 30

Oral decongestants & steroid nasal spray

Question 31

What are the most common organisms in swimmer’s ear (OE)?

Answer 31

Pseudomonas (gram-) | S. Aureus (gram +)

Question 32

What is the treatment for OE?

Answer 32

Cortisporin (Polymyxin B-neomycin-hydrocortisone) ear 4 gtts 4x a day for 7d OR Cipro HC optic bid x7 days

Question 33

Teenager who presents w/ sore throat, fever, and fatigue found to have posterior cervical lymphadenopathy and exudative tonsils with history of close and intimate contact (kissing) is suspected to have what condition?

Answer 33

Infectious mononucleosis

Question 34

What is a major and frequent complication of mono?

Answer 34

Hepatosplenomegaly

Question 35

Dil-Hallpike and Epley maneuvers are helpful in diagnosing which condition?

Answer 35

Benign Postural Vertigo (BPV)

Question 36

Acoustic Neuroma presents as?

Answer 36

Chronic hearing loss and tinnitus caused CN VIII pressure by tumor Schwann tumor affecting the vestibular portion. Sx are slow and insidious. If trigeminal nerve is affected, facial numbness and pain can occur.

Question 37

How does Ménière’s disease present?

Answer 37

Triad of recurrent vertigo, tinnitus and unilateral hearing loss. May or may not experience N/V.

Question 38

What is the treatment for BPV?

Answer 38

Meclizine q4-8 hrs

Question 39

What is the treatment for Ménière’s disease

Answer 39

Referral to ENT Salt restriction Vestibular suppression meds, antiemetics

Question 40

New onset of dizziness, what differentials should be considered?

Answer 40

``` BPV Cerebellar Infarct Stroke Hypoglycemia Near syncope Arrhythmias ```

Question 41

How does BPV usually present?

Answer 41

Sudden onset dizziness, c/o room spinning w/ positional changes and N/V. Nystagmus is typically found.

Question 42

These spots are often found w/ measles?

Answer 42

Koplick spots (oral white spots w/ blue center)

Question 43

Timolol (betimol) has what type of contraindications?

Answer 43

Same as oral beta-blockers

Question 44

A white-yellowish cauliflower-like mass location superior to the TM is what condition?

Answer 44

Cholesteatoma

Question 45

Patients with cholesteotoma often present with what symptoms?

Answer 45

Hearing loss and foul smelling discharge from the ear

Question 46

In the Rinne-Webber test, what is a normal result?

Answer 46

Weber: no lateralization | Rinne; AC>BC

Question 47

In conductive hearing loss, what is found in the Rinne-Webber test?

Answer 47

BC>AC

Question 48

What are some causes of conductive hearing loss?

Answer 48

Cerumen impaction, AOM, and cholesteotoma

Question 49

With the conductive hearing loss, the Weber testing hearing is lateralized to which side first?

Answer 49

The affected side

Question 50

Weber-Rinne tests which CN?

Answer 50

CN VIII (acoustic)

Question 51

When conducting a Weber test, is sound is heard on one side before another, is that a normal finding?

Answer 51

No, that is lateralization which is abnormal. Should be heard equally

Question 52

What are a few types of sensorineural hearing loss?

Answer 52

Presbycusis and Ménière’s disease

Question 53

With sensorineural hearing loss, what is the expected finding in a RInne test?

Answer 53

AC>BC

Question 54

What test would be done to look for corneal abrasion or keratitis?

Answer 54

Fluoroscein test

Question 55

Clouding of the cornea and absence of red light reflex is suggestive of what disorder?

Answer 55

Cataract

Question 56

Patients with cataracts often complain of what issues?

Answer 56

Difficulty with night vision, halos around lights and blurred vision.

Question 57

What is the palpebral conjunctiva?

Answer 57

The mucosal lining of the eyelids

Question 58

What is the mucosal lining covering the eyeball?

Answer 58

Bulbar conjunctiva

Question 59

To be farsighted is?

Answer 59

Hyperopia (blurred near vision) with good distance vision

Question 60

To be nearsighted is?

Answer 60

Myopia- near is intact but distance is blurred

Question 61

Copper and silver wire arterioles, AV nicking and flame hemorrhages is often found with what underlying condition?

Answer 61

Hypertensive retinopathy

Question 62

Microaneurysms, cotton wool spots and flame hemorrhages is found in which condition?

Answer 62

Diabetic retinopathy

Question 63

Papilledema appears as what and is caused by?

Answer 63

Swollen optic disk w/ blurred edges. Due to increased ICP.

Question 64

A deeply cupped disk is suspicious for which condition?

Answer 64

Acute angle closure glaucoma

Question 65

Non-tender, enlarged (>1cm) and fixed nodes are suspicious for what condition?

Answer 65

Cancer (malignancy)

Question 66

The parotid duct is responsible for what and located where?

Answer 66

Major salivatory gland located dismally in the cheek superior the ear

Question 67

Sialandenitis is what?

Answer 67

Swelling to one side of the face (mumps, parotid gland)

Question 68

Painful lump under tongue is likely?

Answer 68

Sialolithiasis: a calculi or stone in a salivary duct/gland.

Question 69

What is the normal cup to disk ratio?

Answer 69

>0.5

Question 70

Mildly dull painful red eye accompanied by vision changes, constricted, none reactive and irregularly shaped pupils is what condition?

Answer 70

Uveitis

Question 71

What is the treatment for Uveitis?

Answer 71

Pupil dilation, corticosteroids, addressing underlying autoimmune cause

Question 72

A benign and painless bony protuberance on the hard palate is?

Answer 72

Torus palatines

Question 73

This condition is caused by UV exposure producing yellow triangle wedge-shaped thickening of the conjunctive that extends across the cornea to the nasal side.

Answer 73

Pterygium

Question 74

What is the treatment for Pterygium and pinguecula?

Answer 74

Artificial tears, strong UV protection and referral to optho for possible steroid eye drops

Question 75

Pinguecula appears as?

Answer 75

Smaller raised white/yellow growth on bulbar conjunctiva next to cornea

Question 76

How is corneal abrasion treated?

Answer 76

Topical abx: polytrim (trimethoprim-polymixinB), Ciprofloxacin for 3-5 days

Question 77

How does a detached retina present?

Answer 77

Sudden onset of unilateral floaters and reduction in vision w/ sense of looking through a curtain, or complete loss of vision. Sudden flashes of light (photopsia) is common. May have photophobia

Question 78

Gradual change in peripheral vision leading to tunnel vision with disc cupping and IOP of >20 are associated with?

Answer 78

Open-Angle Glaucoma

Question 79

What medications are typically used to treat glaucoma?

Answer 79

Timolol (beta-blocker) | Latanoprost- topical prostaglandin

Question 80

When would Timolol be contraindicated?

Answer 80

Persons with asthma, COPD, and heart failure

Question 81

This type of macular degeneration is most common?

Answer 81

Wet (80%)