EENT

Question 1

The orbit is made up of what 5 bones?

Answer 1

1. Sphenoid

2. Zygoma

3. Frontal

4. Maxillary

5. Ethmoid

Question 2

What is the most common cause of blindness in the world?

Answer 2

Cataracts - characterized by opacity of the lens.

Question 3

Three most common bacteria isolated in conjunctivits?

Answer 3

1. Staph aureus

2. Streptococcus Pneumonia

3. Haemophilus Influenza

Question 4

What is the most common cause of a non-traumatic corneal ulcer?

Answer 4

A viral etiology is the most common cause. Specifically, HSV is the most common etiology overall.

Question 5

What organism must we suspect if a contact lens wearer has a corneal ulcer?

Answer 5

Pseudomonas should always be assumed with these patients. Fluoroquinolones should be given as first line treatment.

Question 6

A 30 year old patient is coming in for the evaluation of a corneal ulcer. Fluorescein staining shows dendrites. What is the most likely etiology?

Answer 6

Dendrites = HSV infection. These patients are treated with topical acyclovir.

Question 7

A 40 year old male is complaining of massive headache. Upon further questioning he reveals that he sees what looks like halos around lights. A fixed pupil is noted on exam. What is the most likely diagnosis?

Answer 7

This is classic for closed angle glaucoma. Glaucoma is one of the most common reasons a patient will complain of halos. Decongestants and anticholinergics can precipitate an at- tack.

Question 8

What is the first line treatment for hordeolum?

Answer 8

Warm compress! NOT antibiotics.

Question 9

Why is hyphema so dangerous?

Answer 9

This is an emergency which can lead to blindness. Always evaluate for a ruptured globe and for a retained foreign body.

Question 10

A 65 year old female patient is coming in for central vision loss. The patient reports areas of darkness. What is the most likely diagnosis?

Answer 10

Central vision loss should make you think macular degeneration. These patients are usually 65 years and older.

Question 11

How would you differentiate orbital cellulitis from preorbital cellulitis?

Answer 11

Both present with pain, swelling, and erythema. Orbital cellulitis will also present with paralysis of the extraocular muscles, proptosis, and/or increased pain with eye movement.

Question 12

50 year old diabetic male came in to the office complaining of painless vision loss. He says it felt as if a curtain was pulled down over his eye. What is the most likely diagnosis?

Answer 12

This is classic for retinal detachment. Diabetics are at increased risk for this.

Question 13

What is the most common bacterial etiology in otitis media?

Answer 13

1. Streptococcus Pneumonia

2. Moraxella Catarrhalis

3. Haemophilus Influenzae

Question 14

What is the treatment of choice for otitis media?

Answer 14

If the patient is > 6months of age and immunocompetent, they can be observed. If no improvement after 72 hours or if symptoms are worsening, start antibiotics. First line antibiot- ics will be amoxicillin. Give amoxicillin/clavulanic if they have been given a beta lactam in the last 30 days.

Question 15

What cranial nerve does an acoustic neuroma affect?

Answer 15

This will affect the 8th cranial nerve.

Question 16

What type of hearing loss will occur from presbycusis?

Answer 16

This will be a sensorineural hearing loss. This is an age related high frequency hearing loss. Symptoms are worsened when in a crowded or noisy environment.

Question 17

A 26 year old female patient came in complaining of dizziness. The patient has episodes of dizziness that lasts 5 minutes and self resolve; it has been ongoing
for the past 2 months. The patient also reports tinnitus and hearing loss. What is the treatment of choice?

Answer 17

The diagnosis is Menieres disease. These episodes of vertigo come in clusters for a couple months and then self resolve. Another clue to diagnosis is hearing loss. Vestibular neuritis and BPPV will not have hearing loss. Treat these patients with salt restriction and diuretics.

Question 18

What is the most common etiology of otitis externa?

Answer 18

1. Pseudomonas
2. Staph aureus

3. Staph epidermis

Question 19

Who is at risk for developing malignant otitis externa?

Answer 19

Diabetics and those who are immunocompromised are at increased risk. This occurs when infection spreads to the bone. Their pain will be out of proportion to your exam findings.

Question 20

What is the time frame needed for the diagnosis of acute sinusitis?

Answer 20

Acute sinusitis occurs when symptoms have been present 12 weeks.

Question 21

What signs, when present, indicate a bacterial etiology for acute sinusitis?

Answer 21

1. Purulent nasal discharge

2. Unilateral tooth pain

3. Fever >102

4. Double worsening

Question 22

Where do most nosebleeds originate from?

Answer 22

Most will come from the Keisselbach’s plexus.

Question 23

15 year old patient is complaining of sore throat, fever, and cough. On exam, you notice posterior pharynx exudate. No lymphadenopathy noted. What is the treatment of choice for this patient?

Answer 23

The centor criteria gives this patient a score of 2 for the exudate and fever. These patients should have a throat culture done. If positive for group A strep, treat with penicillin.

Question 24

A 40 year old patient is presenting with a white patch in the oropharynx. You are unable to scrape this off. What is the next step in management?

Answer 24

This is oral leukoplakia. These are considered to be pre cancerous and should be biopsied.