ENT Disorders

Question 1

A patient with a recurrent history of ear infections presents with ear pain and drainage. Upon examination, you find a ruptured tympanic membrane with a cheesy white substance inside. What is the most likely diagnosis?

Answer 1

Cholesteatoma

Question 2

You diagnose a patient with a sensorineural hearing loss related to aging. What is the most appropriate way to describe this in the chart?

Answer 2

Presbycusis

Question 3

A patient was involved in a side-impact motor vehicle collision two days ago. He presents today with swelling to the superior half of his left ear. Exam is otherwise unremarkable. What is the most likely diagnosis?

Answer 3

Auricular hematoma (hematoma of external ear)

Question 4

What is the immediate treatment for auricular hematoma?

Answer 4

Incision and drainage

Question 5

A patient presents with a feeling of “fullness” in her ear that she cannot seem to clear. On examination, you note that the TM seems to have been sucked down around clearly visible inner ear structures. There is a saran wrap type appearance to the TM. What is the most likely cause of the patient’s symptoms?

Answer 5

Eustachian tube dysfunction

Question 6

Before the previous patient could be treated, she developed a sinus infection. She presented this time with ear pain. On examination, you note that inner ear structures are no longer visible, and there appears to be fluid accumulated beneath the TM. What is the most likely diagnosis?

Answer 6

Acute Serous Otitis Media

Question 7

A patient presents with recurrent episodes of dizziness that seem to occur upon getting out of bed most mornings. The episodes last 15-30 seconds, and there is no associated tinnitus or hearing loss. Ear examination is normal, as is the audiogram. What is the most likely diagnosis?

Answer 7

Benign Paroxysmal Positional Vertigo

Question 8

You are treating a patient with hearing loss related to repeated exposure to loud noises. He also complains of “ringing in the ears”. How would you describe this symptom in a verbal report?

Answer 8

Tinnitus

Question 9

You diagnosed a 3 year old patient with acute otitis media last week and prescribed an antibiotic. Her caregiver did not have it filled, however. The child presents today with a high fever and lethargy. The left ear is turned forward. What is the most likely diagnosis?

Answer 9

Acute Mastoiditis

Question 10

A patient presents with vertiginous symptoms associated with unilateral headache, photophobia, nausea, and vomiting. She describes a history of severe motion sickness, but no hearing loss. What is the most likely diagnosis?

Answer 10

Migrainous vertigo

Question 11

A patient suffered an acute attack of vertigo that lasted several days. Even after the vertigo resolved, the patient’s balance has been abnormal and he suffers from high-frequency hearing loss. What is the most likely diagnosis?

Answer 11

Labyrinthitis

Question 12

A patient presents with hearing loss. Upon examination, you are unable to visualize the TM because of earwax accumulation. What is the most likely diagnosis?

Answer 12

Cerumen Impaction

Question 13

Under which circumstances is removal of cerumen indicated?

Answer 13

The patient is symptomatic

The cerumen interferes with examination

Question 14

A toddler presents with unilateral ear pain and drainage. Upon examination, you find a plastic bead lodged in the ear canal. It looks as if removal will be difficult, and the toddler is not cooperative. What is the best course of action?

Answer 14

Refer to ENT for removal, probably under sedation.

Question 15

This structure’s more horizontal orientation in children relative to adults helps to explain the higher incidence of otitis media in the pediatric population.

Answer 15

Eustachian tube

Question 16

A 5 year-old patient presents with fussiness and fever. Her parents report that she has been tugging on her left ear. On examination, you find a bulging, reddened TM with increased vascularity. The light reflex is absent and no internal structures are visible. What is the most likely diagnosis?

Answer 16

Acute otitis media

Question 17

The previous patient’s parents report that this is his fifth ear infection this year. What ENT procedure might you recommend?

Answer 17

Placement of pressure equalization tubes

Question 18

A patient presents with recurrent attacks of vertigo, often lasting for hours at a time, as well as aural fullness and roaring tinnitus. The audiogram shows a low-frequency hearing loss. What is the most likely diagnosis?

Answer 18

Meniere’s Disease

Question 19

A patient presents with severe ear pain. On examination, you find what appears to be a blister over the tympanic membrane. What is the most likely diagnosis?

Answer 19

Bullous myringitis

Question 20

You have diagnosed a patient with Meniere’s Disease. Name three initial interventions that you might recommend.

Answer 20

Sodium restriction
Diuretics
Steroids

Question 21

A 10 year-old child presents with ear pain and discharge. He recently returned home from summer camp where he swam in a lake daily. On exam, you find the ear canal to be erythematous and inflamed. What is the most likely diagnosis?

Answer 21

Otitis Externa

Question 22

A patient presents with ear pain, dizziness, and hearing loss. He recently returned from a SCUBA diving trip. On examination, you find the TM to be bulging outward, but not inflamed or erythematous. What is the most likely diagnosis?

Answer 22

Barotrauma

Question 23

A patient presents with right ear pain, tinnitus, and dizziness. Upon examination, you note a vesicular rash on, in and around the right ear. The patient reports that the rash is very painful, and you also notice some right facial paralysis. What is the most likely diagnosis?

Answer 23

Ramsay-Hunt syndrome

Question 24

What is the etiology of Ramsay-Hunt syndrome?

Answer 24

Herpes zoster infection

Question 25

A patient presents with a gradual unilateral hearing loss, tinnitus, and balance problems that has developed over a period of many years. You order an MRI, looking for what disorder?

Answer 25

Acoustic neuroma

Question 26

You are treating a patient for chronic serous otitis media that always presents in the left ear. It would be prudent to evaluate this patient for what associated disorder?

Answer 26

Nasopharyngeal carcinoma

Question 27

Your patient has been using oxymetazoline nasal spray for the past two weeks to treat congestion. You advise him to discontinue use in order to avoid which complication?

Answer 27

Rhinitis medicamentosa

Question 28

A pediatric patient presents with nosebleed secondary to digital trauma. What part of the nose (anterior/posterior, septal/lateral) do you suspect the bleeding to be coming from, and what term would you use to describe his condition in the chart?

Answer 28

Anterior septal, epistaxis

Question 29

A pediatric patient presents with a foul-smelling discharge from the left nostril. Your first suspicion is what diagnosis?

Answer 29

Foreign body

Question 30

A 60 year-old male patient presents with nasal congestion. He denies eye itching or discharge, and has never had seasonal allergies. Oddly, his symptoms seem to be associated with meals and sex. What is the most likely diagnosis?

Answer 30

Vasomotor rhinitis

Question 31

A patient presents with itchy, watering eyes, nasal congestion, and rhinorrhea. He denies fever. The patient tells you that he has similar symptoms every year around the same time. What is the most likely diagnosis?

Answer 31

Allergic rhinitis

Question 32

You are examining a patient with a history of cystic fibrosis who presents with recurrent sinus infections, nasal obstruction, and anosmia. What abnormality might you inspect for inside the nose?

Answer 32

Nasal polyp

Question 33

On which anatomical structure are most nasal polyps found?

Answer 33

Middle turbinate

Question 34

A patient presents with nasal congestion, facial pain, and purulent nasal discharge. She also complains of headache. The symptoms began ten days ago and seem to have gotten worse over the past three days. What is the most likely diagnosis?

Answer 34

Acute bacterial rhinosinusitis

Question 35

Sinusitis is considered chronic if symptoms persists for more than ______ weeks or if radiographic evidence of sinusitis is apparent after ______ weeks of treatment.

Answer 35

12, 4

Question 36

Mucus color is a ______ (good/poor) indicator of etiology in sinus infections.

Answer 36

Poor

Question 37

Most upper respiratory infections are caused by ______ and ______ require antibiotic treatment.

Answer 37

viruses, don’t

Question 38

Name a risk factor for nasal septum perforation.

Answer 38

Drug use, trauma, Wegener’s granulomatosis