ENT exam

Question 1

Where is the light reflex always located?

Answer 1

Anteriorly

Question 2

What is Tympanosclerosis?

Answer 2

● Chalky white patch with irregular margins which is a deposition of hyaline material
● Often follows severe episode of otitis media
● Does not impair hearing, not clinically significant

Question 3

What is a Serous effusion?

Answer 3

● Caused by viral URI or sudden atmospheric changes
● Popping or fullness in the ear, sometimes painful
● Amber fluid behind eardrum
● Air bubbles can be seen in amber fluid

Question 4

What often causes acute otitis media?

Answer 4

Bacterial infection with:

1. S.pneumoniae
2. H. influenzae

Question 5

What is Bullous myringitis?

Answer 5

● Painful hemorrhagic vesicles in tympanic membrane
● Symptoms: earache, bloody discharge, hearing loss
● Eardrum is reddened, landmarks obscured
● Caused by mycoplasma, viral / bacterial otitis media

Question 6

Symptoms of HYPERthyroidism?

Answer 6

■ Nervousness
■ Weight loss w/ increased appetites
■ Excessive sweating and heat intolerance
■ Palpitations
■ Frequent bowel movements
■ Tremor and proximal muscle weakness

Question 7

Signs Of HYPERthyroidism?

Answer 7

■ Warm, smooth, moist skin
■ For Graves’, eye signs such as stare, lid lag, and exophthalmos
■ Increased Pulse pressure
■ Tachycardia or A-fib
■ Hyperdynamic cardiac pulsations with accentuated S1 tremor and proximal muscle weakness

Question 8

Symptoms of HYPOthyroidism?

Answer 8

■ Fatigue
■ Modest weight gain with anorexia
■ Cold intolerance and Dry coarse skin 
■ Swelling of face, hands, and legs
■ Constipation
■ Weakness, muscle cramps, arthralgias, paresthesias, impaired memory and hearing

Question 9

Signs Of HYPOthyroidism?

Answer 9

■ Dry, coarse skin, sometimes yellowish from carotene with nonpitting edema and loss of hair
■ Periorbital puffiness
■ Decreased Pulse pressure
■ Bradycardia / hypothermia
■ Sometimes decreased intensity of heart sounds
■ Impaired memory, hearing loss

Question 10

What is a Multinodular Goiter?

Answer 10

○ Enlarged thyroid with two or more nodules

• Probably not neoplastic, probably metabolic.
• If positive family history and continued nodular involvement, more likely malignancy

Question 11

Causes of diffuses thyroid enlargement w/o Goiter?

Answer 11

1. Graves’ disease
2. Hashimoto’s thyroiditis
3. Endemic goiter
   * **No nodules noted

Question 12

What are Thyroglossal duct cysts?

Answer 12

• Located at midline of the neck, just above the thyroid cartilage
• Described as small, firm, mobile masses which move upward with tongue protrusion or swallowing

Question 13

What are Branchial cleft cysts?

Answer 13

• Small dimples or openings anterior to the midportion of the sternocleidomastoid muscle
• May be associated with a sinus tract