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ENT Exam Questions Flashcards

1
Q

A 15 yo patient presents to the clinic after noticing white lesions over the posterior pharynx. He has been dealing with GAS pharyngitis. Which of the following is most likely the diagnoses?

a. retropharyngeal abscess
b. Post-strep glomerulonephritis
c. Diphteria
d. peritonsillar abscess

A

c. Diphteria

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2
Q

A 50 yo man presents to the ED complaining of dizziness. After further questions you realize he is describing disequilibrium. He notes his right ear hearing has progressively worsened and complains of tinnitus. What is the most likely diagnoses?

a. BPPV
b. Acoustic Neuroma
c. Meniere’s Disease
d. Labyrinthitis

A

b. Acoustic Neuroma

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3
Q

A 55 year old female presents to the UC complaining of intense itching and pain over the left ear. On physical exam you also notice discharge. She is diagnosed with otomycosis. What is the treatment?

A. IV antibiotics
B. Ciprofloxacin
C. Clotrimazole
D. Azithromycin

A

C. Clotrimazole

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4
Q

A 24 year old patient presents to his primary care office for new evaluation of right ear hearing loss. He denies any fever, chills, or night sweats. He complains of a ‘whistling’ sound when sneezing or blowing his notice. He recalls he felt a sharp pain while using a Q-tip a few days ago but the pain has since disappeared. What is most likely the diagnoses?

A

Perforated Tympanic Membrane

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5
Q

A 4 yo boy is brought to the ER by his parents after sticking a jelly bean in his ear. You explain to his parents there is only 3 indications for removal of a foreign body. What are they?

A
  • Penetrating
  • Insects
  • Batteries
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6
Q

A 4 yo patient presents to the UC with his parents with right ear pain. He has a low grade fever and hearing loss. On physical exam, his tympanic membrane appears bulged and has lost mobility. You diagnose him with AOM. You recommend watchful waiting and discuss the possible complications with his parents. Which of the following is NOT a complication of AOM?

A. TM rupture
B. COM
C. Mastoiditis
D. All of the above are complications of AOM

A

D. All of the above are complications of AOM

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7
Q

A 4 yo patient presents to the UC with his parents with right ear pain. He has a low grade fever and hearing loss. On physical exam, his tympanic membrane appears bulged and has lost mobility. You diagnose him with AOM and recommended watchful waiting. However, his parents want antibiotics. Which of the following is indicated for his population?

A. Amoxicillin
B. Augmentin
C. Doxycycline
D. Azithromycin

A

A. Amoxicillin

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8
Q

A 15 yo patient presents to ED complaining of unilateral right sided facial pain. On PE you notice the swelling is localized over the parotid gland. Buccal swab comes back positive for a bacteria. Which one is most likely?

a. strep P
b. H-Flu
c. M-cat
d. Staph A

A

d. Staph A

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9
Q

A 12 yo patient is brought to the UC by his parents for evaluation of his right ear pain. He complains of pain and itching of his right ear. When obtaining the history he reveals he began feeling the ear pain after a day at the water park. On physical exam, he has pain with tragus pressure and auricle manipulation. What is the treatment if this was a mild, moderate or severe case of otitis externa?

A
  • Mild = topical steroid + acetic acid
  • Moderate = topical steroid + topical cipro
  • Severe = topical + oral cipro
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10
Q

A 6 yo patient presents with vesicular lesions widespread in the oropharynx, hands, feet, and buttocks. What bug is most likely the culprit?

a. Strep P
b. Pseudomonas
c. Coxsackie virus
d. Epstein-Barr virus

A

c. Coxsackie virus

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11
Q

A 6 yo patient presents to your clinic for a regular physical exam. He has a PMHx of recurrent ear infections and has had a tympanostomy tube implanted in the past. When performing the otoscopy exam you notice a calcification of the tympanic membrane. What is his diagnosis?

A. Bullous Myringitis
B. OME
C. Tympanosclerosis
D. Cholesteatoma

A

C. Tympanosclerosis

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12
Q

A patient presents with painful oral ulcerations inside the mouth which expand, become painless, and then disappear. What is the most likely diagnosis?

a. Aphthous ulcers
b. Herpes simplex virus
c. Oral candidiasis
d. Leukoplakia
e. Sialadenitis

A

a. Aphthous ulcers

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13
Q

A 24 year old patient with PMHx of Down Syndrome presents to his primary care office for a routine physical exam. He denies any complaints today. While performing the ear exam you notice a white mass behind an intact tympanic membrane. What should you do next?

A. Tell the patient come back when it hurts
B. Prescribe him antibiotics
C. Refer him to an ENT for surgical excision
D. Don’t mention it at all

A

C. Refer him to an ENT for surgical excision

*Cholesteatoma

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14
Q

A 5-year-old male presents with drooling, high fever, and tripoding. What is the most likely diagnosis?

a. Pharyngitis
b. Croup
c. Epligottitis
d. Mononucleosis

A

c. Epligottitis

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15
Q

A 26 yo presents to the clinic complaining of hematuria. He has been dealing with a bacterial pharyngitis the past few days. Which is the most likely diagnoses?

a. Scarlet fever
b. Post-strep glomerulonephritis
c. Acute rheumatic fever
d. peritonsillar abscess

A

b. Post-strep glomerulonephritis

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16
Q

What is the most common etiology of rhinosinusitis?

A

rhinovirus

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17
Q

What does the CENTOR criteria consist of?

A

+ 1 point for each

  • Absence of cough
  • Tonsillar exudates
  • Tendor anterior cervical lymph nodes
  • Fever
  • Age 3-14 (-1 age >5)
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18
Q

A 26 yo patient presents the UC with a vesicular lesion about the vermillion border. You tell him this appears to be a reactivation of the HSV. He asks for labs to prove your suspicion. What is the best option?

a. Tzanck smear
b. Antibody testing
c. Rapid antigen test
d. PCR

A

d. PCR

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19
Q

A 20 yo patient presents to the UC complaining of nasal congestion. On PE, you notice he has nasal polyps. What is the best treatment for this?

a. humidifiers
b. zinc
c. glucocorticoid nasal spray
d. rest and hydrate

A

c. glucocorticoid nasal spray

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20
Q

A patient presents to the ED with a copious purulence of the tongue. He is diagnosed with gonorrhea. What is the treatment for this?

A
  • Ceftriaxone

- Treat for chlamydia with azithromycin

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21
Q

A 65 year old patient presents to the ER complaining of left ear pain. She has a PMHx of diabetes and HTN. On physical exam you notice granulation tissue over the external auditory canal. What is the most likely diagnoses?

A. AOM
B. Otomycosis
C. Malignant Otitis Externa
D. Hemotympanum

A

C. Malignant Otitis Externa

*Pseudomonas is the bug. Treat with IV antibiotics

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22
Q

A 35 yo woman presents to the ER complaining of dizziness. She denies any hearing loss. On PE, she has horizontal nystagmus and a + Dix-Hallpike. This is consistent with BPPV. When discussing the treatment options which of the following is the ONLY definitive treatment?

A. Meclizine
B. Zofran
C. Dix-Hallpike
D. Epley Maneuver

A

D. Epley Maneuver

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23
Q

A 26 yo patient presents to the UC complaining of severe sore throat. He has a fever and swollen glands but no cough. Rapid antigen test is positive for GAS. Which of the following is the best treatment?

a. Amoxicillin
b. Azithromycin
c. Penicillin
d. Rest and hydrate

A

c. Penicillin

* Pharyngitis

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24
Q

A 4 yo patient presents to the UC with his parents with right ear pain. He has a low grade fever and hearing loss. On physical exam, his tympanic membrane appears bulged and has lost mobility. What is most likely his diagnoses?

A. AOM
B. COM
C. OME
D. Bullous Myringitis

A

A. AOM

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25
Q

A 66 yo patient presents to the ED complaining of persistent vertigo. On physical exam you notice vertical nystagmus. Which of the following most likely is NOT the diagnosis?

a. stroke
b. dissection
c. Acoustic neuroma
d. BPPV

A

d. BPPV

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26
Q

A 24 year old patient presents to his primary care office for new evaluation of right ear hearing loss. He denies any fever, chills, or night sweats. He complains of a ‘whistling’ sound when sneezing or blowing his noise. He recalls he felt a sharp pain while using a Q-tip a few days ago but the pain has since disappeared. In what situation would it be appropriate to prescribe him antibiotics?

A

If his perforated tympanic membrane was secondary to AOM

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27
Q

A 45 year old patient presents to his primary care office complaining of hearing loss. He denies any pain but does have a sense of fullness and itching of his right ear. On physical exam, he has a + Weber test lateralizing to his right ear and a + Rinne test. What is his diagnosis?

A. Presbycusis
B. AOM
C. Cerumen impaction
D. Bullous Myringitis

A

C. Cerumen impaction

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28
Q

A 4 yo presents to the UC complaining of a sore throat. He has been having a low grade fever and complains of neck pain. Which of the following is most likely the diagnoses?

a. retropharyngeal abscess
b. Post-strep glomerulonephritis
c. Acute rheumatic fever
d. peritonsillar abscess

A

a. retropharyngeal abscess

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29
Q

A 26 yo woman presents to the UC complaining of hoarseness that has persisted for over a month. What should you do next?

a. prescribe antibiotics
b. get labs
c. refer to ENT
d. do nothing

A

c. refer to ENT

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30
Q

A 16 yo patient presents to the UC complaining of severe sore throat. He has a fever and swollen glands but no cough. Which of the following is the most likely culprit?

a. adenovirus
b. rhinovirus
c. Staph A
d. Strep Pyogenes

A

d. Strep Pyogenes

  • Group A strep (GAS)
  • Bacterial pharyngitis
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31
Q

A 22 yo male with a PMHx of HIV presents to the ED complaining of a cottony feeling and loss of taste. What is the most likely diagnoses?

a. Aphthous ulcers
b. Herpes simplex virus
c. Oral candidiasis
d. Leukoplakia
e. Sialadenitis

A

c. Oral candidiasis

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32
Q

A 55 yo patient presents to the ED complaining of a ‘woody’ induration in the submandibular space. Which of the following is most likely the diagnosis?

a. Epligottitis
b. Ludwig’s Angina
c. Refractory Pharyngitis
d. Mononucleosis

A

b. Ludwig’s Angina

33
Q

A 16 yo patient presents to the clinic complaining of a severe sore throat. His temperature has rapidly increased since the onset of symptoms. XR has a positive thumb sign. What should you do first.

a. examine the throat
b. stabilize the airway
c. start broad spectrum IV antibiotics = vancomycin
d. get a second xray

A

b. stabilize the airway

34
Q

A 6 yo patient presents to your clinic for evaluation of recurrent ear infections. Your are discussing with his parents the next treatment options. In which 2 circumstances would he be a good candidate for a tympanostomy tube?

A
  • > 3 episodes of AOM in 6 months

- >4 episodes of AOM in 12 months

35
Q

If a patient presents with a nasal trauma what should you always evaluate for and why?

A

septal hematoma; if left untreated could result in a saddle nose deformity

36
Q

A 24 year old patient presents to his primary care office complaining of left ear hearing loss and fullness. On physical exam you notice fluid behind a retracted tympanic membrane. You diagnose him with OME. In which of the following circumstances would you refer him to an ENT for a possible tympanostomy tube?

A. Unilateral OME lasting <6 months
B. Bilateral OME lasting <3 months
C. Bilateral OME lasting >3 months
D. >3 episodes of OME in last 12 months

A

C. Bilateral OME lasting >3 months

37
Q

What criteria is used to diagnose acute rheumatic fever?

A

-Jones criteria

38
Q

90% of epistaxis are a result of anterior bleeds. What is the term for this?

A

Klesselbach’s plexus

39
Q

A 66 yo woman presents to the ER complaining of dizziness. When describes it as a “spinning” sensation. Which of the following is she describing?

A. Vertigo
B. Prescyncope
C. Disequilibrium
D. Other

A

A. Vertigo

40
Q

What is the treatment for epistaxis? (4 steps)

A
  • blow nose
  • oxymetazoline
  • elevate head, lean forward
  • manual pressure 10-15min
41
Q

A 24 yo male presents to the UC with a mass over his left ear. He noticed the mass after a recreational wrestling match with his brother in their backyard. You diagnose him with an auricular hematoma and as indicated drain immediately. What 3 things should be on his aftercare instructions?

A
  • Maintain compression (via compression dressing)
  • Antibiotics covering pseudomonas
  • Can RTP in 7 days
42
Q

A 65 year old patient presents to his primary care office complaining of hearing loss. He denies any pain. On physical exam he has a + whisper test bilaterally and a - Weber test. Which of the following is most likely his diagnoses?

A. Cerumen impaction
B. Presbycusis
C. AOM
D. Tympanosclerosis

A

B. Presbycusis

43
Q

A 1yo patient is brought to the ER by his parents for ear pain. The patient is ill appearing and has a temperature of 100.4F. On physical exam you notice a displaced auricle and erythema over the mastoid. Which of the following bacteria is most likely the culprit?

A. Strep Pyo
B. Strep Pneumonia
C. Staph A
D. Pseudomonas

A

B. Strep Pneumonia

44
Q

A 4 yo patient presents to the UC with his parents with right ear pain. He has a low grade fever and hearing loss. On physical exam, his tympanic membrane appears bulged and has lost mobility. You diagnose him with AOM. Which bacterial infection most likely caused this?

A. Strep P
B. H-Flu
C. M-Cat
D. Pseudomonas

A

A. Strep P

45
Q

A 16 yo patient presents to the UC complaining of nasal congestion and rhinorrhea. On physical exam you notice his nasal turbinates are edematous and a bluish color. You also notice an infraorbital edema. What is finding called?

a. allergic shiners
b. allergic facies
c. dennis-morgan lines
d. allergic salute

A

a. allergic shiners

46
Q

A 40 year old male presents to the ER complaining of a painful left ear rash. On physical exam, you notice the rash is vesicular in nature and a left facial droop. What cranial nerves are most likely involved?

A. CN 3 and 6
B. CN 7 and 10
C. CN 7 and 8
D. CN 7 and 5

A

C. CN 7 and 8

*Herpes Zoster Oticus (Ramsay Hunt Syndrome)

47
Q

A 35 yo woman presents to the ER complaining of dizziness. She denies any hearing loss. On PE, you do not find any e/o of neurological symptoms but she does have horizontal nystagmus. What special test should be performed next?

A

Dix-Hallpike

*BPPV

48
Q

You are discussing the treatment options for Meniere’s Disease with your patient. Which of the following should be tried first?

a. labyrinthectomy
b. vestibular neurectomy
c. intratympanic injection or aminoglycosides
d. none of the above

A

c. intratympanic injection or aminoglycosides

49
Q

A 55 yo patient presents to the ED complaining of severe sore throat with unilateral discomfort. She has a ‘potato voice’ and on PE you notice her uvula is deviated. Which of the following should you do first?

a. IV antibiotics
b. ENT referral
c. Aspirate/Drain
d. discharge

A

c. Aspirate/Drain

50
Q

A 1yo patient is brought to the ER by his parents for ear pain. The patient is ill appearing and has a temperature of 100.4F. On physical exam you notice a displaced auricle and erythema over the mastoid. He is diagnosed with mastoiditis. What is the treatment for this?

A
  • Broad spectrum IV antibiotics 7-10 days
  • Oral antibiotics for 4 weeks
  • If treatment fails = mastoidectomy
51
Q

A 18 yo patient presents to the ER with hemotympanum. He denies any headaches, nausea or vomiting. Next step in your physical exam is to assess for a fracture. What 3 signs indicates a basilar skull fracture?

A
  • Racoon eyes
  • Battle’s Sign
  • Hemotympanum
52
Q

A 10 yo patient returns for a follow up for recurrent ear infections. He complains of hearing loss, fullness and has noticed drainage over his right ear but denies any pain. On physical exam, you noticed his tympanic membrane is perforated. You diagnose him with COM. What bacteria is the culprit?

A. Strep P
B. M-Cat
C. H-Flu
D. Pseudomonas

A

D. Pseudomonas

53
Q

A 16 yo patient presents to the clinic with the common cold. Which of the following 2 medications are recommended for treatment?

a. antibiotics
b. analgesics
c. zinc
d. vitamin B12

A

b. analgesics

c. zinc

54
Q

A 65 yo man presents to his primary care office for a new evaluation of his hearing loss. His symptoms include episodic vertigo that last > 20 minutes and a low pitched tinnitus. Rinne test was negative. Which of the following is most likely his diagnoses?

a. BPPV
b. Acoustic Neuroma
c. Meniere’s Disease
d. Labyrinthitis

A

c. Meniere’s Disease

  • clinical triad:
  • sensorineural hearing loss
  • episodic vertigo
  • low pitched tinnitus
55
Q

A 24 year old patient presents to his primary care office complaining of left ear hearing loss and fullness following a 12 hour flight home. On physical exam you notice fluid behind a retracted tympanic membrane. The TM also appears to have decreased mobility. What is diagnosis?

A. AOM
B. COM
C. OME
D. Mastoiditis

A

C. OME

56
Q

A 5 yo patient and his parents present to the UC complaining of increasing right ear pain. He was recently diagnosed with AOM and elected to not take antibiotics and just treat conservatively. On physical exam, you see a blister on the tympanic membrane. What is the most likely diagnosis and what bacteria is most likely the culprit?

A. Bullous Myringitis; pseudomonas
B. Bullous Myringitis; Mycoplasma
C. COM; pseudomonas
D. COM; Mycoplasma

A

B. Bullous Myringitis; Mycoplasma

57
Q

Which of the following is NOT an absolute indication for tonsillectomy?

a. enlarged tonsils that cause upper airway obstruction
b. peritonsillar abscess that is unresponsive to medical management
c. tonsils requiring biopsy
d. 7 or more episodes of GAS in one year

A

d. 7 or more episodes of GAS in one year

58
Q

A 2 yo presents with a low grade fever, rhinnorhea and a ‘barking seal like’ cough. What finding may you see on an xray?

a. Spine Sign
b. Silhoutte Sign
c. Thumb Sign
d. Steeple sign

A

d. Steeple sign

* Croup

59
Q

A patient presents with painful oral ulcerations inside the mouth which expand, become painless, and then disappear. What is the best prevention strategy for this condition?

a. Vitamin B12 supplementation
b. viscous lidocaine
c. dexamethasone elixir
d. eat spicy foods

A

a. Vitamin B12 supplementation

60
Q

A 55 yo male presents to his primary care office for a regular check up. He is a past smoker. On physical exam you noticed bright white patches on his tongue which does not scrape off. What is the most likely diagnoses?

a. Aphthous ulcers
b. Herpes simplex virus
c. Oral candidiasis
d. Leukoplakia
e. Sialadenitis

A

d. Leukoplakia

61
Q

What are 3 indications for antibiotics in a patient who has acute rhinosinusitis?

A
  • patients who improve but then worsen
  • persistent symptoms for 7-10 days
  • severe symptoms early in course
62
Q

A 26 yo patient presents to the ED complaining of severe congestion. He has an unremarkable PMHx and denies any trauma. He also notes he hears whistling when breathing in. Otherwise, denies any fever or cough. What is the MOST likely etiology?

a. infection
b. auto-immune
c. trauma
d. cocaine

A

d. cocaine

* septal perforation

63
Q

A 12 yo patient is brought to the UC by his parents for evaluation of his right ear pain. He complains of pain and itching of his right ear. When obtaining the history he reveals he began feeling the ear pain after a day at the water park. On physical exam, he has pain with tragus pressure and auricle manipulation. What bacteria is most likely the culprit?

A. Strep Pnuemo
B. Strep Pyo
C. Pseudomonas
D. Anaerobes

A

C. Pseudomonas

*Otitis Externa

64
Q

A 10 yo patient returns for a follow up for recurrent ear infections. He complains of hearing loss, fullness and has noticed drainage over his right ear but denies any pain. On physical exam, you noticed his tympanic membrane is perforated. You diagnose him with COM. What is the treatment for this?

A
  • Aural toilet

- Topical antibiotics 2-4 weeks = levofloxacin

65
Q

A 10 yo patient returns for a follow up for recurrent ear infections. He complains of hearing loss, fullness and has noticed drainage over his right ear but denies any pain. On physical exam, you noticed his tympanic membrane is perforated. What is his diagnosis?

A. AOM
B. OME
C. COM
D. Tympanosclerosis

A

C. COM

66
Q

A 16 yo patient presents to the clinic with the common cold. What is the most likely etiology?

a. coronavirus
b. Epstein-Barr virus
c. rhinovirus
d. strep P

A

c. rhinovirus

67
Q

A 16 yo female singer presents to the UC complaining of aphonia. ENT exam is normal. Denies any fever, fatigue, or weight loss. What is the most likely diagnoses?

a. Aphthous ulcers
b. sialadenitis
c. Oral candidiasis
d. pharyngitis
e. laryngitis

A

e. laryngitis

68
Q

A 24 year old patient presents to his primary care office complaining of left ear hearing loss and fullness following a 12 hour flight home. On physical exam you notice fluid behind a retracted tympanic membrane. You diagnose him with OME. Which of the following is NOT a treatment option?

A. Intra-nasal steroids
B. Antihistamines
C. Decongestants
D. Antibiotics

A

D. Antibiotics

69
Q

A 12 yo patient presents to the clinic complaining of a ‘sandpaper’ like rash and he has noticed his tongue is bright red. He has been dealing with a bacterial pharyngitis for the past few days. Which is the most likely diagnoses?

a. Scarlet fever
b. Post-strep glomerulonephritis
c. Acute rheumatic fever
d. peritonsillar abscess

A

a. Scarlet fever

70
Q

A 15 yo patient presents to ED complaining of unilateral right sided facial pain. On PE you notice the swelling is localized over the parotid gland. What is this a clear sign of?

A

Mumps

71
Q

A 66 yo woman presents to the ER complaining of a ringing noise in her ear. On PE, you discover the ringing noise goes along with her heartbeat. What is this an indication of?

A

Pulsatile tinnitus

72
Q

A 15 yo patient presents to ED complaining of unilateral right sided facial pain. On PE you notice the swelling is localized over the submandibular gland. What is the diagnosis?

a. sialadenitis
b. sialolithiasis
c. oral HSV
d. laryngitits

A

b. sialolithiasis

73
Q

A 35 yo patient presents to the ED complaining of hearing loss. She also has vertigo, nausea, vomiting and has noticed her gait is unstable. Which of the following is most likely the diagnosis?

a. Labyrinthitis
b. vestibular neuritis
c. acoustic neuroma
d. BPPV

A

a. Labyrinthitis

74
Q

If a patient presents with facial pain or pressure with percussion over the sinuses this is most likely indicative of what?

A

acute rhino sinusitis

75
Q

A 16 yo patient presents to the clinic complaining of a severe sore throat. His temperature has rapidly increased since the onset of symptoms. You suspect epligottitis and obtain an XR. What sign should you see?

a. Spine Sign
b. Silhoutte Sign
c. Thumb Sign
d. Steeple sign

A

c. Thumb Sign

76
Q

A 26 yo woman presents to the clinic complaining of nasal congestion and facial pain over the sinuses. What is the best treatment option?

a. analgesia
b. saline irrigation with sterile water
c. topical decongestant + intranasal glucocorticoid
d. antibiotics

A

c. topical decongestant + intranasal glucocorticoid

77
Q

A 5-year-old male presents with drooling, high fever, and tripoding. Which bug is the most likely culprit?

a. Strep P
b. M-Cat
c. H-Flu
d. Staph A

A

c. H-Flu

* Epiglottitis

78
Q 
A 20-year-oldmale presents to urgent care complaining of a sore throat.He denies any cough orshortness of breath. Vitals signs are: Temp 102.3, HR 104, BP 130/78, RR 20. Significant physical exam findings include tender cervical lymphadenopathy and 3+ tonsils with exudate.How many Centorcriteriadoes this patient have using the modified centor criteria?
A. 1
B. 2
C. 3
D. 4
E. 5
A

D. 4

79
Q

In a patient with epliglottitis after stabilizing the airway what antibiotics should they be started on?

A

vancomycin

*broad spectrum IV antibiotics

ENT (3 decks)

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