Head And Neck

Question 1

What is the most sensitive physical findings for otitis media?

Answer 1

Immobility

Question 2

A patient comes with sx of otitis media, what is the best next step?

Answer 2

Start therapy amoxicillin and decongestant

Question 3

What is the most accurate test for otitis media?

Answer 3

Tympanoventesis

Question 4

When would you do tympanocentesis?

Answer 4

No response to antibiotics

Multiple recurrences

Question 5

Best initial therapy for otitis media?

Answer 5

Amoxicillin

Question 6

What therapy would you use for recurring or non responding otitis media?

Answer 6

Amoxicillin and clavulonate
Azithromycin or clarithromycin
Cefuroxime or loracarbef
Levofloxacin, gemifloxacin or moxifloxacin

Question 7

You have a patient that is a kid and has recurring otitis media, you know you have a choice between amoxiclav, azithro, clarithro, cefuroxime, loracarbef, levoflox, gemiflox, moxiflox. Which of those are CI?

Answer 7

Quinolones are relatively contraindicated in children so the …floxacin ones

Question 8

A 34y/o woman with facial pain, discolored nasal discharge, bad taste in mouth, fever and facial tenderness. What dx test would be the most accurate?

Answer 8

Sinus biopsy or aspirate

Question 9

When would you do a sinus biopsy or aspirate?

Answer 9

If sinusitis is recurrent,

If there is no answer to empiric tx

Question 10

A 34y/o woman with facial pain, discolored nasal discharge, bad taste in mouth, fever and facial tenderness, what is the best step in management?

Answer 10

Amoxicillin and decongestant

Question 11

Strep Pharyngitis sx

Answer 11

Pain on swallowing
enlarged lymph nodes
Exudate in pharynx
Fever
No cough and no hoarseness

Question 12

Best initial test in pharyngitis?

Answer 12

Rapid strep test finds GAS in minutes

Question 13

Pharyngitis with small vesicles or ulcers

Answer 13

Hsv or herpangina

Question 14

Pharyngitis and membranous exudates

Answer 14

Diphteria, vincent angina or ebv

Question 15

Best initial tx for pharyngitis?

Answer 15

Penicillin or amoxicillin

Question 16

If pt has pharyngitis and is allergic to penicillin?

Answer 16

Cephalexin (if only rash)

Clindamycin or macrolide if anaphylaxis

Question 17

Influenza sx

Answer 17

Arthralgia
Myalgia
Fever
Cough
Headache
Nausea, vomiting or diarrhea

Question 18

You have a patient with flu sx, what is the most appropriate next step in management?

Answer 18

Depends on onset
Within 48h: perform nasopharyngeal swab or wash that rapidly detects influenza, so treat with oseltamovir and zanamivir
After 48h: symptomatic tx : ibuprofen or other analgesic, antipyretics (acetaminophen), hydration, rest

Question 19

Oseltamivir and zanamivir treat

Answer 19

Influenza A and B

But not complications of flu such a pneumonia

Question 20

Sx of otitis media

Answer 20

Pain, rednedd, immotility, bulging, decreased light reflex, decreased hearing, fever