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UWorld > HEENT > Flashcards

HEENT Flashcards

1
Q

3 yo male presents with fever, irritable mood; PE shows purulent drainage from R ear, obscuring TM; Denies pain with manipulation of ear pinna – diagnosis?

A

Suppurative otitis media with TM perforation

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2
Q

2 alternate names for Suppurative otitis media?

A

Acute otitis media, Bacterial otitis media

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3
Q

Which bacteria is most commonly involved in TM perforation in setting of suppurative otitis media?

A

Group A Strep … (strep pyogenes)

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4
Q

Epidemiology of necrotizing otitis externa?

A

Elderly patients with DM; Immunocompromised patients

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5
Q

Bacteria most commonly responsible for necrotizing otitis externa?

A

Pseudomonas

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6
Q

Clinical presentation of serous otitis media?

A

Middle ear effusion without evidence of infection or inflammation

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7
Q

What is considered a normal oculovestibular reflex?

A

Transient, conjugate, slow deviation of gaze to side of caloric water stimulation, followed by correction to midline

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8
Q

Transient, conjugate, slow deviation of gaze to side of caloric water stimulation during oculovestibular response is mediated by …

A

Brainstem

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9
Q

Saccadic midline correction during oculovestibular response is mediated by …

A

Cortex

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10
Q

Normal oculovestibular reflex is strongly suggestive of ___ coma

A

Psychogenic

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11
Q

3 aspects of clinical presentation for heat-stroke?

A

Hyperthermia, Tachycardia, AMS

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12
Q

Best treatment for heat-stroke?

A

Initiation of rapid-cooling via evaporative heat loss

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13
Q

Child presents with a midline mass that moves superiorly with swallowing – diagnosis?

A

Thyroglossal duct cyst

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14
Q

What event might make secondary infection of thyroglossal duct cyst more likely?

A

Viral URI

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15
Q

Origin of thyroglossal duct cyst?

A

Pharyngeal epithelium … (from base of tongue on its way to forming the thyroid)

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16
Q

___ is associated with thyroglossal duct cyst |

A

Ectopic thyroid tissue

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17
Q

Definitive treatment of thyroglossal duct cyst?

A

Surgical excision … infection of thyroglossal duct cyst makes future infections more likely

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18
Q

Important step of workup before surgical excision of Thyroglossal duct cyst?

A

US/CT … to ensure that thyroglossal duct cyst does not contain functioning thyroid tissue

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19
Q

Structure that is typically removed during surgical excision of Thyroglossal duct cyst?

A

Portion of hyoid bone … Thyroglossal duct passes just posterior to hyoid bone

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20
Q

63 yo male with HX of advanced squamous cell carcinoma of oropharynx presents for neutropenia (WBC = 350); Admitted, treated with TPN; 4 days later, develops fever, R eye pain, light sensitivity; Fundoscopic exam reveals large white lesions, extending from chorioretinal surface into vitreous – diagnosis?

A

Candida endophthalmitis

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21
Q

Candida endophthalmitis most commonly occurs in setting of …

A

Neutropenia

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22
Q

What event in hospital may allow Candida to access bloodstream and disseminate to organs?

A

TPN via central venous catheter

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23
Q

Fundoscopic exam findings associated with Candida endophthalmitis?

A

Focal white lesions on the retina that extend into the vitreous

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24
Q

Best treatment for Candida endophthalmitis that extends into the vitreous?

A

Amphotericin B + vitrectomy

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25
Q

2 physical exam findings for acute mastoiditis?

A

Displacement of external ear, Mastoid tenderness

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26
Q

4 most common bacteria responsible for acute mastoiditis?

A

Strep pneumoniae, Strep pyogenes, Staph aureus, Pseudomonas

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27
Q

Acute mastoiditis is considered a complication of …

A

Acute otitis media

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28
Q

Best management of acute mastoiditis?

A

IV ABX, Middle ear drainage

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29
Q

2 methods of middle ear drainage in acute mastoiditis?

A

Tympanostomy, Mastoidectomy

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30
Q

Epidemiology of auricular hematoma?

A

Athletes who participate in contact sports

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31
Q

2 complications of auricular hematoma?

A

Abscess, Avascular necrosis of external ear cartilage

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32
Q

In setting of auricular hematoma, Avascular necrosis of external ear cartilage may lead to development of …

A

Cauliflower ear

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33
Q

Best management of auricular hematoma?

A

I&D of hematoma, Oral ABX

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34
Q

Which 2 ocular structures are most likely to be damaged in a horizontal laceration of the upper eyelid?

A

Orbital septum, Levator palpebrae muscle

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35
Q

Role of the orbital septum?

A

Separates orbital content from lid tissue

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36
Q

Sign that orbital septum might be damaged?

A

Presence of orbital fat tissue in the wound

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37
Q

Which ocular structure is most likely damaged in the setting of medial eyelid laceration?

A

Canaliculi

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38
Q

2 most common pathogens responsible for otitis externa?

A

Staph aureus, Pseudomonas

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39
Q

Best treatment for cases of mild otitis externa?

A

Topical acidifier (acetic acid)

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40
Q

Best treatment for cases of moderate otitis externa?

A

Topical ABX

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41
Q

2 ABX of choice in treatment of moderate otitis externa?

A

Ciprofloxacin, Neomycin

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42
Q

Alternate name for anterior uveitis?

A

Iritis

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43
Q

Diagnostic test for anterior uveitis (iritis)?

A

Visualization of WBCs in anterior chamber

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44
Q

How can you distinguish anterior uveitis from closed angle glaucoma – both present with pain, redness, vision loss?

A

Intraocular pressure will be elevated in closed angle glaucoma

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45
Q

Presbycusis represents a type of ___ hearing loss

A

Sensorineural

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46
Q

Which range of hearing is first affected in presbycusis?

A

High-frequency hearing

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47
Q

Which type of hearing will likely be normal in presbycusis?

A

Speech discrimination

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48
Q

What will typically draw attention to presbycusis?

A

Introducing background noise

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49
Q

Most common cause of decreased vision in elderly patients?

A

Cortical cataracts

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50
Q

Which ocular condition is associated with Cortical cataracts?

A

Age-related macular degeneration

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51
Q

Pattern of vision loss in setting of cortical cataracts?

A

Painless vision blurring

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52
Q

Pattern of vision loss in macular degeneration?

A

Loss of central vision

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53
Q

Change to fundoscopic exam in macular degeneration?

A

Drusen spots

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54
Q

Initial workup for patient with concussion?

A

Head CT, 24-hour close monitoring

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55
Q

Appropriate return-to-play for patients who present with concussion?

A

Rest for at least 24 hours; Gradual activity increase over 1 week if asymptomatic

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56
Q

Condition associated with malignant otitis externa?

A

DM

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57
Q

Best management of malignant otitis externa?

A

Ciprofloxacin

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58
Q

Duration of ciprofloxacin treatment for malignant otitis externa?

A

6-8 weeks

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59
Q

Most common pathogen responsible for malignant otitis externa?

A

Pseudomonas

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60
Q

Recent procedure that might place patient at increased risk for malignant otitis externa?

A

Aural irrigation … for cerumen impaction

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61
Q

Clinical presentation for malignant otitis externa?

A

Acutely inflamed ear canal with purulent drainage + granulation tissue formation; Pain with manipulation of ear

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62
Q

Pathognomonic physical exam finding for malignant otitis externa?

A

Granulation tissue in external auditory canal … at bone-cartilage margin

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63
Q

2 complications of malignant otitis externa?

A

Osteomyelitis, Cranial nerve palsy … due to extension of infection into skull base

64
Q

2 cephalosporins that cover Pseudomonas?

A

Ceftazidime (3rd generation), Cefepime (4th generation)

65
Q

What accounts for development of angioedema in setting of ACEI use?

A

Inhibition of ACE leads to elevated levels of bradykinin … leading to angioedema

66
Q

How should medications be adjusted in setting of angioedema development during ACEI use?

A

ARBs are prescribed as a replacement for ACEI

67
Q

Clinical presentation for central retinal artery occlusion (CRAO)?

A

Acute painless monocular vision loss

68
Q

Epidemiology of CRAO?

A

Patients > 60 yo with underlying cardiovascular risk factors

69
Q

Etiology of CRAO? | Carotid atherosclerosis

Ophthalmic artery arises from the …

A

Internal carotid artery

70
Q

Appearance of fundoscopic exam in setting of CRAO?

A

Diffuse retinal pallor + Cherry red macula

71
Q

Clinical presentation for allergic rhinitis?

A

Nasal congestion, watery eyes, clear rhinorrhea, sneezing

72
Q

2 physical exam findings in allergic rhinitis?

A

Allergic shiners (dark edematous lower eyelids) + Pale, boggy turbinates

73
Q

First step in management of allergic rhinitis?

A

Allergen avoidance

74
Q

DOC for allergic rhinitis that cannot be managed with avoidance of allergen?

A

Intranasal corticosteroids

75
Q

Example of Intranasal corticosteroid used in management of allergic rhinitis?

A

Fluticasone

76
Q

3 signs that can distinguish orbital cellulitis from pre-septal cellulitis?

A

Orbital cellulitis = limited EOM, proptosis, ophthalmoplegia

77
Q

Most common predisposing factor for orbital cellulitis?

A

Sinusitis

78
Q

3 most common pathogens responsible for orbital cellulitis?

A

Strep viridans, Staph aureus, Strep pneumonia

79
Q

Diagnostic test for orbital cellulitis?

A

CT with contrast, or MRI with contrast

80
Q

Best management of orbital cellulitis?

A

Admission + IV ABX

81
Q

ABX of choice for treatment of orbital cellulitis?

A

Ceftriaxone + Ampicillin-Sulbactam

82
Q

Best management of orbital cellulitis with evidence of focal fluid collection on CT/MRI?

A

Surgical debridement

83
Q

5 characteristics of HA that are associated with life-threatening cause?

A

Systemic symptoms (fever), Neurologic symptoms, New onset, Change in severity/character, Head trauma

84
Q

Best workup for HA that are associated with life-threatening cause?

A

Brain MRI

85
Q

6 characteristics of a cluster HA?

A

Unilateral + Autonomic symptoms (sweating, tearing, ptosis, miosis, nasal congestion)

86
Q

DOC for prevention of future cluster HA?

A

Verapamil

87
Q

Best acute management of a cluster HA?

A

100% O2 via non-rebreather mask

88
Q

Clinical presentation of Strep throat?

A

Fever, sore throat, malaise

89
Q

2 exam findings associated with Strep throat?

A

Tonsillar exudates, Anterior cervical LAD

90
Q

Best management of Strep throat?

A

Oral penicillin

91
Q

Duration of ABX needed for Strep throat?

A

10 days

92
Q

Purpose of ABX use as treatment for Strep throat?

A

Prevent rheumatic fever, Prevent spread to close contacts, Prevention of suppurative complications

93
Q

3 complications of Strep throat?

A

Peritonsillar abscess, Cervical lymphadenitis, Acute rheumatic fever

94
Q

Most common pathogen isolated from corneal foreign bodies?

A

Coagulase (-) Staph

95
Q

Best management of FB-associated corneal abrasions?

A

Empiric ABX

96
Q

Most common pathogen responsible for bacterial infection in contact lens users?

A

Pseudomonas

97
Q

Candida infection of eye is most often found in …

A

Immunosuppressed patients

98
Q

45 yo female presents with R-sided hearing loss; Rhinne test shows air > bone conduction bilaterally; Weber test lateralizes to R ear – diagnosis?

A

R sensorineural hearing loss

99
Q

Normal Rhinne test?

A

AC > BC

100
Q

Rhinne test result in conductive hearing loss?

A

BC > AC in affected ear

101
Q

Weber test result in conductive hearing loss?

A

Lateralizes to affected ear (A/C)

102
Q

Weber test result in sensorineural hearing loss? |

A

Lateralizes to unaffected ear (U/S)

103
Q

Best management of patient with sudden hearing loss?

A

Urgent ENT evaluation

104
Q

2 tests that ENT might perform during workup of sudden hearing loss?

A

MRI, audiogram

105
Q

Possible DOC for treatment of sudden hearing loss?

A

High-dose corticosteroids

106
Q

4 Centor criteria in diagnosis of streptococcal pharyngitis?

A

Tonsillar exudate, tender anterior cervical adenopathy, fever, absence of cough

107
Q

Best management of patients who have >3 Centor criteria for streptococcal pharyngitis?

A

Streptococcal rapid antigen testing

108
Q

Best management of patients who have <3 Centor criteria for streptococcal pharyngitis?

A

Supportive care … for likely viral pharyngitis

109
Q

Best management of patient who develops oropharyngeal damage and respiratory failure after caustic ingestion?

A

Laryngoscopy to assess for impending airway compromise

110
Q

Additional management of patient who develops oropharyngeal damage and respiratory failure after caustic ingestion?

A

Upper endoscopy within 24 hours to determine severity of GI damage

111
Q

4 environmental factors that increase risk of recurrent acute otitis media?

A

Absence of breastfeeding, daycare attendance, pacifier use, second hand smoke exposure

112
Q

3 possibilities for clinical diagnosis of acute bacterial rhinosinusitis (ABRS)?

A

Persistent symptoms for 10+ days; Severe symptoms for 3+ consecutive days; Worsening symptoms after initial improvement

113
Q

DOC for acute bacterial rhinosinusitis (ABRS)?

A

5-7 days of oral augmentin

114
Q

Best management of head and neck CA?

A

Combined CTX + XRT

115
Q

2 DOC for management of non-allergic rhinitis?

A

Topical intranasal glucocorticoids; Intranasal anti-histamine

116
Q

Example of topical intranasal glucocorticoid used in treatment of non-allergic rhinitis?

A

Fluticasone

117
Q

Clinical presentation of non-allergic rhinitis?

A

Nasal blockage, rhinorrhea, post-nasal drip

118
Q

4 most common pathogens responsible for bacterial conjunctivitis?

A

Staph aureus, Strep pneumonia, Moraxella, H. influenzae

119
Q

DOC for bacterial conjunctivitis?

A

Topical erythromycin drops

120
Q

Clinical presentation for bacterial conjunctivitis?

A

Conjunctival erythema, mucopurulent discharge

121
Q

Pathogen typically responsible for bacterial conjunctivitis in contact wearers?

A

Pseudomonas

122
Q

DOC for bacterial conjunctivitis in a contact wearer?

A

Topical fluoroquinolones

123
Q

Complication of bacterial conjunctivitis?

A

Keratitis

124
Q

Definition of keratitis?

A

Inflammation of cornea

125
Q

Clinical presentation of Keratitis?

A

Photophobia, burry vision, foreign body sensation

126
Q

Best initial management of Keratitis?

A

Urgent ophthalmology consult

127
Q

Diagnostic test for Keratitis?

A

Slit lamp examination

128
Q

Appearance of Slit lamp examination for Keratitis?

A

Ulceration of cornea

129
Q

Complication of Keratitis?

A

Scarring of cornea, blindness

130
Q

Which CN is responsible for corneal sensation?

A

CN V

131
Q

38 yo male presents for R eye pain; Earlier today, small metal fragment struck R eye; Now experiencing FB sensation, excessive tearing, decreased vision in R eye; PE shows diffuse subconjunctival hemorrhage, pupil that is irregularly shaped - diagnosis?

A

Open globe injury

132
Q

Best management of Open globe injury?

A

Emergent ophtho consult, CT scan of eye, IV ABX

133
Q

Role of IV ABX in management of Open globe injury?

A

Prevention of endophthalamitis

134
Q

2 most common pathogens responsible for endophthalamitis?

A

Staph aureus, Pseudomonas

135
Q

Patient presents with eye pain/redness, blurred vision, corneal ulceration - diagnosis?

A

Infectious keratitis

136
Q

Best treatment for Infectious keratitis?

A

Antivirals

137
Q

Appearance of Infectious keratitis on cornea?

A

Branched linear lesions

138
Q

Appearance of candida on cornea?

A

Multiple ulcers with feathery margins

139
Q

3 aspects of clinical presentation for early Compartment Syndrome?

A

Pain with passive muscle action, Pain out of proportion, Paresthesia

140
Q

55 yo male presents with hearing loss, fullness in R ear; PE shows translucent TM with clear, amber-colored effusion in R middle ear; Patient is treated with anti-histamines, oral decongestants, nasal corticosteroids; Patient returns 3 months later with unchanged symptoms and PE – diagnosis?

A

Unilateral middle ear effusion that has persisted for >3 months should raise suspicion for nasopharyngeal mass

141
Q

55 yo male presents with hearing loss, fullness in R ear; PE shows translucent TM with clear, amber-colored effusion in R middle ear; Patient is treated with anti-histamines, oral decongestants, nasal corticosteroids; Patient returns 3 months later with unchanged symptoms and PE – what is next step of management?

A

Flexible nasal endoscopy, possibly CT/MRI to evaluate for nasopharyngeal carcinoma

142
Q

Classic triad of symptoms seen in nasopharyngeal carcinoma?

A

Neck mass, nasal obstruction with epistaxis, unilateral + persistent middle ear effusion

143
Q

Clinical presentation for allergic conjunctivitis?

A

Bilateral eye redness with watery discharge, without burning sensation, but with hallmark ocular itching

144
Q

At what point are children with viral conjunctivitis no longer contagious?

A

When eye discharge drainage resolves

145
Q

___ refers to acute ischemic event that leads to transient painless vision loss in 1 eye

A

Amaurosis fugax

146
Q

PE finding associated with Amaurosis fugax?

A

Carotid bruit

147
Q

Next step of workup for patient with Amaurosis fugax?

A

Carotid US to evaluate need for carotid endarterectomy

148
Q

58 yo male presents with generalized tonic-clonic seizure; Reports cough, anorexia, fatigue, 22-lb weight loss; Reports 30 pack-year smoking Hx; PE shows several R-sided enlarged LNs, non-mobile, supraclavicular; Labs show serum Ca2+ 10.6; MRI brain shows 1cm mass at gray-white junction in R frontal lobe; Imaging of chest + abdomen shows 6cm RLL mass, several liver lesions – what is the most appropriate step in diagnosing patient’s condition?

A

Excisional biopsy of supraclavicular LN

149
Q

Best site of biopsy for patients with cancer limited to lung or mediastinal LNs?

A

Biopsy of those areas

150
Q

Best site of biopsy for patients with advanced cancer showing evidence of metastasis?

A

Biopsy of distant metastasis site … OR, ideally the supraclavicular LNs … if supraclavicular LNs are not present, then biopsy the liver/adrenals (not the brain)

151
Q

58 yo male presents with 2 months of hoarseness; HX of tobacco use; Fiberoptic laryngoscopy shows 4mm exophytic, cauliflower mass on free margin of L true vocal cord; Neck CT shows no metastasis; Biops revelas stage 1a - what is best treatment?

A

Laser excision of lesion or XRT

152
Q

What is the mainstay therapy for early stage glottic CA?

A

XRT

153
Q

Medical presentation of a central retinal artery occlusion (CRAO)?

A

Sudden vision loss, painless

154
Q

Funduscopic findings for CRAO?

A

Pale fundus with cherry red spot

155
Q

Endoscopic findings for CRVO?

A

Fundus with retinal hemorrhages and optic disc edema (blood and thunder)

156
Q

Clinical presentation of retinal detachment? s

A

Increased frequency of floaters, flasher

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