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
2
Q
2 alternate names for Suppurative otitis media?
A
Acute otitis media, Bacterial otitis media
3
Q
Which bacteria is most commonly involved in TM perforation in setting of suppurative otitis media?
A
Group A Strep … (strep pyogenes)
4
Q
Epidemiology of necrotizing otitis externa?
A
Elderly patients with DM; Immunocompromised patients
5
Q
Bacteria most commonly responsible for necrotizing otitis externa?
A
Pseudomonas
6
Q
Clinical presentation of serous otitis media?
A
Middle ear effusion without evidence of infection or inflammation
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
8
Q
Transient, conjugate, slow deviation of gaze to side of caloric water stimulation during oculovestibular response is mediated by …
A
Brainstem
9
Q
Saccadic midline correction during oculovestibular response is mediated by …
A
Cortex
10
Q
Normal oculovestibular reflex is strongly suggestive of ___ coma
A
Psychogenic
11
Q
3 aspects of clinical presentation for heat-stroke?
A
Hyperthermia, Tachycardia, AMS
12
Q
Best treatment for heat-stroke?
A
Initiation of rapid-cooling via evaporative heat loss
13
Q
Child presents with a midline mass that moves superiorly with swallowing – diagnosis?
A
Thyroglossal duct cyst
14
Q
What event might make secondary infection of thyroglossal duct cyst more likely?
A
Viral URI
15
Q
Origin of thyroglossal duct cyst?
A
Pharyngeal epithelium … (from base of tongue on its way to forming the thyroid)
16
Q
___ is associated with thyroglossal duct cyst |
A
Ectopic thyroid tissue
17
Q
Definitive treatment of thyroglossal duct cyst?
A
Surgical excision … infection of thyroglossal duct cyst makes future infections more likely
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
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
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
21
Q
Candida endophthalmitis most commonly occurs in setting of …
A
Neutropenia
22
Q
What event in hospital may allow Candida to access bloodstream and disseminate to organs?
A
TPN via central venous catheter
23
Q
Fundoscopic exam findings associated with Candida endophthalmitis?
A
Focal white lesions on the retina that extend into the vitreous
24
Q
Best treatment for Candida endophthalmitis that extends into the vitreous?
A
Amphotericin B + vitrectomy
25
2 physical exam findings for acute mastoiditis?
Displacement of external ear, Mastoid tenderness
26
4 most common bacteria responsible for acute mastoiditis?
Strep pneumoniae, Strep pyogenes, Staph aureus, Pseudomonas
27
Acute mastoiditis is considered a complication of …
Acute otitis media
28
Best management of acute mastoiditis?
IV ABX, Middle ear drainage
29
2 methods of middle ear drainage in acute mastoiditis?
Tympanostomy, Mastoidectomy
30
Epidemiology of auricular hematoma?
Athletes who participate in contact sports
31
2 complications of auricular hematoma?
Abscess, Avascular necrosis of external ear cartilage
32
In setting of auricular hematoma, Avascular necrosis of external ear cartilage may lead to development of …
Cauliflower ear
33
Best management of auricular hematoma?
I&D of hematoma, Oral ABX
34
Which 2 ocular structures are most likely to be damaged in a horizontal laceration of the upper eyelid?
Orbital septum, Levator palpebrae muscle
35
Role of the orbital septum?
Separates orbital content from lid tissue
36
Sign that orbital septum might be damaged?
Presence of orbital fat tissue in the wound
37
Which ocular structure is most likely damaged in the setting of medial eyelid laceration?
Canaliculi
38
2 most common pathogens responsible for otitis externa?
Staph aureus, Pseudomonas
39
Best treatment for cases of mild otitis externa?
Topical acidifier (acetic acid)
40
Best treatment for cases of moderate otitis externa?
Topical ABX
41
2 ABX of choice in treatment of moderate otitis externa?
Ciprofloxacin, Neomycin
42
Alternate name for anterior uveitis?
Iritis
43
Diagnostic test for anterior uveitis (iritis)?
Visualization of WBCs in anterior chamber
44
How can you distinguish anterior uveitis from closed angle glaucoma – both present with pain, redness, vision loss?
Intraocular pressure will be elevated in closed angle glaucoma
45
Presbycusis represents a type of ___ hearing loss
Sensorineural
46
Which range of hearing is first affected in presbycusis?
High-frequency hearing
47
Which type of hearing will likely be normal in presbycusis?
Speech discrimination
48
What will typically draw attention to presbycusis?
Introducing background noise
49
Most common cause of decreased vision in elderly patients?
Cortical cataracts
50
Which ocular condition is associated with Cortical cataracts?
Age-related macular degeneration
51
Pattern of vision loss in setting of cortical cataracts?
Painless vision blurring
52
Pattern of vision loss in macular degeneration?
Loss of central vision
53
Change to fundoscopic exam in macular degeneration?
Drusen spots
54
Initial workup for patient with concussion?
Head CT, 24-hour close monitoring
55
Appropriate return-to-play for patients who present with concussion?
Rest for at least 24 hours; Gradual activity increase over 1 week if asymptomatic
56
Condition associated with malignant otitis externa?
DM
57
Best management of malignant otitis externa?
Ciprofloxacin
58
Duration of ciprofloxacin treatment for malignant otitis externa?
6-8 weeks
59
Most common pathogen responsible for malignant otitis externa?
Pseudomonas
60
Recent procedure that might place patient at increased risk for malignant otitis externa?
Aural irrigation … for cerumen impaction
61
Clinical presentation for malignant otitis externa?
Acutely inflamed ear canal with purulent drainage + granulation tissue formation; Pain with manipulation of ear
62
Pathognomonic physical exam finding for malignant otitis externa?
Granulation tissue in external auditory canal … at bone-cartilage margin
63
2 complications of malignant otitis externa?
Osteomyelitis, Cranial nerve palsy … due to extension of infection into skull base
64
2 cephalosporins that cover Pseudomonas?
Ceftazidime (3rd generation), Cefepime (4th generation)
65
What accounts for development of angioedema in setting of ACEI use?
Inhibition of ACE leads to elevated levels of bradykinin … leading to angioedema
66
How should medications be adjusted in setting of angioedema development during ACEI use?
ARBs are prescribed as a replacement for ACEI
67
Clinical presentation for central retinal artery occlusion (CRAO)?
Acute painless monocular vision loss
68
Epidemiology of CRAO?
Patients > 60 yo with underlying cardiovascular risk factors
69
Etiology of CRAO? | Carotid atherosclerosis
| Ophthalmic artery arises from the …
Internal carotid artery
70
Appearance of fundoscopic exam in setting of CRAO?
Diffuse retinal pallor + Cherry red macula
71
Clinical presentation for allergic rhinitis?
Nasal congestion, watery eyes, clear rhinorrhea, sneezing
72
2 physical exam findings in allergic rhinitis?
Allergic shiners (dark edematous lower eyelids) + Pale, boggy turbinates
73
First step in management of allergic rhinitis?
Allergen avoidance
74
DOC for allergic rhinitis that cannot be managed with avoidance of allergen?
Intranasal corticosteroids
75
Example of Intranasal corticosteroid used in management of allergic rhinitis?
Fluticasone
76
3 signs that can distinguish orbital cellulitis from pre-septal cellulitis?
Orbital cellulitis = limited EOM, proptosis, ophthalmoplegia
77
Most common predisposing factor for orbital cellulitis?
Sinusitis
78
3 most common pathogens responsible for orbital cellulitis?
Strep viridans, Staph aureus, Strep pneumonia
79
Diagnostic test for orbital cellulitis?
CT with contrast, or MRI with contrast
80
Best management of orbital cellulitis?
Admission + IV ABX
81
ABX of choice for treatment of orbital cellulitis?
Ceftriaxone + Ampicillin-Sulbactam
82
Best management of orbital cellulitis with evidence of focal fluid collection on CT/MRI?
Surgical debridement
83
5 characteristics of HA that are associated with life-threatening cause?
Systemic symptoms (fever), Neurologic symptoms, New onset, Change in severity/character, Head trauma
84
Best workup for HA that are associated with life-threatening cause?
Brain MRI
85
6 characteristics of a cluster HA?
Unilateral + Autonomic symptoms (sweating, tearing, ptosis, miosis, nasal congestion)
86
DOC for prevention of future cluster HA?
Verapamil
87
Best acute management of a cluster HA?
100% O2 via non-rebreather mask
88
Clinical presentation of Strep throat?
Fever, sore throat, malaise
89
2 exam findings associated with Strep throat?
Tonsillar exudates, Anterior cervical LAD
90
Best management of Strep throat?
Oral penicillin
91
Duration of ABX needed for Strep throat?
10 days
92
Purpose of ABX use as treatment for Strep throat?
Prevent rheumatic fever, Prevent spread to close contacts, Prevention of suppurative complications
93
3 complications of Strep throat?
Peritonsillar abscess, Cervical lymphadenitis, Acute rheumatic fever
94
Most common pathogen isolated from corneal foreign bodies?
Coagulase (-) Staph
95
Best management of FB-associated corneal abrasions?
Empiric ABX
96
Most common pathogen responsible for bacterial infection in contact lens users?
Pseudomonas
97
Candida infection of eye is most often found in …
Immunosuppressed patients
98
45 yo female presents with R-sided hearing loss; Rhinne test shows air > bone conduction bilaterally; Weber test lateralizes to R ear – diagnosis?
R sensorineural hearing loss
99
Normal Rhinne test?
AC > BC
100
Rhinne test result in conductive hearing loss?
BC > AC in affected ear
101
Weber test result in conductive hearing loss?
Lateralizes to affected ear (A/C)
102
Weber test result in sensorineural hearing loss? |
Lateralizes to unaffected ear (U/S)
103
Best management of patient with sudden hearing loss?
Urgent ENT evaluation
104
2 tests that ENT might perform during workup of sudden hearing loss?
MRI, audiogram
105
Possible DOC for treatment of sudden hearing loss?
High-dose corticosteroids
106
4 Centor criteria in diagnosis of streptococcal pharyngitis?
Tonsillar exudate, tender anterior cervical adenopathy, fever, absence of cough
107
Best management of patients who have >3 Centor criteria for streptococcal pharyngitis?
Streptococcal rapid antigen testing
108
Best management of patients who have <3 Centor criteria for streptococcal pharyngitis?
Supportive care … for likely viral pharyngitis
109
Best management of patient who develops oropharyngeal damage and respiratory failure after caustic ingestion?
Laryngoscopy to assess for impending airway compromise
110
Additional management of patient who develops oropharyngeal damage and respiratory failure after caustic ingestion?
Upper endoscopy within 24 hours to determine severity of GI damage
111
4 environmental factors that increase risk of recurrent acute otitis media?
Absence of breastfeeding, daycare attendance, pacifier use, second hand smoke exposure
112
3 possibilities for clinical diagnosis of acute bacterial rhinosinusitis (ABRS)?
Persistent symptoms for 10+ days; Severe symptoms for 3+ consecutive days; Worsening symptoms after initial improvement
113
DOC for acute bacterial rhinosinusitis (ABRS)?
5-7 days of oral augmentin
114
Best management of head and neck CA?
Combined CTX + XRT
115
2 DOC for management of non-allergic rhinitis?
Topical intranasal glucocorticoids; Intranasal anti-histamine
116
Example of topical intranasal glucocorticoid used in treatment of non-allergic rhinitis?
Fluticasone
117
Clinical presentation of non-allergic rhinitis?
Nasal blockage, rhinorrhea, post-nasal drip
118
4 most common pathogens responsible for bacterial conjunctivitis?
Staph aureus, Strep pneumonia, Moraxella, H. influenzae
119
DOC for bacterial conjunctivitis?
Topical erythromycin drops
120
Clinical presentation for bacterial conjunctivitis?
Conjunctival erythema, mucopurulent discharge
121
Pathogen typically responsible for bacterial conjunctivitis in contact wearers?
Pseudomonas
122
DOC for bacterial conjunctivitis in a contact wearer?
Topical fluoroquinolones
123
Complication of bacterial conjunctivitis?
Keratitis
124
Definition of keratitis?
Inflammation of cornea
125
Clinical presentation of Keratitis?
Photophobia, burry vision, foreign body sensation
126
Best initial management of Keratitis?
Urgent ophthalmology consult
127
Diagnostic test for Keratitis?
Slit lamp examination
128
Appearance of Slit lamp examination for Keratitis?
Ulceration of cornea
129
Complication of Keratitis?
Scarring of cornea, blindness
130
Which CN is responsible for corneal sensation?
CN V
131
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?
Open globe injury
132
Best management of Open globe injury?
Emergent ophtho consult, CT scan of eye, IV ABX
133
Role of IV ABX in management of Open globe injury?
Prevention of endophthalamitis
134
2 most common pathogens responsible for endophthalamitis?
Staph aureus, Pseudomonas
135
Patient presents with eye pain/redness, blurred vision, corneal ulceration - diagnosis?
Infectious keratitis
136
Best treatment for Infectious keratitis?
Antivirals
137
Appearance of Infectious keratitis on cornea?
Branched linear lesions
138
Appearance of candida on cornea?
Multiple ulcers with feathery margins
139
3 aspects of clinical presentation for early Compartment Syndrome?
Pain with passive muscle action, Pain out of proportion, Paresthesia
140
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?
Unilateral middle ear effusion that has persisted for >3 months should raise suspicion for nasopharyngeal mass
141
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?
Flexible nasal endoscopy, possibly CT/MRI to evaluate for nasopharyngeal carcinoma
142
Classic triad of symptoms seen in nasopharyngeal carcinoma?
Neck mass, nasal obstruction with epistaxis, unilateral + persistent middle ear effusion
143
Clinical presentation for allergic conjunctivitis?
Bilateral eye redness with watery discharge, without burning sensation, but with hallmark ocular itching
144
At what point are children with viral conjunctivitis no longer contagious?
When eye discharge drainage resolves
145
___ refers to acute ischemic event that leads to transient painless vision loss in 1 eye
Amaurosis fugax
146
PE finding associated with Amaurosis fugax?
Carotid bruit
147
Next step of workup for patient with Amaurosis fugax?
Carotid US to evaluate need for carotid endarterectomy
148
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?
Excisional biopsy of supraclavicular LN
149
Best site of biopsy for patients with cancer limited to lung or mediastinal LNs?
Biopsy of those areas
150
Best site of biopsy for patients with advanced cancer showing evidence of metastasis?
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
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?
Laser excision of lesion or XRT
152
What is the mainstay therapy for early stage glottic CA?
XRT
153
Medical presentation of a central retinal artery occlusion (CRAO)?
Sudden vision loss, painless
154
Funduscopic findings for CRAO?
Pale fundus with cherry red spot
155
Endoscopic findings for CRVO?
Fundus with retinal hemorrhages and optic disc edema (blood and thunder)
156
Clinical presentation of retinal detachment? s
Increased frequency of floaters, flasher
