HEENT

Question 1

symptoms of acoustic neuroma?

Answer 1

• Unilateral SNHL and tinnitus present for 3-4 years
• Impaired balance with walking, veering and tilting
More common in Asians

Question 2

which cranial nerve is involved in acoustic neuroma?

Answer 2

CN VIII (acoustic nerve)
if facial nerve (CN VII) is involved --> facial paresis and paresthesia

Question 3

symptoms of cholesteatoma?

Answer 3

• Hearing loss and intermittent otorrhea that is purulent and foul smelling
• Perforation in superior quadrant with cauliflower-like mass OR intact TM with mass behind TM
• Hx of chronic or recurrent OM
Can erode into facial bones and damage facial nerve

Question 4

clear golden otorrhea/rhinorrhea may indicate….?

Answer 4

basilar and/or temporal fracture

may be accompanied by Battle sign, raccoon eyes, hemotympanum
REFER TO ED

Question 5

dental avulsion

are primary or secondary teeth considered a dental emergency?

Answer 5

secondary teeth only

A completely avulsed tooth may be permanently retained if replaced in the socket with minimal handling within 30 minutes to 1 hour. Both partial and complete avulsions usually ultimately require root canal therapy because the pulp tissue becomes necrotic.

Question 6

hairy leukoplakia is caused by _______ and is pathognomonic for _____

Answer 6

caused by EBV

pathognomonic for HIV

Question 7

what is the definition (visual acuity) of legal blindness?

Answer 7

best corrected vision of 20/200 or less, or visual field <20 degrees

Question 8

contact lens wearer with corneal abrasion should be treated with _______ to cover for _______

Answer 8

ciprofloxacin or tobramycin
cover for pseudomonas

PATCHING CONTRAINDICATED with recent contact lens wear

Question 9

what is normal IOP range?

Answer 9

8-21 mm Hg

REFER if IOP 30 mm or greater –> urgent referral or to ED

Question 10

physical exam findings of primary closed angle glaucoma

Answer 10

Signs that suggest a rapid rise in IOP include:

Conjunctival redness/ciliary flush
Corneal edema or cloudiness
A shallow anterior chamber
Mid-dilated pupil (4 to 6 mm) that reacts poorly to light - sluggish

Question 11

What is the progression of vision loss with age related macular degeneration?

Answer 11

central –> peripheral

Question 12

hallmark (pathognomonic) sign of age-related macular degeneration?

Answer 12

Drusen spots

Question 13

what are some medications that can cause rhinitis as a side effect?

Answer 13

• oral contraceptives
• erectile dysfunction meds
• some BP meds
• ASA and NSAIDs (if concurrent asthma or rhinosinusitis)
• some antidepressants
• some benzos

Question 14

Red flag for lemierre’s syndrome?

Answer 14

Jugular venous thrombophlebitis (RED FLAG)

• looks ill
• neck pain
• severe pharyngitis
• resp distress

Red Flags for Lemierre’s

1. Rigors (high likelihood ratio for representative of bacteremia)
2. Unilateral neck swelling (either peritonsillar abscess or Lemierre’s)
3. Pulmonary symptoms
    4. No improvement after 5-6 days

Question 15

what is the duration of antibiotic treatment for GAS pharyngitis?

Answer 15

10 days

Question 16

what are signs and symptoms of post-strep glomerulonephritis?

Answer 16

proteinuria
hematuria
tea coloured urine
RBC casts
HTN
edema

Question 17

if AOM presents with concurrent purulent conjunctivitis, consider coverage for which organism?

Answer 17

H influenzae

*capable of producing beta lactamase so need to treat with amox-clav

Question 18

duration of treatment for acute otitis media

Answer 18

uncomplicated, 6 months to 2 years: 10 days
uncomplicated 2 years and older: 5-7 days
with perforation: 10 days all ages

Question 19

Meniere’s disease

Trio of symptoms

Answer 19

Vertigo (at least 2 episodes lasting 20 min to 12 hours each)

Sensorineural hearing loss
(usually unilateral)

Tinnitus (low pitched, roaring)

Question 20

Duration and drug class of treatment for acute sinusitis?

Answer 20

5-7 days

amoxicillin or amox-clav for coverage of strep pneumoniae, h influenzae and moraxella

MACROLIDS, SEPTRA and CEPHALOSPORINS not effective

Question 21

duration of vertigo with BPPV

Answer 21

less than a minute

Question 22

first line treatment of chronic GAS carriers?

Answer 22

• clindamycin
• amox-clav
• rifampin with penicillin

**Only treat if there is outbreak of rheum fever/glomerulonephritis, fam hx rheum fever, outbreak

Question 23

what is the first line treatment for acute bacterial sinusitis for adults?

length of treatment:

Answer 23

amox-clav *high dose amox, need coverage against DRSP

uncomplicated: 5-7 days

Question 24

what is first line treatment for acute bacterial sinusitis for adults if pt has beta lactam allergy?

Answer 24

doxycycline
levofloxacin/moxifloxacin

*doxy is not ok in pregnancy