HEENT

Question 1

What is a Cholesteatoma?

Answer 1

“Cauliflower-like” growth with foul smelling discharge from an ear. On exam,
there is no visibile tympanic membrane or ossicles (destroyed). If not removed,
can erode into skull and the facial nerve (CN 7). A complication from chronic
otitis media infections. Treated with antibiotics and surgical removal of the mass.

Question 2

What physical findings would you expect to see in papilledema?

Answer 2

Optic disc swollen with blurred edges caused by increased intracranial pressure

(ICP) because of brain tumor, abscess, or pseudotumor cerebri.

Question 3

What is AV nicking ?

Answer 3

When the ateriole and vein cross over in the eye creating a kink, decreasing blood flow to the eyes

patients may complain of blurry vision

Question 4

What is the difference between conductive hearing loss vs. Sensorineural?

Answer 4

conductive is because sound waves cannot conduct due to sometype of blockage

Sensorineural is inner and middle ear are not functioning properly, there is toxicity from a drug, physiological as to why someone has hearingloss

Question 5

What is Presbycussis

Answer 5

This is age related hearing loss, and it is sensorineural

Question 6

What type of hearing loss is Ménière disease disease?

Answer 6

sensorineural

Question 7

If your patient has right ear pain, what would the result of their webber test be?

Answer 7

Webber: LATERALIZES TO THE AFFECTED EAR

in this case it would lateralize to the right ear

Question 8

If you patient has left ear pain, how would you interpret the Rhinne test?

Answer 8

In the Left ear that has tinnitus, bone conduction is better than AIR conduction

BC greater than AC!!

Question 9

What organim causes otitis media?

Answer 9

1. Strep pneumonia
2. M. catarrhalis
3. H. Influenzae

Question 10

What is an Xanthelasma?

Answer 10

Raised and yellow soft plaques that are located under the brow on the upper and/or lower lids of the eyes on the nasal side.

May be a sign of hyperlipidemia if
present in persons younger than 40 years of age.

Question 11

What is rhinitis Medicamentosa?

Answer 11

Prolonged use of topical nasal decongestants (>3days) causes rebound effects that result in severe and chronic nasal congestion. If the patient stops using the nasal spray, severe nasal congestion results.

Question 12

What can cause PAINLESS otorrhea (ear drainage) and conductive hearing loss?

Answer 12

1. Tympanic membrane perforation
2. Cholesteatoma

Question 13

What clinical sign has the most sensitivity for otitis media?

Answer 13

Impaired mobility of tympanic membrane

Question 14

Describe the symptom onset of pertussis?

Answer 14

100 day cough
three phases which occur over 6-10 weeks

catarrhal phase: rhinorrhea, mild cough, low grade fever

paroxysmal phase: occurs in bursts, whoop and postussive emesis

convalescence phase: coughing decreases in frequency and intenity

Question 15

What cranial nerve is the Webber and Rhinne test, testing for?

Answer 15

8Th cranial nerve, acoustic

Question 16

What is a normal Rhinne test result?

Answer 16

when air conduction is heard twice as long as bone conduction

Question 17

If you patient has conductive hearing loss what would the results of their Webber and Rhinnes test be?

Answer 17

1. Webber in conductive hearing loss, it would lateralize to the affected ear
2. Rhinne in conductive hearing loss bone conduction would be heard longer than air conduction

Question 18

If your patient has sensorineural hearing loss what findings would you see in Weber and Rhinne test?

Answer 18

1. Webber in sensoineural hearing loss, the sound would lateralize to the non affected ear
2. Rhinne- in sensorineural hearing loss air conduction will be heard almost twice as long as bone conduction

Question 19

How do you diagnose Herpes Keratitis?

Answer 19

Fluorescine dye strip with a black lamp in darkened room, fern like lines

Question 20

What is Cavernous Sinus thrombosis?

Answer 20

a blood clot in the cavernous sinuses. It can be life-threatening.

Question 21

What are the symptoms of Cavernous Sinus Thrombosis>

Answer 21

1. Opthalmoplegia
2. Proptosis
3. Chemosis ( swelling of the eye surface membranes because of accumulation of fluid)
4. Horners syndrome

Question 22

What is horners syndrome

Answer 22

problem with sympathetic nerve supply to one side of face

miosis- constricted pupil
pstosis
anhidrosis- failure to sweat

Question 23

What is diptheria

Answer 23

Complains of extremely sore throat and dysphagia. The posterior pharynx and
respiratory tract are coated with gray-to-yellow pseudomembrane that is hard to
displace.

Question 24

What is Hairy leukoplakia?

Answer 24

enlongated dark colored papilla on lateral aspects of the tongue, rule out HIV

Question 25

What is a subconjunctival hemorrhage?

Answer 25

sudden onset of bright red blood on the eye that does not impede vision and is painless. Event preceded by severe coughing, sneezing, trauma

Question 26

What considerations should be made if prescribing Betimol for

primary open angle glaucoma ?

Answer 26

its a beta blocker eye drop, contraindicated in:

Asthma, COPD, Heart block, heart failure

Question 27

What signs and symptoms would you see in closed angle glaucoma?

Answer 27

sudden severe headache/eye pain
Halos arround lights
severe nausea/vomiting

Question 28

What organisms cause Otitis Externa?

Answer 28

P. aeruginosa
Staphe aureus

Question 29

What are the physical findings of optic neuritis ?

Answer 29

one eye vision loss
washed out color vision
painful
affects CENTRAL vision loss

Question 30

What specific eye conditions cause eye pain

Answer 30

Optic Neuritis
Acute closed angle glaucoma
Keratitis

Question 31

How can you differentiate Iritis (anterior uveitis) from keratitis?

Answer 31

both will be painful, but on physical exam in Iritis the cornea will not be involved (read the question)