HEENT 3

Question 1

OME

Answer 1

middle ear fluid w/o active infection

Question 2

may follow AOM

Answer 2

otitis media with effusion

Question 3

OME most often caused by
5

Answer 3

AOM, allergic rhinitis, recent viral infection, barotrauma

Question 4

OME objective findings
3

Answer 4

1. TM may appear normal or slightly erythematous
2. TM is intact and may or may not be retracted
3. fluid behind TM is often yellow or clear

Question 5

OME may resolve over the course of

Answer 5

12 weeks

Question 6

OME sx mgmt with what
3

Answer 6

oral decongestants (pseudoephedrine)
antihistamines
nasal corticosteroids

Question 7

vertigo is a ____, not a ____

Answer 7

symptom not a dx

Question 8

allergic rhinitis - turbinates findings

Answer 8

nose has blue tinged or pale and boggy nasal turbinates

Question 9

under eye circles is to and why

Answer 9

allergic rhinitis due to subcutaneous venodilation

Question 10

allergic rhinitis first line tx is

Answer 10

topical nasal spray

Question 11

allergic rhinitis glucocorticoid nasal spray OTC options

Answer 11

fluticasone/Flonase BID
or
tramcinolone/Nasacort 1-2 sprays a day

Question 12

allergic rhinitis - if only partial relief with OTC steroid spray then

Answer 12

another option is topical antihistamine nasal spray, azelastine daily or BID

Question 13

allergic rhinitis - no relief from OTC glucocorticoid nasal spray or topical antihistamine

Answer 13

consider combo product azelastine+fluticasone nasal spray, script only called Dysmista

Question 14

rhinitis medicamentosa

Answer 14

prolonged use of topical nasal decongestant sprays (>3 days) that causes rebound effects that result in severe and chronic nasal congestion

Question 15

cheilitis tx plan
3

Answer 15

1. check vitamin B12 level
2. remove underlying causes, check dentures fit correctly
3. when infection has cleared, apply barrier cream with zinc or petroleum jelly at night

Question 16

infectious mononucleosis

Answer 16

infection by EBV (herpesvirus family)

Question 17

mono is spread mainly through

Answer 17

saliva

Question 18

mono classic s/sx

Answer 18

fever
pharyngitis
lymphadenopathy

Question 19

pt presents with fever, pharyngitis, and lymphadenopathy

Answer 19

infectious mono

Question 20

infectious mono - LFTs

Answer 20

elevated aminotransferases are seen in majority of patients but self limited

Question 21

mono - most acute sx resolve by when

Answer 21

1-2 weeks

Question 22

steptococcal pharyngitis/tonsillopharyngitis (step throat)

Answer 22

an acute infections of the pharynx and/or palatine tonsils caused by group A streptococcal bacteria

Question 23

acute pharyngitis - suspect viral etiology if they presents with
5

Answer 23

cough
stuffy nose
rhinitis
clear mucus
watery eyes

Question 24

what bacteria causes strep throat

Answer 24

group A streptococcal bacteria/Streptococcus pyogenes

Question 25

strep throat classic case
5

Answer 25

1. abrupt onset of fever
2. sore throat
3. pain on swallowing
4. mildly enlarged submandibular nodes
5. purulent, patchy tonsillar or pharyngeal exudate

Question 26

test for GAS

Answer 26

rapid antigen detection testing RADT and/or throat culture

Question 27

GAS first line tx for adults

Answer 27

oral PNC V 500 mg 2-3 x day for 10 days

Question 28

GAS first line tx for children

Answer 28

oral PNC V or amoxicillin

Question 29

GAS tx - PNC or beta lactam allergy

Answer 29

clindamycin and macrolides are alternatives

Question 30

inflammatory reaction to strep infection that may affect the heart and the valves, joints, and brain

Answer 30

acute rheumatic fever

Question 31

poststreptococcal glomerulonephritis

Answer 31

abrupt onset of proteinuria, hematuria, dark colored urine, and RBC casts in urine accompanied by HTN and edema