HEENT Flashcards
A 19 y/o man presents with a chief complaint of a red, irritated right eye for the past 48 hours with eyelids that were “stuck together” this morning when he awoke. Examination reveals injected palpebral and bulbar conjuctiva and reactive pupils; vision screen with the Snellen chart evaluation reveals 20/30 in the right eye, left eye, and both eyes; and purulent eye discharge on the right .This presentation is most consistent with:
- suppurative conjunctivitis
- viral conjunctivitis
- allergic conjunctivitis
- mechanical injury
suppurative conjuntivitis
A 19 y/o woman presents with a complaint of bilaterally itchy, red eye s with tearing that occurs intermittently throughout the year and is often accompanied by a rope like eye discharge and clear nasal discharge. This is most consistent with conjunctival inflammation caused by a(n):
- bacterium
- virus
- allergen
- injury
-allergen
Common causative organisms of acute suppurative conjunctivitis include all of the following except:
- Staphyloccoccus aureus
- haemophilus influenzae
- streptococcus pneumoniae
- Pseudomonas aeruginosa
Pseudomonas aeruginosa
Treatment options in suppurative conjunctivitis include all of the following ophthalmic preparations except:
- polymyxin B plus trimethoprim
- levofloxacin
- polymyxin
- azithromycin
polymyxin
Treatment options in acute and recurrent allergic conjunctivitis include all of the following except:
- cromolyn ophthalmic drops
- oral antihistamines
- ophthalmological antihistamines
- corticosteroid ophthalmic drops
corticosteroid ophthalmic drops
The most common virological cause of conjunctivitis is:
- coronavirus
- adenovirus
- rhinovirus
- human papilloma virus
-adenovirus
Treatment of viral conjunctivitis can include:
- moxifloxacin ophthalmic drops
- polymyxin B ophthalmic drops
- oral acyclovir
- no antibiotic therapy needed
no antibiotic therapy needed
Anterior epistaxis is usually caused by:
- HTN
- bleeding disorders
- localized nasal mucosa trauma
- a foreign body
localized nasal mucosa trauma
1st line intervention for anterior epistaxis includes:
- nasal packing
- application of topical thombin
- firm pressure to the area superior to the nasal alar cartilage
- chemical cauterization
firm pressure to the area superior to the nasal alar cartilage
the most common clinical finding in patients with severe or refractory epistaxis is:
- DMII
- HTN
- acute bacterial sinusitis
- anemia
HTN
A 22 y/o man with recurrent epistaxis episodes fails to respond to simple pressure. Alternative approaches include all of the following except:
- initiating systemic prothrombotic therapy
- nasal packing
- chemical cautery
- topical antifibrinolytic agents
initiating systemic prothrombotic therapy
All of the following are componenets of the classic ophthalmological emergency except:
- eye pain
- purulent eye discharge
- red eye
- new onset change in visual acuity
purulent eye discharge
Mrs. Murphy is a 58 y/o woman presenting with a sudden left-sided HA that is most painful in her left eye. Her vision is blurred, and the left pupil is slightly dilated and poorly reactive. The left conjuctiva is markedly injected, and the eyeball is firm. Vision screen with the Snellen chart is 20/30 OD and 20/90 OS. The most likely dx is:
- unilateral herpetic conjunctivitis
- open-angle glaucoma
- angle-closure glaucoma
- anterior uveitis
angle-closure glaucoma
In caring for Mrs. Murphy, the most appropriate next action is:
- prompt referral to an ophthalmologist
- to provide analgesia and repeat the evaluation when the patient is more comfortable
- to instill a corticosteroid ophthalmic solution
- to patch the eye and arrange for f/u in 24hrs
prompt referral to an ophthalmologist
A 48 y/o man presents with a new onset right eye vision change accompanied by dull pain, tearing, and photophobia. The right pupil is small, irregular, and poorly reactive. Vision testing obtained by using the Snellen chart is 20/30 OS and 20/80 OD. The most likely dx is:
- unilateral herpetic conjunctivitis
- open-angle glaucoma
- angle-closure glaucoma
- anterior uveitis
anterior uveitis
Mrs. Allen is a 67 y/o woman iwth DMII who c/o seeing flashing lights & floaters, decreased visual acuity, and metamorphopsia in her L eye. The most likely dx is:
- open-angle glaucoma
- central retinal artery occlusion
- anterior uveitis
- retinal detachment
retinal detachment
For Mrs. Allen, the most appropriate next course of action is:
- placement o an eye shield and f/u in 48h
- initiate tx with an ophthalmic antimicrobial solution
- initiate tx with a corticosteroid ophthalmic solution
- immediate referral to an ophthalmologist
immediate referral to an ophthalmologist
A 46 y/o man presents with eye pain. He reports that he was cutting a tree with a chain saw when some wood fragments is his eye. You consider all of the following except:
- education the patient on the use of appropriate eye protection for primary prevention of eye trauma
- immediately removing any protruding foreign body from the eye
- using fluorescein staining to detect small objects in the eye
- prompt referral to an eye care specialist
prompt referral to an eye care specialist
*Which of the following is a common vision problem in the person with untreated primary open-angle glaucoma (POAG)?
- peripheral vision loss
- blurring of near vision
- difficulty with distant vision
- need for increased illumination
peripheral vision loss
POAG is primarily caused by:
-degeneration of the optic nerve
-hypotension in the anterior maxillary artery
elevated intraocular pressure
Which of the following is most likely to be found on the fundoscopic examination in a patient with untreated POAG?
- excessive cupping of the optic disk
- arteriovenous nicking
- papilledema
- flame-shaped hemorrhages
excessive cupping of the optic disk
Risk factors for POAG include all of the following except:
- African ancestry
- DMII
- advance age
- blue eye color
blue eye color
Key diagnostic findings in POAG include which of the following?
- intraocular pressure greater than 25mmHG
- papilledema
- cup to disk ratio greater than 0.4
- sluggish pupillary response
intraocular pressure greater than 25mmHG
Adults at high risk for POAG should undergo a complete eye exam every:
1-2 yrs
3-4 yrs
5-6 yrs
3-6 months
1-2 yrs
Treatment options for POAG include all of the following topical ocular agents except:
- beta-adrenergic antagonists
- alpha2-agonists
- prostlandin analogues
- mast cell stabilizers
mast cell stabilizers
Mr. cloud, aged 74 y/o, comes to your primary careoffice c/o changes in his vision. He reports taht straight lines appear bent and that things are appearing blurred, dark, and empty. In addition, colors do not seem as bright. You suspect
- diabetic retinopathy
- glaucoma
- cataracts
- senile macular degeneration
-senile macular degeneration
Which d/o is characterized by unilateral loss of vision in one eye
- amaurosis fugax
- dry eye syndrome
- glaucoma
- keratitis
-amaurosis fugax
When should glaucoma screening be instituted?
- 65 y/o
- when the client exhibits visual problems
- at the client’s annual examination
- 40 y/o
-40 y/o
A normal optic disk is
- yellowish pinkish
- bright orange
- dark brown
- pearly grey
-yellowish pinkish
Justine has conjunctivitis. What sign or symptom do you tell her to be on the alert for and, it it is noted, to call you right away?
- purulent d/c
- pain
- erythema of the conjunctiva
- preauricular adenopathy
-pain
Which differential dx of red eye includes photophobia?
- acute conjunctivitis
- acute iritis
- narrow-angle glaucoma
- corneal abrasion
-acute iritis
Which of the following is a characteristic of migraine HA’s?
- they are more common in men than women
- onset is usually b/f 25 y/o
- FHx in 75% of clients
- they are paroxysmal in nature, occurring and average of 4x/month
-onset is usually b/f 25 y/o
IOP varies diurnally and is highest at what time of the day?
- morning
- afternoon
- early evening
- at the end of the day, before bed
-morning
The best functional and clinically relevant test for hearing loss is:
- an audiogram
- whisper test
- Weber test
- Rinne test
-whisper test
Certain conditions should signal a potentially life-threatening situation in a client with neck pain. These include:
- neck pain in a child with hx of malignancies
- radicular symptoms of numbness & tingling in the associated limb
- fever
- sudden onset
-neck pain in a child with hx of malignancies
a benign heart murmur, previously undomcumented and discovered after an p\epidsode of pharyngitis, may be a clue to the dx of
- scarlet fever
- Reye’s sydrome
- rheumatic fever
- diphtheria
-rheumatic fever
which type of pharyngitis do you suspect when a client has a sore throat with dysphagia and thin, white nonvesicular diffuse exudative ulcers on the mucosa?
- allergic pharyngitis
- streptococcal pharyngitis
- mononucleosis
- candida infection
-candida infection
Angie, age 17, is c/o nasal congestion, sneezing, and itchiness of the eyes that worsens when she does yard work. She has been self-medicating with an OTC nasal decongestant spray. Although this has been temporarily helpful, she reports that her symptoms are now worsening. You should
- counsel her to avoid yard work
- advise her of the rebound effect of the nasal spray
- order a non-sedating antihistamine and a corticosteroid nasal spray
- advise a combination non-sedating antihistamine and decongestant tablet
-advise a combination non-sedating antihistamine and decongestant tablet
Mark has a dx of bullous myringitis what might you expect to see during an otoscopic examination?
- bulging of the TM
- serous amber fluid & air behind the TM
- vesicles on the TM
- perforation of the TM
-vesicles on the TM
ginny, age 62, comes to the office with a sudden onset of severe, throbbing eye pain & unilateral vision loss. Even before you examine her, you suspect
- a unilateral cataract
- iritis
- a detach retina
- acute angle-closure glaucoma
-acute angle-closure glaucoma
Andrea, age 16, is seen in your office for an injury to her eye. You remove a small foreign body from her cornea. There is no rust ring. In preparation for d/c, you would
- patch here eye
- prescribe anesthetic eye drops
- prescribe steroid eye drops
- tell her that she may return to normal activity and take an NSAID for pain PRN
-tell her that she may return to normal activity and take an NSAID for pain PRN
Mackenzie, age 8, is c/o something being stuck in side her ear. You consider a number of actions. Teh action you should NOT do is which of the following?
- instill several drops of mineral oil
- use a small ear syringe to suction out the item
- inspect the inside of the ear with your otoscope even though she is crying in pain
- reassure her that this will pass
-use a small ear syringe to suction out the item
When performing an ophthalmoscopic exam, you note retinal hemorrhages & narrowing, obliteration dilation, & tortuousness of the retinal vessels. You dx this as
- macular degeneration
- hypertensive retinopathy
- diabetic retinopathy
- a cataract
-diabetic retinopathy
