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HEENT > HEENT > Flashcards

HEENT Flashcards

1
Q

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
A

suppurative conjuntivitis

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2
Q

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
A

-allergen

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3
Q

Common causative organisms of acute suppurative conjunctivitis include all of the following except:

  • Staphyloccoccus aureus
  • haemophilus influenzae
  • streptococcus pneumoniae
  • Pseudomonas aeruginosa
A

Pseudomonas aeruginosa

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4
Q

Treatment options in suppurative conjunctivitis include all of the following ophthalmic preparations except:

  • polymyxin B plus trimethoprim
  • levofloxacin
  • polymyxin
  • azithromycin
A

polymyxin

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5
Q

Treatment options in acute and recurrent allergic conjunctivitis include all of the following except:

  • cromolyn ophthalmic drops
  • oral antihistamines
  • ophthalmological antihistamines
  • corticosteroid ophthalmic drops
A

corticosteroid ophthalmic drops

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6
Q

The most common virological cause of conjunctivitis is:

  • coronavirus
  • adenovirus
  • rhinovirus
  • human papilloma virus
A

-adenovirus

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7
Q

Treatment of viral conjunctivitis can include:

  • moxifloxacin ophthalmic drops
  • polymyxin B ophthalmic drops
  • oral acyclovir
  • no antibiotic therapy needed
A

no antibiotic therapy needed

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8
Q

Anterior epistaxis is usually caused by:

  • HTN
  • bleeding disorders
  • localized nasal mucosa trauma
  • a foreign body
A

localized nasal mucosa trauma

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9
Q

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
A

firm pressure to the area superior to the nasal alar cartilage

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10
Q

the most common clinical finding in patients with severe or refractory epistaxis is:

  • DMII
  • HTN
  • acute bacterial sinusitis
  • anemia
A

HTN

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11
Q

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
A

initiating systemic prothrombotic therapy

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12
Q

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
A

purulent eye discharge

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13
Q

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
A

angle-closure glaucoma

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14
Q

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
A

prompt referral to an ophthalmologist

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15
Q

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
A

anterior uveitis

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16
Q

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
A

retinal detachment

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17
Q

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
A

immediate referral to an ophthalmologist

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18
Q

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
A

prompt referral to an eye care specialist

19
Q

*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
A

peripheral vision loss

20
Q

POAG is primarily caused by:

-degeneration of the optic nerve
-hypotension in the anterior maxillary artery

A

elevated intraocular pressure

21
Q

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
A

excessive cupping of the optic disk

22
Q

Risk factors for POAG include all of the following except:

  • African ancestry
  • DMII
  • advance age
  • blue eye color
A

blue eye color

23
Q

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
A

intraocular pressure greater than 25mmHG

24
Q

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

A

1-2 yrs

25
Q

Treatment options for POAG include all of the following topical ocular agents except:

  • beta-adrenergic antagonists
  • alpha2-agonists
  • prostlandin analogues
  • mast cell stabilizers
A

mast cell stabilizers

26
Q

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
A

-senile macular degeneration

27
Q

Which d/o is characterized by unilateral loss of vision in one eye

  • amaurosis fugax
  • dry eye syndrome
  • glaucoma
  • keratitis
A

-amaurosis fugax

28
Q

When should glaucoma screening be instituted?

  • 65 y/o
  • when the client exhibits visual problems
  • at the client’s annual examination
  • 40 y/o
A

-40 y/o

29
Q

A normal optic disk is

  • yellowish pinkish
  • bright orange
  • dark brown
  • pearly grey
A

-yellowish pinkish

30
Q

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
A

-pain

31
Q

Which differential dx of red eye includes photophobia?

  • acute conjunctivitis
  • acute iritis
  • narrow-angle glaucoma
  • corneal abrasion
A

-acute iritis

32
Q

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
A

-onset is usually b/f 25 y/o

33
Q

IOP varies diurnally and is highest at what time of the day?

  • morning
  • afternoon
  • early evening
  • at the end of the day, before bed
A

-morning

34
Q

The best functional and clinically relevant test for hearing loss is:

  • an audiogram
  • whisper test
  • Weber test
  • Rinne test
A

-whisper test

35
Q

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
A

-neck pain in a child with hx of malignancies

36
Q

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
A

-rheumatic fever

37
Q

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
A

-candida infection

38
Q

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
A

-advise a combination non-sedating antihistamine and decongestant tablet

39
Q

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
A

-vesicles on the TM

40
Q

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
A

-acute angle-closure glaucoma

41
Q

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
A

-tell her that she may return to normal activity and take an NSAID for pain PRN

42
Q

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
A

-use a small ear syringe to suction out the item

43
Q

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
A

-diabetic retinopathy

HEENT (4 decks)

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