HEENT

Question 1

What is the next best step in management of a patient with voice hoarseness for > 3 months?

Answer 1

Laryngoscopy

Question 2

What is the most likely cause of chronic unilateral nasal obstruction in an adult?

Answer 2

Deviated nasal septum

Question 3

What is vocal cord dysfunction?

Answer 3

Vocal cord dysfunction is an idiopathic disorder commonly seen in patients in their twenties and thirties in which the vocal cords partially collapse or close on inspiration. It mimics, and is commonly mistaken for, asthma. Symptoms include episodic tightness of the throat, a choking sensation, shortness of breath, and coughing. A careful history and examination reveal that the symptoms are worse with inspiration than with exhalation, and inspiratory stridor during the episode may be mistaken for the wheezing of asthma. The sensation of throat tightening or choking also helps to differentiate it from asthma.
Pulmonary function tests (PFTs) are normal, with the exception of flattening of the inspiratory loop, which is diagnostic of extra-thoracic airway compression. Fiberoptic laryngoscopy shows paradoxical inspiratory and/or expiratory partial closure of the vocal cords. Vocal cord dysfunction is treated with speech therapy, breathing techniques, reassurance, and breathing a helium-oxygen mixture (heliox).

Question 4

What headache type is always unilateral?

Answer 4

Cluster headaches

Question 5

What risk factors are associated with macular degeneration?

Answer 5

Smoking and HTN

Question 6

What is the primary treatment for OSA in non-obese children?

Answer 6

Adenotonsillectomy - age 2-8 years old is the peak growth of tonsils and adenoids so this is when children are at greatest risk

Question 7

When should tinnitus prompt consideration for a brain MRI?

Answer 7

If it is unilateral, pulsatile, or associated with asymmetric hearing loss