Ophtho / HEENT

Question 1

Signs of Globe Rupture

Answer 1

RAPD
Asymmetric Pupil
Seidel Sign
Extrusion of Vitreous
Uveal Prolapse

Question 2

Mgmt of Globe Rupture

Answer 2

Urgent Ophthalmology Consult
Shield eye
Elevated head of bed
Antiemetic
Analgesia
Tetanus + ABx - Vanco + Ceftazadime

Question 3

Management of Chemical Burns (Acid and Base)

Answer 3

Copious irrigation - at least 30 mins with Morgan lens
Irrigate until pH. = 7.0
Topical anesthetic and fluorescein slit lamp
If no globe rupture: Test IOP (can be elevated in
- If elevated treat with acetazolamide

Question 4

Eye Exam Basics

Answer 4

Visual Acuity
External Eye, lids / lashes
EOMs
Pupils (reactivity, RAPD)
Pressure (IOP)
Slit Lamp / Fundoscopy

Question 5

Vertigo: Posterior Canal Nystagmus Pattern?

Answer 5

Upward and rotatory bilaterally

Question 6

Vertigo: Terrible D’s (5)

Answer 6

Dysarthria
Diplopia
Dysphagia
Dysmetria
Dysphonia

Question 7

Define AOM and Mgmt

Answer 7

Infection of the inner ear leading to:
Bulging tympanic membrane, otalgia, erythema, fever
Mgmt: Kids - if sick appearing highdose amox divided TID (80-90 mg/kg/day)

RF: Facial structure abnormality, young age, bottle feeding, smoking in home, previous hx, siblings with AOM

Question 8

Complications of AOM

Answer 8

Intratemporal:
Ruptured TM / hearing loss
Ossicular erosions
Retraction pocket
Balance and motor isssues
Cholesteatoma
Mastoiditis

Intracranial:
Meningitis
Epidural abscess
Sinus thrombosis
Subdural empyema
Carotid artery thrombosis

Question 9

Complications of Otitis Externa

Answer 9

-Necrotizing Otitis externa
- Infection through canal floor of meatus via fissures of Sanotrini. Can lead to skull-base osteomyelitis
- Cranial nerve palsies

Question 10

What is Ramsay-Hunt Syndrome (and it’s Management)

Answer 10

Zoster of the 8th cranial nerve (=/- 7th involvement). Herpes Zoster Oticus.
Tx: Analgesia and antivirals
Valacyclovir 1000 mg TID

Question 11

Approach to sudden sensorineural hearing loss (SSNHL). Describe Weber and Rinne tests / meaning

Answer 11

Sudden onset hearing loss - usually in the 40s-50s.
DDx: Cerumen, AOM / OE, stroke, age associated HL
Full CN exam and rule out stroke
Ear exam.
Weber: 512 Hz tuning on middle of forehead. If hear better in the affected ear then its a conductive loss in the affected ear. If heard better in the non-affected ear then a SSNHL in the affected ear.