Opthalmology and Otorhinolaryngology (HEENT)

Question 1

Blepharitis vs hordeolum definition

Answer 1

Inflammation of the eyelid margin vs localized abscess of the eyelid margin, both are painful

Question 2

Steps of management of a globe rupture (3)

Answer 2

1) rigid eye shield to protect eye from applied pressure, impaled objects should be left undisturbed
2) IV antibioitics and tentanus prophylaxis if needed
3) Emergent opthalmology consult

Question 3

Antibiotics to give in the case of an orbital floor blow out fracture

Answer 3

augmentin or clindamycin

Question 4

Retinoblastoma definition

Answer 4

Most common primary intraocular malignancy in childhood, most diagnosed before 3 years of age almost found exclusively in children, presents with leukocoria (presence of abnormal white reflex instead of normal red reflex), may develop strabismus or nystagmus, fatal if untreated by 95% survive if treated properly

Question 5

Most common cause of permanent legal blindness and vision loss in older adults

Answer 5

Macular degeneration

Question 6

2 types of macular degeneration

Answer 6

Dry (atrophic) - most common type, progressive over decades, drusen bodies (small white yellow spots on outer retina representing localized deposits)
Wet (neovascular or exudative) - less common but much more aggressive within months new abnormal vessels causing retinal hemorrhage and scarring

Question 7

Side effect of PDE5 inhibitors such as sildenafil

Answer 7

Blue tinted vision

Question 8

Macular degeneration diagnosis

Answer 8

Fundoscopy, fluorescin angiography, amsler grid

Question 9

Most common cause of new permanent vision loss in 20-74 year olds

Answer 9

Diabetic retinoapthy

Question 10

Diabetic retinopathy preventative screeing

Answer 10

Annual eye exam in diabetics

Question 11

Management of retinal detachment

Answer 11

Keep patient supine with head turned toward side of detachment and immediately consult opthalmology

Question 12

Causes of neonatal conjunctivitis based on timeline and management of each respective form

Answer 12

Day 1 - chemical conjunctivits (artificial tears)
Day 2-5 - Gonococcal (IM or IV ceftriaxone once infection as occurred, topical erythromycin drops are used prophylactically to prevent)
Day 5-7 - Chlamydia (oral erythromycin)

Question 13

Treatment for contact wearer conjunctivits or corneal abrasion

Answer 13

Topical cipro or ofloxacin drops (cover pseudomonas)

Question 14

First line management of ocular chemical burns

Answer 14

Copious irrigation till a neutral pH is achieved with lactated ringers or normal saline

Question 15

Strabismus definition and first line treatment

Answer 15

Misalignment of one or both eyes either esotropic (convergent) or exotropic (divergent), first line treatment is occlusive patch therapy

Question 16

What distinguishes periorbital cellulitis from orbital cellulitis

Answer 16

Absence of proptosis, ocular pain with EOM

Question 17

Clinical manifestations of uveitis and how is it managed?

Answer 17

Unilateral severe ocular pain and photophobia, eye redness, tearing, blurred or decreased vision, constricted pupil
Managed with topical glucocorticoids

Question 18

Most common cause of blindness in the world

Answer 18

Cataracts

Question 19

Papilledema diagnosis and management

Answer 19

Fundoscopy followed by MRI or CT to rule out mass effect followed by LP

Managed with acetazolamide to decrease CSF production, and treating underlying causes

Question 20

Side effect of ethambutol

Answer 20

Optic neuritis

Question 21

Optic neuritis maangement

Answer 21

IV methylprednisolone followed by oral corticosteroids

Question 22

Marcus gunn pupil definition

Answer 22

Affected eye pupils appear to dilate during swinging flashlight test

Question 23

Treatment of acute narrow angle closure glaucoma

Answer 23

Timolol, pilocarpine, PO or IV acetazolamide

Question 24

How does glaucoma vision loss present (either acute or chronic)

Answer 24

Peripheral vision loss (tunnel vision) initially. Acute is very painful while chronic is painless

Question 25

Management of chronic open angle glaucoma

Answer 25

Prostaglandin analogs like latanoprost, timolol, acetazolamide

Question 26

Treatment of otitis externa

Answer 26

Cipro or ofloxacin topical drops

Question 27

Most common cause of otitis externa, most common cause of malignant necrotizing otitis externa

Answer 27

Pseudomonas in both cases

Question 28

Treatment of malignant necrotizing otitis externa

Answer 28

Admission plus IV ciprofloxacin

Question 29

Chronic otitis media definition

Answer 29

Recurrent or persistent infection of the middle ear in the presence of tympanic membrane perforation >6 weeks, most often pseudomonas, sees persistent or recurrent purulent otorrhea, may have a cholesteatoma, requires topical antibiotic drops first line like ofloxacin or cipro

Question 30

Most common cause of acute otitis media

Answer 30

Strep pneumoniae

Question 31

Treatment of acute otitis media

Answer 31

Amoxicillin drug of choice, alternatives include augmentin, azithromycin

Question 32

Serous otitis media with effusion definition

Answer 32

Middle ear fluid with no signs or symptoms of inflammation like fever ear pain or erythema or bulging of TM, may see after resolution of acute otitis media or in patients with eustachian tube dysfunction, TM is retracted or flat and has hypomobilitiy with insufflation, observation is required in most cases

Question 33

Caloric testing

Answer 33

Cold water causes the eyes to look toward the side of the drop, beats of nystagmus therefore occur opposite. Warm water causes eyes to look away the side of the drop, beats of nystagmus therefore occur same side.

Question 34

Sensorineural hearing loss will lateralize to the __ ear and have a ____ rinne result, while conductive will lateralize to the ___ ear and have a ____ rinne result

Answer 34

Normal, normal (AC>BC), affected ear, abnormal (BC>AC)

Question 35

Most common cause of conductive hearing loss, most common cause of sensorineural

Answer 35

Cerumen impaction, presbycusis

Question 36

What drug class should be absolutely avoided when there is a TM rupture

Answer 36

Topical aminoglycosides as they are notoriously ototoxic

Question 37

Cholesteatoma presentation

Answer 37

Painless otorrhea, may perforate TM, brought on by abnormal keratinized collection of epithelium in middle ear, surgical excision is treatment

Question 38

Peripheral vs central vertigo signs

Answer 38

Peripheral has horizontal nystagmus that is fatigable, central has vertical that is nonfatigable and positive other CNS signs

Question 39

Differences between benign positional vertigo, meniere, vestibular neuritis, and labrynthitis

Answer 39

BPPV - episodic vertigo no hearing loss Meniere's - episodic vertigo plus hearing loss Vestibular neuritis - continuous vertigo, no hearing loss Labyrinthitis - continuous vertigo and hearing loss

Question 40

BPPV diagnosis and treatment

Answer 40

Dix halpike producing fatigable horizontal nystagmus, treated with epley maneuver

Question 41

Vestibular neuritis and labrynthitis treatment

Answer 41

Glucocorticoids and symptomatic relief such as antihistamines (meclizine)

Question 42

Meniere's disease treatment

Answer 42

Initial is dietery modifications, if no relief, antihistamines like meclizine, anticholinergics such as scopolamine, or diuretics such as HCTZ

Question 43

Unilateral sensorineural hearing loss is ___ until proven otherwise, how is that diagnosed (2)?

Answer 43

acoustic neuroma (benign tumor), MRI imaging and audiometry lab testing

Question 44

Antibiotic of choice for acute rhinosinusitis

Answer 44

Augmentin

Question 45

Fungal infection of the sinuses (most often seen in DM or immunocompromised patients) treatment

Answer 45

IV amphotericin B and surgical debridement 1st line

Question 46

Most common cause of infectious rhinitis

Answer 46

Rhinovirus

Question 47

Treatment of nasal polyps that are often caused by allergic rhinitis

Answer 47

Intranasal glucocorticoids

Question 48

Most common source of anterior epistaxis and most common source of posterior

Answer 48

Kiesselbach plexus, sphenopalatine artery brancehs and woodruff's plexus

Question 49

Management of anterior epistaxis

Answer 49

- Direct pressure, leaning forward - cauterization or silver nitrate - nasal packing

Question 50

Management of posterior epistaxis

Answer 50

-Balloon catheters

Question 51

Most common bacterial source of acute pharyngitis, what is the most common overall cause of pharyngitis

Answer 51

Group A strep, viral

Question 52

Anterior cervical lymphadenopathy is more suggestive of ___, while posterior is more suggestive of ___

Answer 52

strep pharyngitis, mono

Question 53

1st and 2nd line medications for strep throat

Answer 53

PCN, if allergic then macrolides

Question 54

Oral lichen planus definition

Answer 54

Idiopathic autoimmune response affecting skin and mucus membranes, reticular leukoplakia of oral mucosa most common form, diagnosed mainly clinical but biopsy can be performed to rule out malignancy, treated with local glucocorticoids

Question 55

Ludwig's angina description

Answer 55

Tender, symmetric swelling woody induration and erythema of the upper neck and chin

Question 56

Ludwig angina initial test of choice for diagnosis

Answer 56

CT scan

Question 57

Painless erythematous soft velvety patch in the oral cavity might be erythroplakia, what is that?

Answer 57

Uncommon oral lesion with high risk of malignancy, 90% are cancerous, biopsy required to rule out squamous cell carcinoma

Question 58

Most common agent causing acute bacterialsialadenitis

Answer 58

S Aureus

Question 59

Oral hairy leukoplakia definition

Answer 59

Mucocutaneous manifestation of epstein barr virus seen in HIV infected patients or other severe immunocompromised states, have painless, white, smooth hairy plaque on the lateral tongue border or buccal mucosa that cannot be scraped off, may resolve on its own and doesn't need specific treatment