EENT Clinical Qs Exam 2 Questions with
Answers
Which antibiotic would you use, considering the patient has a PCN allergy? - Answer-
Erythromycin (streptococcal infection)
A 78-year-old Caucasian man presents with unilateral painless loss of vision in the right
eye of 3 hours duration. Examination reveals an elderly man who is anxious but in no
acute distress. Visual acuity is light perception only in the right eye and 20/30 in the left
eye. Pupillary examination is significant for an afferent pupillary defect on the right side.
Penlight examination of the eyes is otherwise unremarkable. Retinal examination of the
right eye reveals a cherry-red spot. Retinal examination of the left eye is unremarkable.
What disease process most likely accounts for the patient's presentation? - Answer-
Central retinal artery occlusion
A 25-year-old man presents to you with an acute otitis media with serous otitis in the
right ear. You perform the Weber and Rinne tests.
what results would you expect? - Answer-Weber—sound is heard louder in right ear;
Rinne—bone conduction exceeds air conduction in right ear
A 48-year-old Caucasian man presents with acute onset of blurring of vision and severe
pain in the left eye that began 30 minutes ago. He notes seeing halos with his left eye.
He is also experiencing nausea and vomiting. These symptoms started at the same
time as the pain. The patient reports that he was relaxing on his porch when the pain
started. His temperature is 36.9°C, pulse 90/min, BP 130/90 mm Hg, and respirations
20/min. Physical examination reveals a shallow anterior chamber, a hazy cornea, a
fixed, moderately dilated pupil, and ciliary injection.
What test might you perform based on your diagnosis suspicion? - Answer-tonometry
(check for IOP- acute angle glaucoma)
A 28-year-old woman with a past medical history of well-controlled asthma presents
with recurrent sneezing episodes, nasal itching, congestion, and headache. Her
physical exam reveals post-nasal drip, a transverse nasal crease, and bilateral
infraorbital cyanosis.
What additional finding might support an allergic etiology of this patient's presentation? -
Answer-pale nasal mucosa
,A 4-year-old boy has had intermittent rhinorrhea, nasal congestion, and cough for about
3 weeks. His mother says he had felt warm at night when his symptoms started, and he
sneezes occasionally. He goes to a large daycare 4 days a week. Otherwise, he has
been healthy except for an occasional dry itchy rash that he has had on and off for "a
long time." Mom has been treating this with OTC moisturizers. On exam, his
temperature is 98.4°F, respirations 24, pulse 86 beats/min. He appears somewhat tired,
with dark circles under his eyes. There is slightly cloudy nasal drainage, turbinates
seem a little boggy, lungs are clear, ears and throat are normal and his neck is supple
without any lymphadenopathy. His skin exam reveals a fine roughened slightly
hyperpigmented maculopapular rash in elbow creases with a few healing excoriations.
Diagnosis? - Answer-allergic rhinitis
A 3-day-old female newborn presents at your outpatient clinic with rapidly progressing
bilateral conjunctivitis with white discharge. She was born full-term via precipitous
vaginal delivery; her mother had no prenatal care. On exam, she is alert and active. The
eye discharge is purulent and she has bilateral eyelid edema.
Next treatment step? - Answer-admit for IV antibiotics (N. gonorrhoeae conjunctivitis
possible)
An 18-year-old girl has had a small slightly tender swelling in her left upper eyelid for 10
days. For the first day or two, it was red and a little painful. Now it is painless, but it has
grown in size. There has not been any drainage, visual changes, or itching noted. She
has been well otherwise. On exam, vitals are normal, extraocular muscles are intact,
and pupils are equal and reactive to light. Her left upper eyelid has a 1.5 cm round non-
tender swollen mass that is mildly erythematous without any drainage. The underside of
the lid is grayish-red.
diagnosis? - Answer-Chalazion
A 64-year-old African American man presents to the emergency department after he
went blind in his right eye "out of the blue" 20 minutes ago. There is no pain associated
with his symptoms and he is not nauseated. Past medical history is positive for type 2
diabetes mellitus for the past 10 years. The pupil reaction on the left side is normal with
pressure of 17 mm Hg. Right pupil evaluation reveals no reaction to light or
accommodation with pressure of 20 mm Hg. Right eye ophthalmoscopy reveals
arteriolar narrowing, vascular stasis, and "boxcar" pattern.
A 42-year-old man presents with a 4-day history of worsening headache, stuffy nose,
and clear-to-green nasal discharge. He admits to facial pain and a dry cough. He denies
shortness of breath, abdominal pain, nausea, or vomiting. He is a non-smoker, has no
significant past medical history, and is only taking acetaminophen. On exam, he has a
slight fever of 99.2°F taken orally, pulse 86/min, BP 120/76 mm Hg left arm sitting, and
SPO2 94% on room air. Lungs are clear and abdomen normal. Nasal mucosa appears
, boggy, and there is tenderness with palpation over the facial bones (maxillary area).
Pharynx is without exudates.
Which organism is most likely the cause of his symptoms? - Answer-Rhinovirus
(acute viral rhinosinusitis)
A 42-year-old man presents with a 10-day history of worsening headache, stuffy nose,
greenish nasal discharge, and a low grade fever. He has body aches and facial pain, as
well as a dry cough. He denies shortness of breath, abdominal pain, nausea, or
vomiting. He is a non-smoker, has no significant past medical history, and is only taking
acetaminophen. On exam, he has a temperature of 100.9°F taken orally. Pulse is
86/min, BP is 120/76 mm Hg left arm sitting, and SPO2 is 94% on room air. Lungs are
clear and abdomen normal. Nasal mucosa appears boggy, and there is tenderness with
palpation over the facial bones (maxillary area). Pharynx is without exudates.
What component of the history is the most informs your decision to prescribe antibiotics
for this patient? - Answer-Length of time the symptoms have been present
A 19-year-old woman presents with a painful sore in her mouth that has been present
for 3 days. She denies oral trauma. She describes a single painful lesion that feels like a
bump between her cheek and gum line. She has not tried any treatments at home. She
denies history of similar lesions. She has otherwise been feeling well and denies recent
flu-like symptoms.
Her past medical history is unremarkable, with no known medical conditions or history
of surgery; she takes no medications and has no allergies. She lives in an apartment
with her boyfriend; she works at a convenience store; and she denies the use of
alcohol, tobacco (including chewing tobacco), and recreational drugs.
On physical exam, her vitals are normal. A single tender lesion is identified on the
buccal mucosa, just across from the lower right jaw. It is a small shallow ulcer
approximately 3 mm diameter with a yellow-gray center surrounded by a red - Answer-
topical corticosteroids
(aphthous ulcer)
A 4-year-old boy presents with a 4-day history of frequent sneezing, noticeable
congestion, nasal discharge, and irritability; his mother has a history of airborne
seasonal allergies and believes her son may have a problem with his sinuses. The
mother denies noticing any shortness of breath, problems breathing, or fever; the boy
has not been in close contact with sick individuals in the last few weeks. Physical
examination reveals unilateral purulent nasal drainage from the left nare and a foul
odor.
Diagnosis? - Answer-Nasal foreign body
