HEENT ROSH REVIEW | Questions & Answers (100 %Score) Latest Updated 2024/2025
Comprehensive Questions A+ Graded Answers | With Expert Solutions
A 28-year-old woman presents with intense pain, tearing, and ocular foreign body
sensation in both eyes that began yesterday. She denies any trauma, past medical
problems, or contact lens use and reports that she works as ski patrol for a local resort.
Her physical examination is significant for bilateral decreased visual acuity, injected
conjunctiva, and diffuse punctuate corneal lesions with a discrete superior border. Her
pupils are equal, round, and reactive to light. Given this patient's clinical presentation,
which of the following is the most likely diagnosis? - Ultraviolet ketartitis
What is another name for ultraviolet keratitis and how is it caused? - This patient has
ultraviolet keratitis, also known as snow blindness. This is a radiation burn that occurs
when an individual comes in close contact with an ultraviolet-ray-containing light source.
It may be caused by sun lamps, tanning booths, or exposure to intense reflected
sunlight, particularly in high-altitude environments
How will flouresence staining present with ultraviolet keratitis? - Fluorescein staining
reveals superficial punctate epithelial surface irregularities, which usually cover the
entire surface of the cornea. This condition is usually referred to as superficial punctate
keratitis (SPK)
What is the treatment for ultraviolet keratitis? - Treatment consists of flushing the eye for
several minutes with water or saline solution and prescribing a short-acting cycloplegic
agent for pain management. The use of ophthalmic antibiotics has not been shown to
improve healing. While oral pain medications are often needed, topical anesthetics
should be avoided due to an increased risk of corneal ulceration.
What is episcleritis and how is it caused? - Episcleritis (B) is a common, benign
inflammatory condition of the episclera and most often occurs in young adults. It is
usually idiopathic but may be associated with systemic conditions such as diabetes
mellitus, systemic lupus erythematosus, rheumatoid arthritis, and inflammatory bowel
disease. Patients typically complain of a foreign body sensation, mild pain, photophobia,
and lacrimation. The condition is usually self-limiting.
What is iritis? - Iritis (C), also known as anterior uveitis, is an inflammation of the
anterior portions of the uvea (iris, ciliary body, and choroid). It is often idiopathic but may
be associated with systemic diseases such as rheumatoid arthritis, sarcoidosis, Reiter
syndrome, and tuberculosis.
How do cycloplegics work? - They relax ciliary muscle spasm and prevent contraction of
the iris, reducing pupillary photoresponse.
, What is leukoplakia? - Leukoplakia is a premalignant white patch or plaque that may
eventually progress to an ulcer or mass. It is a pre-malignant oral lesion. The biggest
risk factors are tobacco and alcohol use.
If oral leukoplakia is persistent for more than 2 weeks what is required? - If oral
leukoplakia persists for more than 2 weeks, biopsy and treatment is required.
What is the 5-year survival rate for oral cancer? - 50-55%.
The histopathologic findings of this disease includes endolymphatic hydrops, which is
thought to be caused by either overproduction or underresorption of endolymph in the
inner ear. - Meniere's disease
What percentage of vertigo is due to central vestibular etiologies? - Less than 10%
What is the treatment for menieres disease? - Vestibular rehabilitation, low-salt diet,
HCT, surgery
What is the treatment for a subconjunctival hemmorrage? - Reassurance and follow up
What is the cause of a subconjunctival hemmorrhage? - Subconjunctival hemorrhage
results from rupture of small subconjunctival blood vessels. It is thought to occur from
trauma or Valsalva maneuvers (e.g. coughing) although patients often have no memory
of an inciting event.
What history with subconjunctival hemorrhage would prompt investigation into a
bleeding diathesis? - Bilateral or recurrent subconjunctival hemorrhage should have a
bleeding diathesis workup.
What is the cause of mastoiditis? - This patient has acute mastoiditis, an infection of the
mastoid air cells that usually results from extension of untreated or inadequately (as in
this case) treated otitis media.
What are the symptoms of mastoiditis? - Patients typically present with fever, chills,
postauricular (mastoid) erythema and tenderness, and discharge from the external
auditory canal. It is critical to identify and treat mastoiditis because untreated mastoiditis
can progress to meningitis, encephalitis, sinus thrombosis, brain abscess, facial nerve
palsy, and sepsis.
What imaging is required to confirm the diagnosis of mastoiditis? - A contrast-enhanced
CT scan of the head with inclusion of the petrous portion of the temporal bones should
be obtained to confirm the diagnosis (primarily through visualization of fluid in the
mastoid air cells) and identify the presence of any complications.
