EENT Clinical Clin Med Exam 2
Questions with Answers
A 70-year-old woman with long-standing type 2 diabetes mellitus presents due to pain in
the left ear along with purulent drainage. On physical examination, the patient is
afebrile. The pinna of the left ear is tender, and the external auditory canal is swollen
and edematous. The white blood cell count is normal.
What organism is most likely to grow from purulent discharge - Answer-Pseudomonas
aeruginosa
A 22-year-old woman presents due to clogging of the right ear, hearing loss, dizziness,
ringing of the ear, and ear pain. She was scuba diving in Florida last week. A thorough
ear exam was conducted. The eardrum appears slightly pushed outward from where it
normally sits. Laboratory results showed no abnormal findings.
most likely explanation? - Answer-barotrauma
A 52-year-old man presents with a burning sensation in both eyes. He denies recent
trauma and contact with individuals who have similar symptoms. On examination, his
eyelid margins are red and inflamed. His eyelashes are greasy and adherent with a
surrounding dandruff-like scale. Conjunctivae are clear.
Most likely diagnosis? - Answer-Blepharitis
A 78-year-old woman presents with behavioral changes over the past few months. Her
daughter feels that her mother is depressed, as she talks less frequently with her family
members. She was a regular at various social gatherings, but the patient has been
avoiding them lately due to some difficulty in communication. She has been spending
more time painting portraits and has been watching television at a higher volume than
usual. She has no suicidal thoughts. She is well oriented to time, place, and person; her
mood today seems good. Ear examination and tests indicate sensorineural hearing
loss. The rest of her physical examination is within normal limits.
What is the best initial step to pursue? - Answer-hearing aids
A 24-year-old man with no significant past medical history presents with a 3-month
history of progressive hearing loss of his left ear. He states that he has the greatest
difficulty in hearing high-pitched sounds. He denies trauma, recent travel, sick contacts,
pressure changes, headache, nausea, otorrhea, otalgia, fever, chills, vertigo, swollen
glands, rashes, sore throat, vision changes, or rhinitis. He states that he enjoys listening
,to music on his personal music device and attends concerts frequently. An otoscopic
speculum exam reveals no observable abnormalities.
What diagnostic test would be most helpful in identifying the cause of the patient's
hearing loss at this time? - Answer-Weber test
A 9-year-old girl presents with a sore throat. The mother states that she began to run a
fever a few days ago, and she complained that her throat hurt. On physical exam, you
note a red throat, a red and beefy tongue, tonsillar exudates, and swollen anterior
cervical lymph nodes. It is noted in the patient's records that she has had a severe
anaphylactic reaction to penicillin.
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 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)
