EENT

A patient presents with eye pain and blurred vision. Snellen testing reveals vision of 20/200 in the affected eye and 20/20 in the unaffected eye. Fluorescein staining reveals the presence of a dendritic ulcer. Which of the following is the most likely diagnosis?

Viral keratitis (HSV)

You are evaluating a 67 year-old Asian male in the emergency room for acute onset right eye pain. He states he was at the evening premier of a newly released movie when the pain started. He had acute, profound visual loss in the affected eye. The pain was intense enough for him to leave the theatre before the movie's conclusion, and present to your location. On examination, the eye appears injected (red) and the cornea appears hazy. His pupils are 6 mm on the affected side and 3 mm on the unaffected side. They respond to light on the unaffected side but not on the affected side. On palpation, the globe feels tense. What history question is most relevant to support the diagnosis?

Visualizing halos around street lights (Primary acute angle-closure glaucoma)

A 23 year-old graduate student presents with sudden onset of severe dizziness, with nausea and vomiting for the past couple of hours. She denies hearing loss or tinnitus. She has had a recent cold. Which of the following is the most likely diagnosis?

Vestibular neuronitis

Which of the following is the most common cause of adult blindness in the USA?

Diabetes mellitus

Which of the following is the leading cause of permanent visual loss in a patient over the age of 75?

Macular degeneration

Closure of the eyelids is mediated by which cranial nerve?

cranial nerve VII

In infants, the eyes should move in parallel without deviation by the age of

6 months

At what age does the first tooth usually erupt in an infant?

6-8 months

A 16 year-old male involved in a fight sustained a laceration to his right upper eyelid. He is unable to open his eye, and a possible laceration of the globe is suspected. Which of the following is the next step?

Apply a metal eye shield and refer to an ophthalmologist

A 19 year-old college student complains of a sore throat for over a week, with fever and general malaise. On exam T- 38 degrees C, P-70/minute, RR-20/minute, BP-110/76 mmHg. The skin is warm, dry, and without rash. The TMs have a normal light reflex and the canals are clear. The oropharynx is inflamed, with bilaterally enlarged tonsils, and a small amount of exudate. The neck is supple, with anterior cervical adenopathy. The abdomen is soft, nontender and a spleen tip is palpable. The labs reveal a negative rapid strep screen and positive heterophil antibody. The WBC count is 9,000/microliter with a differential of 40% atypical lymphocytes, 35% lymphocytes, 5% monocytes, 10% eosinophils, and 10% neutrophils. Which of the following is the most appropriate treatment?

Acetaminophen (mono)

A 19 year-old college student complains of a sore throat for over a week, with fever and general malaise. On exam T-38°C P-70/minute R-20/minute BP-110/76 mmHg. The patient is alert and oriented x 3. The skin is warm, dry, and without rash. The TMs have a normal light reflex and the canals are clear. The oropharynx is inflamed, with bilaterally enlarged tonsils, and a small amount of exudate. The neck is supple, with anterior cervical adenopathy. The lungs are clear. The heart has a regular rhythm without murmurs. The abdomen is soft, nontender and a spleen tip is palpable. The labs reveal a negative rapid strep screen and positive Monospot. The WBC count is 9,000/microliter with a differential of 40% atypical lymphocytes, 35% lymphocytes, 5% monocytes, 10% eosinophils, and 10% neutrophils. Which of the following is the most appropriate treatment?

Acetaminophen (mono)

A 56 year-old female presents complaining of intense left eye pain associated with unilateral headache, nausea, and colored rings around lights. On examination you note decreased visual acuity, a pupil that is fixed and mid-dilated, and ciliary flushing. Which of the following is the most likely diagnosis?

Acute glaucoma

A 64 year-old woman complains of headache and left eye pain for about a day. She says it started yesterday as a dull ache and now is throbbing. She also complains of nausea and vomiting, which she attributes to the popcorn she ate at the movie theater yesterday afternoon. On exam, the left pupil is mid-dilated and nonreactive. The cornea is hazy. A ciliary flush is noted. Which of the following is the most likely diagnosis?

Acute glaucoma

A patient presents complaining of gradual hearing loss over the past 3 months. He admits to use of Q-tips and otherwise does not wear ear plugs or place other foreign objects in his ear. On examination external auditory canals are obstructed with cerumen. After removal of cerumen, hearing is equal on both sides. Appropriate counseling of this patient includes which of the following?

Advise him to discontinue use of cotton swabs

Which of the following would indicate an optic nerve lesion?

Afferent pupillary defect

In addition to tobacco products, which of the following is also considered a major risk factor in the development of oral cancer?

Alcohol abuse

A patient presents complaining of left eye discharge and eyes that were matted shut this morning. The patient denies changes in visual acuity, but states that he is afraid to put his contacts in. On physical examination you note erythematous conjunctivae and mucopurulent discharge of the left eye. The cornea is clear. Which of the following topical agents is the treatment of choice in this patient?

Aminoglycoside (Tobrex)

A 2 year-old female presents with purulent nasal discharge bilaterally with fever and cough for several days. Her mom had taken her out of daycare for a similar occurrence 2 months ago, that was treated with Amoxicillin. Exam further reveals halitosis and periorbital edema. Treatment should be initiated with which of the following?

Amoxicillin-clavulanate (Augmentin) (bacterial sinusitis)

An otherwise healthy college student presents with complaints of cough, malaise, fever, yellow-green nasal discharge and headache for the past 3 weeks. She complains of facial pain over the cheeks and while chewing. On examination, the nasal turbinates are erythematous and edematous nearly obstructing the nares bilaterally. She has not been previously evaluated. What is the most appropriate antibiotic in this patient?

Amoxicillin/clavulanate (Augmentin)(Acute bacterial rhinosinusitis (sinusitis))

A 33 year-old presents with sinusitis unresponsive to three various antibiotics over the past four months. Sinus puncture is performed with culture positive for Aspergillus fumigatus. What is the most appropriate treatment for this patient?

Amphotericin (Amphotericin B)

A 72-year-old male presents with progressive bilateral loss of central vision. This has made driving difficult, and often finds himself needing a bright light to look at objects. He reports that his peripheral vision is intact. When looking at a specific region at line grid, he reports a dark "spot" in the center, with bent lines. Dilated ophthalmic examination is shown here. What is the most likely diagnosis?

Atrophic (dry) macular degeneration

A patient presents with complaint of sudden onset of recurrent episodic vertigo for one week that happens when rolling onto the left side. The patient states that this sensation lasts approximately 30 seconds and then goes away. The patient admits to associated nausea. The patient denies associated hearing difficulties or tinnitus. Which of the following is the most likely diagnosis?

Benign positional vertigo

Lesions of the optic chiasm will produce which of the following conditions?

Bitemporal hemianopia

Which of the following is most helpful in the diagnosis of a retropharyngeal abscess?

CT of the neck with contrast

A 26 year-old male presents with headache, sinus pressure, and sinus congestion for over a month. He has a thick nasal discharge in the mornings, but this improves as the day goes on. He is afebrile. On exam, there is tenderness over the face. TMs have normal light reflex. Nasal mucosa reveals thick yellowish discharge. Neck is supple, without lymphadenopathy. Which of the following is the diagnostic study of choice?

CT scan of sinuses

In a patient with amaurosis fugax what is the most appropriate initial diagnostic study?

Carotid ultrasound

A 66 year-old male presents complaining of 6 month history of progressive blurred vision without associated pain. On examination there is no erythema or injection of the sclera. On funduscopic examination there is an absent red reflex and a cloudy lens. Which of the following is the most likely diagnosis?

Cataract

A patient presents with a nontender, painless, nodule involving a meibomian gland. Which of the following is the most likely diagnosis?

Chalazion

A 4 year-old child presents with a rapid onset of high fever and extremely sore throat. Which of the following findings are suggestive of the diagnosis of epiglottitis?

Croupy cough and drooling

A 24 year-old patient presents after a recent vacation. He complains of left ear pain. Physical examination reveals an inflamed external auditory canal and the tympanic membrane can not be visualized. Which of the following is the most appropriate treatment?

Ciprodex otic drops(OE)

A 35-year-old patient has recurrent seasonal rhinitis and a history of mild asthma. Which of the following should be included for first-line management?

Corticosteroid inhalers

A patient with history of hypertension and dyslipidemia presents for routine follow up. On funduscopic examination you note moderate sized fluffy white lesions with irregular borders. This is most consistent with which of the following?

Cotton-wool patches

Small grayish vesicles and punched-out ulcers in the posterior pharynx in a child with pharyngitis is representative of which organism?

Coxsackievirus

A 34 year-old female presents with recurrent bouts of dizziness, tinnitus, and hearing loss. She states that the episodes are incapacitating and cause her to become nauseous and vomit. The attacks last about one hour and the symptoms disappear after a few days. The last two episodes were treated with meclizine (Antivert) and prochlorperazine (Compazine) at the emergency room. Audiologic testing reveals low-tone frequency hearing loss. Which of the following is the most appropriate long-term management for this patient?

Diuretics and low-sodium diet (Meniere's disease)

A 23 month-old male presents to the office with his father who reports the patient has had an acute onset of severe pharyngitis, fever of 103.5 degrees F and what sounds like harsh, high-pitched breath sounds. His dad states the child has started drooling and seems to be worsening. The child is not presently crying but has muffled voice sounds. The child has not been immunized due to religious reasons. What is the most appropriate next step?

Emergent transfer

A 35 year-old patient presents with a sudden onset of fever, dysphonia, drooling, and difficulty drinking a few hours ago. Physical examination reveals a temperature of 102 degrees F. The patient appears ill and is sitting forward. Inspiratory retractions are noted and there is a soft stridor. Which of the following is the most likely diagnosis?

Epiglottitis

A 75 year-old woman presents to the office with complaint of vision loss. Examination reveals a palpable cord in the temporal region. Which of the following is the most helpful initial test to order on this patient?

Erythrocyte sedimentation rate (temporal arteritis)

Which of the following is a staphylococcal infection characterized by a localized red swollen and acutely tender abscess of the upper or lower eyelid?

Hordeolum

A patient presents with acute eye pain and photophobia after putting in his contact lens. The patient states he removed his contact which he noted to be torn. Which of the following is the diagnostic study of choice in this patient?

Fluorescein staining

An 18 year-old college student took her goggles off in the chemistry lab while she was washing her glassware from an experiment she had just completed. She thinks the beaker had contained sodium hydroxide, and it splashed into her right eye. She rinsed her eye out for about five minutes in the lab. Which of the following is the most appropriate first step?

Flush the eye with two liters saline

Use of systemic corticosteroids can cause which of the following adverse effects in the eye?

Glaucoma

During a baseball game, a 22 year-old college student is hit in the right eye by a baseball. He complains of blurry vision in that eye. On physical exam, the physician assistant notes proptosis of the right eye, and limitation of movement in all directions. On CT scan, which of the following is most likely to be seen?

Hematoma of the orbit

A 67 year-old African American male presents for a new patient evaluation. History reveals an aphasic CVA which limits his history. Funduscopic examination reveals an abnormal vessel light reflex described as a silver or copper- wire appearance. Where the vessels intersect, there appears to be some nicking. He has no carotid bruits, and his cardiac exam is normal. What is the most likely cause of his ocular findings?

Hypertensive retinopathy

A 32 year-old female presents complaining of spiking fevers. She was seen four weeks ago with a complaint of left ear pain and was treated for otitis media. She continues to have symptoms, but now has pain behind the ear. On examination you note left post auricular tenderness and erythema. Which of the following is the treatment of choice in this patient?

IV antibiotics (mastoiditis)

A 17 year-old male is accidentally struck in the right eye while playing football and is immediately transported to the hospital. In the emergency room, he complains of severe pain behind the eye as well as double vision. On examination, he has exophthalmos, cannot move his right eye upward and blood is noted in the anterior chamber. Which of the following is the most appropriate course of action at this time?

Immediately refer the patient to an ophthalmologist (blowout)

A 20-year-old presents 30 minutes after being struck by a hockey puck in the mouth. On physical examination, a central incisor is missing from its socket. The patient has the tooth wrapped in tissue paper and the root appears intact. Which of the following is the most appropriate next step in the treatment of this patient?

Immediately reimplant the tooth and refer to an oral surgeon

A 9 year-old patient presents for follow up of his allergic rhinitis symptoms. He continues to complain of nasal congestion, sneezing, rhinorrhea, and eczema despite avoidance therapy and treatment with oral cetirizine (Zyrtec) and nasal flunisolide (Nasarel). Examination reveals pale, boggy nasal mucosa and eczema of the face and lower extremities. Which of the following is the most appropriate treatment at this time?

Immunotherapy

A 4 year-old boy presents with pain and irritation of his left ear. Otoscopic examination reveals an insect in the left auditory canal. The tympanic membrane is not completely visualized. Which of the following is the most appropriate management of this patient?

Insertion of 2% lidocaine solution with suction or forceps removal

What is the most common location of anterior nasal epistaxis?

Kiesselbach's triangle

A 45 year-old smoker presents with a sore mouth and increasing difficulty eating for two weeks. Physical examination reveals a 1 cm white lesion on the buccal mucosa that cannot be rubbed off. Which of the following is the most likely diagnosis?

Oral cancer

A 58 year-old patient presents with spells of dizziness which is described as a spinning sensation. This has occurred several times a day for the last month. The patient also complains of some mild hearing loss, fullness, and a blowing sound in the right ear. Which of the following is the most likely diagnosis?

Meniere's syndrome

A 6-year-old previously healthy boy is brought to the emergency department for right ear pain. His mother states he has been pulling at his ear for the past 2 days and has complained of discomfort. She states he felt warm but has not taken his temperature. His birth history is unremarkable and he has no significant medical history. His temperature is 100.4°F (38.0°C), blood pressure is 94/54 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding seen here. Which of the following is the most likely etiology of this patient's symptoms?

Moraxella catarrhalis (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common causes)

A 52 year-old female presents with complaints of intermittent episodes of dizziness, tinnitus, and hearing loss in the right ear for 6 months. She describes the dizziness as the "room spinning around her," with the episodes typically lasting for 2 to 4 hours. Physical examination reveals horizontal nystagmus and right ear hearing loss, but the remainder of the examination is unremarkable. Which of the following is the most likely diagnosis?

Ménière's syndrome

A 12 year-old presents with complaint of both eyes "watering." He also complains of sinus congestion and sneezing for two weeks. On exam vital signs are T-38°C, P-80/minute, and RR-20/minute. The eyes reveal mild conjunctival injection bilaterally, clear watery discharge, and no matting. Pupils are equal, round, and reactive to light and accommodation. The extraocular movements are intact. The funduscopic exam shows normal disc and vessels. The TMs are normal and the canals are clear. The nasal mucosa is boggy, with clear rhinorrhea. Which of the following is the most helpful pharmacologic agent?

Naphazoline (Naphcon-A) drops (allergic conjunctivitis)

A 4 year-old boy presents with purulent, foul-smelling nasal discharge for three days. He has not had any other symptoms of respiratory illness, cough, wheeze, or fever. His activity level and appetite has been normal. On exam, he is afebrile. TM's have normal light reflex, canals are clear. Left nare is clear; there is considerable amount of purulent exudate from the right nare, and a bright reflection of light is noticed. Oropharynx is without inflammation or exudate. Neck is supple, without lymphadenopathy. Lungs are clear, with equal breath sounds and no wheezing. Heart has regular rhythm without murmurs. Which of the following is the most likely diagnosis?

Nasal foreign body

A 22 year-old woman presents with sneezing, runny nose, postnasal drip, and nasal congestion for the last week. She says this happens every spring. She is not allergic to any medications. Which of the following is the most appropriate pharmacologic treatment for this patient?

Nedocromil

A 14 year-old male presents with complaint of worsening sore throat for two weeks. He now complains of fever, difficulty swallowing, and difficulty opening his mouth. The patient's mother states his voice seems muffled. On examination his left tonsil is bulging and the uvula is displaced to the right. Which of the following is the most appropriate management?

Needle aspiration (peritonsillar abscess)

A 33-year-old woman presents to her primary care physician complaining of right jaw pain for the last 3 weeks. She first noticed it while eating a steak dinner but generally feels that it is worse in the morning. She describes the pain as deep and dull, with occasional radiation to the ear and back of her neck. She denies any incidents of jaw locking. The patient also states that her husband has noticed her grinding her teeth in her sleep in the last several months. She has a past medical history of depression, for which she takes fluoxetine, and carpal tunnel syndrome, for which she uses a wrist brace. The patient works as a secretary. Her father passed away from coronary artery disease at the age of 54, and her mother has rheumatoid arthritis. At this visit, her temperature is 98.5°F (36.9°C), blood pressure is 135/81 mmHg, pulse is 70/min, and respirations are 14/min. On exam, there is no overlying skin change on the face, but there is mild tenderness to palpation at the angle of the mandible on the right. Opening and closing of the jaw results in a slight clicking sound. The remainder of the exam is unremarkable. Which of the following is the next best step in management?

Nighttime bite guard (TMJ)

Otitis externa can be differentiated from uncomplicated otitis media by which of the following physical examination findings?

Normal pneumatic otoscopy

A 54 year-old type 2 diabetic male presents for follow up evaluation of previously diagnosed persistent otitis externa. Early in the disease process, a CT scan was obtained secondary to non-improvement on antibiotics. Results showed osseous erosion of the floor of the ear canal. He has been on ciprofloxacin 1000mg twice daily for two months since the CT scan and currently has no further edema, erythema, or exudate from the external auditory canal or surrounding tissue. Which of the following is an appropriate treatment plan?

Obtain gallium scan to ensure reduction of inflammatory process

A 13 year-old presents with pain in his right ear and loss of hearing since yesterday. He has never had an episode like this before. On exam vital signs are T- 38°C P- 70/minute R- 18/minute BP- 90/60 mmHg. Neck is supple, without lymphadenopathy. Right tympanic membrane is not visible; the canal is swollen, with small amount of exudate noted. There is tenderness of the external ear, especially with gentle traction of the tragus. Left tympanic membrane is normal, and the canal is clear. Oropharynx is normal. Which of the following is the most appropriate topical treatment for this patient?

Ofloxacin otic suspension (tympanic perforation.)

Which physical examination finding distinguishes allergic rhinitis from other rhinitis etiologies?

Pale nasal turbinates

In patients with diabetic retinopathy, what clinical intervention is most successful in preserving vision?

Panretinal laser photocoagulation

An 18-year-old sexually active female was seen in the student health clinic 1 week ago for a sore throat. A streptococcal antigen test was positive, and she was given a prescription for oral penicillin. After 3 days, she stopped her medication because she felt better. She now presents with a severe sore throat. On physical examination, she has a temperature of 102.6° F (39.2° C), marked pharyngeal erythema, a medial deviation of the soft palate on the left, tender left anterior cervical adenopathy, and a "hot potato" voice. The rest of her history and physical examination are unremarkable. Which of the following is the most likely diagnosis?

Peritonsillar abscess

Which of the following is described as a harmless triangular nodule in the bulbar conjunctiva on either side of the iris?

Pinguecula

A patient presents complaining of right ear pain and itching. On physical examination you note erythema and edema of the right ear canal with purulent exudate. Palpation of the tragus and manipulation of the auricle is painful. The tympanic membrane is not well visualized. Which of the following is the treatment of choice for this patient?

Polymyxin B-neomycin-hydrocortisone (Cortisporin otic suspension) (OE)

An elderly patient with a history of hypertension presents with epistaxis. On examination you note blood from both nares and down the posterior oropharynx. Examination of the nasal cavity with an ENT headlamp does not show an area of bleeding. Which of the following is the treatment of choice in this patient?

Posterior nasal packing

A 57 year-old male was working on his farm, when some manure was slung hitting his left eye. He presents several days after with a red, tearing, painful eye. Fluorescein stain reveals uptake over the cornea looking like a shallow crater. Which of the following interventions would be harmful?

Pressure patch (abrasion)

A 20 year-old woman presents with a 3-day history of sneezing, watery nasal discharge, and a nonproductive cough. Her throat was sore for the first 2 days, and she now complains of fatigue and difficulty breathing because of her "stuffy nose." Which of the following is most likely to improve this patient's status?

Pseudoephedrine

A blacksmith presents to your clinic after feeling like something went in his eye while he was grinding on a piece of metal. You stain the eye with Fluorescein and can visualize uptake with what appears like a deep abrasion. You are unable to visualize any foreign body with your indirect ophthalmoscope. Although he makes an attempt, he complains of some visual loss in that eye. His last Tetanus booster was 4 years ago. What is the most appropriate next step in the management of this patient?

Refer to ophthalmologist

A 59 year-old male complains of "flashing lights behind my eye" followed by sudden loss of vision, stating that it was "like a curtain across my eye." He denies trauma. He takes Glucophage for his diabetes mellitus and atenolol for his hypertension. He has no other complaints. On funduscopic exam, the retina appears to be out of focus. Which of the following is the most likely diagnosis?

Retinal detachment

You are counseling a newly diagnosed type 2 diabetic about the need for referral to ophthalmology for a dilated funduscopic exam. Which of the following best describes the rationale for referral?

Retinopathy is present in 20% of patient with type 2 Diabetes Mellitus at time of diagnosis

A 62 year-old male chronic smoker is examined for slowly progressive non-painful vision loss. Visual acuity showed 20/150 in both eyes. Extra-ocular muscles are intact. Pupils are responsive to direct and consensual stimuli however appear hazy. During funduscopic exam you are unable to visualize the optic cup, disk or the vessels. What is the most appropriate diagnosis?

Senile cataract

A 75 year-old patient with history of macular degeneration and hypertension presents with complaint of sudden onset of visual loss in the left eye. The patient denies pain. On examination you note a dome-shaped retina and subretinal fluid that shifts with position changes. Which of the following is the most likely diagnosis in this patient?

Serous retinal detachment

At what age should a child's eyes be consistently well-aligned?

Six months

Which of the following are normal findings in a Weber test?

Sound is heard equally in both ears when a vibrating tuning fork is placed on the mid forehead

Whispered voice test on a patient reveals decreased hearing in the left ear. Which of the following would be most consistent with conductive hearing loss in the left ear?

Sounds best heard in the left ear on Weber test

Which of the following is diagnosed by use of the cover/uncover test?

Strabismus

Dental caries are caused by which of the following organisms?

Streptococcus mutans

A 3 year-old patient is brought in with a 10 day history of clear nasal drainage and cough which has now developed into otalgia and fever exceeding 101 degrees F for the last 5 days. Mom denies other chronic medical problems. The patient has had similar complaints three times in her life. Which of the following is the most likely causative organism?

Streptococcus pneumoniae

Which of the following is the most common etiologic agent associated with acute bacterial sinusitis in the adult population?

Streptococcus pneumoniae

Which of the following is the most likely organism in a 2 year-old child with acute otitis media?

Streptococcus pneumoniae

A 9 year-old patient presents with conjunctivitis after swimming at the local pool. On examination, there is visible lid edema with redness of the palpebral conjunctiva, copious watery discharge, and scanty exudate. The sanitation system of the public pool is through the use of a salt water system; therefore, the possibility of a chemical induced conjunctivitis is almost non-existent. Which of the following should be instituted to prevent the sequalae of the condition

Sulfacetamide ophthalmic

A patient with type 2 diabetes mellitus presents for a yearly eye exam. Ophthalmoscopic exam reveals neovascularization. Which of the following is the most likely complication related to this finding?

Vitreous hemorrhage (Proliferative retinopathy)

A 60 year-old patient with a history of tobacco and alcohol abuse presents for a routine physical. Which of the following physical examination findings is suspicious for oral carcinoma?

White lesion that cannot be removed by rubbing

A 32 year-old carpenter complains of right eye irritation all day after driving a metal stake into the ground with his hammer. He states that "something flew into my eye." Visual acuity is 20/20. Pupils are equal, round, reactive to light and accommodation. Extraocular movements are intact. There is minimal right corneal injection. No foreign body is noted with lid eversion. Fluorescein stain reveals a tiny pinpoint uptake in the area of the corneal injection. Which of the following is the most appropriate diagnostic test at this stage?

X-ray orbits

A 2 month-old infant presents for a routine health maintenance visit. The mother has been concerned about the infant's hearing since birth. Physical examination reveals no apparent response to a sudden loud sound. Which of the following is the most appropriate diagnostic evaluation?

auditory-evoked potentials

A 23 year-old sexually active female presents with a 4 day history of painless bilateral eye exudates which she describes as copious. Visual acuity is 20/20, generalized conjunctival inflammation with sparing of the cornea is noted on physical examination. Gram stain of the exudate reveals gram negative diplococci. Appropriate management of this case is

ceftriaxone (Rocephin) (ophthalmic gonorrhea)

A patient with Type 1 diabetes mellitus was treated for otitis externa of the right ear for 2 weeks with topical ear drops. The patient presents today with persistent, foul aural discharge, granulations in the ear canal, and deep ear pain. Which of the following is the proper treatment at this time?

ciprofloxacin (Cipro) IV

A 2 year-old child is brought to the office because of a cough and a fever of 102 degrees F for 2 days. The physician assistant notes the presence of hoarseness, a barking cough, and stridor. The ears and nose exam are unremarkable. Auscultation of the chest reveals decreased breath sounds without crackles or expiratory wheezes. Which of the following would be the initial diagnostic impression?

croup

A 53 year-old woman complains that she has not been able to smell for several weeks. Prior to an upper respiratory infection 3 weeks ago, her sense of smell was "just fine." The most likely cause of the anosmia is

destruction of the olfactory neuroepithelium

A patient presents with the complaint of irritation of the left eye one day after gardening. He states "I think there is something in my eye." Which of the following findings is consistent with your suspected diagnosis?

fluorescein uptake

A 45 year-old male complains of loss of hearing in his left ear. He also complains of ringing in the ear, and has had occasional dizziness. On exam, there is unilateral left- sided sensorineural hearing loss and a diminished corneal reflex. Neuro exam is otherwise normal. TMs are normal, and canals are clear. Neck is supple, without adenopathy. Oropharynx is normal. Of the following, the best diagnostic study to identify the cause of this patient's complaints is

gadolinium-enhanced MRI

Which of the following is a potential complication of a traumatic hyphema?

glaucoma

The most common cause of conductive hearing loss is

impacted cerumen

A 66 year-old male presents with epistaxis of two hours duration. He has been unable to stop the bleeding at home. He has a history of hypertension and cardiovascular disease. On exam the vital signs are T-38°C, P-74/minute, RR-20/minute, and BP-180/110 mmHg. Bleeding is noted from the right nare; the left is essentially clear with normal nasal mucosa. After applying pressure for 15 minutes, a bilateral anterior pack is placed. You note persistent bleeding, with blood in the posterior oropharynx. Of the following, the most appropriate treatment is to remove the packing and

insert a posterior balloon pack

A 13 year-old boy with leukemia presents with epistaxis for 2 hours. The bleeding site appears to be from Kiesselbach's area. The most appropriate intervention is

intranasal petrolatum gauze

A 28 year-old HIV positive male presents complaining of fever, dysphagia, odynophagia, and trismus for the past 2 days. Physical examination reveals an ill-appearing male with a temperature of 101.3 degrees F, poor dentition, "woody" edema in the sublingual area and neck, tongue displaced posteriorly, and drooling. The immediate management of this patient includes which of the following?

intubation (ludwig's angina)

A 10 year-old boy was playing with sparklers (magnesium sulfate) and got some of the "sparkle" in his right eye. Which of the following is the most appropriate initial treatment

irrigate the eye for at least 20 minutes

Hairy leukoplakia has the greatest prevalence of distribution on the

lateral tongue

The most reliable sign of acute otitis media (AOM) is

loss of tympanic membrane mobility

Which of the following may precipitate acute angle-closure glaucoma?

metoclopramide

The best course of action for a patient with a bothersome inflamed pinguecula (pingueculitis) is

no treatment

Bitemporal hemianopia is noted on physical examination in a patient with visual changes over the past 2 years. The central field of vision is spared. The lesion is located in the

optic chiasm

Which of the following is considered a risk factor for retinopathy of prematurity?

perinatal oxygen therapy

Which of the following findings is most consistent with cataracts?

poorly visualized optic disc

When performing a Weber test on a patient with impacted cerumen in the right canal, the sound should be

referred to the right ear

A 23 year-old graduate student presents with sudden onset of severe dizziness, with nausea and vomiting for the past couple of hours. She denies hearing loss or tinnitus. She has had a recent cold. Which of the following is the most likely diagnosis?

vestibular neuronitis

A patient is evaluated in the office with a red eye. The patient awoke with redness and a watery discharge from the eye. The eyelids were not matted together. Examination reveals a palpable preauricular node. Which of the following is the most likely diagnosis?

viral conjunctivitis