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Exam 1 SmartyPANCE ?'s

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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? A. Advise him to discontinue use of cotton swabs B. Encourage jet irrigator (i.e. WaterPik) to clean ears C. Instruct in ear irrigation with cold water D. Refer to dermatologist

A. Advise him to discontinue use of cotton swabs

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? A. Amphotericin (Amphotericin B) B. Amoxicillin/Clavulanate (Augmentin) C. Ofloxacin (Floxin) D. Cefuroxime (Ceftin)

A. Amphotericin Fungal infection

A patient presents with a 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? A. Benign positional vertigo B. Ménière's disease C. Acoustic neuroma D. Vestibular neuronitis

A. Benign positional vertigo. No hearing loss. Positional based. resolves quickly.

our patient is a 54 year-old male that presents with headaches, decreased hearing out of the right ear, right side facial paresthesias. The MRI of brain reveals a 2 x 3 cm right sided acoustic neuroma. Which of the following is not true regarding acoustic neuromas? A. Chemotherapy is the cornerstone of therapy B. Bilateral acoustic neuromas should increase a suspicion for neurofibromatosis C. Larger tumors may cause ataxia D. You can have decreased taste or taste disturbances with these

A. Chemotherapy is the cornerstone of therapy. Observation (slow growing), Surgical excision or radiation therapy.

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? A. ciprofloxacin (Cipro) IV B. cefuroxime (Zinacef) IV C. ampicillin-sulbactam (Unasyn) PO D. azithromycin (Zithromax) PO

A. Ciprofloxacin Pseudomonas, need to treat malignant otitis media

A. Ciprofloxacin IV Covers for Pseudomonas

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? A. Croupy cough and drooling B. Thick gray, adherent exudate C. Beefy red uvula, palatal petechiae, white exudate D. Inflammation and medial protrusion of one tonsil

A. Croupy cough and drooling

A 47-year-old male presents to the clinic complaining of severe pain in his lower jaw, fever, and facial swelling. He describes a constant, throbbing pain which prevents him from eating or sleeping because the pain intensifies if he tries to lie down. The patient's breath exhibits a foul odor and there is an erythematous, fluctuant, tender mass near the left lower third molar. What is the most likely diagnosis? A. dental abscess B. halitosis C. mumps infection D. sialadenitis

A. Dental abscess Diagnose with CT and treat with Ceftiraxone and Amoxicillin

Your patient is a 45 year old male that is not immunized. He presents with a fever of 102, dysphagia, drooling, and shortness of breath. Lungs are clear. O2 Sat 100%. Pulse 102. RR-24. Soft tissue neck reveals a thumb sign. All of the following are acceptable management plans except: A. Give a Racemic Epinephrine aerosol treatment and discharge the patient home on steroids B. Begin Vancomycin and Ceftriaxone C. Intubate the patient in the operation room D. Consult anesthesia or ENT

A. Give a racemic epinephrine aerosol treatment and discharge the patient home on steroids

Your patient is a 23 year old female that presents with white plaques on tongue. She has no history of chemotherapy, dentures, oral inhaled glucocorticoids, or radiation therapy. She is not a diabetic. Which of the following is the most likely etiology of her symptoms? A. HIV B. Smokeless tobacco C. Aphthous ulcers D. HSV

A. HIV Whenever there is unexplained thrush in a healthy individual, HIV should be considered. Aphthous ulcers do not produce white plaques HSV presents as vesicles

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? A. IV antibiotics B. Mastoidectomy C. IM steroids D. Ventilating tube placement

A. IV Antibiotics Patient likely has mastoiditis

There is considerable debate about the use of tympanostomy tubes in the management of recurrent otitis media in children. Tympanostomy tube placement has been proven to A. improve hearing B. prevent mastoiditis C. prevent recurrence of effusion D. prevent delayed language development

A. Improve hearing

There is considerable debate about the use of tympanostomy tubes in the management of recurrent otitis media in children. Tympanostomy tube placement has been proven to A. Improve hearing B. Prevent mastoiditis C. Prevent recurrence of effusion D. Prevent delayed language development

A. Improve hearing Effusion can still occur with tympanostomy tubes

Your patient is a 54 year old male that presents with a runny nose and cough. The patent is also complaining of vertigo, tinnitus, and right sided hearing loss. Which of the following is the most likely diagnosis? A. Labyrinthitis B. Acute Vestibular Neruritis C. Cerumen impaction D. Benign Postural Positional Vertigo

A. Labyrinthitis NO HEARING LOSS IN ACUTE VESTIBULAR NERURITIS

Recurrent vertigo, tinnitus, and hearing loss are hallmark findings of A. Meniere's disease B. Cholesteatoma C. Vestibular neuronitis D. Benign positional vertigo E. Acoustic neuroma

A. Meniere's disease

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? A. Menieres Syndrome B. Labyrinthitis C. Benign paroxysmal positioning vertigo D. Vestibular neuronitis

A. Menieres Syndrome Episodic, tinnitus, room spinning and hearing loss

Your patient is 54 year old immunocompetent male that presents with right sided parotitis, trismus, and a fever of 101.6. Which of the following antibiotic regimens are most appropriate? A. Naficillin and Metronidazole B. Naficillin C. Metronidazole D. Azithromycin

A. Naficillin and Metronidazole Empiric therapy If a patient is immunocompromised vancoymin/cefepime or imipenem is recommended

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? A. Oral cancer B. Oral candidiasis C. Aphthous ulcer D. Necrotizing ulcerative gingivitis

A. Oral Cancer Stomatitis would be a couple mm, but due to the cm size, this is more concerning for cancer. If leukoplakia lasts for >6 weeks proceed with excisional biopsy.

Chronic gingivitis as a result of chronic plaque buildup can initially lead to A. Periodontitis B. Dental caries C. Glossitis D. Oropharyngeal cancer E. Oropharyngeal candidiasis

A. Periodontitis

A 16-year-old high school wrestler presents after an injury during a match which has resulted in a fluctuant, mildly tender edematous lesion of the anterior-superior outer portion of the right pinna. Which of the following is the most appropriate treatment? A. Refer to otolaryngology for definitive treatment with I & D and pressure dressing B. Perform I & D only if the pinna becomes erythematous and extremely tender C. Prescribe a 10-day course of amoxicillin/clavulanate (Augmentin) and schedule a follow-up appointment in 2 weeks D. Apply a soft bulky dressing to the pinna and recommend no further treatment, but have the patient follow-up only if he develops a temperature greater than 101 degrees

A. Refer to ENT for definitive Tx with I&D and pressure dressing

When performing a Weber test on a patient with impacted cerumen in the right canal, the sound should be A. referred to the right ear B. referred to the left ear C. equal in both ears D. louder with air conduction

A. Referred to the right ear In unilateral conductive hearing loss, the sound is referred to the impaired side

Dental caries are caused by which of the following organisms? A. Streptococcus mutans B. Streptococcus pyogenes C. Staphylococcus epidermidis D. Staphylococcus aureus

A. Strep. Mutans Principle organism that helps to demineralize the enamel

A 39-year-old woman comes to your office with a 2-day history of "unrelenting dizziness." The room feels like it is spinning, and there is associated nausea and vomiting. There has been no hearing loss, tinnitus, or sensation of aural fullness. The patient has just recovered from an upper respiratory tract infection. The patient is afebrile. On examination, nystagmus is present. The slow phase of the nystagmus is toward the left, and the rapid phase of the nystagmus is toward the right. There is a significant ataxia present. A. vestibular neuronitis B. acute labyrinthitis C. positional vertigo D. orthostatic hypotension

A. Vestibular neuronitis Vesitbular neuronitis has no auditory symptoms

A 37-year-old woman comes to your office for assessment of hearing loss. She has had problems intermittently for the past 12 months. On examination, the Weber tuning fork test lateralizes to the right ear, and the Rinne tuning fork test is negative in the right ear (bone conduction is greater than air conduction [BC > AC]). This suggests which of the following? A. a right-sided conductive hearing loss B. a left-sided conductive hearing loss C. a right-sided sensorineural hearing loss D. a left-sided sensorineural hearing loss

A. a right-sided conductive hearing loss. If the patient has a conductive hearing loss in one ear, the sound will be perceived loudest in the affected ear (i.e., it will lateralize). When a unilateral sensorineural hearing loss is present, the tone is heard in the unaffected ear. The Rinne test compares air conduction with bone conduction. Normally, AC is greater than BC. Sound stimulation by air in front of the pinna is normally perceived twice as long as sound placed on the mastoid process (AC > BC). With conductive hearing loss, the duration of AC is less than BC (i.e., negative Rinne test result). In the presence of sensorineural hearing loss, the durations of both AC and BC are reduced; however, the 2: 1 ratio remains the same (i.e., a positive Rinne test result). Facts for this question: (1) Bone conduction is greater than air conduction. This indicates that this is a conductive hearing loss. (2) In conductive hearing loss, the Weber test lateralizes to the affected ear, and because the Weber test lateralized to the right ear in this patient, she has a unilateral right-sided conductive hearing loss.

An otherwise healthy college student presents with complaints of cough, malaise, fever, sore throat, 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. Her face is tender to palpation over the maxillary sinuses. She has not been previously evaluated. What is the most appropriate antibiotic for this patient? A. Amoxicillin/clavulanate (Augmentin) B. Amoxicillin C. Ampicillin-sulbactam D. Clindamycin E. Levofloxacin

A. augmentin Covers Strep. Pnemo, H. Influenza and M. Catarrhalis common for ABRS

A 35-year-old patient presents with unilateral hearing loss. Weber reveals lateralization to the right ear. Rinne test reveals the following: RIGHT: bone conduction = 10 seconds, air conduction = 5 seconds; LEFT: bone conduction = 5 seconds, air conduction = 10 seconds. Which of these other physical exam findings is to be expected? A. cerumen impaction in the right ear B. effusion in the left ear C. otitis media in the left ear D. pain on palpation of tragus or mastoid area

A. cerumen impaction of the right ear.

A. croup cough and drooling.

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? A. Needle aspiration B. Corticosteroid administration C. Nebulized epinephrine administration D. Nasotracheal intubation

A. needle aspiration Surgical drainage by needle aspiration and antibiotic therapy is the treatment choice for peritonsillar abscess.

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? A. Sounds best heard in the left ear on Weber test. B. Air conduction longer than bone conduction in the left ear on Rinne test. C. Sound best heard in the right ear on Weber test. D. Bone conduction longer than air conduction in the right ear.

A. sounds best heard in the left ear on Weber test. B. = With conductive hearing loss, bone conduction should be heard as long as or longer than air conduction of sound in the effected ear. Air conduction lasting longer than bone conduction of sound would indicate sensorineural hearing loss. C = Sound best heard in the ear with unaffected hearing on Weber test (in this case, the right ear) is indicative of sensorineural hearing loss. D = With conductive hearing loss, bone conduction should be heard as long as or longer than air conduction of sound in the affected ear. The right ear showed normal hearing on physical exam.

The most reliable sign of acute otitis media (AOM) is A. bulging of the tympanic membrane B. loss of tympanic membrane mobility C. reddening of the tympanic membrane D. air bubbles behind the tympanic membrane

B. Loss of tympanic membrane mobility There can be bulging/air bubbles behind the TM represent OM with effusion

At what age does the first tooth usually erupt in an infant? A. 2-4 months B. 6-8 months C. 10-12 months D. 14-16 months

B. 6-8 months

A 26-year-old female presents with a whitish coating on her tongue and lips. When you attempt to rub the plaque with a tongue depressor, a small amount of bleeding is noted from the oral mucosa. Her past medical history includes asthma. What diagnostic test would you perform to confirm your diagnosis? A. A culture an sensitivity B. A wet mount potassium hydroxide preparation C. A gram stain D. A rapid strep test

B. A wet mount potassium hydroxide preparation Candidiasis

A 26-year-old woman comes to your office with a 6-day history of severe dizziness associated with ataxia and right-sided hearing loss. She had an upper respiratory tract infection 1 week ago. At that time, her right ear felt plugged. On examination, there is fluid behind the right eardrum. There is horizontal nystagmus present, with the slow component to the right and the quick component to the left. Ataxia is present. What is the most likely diagnosis in this patient? A. vestibular neuronitis B. acute labyrinthitis C. positional vertigo D. orthostatic hypotension E. Meniere disease

B. Acute Labyrinthitis Usualy follows URI or otitis media. Maybe febrile. Significant sensorineural hearing loss and severe vertigo. Acute onset, hearing loss, vertigo, tinnitus. Treatment is rest and antiemetics, meclizine for vertigo. If bacterial etiology include Abx such as amoxicillin.

In addition to tobacco products, which of the following is also considered a major risk factor in the development of oral cancer? A. Sun exposure B. Alcohol abuse C. Occupational exposure D. History of oral candidiasis

B. Alcohol Abuse

Your patient is an 18 year-old female that presents with right side purulent otorrhea. Visualized tympanic membrane on the right side reveals a small perforation. Which of the following is the most appropriate treatment regimen? A. Floxin Otic Drops B. Amoxicillin and Floxin Otic Drops C. Zithromax D. Amoxicillin

B. Amoxicillin and Floxin otic drops

An 18-year-old sexually active woman presents with a single ulcer that is located on the lower lip and is painful. She is a smoker and has noticed that the ulcers have been recurrent and correlate with the onset of menses. The most likely diagnosis is A. Kawasaki disease B. Aphthous stomatitis C. Squamous cell carcinoma of the lip D. Syphilis E. Kopliks Spot

B. Aphthous stomatitis These are usually a couple mm in size. Triggered by stress, dietary deficiencies, viral Majority are self limiting and benign. Inquire about hx of SLE, HIV, Behcet disease, Reiter disease, Cancer, IBD, syphilis/herpes >3wks biopsy

Your patient is a 3 year-old male that presents with a bulging right tympanic membrane and a fever of 103.0. He has just finished a course of amoxicillin 14 days ago. Which of the following is the most appropriate treatment? A. High-dose amoxicillin B. Augmentin C. Keflex D. Cipro

B. Augmentin Otitis media

Your patient is a 63 year old female that has a history of HTN and CAD. She has had a 3 month history of recurrent episodes of vertigo. These episodes tend to occur when she lays back in bed with her head not propped up. Her ENT exam is unremarkable. She has had an MRI of her brain that was negative as well as carotid dopplers. Which of the following is the most likely diagnosis? A.Meniere's Disease B. Benign Paroxysmal Positional Vertigo C. Vestibular Neuritis D. Cerebellar Infarct

B. Benign Paroxysmal Positional Veritgo

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? A. Oral penicillin B. Ciprodex otic drops C. VoSoL drops D. Oral prednisone

B. Ciprodex otic drops VoSoL drops are preventative

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 A. intranasal obstruction B. destruction of the olfactory neuroepithelium C. thickened mucus covering the olfactory cilia D. depletion of the G-protein in the ciliary membrane

B. Destruction of the olfactory neuroepithleium

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? A. Epley maneuver B. Diuretics and low-sodium diet C. Broad-spectrum antibiotics and Ibuprofen D. Scopolamine transdermal patch

B. Diuretics and low-Na diet Decrease endolymphatic pressure in the semicircular canals

B. Diuretics and low-sodium diet. There is some thought that there is an excess endolymphatic pressure in the semicircular canals due to excess fluid.

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? A. Administer ceftriaxone (Rocephin) B. Emergent transfer C. Administer racemic epinephrine D. Obtain intravenous access

B. Emergent transfer The child may need endotracheal intubation to maintain the airway. Need to get them to an ED or OR for this.

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 A. auditory brainstem evoked response B. gadolinium-enhanced MRI C. acoustic reflex testing D. vestibular testing

B. Gadolinium-enhanced MRI. Evaluate for acoustic neuroma (Vestibular shwannoma)

Which of the following is the most appropriate management for an auricular hematoma? A. Observation B. Incision and drainage C. Ice for 20 minutes 4 times per day. D. Start cephalexin

B. I&D

Which of the following is not true about peritonsillar abscess? A. Group A Streptococcus is the most common organism B. MRI of the soft tissue neck is the imaging study of choice for confirmation C. Appropriate empiric antibiotic therapy includes clindamycin or Unasyn D. Vancomycin is an appropriate add-on antibiotic if there are airway issues

B. MRI of the soft tissue neck is the imaging study of choice for confirmation. CT scan of soft tissue of the neck with IV contrast is the imaging study of choice

Which nasal condition, if found in young children, is suggestive of cystic fibrosis? A. chronic rhinorrhea B. nasal polyps C. choanal atresia D. perennial allergic rhinitis E. acute sinusitis

B. Nasal polyps

Which of the following is the most common cause for hearing loss? A. Acoustic Neuroma B. Presbycusis C. Cerumen impaction D. Vestibular Neuritis

B. Presbycusis Age-related hearing loss

A 45-year-old male presents with purulent discharge from his right ear for three weeks. He states that despite being treated by his family doctor for an ear infection one month ago, the problem continues to get worse. Upon exam, you note purulent discharge in the ear canal, an erythemic tympanic membrane, and a possible perforation. What are the pathogens most likely to culture positive? A. Strep pneumoniae B. Pseudomonas C. E.coli D. Candida albicans E. mycoplasma

B. Pseudomonas Chronic otitis media 95% of the time is Pseudomonas

A 52-year-old male presents with unilateral left-sided hearing loss that has progressed over 2 months. His wife states that he has difficulty discriminating words, although he can hear the sounds. He has also experienced some imbalance lately, but he contributes this to trying to do too many things too quickly. Which of the following is the likely pattern of testing on physical exam? A. Rinne air conduction greater than bone conduction; Weber lateralizes to left. B. Rinne air conduction greater than bone conduction; Weber lateralizes to right. C. Rinne bone conduction greater than air conduction; Weber lateralizes to right. D. Rinne bone conduction greater than air conduction; Weber lateralizes to left.

B. Rinne air conduction greater than bone conduction; Weber lateralizes to right In conductive hearing loss the rinne will result in bone conduction greater than air conduction.

Which of the following is the most common etiologic agent associated with acute bacterial sinusitis in the adult population? A. Staphylococcus aureus B. Streptococcus pneumoniae C. Pseudomonas aeruginosa D. Mycoplasma pneumoniae

B. Strep. Pneumo Other include M. Catarrhalis and H. influenza

A 68-year-old female is brought to the clinic by her husband with complaints of severe episodes of vertigo. This is her fourth attack this week. She is nauseous but has not vomited. She also reports fullness in her left ear accompanied by a low-tone blowing tinnitus and sensation of "fullness." Which of the following represents an appropriate treatment for this patient? A. oral steroids on an as-needed basis B. symptomatic care with antihistamines and diuretics C. topical antibiotic drops for 7 days D. vestibular suppressant medication until symptoms subside

B. Symptomatic care with antihistamines and diuretics. Menieres disease. Meclizine, low salt diet.

Which of the following conditions are not associated with allergic rhinitis? A. Atopic Dermatitis B. Urticaria C. Sinusitis D. Asthma

B. Urticaria

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? A. Ménière's disease B. Vestibular neuronitis C. Benign positional vertigo D. Vertebrobasilar insufficiency

B. Vestibular Neuronitis

B. Vestibular neuronitis. Sudden onset, dizziness, N/V, NO HEARING LOSS/TINNITUS. Same symptoms as Labryinthitis, but that has hearing loss.

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?+ A. CT of the neck B. intubation C. start IV penicillin D. incision and drainage of the abscess

B. intubation Classic SSX of Ludwig's Angina. Unable to handle his secretions and the displacement of his tongue suggests impending airway obstruction. Intubation to secure his airway is the most immediate concern. CT of the neck for diagnosis, starting IV antibiotics and I&D are actions that need to be taken after securing the airway

Which of the following disorders is characterized by a "thumb sign" on a soft tissue neck x-ray? A. Laryngitis B. Croup C. Epiglottitis D. Foreign Body

C. Epiglottits B. = Steeple sign

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? A. Penicillin B. Erythromycin C. Acetaminophen D. Acyclovir

C. Acetaminophen

C. Acetaminophen no tx for mononucleosis

A 63-year-old male presents with an asymptomatic lesion in his mouth that was discovered by his dentist at a check-up. It is ill marginated with pigment ranging from medium brown to black. Parts of the lesion are raised. What is the next appropriate step in management? A. Have the patient return in 30 days to see if the lesion resolves on its own. B. KOH prep of the lesion C. Biopsy D. Call your supervising physician

C. Biopsy Concerning for oropharyngeal melanoma

Which of the following is most helpful in the diagnosis of a retropharyngeal abscess? A. CBC with differential B. fever and a muffled voice on examination C. CT of the neck with contrast D. history of a recent throat infection

C. CT of the neck w/ contrast

C. CT of the neck with Contrast GOLD STANDARD for the dx of retro-pharyngeal abscess

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? A. Transillumination of sinuses B. Routine sinus films C. CT scan of sinuses D. nasal culture

C. CT scan of sinuses. Likely chronic sinusitis.

Which of the following is not an etiology of tinnitus? A. ASA B. Congenital AV Malformations C. Cerumen Impaction D. Vascular Pathology

C. Cerumen Impaction

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? A. Immunotherapy B. Decongestants C. Corticosteroid inhalers D. Cromolyn sodium (Intal)

C. Corticosteroid inahlers

C. Corticosteroid inhaler

Small grayish vesicles and punched-out ulcers in the posterior pharynx in a child with pharyngitis is representative of which organism? A. Epstein-Barr virus B. Group C Streptococcus C. Coxsackievirus D. Gonorrhea

C. Coxsackievirus Grayish vesicles on posterior pharynx typical sign

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? A. pneumonia B. bronchiolitis C. croup D. asthma

C. Croup

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? A. Angioedema B. Foreign body aspiration C. Epiglottitis D. Bacterial pharyngitis

C. Epiglottitis

Your patient is a 54 year old male that presents with erythema and redness to the right submandibular area. There is no pain to palpation over the floor of the mouth. Physical exam of the mouth reveals pus covering from the salivary duct. There is no dental pain or trismus. Which of the following is not true regarding the patient's condition? A. Usually resolves in 7-10 days with antibiotics B. Typically responds to Keflex or dicloxacillin C. If the diagnosis is in question an ultrasound of the neck is the best imaging modality D. Can be caused by salivary duct stone

C. If the diagnosis is in question an ultrasound of the neck is the best imaging modality The imaging modality of choice for sialadenitis is a CT scan of soft tissue neck with IV contrast

The most common cause of conductive hearing loss is A. otosclerosis B. cholesteatoma C. impacted cerumen D. chronic serous otitis media

C. 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 A. replace with Gelfoam packing B. cauterize Kiesselbach's plexus C. insert a posterior balloon pack D. Apply topical solution of lidocaine and epinephrine

C. Insert a posterior balloon pack Admit and consult ENT

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 A. replace with Gelfoam packing B. cauterize Kiesselbach's plexus C. insert a posterior balloon pack D. apply topical solution of lidocaine and epinephrine

C. Insert a posterior balloon pack Must admit patient to hospital and prompt consultation with an ENT

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? A. Debrox insertion with suction removal B. Irrigation with room temperature saline C. Insertion of 2% lidocaine solution with suction or forceps removal D. Polymyxin drop insertion via wick

C. Insertion of 2% lidocaine solution with suction or forceps removal

Hairy leukoplakia has the greatest prevalence of distribution on the A. palate B. floor of the mouth C. lateral tongue D. gingiva

C. Lateral tongue

Hairy leukoplakia has the greatest prevalence of distribution on the A. palate B. floor of the mouth C. lateral tongue D. gingiva

C. Lateral tongue White plaque formation that is unable to be scraped off. Usually hx of alcoholic consumption/smoking This is usually a benign condition, but 5% can result in SCC. Erythroplakia is significantly more concerning with dysplasia CA risk to 90%

Otitis externa can be differentiated from uncomplicated otitis media by which of the following physical examination findings? A. Erythematous tympanic membrane B. Mastoid tenderness C. Normal pneumatic otoscopy D. Posterior auricular adenopathy

C. 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 1000 mg 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? A. Continue prophylactic antibiotics for an additional 6 weeks B. Immediately discontinue antibiotics C. Obtain gallium scan to ensure reduction of inflammatory process D. Skin swab culture of healthy tissue

C. Obtain gallium scan to ensure reduction of inflammatory process. Malignant extenral otitis requires prolonged antipseudomonal abx administration for several months. Abx continued even in asymptomatic patients. Until gallium scanning indicates a marked reduction in the 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 and blood 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? A. Tobramycin otic drops B. Erythromycin solution C. Offloxacin otic drops D. Gentamicin drops

C. Offloxacin otic Drops Common pathogens are S. Aureus and P. Aeruginosa. These drops are non-ototoxic - Avoid swimming

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? A. Acetic acid solution B. Erythromycin solution C. Ofloxacin otic suspension D. Gentamicin drops

C. Ofloxacin otic suspension Covers against Staph Aureus and P. Aeruginosa Fluoroquinolones are good in perforations

A 54 year old male presents with fever, trismus, dysphagia, and a sore throat. Which of the following is the most likely diagnosis? A. Parotitis B. Sialadenitis C. Peritonsillar abscess D. GERD

C. Peritonsillar abscess

A 30-year-old man comes to your office for assessment of dizziness. The dizziness occurs when he rolls over from the lying position to either the left side or the right side. It also occurs when he is looking up. He describes a sensation of "the world spinning around" him. The episodes usually last 10 to 15 seconds. They have been occurring for the past 6 months and occur on average one or two times per day. A. vestibular neuronitis B. acute labyrinthitis C. positional paroxysmal vertigo D. Meniere disease

C. Positional paroxysmal vertigo BPPV is caused by the formation of crystalline debris in the semicircular canals that leads to labyrinthine irriation, causing vertigo/nystagmus

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? A. Ascorbic acid B. Amoxicillin C. Pseudoephedrine D. Chlorpheniramine

C. Pseudoephedrine

C. Pseudoephedrine Likely viral RS. No need for abx at this time.

A 16-year-old women's lacrosse player is struck in the mouth with a ball. Several of her front teeth are knocked out of the socket. An emergent dentist appointment is made. What additional steps in initial management are recommended? A. Rinse the teeth in saline and place them in ice B. Scrub the roots with saline and reimplant them back in the sockets C. Rinse the teeth in saline and place them in milk D. Scrub the teeth with a brush and place them on ice E. Scrub the teeth with a brush and place them in milk

C. Rinse the teeth in saline and place them in milk NEVER SCRUB THE TEETH

Which of the following is the most common organism causing mastoiditis? A. H. Influenzae B. S. Aureus C. S. Pneumoniae D. Group B Hemolytic Strep

C. S . Pneumoniae

The most common cause of tinnitus is A. Infection (otitis media) B. Chronic use of salicylates C. Sensorineural hearing loss D. Hypertension E. Acoustic neuroma

C. Sensorineural hearing loss Can perform an audiogram or CT / MRI head to evaluate. 1. Pulsatile tinnitus may require vascular studies to r/o aneurysm formation. 2. Episode, low-pithced, rumbling tinnitus - Meniere disease 3. Continuous tinnitus - presbycusis or long-term hearing loss Unilateral tinnitus and hearing loss poss acoustic neuroma, get a MRI gadolinium-enhanced Unilateral tinnitus and NO hearing loss no need for MRI unless symptoms >6 months.

Which of the following are normal findings in a Weber test? A. The tympanic membrane is movable with pneumatic otoscopy B. The tympanic membrane is pearly gray with a sharp cone of light with apex at the umbo C. Sound is heard equally in both ears when a vibrating tuning fork is placed on the mid forehead D. Air conduction is greater than bone conduction when a vibrating tuning fork is moved from the mastoid bone to close to the ear canal

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

Your patient is a 39-year-old second grade teacher who states that she developed acute hoarseness 3 days ago. Prior to that, she had a cold, the symptoms of which are improving. There is no history of smoking or other tobacco use. What is the most important intervention for the patient at this time? A. Discuss that due to her occupation, she is at increased risk of leukoplakia of the vocal cords B. She should be placed on an antibiotic as she most likely has a bacterial infection C. Discuss her increased risk of vocal cord paralysis D. Advise the patient to avoid singing or shouting until her normal voice returns

D. Advise the patient to avoid singing or shouting until her normal voice returns Acute laryngitis is a common cause of hoarseness S/p URI. Majority are viral in nature

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? A. audiometry B. tympanometry C. acoustic reflectometry D. auditory-evoked potentials

D. Auditory-evoked potentials (AEO) Test does not require any active response from the patient and is useful in the evaluation of suspected hearing loss in an infant.

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? A. Antihistamines B. Ribavirin C. Intranasal corticosteroids D. Amoxicillin-clavulanate (Augmentin)

D. Augmentin Likely resistant bacterial sinusitits.

Your patient is a 34-year-old male that has had maxillary sinus pressure and purulent drainage for 3 weeks. The patient has had a history of anaphylaxis with penicillin. Which of the following is the most appropriate antibiotic choice? A. Augmentin B. Cephalexin C. Amoxicillin D. Bactrim

D. Bactrim. A. would be the best option, but he is allergic to penicillin

All of the following are causes of otitis externa except? A. Trauma B. Infection C. Allergic contact dermatitis D. Cerumen impaction

D. Cerumen impaction

A 13-year-old boy with leukemia presents with epistaxis for two hours. The bleeding site appears to be from Kiesselbach's area. The most appropriate intervention is A. electrocautery of the bleeding site. B. silver nitrate application C. posterior nasal packing D. intranasal petrolatum gauze

D. Intranasal petrolatum gauze

Which of the following areas is the most common site for epistaxis to occur? A. Arterioles off the external carotid artery B. Arterioles off the internal carotid artery C. Stensen's Plexus D. Kiesselbach's Plexus

D. Kiesselbach's Plexus

Your patient is a 72 year-old female that presents with recurrent nose bleeds of right nostril and has right sided cervical lymphadenopathy. She is not on any anticoagulants. Her labs including INR, CBC and PTT are normal. Which of the following is the most likely diagnosis? A. Blood dyscrasia B. Thrombocytopenia C. AV malformation D. Malignancy

D. Malignancy C is a plausible answer, but in this situation there is lymphadenopathy mentioned with recurrent epistaxis, concerning for malignancy.

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? A. Acute Labyrinthitis B. Positional Vertigo C. Acoustic Neuroma D. Menieres Syndrome

D. Menieres Syndrome Episodic dizziness, hearing loss, chronic, lasting several hours.

Your patient is a 45 year old male that presents with episodic vertigo, hearing loss, and tinnitus over the last year. His Brain MRI was unremarkable. He has had no preceding viral syndrome. Which of the following is the most likely diagnosis? A. Benign Postural Peripheral Vertigo B. Vestibular Neuritis C. Labyrinthitis D. Meniere's Disease

D. Menieres disease BPPV = no ear symptoms Vestibular Neuritis = no auditory symptoms Labyrinthitis = Viral disease preceding / symptoms not this long

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? A. Viral URI B. Acute sinusitis C. Allergic rhinitis D. Nasal foreign body

D. Nasal Foreign body

D. Nasal foreign body

Which of the following statements is true regarding orolabial herpes? A. Highest rate of infection occurs in adolescent children. B. Lesions are usually painless vesicles that form on the tongue, palate, and gingival area. C. Topical acyclovir is the drug of choice. D. Recurrent infections are less severe and shorter in duration. E. Pain associated with lesions typically lasts 2 to 3 weeks.

D. Recurrent infections are less sever and shorter in duration. Common in pre-schoolers. Duration is 2-3 weeks. Common to have pharyngitis Tx oral acyclovir Magic mouthwash for symptomatic relief

A young mother brings her 3-week-old daughter for the care of a rash in her mouth. The mother indicates the baby was doing fine until 2 days ago when she noticed white spots in the infant's mouth. On examination, the lesions scrape off with a tongue blade. She is bottle-feeding the infant without any problem. Which of the following is the most likely diagnosis of this problem? A. leukoplakia B. hand-foot-mouth disease C. herpangina D. oral candidiasis

D. Oral Candidias If it is able to be scraped off it is likely oral candidias. If scraped off it you will see erythematous patches. If not, concern goes up for possible leukoplakia which is a pre-cursor to cancer growth. Antifungals

A 60-year-old male presents with complaints of irritation and a white plaque on his tongue. He denies pain. During physical exam you are unable to remove the white plaque from the mucosa with a tongue depressor. What is the most likely diagnosis, represented as follows? A. Glossitis B. Geographic tongue C. Lichen Planus D. Oral leukoplakia

D. Oral Leukoplakia

A 23-year-old woman comes to your office with a 6-month history of dizziness. She "feels dizzy" when she stands up (as if she is going to faint). The sensation disappears within a minute. She has a history of major depression. She started taking doxepin 6 months ago, and her depression has improved much since that time. The patient's blood pressure is 140/ 90 mm Hg sitting and decreases to 90/ 70 mm Hg when she stands. There is no ataxia, nystagmus, or other symptoms. What is the most likely diagnosis in this patient? A. vestibular neuronitis B. acute labyrinthitis C. benign positional paroxysmal vertigo D. orthostatic hypotension

D. Orthostatic hypotension Shows importance to ask to describe the dizziness. Associated symptoms as well. New medications are most likely culprit in this scenario, but occasionally there is no responsible etiology.

Which physical examination finding distinguishes allergic rhinitis from other rhinitis etiologies? A. Clear rhinorrhea B. Erythematous pharynx C. Nasal flaring D. Pale nasal turbinates

D. Pale nasal turbinates

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, 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? A. Recurrent streptococcal pharyngitis B. Infectious mononucleosis C. Gonococcal pharyngitis D. Peritonsillar abscess

D. Peritonsillar abscess Presentation is more typical of a incompletely treated strep. pharyngitis rather than recurrent (Choice A).

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? A. Amoxicillin B. Aqueous irrigation C. Tympanocentesis D. Polymyxin B sulfate

D. Polymyxin B Sulfate

Which of the following bacteria is not a possible cause of bacterial tonsillitis? A. Group A Streptococcus B. Neisseria Gonorrhea C. Mycoplasma D. Proteus

D. Proteus (UTI)

Which of the following is the most likely organism in a 2 year-old child with acute otitis media? A. Staphylococcus aureus B. Moraxella catarrhalis C. Pseudomonas aeruginosa D. Streptococcus pneumoniae

D. S. Pneumoniae

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? A. Mycoplasma pneumoniae B. Pneumocystis jiroveci C. Pseudomonas aeruginosa D. Streptococcus pneumoniae

D. S. Pneumoniae (Acute Otitis media)

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? A. Anterior uveitis B. Narrow angle glaucoma C. Retinal detachment D. Senile cataract

D. Senile cataract Bilateral, over 60, slowly progressive

D. Strep. Pneumo Common pathogens in children with AOM = Strep pneumo, H. influenza, and Strep pyogenes

All of the following are potential etiologies for parotitis except? A. Stensen's Duct obstructed with a stone B. Retrograde salivary stasis and seeding in Stensen's Duct C. Staphylococcus aureus D. Streptococcus Virdans

D. Strep. Virdans

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? A. Painful creamy-white patches overlying erythema B. Red smooth surface tongue C. Small vesicles on an erythematous base D. White lesion that cannot be removed by rubbing

D. White lesion that cannot be removed by rubbing. Leukoplakia

Your patient is a 65 year old male that presents with Fordyce spots noted in his oral cavity. What is the likely etiology of these? A. Mucocele B. Melanoma C. Amalgam Tattoo D. Benign Sebaceous Cyst Tumor

D. benign sebaceous cyst tumor Melanomas are oral pigmented lesions that have irregular borders and symmetry Amalgam tattoo are black macules near gingiva of dental fillings

Which physical examination finding distinguishes allergic rhinitis from other rhinitis etiologies? A. Clear rhinorrhea B. Erythematous pharynx C. Nasal flaring D. Pale nasal turbinates

D. pale nasal turbinates

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? A. Electrical cautery B. Direct pressure on the nose C. Petroleum jelly application D. Posterior nasal packing

D. posterior nasal packing Admit + ENT consult

A 38-year-old woman comes to your office with a 1-year history of episodic dizziness, ringing in both ears, a feeling of aural fullness, and hearing loss. The symptoms come on every 1 or 2 weeks and usually last for 12 hours. Nausea and vomiting are present. When asked to describe the dizziness, the patient says, "The world is spinning around me." On physical examination, the patient has horizontal nystagmus. The slow phase of the nystagmus is to the left, and the rapid phase is to the right. Audiograms reveal bilateral sensorineural hearing loss in the low frequencies. What is the most likely diagnosis in this patient? A. vestibular neuronitis B. acute labyrinthitis C. positional paroxysmal vertigo D. orthostatic hypotension E. Meniere disease

E. Meniere Disease

The most appropriate treatment for cholesteatoma is A. Oral antibiotics B. Antibiotic otic drops C. Oral steroids D. Tympanostomy tube placement E. Surgical removal

E. Surgical removal Can cause further damage to TM or mastoid.

What are presenting symptoms for acoustic neuroma?

Insidious unilateral hearing loss, tinnitus, headache, facial numbness, continuous disequilibrium Audiogram - usually reveals asymmetric sensorineural hearing loss and greater impairment of speech discrimination. FUP test with gadolinium-enhnanced MRI Tx - microsurgery or radiation

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