Clin Med II: EENT Practice Questions

E. C&D

Viral rhinitis generally presents with ________ nasal drainage/discharge. A. red B. yellow C. clear D. white E. C&D

B. cholesterol

A patient has a benign xanthelsma noted on the upper eyelid. Which serum levels would you expect to be elevated? A. hematocrit B. cholesterol C. ALT/AST D. HDL's E. none of the above

B. nasal polyps

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

C. recurrent laryngeal

Which nerve damage is often associated with thyroid surgery? A. Sublingual B. vagus C. recurrent laryngeal D. facial E. trigeminal

A. paragangliomas

Which of the following are capable of producing catecholamines? A. paragangliomas B. carotid body tumors C. metastatic squamous cell carcinoma D. schwannomas E. neurofibromas

E. all of the above

Which of the following are often associated with Vasomotor Rhinitis? A. changes in temperature B. eating C. exposure to odors & chemicals D. alcohol use E. all of the above

B. Horner syndrome

Which of the following conditions generally results from a pancoast lung tumor that compresses the nerve root C7? A. Anisocoria B. Horner syndrome C. Argyll Robertson pupil D. Adie (tonic) pupil E. Myasthenia gravis

B. Churg-Strauss syndrome

Which of the following conditions is allergy-related? A. Sarcoidosis B. Churg-Strauss syndrome C. Rhinoscleroma D. Wegener granulomatosis E. T-cell lymphoma

A. viral infection of the upper respiratory tract

Which of the following conditions is the most common for predisposing a patient to develop acute sinusitis? A. viral infection of the upper respiratory tract B. dental infections C. intranasal foreign body D. barotrauma from diving E. nasal steroid

A. viral infection of the upper respiratory tract

Which of the following conditions is the most common for predisposing someone to developing acute sinusitis? A. viral infection of the upper respiratory tract B. dental infections C. intranasal foreign body D. barotrauma from deep-sea diving or airplane travel E. nasal steroid use

D. acute angle-closure glaucoma

Which of the following conditions warrants a peripheral iridotomy as the surgical treatment of choice? A. nasolacrimal duct obstruction B. cataracts C. chronic open-angle glaucoma D. acute angle-closure glaucoma E. myopia

C. posterior cavity

Which of the following contains vitreous fluid/body? A. anterior cavity B. fornix C. posterior cavity D. ciliary body E. limbus

E. B&C

Which of the following generally presents with a midline mass, nasal obstruction, or CSF leak? A. nasal dermoid cysts B. nasal encephaloceles C. nasal gliomas D. Choanal atresia E. B&C

C. allergic rhinitis

Which of the following generally presents with bluish, pale, boggy turbinates? A. viral rhinitis B. vasomotor rhinitis C. allergic rhinitis D. normal rhinitis during pregnancy E. rhinitis medicamentosa

D. exotropia

Which of the following has a higher risk for developing myopia? A. hypertropia B. hypotropia C. strabismus D. exotropia E. esotropia

E. Photoreceptors are synthesized from vitamin B

Which of the following is FALSE? A. Normal vision is 20/20. B. 20/15 represents better vision than normal where the patient is able to see details that would be clear to a normal eye at only a distance of 15 feet. C. In hyperopia the lens is too flat D. emmetropia refers to normal vision E. Photoreceptors are synthesized from vitamin B

B. X-ray of the chest

Which of the following is NOT generally included in the work up for Zenker diverticulum? A. barium swallow study B. X-ray of the chest C. esophageal manometry D. ambulatory pH monitoring E. all of the above are included

B. steeple sign

Which of the following is a classic radiographic sign associated with croup? A. Thumb print sign B. steeple sign C. consolidation at the lung apices D. tracheal deviation E. none of the above

D. presbystasis

Which of the following is a disequilibrium that occurs with the aging process? A. cholesteatoma B. otosclerosis C. presbycusis D. presbystasis E. benign paroxysmal positional vertigo (BPPV)

E. Alport syndrome

Which of the following is a genetic disorder that presents with glomerulonephritis, end stage renal disease, and hearing loss? A. DiGeorge syndrome B. Trisomy 21, Down syndrome C. Trisomy 18, Edward syndrome D. osteogenesis imperfecta E. Alport syndrome

A. spindle cell sarcoma

Which of the following is a malignant type of tracheal neoplasms? A. spindle cell sarcoma B. squamous cell papilloma C. chondroma D. leiomyoma E. lipoma

C. acute angle-closure glaucoma

Which of the following is a true medical emergency? A. ocular hypertension B. chronic, open angle glaucoma C. acute angle-closure glaucoma D. low-pressure primary open angle glaucoma E. angle-recession glaucoma

D. inner ear decompression sickness

Which of the following is an over production of bubbles that is transported to the system as one ascends after diving? A. BPPV B. barotrauma of the TM C. perforation of the TM D. inner ear decompression sickness E. Meniere disease

B. laryngocele

Which of the following is associated with malignancy? A. vocal cord fistulas B. laryngocele C. vocal cord polyps D. vocal cord nodules E. laryngeal cysts

C. vocal cord polyps

Which of the following is associated with smoking and voice abuse? A. vocal cord neoplasms B. vocal cord fistulas C. vocal cord polyps D. vocal cord nodules E. laryngeal cysts

D. vocal cord nodules

Which of the following is commonly seen among singers? A. vocal cord neoplasms B. vocal cord fistulas C. vocal cord polyps D. vocal cord nodules E. laryngeal cysts

D. If the canal of Schlemm is blocked, intraocular pressure decreases resulting in glaucoma

Which of the following is false? A. The intraocular pressure reflects the pressure where the fluid is pushing against the inner surface of the cornea in the anterior chamber. B. Normal intraocular pressure ranges from 12-21 mm Hg. C. Unlike the aqueous humor, the vitreous body is not replaced. D. If the canal of Schlemm is blocked, intraocular pressure decreases resulting in glaucoma

B. chalazion

Which of the following is generally a result from an blockage of the Meibomian gland? A. hordeolum B. chalazion C. conjunctivitis D. Sty E. Blepharitis

A. cow's milk

Which of the following is least likely to cause cavities in children? A. cow's milk B. Enfamil C. Soy formula D. Similac E. mother's milk

C. Wilson disease

Which of the following is related with Kayser-Fleischer rings in the eyes? A. vitamin A deficiency B. albinism C. Wilson disease D. Horner Syndrome E. Multiple Sclerosis

C. lipomas

Which of the following is the most common benign soft tissue neoplasm? A. paragangliomas B. carotid body tumors C. lipomas D. schwannomas E. neurofibromas

A. embolus

Which of the following is the most common cause of Central Retinal Artery Occlusion? A. embolus B. giant cell arteritis C. hypercoagulable states D. other collagen-vascular diseases E. trauma

B. corneal laceration

A patient has a positive Seidel test. Which of the following is the most likely diagnosis? A. blow out fracture B. corneal laceration C. glaucoma D. shaken baby syndrome E. retinal hemorrhages

B. positional vertigo

A patient presents with a 3-day history of vertigo associated with turning over in his bed, which lasts for several minutes. There are no other symptoms of the ear. Dix-Hallpike testing shows rotary nystagmus, which diminishes with repeated testing. Which of the following is the most likely diagnosis? A. central nervous system (CNS) lesion B. positional vertigo C. labyrinthitis D. Meniere disease E. vestibular neuronitis

A. treat as an acute episode of sinusitis

A patient presents with a history of a cold for the last 10 days or so. Initially, she thought she was getting better. However, during the last couple of days, she has had a fever, increasing right maxillary facial pain, and copious purulent drainage from the right nostril. What is the most appropriate next step? A. treat as an acute episode of sinusitis B. order a CT scan to confirm a bacterial infection C. treat symptomatically with decongestants and Tylenol D. perform a culture on the drainage and await the results before treating E. refer to an otolaryngologist

C. antibacterial ear drops

A patient presents with swelling and mild edema of the right ear canal after swimming. What is the most appropriate initial treatment? A. oral antibiotics to prevent further swelling B. insert an otowick into the canal to prevent the canal from closing C. antibacterial ear drops D. vigorous irrigation with saline to clean the ear E. self-limited disorder requiring no treatment

A. nasal dermoid cysts (no expansion of the lesions with crying)

A positive Furstenberg test is found in which of the following conditions? A. nasal dermoid cysts (no expansion of the lesions with crying) B. nasal encephaloceles C. nasal gliomas D. Choanal atresia E. nasal pyriform aperture stenosis

D. rhinitis of pregnancy

A young woman in her second trimester of pregnancy complains of chronic nasal congestion. She denies rhinorrhea, facial pain, or fever. She has not had previous problems with nasal symptoms until the last several weeks. It seems to be getting worse. Your examination of the nose and throat is normal. What is your diagnosis? A. allergic rhinitis B. perennial rhinitis C. vasomotor rhinitis D. rhinitis of pregnancy E. chronic rhinitis

B. serous otitis media

There is a high incidence noted between cleft lip & palate and which of the following? A. otitis externa B. serous otitis media C. Strep. Pharyngitis D. Sinusitis E. infection of the adenoids

TRUE

True or False: Sound waves are transmitted through the external ear canal, onto the TM, causing displacement/movement of the auditory ossicles, moving the stapes at the oval window, establishing pressure waves in the perilymph of the vestibular duct, therefore distorting the basilar membrane through the tympanic duct. At this point information about the region is relayed over the cochlear branch of cranial nerve VIII and then exits back out through the round window.

TRUE

True or False: Sounds lateralize toward a conductive hearing loss and away from a sensorineural one on Weber examination.

TRUE

True or False: Steroid use and smoking place a patient at a greater risk for developing cataracts.

TRUE

True or False: The Submandibular gland empties under the tongue at the Wharton duct.

FALSE

True or False: The most common malignant neoplasm of the nose and paranasal sinuses is basal cell carcinoma.

TRUE

True or False: The most common organisms responsible for acute sinusitis include: Strep. Pneumoniae H. Influenzae Moraxella catarrhalis These are the same top 3 most common with otitis media as well.

TRUE

True or False: The most common site for epistaxis is the anterior aspect of Kiesselbach's plexus which consists of 4 main arteries that anastomose. These are the anterior ethmoidal artery, sphenopalative artery, greater palatine artery, and the superior labial artery.

TRUE

True or False: The parotid gland empties at Stensen duct up above the 2nd molar.

TRUE

True or False: The parotid gland is the most common salivary gland to be affected with a malignant neoplasm.

FALSE

True or False: The round window is in the external ear.

TRUE

True or False: The stapes is bound to a ligamentous sheet that spans the oval window, an opening in the bone that surrounds the inner ear.

TRUE

True or False: Treatment for GERD includes life-style modifications such as weight loss, decrease tight clothes, avoid caffeine, chocolate, and alcohol. Antacids, H2 blockers, proton pump inhibitors, or laparoscopic fundoplication.

TRUE

True or False: Treatment for Wegener granulomatosis consists of prednisone & cyclophosphamide for a month.

TRUE

True or False: Vocal process granulomas is related with intubation trauma and GERD & recurrence may be treated with botulinum toxin.

TRUE

True or False: With skin cancer, one of the commonly used definitive treatments is Mohs surgical technique where the tumor tissue is fixed in place & a layer is removed. That portion is then examined microscopically. This procedure is repeated until the entire tumor is removed and not apparent in any layer any longer via microscopy.

TRUE

True or False: The vestibule includes a pair of membranous sacs referred to as the saccule and the utricle. Receptors in these sacs provide sensation of gravity, equilibrium sensation, and linear acceleration.

TRUE

True or false: The anterior cavity of the eye is subdivided into the anterior and posterior chambers.

FALSE

True or false: The posterior cavity of the eye contains aqueous humor.

D. achalasia

Upon barium swallow examination, narrowing at the level of the gastroesophageal junction (bird's beak appearance) is noted. Which of the following is the most likely diagnosis? A. GERD B. Barrett's esophagitis C. esophageal cancer D. achalasia E. Zenker diverticulum

FALSE

True or False: A 32 year old male presents with nasal discomfort and rhinorrhea. On physical examination a large perforation is noted in the nasal septum. Your number one differential includes osteomyelitis.

TRUE

True or False: A cavernous sinus thrombosis is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxgenated blood from the brain back to the heart. It often is a complication of sinusitis left untreated. Symptoms include: decreased vision, exopthalmos, headaches, and paralysis of the cranial nerves.

TRUE

True or False: Arrhinia is defined as the congenital absence of the nose

TRUE

True or False: Barrett's esophagus involves metaplasia of the esophageal mucosa caused by replacement of the squamous epithelium with columnar epithelium.

FALSE

True or False: Barrett's esophagus is a metaplasia that may progress to high-grade dysplasia and eventually to squamous cell carcinoma.

TRUE

True or False: Common presenting symptoms for TMJ include joint noises, clicking, popping, and grating when the mandible is closed or open.

TRUE

True or False: Conductive hearing loss involves a defect in the external or middle ear up to the oval window (which is all filled with air), and a sensorineural hearing loss involves a defect in the inner ear including the vestibule, semicircular canals, and the cochlea (which is fluid filled).

FALSE

True or False: Croup generally presents with severe wheezing, hoarseness, and is generally preceded by an upper respiratory infection.

FALSE

True or False: Cycloplegic agents (such as scopolamine) paralyze the ciliary muscles resulting in pupillary constriction.

TRUE

True or False: During pregnancy, systemic concentration of estrogen rises which leads to a rise in hyaluronic acid in the nasal tissue, which can result in increasing nasal edema and congestion.

FALSE

True or False: Foreign bodies in the bronchi are more likely to drop down the left main bronchi due to anatomical position.

FALSE

True or False: Methimazole applied to the posterior choanae at completion of correction surgery in combination with stenting often decreases recurrence rates of choanal atresia as compared to stenting alone.

TRUE

True or False: Nasal encephaloceles occur as a result of herniation of the meninges through a congenital skull base defect.

FALSE

True or False: Normally the pupil dilates in the light and constricts in darkness

TRUE

True or False: One of the only presenting symptoms for hyperthyrodism in the elderly might be atrial fibrillation.

TRUE

True or False: Painless shortening of a muscle, usually secondary to a prior of limited ROM is referred to as a contracture.

FALSE

True or False: Parotid cysts are firm and consistent in size

TRUE

True or False: Regarding Allergic Rhinitis, common allergens include: pollens, mold spores, animal dander, dust mites, foods, and stinging insects.

TRUE

True or False: Sleep apnea in children is most commonly caused by adenotonsillar hypertrophy

D. Organ of Corti

The bony labyrinth of the inner ear can be further divided into all of the following EXCEPT: A. vestibule B. semicircular canals C. cochlea D. Organ of Corti

A. CT scan

The diagnostic test of choice for choanal atresia is which of the following? A. CT scan B. MRI C. U/S D. plain radiograph

B. Conjunctiva

The epithelium covering the inner surfaces of the eyelids and the outer surface of the eye is referred to as which of the following? A. Cornea B. Conjunctiva C. Canthus D. Sclera E. Pupil

C. palpebrae

The eyelids are often referred to as which of the following? A. canthus B. conjunctiva C. palpebrae D. nasolacrimal apparatus E. meatus

D. Organ of Corti

The hair cells of the cochlear duct are located in the: A. vestibule B. semicircular canals C. cochlea D. Organ of Corti E. all of the above

B. fovea

The highest concentration of cones (which produce color vision) occurs in which of the following structures of the eye & is referred to as the site if sharpest vision? A. optic disc B. fovea C. choroid D. sclera E. ciliary body

D. stapedius muscle

The inner ear consists of all of the following EXCEPT: A. Bony labyrinth B. perilymph C. Organ of Corti D. stapedius muscle E. semicircular canal

B. squamous cell carcinoma

The majority of malignant laryngeal lesions are which of the following? A. adenocarcinoma B. squamous cell carcinoma C. melanoma D. basal cell carcinoma E. none of the above

B. Streptococcus

The most common causative organism for Adenotonsillar disease is which of the following? A. Staph. Aureus B. Streptococcus C. Lactobacillus D. bacteroides E. actinomyces

D. postnasal drip syndrome

The most common cause of chronic cough in adults is which of the following? A. common cold B. sinusitis C. asthma D. postnasal drip syndrome E. gastroesophageal reflux disease

A. reactive viral infection

The most common cause of inflammatory, infectious neck masses in children is which of the following? A. reactive viral infection B. HIV associated disorder C. bacterial infection D. granulomatous diseases E. fungal infections

C. papillary (and it has the best prognosis)

The most common type of thyroid cancer is which of the following? A. follicular B. medullary C. papillary (& it has the best prognosis) D. anaplastic carcinomas E. MEN type 1

D. age

The most important element in the evaluation of a neck mass is which of the following? A. smoking hx B. weight C. diet D. age E. none of the above

C. cochlea

The receptors for hearing are found in the: A. vestibule B. semicircular canals C. cochlea D. Organ of Corti E. all of the above

B. semicircular canals

The receptors that sense rotation of the head are found in the: A. vestibule B. semicircular canals C. cochlea D. Organ of Corti E. all of the above

A. tympanic membrane

The structures of the Middle ear include all of the following EXCEPT: A. tympanic membrane B. malleus C. incus D. stapes E. auditory/Eustachian tube

E. oval window

The structures of the external ear include all of the following EXCEPT: A. Pinna/auricle B. tragus C. external auditory canal/ear canal D. tympanic membrane (TM) E. oval window

A. submandibular

The majority of sialolithiasis (salivary stone obstructions) occurs in which gland? A. submandibular B. parotid C. A&B D. none of the above

D. postnasal drip

The most common cause of chronic cough in adults is which of the following? A. common cold B. sinusitis C. asthma D. postnasal drip E. GERD

A. Cornea

The transparent, fibrous layer covering the eye is referred to as which of the following? A. Cornea B. Conjunctiva C. Canthus D. Sclera E. Pupil

A. nasal dermoid cysts

The most common congenital abnormality of the nose is which of the following? A. nasal dermoid cysts B. nasal encephaloceles C. nasal gliomas D. Choanal atresia E. nasal pyriform aperture stenosis

D. dysphonia

The most common presenting symptom in a patient with a benign laryngeal lesion is which of the following? A. hematemesis B. chest pain C. insomnia D. dysphonia E. GERD

C. mumps

The most common viral disorder causing parotitis is which of the following? A. varicella B. Shingles/Varicella Zoster C. mumps D. HSV E. HIV

A. medial

The optic disc is located just __________ to the fovea. A. medial B. lateral C. superior D. inferior E. posterior

D. VII

Inability to close the eye is due to palsy of which CN? A. II B. III C. V D. VII E. X

C. foreign body

A 3-year-old boy presents with a 2-week history of purulent rhinorrhea from his right nostril. Mother complains that the child's nose has a bad odor. What is the most likely diagnosis? A. maxillary sinusitis B. ethmoid sinusitis C. foreign body D. nasal polyp E. acute viral rhinitis

A. hordeolum (aka sty)

A painful, localized swelling of the eyelid that is infectious is referred to as which of the following? A. hordeolum (aka sty) B. chalazion C. conjunctivitis D. Blepharitis E. Emmetropia

D. neomycin allergy

A 14-year-old boy presents with a history of "swimmer's ear," which was treated with Cortisporin Otic suspension 3 days prior. He now presents with increased erythema and crusting around the outer ear canal and a weeping somewhat vesicular area that extends below the tragus. His pain has increased. What is the likely diagnosis? A. Pseudomonas otitis externa B. mastoiditis C. Ramsay-Hunt syndrome D. neomycin allergy E. necrotizing otitis externa

B. Reiter syndrome

A 26-year-old male presents with bilateral conjunctivitis, dysuria, and pain in his lower back and right Achilles tendonitis. What is the probable diagnosis? A. ankylosing spondylitis B. Reiter syndrome C. Behcet disease D. polyarteritis nodosa E. gonococcal disease

D. HSV keratitis

A 28 year old female presents with a painful, red eye, photophobia, and excessive tearing. Scrapings of the cornea reveal multinucleated giant cells. Which of the following is the most likely diagnosis? A. Fungal keratitis B. acanthamoeba keratitis C. bacterial keratitis D. HSV keratitis

C. CT scan

1The diagnostic test of choice for mucoceles in the mouth is which of the following? A. MRI B. x-ray/radiograph C. CT scan D. bone scan E. EEG

A. chalazion

A 10-year-old boy presents with a fibrous nodule under his upper eyelid. It has been present for a couple of months. There is no drainage or pain. What is the most likely diagnosis? A. chalazion B. stye C. chronic dacryocystitis D. dacryocystocele E. foreign body reaction

A. obtain an urgent surgical consult for tonsillectomy

A 14-year-old boy presents with a history of unilateral tonsillitis from a previous visit. His mother has noticed that his right tonsil has continued to rapidly enlarge over a period of 6 weeks despite a 10-day course treatment with amoxicillin. The pharynx is normal except for a unilaterally enlarged tonsil on the right. There is no exudate or inflammation noted. Careful oral palpation and comparison of the tonsils demonstrates a firm nontender right tonsil that is 50% larger than the tonsil on the left. He has nontender right anterior cervical adenopathy. A CBC and differential is within normal limits. Which of the following is most appropriate in managing this patient? A. obtain an urgent surgical consult for tonsillectomy B. prescribe an alternative antibiotic and schedule for routine follow-up C. perform a monospot test D. reassure the patient and his mother that this is normal after tonsillitis and that the tonsil will eventually decrease in size as the patient ages E. request a soft tissue lateral radiograph to rule out a retropharyngeal abscess

E. perform a serum assay for mononucleosis

A 15-year-old boy presents with an exudative tonsillitis. Anterior and posterior cervical lymph nodes are enlarged and tender. The rapid antigen test for strep is negative for group A B-hemolytic streptococcus. What is the most appropriate step in treating this disease? A. treat presumptively with PCN B. check for a history of recurrent tonsillitis C. wait for confirmation of the disease with a formal culture D. assume it is viral and, therefore, self-limited E. perform a serum assay for mononucleosis

C. CT of the head (r/o skull base osteomyelitis/malignant external otitis/necrotizing otitis)

A 16 year old male presents with left ear pain for the past 3 weeks. He "just thought it would go away". He is a competitive diver. Physical examination reveals intense left otalgia, pruritus, trismus of the muscles of mastication, cranial nerve neuropathies. Which of the following should be ordered STAT? A. MRI of the head B. Lumbar puncture C. CT of the head (r/o skull base osteomyelitis/malignant external otitis/necrotizing otitis) D. CBC, electrolytes E. blood cultures

C. X-ray of the orbits

A 16 year old softball player presents with a fractured nose which occurred during a game. Which study must always be ordered in addition to nasal x-rays? A. bone scan B. MRI of the head C. X-ray of the orbits D. U/S

A. refer the patient for incision and drainage (I&D) and pressure dressing

A 16-year-old boy presents with a history of injury to his left pinna while competing at a wrestling match. The superior outer portion of the pinna is edematous and fluctuant to palpation. There is minimal tenderness to palpation, and the patient is diagnosed with cauliflower ear. Which of the following management decisions is most appropriate? A. refer the patient for incision and drainage (I&D) and pressure dressing B. have the patient return only if he develops a fever C. apply a soft, bulky, and loose-fitting dressing to protect the pinna D. prescribe a 10-day course of amoxicillin and schedule for a clinic follow-up E. perform an I&D only if the pinna becomes red and tender

E. sweat chloride test (r/o CF)

A 2 year old male presents with chronic rhinitis, thick secretions, and respiratory symptoms. On physical examination you note several polyps. Which of the following is the first test that should be ordered? A. plain radiograph of the nose B. CT of the head C. MRI of the head D. CBC, electrolytes E. sweat chloride test (r/o CF)

A. amblyopia

A 2-year-old child presents with mild but obvious crossed-eyes since birth. Unless this is treated by an ophthalmologist, what is the likely outcome? A. amblyopia B. esotropia C. exotropia D. hypophoria E. strabismus

C. emergent referral to an ENT provider

A 20 year old male sustains a blow to his nose during a disagreement with some friends 5 or 6 days prior to his visit today. He complains that his breathing progressively worsened despite a decrease in external nasal swelling. Your examination shows soft fluctuant swelling of the septum bilaterally. This area is not tender to palpation. What is your treatment plan? A. nasal steroids for a couple weeks to reduce intranasal swelling B. broad-spectrum antibiotic to prevent abscess formation C. emergent referral to an ENT provider D. CT scan to rule out a complex nasal fracture E. needle aspiration of the fluctuant area with cultures

B. temporal bone fracture

A 23 year old male is brought in by EMT after a MVA with a positive battle sign and raccoon sign. Otoscopic examination reveals hemotympanum and bloody otorrhea. Which of the following is the most likely diagnosis? A. perforated TM B. temporal bone fracture C. vestibular schwannoma D. Meniere disease E. zygotic arc fracture

E. erythroplakia

A 24 year old baseball player presents with "a white patch in my mouth". Upon questioning he admits to frequent use of chewing tobacco. On physical examination, you are NOT able to scrape off the lesion. Which of the following is the most likely diagnosis? A. oral candidiasis B. strep. Pharyngitis C. squamous cell carcinoma D. Malignant melanoma E. erythroplakia

E. oral steroids and antiviral medications

A 24-year-old female presents with an acute onset of right facial paralysis. She woke with some discomfort behind the right ear and noted weakness of the face. She complains of a bitter taste in the mouth. Examination of the ear and face is completely normal. She has no history of rash, tick bites, or diabetes. What is the most appropriate treatment of this condition? A. IV steroids B. oral antibiotics alone C. antiviral and antibiotic medications D. eye precautions and saline eye drops E. oral steroids and antiviral medications

E. evert the upper eyelid

A 24-year-old male is working in a factory and felt a speck of material get into his eye, which was quite painful. He flushed out his eye at work but still complains of pain. He states that blinking makes the pain worse. The eye is very red. What is your next step? A.patch the eye and refer to an ophthalmologist B. flourescein staining C. cycloplegics to reduce the patient's pain D. slit-lamp examination E. evert the upper eyelid

E. glucose dipstick

A 26-year-old healthy-appearing male presents with rhinorrhea since having a nondisplaced nasal fracture 3 weeks prior. According to the patient, his nose has completely healed and feels fine now. He complains of short gushes of a clear salty tasting liquid out of his right nostril several times a day. He states that he can sometimes precipitate the drainage by leaning his head forward. Which test should you run on this liquid? A. "bull's-eye" test B. specific gravity C. gram stain D. culture & sensitivity E. glucose dipstick

A. Meniere disease

A 33-year-old female presents with episodes of vertigo lasting about 20 minutes and associated with fluctuating hearing loss and a low-frequency nonpulsatile tinnitus in the affected ear. After these episodes of vertigo, the patient states that her hearing improves and the tinnitus resolves. Which of the following illnesses is suggested by these symptoms? A. Meniere disease B. Eustachian tube dysfunction C. vestibular neuronitis D. paroxysmal positional vertigo E. none of the above

B. otomycosis

A 34 year old female presents with severe right ear pain, swelling, and a black discharge from the ear. Which of the following is the most likely diagnosis? A. otitis externa B. otomycosis C. auricular hematoma D. otitis media E. auricular laceration

D. Tensilon test

A 35-year-old female presents with a history of a self-limited upper respiratory illness 3 weeks prior to this clinic visit. She now complains of persistent weakness and malaise, which worsens near the end of the day. She complains that she has a difficult time keeping her right eye open during the later part of the day. Taking a nap often helps. You notice that her right eyelid covers the top portion of her pupil. Pupillary reaction is otherwise negative. Which evaluation is the most likely to confirm your preliminary diagnosis? A. CT scan of the brain B. lumbar puncture C. funduscopic examination D. Tensilon test E. psychiatric evaluation

B. chalazion

A 35-year-old male presents to your office complaining of a painless, localized swelling of his left lower eyelid that has developed over a period of weeks. He comes in today because it is now producing a foreign body sensation in his left eye. On physical examination, his visual acuity is normal and there is no evidence of injection or discharge. There is a nontender, localized nodule on the lower eyelid. What is the likely diagnosis? A. hordeolum B. chalazion C. pterygium D. dacryocystitis E. blepharitis

D. oral steroids

A 35-year-old male presents with a 1-week history of a marked decrease of hearing in his right ear. He denies trauma, otorrhea, or vertigo. The physical examination appears to be normal except for his tuning fork tests. The Weber test lateralizes to the better ear and the Rinne test shows air conduction to be better than bone conduction in both ears. After confirmation of your findings with an audiometric evaluation, what would be the most appropriate treatment? A. broad-spectrum antibiotic B. nasal steroids C. decongestant D. oral steroids E. antihistamines

D. sensorineural hearing loss in the right ear

A 36 year old female who works with snow blowers presents with diminished hearing in the right ear. Weber test lateralizes to the left ear. Air conduction is longer than bone conduction in the left ear, and bone conduction is equal to air conduction in the right ear. Which of the following is the most likely diagnosis? A. conductive hearing loss in the left ear B. conductive hearing loss in the right ear C. sensorineural hearing loss in the left ear D. sensorineural hearing loss in the right ear E. both C&D

B. debris in the posterior semicircular canal (BPPV)

A 37 year old female presents with vertigo. On examination she sits with legs extended and then lies back with her head held at 20 degrees extension. Rotational nystagmus is noted. What is the underlying etiology of the condition that she has? A. Limited blood flow to the brain B. debris in the posterior semicircular canal (BPPV) C. increase in the amount of endolymph fluid in the membranous labyrinth D. demyelination of the nerve sheaths E. underlying viral illness

B. MRI (vestibular Schwannoma, nerve sheath tumor of CN VIII)

A 37 year old male presents with hearing loss in the right ear & tinnitus. On PE the right TM is red-streaked & sensorineural loss is noted in the right ear. Which diagnostic test is gold standard for this condition? A. CT scan B. MRI (vestibular Schwannoma, nerve sheath tumor of CN VIII) C. audiology testing D. EEG E. serial audiograms

C. restricted ocular movement; CT scan

A 38-year-old male presents to the emergency department complaining of persistent double vision after being hit in the left eye during a fistfight the night before. On physical examination, his left periorbital area is markedly edematous and ecchymotic. On the basis of his history, what other abnormal findings might you expect to find as you complete your ophthalmic examination, and what diagnostic study would you order to best confirm your diagnosis? A. hyphema; Schiotz tonometer B. hyphema; plain radiograph C. restricted ocular movement; CT scan D. restricted ocular movement; plain radiograph E. ruptured globe; retinal angiography

E. orbital cellulitis

A 39 year old female with a long history of sinus infections presents with a sore right eye. Her temperature is 103.1 degrees F. PE reveals erythema and edema of the eyelids and conjunctivae. The eyeball is protruding as well. Which of the following is the most likely diagnosis? A. bacterial conjunctivitis B. blepharitis C. dacryocystitis D. hordeolum/stye E. orbital cellulitis

D. perform a test using fluorescein dye

A 40-year-old male presents with a history of having a fleck of metal getting into the eye while the patient was pounding on a piece of metal scrap. There is significant subconjunctival hemorrhage with a central abrasion on the sclera. How can you rule out a perforation of the globe? A. apply gentle pressure to the globe to see if there is extrusion B. perform a MRI test C. perform a Schiotz tonometry test D. perform a test using fluorescein dye E. do nothing until cleared by an ophthalmologist

B. vestibular neuritis

A 42 year old female presents with a viral URI for the past 2 weeks. She, also, has nausea, vomiting, and acute vertigo for the past week. Which of the following is the most likely diagnosis? A. Meniere disease B. vestibular neuritis C. BPPV D. vestibular schwannoma E. neoplasm of the temporal bone

A. Staphylococcus aureus

A 43-year-old male presents with a 3-day history of localized pain, redness, and swelling of his upper eyelid. He denies fever, visual changes, or photophobia. On physical examination, the patient's eyelid is diffusely red, with a tender, localized area of swelling, which points outward. He appears to have an infection of the glands of the upper eyelid. The most common pathogen associated with this infection is which of the following? A. Staphylococcus aureus B. Streptococcus pneumoniae C. Haemophilus influenzae D. Candida albicans E. Aspergillus species

C. optic chiasm

A patient experiencing visual loss in the temporal half of each eye. Where do you suspect the lesion to be? A. right optic radiation B. left optic radiation C. optic chiasm D. right optic tract E. left optic tract

D. rhinitis medicamentosa

A 45 year old male presents with chronic nasal congestion. He has been using a topical 12 hour duration nasal decongestant for the last several weeks, which has, up until recently, been very effective. Initially, he used it only a couple of times per day. Now, he states that he has to use it every 2-3 hours. If he does not use the nasal spray, he feels very congested and cannot breathe. He denies purulent drainage or epitaxis. What is the diagnosis? A. deviated septum B. allergic rhinitis C. nasal polyps D. rhinitis medicamentosa E. chronic sinusitis

B. otosclerosis

A 45 year old male presents with slowly, progressive bilateral hearing loss, tinnitus, vertigo, imbalance, aural fullness, otorrhea, and headache. He has a family history of "hearing impairment". He has conductive hearing loss in the right ear. On otoscopic examination a dense, white region is noted of the otic capsule anterior to the stapes footplate. Which of the following is the most likely diagnosis? A. cholesteatoma B. otosclerosis C. presbycusis D. presbystasis E. benign paroxysmal positional vertigo (BPPV)

E. primary acute angle closure glaucoma

A 45-year-old female presents with sudden onset of excruciating pain in the right eye, blurred vision, nausea, and vomiting. Physical examination reveals decreased visual acuity, intraocular pressure of 70 mm Hg, shallow anterior chamber, steamy cornea, and a moderately dilated right pupil. Which of the following is the most likely diagnosis? A. retinal detachment B. retinal artery occlusion C. uveitis D. primary open angle glaucoma E. primary acute angle closure glaucoma

E. no treatment necessary

A 45-year-old male presents with decreased nasal flow from either nostril. He first noticed this when smoking and saw a decrease in the volume of air coming from one nostril and then reversing. Otherwise, he does not feel as if he is having problems breathing. He denies purulent drainage or facial pain. What treatment is most appropriate? A. nasal steroid sprays B. topical nasal decongestants C. oral decongestant D. saline irrigation E. no treatment necessary

D. obstructive sleep apnea (OSA)

A 45-year-old white male presents with a history of persistent fatigue throughout the day despite a full night of sleep. He complains of a sore throat and headache each morning. He has used short-acting sleeping pills, which only seem to worsen his symptoms. He is being treated for poorly controlled hypertension. The patient is morbidly obese. Which of the following conditions is most likely for this patient? A. endogenous depression B. diabetes mellitus C. hypothyroidism D. obstructive sleep apnea (OSA) E. Cushing syndrome

D. rhinitis medicamentosa

A 45-year-oldmale presents with chronic nasal congestion. He has been using a topical 12-hour-duration nasal decongestant for the last several weeks, which has, up until recently, been very effective. Initially, he used it only a couple of times per day. Now, he states that he has to use it every 2 to 3 hours. If he does not use the nasal spray, he feels very congested and cannot breathe. He denies purulent drainage or epistaxis. What is the diagnosis? A. deviated septum B. allergic rhinitis C. nasal polyps D. rhinitis medicamentosa E. chronic sinusitis

C. KOH prep

A 46 year old female s/p radical mastectomy, lymph nose excision, and chemotherapy develops white patches in her mouth. On PE they easily scrape off but bleed. Which of the following studies is most appropriate? A. radiation therapy B. CBC, electrolytes C. KOH prep D. panoramic view x rays E. none of the above

D. evaluation with a tongue blade

A 5 year old male presents to the ER with odynophagia, drooling, irritability, fever, toxicity, and is sitting & leaning forward with the neck extended. Thumb print sign is seen on radiographs. Which of the following is completely contraindicated in this child? A. ceftriaxone B. PCN C. IV cannula insertion D. evaluation with a tongue blade E. emergency tracheotomy

C. nasal foreign body

A 5 year old presents with unilateral, malodorous discharge from the right nare. The discharge appears to be mixed with blood. Which of the following is the most likely diagnosis? A. allergic rhinitis B. juvenile angiofibroma C. nasal foreign body D. nasal polyp E. vasomotor rhinitis

B. otosclerosis

A 50-year-old female presents with a progressive sense of decreased hearing in her right ear over several years. Her father had hearing problems at a young age but never was evaluated. She denies trauma, noise exposure, or ear disease as a child. Your examination demonstrates a completely normal-appearing TM, which is mobile to pneumatic testing. Tuning fork tests show a Weber test that lateralizes to the affected (right) ear. Air conduction is greater than bone conduction of the left; on the right bone conduction is greater than air conduction. What is the diagnosis? A. serous otitis media B. otosclerosis C. presbycusis D. tympanosclerosis E. idiopathic hearing loss

A. no treatment is needed

A 50-year-old male presents with an acute and painless onset of a bright red patch along the lateral part of his sclera. His visual acuity is normal and blood pressure is within normal limits. He has had a cough, which is getting better. What is the most appropriate treatment? A. no treatment is needed B. CT scan to rule out intracranial hemorrhage C. CBC and bleeding studies D. emergent consultation with an ophthalmologist E. a complete intraocular examination with dilation

D. palsy of right CN#12

A 57 year old female presents with "difficulty speaking for the past week". On examination her tongue is slightly deviated to the right. Which of the following is the most likely diagnosis? A. palsy of left CN #9 B. palsy of right CN #9 C. palsy of left CN#12 D. palsy of right CN#12 E. palsy of CN#6

C. temporomandibular joint dysfunction

A 59-year old female presents with severe right ear pain for the last week. She also complains that the ear hurts most when chewing. Her hearing has not been affected. Examination shows tenderness to palpation of the external canal meatus anteriorally. The TM is clear. What is the most likely diagnosis? A. otitis externa B. otitis media C. temporomandibular joint dysfunction D. furuncle of the canal E. chondritis

C. allergic rhinitis

A 6 year old boy presents with dark circles under the eyes, facial grimacing, mouth breathing, and the "nasal salute". Which of the following is the most likely diagnosis? A. viral rhinitis B. vasomotor rhinitis C. allergic rhinitis D. normal rhinitis during pregnancy E. rhinitis medicamentosa

B. Ramsay-Hunt

A 60-year-old female presents with an acute onset of left facial nerve paralysis. She has severe pain. You notice that she has vesicles on the pinna. What is the name of this syndrome? A. Bell palsy B. Ramsay-Hunt C. Mobius D. Millard-Gubler E. Melkersson-Rosenthal

B. benign paroxysmal positional vertigo

A 60-year-old male presents with a 2-week history of sensation of spinning when turning over in bed at night. He occasionally has a spinning sensation when turning his head to the right. He denies tinnitus or decrease in his hearing. He also complains about ringing in his ear and notes that his wife complains about his inability to hear. He hears a pulsating sound in his right ear, which is worse at night. What is your diagnosis? A. central vertigo B. benign paroxysmal positional vertigo C. labyrinthine neuronitis D. viral labyrinthitis E. basilar migraine

E. microaneurysms and hard exudates

A 60-year-old male presents with long-standing poorly controlled hypertension. Which of the following is/are generally NOT associated with hypertensive retinopathy? A. AV nicking with focal arteriolar damage B. cooper wire arterioles C. decreased AV ration D. papilledema E. microaneurysms and hard exudates

C. request an emergent CT of the head

A 62-year-old female presents with a 3-week history of progressively more painful and worsening external otitis. She is a type 2 diabetic patient and has been poorly controlled on oral hypoglycemics. Examination demonstrates a foul-smelling purulent drainage and the presence of granulation tissue within the auditory canal. The tympanic membrane appears to be normal and mobile to pneumatic testing. What is the most appropriate management decision at this time? A. debride the canal and start on oral anti-pseudomonal antibiotics such as ofloxacin B. perform a gram stain and culture of the discharge C. request an emergent CT of the head D. prescribe oral antibiotics, topical otic antibacterial drops, and effective pain management E. improve management of the diabetes to improve efficacy of conservative therapy

A. emergency referral to an ophthalmologist

A 65-year-old female fell down and bumped her head earlier in the evening. She now presents with a sensation of flashing lights and floaters in her right eye. She has a history of diabetic retinopathy. She now has decreased visual acuity and feels that there is a curtain over her left visual field. Funduscopic examination is difficult and, therefore, nondiagnostic since the patient is on eye drops for glaucoma. What is the most appropriate disposition for this patient? A. emergency referral to an ophthalmologist B. fasting blood glucose level C. CT scan of the head D. neurologic evaluation E. admission to the hospital for head injury observation

C. Cerebrovascular accident

A 65-year-old male with a history of diabetes mellitus presents with an acute episode of left facial paralysis. He is still able to wrinkle and elevate both sides of his forehead. He denies recent viral illness or ear pain. His diabetes has been well controlled. Examination of the TMs and the external pinnae are normal. The Weber and Rinne tuning fork assessments are normal. Visual acuity, extraocular movements, and pupillary responses are all normal and equal bilaterally. Which of the following is the most likely diagnosis? A. Bell palsy B. Ramsay-Hunt syndrome C. Cerebrovascular accident D. peripheral facial nerve palsy E. diabetic neuropathy

C. two percent lidocaine

A 7 year old male presents with "a weird sound in my left ear that bothers me". Otoscopic examination reveals an insect in the patient's left ear. Which of the following should be applied into the ear prior to removal? A. an otowick B. bactroban ointment C. two percent lidocaine D. warm saline E. pneumatic otoscopy

B. Foley catheter and anterior pack to stop a posterior bleed

A 70-year-old male presents to the ER with a 3-hour history of severe epistaxis from the right nostril. A bleeding site cannot be visualized. It is not controlled with a nasal decongestant, firm digital pressure of the nares, or anterior packing. Persistent bleeding is noted in the pharynx despite these measures. The patient is currently on a prophylactic antiplatelet medication. What is the most appropriate assessment or treatment while awaiting an ENT consultation? A. CT scan of the sinuses B. Foley catheter and anterior pack to stop a posterior bleed C. sedation D. transfusion E. replace the anterior packing

B. a pale or milky retina with a cherry-red fovea

A 75-year-old male presents with a painless, sudden loss of vision in one eye. A careful history reveals previous episodes of vision loss that resolved spontaneously. A workup for these previous episodes included a carotid ultrasound, which confirmed a diagnosis of bilateral carotid stenosis. Given the patient's current symptoms and medical history, which of the following findings would be expected on funduscopic examination? A. retinal lines that have the appearance of a "ripple on a pond" or a "billowing sail" B. a pale or milky retina with a cherry-red fovea C. enlarged physiologic cup, occupying more than half of the disc's diameter D. swollen disc with blurred margins; physiologic cup is not visible E. yellowish-orange to creamy-pink disc with sharp margins and a centrally located physiologic cup

C. consult ENT immediately for an emergent consult

A child with a history of a recent episode of acute otitis media presents with a painful swelling of the area behind the right ear. There is protrusion of the ear. The child is febrile and looks very ill. You notice that he has a right facial paresis. Your examination shows a hyperemic and bulging right TM with a purulent effusion. The TM is immobile to pneumatic testing. What is your next step? A. insert an otowick and start the child on antibiotic otic drops to prevent further extension of the infection B. admit the child to a pediatric service to watch and wait for additional CNS extension C. consult ENT immediately for an emergent consult D. prescribe high-dose amoxicillin E. perform close outpatient follow-up the following day after prescribing oral antibiotics

E. Rhizopus (fungal sinusitis)

A diabetic male presents with nasal congestion, obstruction, & facial pain which radiates to the teeth. Water view x-ray reveals consolidation of the right maxillary sinus. Black necrotic debris is noted. The most likely causitive organism for this condition is which of the following? A. Strep. Pnuemoniae B. H. influenzae C. Aspergillus D. Mucor E. Rhizopus (fungal sinusitis)

E. peritonsillar abscess

A febrile, 18-year-old boy presents with a 4 day history of sore throat that has suddenly become much worse. He complains of pain when attempting to eat or drink and has difficulty opening his mouth. He has a "hot potato" voice. On the basis of this clinical presentation, what is the diagnosis? A. epiglottis B. retropharyngeal abscess C. croup D. tonsillitis E. peritonsillar abscess

A. topical erythromycin

A neonate develops newborn conjunctivitis. If no particular organism is suspected, what is your first line therapy? A. topical erythromycin B. ceftriaxone C. acyclovir D. preservative-free artificial tears only E. none of the above

E. septal porforation

Allergic rhinitis can be associated with other chronic conditions including all of the following EXCEPT: A. asthma B. otitis media with effusion C. rhinosinusitis D. nasal polyposis E. septal porforation

B. scotomas

Abnormal blind spots are referred to as which of the following? A. cataracts B. scotomas C. astigmatism D. presbyopia E. emmetropia

E. all of the above

After a long history of sinus infections or a sty left untreated, a patient is at risk for developing preseptal cellulitis. Which of the following pathogens are generally involved? A. H. influenzae B. streptococcus pneumoniae C. staph aureus D. the same 3 generally associated with otitis media E. all of the above

E. all of the above

Age-related macular degeneration (aka presbyopia) may be prevented by taking which of the following? A. vitamin C B. vitamic E C. beta carotene D. zinc E. all of the above

C. metastatic squamous cell carcinoma (generally from the upper aerodigestive tract)

All of the following are considered to be benign neoplasms of the neck EXCEPT: A. paragangliomas B. carotid body tumors C. metastatic squamous cell carcinoma (generally from the upper aerodigestive tract) D. schwannomas E. neurofibromas

E. PCN

All of the following are considered to be ototoxic drugs EXCEPT: A. cisplatin B. salicylates C. aminoglycosides antibiotics D. loop diuretics E. PCN

E. brain glioma

All of the following are potential complications of otitis media left untreated EXCEPT: A. tympanosclerosis B. mastoiditis C. facial nerve palsy D. meningitis E. brain glioma

D. aminoglycoside therapy

All of the following may be given as a prophylaxis for Eustachian tube obstruction while diving EXCEPT: A. oral decongestants B. steroid nasal sprays C. short course nasal decongestants D. aminoglycoside therapy

E. all of the above are involved

All of the following muscles are involved in mastication EXCEPT: A. masseter B. temporalis C. medial ptergoid D. lateral ptergoid E. all of the above are involved

D. GERD

All of the following often leads to a tracheoesophageal fistula EXCEPT: A. prolonged mechanical ventilation B. neoplasm C. radiation treatment D. GERD

B. right CN XII

An elderly patient presents with slurred speech. You have her protrude her tongue and it deviates to the right. Which cranial nerve is involved? A. left CN XII B. right CN XII C. left CN X D. right CN X E. left CN IX

E. focus your attention on the bleeding. Carefully insert a cotton pledget soaked in a topical vasoconstricter and pinching the nose. If this fails to slow down the bleeding, insert a nasal tampon or one of the many commercially prepared emergency nasal packs

An elderly patient with a history of hypertension, diabetes mellitus, and supraventricular tachycardia presents with a brisk episode of epistaxis from the left nostril and a mild amount of bleeding from the right nostril. The bleeding first occurred last night and lasted for about 20 minutes. You are in the ER and are unable to visualize the bleeding site because of the extent of bleeding from the left nostril. What is the most appropriate next step in your evaluation? A. get a detailed history of medications, prior surgery, prior episodes of epistaxis, and possible nasal disease. Review prior medical records available B. perform diagnostic laboratory work including a CBC, hemoglobin, hematocrit, and clotting factor levels. Prepare the patient for vitamin K administration C. assess the hemodynamic state of the individual by obtaining blood pressures including a "tilt" test to rule out hypovolemia, pulse, and EKG for cardiac monitoring D. start a large bore IV line and provide at least 1 L of lactated Ringer's solution. Start oxygen by mask with a flow of at least 2 L/min. E. focus your attention on the bleeding. Carefully insert a cotton pledget soaked in a topical vasoconstricter and pinching the nose. If this fails to slow down the bleeding, insert a nasal tampon or one of the many commercially prepared emergency nasal packs

B. acanthamoeba keratitis

An otherwise healthy 25 year old male who wears contact lens and has recently been in the hot-tub several times over the past week develops a small corneal ulcer. Which of the following is the most likely cause? A. Fungal keratitis B. acanthamoeba keratitis C. bacterial keratitis D. HSV keratitis

D. Wegener granulomatosis

Anti-neutrophilic cytoplasmic antibodies (ANCA) are very specific for which of the following? A. Sarcoidosis B. Churg-Strauss syndrome C. Rhinoscleroma D. Wegener granulomatosis E. T-cell lymphoma

D. Fine-needle aspiration

Definitive diagnosis for malignancy of the salivary glands includes which of the following? A. MRI B. CT scan C. X-ray D. Fine-needle aspiration E. Mohs surgery

B. wrestlers

Auricular hematoma aka "cauliflower ear" is often seen in which group of athletes? A. football players B. wrestlers C. baseball players D. basketball players E. none of the above

D. parotid

Auricular melanoma (which only accounts for 1% of all melanomas) most commonly spreads to which gland? A. thyroid B. parathyroid C. lacrimal D. parotid E. submandibular

A. psoriasis

Auspitz sign (bleeding in pinpoint areas when scratched) is seen in which of the following conditions? A. psoriasis B. seborrheic dermatitis C. squamous cell carcinoma D. atopic dermatitis E. rosacea

B. II (optic nerve)

Axons from an estimated 1 million ganglion cells converge and form the optic disc which is the origin of which cranial nerve? A. I B. II (optic nerve) C. III D. IV E. V

E. all of the above

Differentials for viral rhinitis includes: A. TMJ pain B. headache C. trigeminal pain D. sinus neoplasm E. all of the above

E. all of the above

Bilateral complete Vagal nerve paralysis is generally secondary to neurologic causes including which of the following? A. brainstem infarction B. MS, multiple sclerosis C. motor neuron disease D. ALS, amytrophic lateral sclerosis E. all of the above

D. Benzathine penicillin G

Beta-hemolytic streptococci pharyngitis left untreated may lead to Scarlet fever with a "strawberry tongue". How is this treated? A. amoxicillin B. erythromycin C. Flagyl D. Benzathine penicillin G E. Augmentin

D. methimazole

Choanal atresia is seen with increased rates when exposure to which medication in utero is seen? A. Bactrim B. prednisone C. Lasix D. methimazole E. fluconazole

E. All of the above

Chronic granulomatous sialadenitis (inflammation of the salivary glands) is most often caused by which of the following? A. TB B. cat-scratch disease C. sarcoidosis D. Wegener granulomatosis E. All of the above

E. all of the above

Complications of acute adenotonsillitis include: A. Scarlet fever B. acute rheumatic fever C. poststreptococcal glomerulonephritis D. peritonsillar abscess E. all of the above

E. all of the above apply

Complications of treatment of laryngeal carcinoma includes all of the following EXCEPT: A. swallowing problems B. loss of taste and smell C. fistula development D. hematoma E. all of the above apply

E. all of the above

Congenital protruding ears are often treated by: A. recreating the antihelical fold B. postaurical skin excision C. conchal-mastoid suture D. otoplasty E. all of the above

D. dehydration

Hairy tongue is generally secondary to which of the following? A. oral carcinoma B. Strep. Infection C. mumps D. dehydration E. all of the above

C. dysosmia

Distorted sense of smell is referred to as which of the following? A. anosmia B. hyposmia C. dysosmia D. phantosmia E. agnosia

E. Zenker diverticulum

Dysphagia, regurgitation of undigested food (with risk of aspiration), gurgling sounds in the neck, and halitosis are generally associated with which of the following conditions? A. GERD B. Barrett's esophagitis C. esophageal cancer D. achalasia E. Zenker diverticulum

D. atopic dermatitis

Elevated IgE and eosinophilia are seen with which condition? A. psoriasis B. seborrheic dermatitis C. squamous cell carcinoma D. atopic dermatitis E. none of the above

D. H. influenzae type B

Epiglottitis is most commonly caused by which of the following? A. E. coli B. strep. Pneumoniae C. staph. Aureus D. H. influenzae type B E. H. influenzae type A

F. all of the above

Esophageal atresia and tracheoesophageal fistula is often seen in conjunction with VACTERL symptoms. This refers to abnormalities of the- A. vertebra B. anal C. cardiac D. renal E. limb F. all of the above

C. VII

Facial nerve Schwannomas may present with sensorineural hearing loss, tinnitus, vestibular dysfunction, and altered balance. Which CN is involved? A. V B. VI C. VII D. VIII E. IX

C. Amoxicillin

First line treatment for acute otitis media is generally: A. PCN B. Augmentin C. Amoxicillin D. Ceclor E. Bactrim

C. rib cartilage

In regards to congenital microtia, what structure is commonly harvested for ear reconstruction? A. hip-ASIS B. distal radius C. rib cartilage D. Hip-PSIS E. none of the above

B. orbital blow-out fracture

In which of the following conditions do muscles become trapped, therefore EOM for 6 cardinal directions must be performed on physical examination? A. eyelid laceration B. orbital blow-out fracture C. traumatic retrobulbar hemorrhage D. corneal laceration E. iridodialysis

A. Meniere disease

Increased endolymphatic fluid owing to impaired reabsorption of endolymphatic fluid in the duct and sac is referred to as which of the following? A. Meniere disease B. otosclerosis C. presbycusis D. presbystasis E. benign paroxysmal positional vertigo (BPPV)

B. HPV

Infection of the larynx with Papollomatosis is caused by which virus? A. HSV B. HPV C. shingles D. varicella E. CMV

C. cornea (transparent layer of eye)

Keratopathy refers to any disease of the: A. pupil B. iris C. cornea (transparent layer of eye) D. retina E. macula

C. immediate removal under general anesthesia

Laryngeal foreign bodies, such as a peanut, lodged in the larynx are treated by which of the following techniques? A. valsalva maneuver B. laryngoscopy with evacuation in the office C. immediate removal under general anesthesia D. Heimlich maneuver E. none of the above, observation then precedes

B. parainfluenzae virus

Laryngotracheobronchitis (Croup) is generally caused by which virus? A. adenovirus B. parainfluenzae virus C. CMV D. coxsackie virus E. Small pox virus

C. chronic open-angle glaucoma

Laser trabeculectomy is the surgical treatment of choice for which of the following conditions? A. nasolacrimal duct obstruction B. cataracts C. chronic open-angle glaucoma D. retinoblastomas E. myopia

C. 20/200

Legally blind is considered which of the following? A. 20/100 B. 100/20 C. 20/200 D. 200/20 E. 20/20

C. only symptomatic treatment required

Melissa is a 7-year-old girl who is brought to her pediatrician by her mother for evaluation of a 2-day history of fever (101 degrees F), sore throat, and redness and tearing in both eyes. She denies any cough, nasal congestion, or any pain or photophobia in her eyes. Melissa has been taking swimming lessons 2 days a week for the past month. Findings on physical examination include copious watery discharge and scanty exudate in both eyes, prominent follicles present on both her conjunctiva and pharyngeal mucosa, and nontender preauricular lymphadenopathy. The most appropriate treatment for Melissa at this time is which of the following? A. PCN to be taken 4 times/day by mouth B. topical or systemic antiviral such as acyclovir C. only symptomatic required D. instillation of a mast cell stabilizer to each eye E. culture of ocular exudate

C. gastric

Metastatic cancer to the trachea generally originates from all of the following EXCEPT: A. thyroid B. esophagus C. gastric D. bronchogenic/lung tumors E. all of the above apply

C. U/S (noted in utero)

Nasal gliomas may be initially detected most commonly via: A. CT scan B. MRI C. U/S (noted in utero) D. plain radiograph

E. all of the above

Nasal polyps may be seen in: A. ASA sensitivity B. chronic sinusitis C. cystic fibrosis D. allergic rhinitis E. all of the above

A. allergies

Nasal polyps may be seen with all of the following EXCEPT: A. allergies B. ASA sensitivity C. cystic fibrosis D. chronic sinusitis

C. sodium fluoride therapy

Non-surgical measures for treatment of otosclerosis includes which of the following? A. prednisone B. methotrexate C. sodium fluoride therapy D. ofloxacin drops E. polymyxin B drops

D. pain and swelling of the gland associated with eating

One of the main presenting symptoms with sialolithiasis is which of the following? A. increased salivary fluid production B. fever C. only dry mouth D. pain and swelling of the gland associated with eating

A. Pseudomonas aeruginosa & Staph. Aureus

Otitis externa is most often caused by which 2 organisms? A. Pseudomonas aeruginosa & Staph. Aureus B. E. coli & Staph. Aureus C. Pseudomonas aeruginosa & H. influenzae D. Staph. Aureus & Strep. pneumoniae

E. HIV

Painless, bilateral enlarged parotid glands, xerostomia (dry mouth), associated cervical lymphadenopathy, and amaylase in the cyst fluid are most consistent with which of the following diseases? A. vericella B. Shingles/Varicella Zoster C. mumps D. HSV E. HIV

E. juvenile angiofibroma

Parents bring their 14 year old son in for several nosebleeds from the left nostril over the past 2 weeks. There is a large reddish-brown mass within the left posterior nasal cavity. What is this mass? A. blood clot B. inverting papilloma C. hemorrhagic polyp D. septal hematoma E. juvenile angiofibroma

E. juvenile angiofibroma

Parents bring their 14-year old son in for several severe nosebleeds from the left nostril over the past 2 weeks. There is a large reddish-brown mass within the left posterior nasal cavity. What is this mass? A. blood clot B. inverting papilloma C. hemorrhagic polyp D. septal hematoma E. juvenile angiofibroma

A. Choroid

The vascular layer of the eye that separates the fibrous (sclera) and neural (retina) tunics is referred to as which of the following? A. Choroid B. Conjunctiva C. Canthus D. Iris E. Pupil

E. retina

Photoreceptors are located in which of the following? A. sclera B. choroid C. fovea D. macula E. retina

A. selenium sulfide

Primary treatment for seborrheic dermatitis is which of the following? A. selenium sulfide B. antihistimines C. bactroban ointment D. corticosteroids E. PCN

A. cholesteatoma

Retraction of the TM, generally the pars flaccida, with a squamous, keratin debris collection or a whitish mass behind an intact TM generally describes which of the following disorders? A. cholesteatoma B. otosclerosis C. presbycusis D. presbystasis E. benign paroxysmal positional vertigo (BPPV)

D. HTN

Risk factors for sleep apnea include all of the following EXCEPT: A. obesity B. large circumference of the neck C. Native Americans D. HTN E. genetic syndromes

C. inner ear

Sense of equilibrium and hearing are provided by receptors of the: A. External ear B. middle ear C. inner ear D. all of the above

E. it's an autoimmune condition

Sjogren Syndrome presents with dryness of the mouth and eyes. What is the underlying etiology? A. HSV B. Shingles C. mumps D. polio E. it's an autoimmune condition

D. Epstein-Barr

T-cell lymphoma is commonly seen in association with which virus? A. influenzae B. varicella C. HSV D. Epstein-Barr E. adenovirus

C. amphotericin B (most aggressive systemic therapy)

Treatment for inflammatory fungal infections of the neck would include which of the following? A. fluconazole/ diflucan B. nystatin C. amphotericin B (most aggressive systemic therapy) D. triazole E. lamisil

E. all of the above apply

Treatment for sleep apnea includes all of the following EXCEPT: A. CPAP therapy B. weight loss C. positional therapy D. Mandibular repositioning devices E. all of the above apply

E. All of the above apply

Treatments for Respiratory Papillomatosis include all of the following EXCEPT: A. cryosurgery B. CO2 laser C. possible tracheotomy D. electrocautery E. All of the above apply

TRUE

True or False: The anterior cavity is subdivided into the anterior and posterior chambers. They are filled with aqueous humor which circulates by passing from the posterior chamber, through the pupil, into the anterior chamber, then drains through the Canal of Schlemm

TRUE

True or False: The lacrimal apparatus produces tears secreted from the lacrimal gland into the lacrimal ducts which is transported through the lacrimal canals into the lacrimal sac, and drains into the nasolacrimal duct. This duct delivers the tears to the inferior meatus of the nasal cavity.

E. B&C

Vocal cord paralysis is generally secondary to disruption of the motor innervation of the larynx. This is most commonly related to which nerve(s)? A. Sublingual B. vagus C. recurrent laryngeal D. A&B E. B&C

D. Strep. Pneumoniae, M. catarrhalis, H. influenza

What are the 3 most common organisms seen with otitis media? A. E. coli, M. Catarrhalis, and Strep. Pneumoniae B. H. influenzae, E. coli, Strep. Pneumoniae C. Pseudomonas, Strep. Pneumonae, M. catarrhalis D. Strep. Pneumoniae, M. catarrhalis, H. influenzae

E. age-related macular degeneration (ARMD)

What is the leading cause of permanent vision loss in people older than 65 years in the United States? A. diabetic retinopathy B. glaucoma C. hypertensive retinopathy D. cataracts E. age-related macular degeneration (ARMD)

A. Adenovirus

What is the most common causative agent for acute conjunctivitis? A. Adenovirus B. HSV I C. HSV II D. Neisseria gonorrhoeae E. staphylococcus aureus

C. squamous cell carcinoma

What is the most common form of esophageal cancer? A. Barrett's esophagitis B. adenocarcinoma C. squamous cell carcinoma D. melanoma E. metastatic secondary cancer

B. minor trauma (picking of the nose)

What is the number one cause for epistaxis? A. foreign bodies B. minor trauma (picking of the nose) C. coagulopathies D. dry mucosa

C. orbital cellulitis

What is the number one complication associated with bacterial sinusitis? A. rhinitis B. headaches C. orbital cellulitis D. conjunctivitis E. meningitis

D. achromatopsia

What is the term for color-blindbness? A. aniridia B. albinism C. amaurosis D. achromatopsia

A. tertiary syphilis

What is the underlying etiology for Argyll Robertson pupils? A. tertiary syphilis B. gonorrhea C. chlamydia D. CN 3 palsy E. CN 7 palsy

D. defective lower esophageal/cardiac sphincter with retrograde flow of gastric contents

What is the underlying pathology associated with GERD? A. excess gastric fluid production B. H. Pylori C. Strep. Pneumoniae D. defective lower esophageal/cardiac sphincter with retrograde flow of gastric contents E. Insufficient relaxation at the LES leading to obstruction

C. Seborrheic dermatitis

What skin condition places a patient at a higher risk for developing blepharitis? A. Psoriasis B. Roseca C. Seborrheic dermatitis D. Tinea corporis E. Basal cell carcinoma

E. lens

What structure divides the posterior and anterior cavities of the eye? A. Pupil B. cornea C. sclera D. choroid E. lens

A. inverted papillomas

Which condition is associated with HPV? A. inverted papillomas B. juvenile angiofibromas C. nasal polyps D. sinuisitis E. rhinitis

C. hyperopia

Which condition is referred to as far-sightedness, when the patient cannot see close objects? A. emmetropia B. myopia C. hyperopia D. hypertropia E. Presbyopia

B. Myasthenia gravis

Which condition is treated with plasmapheresis? A. Multiple Sclerosis B. Myasthenia gravis C. Neurosyphillis D. Horner's syndrome E. CN III palsy

A. hyphema

Which condition may be a presenting sign of a bleeding disorder such as hemophilia or sickle cell? A. hyphema B. ruptured globe C. Commotio retinae D. Purtscher retinopathy E. Cataract

C. HSV

Which condition presents with Tzanck smear cells that are multinucleated and giant? A. CMV B. adenovirus C. HSV D. coxsackie A E. all of the above

A. anterior septum

Which is the most common site of epistaxis in adults? A. anterior septum B. posterior septum C,. Inferior turbinate D. superior nasal vault E. floor of nose

E. MRI

Which is the study modality of choice when evaluation complete vagal paralysis of the larynx? A. EEG B. CT C. MRI D. U/S E. MRI

C. presbycusis (otherwise unexplained, slowly progressive, predominately high frequency symmetric hearing loss due to the normal aging process)

Which of the following is the most common cause of sensorineural hearing loss? A. cholesteatoma B. otosclerosis C. presbycusis (otherwise unexplained, slowly progressive, predominately high frequency symmetric hearing loss due to the normal aging process) D. presbystasis E. benign paroxysmal positional vertigo (BPPV)

C. basal cell carcinoma of the auricle

Which of the following is the most common malignant neoplasm of the skin/auricle? A. cutaneous squameous cell carcinoma B. melanoma of the external ear C. basal cell carcinoma of the auricle D. lipoma of the auricle E. none of the above

D. doxycycline

Which of the following is the primary treatment for Lyme disease? A. PCN B. amoxicillin C. Bactrim D. doxycycline E. cipro

A. pterygium

Which of the following is thought to be caused by excessive sunlight exposure and chronic irritation? A. pterygium B. hordeolum/sty C. chalazion D. blepharitis E. corneal ulcer

C. Tobramycin & Ticarcillin

Which of the following long-term antibiotics are most commonly used to treat necrotizing otitis? A. Cipro and Bactrim B. Augmentin & Vancomycin C. Tobramycin & Ticarcillin D. Tobramycin & Amoxicillin E. Cipro & Vancomycin

C. zinc sulfate

Which of the following may enhance improvement in olfaction following trauma? A. vitamin A B. vitamin C C. zinc sulfate D. albuterol E. Allegra

D. tonsilloliths

Which of the following might be treated with 3% hydrogen peroxide? A. mucoceles B. salivary infection C. strep. Pharyngitis D. tonsilloliths E. none of the above

E. Papilledema

Which of the following might occur in conjunction with optic nerve swelling, HTN, A/V nicking, obesity, or increased intracranial pressure? A. Glaucoma B. Cataract C. Astigmatism D. Presbyopia E. Papilledema

C. Astigmatism

Which of the following occurs when the degree of curvature or cornea or lens varies from one axis to another during accommodation? A. Emmetropia B. Glaucoma C. Astigmatism D. Esotropia E. Exotropia

B. myopia

Which of the following occurs when the lens is too round, therefore the visual image is too short and does not reach the retina? A. emmetropia B. myopia C. hyperopia D. hypertropia E. Presbyopia

B. carotid body tumors

Which of the following presents with large tumors, pressure, dysphasia, cough, and hoarseness & generally at the anterior border of the sternocleidomastoid muscle? A. paragangliomas B. carotid body tumors C. metastatic squamous cell carcinoma D. schwannomas E. neurofibromas

D. Meniere syndrome

Which of the following presents with vertigo, hearing loss, and tinnitus as a result of distention of the endolymphatic system in the ear? A. vertebrobasilar insufficiency B. cardiovascular disease C. BPPV D. Meniere syndrome E. acute labyrinthitis

D. Amaurosis fugax

Which of the following refers to temporary loss of vision in one eye and might be caused by an embolism? A. Emmetropia B. Astigmatism C. Hypertropia D. Amaurosis fugax E. Amblyopia

B. auditory brainstem response

Which of the following tests are generally used for newborn hearing screening? A. word recognition/whisper testing B. auditory brainstem response C. tympanometry D. acoustic reflexes E. all of the above

E. agnosia

Which refers to the inability to classify, contrast, or identify odor sensations verbally, even though the ability to distinguish between odorants may be normal? A. anosmia B. hyposmia C. dysosmia D. phantosmia E. agnosia

C. Orogastric tube curled up in the upper chest or neck

With Esophageal atresia and tracheoesophageal fistula, what findings are most commonly seen on x-ray? A. consolidation in the lungs B. enlarged heart C. Orogastric tube curled up in the upper chest or neck D. thumb print sign E. steeple sign