Eye pt 1
Eye pt 2
Ear
Nose
Throat
100
A 28 year-old woman presents complaining of a painless lump in her upper eyelid with redness and swelling to affected area. Initially it was small, and now it is the size of a pea. She works in a daycare, denies watery discharge, and recently got a new indoor cat named Simba. Which of the following is the next best step in managing her suspected diagnosis?
Warm compresses
100
A 55 year-old patient presents complaining of headache and left eye pain for three hours, decreased vision to affected eye, and associated nausea. Upon examination he has a moderately dilated and nonreactive pupil to the affected eye. Which of the following findings is most supportive of his condition?
A. Peripheral vision loss with Amsler grid chart
B. Central vision loss with Amsler grid chart
C. Intraocular pressure of 12 mm Hg on tonometry
D. Intraocular pressure of 40 mm Hg on tonometry
D. Intraocular pressure of 40 mm Hg on tonometry
100
What is the first-line antibiotic treatment for a 4 year-old male with acute otitis media and a penicillin allergy?
Macrolide: Azithromycin (Zithromax)
100
An otherwise healthy college age student presents with complaints of cough, malaise, fever, yellow-green nasal discharge and headache for the past 3 weeks. She complains of facial pain over the cheeks and while chewing. On examination, the nasal turbinates are erythematous and edematous nearly obstructing the nares bilaterally. She has not been previously evaluated. What is the most appropriate first-line therapy for this patient?
Antibiotic treatment for 10-14 days
100
A febrile 17 year-old male presents to your clinic complaining of fever, sore throat, trouble swallowing, and now a “hot potato” voice. Onset of symptoms was over 10 days ago, and he can no longer tolerate the pain. Upon examination he has left sided cervical lymphadenopathy with tenderness to palpation, bulging of the posterior and soft palate with uvular deviation. Which of the following is the most appropriate management?
Needle aspiration/ I&D
200
A 38 year-old female presents complaining of burning pain and itchy sensation to bilateral eyelids primarily to eye lashes with recent eyelash loss. Upon examination there is mild erythema to upper and lower lids, scales and granulations are noted clinging to the lashes. What is the most likely diagnosis, pathogen responsible, treatment?
Blepharitis
Staph
lid scrubs, warm compresses, and/or topical bacitracin
200
Which test or study is most supportive in diagnosing the leading cause of permanent visual loss in a patient over the age of 75?
Amsler grid
200
A 58 year-old female presents complaining of increased balance difficulty which seem to be provoked by rolling over in bed with associated nausea. She denies associated hearing difficulties or tinnitus. Upon examination a burst of nystagmus is noted when moving her from sitting to supine with head turned 45 degrees to one side and then 20 degrees backward. Which of the following is the most likely diagnosis?
BPPV
200
A 71 year-old male presents to your clinic complaining of profuse bleeding to his right nose which started about 10 minutes prior to arriving to your clinic. He has history of controlled hypertension, denies recent infection, no trauma, and does not use any illicit drug such as cocaine. Upon examination, you are unable to identify a bleed to the anterior portion of his nasal cavity. There is visible trickling blood in the posterior pharynx on examination. What is the treatment of choice in this patient?
Posterior Nasal Packing
200
A 3 year old male presents to the clinic with his father who reports the patient does not want to eat, has been drooling more frequently, and had a fever of 102 F this morning. Your records show that the child has not been vaccinated, and father says its due to religious reasons. Upon examination he is seated on his father’s lap leaning forward with his chin hyperextended. Lung sounds are consistent with inspiratory stridor. What is the most appropriate next step?
Emergent transfer, do not agitate child
300
A 10 year-old female presents to your clinic complaining of profuse tearing for 3 days, fever of 100.5 F which started today, minimal discharge to bilateral eyes, and a mildly sore throat. Upon examination you notice periauricular adenopathy, and erythema to conjunctiva. They recently moved to the area this summer, and states her daughter’s symptoms began after beginning her swim classes at her local community pool. Which of the following treatment plans is most appropriate for her suspected condition?
Cool compresses and artificial tears
300
A 17-year-old boy presents to your clinic complaining of right eye pain which started after he was struck in the face with a baseball during yesterday’s game. Pain is 9/10, reports double vision, and mild numbness to left orbital area with some cheek involvement. Swelling and ecchymosis to periorbital area. Which of the following sets of physical exam findings is most supportive of her condition, and which imaging would be most helpful?
Physical exam finding: Limited upward gaze to affected eye;
Imaging: CT imaging of the orbits
300
Presbycusis is the most common cause of sensorineural hearing loss in adults. Which of the following is most consistent with this condition?
Rinne test would result air conduction > bone conduction
300
An afebrile 3 year-old male presents to your clinic with their parent stating that her child has had trouble breathing from her right nose these past few days. She now has foul-smelling discharge to affected nostril with occasional nose bleeding. Which of the following is the most likely diagnosis in this patient?
Nasal FB
300
Diagnosis, Work-up, treatment?
Leukoplakia, Biopsy, Referral to ENT
400
A 34 year-old male presents pain to his left eye which has worsened over the past few days. He recalls leaving his contact lenses overnight prior to onset of symptoms. He now complains of photophobia, tearing, and changes in his vision. The ulcer is scraped to recover material for gram staining which returns as gram-negative bacillus. What is the treatment of choice for this patient’s condition?
High-concentration topical antibiotic drops
400
A 41 year-old patient presents to the clinic complaining increased right eye tearing, fever of 102F, right eye pain, and increasing difficulty opening his affected eye. He reports having a recent sinus infection in which he did not seek treatment. He denies any injury or trauma. Examination of the patient reveals tenderness to both upper and lower eyelids, increased warmth, proptosis, decreased visual acuity, and surrounding erythema. What is the most appropriate next best step for your suspected diagnosis?
CT, Labs with Blood Cx, Admission and IV antibiotics (2nd or 3rd gen cephalosporin)
400
A febrile 33 year-old female presents complaining pain and swelling to her right ear which has now worsened over past few days. She was seen at another clinic and treated for an ear infection about 3 weeks ago, however, she did not finish her amoxicillin antibiotics. Upon examination she has postauricular pain to affected ear with surrounding erythema, and the tympanic membrane is bulging with erythema. X-rays taken in office show a coalescence of mastoid air cells. What is the treatment of choice in this patient?
IV Anitbiotics; cefuroxime
400
A 32 year-old male presents to your clinic complaining of ongoing itchiness to bilateral eyes, sneezing dry cough, and nasal discharge. His symptoms come and go depending on the season. Upon examination, he has pale boggy bluish mucosa, and clear nasal watery discharge. Which of the following is the most appropriate treatment plans for this patient?
Intranasal corticosteroid or Second generation H1 blockers
400
A 29 year-old female presents with 1-day history of severe, continuous dizziness with episodes of nausea and vomiting. No hearing loss. She is otherwise healthy with the exception of a recent upper respiratory infection. Which of the following is the most likely cause of her symptoms?
Vestibular neuritis
500
A 55 year-old male presents complaining of painless blurred vision distortion, reduced color perception, and halos around lights which has been worsening over the past few months. He denies trauma, no injury, and has noticed no improvement with new readings glasses purchased from grocery store. Upon examination lens opacity changes are noted bilaterally, absent red reflex is noted to right eye and difficult to visualize red reflex in left eye. Tonometry readings are between 10-11mm Hg to both eyes. Which of the following is the most likely diagnosis?
Cataracts
500
A 52 year-old type 2 diabetic male presents for follow up evaluation for persistent purulent discharge to his left ear. Initially, a CT scan was obtained due to non-improvement on antibiotics. Results showed osseous erosion of the floor of the ear canal. He has been on ciprofloxacin 1000mg twice daily for two months since the initial CT scan and currently has no further edema, erythema, or exudate from the external auditory canal or surrounding tissue. What condition is the patient currently being treated for?
Malignant otitis externa
500
A 22 year-old afebrile male presents complaining of acute onset of pain to his left ear, pink discharge from affected ear, and ringing in ear that comes and goes. He reports having mild discomfort to the same ear for some time but dismissed it to studying for his upcoming exams. Upon examination he has bloody discharge to his left external ear canal originating from a hole in his tympanic membrane, and normal appearing external ear canal with no erythema or swelling. What is the treatment of choice in this patient?
Reassurance that his condition will heal spontaneously, antibiotics are not needed
500
A 16 year-old male presents complaining of worsening sore throat, fatigue, malaise, and high fevers of 103F. Onset of symptoms x 8 days ago. He reluctantly tells you that his girlfriend has similar symptoms too. Upon examination he has petechiae to his hard and soft palate, no peritonsillar exudates, lymphadenopathy with a large cervical nodes, and a palpable spleen. He is the team captain for his soccer team, and has a championship game in 1 week. You initially ordered a rapid strep screen test and it returned negative. He is mainly concerned about his upcoming game. What is the most appropriate treatment plan for this patient?
NSAIDs or acetaminophen, warm saline gargles, and avoid contact sports for minimum of 4 weeks
500
A 72 year-old female with a history of diabetes mellitus presents with sudden onset of painless flashing lights and floaters followed by curtain-like vision loss sparing the central vision in the right eye. Which of the following is the most likely diagnosis?
Retinal Detachment