Disorders of the Head
An infant with a flattened occiput and no suture ridging improves with tummy time and repositioning; this condition (vs. the one requiring neurosurgical referral).
What is positional plagiocephaly (vs. craniosynostosis)?
2–5 days after birth: copious purulent conjunctival discharge with marked eyelid edema—likely pathogen and urgent treatment approach.
What is Neisseria gonorrhoeae; treat urgently with parenteral ceftriaxone (or cefotaxime if hyperbilirubinemic) and ophthalmology consult?
A child with bulging tympanic membrane + middle ear effusion—first‑line antibiotic and dosing strategy (when antibiotics are indicated).
What is high‑dose amoxicillin 80–90 mg/kg/day for acute otitis media (per AAP criteria)?
A child with allergic shiners, Dennie–Morgan lines, allergic salute—first‑line controller therapy.
What is intranasal corticosteroid (with or without oral second‑generation antihistamine)?
Pediatric sore throat with fever, tonsillar exudates, tender anterior nodes, absence of cough—test and treatment.
What is RADT (culture if negative in children) and penicillin/amoxicillin for Group A Strep?
No same‑day return for this adolescent sports injury; management includes 24–48 hours of relative rest and stepwise return-to-play when symptom-free.
What is concussion?
Pain with extraocular movements, proptosis, decreased vision/chemosis distinguish this condition in children and require imaging + IV antibiotics.
What is orbital cellulitis (vs. preseptal cellulitis)?
Pain with tragus/pinna manipulation, swollen ear canal, recent swimming—first‑line therapy.
What is topical antibiotic drops (e.g., fluoroquinolone ± steroid), analgesia, keep ear dry; wick if marked edema (otitis externa)?
Bacterial rhinosinusitis criteria: symptoms >10 days, severe fever ≥39 °C + purulent discharge ≥3–4 days, or double‑worsening—first‑line antibiotic.
What is amoxicillin‑clavulanate (adult or peds dosing per guidelines)?
Adolescent with exudative pharyngitis, posterior cervical adenopathy, fatigue, splenomegaly—counseling and medication to avoid.
What is counsel no contact sports for ~3–4 weeks and avoid ampicillin/amoxicillin (rash risk) in EBV mononucleosis?
Severe, unilateral, electric shock‑like facial pain triggered by light touch—first‑line pharmacologic treatment.
What is carbamazepine (or oxcarbazepine) for trigeminal neuralgia?
Severe eye pain, halos around lights, mid‑dilated fixed pupil, steamy cornea—name the emergency and initial management.
What is acute angle‑closure glaucoma; urgent IOP‑lowering (e.g., acetazolamide), topical agents, analgesia/antiemetics, and emergent ophthalmology?
Sudden unilateral hearing loss over <72 hours with sensorineural pattern on tuning fork—urgency and treatment.
What is an otologic emergency; start high‑dose oral steroids and urgent ENT referral for sudden sensorineural hearing loss?
Anterior epistaxis (Kiesselbach’s plexus)—initial steps in the clinic.
What is firm compression of the soft nose for 10–15 min, patient leaning forward, topical vasoconstrictor (e.g., oxymetazoline), and silver nitrate cautery if the vessel is visualized?
Trismus, “hot‑potato” voice, uvular deviation, severe unilateral throat pain—diagnosis and management.
What is peritonsillar abscess; drainage, IV antibiotics, analgesia, and airway monitoring?
An older adult with new unilateral headache, scalp tenderness, jaw claudication, and high ESR/CRP—the immediate next step to prevent vision loss.
What is start high‑dose glucocorticoids immediately and arrange temporal artery biopsy (giant cell arteritis)?
Sudden, painless, monocular vision loss with cherry‑red spot—what to do immediately.
What is activate emergency stroke evaluation, urgent ophthalmology, attempt IOP‑lowering and ocular massage while arranging definitive care (CRAO)?
Chronic malodorous otorrhea, retraction pocket with keratin debris, conductive hearing loss—diagnosis and next step.
What is cholesteatoma; refer to ENT (imaging and surgical management)?
Neonate with cyanosis relieved by crying, feeding difficulty, and failure to pass a nasal catheter—diagnosis and immediate priority.
What is choanal atresia; secure the airway (oral airway/oropharyngeal airway) and ENT evaluation?
Rapid-onset odynophagia, drooling, muffled voice (pediatric or adult)—key precautions and first steps.
What is suspected epiglottitis; avoid oropharyngeal manipulation, secure airway emergently, and start IV antibiotics?
Rapidly enlarging head circumference, bulging fontanelle, “sunsetting” eyes in a neonate—first‑line imaging.
What is cranial ultrasound (through the open fontanelle)?
Central vision distortion/scotoma in a geriatric patient with subretinal fluid/hemorrhage—type of AMD and first‑line therapy.
What is neovascular (wet) AMD treated with intravitreal anti‑VEGF therapy?
Newborn fails hearing screen—state the EHDI 1–3–6 benchmarks.
What is screen by 1 month, diagnostic audiology by 3 months, and early intervention by 6 months?
Unilateral clear rhinorrhea with positional dependence and salty/metallic taste after head trauma—confirmatory test and referral.
What is β‑2 transferrin testing for CSF and urgent ENT/neurosurgery referral (CSF rhinorrhea)?
Persistent hoarseness >2–4 weeks, especially with tobacco/alcohol use, dysphagia, weight loss—next step.
What is urgent ENT referral for laryngoscopy to evaluate for laryngeal or hypopharyngeal malignancy?