Packrat Heent Questions and Answers 2024.

Packrat Heent Questions and Answers 2024. Diagnosis/ENT/Ophthalmology A 20 year-old female patient complains of sore throat, dysphagia, and fever for the past several days. Her throat appears erythematous and edematous with her right tonsil displaced medially. The physician assistant also notes the patient has a "hot potato" voice. The most likely diagnosis is A. acute pharyngitis. B. acute epiglottitis. C. peritonsillar abscess. D. retropharyngeal abscess Explanations (u) A. Acute pharyngitis may present with similar symptoms, but without unilateral abscess or dysphonia. (u) B. Acute epiglottitis usually presents in acute distress and is often accompanied by drooling, fever, and respiratory compromise. The pharynx may show little clinical evidence of the epiglottal inflammation and swelling. (c) C. Peritonsillar abscess usually presents as described and "hot potato" voice is pathognomonic. (u) D. Retropharyngeal abscess usually presents in acute distress with severe throat pain. There may also be drooling, nuchal rigidity, and respiratory compromise. Clinical Intervention/ENT/Ophthalmology A 37 year-old male presents with fever, headaches, nasal congestion, and green nasal discharge for 3 days. On examination, he is febrile and there is tenderness over the maxillary sinus area. Which of the following is the next best intervention? A. Surgery B. Antihistamines C. Antibiotics D. No treatment is needed. Explanations (h) A. Surgery is not indicated in acute sinusitis and could lead to increased morbidity and mortality. (u) B. Antihistamines are not recommended due to the concern over mucociliary clearance impairment. (c) C. Antibiotics are indicated in bacterial sinusitis. History & Physical/ENT/Ophthalmology Which of the following is the most consistent ophthalmoscopic finding in a patient with macular degeneration? A. Floaters B. Drusen bodies C. Papilledema D. Cotton-wool spots Explanations (u) A. Floaters are usually not significant, but may indicate a retinal detachment. (c) B. Drusen bodies, discrete, yellow-white deposits on the retina, are noted in macular degeneration. (u) C. Papilledema is noted in conditions with increased intracranial pressure. (u) D. Cotton-wool spots are noted in diabetic retinopathy. Clinical Intervention/ENT/Ophthalmology A 3 year-old presents with sore throat and fever. The child appears toxic and is having trouble handling oral secretions. Which of the following is the next most appropriate step in the evaluation of this patient? A. Order a chest airway fluoroscopy. B. Examine the patient's throat directly. C. Prepare for immediate laryngoscopy. D. Order a lateral neck x-ray study. Explanations (u) A. With suspected epiglottitis, a chest airway fluoroscopy will not be helpful. (h) B. Direct visualization of the throat in a patient with suspected epiglottitis may lead to laryngeal spasm and suffocation of the patient. (u) C. Laryngoscopy should be attempted only under controlled condition, usually the operating room. (c) D. In a patient with suspected epiglottis a lateral neck x-ray films may be helpful in demonstrating a classic "thumbprint" sign that will guide intervention. History & Physical/ENT/Ophthalmology Which of the following clinically represents ectropion? A. Red, inflamed eyelid margins B. A turning inward of the eyelid margins C. Sagging and eversion of the eyelid margins D. Slightly raised, yellowish plaques on the eyelid Margins Explanations (u) A. Blepharitis presents with red, inflamed eyelid margins. (u) B. Entropion presents with a turning inward of the eyelid margins. (c) C. Ectropion presents with sagging and eversion of the eyelid margins. (u) D. Xanthelasma presents with slightly raised, yellowish plaques on the eyelid margins. Clinical Therapeutics/ENT/Ophthalmology Which of the following may be precipitated by the instillation of phenylephrine (Neo-synephrine) in the eye? A. Episcleritis B. Pinpoint pupils C. Acute glaucoma D. Cranial nerve VI paralysis Explanations (u) A. Episcleritis is inflammation immediately underlying the conjunctiva and would not be caused by instillation of mydriatic drops. (u) B. Mydriatic drops dilate the pupils. (c) C. Mydriatic drops can precipitate an attack of acute angle-closure glaucoma in a patient with a narrow anterior chamber angle. (u) D. Mydriatic drops have no effect on cranial nerve VI function. Clinical Intervention/ENT/Ophthalmology A patient is seen in follow-up after initial treatment for a corneal abrasion of the left eye. Physical examination reveals a white necrotic area around the corneal crater and a small amount of grey exudate.