EENT EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED GRADED A++
A 18-year-old woman presents to an urgent care clinic with complaints of left eye
pain that started two days ago and has gotten progressively worse. On exam, the
left eye there is a localized area of swelling and erythema on the upper eyelid as
shown above. The area is very painful to touch. The conjunctiva and sclera are
clear. Fluorescein staining does not reveal any areas of increased uptake of stain.
Which of the following is the most likely diagnosis?
AChalazion
BHordeolum
CHyphema
DHypopyon
B
A 55-year-old mechanic complains of irritation in his right eye lasting for 2 days.
On direct visualization you see a small, dark foreign body on the periphery of the
cornea and are unable to remove it. There is a patch of reddish-brown
discoloration extending several millimeters around the area where the foreign
body is located. Which one of the following is most appropriate for this patient?
A. An antibiotic ointment to be used every 2-4 hours
,B. Irrigation with 0.9% saline solution under pressure
C. Prompt ophthalmologic evaluation
D. Watchful waiting
C
A 65-year-old woman presents to the ED with sudden onset of right eye pain and
blurred vision. Physical examination reveals circumcorneal injection, a 7 mm
right pupil that is unresponsive to light and an intraocular pressure of 35 mm Hg.
Which of the following is the gold standard test to confirm the diagnosis?
Dark room provocation
Dilated fundus examination
Gonioscopy
Slit lamp grading
Gonioscopy
Gonioscopy is considered the gold standard in the diagnosis of acute angle closure
glaucoma, an ocular emergency that this patient is experiencing. This method allows
the examiner to examine the angle that is formed between the cornea's posterior
surface and the iris' anterior surface. An experienced provider, such as an
ophthalmologist, should perform this test. Care must be taken to not shine light directly
onto the pupil as the angle could widen and create an error in measurement.
Dark room provocation (A) is a process in which a patient is placed in a dark room with
,the head in the prone position, thus displacing the lens forward and encouraging dilation
of the pupil. This test is not recommended. Dilated fundus examination (B) should not
be utilized to diagnose acute angle closure glaucoma and, in fact, can worsen the
condition. Slit lamp grading (D) can be used to estimate the angle width by shining light
on the anterior chamber but is not considered as accurate as gonioscopy.
A 55-year-old man presents with sudden onset of decreased vision and pain in
his right eye. He reports vomiting twice prior to presentation. Examination reveals
normal extraocular motions and a mid position pupil that does not react to light.
What management should be pursued?
AAcetazolamide drops
BMetoprolol intravenous
CTetracaine drops
DTimolol drops
D
A 72-year-old man presents with a painful red eye and visual loss worsening over
the last 24 hours. He recently had cataract surgery. Examination of the eye
reveals the image above. Which of the following is the most likely diagnosis?
AEndophthalmitis
BHyphema
CTraumatic iritis
DVitreous hemorrhage
A
, A 38-year-old man presents to the ED with his friend. They were playing
racquetball and the man was hit directly in the eye with the ball. Examination
reveals limitation of upward gaze, periorbital erythema, and subconjunctival
hemorrhage of right eye. Imaging of the orbit would most likely show a fracture of
which bone?
AFrontal
BMaxillary
CSphenoid
DZygomatic
B
A 35-year-old woman just arrived from vacation where she spent five days skiing
in Colorado. She presents to the Emergency Department complaining of bilateral
eye pain and tearing. She denies any direct ocular trauma. Her visual fields are
intact and no foreign body is identified on examination. There is marked
conjunctival erythema, lid swelling, and chemosis. Diffuse punctate lesions are
seen on the cornea with fluorescein staining as shown above. Which of the
following is the most likely diagnosis?
ABlepharitis
BEndophthalmitis
CUltraviolet keratitis
DZoster ophthalmicus
C
COMPLETE SOLUTIONS VERIFIED GRADED A++
A 18-year-old woman presents to an urgent care clinic with complaints of left eye
pain that started two days ago and has gotten progressively worse. On exam, the
left eye there is a localized area of swelling and erythema on the upper eyelid as
shown above. The area is very painful to touch. The conjunctiva and sclera are
clear. Fluorescein staining does not reveal any areas of increased uptake of stain.
Which of the following is the most likely diagnosis?
AChalazion
BHordeolum
CHyphema
DHypopyon
B
A 55-year-old mechanic complains of irritation in his right eye lasting for 2 days.
On direct visualization you see a small, dark foreign body on the periphery of the
cornea and are unable to remove it. There is a patch of reddish-brown
discoloration extending several millimeters around the area where the foreign
body is located. Which one of the following is most appropriate for this patient?
A. An antibiotic ointment to be used every 2-4 hours
,B. Irrigation with 0.9% saline solution under pressure
C. Prompt ophthalmologic evaluation
D. Watchful waiting
C
A 65-year-old woman presents to the ED with sudden onset of right eye pain and
blurred vision. Physical examination reveals circumcorneal injection, a 7 mm
right pupil that is unresponsive to light and an intraocular pressure of 35 mm Hg.
Which of the following is the gold standard test to confirm the diagnosis?
Dark room provocation
Dilated fundus examination
Gonioscopy
Slit lamp grading
Gonioscopy
Gonioscopy is considered the gold standard in the diagnosis of acute angle closure
glaucoma, an ocular emergency that this patient is experiencing. This method allows
the examiner to examine the angle that is formed between the cornea's posterior
surface and the iris' anterior surface. An experienced provider, such as an
ophthalmologist, should perform this test. Care must be taken to not shine light directly
onto the pupil as the angle could widen and create an error in measurement.
Dark room provocation (A) is a process in which a patient is placed in a dark room with
,the head in the prone position, thus displacing the lens forward and encouraging dilation
of the pupil. This test is not recommended. Dilated fundus examination (B) should not
be utilized to diagnose acute angle closure glaucoma and, in fact, can worsen the
condition. Slit lamp grading (D) can be used to estimate the angle width by shining light
on the anterior chamber but is not considered as accurate as gonioscopy.
A 55-year-old man presents with sudden onset of decreased vision and pain in
his right eye. He reports vomiting twice prior to presentation. Examination reveals
normal extraocular motions and a mid position pupil that does not react to light.
What management should be pursued?
AAcetazolamide drops
BMetoprolol intravenous
CTetracaine drops
DTimolol drops
D
A 72-year-old man presents with a painful red eye and visual loss worsening over
the last 24 hours. He recently had cataract surgery. Examination of the eye
reveals the image above. Which of the following is the most likely diagnosis?
AEndophthalmitis
BHyphema
CTraumatic iritis
DVitreous hemorrhage
A
, A 38-year-old man presents to the ED with his friend. They were playing
racquetball and the man was hit directly in the eye with the ball. Examination
reveals limitation of upward gaze, periorbital erythema, and subconjunctival
hemorrhage of right eye. Imaging of the orbit would most likely show a fracture of
which bone?
AFrontal
BMaxillary
CSphenoid
DZygomatic
B
A 35-year-old woman just arrived from vacation where she spent five days skiing
in Colorado. She presents to the Emergency Department complaining of bilateral
eye pain and tearing. She denies any direct ocular trauma. Her visual fields are
intact and no foreign body is identified on examination. There is marked
conjunctival erythema, lid swelling, and chemosis. Diffuse punctate lesions are
seen on the cornea with fluorescein staining as shown above. Which of the
following is the most likely diagnosis?
ABlepharitis
BEndophthalmitis
CUltraviolet keratitis
DZoster ophthalmicus
C
