HEENT (Case) QUESTIONS AND
ACCURATE RESPONSES FREQUENTLY
TESTED.
A 40 y/o M presents with a decreased smell and nasal congestion in both
nares. His history is significant for asthma. He also tells you he has severe
reaction to aspirin and can not take it. Upon PE of the nasal mucosa you
notice gray glistening masses.
1. Diagnosis?
2. Treatment?
1. Nasal polyps - Samter's triad (Aspirin intolerant, astma, nasal polyps.)
2. Nasal/low dose steroids, surgical excision is steroids don't decrease size.
A 72 y/o male with a history of blood clots comes into the ED in winter
time with a persistent nose bleed. The patient tells you that he is also on
Plavix.
1. Diagnosis?
2. Treatment?
1. Epistaxis - MC is Keisselbach's plexus in anterior nose
2. Identify site, compress nares with head forward. Can do nasal packing,
cautery with silver nitrate, humidifier, or Afrin in nose.
Upon examination, you notice that a newborn F is in respiratory distress
and also notice noisy breathing and increased nasal discharge.
1. Diagnosis?
2. Treatment?
,1. Bilateral Choanal Atresia - rare and life threatening (unilateral MC)
2. Transnasal puncture and stenting or resection of the posterior nasal septum
approach with or without stenting
A 30 y/o presents to her PCP complaining of painful swallowing, cough,
fever, nasal congestion, and malaise for the past 3 days. Upon PE you
notice no exudates and tonsils are not inflamed. Rapid strep test in office
is negative.
1. Diagnosis and most common cause?
2. Treatment?
1. Viral pharyngitis - Rhinovirus
2. Supportive treatment: recommend humidification, salt water gargles, fluids,
NSAIDs.
If not improvement within 3-4 days may not be viral.
A 10 y/o boy presents to urgent care complaining of a dysphagia and
explains it as a "swallowing glass feeling" and a fever. He has NO
COUGH. Upon PE you notice pharyngeal edema, edema of uvula,
petechiae of the soft palate, tonsil exudates, and tender cervical
lymphadenopathy. Rapid strep test was negative.
1. What is your next step?
2. Dx and most likely cause?
3. Treatment?
1. Obtain a throat culture
2. Strep pharyngitis d/t Group A beta-hemolytic aka strep pyogenes
3. Amoxicillin x 10 days. If allergic give clindamycin or cephalosporins.
, A 20 y/o F recovering from a bout of pharyngitis presents to the ED with a
high fever, R sided throat pain dysphagia, trismus, drooling, otalgia, and a
"hot potato" voice. Upon PE you notice a displaced uvula to the L side of
the throat, a swollen R tonsil, and anterior cervical lymphadenopathy.
1. Diagnosis?
2. Other tests?
3. Treatment?
1. Peritonsillar abscess
2. ultrasound or CT - to r/o abscess vs. cellulitis
3. I&D*, salt water gargles, abx, if not improved or recurrent tonsillectomy
A 25 y/o M presents to the clinic for her f/u. She has been taking ampicillin
for her sore throat for 1 week now with no improvement. She is now
complaining of other symptoms such as fatigue, H/A, and malaise. Upon
PE you notice splenomegaly, petechiae on the hard palate, rash, kissing
tonsils, and posterior cervical lymphadenopathy.
1. What tests would you order?
2. Most likely diagnosis and cause?
3. Treatments?
1. Monospot, peripheral smear looking at lymphocytosis >50%, CBC
2. Infectious mononucleosis - EBV
3. Avoid trauma/contact sports. Supportive treatment. Steroids should be
avoided and used only if airway obstruction. if secondary strep give PCN and
erythromycin, avoid ampicillin.
A 6 y/o type 1 diabetic patient comes into the ER c/o dysphagia, drooling,
and is in distress. He has a fever, "hot potato voice", hoarseness, and
dyspnea. Lateral plain radiographs reveal "thumb print sign". The patients
ACCURATE RESPONSES FREQUENTLY
TESTED.
A 40 y/o M presents with a decreased smell and nasal congestion in both
nares. His history is significant for asthma. He also tells you he has severe
reaction to aspirin and can not take it. Upon PE of the nasal mucosa you
notice gray glistening masses.
1. Diagnosis?
2. Treatment?
1. Nasal polyps - Samter's triad (Aspirin intolerant, astma, nasal polyps.)
2. Nasal/low dose steroids, surgical excision is steroids don't decrease size.
A 72 y/o male with a history of blood clots comes into the ED in winter
time with a persistent nose bleed. The patient tells you that he is also on
Plavix.
1. Diagnosis?
2. Treatment?
1. Epistaxis - MC is Keisselbach's plexus in anterior nose
2. Identify site, compress nares with head forward. Can do nasal packing,
cautery with silver nitrate, humidifier, or Afrin in nose.
Upon examination, you notice that a newborn F is in respiratory distress
and also notice noisy breathing and increased nasal discharge.
1. Diagnosis?
2. Treatment?
,1. Bilateral Choanal Atresia - rare and life threatening (unilateral MC)
2. Transnasal puncture and stenting or resection of the posterior nasal septum
approach with or without stenting
A 30 y/o presents to her PCP complaining of painful swallowing, cough,
fever, nasal congestion, and malaise for the past 3 days. Upon PE you
notice no exudates and tonsils are not inflamed. Rapid strep test in office
is negative.
1. Diagnosis and most common cause?
2. Treatment?
1. Viral pharyngitis - Rhinovirus
2. Supportive treatment: recommend humidification, salt water gargles, fluids,
NSAIDs.
If not improvement within 3-4 days may not be viral.
A 10 y/o boy presents to urgent care complaining of a dysphagia and
explains it as a "swallowing glass feeling" and a fever. He has NO
COUGH. Upon PE you notice pharyngeal edema, edema of uvula,
petechiae of the soft palate, tonsil exudates, and tender cervical
lymphadenopathy. Rapid strep test was negative.
1. What is your next step?
2. Dx and most likely cause?
3. Treatment?
1. Obtain a throat culture
2. Strep pharyngitis d/t Group A beta-hemolytic aka strep pyogenes
3. Amoxicillin x 10 days. If allergic give clindamycin or cephalosporins.
, A 20 y/o F recovering from a bout of pharyngitis presents to the ED with a
high fever, R sided throat pain dysphagia, trismus, drooling, otalgia, and a
"hot potato" voice. Upon PE you notice a displaced uvula to the L side of
the throat, a swollen R tonsil, and anterior cervical lymphadenopathy.
1. Diagnosis?
2. Other tests?
3. Treatment?
1. Peritonsillar abscess
2. ultrasound or CT - to r/o abscess vs. cellulitis
3. I&D*, salt water gargles, abx, if not improved or recurrent tonsillectomy
A 25 y/o M presents to the clinic for her f/u. She has been taking ampicillin
for her sore throat for 1 week now with no improvement. She is now
complaining of other symptoms such as fatigue, H/A, and malaise. Upon
PE you notice splenomegaly, petechiae on the hard palate, rash, kissing
tonsils, and posterior cervical lymphadenopathy.
1. What tests would you order?
2. Most likely diagnosis and cause?
3. Treatments?
1. Monospot, peripheral smear looking at lymphocytosis >50%, CBC
2. Infectious mononucleosis - EBV
3. Avoid trauma/contact sports. Supportive treatment. Steroids should be
avoided and used only if airway obstruction. if secondary strep give PCN and
erythromycin, avoid ampicillin.
A 6 y/o type 1 diabetic patient comes into the ER c/o dysphagia, drooling,
and is in distress. He has a fever, "hot potato voice", hoarseness, and
dyspnea. Lateral plain radiographs reveal "thumb print sign". The patients
