Ophthalmology & Otolaryngology (PANCE 4th Ed. O'Connell)
PANRE
A 68-year-old female presents with rapid onset of significant eye pain and visual
loss. She notes that lights appear to have "halos." Exam reveals a red eye, steamy
cornea, and dilated, nonreactive pupil. What is the initial treatment option?
A. IV acetazolamide
B. IVmannitol
C. topical pilocarpine
D. topical latanoprost - CORRECT ANSWER The answer is A [Ophthalmology and
Otolaryngology, Geriatrics].
A. Initial treatment of primary acute closure glaucoma is control of intraocular
pressure. IV acetazolamide followed by oral dosing is usually adequate. Osmotic
diuretics, such as mannitol, may also be required, especially in patients with
severely elevated intraocular pressure.
B. See A.
C. After the intraocular pressure decreases, topical pilocarpine is used to reverse
the underlying angle closure. Definitive treatment, however, is with surgery
(peripheral iridotomy or iridectomy).
D. Prostaglandin analogs are often used as first line therapy in chronic glaucoma.
A 36-year-old schoolteacher presents with an acute onset of fever, chills, malaise,
headache, and congestion. She is coughing and sneezing. Conjunctivae are
injected; pharyngeal mucosa is edematous and injected. What is expected on
examination of the lungs?
A. clear lung fields with good air exchange
B. diffuse expiratory wheezes
C. dullness and rhonchi at the bases
D. scattered crackles and inspiratory wheeze - CORRECT ANSWER The answer is A
[Ophthalmology and Otolaryngology].
A. As long as sympathetic and parasympathetic innervation is intact, unilateral
blindness does not cause anisocoria. A light directed into the seeing eye causes
both pupils to constrict; a light directed into the blind eye does not cause
,any response in either eye.
B. See A.
C. See A.
D. See A.
A basketball player presents after being struck above the eye with an opponent's
elbow. Exam is significant for bruising around the eye as well as bleeding into the
anterior chamber. Computed tomography is negative for fracture. What is the
most appropriate treatment?
A. NSAIDs to reduce pain and swelling
B. rest and close ophthalmologic follow up
C. surgical intervention
D. vitamin K to induce clotting - CORRECT ANSWER The answer is B
[Ophthalmology and Otolaryngology].
A. NSAIDs and any drugs that affect coagulation should be
avoided due to increased risk of secondary hemorrhage.
B. An injury that causes hyphema has the risk of secondary hemorrhage, which
can lead to problematic glaucoma and permanent visual loss. The patient should
rest until complete resolution; daily ophthalmologic assessment is recommended.
C. Surgical intervention may be indicated in blowout fractures.
D. Vitamin K deficiency in healthy people is very rare. It may
be given to reverse the effects of warfarin.
An 18-year-old water skier presents with left ear pain with pruritus and discharge.
Exam reveals pain on auricular manipulation as well as redness and swelling of
the ear canal with purulent debris. The tympanic membrane is intact. What is the
most appropriate management?
A. oral fluoroquinolone
B. otic antibiotic/anti-inflammatory drops
C. surgical intervention
D. use of an ear wick with otic drops - CORRECT ANSWER The answer is B
[Ophthalmology and Otolaryngology, Infectious Disease].
A. In resistant cases, especially with development of cellulitis around the auricle,
an oral fluoroquinolone (i.e., ciprofloxacin) is the drug of choice due to
effectiveness against Pseudomonas.
B. An antibiotic/anti-inflammatory otic drop is the most ap- propriate treatment
in uncomplicated otitis externa.
, C. In the diabetic or immunocompromised patient, persistent external otitis can
develop into osteomyelitis (malignant external otitis). Surgical debridement is
needed if medical therapy fails.
D. If there is significant edema of the ear canal wall, which prevents the entry of
drops into the ear, a wick can be placed. Here the tympanic membrane can be
visualized, which makes the ear wick unnecessary.
An elderly patient with diabetes mellitus type 2 presents with mouth irritation.
Exam reveals creamy white, curd-like patches which are easily scraped off
revealing erythematous buccal mucosa. What is the most appropriate treatment?
A. acyclovir
B. fluconazole
C. penicillin
D. prednisone - CORRECT ANSWER The answer is B [Ophthalmology and
Otolaryngology, Infectious Disease, Geriatrics].
A. Acyclovir may shorten the course and decrease posther-petic pain in herpetic
stomatitis.
B. Fluconazole is one of the effective antifungal therapies for
candidiasis. Others include ketoconazole, clotrimazole
troches, and nystatin mouth rinses.
C. Penicillin is not indicated with oral candidiasis.
D. A tapering dose of prednisone may be used to treat aphthous
ulcers.
An elderly male presents with unilateral hearing loss for 1 day. He denies URI
symptoms, fever, or ear pain or discharge. He further denies any dizziness or
headaches. Physical exam reveals normal balance, negative Romberg, but
evidence of conductive hearing loss in the affected ear. What is the most likely
diagnosis?
A. barotrauma
B. cerumen impaction
C. eustachian tube dysfunction D. otitis media - CORRECT ANSWER The answer is
B [Ophthalmology and Otolaryngology, Geriatrics].
A. Patients with poor eustachian tube function may be unable to equalize
barometric changes on the middle ear when confronted with rapid changes such
as with flying, under- water diving, or rapid altitude change. Such barotrauma
may present with ear pain and hearing loss related to those activities.
PANRE
A 68-year-old female presents with rapid onset of significant eye pain and visual
loss. She notes that lights appear to have "halos." Exam reveals a red eye, steamy
cornea, and dilated, nonreactive pupil. What is the initial treatment option?
A. IV acetazolamide
B. IVmannitol
C. topical pilocarpine
D. topical latanoprost - CORRECT ANSWER The answer is A [Ophthalmology and
Otolaryngology, Geriatrics].
A. Initial treatment of primary acute closure glaucoma is control of intraocular
pressure. IV acetazolamide followed by oral dosing is usually adequate. Osmotic
diuretics, such as mannitol, may also be required, especially in patients with
severely elevated intraocular pressure.
B. See A.
C. After the intraocular pressure decreases, topical pilocarpine is used to reverse
the underlying angle closure. Definitive treatment, however, is with surgery
(peripheral iridotomy or iridectomy).
D. Prostaglandin analogs are often used as first line therapy in chronic glaucoma.
A 36-year-old schoolteacher presents with an acute onset of fever, chills, malaise,
headache, and congestion. She is coughing and sneezing. Conjunctivae are
injected; pharyngeal mucosa is edematous and injected. What is expected on
examination of the lungs?
A. clear lung fields with good air exchange
B. diffuse expiratory wheezes
C. dullness and rhonchi at the bases
D. scattered crackles and inspiratory wheeze - CORRECT ANSWER The answer is A
[Ophthalmology and Otolaryngology].
A. As long as sympathetic and parasympathetic innervation is intact, unilateral
blindness does not cause anisocoria. A light directed into the seeing eye causes
both pupils to constrict; a light directed into the blind eye does not cause
,any response in either eye.
B. See A.
C. See A.
D. See A.
A basketball player presents after being struck above the eye with an opponent's
elbow. Exam is significant for bruising around the eye as well as bleeding into the
anterior chamber. Computed tomography is negative for fracture. What is the
most appropriate treatment?
A. NSAIDs to reduce pain and swelling
B. rest and close ophthalmologic follow up
C. surgical intervention
D. vitamin K to induce clotting - CORRECT ANSWER The answer is B
[Ophthalmology and Otolaryngology].
A. NSAIDs and any drugs that affect coagulation should be
avoided due to increased risk of secondary hemorrhage.
B. An injury that causes hyphema has the risk of secondary hemorrhage, which
can lead to problematic glaucoma and permanent visual loss. The patient should
rest until complete resolution; daily ophthalmologic assessment is recommended.
C. Surgical intervention may be indicated in blowout fractures.
D. Vitamin K deficiency in healthy people is very rare. It may
be given to reverse the effects of warfarin.
An 18-year-old water skier presents with left ear pain with pruritus and discharge.
Exam reveals pain on auricular manipulation as well as redness and swelling of
the ear canal with purulent debris. The tympanic membrane is intact. What is the
most appropriate management?
A. oral fluoroquinolone
B. otic antibiotic/anti-inflammatory drops
C. surgical intervention
D. use of an ear wick with otic drops - CORRECT ANSWER The answer is B
[Ophthalmology and Otolaryngology, Infectious Disease].
A. In resistant cases, especially with development of cellulitis around the auricle,
an oral fluoroquinolone (i.e., ciprofloxacin) is the drug of choice due to
effectiveness against Pseudomonas.
B. An antibiotic/anti-inflammatory otic drop is the most ap- propriate treatment
in uncomplicated otitis externa.
, C. In the diabetic or immunocompromised patient, persistent external otitis can
develop into osteomyelitis (malignant external otitis). Surgical debridement is
needed if medical therapy fails.
D. If there is significant edema of the ear canal wall, which prevents the entry of
drops into the ear, a wick can be placed. Here the tympanic membrane can be
visualized, which makes the ear wick unnecessary.
An elderly patient with diabetes mellitus type 2 presents with mouth irritation.
Exam reveals creamy white, curd-like patches which are easily scraped off
revealing erythematous buccal mucosa. What is the most appropriate treatment?
A. acyclovir
B. fluconazole
C. penicillin
D. prednisone - CORRECT ANSWER The answer is B [Ophthalmology and
Otolaryngology, Infectious Disease, Geriatrics].
A. Acyclovir may shorten the course and decrease posther-petic pain in herpetic
stomatitis.
B. Fluconazole is one of the effective antifungal therapies for
candidiasis. Others include ketoconazole, clotrimazole
troches, and nystatin mouth rinses.
C. Penicillin is not indicated with oral candidiasis.
D. A tapering dose of prednisone may be used to treat aphthous
ulcers.
An elderly male presents with unilateral hearing loss for 1 day. He denies URI
symptoms, fever, or ear pain or discharge. He further denies any dizziness or
headaches. Physical exam reveals normal balance, negative Romberg, but
evidence of conductive hearing loss in the affected ear. What is the most likely
diagnosis?
A. barotrauma
B. cerumen impaction
C. eustachian tube dysfunction D. otitis media - CORRECT ANSWER The answer is
B [Ophthalmology and Otolaryngology, Geriatrics].
A. Patients with poor eustachian tube function may be unable to equalize
barometric changes on the middle ear when confronted with rapid changes such
as with flying, under- water diving, or rapid altitude change. Such barotrauma
may present with ear pain and hearing loss related to those activities.
