EENT (Eyes, Ears, Nose, Throat) ALL SOLUTION AND ANSWERS 2025/2026 EDITION GUARANTEED GRADE A+

EENT (Eyes, Ears, Nose, Throat) ALL SOLUTION AND ANSWERS 2025/2026 EDITION GUARANTEED GRADE A+ A patient presents with an acute infection of the parotid gland. After several trials of antibiotics and sialogogues, the swelling has not resolved. What would you do next? A. Culture the area B. Observe the swelling for another month C. Order a panoramic radiograph D. Send to an ENT specialist for further evaluation D. Send to an ENT specialist for further evaluation Some cases of parotitis may require surgery if the stone does not pass. Refer the patient to an ENT for further evaluation if this occurs. If you have already tried several courses of antibiotics, a culture will not help at this point, since it is likely that the stone may lodge in the salivary gland. Even if you were able to locate the stone on a radiograph, once conservative treatment fails an ENT may have to remove the stone. A 4-year-old boy being treated for sinusitis presents to the emergency department with a fever and headache. The boy was seen by his primary care provider 2 days ago and given a prescription for amoxicillin. You cannot obtain a clear history from the mother on whether she administered the medication properly. On examination, you notice that his eyelid is swollen, there is restricted extraocular movements, and proptosis is present. The remainder of the examination is normal. What is the most likely diagnosis? A. Meningitis B. Orbital cellulitis C. Chronic Sinusitis D. Mastoiditis B. Orbital Cellulitis Orbital cellulitis can develop from a sinus infection if left untreated. A patient may have decreased visual acuity, limited ocular motility, and chemosis. The eyelid becomes warm, erythematous, and painful. Computed tomography (CT) scans of the orbit and sinuses should be obtained. Treatment consists of hospital admission and intravenous therapy. Meningitis would present with meningeal signs including a high fever, headache, and neck pain. Resistant chronic sinusitis would not present with restricted extraocular movements. Mastoiditis usually presents after an otitis media with pain, swelling, and erythema around the ear in the area of the mastoid. A 12-year-old girl was recently diagnosed clinically with a viral pharyngitis but now presents with worsening of throat pain, fever, tender lymph nodes, and a red rash over her shoulders only. What is the most likely diagnosis? A. Hand, foot, and mouth disease B. Measles C. Roseola D. Scarlet fever D. Scarlet fever This patient most likely had a group A beta-hemolytic streptococci (GABHS) and is now presenting with scarlet fever. A scarlatiniform rash or strawberry tongue is also considered pathognomonic of streptococcal disease. Hand, foot, and mouth disease can present with upper respiratory symptoms, but usually the rash is isolated to the hands and feet. Oral ulcers can occur as well. Measles can also present with upper respiratory symptoms, but subsequently the patient develops Koplik spots in the mouth and a rash that starts at the head and then spreads downward across the body. Roseola infantum is also referred to as sixth disease. It starts as a high fever and once the fever resolves, a characteristic rash appears on the trunk. When conductive hearing loss occurs, the lesion causing the hearing deficit usually involves which of the following structures? A. Cochlea B. Eighth cranial nerve C. Central auditory pathway D. Middle Ear D. Middle Ear Conductive hearing loss results from lesions involving the external or middle ear. Sensorineural hearing loss results from lesions of the cochlea, auditory division, or eighth cranial nerve. Central hearing disorders result from lesion of the central auditory pathway. What is the most common pathogen associated with otitis media? A. Streptococcus pneumoniae B. Haemophilus influenza C. Moraxella catarrhalis D. Staphylococcal aureus A. Streptococcus pneumoniae The most common pathogen associated with otitis media is S. pneumoniae, followed by H. influenzae and M. catarrhalis A 5-year-old child presents with an acute case of fever, chills, adenopathy, and pharyngitis. The caretaker has tried symptomatic treatment for over a week. What would be the next appropriate step in this situation? A.Perform a cervical spine radiograph to look at the soft tissue structures of the neck B. perform a throat swab C. start amoxicillin D. Observe the patient for 48 hours before starting treatment B. perform a throat swab When a child presents with a sore throat, a throat culture should be performed to determine if group A beta-streptococcal pharyngitis is present, and if so, appropriate treatment should be started. Penicillin is still the treatment of choice for group A streptococcus and amoxicillin is too broad spectrum a treatment. A radiograph will not offer any additional information. Since the symptoms have been occurring for over a week, it is important to determine if the infection is caused by group A streptococcus so it can be treated promptly to avoid sequelae of this type of infection. Which of the following findings helps to confirm the diagnosis on a peritonsillar abscess? A. Enlarged tonsils B. Pharyngeal erythema C. Displacement of the uvula D. Swollen Lymph nodes C. Displacement of the uvula Although all the above can occur with a peritonsillar abscess, displacement of the uvula should alert the clinician that the signs are suggestive of this diagnosis and not a simple pharyngitis. Which form of oral candidiasis commonly presents as white fungal plaques on the tongue or other oral surfaces of the mouth and can be easily wiped off? A. Pseudomembranous B. Erythema C. Hyperplastic D. Neoplastic A. Pseudomembranous Pseudomembranous (thrush) candidiasis presents as white fungal plaques along the oral surfaces of the mouth that can easily be wiped off. Erythematous (atrophic) candidiasis presents as a reddish lesion. Hyperplastic plaques are white, have fungal hyphae within the surface layers of hyperkeratotic epithelium, and do not rub off. When a patient presents with acute otitis media, what is the expected finding on otoscopic examination? A. Pinkish gray eardrum B. Deposition of hyaline material within the layers of the eardrum C. Red, bulging eardrum D. Amber fluid behind the eardrum with an air fluid level C. Red, bulging eardrum With acute otitis media, the eardrum is usually red and bulging. A normal eardrum is pinkish gray. Deposition of hyaline material within the layers of the eardrum is characteristic of tympanosclerosis. Serous effusions usually present with amber fluid behind the eardrum. A 10-year-old boy who was recently diagnosed with acute otitis media now presents with pain and swelling around his ear. On examination his auricle is protruding and the pinna is displaced downward and outward. What test would you order next? A. radiograph of the soft tissues of the neck B. radiograph of the orbits C. CT scan of the temporal bones D. MRI of the brain C. CT scan of the temporal bones In the case of mastoiditis, a CT scan of the temporal bones should be ordered to determine the extent of the disease. Radiographs and an MRI scan are neither indicated nor helpful. What is the best test to check for nonparalytic strabismus? A. Funduscopic examination B. Visual acuity C. Cover-uncover test D. Pupillary reaction C. Cover-uncover test One way to check for strabismus in a child is the cover-uncover test, recognizing that it will require the child's full cooperation. A 3-year-old boy presents to the emergency department febrile, drooling, and sitting in a tripod position to help himself breathe. Which of the following should be avoided? A. Auscultation of the lungs B. Auscultation of the heart C. Direct examination of the throat D. Direct examination of his eyes and ears C. Direct examination of the throat Epiglottitis is an emergency situation. Do not stick a tongue depressor in the patient's mouth because doing so can cause a laryngeal spasm. Be prepared for emergent intubation. A 10-year-old female is being treated with amoxicillin 80 milligrams/kilogram of body weight for 10 days for otitis media with no improvement of symptoms. What would you do next? A. change the antibiotic to erythromycin B. change the antibiotic to azithromycin C. change the antibiotic to penicillin D. Change the antibiotic to amoxicillin/clavulanate D. change the antibiotic to amoxicillin/clavulanate Symptoms of otitis media should begin to improve within 72 hours of starting antibiotic therapy. If there is no improvement, second-line therapy with amoxicillin/clavulanate should be started. Azithromycin should be reserved for patients allergic to penicillin. Erythromycin and penicillin have limited effectiveness in treating acute cases of otitis media. A 14-year-old girl presents with sore throat, dysphagia, neck pain, stridor, and a fever. On examination of the throat she has tonsillar enlargement and her uvula is deviated to the left. What is the most likely diagnosis? A. epiglottitis B. Tonsillitis C. Mononucleosis D. Peritonsillar abscess D. Peritonsillar abscess This is the classic presentation of a peritonsillar abscess. Patients with tonsillitis can have neck pain, sore throat, and tonsillar enlargement, but no deviation of the uvula should occur. Although mononucleosis presents similarly as well, once again there should not be deviation of the uvula. A 4-year-old child presents with numerous painful small vesicles throughout his oral mucosa with accompanying malaise, headache, fever, and cervical lymphadenopathy. What is the most likely diagnosis? A. Neisseria gonorrhoeae B. Primary herpetic gingivostomatitis C. Condyloma latum D. Aphthous ulcers B. primary herpetic gingivostomatitis In the case of herpetic gingivostomatitis, the child will complain of painful lesions in the mouth along with associated, malaise, headache, fever, and cervical lymphadenopathy. Symptoms are usually self-limited. Although one can have multiple aphthous ulcers, this not a common presentation of them and aphthous ulcers are not associated with the above symptoms. A 3-year-old presents with drooling, stridor, and difficulty swallowing. On examination, he is sitting with his knees pulled toward his chest, and he is leaning forward. What would you expect to see on a lateral radiograph of the neck? A. steeple sign B. thumbprint sign C. tear drop sign D. sail sign B. thumbprint sign In a patient with epiglottitis, a lateral view radiograph of the soft tissue of the neck reveals a thumblike projection, in contrast to croup, which has a steeple sign. A 10-year-old boy with type 1 diabetes mellitus presents with otitis externa. He is treated with topical drops, but 4 days later develops facial paralysis, vertigo, and sensorineural hearing loss. What is the most likely causative agent associated with this infection? A. streptococcus pneumoniae B. Haemophilus influenza C. Moraxella catarrhalis D. Pseudomonas aeruginosa D. Pseudomonas aeruginosa Patients with diabetes mellitus are at risk for otitis externa caused by P. aeruginosa. Immediate treatment with intravenous antibiotics and an ENT referral is necessary. A 7-year-old boy tested positive for Group A beta-streptococcus (GABS). What physical finding supports the diagnosis of GABS? A. gray exudates on the tonsils B. large red tonsils with or without exudates C. trismus D. tonsillar asymmetry B. large red tonsils with or without exudates GABS typically presents with large red tonsils having tender cervical adenopathy. Gray tonsillar exudates are seen in cases of diphtheria. Trismus and tonsillar asymmetry are seen with peritonsillar abscesses. A child is undergoing treatment for acute dacryoadenitis when the caretaker notices that the child's entire eye has begun to swell and bulge forward. On examination the child has proptosis and restricted extraocular movements. What would you do next? A. increase the dose of current antibiotic B. add cool compresses to the treatment C. order a CT scan of the orbits D. reassure the patient that this is normal and should resolve C. order a CT scan of the orbits When treating a patient for dacryoadenitis, it is important to monitor for signs of orbital cellulitis. If proptosis and restricted eye movements occur while the patient is on appropriate antibiotics, a CT of the orbits is necessary to determine if the patient is developing an orbital cellulitis. Adding cool compresses to the treatment and observing the progression of the cellulitic spread can be harmful. A young boy is diagnosed with otitis media. What would you treat the child with if he were allergic to penicillin? A. Cefuroxime CONTINUED...