ENT EXAM MASTER QUESTIONS WITH
100% CORRECT ANSWERS 2025
Case
A 74-year-old man presents with a 1 ½-hour history of severe pain and blurred vision
in his left eye. Upon examination, his left eye is erythematous with a steamy cornea
and a nonreactive, dilated pupil. An ophthalmologic consult is ordered, and
tonometry is completed, revealing an elevated intraocular pressure and a confirmed
diagnosis of acute angle-closure glaucoma.
Question Ico-delete Highlights
What will be the definitive treatment for this patient? - ANSWER-Correct answer:
Bilateral laser peripheral iridotomy
Explanation The correct answer is bilateral laser peripheral iridotomy. This is a
procedure during which a puncture-like opening is made near the base of the iris in
order to decrease intraocular pressure in patients with angle-closure glaucoma.
While there are various medications used to treat acute episodes, this procedure will
correct the disorder definitively, whereas the medications are temporary treatment.
Patients with narrow anterior chambers are at risk for angle-closure glaucoma. If this
occurs unilaterally, they are even more at risk for acute episodes in the other eye.
For this reason, the procedure is typically performed bilaterally.
Left laser peripheral iridotomy is not the correct answer. While there are various
medications used to treat acute episodes of angle-closure glaucoma, this procedure
will correct the disorder definitively, whereas the medications are temporary
treatment. Patients with narrow anterior chambers are at risk for angle-closure
glaucoma. Narrow anterior chambers always occur bilaterally. If acute angle-closure
glaucoma occurs unilaterally, they are even more at risk for acute episodes in the
other eye. For this reason, the procedure is typically performed bilaterally as
opposed to being done in JUST the affected eye.
IV acetazolamide is not the correct answer. This medication is given in episodes of
acute angle-closure glaucoma in order to decrease the intraocular pressure. It is
typically given in a single 500mg IV dose followed by 250mg orally 4 times daily. This
is effective to control the acute episode, but will not treat the disorder definitively, as
the patient's underlying issue is narrow anterior chambers.
Oral glycerol is not the correct answer. This medication is an osmotic diuretic that
can be given 1-2 g/kg in or
Question Ico-delete Highlights
A 36-year-old woman presents with a small and irregular right pupil. On exam, you
note that the pupil does not respond to direct or consensual light stimuli; however, it
becomes smaller during an accommodation testing. What is the most likely
diagnosis? - ANSWER-Correct answer:
Neurosyphilis
,Explanation
The clinical picture is suggestive of neurosyphilis; more specifically, it is likely tabes
dorsalis. The pupil described here is the Argyll Robertson pupil. The pupil reacts
poorly to light, but it reacts well to accommodation.
Signs and symptoms seen in a TIA include temporary weakness and heaviness of
the contralateral arm, leg, or face. There may be monocular vision loss in the eye
contralateral to the affected limbs, which are not described in this patient.
Retinal vein or artery occlusion will produce sudden vision loss, which is not
described in this patient.
Herpes simplex can involve the eyes, but the patient would develop keratitis (corneal
inflammation) with impaired vision, and dendritic ulcers can be seen with fluorescein
stain.
Case
A 22-year-old man presents with a 3-month history of worsening diarrhea that comes
and goes. While performing a comprehensive oral exam, you note 2 lesions on the
buccal mucosa on the right side of the oral cavity. You document these lesions as 2
round lesions that measure approximately 2 mm in diameter and have a white-yellow
center, which is surrounded by a red halo. Pertinent positives also include a reduced
appetite, abdominal pain, and cramping.
Question Ico-delete Highlights
Based on these current history, physical exam findings, and possible disease
pathologies, what diagnosis is very high on your differential? - ANSWER-Correct
answer:
Crohn's disease
Explanation
The patient above has an aphthous ulcer, also sometimes referred to as a canker
sore or aphthous stomatitis. These painful, open sores are found in the oral cavity
and are the most common form of mouth ulcer. Many times these lesions are
described as having a white or yellow center and are surrounded by a bright red
area. They are benign, noncancerous, noninfectious, and many times, the cause is
unknown; however, aphthous lesions are common extra intestinal manifestations
found in patients suffering from Crohn's disease.
Patients who have the other form of inflammatory bowel disease, ulcerative colitis,
will not typically develop such signs as aphthous ulcers. More common signs of
cholecystitis include right-sided abdominal pain, vomiting, fever, a positive Murphy's
sign, or even palpable gallbladder.
GERD symptoms generally surround the complaint of heartburn, although it can
cause issues such as asthma, chronic cough, chronic laryngitis, sore throat, or even
non-cardiac chest pain.
,Colon cancer can present with anemic qualities on serology tests, abdominal pain,
changes in bowel habits, as well as hemoccult-positive stool.
Case
A man has had 4 diagnosed sinus infections in the last 5 months, so you order a CT
scan of his sinuses. He does not believe that any of the episodes completely
resolved. The patient has a long history of excessive seasonal allergies; he treats
them with daily oral OTC anti-histamines and he has repeatedly declined beginning
allergy immunotherapy. He also has a history of asthma that is well controlled with
daily inhaled corticosteroids.
Question Ico-delete Highlights
What imaging discovery do you expect to find? - ANSWER-Correct answer:
Opacification
Explanation
This patient is most likely suffering from chronic rhinosinusitis (CRS); there may or
may not be involvement of nasal polyps. The CRS would be classified as chronic
due to the fact that he has had symptoms for over 12 weeks. CRS without nasal
polyps accounts for up to 65% of cases of CRS. Risk factors that contribute to this
condition include the presence of allergic rhinitis and asthma.
On computed tomography (CT) studies, patients suffering from CRS without nasal
polyps will generally present with sinus opacification (or sinus ostial obstruction) as
well as mucosal thickening of the affected sinus cavity. Mucosal thinning and
translucency are not associated findings on CT in CRS. Hypoattenuation generally
describes an area whiter than usual and is used when referring to organs, such as
the liver or kidneys.
Question Ico-delete Highlights
A 44-year-old man presents for follow-up of poorly controlled type I diabetes mellitus,
which was diagnosed 32 years ago. What change on his funduscopic examination
would indicate a need for urgent referral to an ophthalmologist? - ANSWER-Correct
answer:
Neovascularization
Explanation
Neovascularization is the hallmark of proliferative diabetic retinopathy. New vessels
can appear at the optic nerve and the macula as a result of retinal hypoxia. They are
susceptible to rupture, resulting in vitreous hemorrhage, retinal detachment, and
blindness. Proliferative retinopathy requires urgent referral to an ophthalmologist and
is usually treated with pan retinal laser photocoagulation.
The risk of developing diabetic retinopathy is related to the extent of glycemic control
and the duration of diabetes. It is classified as nonproliferative and proliferative.
Blot hemorrhages, cotton wool spots, and microaneurysms are indicative of
nonproliferative diabetic retinopathy, which is usually seen 10 to 20 years after the
onset of diabetes. Nonproliferative retinopathy does not always progress to
, proliferative retinopathy, but if it becomes extensive, it can result in retinal ischemia,
which increases the likelihood of proliferative disease.
Flame-shaped hemorrhages are indicative of hypertensive retinopathy.
Question Ico-delete Highlights
What health maintenance strategy is correct regarding this patient? - ANSWER-
Correct answer:
Pillow and mattress covers, air purifiers, and dust filters should be purchased.
Explanation
This patient's diagnosis is allergic rhinitis and conjunctivitis.
Maintaining an allergen-free environment by covering pillows and mattresses with
plastic covers, substituting synthetic materials for animal products, removing dust-
collecting household fixtures, and using air purifiers and dust filters are all
recommended.
Warm compresses are useful in managing hordeolums and blepharitis, not allergic
conjunctivitis.
Numerous over-the-counter antihistamines offer the benefit of reduced cost but are
associated with higher rates of drowsiness.
When using intranasal corticosteroids, patients should be reminded that there may
be a delay in the onset of relief for 2 or more weeks. Corticosteroid sprays may also
shrink nasal polyps, delaying or eliminating the indications for endoscopic sinus
surgery.
A 62-year-old woman presents to the emergency department with acute unilateral
loss of vision for 1 hour. Fundoscopic examination demonstrates vein dilation,
intraretinal hemorrhages, and cotton-wool spots with optic disc swelling. What is the
most likely diagnosis? - ANSWER-Correct answer:
Retinal vein occlusion
Explanation
Retinal vein occlusion results in acute vision loss with retinal vein dilation, intraretinal
hemorrhages, cotton-wool spots, and optic disc swelling on fundus examination.
Macular degeneration does not cause acute vision loss but progressive loss over
time and does not result in the findings above.
Retinal artery occlusion does not cause retinal vein dilation and causes a classic
cherry-red spot at the fovea.
Diabetic retinopathy does not cause the constellation of signs noted above.
Retinal detachment was not found on fundoscopic examination.
Question
100% CORRECT ANSWERS 2025
Case
A 74-year-old man presents with a 1 ½-hour history of severe pain and blurred vision
in his left eye. Upon examination, his left eye is erythematous with a steamy cornea
and a nonreactive, dilated pupil. An ophthalmologic consult is ordered, and
tonometry is completed, revealing an elevated intraocular pressure and a confirmed
diagnosis of acute angle-closure glaucoma.
Question Ico-delete Highlights
What will be the definitive treatment for this patient? - ANSWER-Correct answer:
Bilateral laser peripheral iridotomy
Explanation The correct answer is bilateral laser peripheral iridotomy. This is a
procedure during which a puncture-like opening is made near the base of the iris in
order to decrease intraocular pressure in patients with angle-closure glaucoma.
While there are various medications used to treat acute episodes, this procedure will
correct the disorder definitively, whereas the medications are temporary treatment.
Patients with narrow anterior chambers are at risk for angle-closure glaucoma. If this
occurs unilaterally, they are even more at risk for acute episodes in the other eye.
For this reason, the procedure is typically performed bilaterally.
Left laser peripheral iridotomy is not the correct answer. While there are various
medications used to treat acute episodes of angle-closure glaucoma, this procedure
will correct the disorder definitively, whereas the medications are temporary
treatment. Patients with narrow anterior chambers are at risk for angle-closure
glaucoma. Narrow anterior chambers always occur bilaterally. If acute angle-closure
glaucoma occurs unilaterally, they are even more at risk for acute episodes in the
other eye. For this reason, the procedure is typically performed bilaterally as
opposed to being done in JUST the affected eye.
IV acetazolamide is not the correct answer. This medication is given in episodes of
acute angle-closure glaucoma in order to decrease the intraocular pressure. It is
typically given in a single 500mg IV dose followed by 250mg orally 4 times daily. This
is effective to control the acute episode, but will not treat the disorder definitively, as
the patient's underlying issue is narrow anterior chambers.
Oral glycerol is not the correct answer. This medication is an osmotic diuretic that
can be given 1-2 g/kg in or
Question Ico-delete Highlights
A 36-year-old woman presents with a small and irregular right pupil. On exam, you
note that the pupil does not respond to direct or consensual light stimuli; however, it
becomes smaller during an accommodation testing. What is the most likely
diagnosis? - ANSWER-Correct answer:
Neurosyphilis
,Explanation
The clinical picture is suggestive of neurosyphilis; more specifically, it is likely tabes
dorsalis. The pupil described here is the Argyll Robertson pupil. The pupil reacts
poorly to light, but it reacts well to accommodation.
Signs and symptoms seen in a TIA include temporary weakness and heaviness of
the contralateral arm, leg, or face. There may be monocular vision loss in the eye
contralateral to the affected limbs, which are not described in this patient.
Retinal vein or artery occlusion will produce sudden vision loss, which is not
described in this patient.
Herpes simplex can involve the eyes, but the patient would develop keratitis (corneal
inflammation) with impaired vision, and dendritic ulcers can be seen with fluorescein
stain.
Case
A 22-year-old man presents with a 3-month history of worsening diarrhea that comes
and goes. While performing a comprehensive oral exam, you note 2 lesions on the
buccal mucosa on the right side of the oral cavity. You document these lesions as 2
round lesions that measure approximately 2 mm in diameter and have a white-yellow
center, which is surrounded by a red halo. Pertinent positives also include a reduced
appetite, abdominal pain, and cramping.
Question Ico-delete Highlights
Based on these current history, physical exam findings, and possible disease
pathologies, what diagnosis is very high on your differential? - ANSWER-Correct
answer:
Crohn's disease
Explanation
The patient above has an aphthous ulcer, also sometimes referred to as a canker
sore or aphthous stomatitis. These painful, open sores are found in the oral cavity
and are the most common form of mouth ulcer. Many times these lesions are
described as having a white or yellow center and are surrounded by a bright red
area. They are benign, noncancerous, noninfectious, and many times, the cause is
unknown; however, aphthous lesions are common extra intestinal manifestations
found in patients suffering from Crohn's disease.
Patients who have the other form of inflammatory bowel disease, ulcerative colitis,
will not typically develop such signs as aphthous ulcers. More common signs of
cholecystitis include right-sided abdominal pain, vomiting, fever, a positive Murphy's
sign, or even palpable gallbladder.
GERD symptoms generally surround the complaint of heartburn, although it can
cause issues such as asthma, chronic cough, chronic laryngitis, sore throat, or even
non-cardiac chest pain.
,Colon cancer can present with anemic qualities on serology tests, abdominal pain,
changes in bowel habits, as well as hemoccult-positive stool.
Case
A man has had 4 diagnosed sinus infections in the last 5 months, so you order a CT
scan of his sinuses. He does not believe that any of the episodes completely
resolved. The patient has a long history of excessive seasonal allergies; he treats
them with daily oral OTC anti-histamines and he has repeatedly declined beginning
allergy immunotherapy. He also has a history of asthma that is well controlled with
daily inhaled corticosteroids.
Question Ico-delete Highlights
What imaging discovery do you expect to find? - ANSWER-Correct answer:
Opacification
Explanation
This patient is most likely suffering from chronic rhinosinusitis (CRS); there may or
may not be involvement of nasal polyps. The CRS would be classified as chronic
due to the fact that he has had symptoms for over 12 weeks. CRS without nasal
polyps accounts for up to 65% of cases of CRS. Risk factors that contribute to this
condition include the presence of allergic rhinitis and asthma.
On computed tomography (CT) studies, patients suffering from CRS without nasal
polyps will generally present with sinus opacification (or sinus ostial obstruction) as
well as mucosal thickening of the affected sinus cavity. Mucosal thinning and
translucency are not associated findings on CT in CRS. Hypoattenuation generally
describes an area whiter than usual and is used when referring to organs, such as
the liver or kidneys.
Question Ico-delete Highlights
A 44-year-old man presents for follow-up of poorly controlled type I diabetes mellitus,
which was diagnosed 32 years ago. What change on his funduscopic examination
would indicate a need for urgent referral to an ophthalmologist? - ANSWER-Correct
answer:
Neovascularization
Explanation
Neovascularization is the hallmark of proliferative diabetic retinopathy. New vessels
can appear at the optic nerve and the macula as a result of retinal hypoxia. They are
susceptible to rupture, resulting in vitreous hemorrhage, retinal detachment, and
blindness. Proliferative retinopathy requires urgent referral to an ophthalmologist and
is usually treated with pan retinal laser photocoagulation.
The risk of developing diabetic retinopathy is related to the extent of glycemic control
and the duration of diabetes. It is classified as nonproliferative and proliferative.
Blot hemorrhages, cotton wool spots, and microaneurysms are indicative of
nonproliferative diabetic retinopathy, which is usually seen 10 to 20 years after the
onset of diabetes. Nonproliferative retinopathy does not always progress to
, proliferative retinopathy, but if it becomes extensive, it can result in retinal ischemia,
which increases the likelihood of proliferative disease.
Flame-shaped hemorrhages are indicative of hypertensive retinopathy.
Question Ico-delete Highlights
What health maintenance strategy is correct regarding this patient? - ANSWER-
Correct answer:
Pillow and mattress covers, air purifiers, and dust filters should be purchased.
Explanation
This patient's diagnosis is allergic rhinitis and conjunctivitis.
Maintaining an allergen-free environment by covering pillows and mattresses with
plastic covers, substituting synthetic materials for animal products, removing dust-
collecting household fixtures, and using air purifiers and dust filters are all
recommended.
Warm compresses are useful in managing hordeolums and blepharitis, not allergic
conjunctivitis.
Numerous over-the-counter antihistamines offer the benefit of reduced cost but are
associated with higher rates of drowsiness.
When using intranasal corticosteroids, patients should be reminded that there may
be a delay in the onset of relief for 2 or more weeks. Corticosteroid sprays may also
shrink nasal polyps, delaying or eliminating the indications for endoscopic sinus
surgery.
A 62-year-old woman presents to the emergency department with acute unilateral
loss of vision for 1 hour. Fundoscopic examination demonstrates vein dilation,
intraretinal hemorrhages, and cotton-wool spots with optic disc swelling. What is the
most likely diagnosis? - ANSWER-Correct answer:
Retinal vein occlusion
Explanation
Retinal vein occlusion results in acute vision loss with retinal vein dilation, intraretinal
hemorrhages, cotton-wool spots, and optic disc swelling on fundus examination.
Macular degeneration does not cause acute vision loss but progressive loss over
time and does not result in the findings above.
Retinal artery occlusion does not cause retinal vein dilation and causes a classic
cherry-red spot at the fovea.
Diabetic retinopathy does not cause the constellation of signs noted above.
Retinal detachment was not found on fundoscopic examination.
Question
