HEENT ROSH REVIEW UPDATED ACTUAL Questions and CORRECT Answers
1. A 28-year-old woman presents with in- Ultraviolet ketartitis
tense pain, tearing, and ocular foreign
body sensation in both eyes that began
yesterday. She denies any trauma, past
medical problems, or contact lens use
and reports that she works as ski patrol
for a local resort. Her physical examina-
tion is significant for bilateral decreased
visual acuity, injected conjunctiva, and
diffuse punctuate corneal lesions with a
discrete superior border. Her pupils are
equal, round, and reactive to light. Giv-
en this patient's clinical presentation,
which of the following is the most likely
diagnosis?
2. What is another name for ultraviolet This patient has ultraviolet keratitis, also known
keratitis and how is it caused? as snow blindness. This is a radiation burn
that occurs when an individual comes in close
contact with an ultraviolet-ray-containing light
source. It may be caused by sun lamps, tanning
booths, or exposure to intense reflected sun-
light, particularly in high-altitude environments
3. How will flouresence staining present Fluorescein staining reveals superficial punc-
with ultraviolet keratitis? tate epithelial surface irregularities, which usu-
ally cover the entire surface of the cornea. This
condition is usually referred to as superficial
punctate keratitis (SPK)
4. What is the treatment for ultraviolet ker- Treatment consists of flushing the eye for sev-
atitis? eral minutes with water or saline solution and
, prescribing a short-acting cycloplegic agent
for pain management. The use of ophthalmic
antibiotics has not been shown to improve
healing. While oral pain medications are often
needed, topical anesthetics should be avoided
due to an increased risk of corneal ulceration.
5. What is episcleritis and how is it caused? Episcleritis (B) is a common, benign inflamma-
tory condition of the episclera and most often
occurs in young adults. It is usually idiopathic
but may be associated with systemic conditions
such as diabetes mellitus, systemic lupus ery-
thematosus, rheumatoid arthritis, and inflam-
matory bowel disease. Patients typically com-
plain of a foreign body sensation, mild pain,
photophobia, and lacrimation. The condition is
usually self-limiting.
6. What is iritis? Iritis (C), also known as anterior uveitis, is an in-
flammation of the anterior portions of the uvea
(iris, ciliary body, and choroid). It is often idio-
pathic but may be associated with systemic dis-
eases such as rheumatoid arthritis, sarcoidosis,
Reiter syndrome, and tuberculosis.
7. How do cycloplegics work? They relax ciliary muscle spasm and prevent
contraction of the iris, reducing pupillary pho-
toresponse.
8. What is leukoplakia? Leukoplakia is a premalignant white patch or
plaque that may eventually progress to an ul-
cer or mass. It is a pre-malignant oral lesion.
, The biggest risk factors are tobacco and alcohol
use.
9. If oral leukoplakia is persistent for more If oral leukoplakia persists for more than 2
than 2 weeks what is required? weeks, biopsy and treatment is required.
10. What is the 5-year survival rate for oral 50-55%.
cancer?
11. The histopathologic findings of this dis- Meniere's disease
ease includes endolymphatic hydrops,
which is thought to be caused by ei-
ther overproduction or underresorption
of endolymph in the inner ear.
12. What percentage of vertigo is due to Less than 10%
central vestibular etiologies?
13. What is the treatment for menieres dis- Vestibular rehabilitation, low-salt diet, HCT,
ease? surgery
14. What is the treatment for a subconjunc- Reassurance and follow up
tival hemmorrage?
15. What is the cause of a subconjunctival Subconjunctival hemorrhage results from rup-
hemmorrhage? ture of small subconjunctival blood vessels. It
is thought to occur from trauma or Valsalva
maneuvers (e.g. coughing) although patients
often have no memory of an inciting event.
16. What history with subconjunctival he- Bilateral or recurrent subconjunctival hem-
morrhage would prompt investigation orrhage should have a bleeding diathesis
into a bleeding diathesis? workup.
1. A 28-year-old woman presents with in- Ultraviolet ketartitis
tense pain, tearing, and ocular foreign
body sensation in both eyes that began
yesterday. She denies any trauma, past
medical problems, or contact lens use
and reports that she works as ski patrol
for a local resort. Her physical examina-
tion is significant for bilateral decreased
visual acuity, injected conjunctiva, and
diffuse punctuate corneal lesions with a
discrete superior border. Her pupils are
equal, round, and reactive to light. Giv-
en this patient's clinical presentation,
which of the following is the most likely
diagnosis?
2. What is another name for ultraviolet This patient has ultraviolet keratitis, also known
keratitis and how is it caused? as snow blindness. This is a radiation burn
that occurs when an individual comes in close
contact with an ultraviolet-ray-containing light
source. It may be caused by sun lamps, tanning
booths, or exposure to intense reflected sun-
light, particularly in high-altitude environments
3. How will flouresence staining present Fluorescein staining reveals superficial punc-
with ultraviolet keratitis? tate epithelial surface irregularities, which usu-
ally cover the entire surface of the cornea. This
condition is usually referred to as superficial
punctate keratitis (SPK)
4. What is the treatment for ultraviolet ker- Treatment consists of flushing the eye for sev-
atitis? eral minutes with water or saline solution and
, prescribing a short-acting cycloplegic agent
for pain management. The use of ophthalmic
antibiotics has not been shown to improve
healing. While oral pain medications are often
needed, topical anesthetics should be avoided
due to an increased risk of corneal ulceration.
5. What is episcleritis and how is it caused? Episcleritis (B) is a common, benign inflamma-
tory condition of the episclera and most often
occurs in young adults. It is usually idiopathic
but may be associated with systemic conditions
such as diabetes mellitus, systemic lupus ery-
thematosus, rheumatoid arthritis, and inflam-
matory bowel disease. Patients typically com-
plain of a foreign body sensation, mild pain,
photophobia, and lacrimation. The condition is
usually self-limiting.
6. What is iritis? Iritis (C), also known as anterior uveitis, is an in-
flammation of the anterior portions of the uvea
(iris, ciliary body, and choroid). It is often idio-
pathic but may be associated with systemic dis-
eases such as rheumatoid arthritis, sarcoidosis,
Reiter syndrome, and tuberculosis.
7. How do cycloplegics work? They relax ciliary muscle spasm and prevent
contraction of the iris, reducing pupillary pho-
toresponse.
8. What is leukoplakia? Leukoplakia is a premalignant white patch or
plaque that may eventually progress to an ul-
cer or mass. It is a pre-malignant oral lesion.
, The biggest risk factors are tobacco and alcohol
use.
9. If oral leukoplakia is persistent for more If oral leukoplakia persists for more than 2
than 2 weeks what is required? weeks, biopsy and treatment is required.
10. What is the 5-year survival rate for oral 50-55%.
cancer?
11. The histopathologic findings of this dis- Meniere's disease
ease includes endolymphatic hydrops,
which is thought to be caused by ei-
ther overproduction or underresorption
of endolymph in the inner ear.
12. What percentage of vertigo is due to Less than 10%
central vestibular etiologies?
13. What is the treatment for menieres dis- Vestibular rehabilitation, low-salt diet, HCT,
ease? surgery
14. What is the treatment for a subconjunc- Reassurance and follow up
tival hemmorrage?
15. What is the cause of a subconjunctival Subconjunctival hemorrhage results from rup-
hemmorrhage? ture of small subconjunctival blood vessels. It
is thought to occur from trauma or Valsalva
maneuvers (e.g. coughing) although patients
often have no memory of an inciting event.
16. What history with subconjunctival he- Bilateral or recurrent subconjunctival hem-
morrhage would prompt investigation orrhage should have a bleeding diathesis
into a bleeding diathesis? workup.
