PANCE - ENT QUESTIONS WITH COMPLETE SOLUTIONS GRADED A+

15 year old patient is complaining of sore throat, fever, and cough. On exam, you notice posterior pharynx exudate. No lymphadenopathy noted. What is the treat- ment of choice for this patient? - The centor criteria gives this patient a score of 2 for the exudate and fever. These patients should have a throat culture done. If positive for group A strep, treat with penicillin. A 14-year-old male presents with sore throat and fever, but denies cough. Exam reveals elevated temperature, tender anterior cervical adenopathy, and pharyngeal exudate. What is the most likely diagnosis? A. epiglottitis B. mononucleosis C. peritonsillar abscess D. strep pharyngitis - Answer: D [Ophthalmology and Otolaryngology, Infectious Disease, Pediatrics]. A. Epiglottitis should be suspected when a patient presents with a rapidly developing sore throat or when pain with swallowing is out of proportion to minimal findings on physical exam. It is less common today in children secondary to Hib (Haemophilus influenzae type b) vaccination programs. B. Mononucleosis is suggested by prominent adenopathy and a shaggy, white-gray tonsillar exudate, which may extend into the nasopharynx, especially in young adults. C. Peritonsillar abscess presents with severe sore throat, pain on swallowing, trismus ("lockjaw"), medial deviation of the soft palate, and a muffled ("hot potato") voice. D. These clinical features (fever, tender anterior cervical adenopathy, lack of cough, and pharyngotonsillar exudate) strongly suggest group A- Beta hemolytic streptococcus. A 16-year-old Hispanic female presents to the clinic complaining of severe pain in her right ear. She is on the local high school swim team and has been participating in extra practice sessions. Her ear pain is so severe that she cannot lie on her right side to sleep. On physical exam, the right tragus is tender to palpation. The right ear canal is swollen and has scant white, clumpy discharge. Culture of this discharge would most likely reveal what organism? A. Haemophilus influenzae B. Moraxellacatarrhalis C. Pseudomonas-aeruginosaD. Streptococcus pneumoniae - Answer: C [Ophthalmology and Otolaryngology, Infectious Disease, Pediatrics]. A. The incidence of otitis media due to Haemophilus influen- zae has been significantly decreased with vaccination pro- grams. It rarely causes otitis externa. B. Moraxella catarrhalis is a common pathogen in otitis media. C. The majority of cases of otitis externa are caused by Pseudomonas aeruginosa or Proteus spp. Less common causes include Staphylococcus aureus, Staphylococcus epidermidis, Aspergillus, and Actinomyces. Topical antibiotic coverage should include antipseudomonal activity. D. Acute otitis media typically follows a viral URI. Viruses can cause the infection or predispose the patient to a sec- ondary bacterial infection. Streptococcus pneumoniae is the most common bacterial pathogen. A 26 year old female patient came in complaining of dizziness. The patient has episodes of dizziness that lasts 5 minutes and self resolve; it has been ongoing for the past 2 months. The patient also reports tinnitus and hearing loss. What is the treatment of choice? - The diagnosis is Menieres disease. These episodes of vertigo come in clusters for a cou- ple months and then self resolve. Another clue to diagnosis is hearing loss. Vestibular neuritis and BPPV will not have hearing loss. Treat these patients with salt restriction and diuretics. A 27-year-old patient with HIV disease presents with loss of appetite and odynophagia. Examination of the buccal mucosa and tongue reveals thick, white plaques somewhat adherent to the underlying mucosa. After scraping the patches with a tongue blade, the surface below appears raw and reddened. What is the most likely diagnosis? A. candidiasis B. carcinoma C. diphtheria D. hairy leukoplakia - Answer: A [Ophthalmology and Otolaryngology, Infec- tious Disease]. A. The thick, white coating from Candida infection can be scraped off revealing a raw, reddened surface underneath. Candida infections are commonly seen in patients who are immunocompromised. B. Cancer of the tongue is more common in men over age 50, especially in patients who abuse tobacco and alcohol. Cancers occur most often on the side of the tongue and any persistent nodule or ulcer must be suspect. Lesions can be red or white. C. Physical examination of a patient infected with Corynebac- terium diphtheria reveals a dull, red throat with a gray exu- date present on the uvula, pharynx, and tongue.D. HIV-positive patients are vulnerable to the whitish raised, feathery coating seen in hairy leukoplakia. In contrast to candidiasis, these areas cannot be scraped off. A 36-year-old male presents with purulent nasal discharge, headaches, and maxillary jaw pain for 9 days despite the use of nasal saline lavage. This is the fourth episode of similar symptoms so far this year. What diagnostic modality is most appro- priate at this time? A. computed tomography of sinuses B. magnetic resonance of sinuses C. radiographs of the skull D. culture and sensitivity of the nasal discharge - Answer: A [Ophthalmology and Otolaryngology, Infectious Disease].