HEENT Rosh Review UPDATED ACTUAL Questions and CORRECT Answers
1. orbital cellulitis Infection involving orbital fat and ocular muscles - complications include orbital
abscess, vision loss, intracranial infection
Risk factors: sinusitis, orbital trauma or surgery
Sx: eyelid swelling, pain with eye movement
PE: proptosis, ophthalmoplegia, decreased vision
Dx is made clinically, confirmed with CT scan
Most commonly caused by S. aureus, streptococci
Treatment is ophthalmology evaluation, broad spectrum antibiotics
2. Acute Angle-Clo- Sx: acute unilateral pain and vision loss, headache, vomiting, seeing halos around
sure Glaucoma lights
Clinical: can occur in the setting of significant hyphema
PE: cloudy cornea and fixed mid-dilated pupil
Dx: increased IOP on tonometry
Tx: emergent ophthalmology evaluation, topical beta-blockers (timolol), topical
alpha-agonists (apraclonidine), carbonic anhydrase inhibitors (acetazolamide),
iridotomy
3. diabetic retinopa- History of diabetes
thy Progressive central vision loss and seeing spots and floaters
Funduscopic exam: microaneurysms, neovascularization, flame-shaped and splin-
ter hemorrhages, cotton-wool spots
Tx options: glucose control, anti-VEGF agents, laser photocoagulation, vitrectomy
Screening: perform at time of diagnosis of type 2 diabetes, perform within 5 years
of diagnosis of type 1 diabetes
4. central retinal Sx: sudden, painless monocular vision loss
artery occlusion Funduscopy: retinal whitening, cherry red spot, boxcar appearance (from segmen-
tal blood flow)
Tx: ocular emergency, evidence unclear re: optimal therapy
5.
, open angle glau- Increased IOP, diagnosed by tonometry
coma Risk factors: genetics, HTN, DM, certain medications
Patients may be asymptomatic
Initial treatment: prostaglandin analog drops
Second-line treatment: beta-blocker eye drops
Ophthalmology follow-up
6. macular degen- Patient will be older
eration Bilateral, gradual central field vision loss
PEDry (85% of cases): atrophic changes and yellow retinal deposits (drusen spots)
Wet: vascular changes
Diagnosis is made by characteristic findings on dilated eye examination
Most common cause of blindness in the older population
7. anterior uveitis limbic erythema, pinpoint pupils, and a hazy anterior chamber. Definitive diagnosis
of anterior uveitis can be made with slit-lamp examination, which reveals leuko-
cytes in the anterior chamber
8. papilledema Patient presents with acute onset of intermittent headaches and blurred vision
PE will show optic disk swelling
Focus on finding intracranial pathology
Most commonly caused secondary to increased intracranial pressure
Treatment is the treatment of the underlying disorder
9. optic neuritis Most commonly caused by multiple sclerosis
Sx: acute monocular vision loss, pain worse with eye movements, loss of color (red)
vision, and transient worsening of vision with increased body temperature (Uhthoff
phenomenon)
Dx: made clinically. Bedside US might be helpful; MRI will confirm demyelination
Tx: IV methylprednisolone
10. pituitary tumors Visual Sx (bitemporal hemianopia or hemianopsia)
Prolactinoma: (most common), amenorrhea, impotence
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1. orbital cellulitis Infection involving orbital fat and ocular muscles - complications include orbital
abscess, vision loss, intracranial infection
Risk factors: sinusitis, orbital trauma or surgery
Sx: eyelid swelling, pain with eye movement
PE: proptosis, ophthalmoplegia, decreased vision
Dx is made clinically, confirmed with CT scan
Most commonly caused by S. aureus, streptococci
Treatment is ophthalmology evaluation, broad spectrum antibiotics
2. Acute Angle-Clo- Sx: acute unilateral pain and vision loss, headache, vomiting, seeing halos around
sure Glaucoma lights
Clinical: can occur in the setting of significant hyphema
PE: cloudy cornea and fixed mid-dilated pupil
Dx: increased IOP on tonometry
Tx: emergent ophthalmology evaluation, topical beta-blockers (timolol), topical
alpha-agonists (apraclonidine), carbonic anhydrase inhibitors (acetazolamide),
iridotomy
3. diabetic retinopa- History of diabetes
thy Progressive central vision loss and seeing spots and floaters
Funduscopic exam: microaneurysms, neovascularization, flame-shaped and splin-
ter hemorrhages, cotton-wool spots
Tx options: glucose control, anti-VEGF agents, laser photocoagulation, vitrectomy
Screening: perform at time of diagnosis of type 2 diabetes, perform within 5 years
of diagnosis of type 1 diabetes
4. central retinal Sx: sudden, painless monocular vision loss
artery occlusion Funduscopy: retinal whitening, cherry red spot, boxcar appearance (from segmen-
tal blood flow)
Tx: ocular emergency, evidence unclear re: optimal therapy
5.
, open angle glau- Increased IOP, diagnosed by tonometry
coma Risk factors: genetics, HTN, DM, certain medications
Patients may be asymptomatic
Initial treatment: prostaglandin analog drops
Second-line treatment: beta-blocker eye drops
Ophthalmology follow-up
6. macular degen- Patient will be older
eration Bilateral, gradual central field vision loss
PEDry (85% of cases): atrophic changes and yellow retinal deposits (drusen spots)
Wet: vascular changes
Diagnosis is made by characteristic findings on dilated eye examination
Most common cause of blindness in the older population
7. anterior uveitis limbic erythema, pinpoint pupils, and a hazy anterior chamber. Definitive diagnosis
of anterior uveitis can be made with slit-lamp examination, which reveals leuko-
cytes in the anterior chamber
8. papilledema Patient presents with acute onset of intermittent headaches and blurred vision
PE will show optic disk swelling
Focus on finding intracranial pathology
Most commonly caused secondary to increased intracranial pressure
Treatment is the treatment of the underlying disorder
9. optic neuritis Most commonly caused by multiple sclerosis
Sx: acute monocular vision loss, pain worse with eye movements, loss of color (red)
vision, and transient worsening of vision with increased body temperature (Uhthoff
phenomenon)
Dx: made clinically. Bedside US might be helpful; MRI will confirm demyelination
Tx: IV methylprednisolone
10. pituitary tumors Visual Sx (bitemporal hemianopia or hemianopsia)
Prolactinoma: (most common), amenorrhea, impotence
2/8
