BATES HEENT EXAM SCRIPT 2025/2026 QUESTIONS WITH
SOLUTIONS GRADED A+
✔✔PTerygium - ✔✔A triangular thickening of the bulbar conjunctiva that grows slowly
across the outer surface of the cornea, usually from the nasal side. Reddening may
occur. May interfere with vision as it encroaches on the pupil.
✔✔Cataracts - ✔✔Opacity of the lenses visible through the pupil. Risk factors are older
age, smoking, diabetes, corticosteroid use.
✔✔Nuclear Cataract - ✔✔Looks gray when seen by a flashlight. If the pupil is widely
dilated, the gray opacity is surrounded by a black rim.
✔✔Peripheral Cataract - ✔✔Produces spokelike shadows that point— gray against
black, as seen with a flashlight, or black against red with an ophthalmoscope. A dilated
pupil, as shown here, facilitates this observation.
✔✔Anisocoria - ✔✔unequal pupil size
Causes include blunt trauma to the eye, open-angle glaucoma (p. 270), and impaired
parasympathetic innervation to the iris, as in tonic pupil and oculomotor nerve (CN III)
paralysis.
✔✔Tonic Pupil (Adie's Pupil) - ✔✔Pupil is large (dilated), regular, and usually unilateral.
Reaction to light is severely reduced and slowed, or even absent. Constriction during
the near vision is present, although very slow (tonic). These changes reflect
parasympathetic denervation. Slow accommodation causes blurred vision.
✔✔CN III paralysis - ✔✔The pupil is large and fixed to light and near effort. Ptosis of the
upper eyelid (due to impaired CN III innervation of the levator palpebrae muscle) and
lateral deviation of the eye downward and outward are almost always present.
✔✔Horner syndrome (sympathetic chain lesion) - ✔✔The affected pupil is small,
unilateral, reacts briskly to light and near effort, but dilates slowly, especially in dim light.
Anisocoria is >1 mm, with ipsilateral ptosis of the eyelid and often loss of sweating on
the forehead.
These findings reflect the classic triad of Horner syndrome—miosis, ptosis and
anhydrosis, due to a lesion in the sympathetic pathways anywhere from the
hypothalamus through the brachial plexus and cervical ganglia into the
oculasympathetic fibers of the eye.
Causes include ipsilateral brainstem lesions, neck and chest tumors affecting the
ipsilateral sympathetic ganglia, and orbital trauma or migraines.
, In congenital Horner syndrome, the involved iris is lighter in color than its fellow
(heterochromia).
✔✔Small irregular pupils (argyll Robertson pupils) - ✔✔The pupils are small, irregular
and usually bilateral. They constrict with near vision and dilate with far vision (a normal
near reaction) but do not react to light, seen in neurosyphilis and rarely in diabetes.
✔✔Equal Pupils and One Blind Eye - ✔✔Unilateral blindness does not cause anisocoria
as long as the sympathetic and parasympathetic innervation to both irises is normal. A
light directed into the seeing eye produces a direct reaction in that eye and a
consensual reaction in the blind eye. A light directed into the blind eye, however, causes
no response in either eye.
✔✔Esotropia - ✔✔inward turning of the eye
✔✔exotropia - ✔✔outward turning of the eye
✔✔papilledema - ✔✔Elevated intracranial pressure causes intraxonal edema along the
optic nerve, leading to engorgement and swelling of the optic disc.
Color pink, hyperemic Often with loss of venous pulsations Disc vessels more visible,
more numerous, curve over the borders of the disc Disc swollen with margins blurred
The physiologic cup is not visible. Seen in intracranial mass, lesion, or hemorrhage,
meningitis
✔✔AV Nicking or Concealment - ✔✔The vein appears to stop abruptly on either side of
the artery.
✔✔Tophi - ✔✔A deposit of uric acid crystals characteristic of chronic tophaceous gout.
It appears as hard nodules in the helix or antihelix and may discharge chalky white
crystals through the skin.
✔✔Keloid - ✔✔A firm, nodular, hypertrophic mass of scar tissue extending beyond the
area of injury. It may de- velop in any scarred area but is most common on the
shoulders and upper chest. A keloid on a pierced ear- lobe may have unwanted
cosmetic effects. Keloids are more common in darker- skinned people and may recur
following treatment.
✔✔Rheumatoid Nodules - ✔✔In chronic rheumatoid arthritis, look for small lumps on
the helix or antihelix and addi- tional nodules elsewhere on the hands and along the sur-
face of the ulna distal to the elbow (p. 702), and on the knees and heels. Ulceration may
result from repeated inju- ries. These nodules may ante- date the arthritis.
✔✔cutaneous cyst - ✔✔Formerly called a sebaceous cyst, a dome-shaped lump in the
dermis forms a benign closed firm sac attached to the epidermis. A dark dot (black-
SOLUTIONS GRADED A+
✔✔PTerygium - ✔✔A triangular thickening of the bulbar conjunctiva that grows slowly
across the outer surface of the cornea, usually from the nasal side. Reddening may
occur. May interfere with vision as it encroaches on the pupil.
✔✔Cataracts - ✔✔Opacity of the lenses visible through the pupil. Risk factors are older
age, smoking, diabetes, corticosteroid use.
✔✔Nuclear Cataract - ✔✔Looks gray when seen by a flashlight. If the pupil is widely
dilated, the gray opacity is surrounded by a black rim.
✔✔Peripheral Cataract - ✔✔Produces spokelike shadows that point— gray against
black, as seen with a flashlight, or black against red with an ophthalmoscope. A dilated
pupil, as shown here, facilitates this observation.
✔✔Anisocoria - ✔✔unequal pupil size
Causes include blunt trauma to the eye, open-angle glaucoma (p. 270), and impaired
parasympathetic innervation to the iris, as in tonic pupil and oculomotor nerve (CN III)
paralysis.
✔✔Tonic Pupil (Adie's Pupil) - ✔✔Pupil is large (dilated), regular, and usually unilateral.
Reaction to light is severely reduced and slowed, or even absent. Constriction during
the near vision is present, although very slow (tonic). These changes reflect
parasympathetic denervation. Slow accommodation causes blurred vision.
✔✔CN III paralysis - ✔✔The pupil is large and fixed to light and near effort. Ptosis of the
upper eyelid (due to impaired CN III innervation of the levator palpebrae muscle) and
lateral deviation of the eye downward and outward are almost always present.
✔✔Horner syndrome (sympathetic chain lesion) - ✔✔The affected pupil is small,
unilateral, reacts briskly to light and near effort, but dilates slowly, especially in dim light.
Anisocoria is >1 mm, with ipsilateral ptosis of the eyelid and often loss of sweating on
the forehead.
These findings reflect the classic triad of Horner syndrome—miosis, ptosis and
anhydrosis, due to a lesion in the sympathetic pathways anywhere from the
hypothalamus through the brachial plexus and cervical ganglia into the
oculasympathetic fibers of the eye.
Causes include ipsilateral brainstem lesions, neck and chest tumors affecting the
ipsilateral sympathetic ganglia, and orbital trauma or migraines.
, In congenital Horner syndrome, the involved iris is lighter in color than its fellow
(heterochromia).
✔✔Small irregular pupils (argyll Robertson pupils) - ✔✔The pupils are small, irregular
and usually bilateral. They constrict with near vision and dilate with far vision (a normal
near reaction) but do not react to light, seen in neurosyphilis and rarely in diabetes.
✔✔Equal Pupils and One Blind Eye - ✔✔Unilateral blindness does not cause anisocoria
as long as the sympathetic and parasympathetic innervation to both irises is normal. A
light directed into the seeing eye produces a direct reaction in that eye and a
consensual reaction in the blind eye. A light directed into the blind eye, however, causes
no response in either eye.
✔✔Esotropia - ✔✔inward turning of the eye
✔✔exotropia - ✔✔outward turning of the eye
✔✔papilledema - ✔✔Elevated intracranial pressure causes intraxonal edema along the
optic nerve, leading to engorgement and swelling of the optic disc.
Color pink, hyperemic Often with loss of venous pulsations Disc vessels more visible,
more numerous, curve over the borders of the disc Disc swollen with margins blurred
The physiologic cup is not visible. Seen in intracranial mass, lesion, or hemorrhage,
meningitis
✔✔AV Nicking or Concealment - ✔✔The vein appears to stop abruptly on either side of
the artery.
✔✔Tophi - ✔✔A deposit of uric acid crystals characteristic of chronic tophaceous gout.
It appears as hard nodules in the helix or antihelix and may discharge chalky white
crystals through the skin.
✔✔Keloid - ✔✔A firm, nodular, hypertrophic mass of scar tissue extending beyond the
area of injury. It may de- velop in any scarred area but is most common on the
shoulders and upper chest. A keloid on a pierced ear- lobe may have unwanted
cosmetic effects. Keloids are more common in darker- skinned people and may recur
following treatment.
✔✔Rheumatoid Nodules - ✔✔In chronic rheumatoid arthritis, look for small lumps on
the helix or antihelix and addi- tional nodules elsewhere on the hands and along the sur-
face of the ulna distal to the elbow (p. 702), and on the knees and heels. Ulceration may
result from repeated inju- ries. These nodules may ante- date the arthritis.
✔✔cutaneous cyst - ✔✔Formerly called a sebaceous cyst, a dome-shaped lump in the
dermis forms a benign closed firm sac attached to the epidermis. A dark dot (black-
