HEENT:
Vitreous humor – fluid in back of eye
Ophthalmologist is an eye surgeon.
Optometrist isn’t.
Eye Layers: Sclera, Choroid comes up to
meet iris, retina (has 9 layers)
Lens is getting thicker bc needs to refract
light
Aqueous humor – fluid in front of eye
S. aureus – found on skin or nose
Trauma can increase IOP. Sudden intense
pressure on vessels will break capillaries
and fluid leaks and person will see redness.
Most of time it will clear out – body
reabsorbs (similarly to hematoma)
 HEENT: EYES

Blepharitis

 Chronic, bilateral inflammation of lid margins/eye follicle

 Causes: SLAB - seborrhea, lice, allergies, bacterial
 “Sand-like sensation”
 S/Sx: red, swell, itch
 Tx: clean eyelid; abx ointment

Blowout fracture
 Object hits the eye, rim intact, but floor of eye compromised. As
Cracks may catch tissue – inferior rectus entrapped in floor
 S/Sx: diplopia, blurry vision, cheek/jaw pain (inflammation),
subconj hemorrhage, periorbital ecchymosis
 Dx: check EOM, ophthalmologist referral,
– XR or CT bones of eye socket
 Tx: heal by itself; surgery if: exophthalmos > 2mm, diplopia,
entrapment of EOM

Cataracts
 Painless clouding of lens
– usually bilaterally
 Causes: SAD – smoking, Aging, DM2
 S/Sx: absent red reflex, progressive blurring, altered night vision
(halos/starbursts)
 Dx: PE
 Tx: Glasses and (phacoemulsification)

Chalazion
 Blocked Meibomian gland
– secretes oil for eyelid lubrication
 S/Sx: eye tenderness, tear formation
 Dx: PE
 Tx: self-limiting; warm compress 4x/day;
if infex  abx eyedrops; I&C (incision + curettage), steroid injex

Conjunctivitis
 Acute inflammation of the conjunctiva
 Cause: viral, bacterial, allergic
– MC viral cause = adenovirus
– Staph, Strep, Neisseria, Chlamydia
 S/Sx: eye discharge, scleral erythema
 Dx: Gram stain / culture
 Tx: self-limiting; Abx drops - bacterial

Corneal Abrasion
 Corneal injury  trauma to eye
 Causes: foreign body, occupation, overuse
 S/Sx: decreased sensation, pain, blurred
vision
 Dx: Fluorescein, slit lamp, PE
 Tx: only tx if severe; if object gets in eye,
don’t remove – go to ER; abx – if infex

Dacryoadenitis
 Inflammation of the lacrimal glands
 Population: infants and ppl > 40YO
 Causes: viruses (MC mumps) & bacterial infex; EBV, Staph.
aureus, Gonococcus; noninfectious causes – sarcoidosis,
thyroid eye disease (pressing on lacrimal gland)
 S/Sx: unilateral, red, swell, discharge, purulence if bacteria
 Dx: PE; if chronic – CT (if suspect lacrimal duct CA  V rare)
 Tx: warm compress

Ectropion
 Turning out of eyelid - inner surface exposed
 Causes: aging (weak eye CT), contraction of scar tissue - burns,
facial palsy, congenital (Down Syndrome)
 S/Sx: tearing, redness
 Dx: PE
 Tx: artificial tears; surgery - tighten eye muscle

Entropion
 Turning in of eyelid’s edges - degeneration of lid fascia
 Causes: congenital, Chlamydia
 Sx: eyelash rub against eye surface causing scarring (<
trachoma causes this too); tearing, irritation, red
 Dx: PE
 Tx: tears and surgery – esp if lashes rubbing cornea;
Botulinum toxin injex - temporary fix

Foreign Body

 Foreign object placed in any orifice of the body

 Sx: bad smell (bacteria on foreign object)
 Dx: PE
 Tx: use alligator clip to withdraw it; Debrox – dissolves cerumen

Glaucoma
 Increased IOP (open angle vs closed angle)
 Open angle: – we have passage + increased IOP
 Closed angle– no passage + increased IOP
 Population: AA (MC); diabetics
 Sx: halos, papilledema, nausea, eye pain
 Dx: Tonometry
 Tx: BB (timolol) and pilocarpine; trabeculoplasty,
iridotomy

Hordeolum
 Infex of sebaceous/sweat gland
 Pathogen: S. aureus (MC)
 Population: MC in kids than adults
 Sx: redness + pain around edge of eyelid; Localized abscess, tender on
outside of lid (internal sty is a Meibomian gland abscess)
 Dx: PE
 Tx: hot compress + Abx ointment (bacitracin/erythromycin); hand hygiene

Hyphema

 Blood in the front of eye

 Cause: trauma
 Sx: blood in front of eye (vision problems), eye pain
 Dx: Tonometry – bc acute glaucoma can occur suddenly
 Tx: self-limiting; bed rest + eye patch; a lot of blood = referral
to ophthalmology

Senile Macular Degeneration

 Atrophic exudative degeneration of the retina
–partial breakdown of retinal pigment epithelium
 MCC of blindness in people > 60YO
 Macula – allows you to see fine detail in the center
of the visual field
 S/Sx: gradual loss of acuity esp in central vision,
yellow deposits on macula (drusen), scotoma,
blurry/dark vision
 Dx: Fluorescein angiography, visual acuity test,
refraction test, slit lamp
 Tx: laser photocoagulation – stop leaking in
choroidal BV (photodynamic therapy)

Orbital Cellulitis
 Infex of tissues immediately surrounding eye
(cheek, lid, brow)
 Pathogens: Staph, Strep, H. flu
 S/Sx: fever to 102F or higher, pain, painful eyelids,
decreased vision, red eye, bulging eyes
 Dx: CBC, blood culture, LP – bc could be CNS problem
and can spread (more commonly done in kids), XR/CT
– see soft tissue swelling
 Tx: Abx (esp for kids), surgery if needed

Pterygium
 Non-cancerous growth (epithelial tissue) of the
clear, thin tissue that lays over the sclera
 S/Sx: blurry vision (when grows over pupil), but
usually Asx/painless growth
 Dx: PE
 Tx: none, unless vision obstructed; surgery to
scrape off – if it obstructs growth

Retinal Detachment
 Tear in retina = flapping into vitreous humor
 Cause: trauma; spontaneous; myopia
 Sugar Ray Leonard (boxer) had this
 Sx: acute onset of blurred/blackened vision; floaters and flashing lights,
curtain coming down the eye, painless vision loss
 Dx: fundoscopy – shows tear
 Tx: Nothing, esp if only a piece of retina detached; some cases laser
and cryotherapy – to stop bleeding

Retinal Vascular Occlusion

 Occlusion of either A or V due to embolism causes or temporal
arteritis, increased IOP
 S/Sx: unilateral vision loss
 Dx: pale fundus
 Tx: referral, O2, corticosteroids (GCA), acetazolamide, mannitol,
thrombolysis, ocular massage, timolol, carbogen (5% CO2 + 95% O2)
= CO2 = VD
 ROCAM TOM TC
 Diabetic Retinopathy

 Damage to retinal vascularization w/

neovascularization/microvascularization changes
 S/Sx: exudates/hemorrhages causing vision loss
 Dx: hx of HTN or DM
 Tx: laser therapy, control diabetes

Strabismus

 Cross eye - eyes are misaligned

 Population: seen more frequently in kids
– NL at birth although may be acquired
 Causes: Associated w/ DM – nerve problems; stroke,
Guillain-Barre Syndrome, botulinum
 S/Sx: unilateral blindness in weaker eye (amblyopia), if
not tx’d earlier; uncoordinated diplopia
 Dx: PE
 Tx: glasses, patches (block stronger eye), or surgery
  Nasal fibers see temporal eye fields. If nasal fibers (bc of curvature of eye)
do this, temporal fibers see nasally
 When a patient dies, pupils dilate
 Medial longitudinal fasciculus: conjugates gaze (one eye looks laterally, one
looks medially when giving “side eye”)
 Bitemporal Hemianopsia: lesion at optic chiasm
 Blindness in 1 eye: MS – demyelinating autoimmune disease, TIA, stroke

HEENT: EARS and NOSE

Acute Otitis Media

 Dx: PE and clinical presentation
 Infex of the middle ear (behind TM)
 Tx: amoxicillin, Augmentin, TMP-SMX, Cefachlor
 Population: children 4 - 24 months
(2nd-gen Cephalosporin); abx prophylaxis +
bc of short and horizontal Eustachian tube
myringotomy - recurrent infex
 Association: Down syndrome, cleft palate,
 Cx: mastoiditis, meningitis, permanent HL
adenoidal hypertrophy
 Cause: bacterial (70-90% of time) Staph, Strep
pneumo and pyogenes, H. flu, Moraxella catarrhalis
 Sx: ear pain + fever; hearing loss; TM – loss of bony
landmarks, light reflex, mobility; bloody / purulent
d/c if perf; preceded by viral resp infex bulging that
blocks ET; child will present with tugging on ear;
)

Mastoiditis
 Infex of mastoid bone
 Population: children
 Cause: acute OM or other URI
 Pathogen: H. flu usually; same pathogens as OM
 Sx: erythema, pain, swelling behind ear
 Dx: skull XR – destruction of mastoid air cells and fluid in the
air pockets; CT – definitive Dx; culture of drainage
 Tx: difficult; IV abx; mastoidectomy

Otitis Externa
 Inflammation of outer ear (EAC and auricle)
 Causes: moisture – we treat burns with water
 Pathogens: E. coli, Pseudomonas, Proteus, S. aureus; and fungi
 Sx: itching, ear d/c, red/swollen EAC, painful, erythematous auricle;
pain palpating tragus; child won’t let you inspect inside canal, HL
 Dx: PE and clinical presentation (swimming in dirty water)
 Tx: topical abx; neomycin, polymyxin, hydrocortisone; remove infected
debris from canal with suction or dry cotton wipes – DONT IRRIGATE!

OM OE
 Pathogen: Staph and Strep  Pathogen: Pseudomonas
 Precip Factors: URI  Precip Factors: swimming or EAC trauma
 Population: Kids  Population: Adults
 Sx: FEVER;  Sx: NO FEVER,
Can see TM – bulging; Usually can’t see TM (swelling);
Pain inside ear (exam doesn’t worsen it); Discharge Pain with manipulation of auricle;
ONLY if perf Ear canal discharge
 Tx: PO abx – amox (high dose 80-90)  Tx: topical abx – ciprodex
 Cx: meningitis, mastoiditis, brain abscess  Cx: “malignant” OE, facial nerve palsy

Barotrauma
 On NL level, we are at 1atm; to feel a difference,  Sx: eardrum may bulge in or out
you need to go ~33ft down  Dx: PE
 Ear discomfort by pressure diff bw inside and  Tx: work the jaw, yawn, and chew gum.
outside of eardrum Decongestants and/or antihistamines, sometime
 Causes: eustachian blockage can cause this in children they may even puncture TM and
(URI/Colds); flying/diving, punch to the ear aspirate fluid; myringotomy tube

Cerumen Impaction
 Dx: PE
 Cause: buildup of cerumen  Tx: soften wax  glycerin, mineral oil, Debrox
 Sx: tinnitus, earache, ear fullness, partial hearing loss, (wax softener), bare H2O to clean it out;
sensation of fullness suction as last resort

Hearing Impairment
 2 types of HL  AC > BC = NL hearing
  Sx: hearing loss
 Dx: Hearing Test; Weber / Rinne
 Tx: fix CHL; surgery for SNHL
Conductive Hearing Loss
 Causes: cerumen impact, foreign body, perforation,
fluids behind eardrum, otosclerosis – hardening of TM
or bones, drugs, cholesteatoma, OM, OE
Weber – w/o lateralization + Rinne – both
ears
Sensorineural Hearing Loss:
 Causes: presbycusis (MC men) – higher
frequencies will go first and are associated w/
tinnitus

Meniere’s Disease
 Recurrent and usually progressive group of Sx that include HL, tinnitus,
dizziness, and vertigo
– Dz characterized by feeling like the person is spinning
– Attacks may last min-hrs; unsteadiness may last longer
 Cause: unknown; appears to be related to distension of endolymph
compartment of inner ear
 Sx: vertigo, HL, tinnitus, N/V, dizziness, feeling of pressure in ear
 Dx:   2 episodes vertigo, lasting ≥ 20 min, but < 24 hours. HL - hearing
test. Tinnitus or a feeling of fullness in your ear.
 Tx: therapy – vestibular rehab; self-care – salt restriction, avoid
caffeine, tobacco, chocolate; devices – hear aid; meds – diuretics,
antihistamines, sedatives

Labyrinthitis / Vestibular Neuritis

 Otitis Interna  Tx: stop drugs, antihistamines,
 Labyrinth: cochlea, semicircular canals, utricle, saccule anticholinergics, sedatives, antiemetics,
 Irradiation of swelling of the inner ear benzos
 Causes: bacteria (OM), viral (URI), allergy, alcohol, drugs
(aminoglycosides can cause hearing probz),
cholesteatoma – abNL skin growth in ME behind TM
caused by repeated infex /TM tear  prevents vibrations
from passing. Often develop as cysts/pouches that shed
layers of old skin that build up inside middle ear
 Sx: dizziness, vertigo, tinnitus, nystagmus, HL, deafness +
loss of balance
 Dx: CT/MRI; hearing tests

TM Perforation
 Cause: trauma
 Tx: Small tear – leave alone bc it will grow back;
Big tear – need surgery

Vertigo
 Inappropriate sensation of movement  Causes: CN 8 problems, MS, Meniere’s disease
 Associated w/: vestibular apparatus of ear,  Tx: Meclizine; Diazepam (Valium); antihistamine –
vestibular nuclei or brainstem and cerebellum, to prevent N/V and dizziness caused by motion
CN VIII, MS, Meniere’s disease sickness

Acute Sinusitis
 Sinus – air space bordered by bone, so if infected – same issue as
mastoiditis
 Cause: any URI (Strep, H. flu, M. cat)
 Tx: Abx for bacterial  something that will cover Strep, H. flu, Moraxella;
decongestants, surgery – to drain sinus

Allergic Rhinitis
 Similar to sinusitis Hay fever
– seasonal form of AR
 Sx: Itching, tearing, and clear nasal discharge. Coughing + wheezing -
severe. Injected conjunctiva + erythematous nasal membranes
 Dx: H&P. Eosinophils in nasal secretions supports dx. (Eosinophils =
NAACP)
 Tx: Antihistamines (diphenhydramine [Benadryl], Loratadine [Claritin],
Cetirizine [Zyrtec]), decongestants (Phenylephrine),
nasal glucocorticoid sprays, and cromolyn sodium.
Long-term desensitization therapy (allergy shots given in increasing
increments)

Epistaxis
 Nosebleed
 Population: all ages; severe in elderly on antiHTN or anticoags
 Causes: trauma, dry heat/mucosa, drugs (aspirin, cocaine), tumors,
heredity, coagulopathies (ITP)
 Location: Kiesselbach’s plexus – anteriorly/inferior nasal septum
– 4 arteries anastomose to form vascular plexus
– 90% of nosebleeds occur here
 Tx: pressure (15 minutes)

Nasal Polyps
 Small sac-like growth consisting of inflamed nasal mucosa
 Large polyps block airway
 Associations: ASA triad = Samter’s triad
– ASA sensitivity esp to airborne fungi, asthma, allergic rhinitis;
Cystic Fibrosis = autosomal recessive (1 in 4 w/ CF have nasal
polyps)
 Sx: nose obstruction, difficulty speaking due to congestion;
grayish, grape-like mass in nasal cavity
 Dx: PE; nasal endoscopy; CT / MRI – in addition to PE to pinpoint
size and location; test for CF and allergies
 Tx: steroids; surgery if too big

HEENT: Mouth

Strep Pharyngitis
 Pathogen: MC  GAS (pyogenes); bacterial – Corynebacterium diphtheria,
gonococcus; viral – EBV; fungal
 Sx: fever, sore throat, beefy red pharynx w/ tonsillar exudates, peritonsillar
abscess (medical emergency), difficulty swallowing, pharyngeal
lymphadenopathy, rhinitis, cough
– viral infex: coryza – watery eyes w/o exudates; low grade fever
– bacterial infex: Ludwig’s angina  rare bacterial infex in floor of mouth
under the tongue; associated w/ tooth abscess; caused when strep not tx’d
 Dx: rapid strep antigen/culture – IDs
 Tx: PCN (amox), erythromycin (macrolide); viral – tx is supportive
 Photos: Top – Streptococcal pharyngitis; Bottom – viral pharyngitis

Acute Tonsillitis

 Infex of the palatine tonsils

 Sx: swollen tonsil, purulent exudates (acute
inflammation resulting in increased vascular
permeability = excessive leakage of plasma proteins into
extravascular compartment – also contains fibrin and
neutrophils [looks turbid vs transparent transudate 
not associated with inflammation]),
 Tx: PCN

Aphthous Ulcers
 Sores in the mouth including (canker, gingival stomatitis, herpes,
CA, thrush, histoplasmosis)
 Location: buccal mucosa; can range from 1-many
 Causes: GC and syphilis, trauma, xerostomia
 Avoid: spicy foods
 Sx: pain and sores
 Dx: PE, blood test, bx
 Tx: hygiene (bc poor hygiene is the cause), topical antihistamines,
steroids, antivirals (acyclovir, etc…), swish and swallow
fluconazole, antacids for reflux ulcers

Dental Abscess
 Collection of pus (from bacterial infex) in center of tooth (pulp)
 Cause: tooth decay or trauma
 Sx: severe pain, bad breath (bacteria take 20 min to reproduce),
toothache (pt can ID specific tooth), fever, and swollen neck or jaw
 Dx: PE
 Tx: Abx, warm salt water rinses. OTC pain meds. Surgical drainage (root
canal – they may put cap on tooth)

Epiglottitis
 Swelling/inflammation of epiglottis
 Medical emergency - sudden respiratory obstruction
 Population: more commonly children (dramatic decrease in cases w/ vax)
 Pathogen: Usually H. influenzae; GAS, Staph, Pneumococcus
 Sx: stridor, drooling, high fever, sore throat, difficulty swallowing, muffled
voice
 Dx: XR (lateral C-spine) – “thumb print sign”
– thickened edge of inflamed epiglottis causes it to appear more radio-
opaque resembling distal thumb
 Tx: admit for intubation and IV abx (1-3 days); send home w/ PO abx for 10
days  Bactrim, Cefuroxime, Clarithromycin (we like this for bone),
Quinolones (all these have B-lactamase)
 Prevention: H. flu vax; Rifampin for close contacts – esp unvax

Laryngitis

 Inflammation of the larynx

 Precipitated by URI
 Sx: hoarse voice
 Dx: clinical sx and PE
 Tx: supportive

Oral Candidiasis (Thrush)

 Population: immunocompromised, HIV, young, old
 Sx: white patchy lesions that can be scraped off;
erythematous lesion on legs (satellite lesions are less
severe) – in kids
 Dx: KOH wet mount – hyphae and KOH
 Tx: antifungals – nystatin, fluconazole, ketoconazole

Oral Herpes Simple (Cold Sore)

 “fever blister”
 Latent infection vs. Reactivation – causes recurrent sores
 HIGHLY contagious
 Sx: skin lesions on the lips, blisters may break and ooze
 Dx: PE; Tzanck smear – scraping of an ulcer base and put on
slide to look for Tzanck cells (multinucleated giant cells)
 Tx: acyclovir, antiviral meds to reduce duration of sx. Wash
and antiseptic soap (maintaining good hygiene)

Leukoplakia (Pre-cancerous Lesion)

 Precancerous lesion on the tongue
 Cause: chronic irritation (months-yrs) – tobacco,
alcohol, drugs
 Hairy leukoplakia:
– Cause: HIV infex or EBV
– Sx: fuzzy patches on tongue
– also precancerous
 Sx: white plaques that can’t be scraped off
 Dx: PE or Bx
 Tx: remove source of irritation

Peritonsillar Abscess
 Abscess near tonsils
 Complication of tonsillitis
 Causes: MCC – GAS; Bacteroides and strep
infex
 Sx: difficulty breathing; trismus (inability to
normally open mouth – can be caused by
tetanus, TMJ), hot potato voice,
contralateral uvula displacement; sore
throat, dysphagia, fever
 Dx: PE
 Tx: Abx; tonsillectomy

Sialadenitis

 Inflammation of salivary glands

– 3 pairs: parotid (largest), submandibular,
sublingual
 Saliva moistens and dissolves food
– salivary amylase (ptyalin)
– washes mouth out well
 Associated w/ mumps
 Sx: facial swelling, pain, fever
 Dx: PE – dentist may see pus; pain might be
due to bacteria; mumps = painless swelling
 Tx: sometimes none needed; Abx, oral
hygiene, warm salt water salt rinses;
hydration and sugar-free lemon drops to
increase flow of saliva (sialagogues)

HEENT Questions:
1. Aphthous ulcers are most effectively treated w/?
a. Steroids

2. 2YO w/ foul-smelling drainage from one nostril. Most likely dx is?

a. Foreign body

3. 80YO male comes in with wife. She states her husband is not hearing clearly.
No cerumen impaction. TM – grey, intact, shiny; AC > BC bilaterally. No neuro
deficits. Audiogram – high frequency HL. MCC?
a. Presbycusis

4. 6YO presents with OM. Which of the following drugs is not indicated for tx?
a. Erythromycin-Sulfasuxazole (Pediazole)
b. Amoxicillin (Amoxil)
c. TMP-SMX (Bactrim)
d. Doxycycline (Vibramycin)  teeth staining and bone issues

5. Nasal furuncles (boil) are MCC by?

a. Pseudomonas aeruginosa
b. Streptococcus pneumoniae
c. Staphylococcus aureus
d. Proteus vulgaris (found in human intestinal tract)

6. After 4-6 months of confirmed OM w/ effusion and significant HL, which of the
following interventions is recommended?
a. Oral steroids
b. Oral decongestants
c. 4-week course of Abx
d. Bilateral myringotomy w/ tympanostomy tube
because 4-6mo is a long time to have OM and HL issues

7. Which of the following can be used to prevent OE?

a. Oral abx
 b. Acetic acid + ETOH drops
c. Ear plugs when swimming
d. Clotrimazole otic solution
e. C&D

8. All of the following are most consistent with OM w/ effusion except?

a. Tympanogram
b. Immobile TM
c. Dull, retracted TM
d. Red, bulging TM

9. Pt complains of HL in R ear, on exam  Weber – lateralizes to the L ear. Rinne

– AC > BC in both ears. Pt most likely has…
a. NL exam
b. Sensorineural HL on R
c. Sensorineural HL on L
d. Conductive HL on R

10. Use of systemic corticosteroids can cause which of the following adverse
effects in the eye?
a. Cortical blindness
b. Optic atrophy
c. Glaucoma – esp topical, but can happen w/ systemic IV too
d. Papilledema

11. Dental caries is caused by which of the following organism?

a. S. aureus
b. S. pneumoniae
c. S. mutans
d. S. epidermitus

12. Chronic OM w/ effusion in kids ages 1-3YO, may result in…

a. Conductive HL
 b. Delayed speech
c. Cognitive deficits
d. All of the above
e. 2 of the choices

13. Pt presents w/ eye pain + blurred vision, Snellen test = vision of 20/200 in
affected eye and 20/20 in unaffected eye. Fluorescein staining reveals a
presence of dendritic ulcer (epithelial keratitis). Which of the following is the
most likely Dx?
a. Viral keratitis (HSV)
b. Fungal corneal ulcer
c. Acanthamoeba keratitis
d. Bacterial corneal ulcer
dendritic ulcer  classic pre-herpetic lesion consists of liner branching corneal ulcer.
Fluorescein – corneal is minimally inflamed

14. Pt presents w/ episodic vertigo, tinnitus, and HL. Most likely dx?
a. Meniere’s dz (endolymphatic hydrops)
b. Otosclerosis – bones behind the ear (does not cause tinnitus or vertigo)
c. Positional vertigo (happens longer then Meniere’s) – not associated with
tinnitus and HL
d. Acoustic neuroma (Schwannoma – usually unilateral)

15. Asx pt w/ HIV has areas of creamy white, fluffy exudates in the posterior
pharynx that is easily removed to show erythematous bases. Initial tx of
choice?
a. Amphotericin
b. Fluconazole tablets
c. Griseofulvin tablets – antifungal but not good for candida
d. Nystatin oral suspension – requires intact immune system.
Uncomplicated oral Candiasis

16. 4YO w/ fever, drooling, and inspiratory retractions is seen sitting up and
leaning forward. Which of the following is initially indicated?
a. Throat culture
b. Blood culture
c. US of neck
d. Lateral soft tissue film of the neck
17. 53YO woman present to ER w/ severe R eye pain + blurred vision. Unable to
perform visual acuity test bc of discomfort. States she sees halos around lights
but can distinguish # of fingers. Conjunctiva is red, cornea appears steaming,
pupil is moderately dilated and nonreactive to light. Most appropriate
therapy?
a. Acetazolamide w/ diuretics – because acute angle glaucoma, then
iridotomy
b. Timolol eye drops
c. Topical or systemic corticosteroids
d. Oral Ceftriaxone and topical erythromycin

18. Pt recently treated for acute OM presents w/ post-auricular pain, erythema

and spiking fevers. The most likely dx is?
a. Mastoiditis – follows acute OM
b. Chronic OM – will have discharge but will be painless
c. Osteomyelitis – cx of OE, not OM  foul-smelling discharge, otalgia, CN
palsies
d. Otosclerosis – tends to run in families. Progressive dz. Conductive HL.

19. 54YO pt in intensive care undergoing IV abx therapy for intraabdominal

abscess. Stool cultures + for C. diff, which is the oral medication recommended
for initial Tx?
a. Cholestyramine – bind to C. diff, but it binds to Abx too
 b. Clindamycin -
c. Metronidazole
d. Vancomycin – much muns  2nd choice

20.60YO with diabetic retinopathy, proteinuria, HTN, and serum Cr of 1.5 mg/dL,
and CHF comes to you for anti-hypertensive. Which do you give?
a. ACEI – due to renal protection and it reduces afterload
b. CCB
c. BB
d. Alpha blockers

21.Which clinical manifestation occurs in individuals with nephrotic syndrome in

addition to typical findings or proteinuria, edema, ascites?
a. Hyperlipidemia (hypertriglyceridism)
b. Hyperthyroidism
c. Hypocoagulability (HYPERcoagulability is associated with nephrotic
syndrome. We lose AT3 and we lose proteins)
d. Hypoaldosteronism

22.When evaluating a pt in whom essential HTN is suspected, which organ is least

likely to show signs of end-organ damage?
a. Heart
b. Eyes
c. Lungs
d. Kidneys – HTN is a common cause of kidney insufficiency

23. 46YO w/ 1mo hx of weakness, fatigue, cold intolerance, weight gain. PE – dry
skin, brittle nails, thinning hair, delayed DTRs. What test would be the most
helpful in making the Dx?
a. TSH – best initial test; T3 and T4 best evaluated for after TSH
b. T4
c. Thyroid antibodiqes – help to differentiate hyperthyroid conditions
d. T3

CHL vs SNHL
Know anatomy of eye and ear
Know malleus incus stapes
Know bitemporal hemoanopsia and hemianopsia
Understand glaucoma and how it happens. And in both open and closed angle

Hemiballismus
Ballismus or ballism (called hemiballismus or hemiballism in its unilateral form) is a
very rare movement disorder. It is a type of chorea caused in most cases by a decrease
in activity of the subthalamic nucleus of the basal ganglia, resulting in the appearance of
flailing, ballistic, undesired movements of the limbs.

Anticholinergics (like metoclopramide) can lead to acute narrow-angle glaucoma

Leukoplakia = premalignant