EENT 8

A patient is diagnosed with chronic malignant otitis externa. This ear disorder is most likely to be present in a patient who has which of the following?

An 18-year-old female presents with concern over pressure in her neck when she swallows. On physical exam you find a mildly enlarged right lobe of her thyroid. Ultrasound is performed and finds a 1.2 cm nodule. Which of the following is the most appropriate next step?

Which of the following is the most common site of anterior epistaxis?

A 34-year-old male presents concerned after experiencing bloody discharge two days ago from his right ear. The patient is unaware of any direct trauma but was recently on a flight. On physical exam you find a small perforation of the right tympanic membrane with slight erythema. The patient presently has no discharge and no evidence of infection. Which of the following is the treatment of choice?

A 30-year-old male working on a construction site stepped off a ladder into a pile of debris and suffered a puncture wound in the bottom of his foot. The patient is unsure if, or when he has had a tetanus shot. After properly cleaning and dressing the wound, which of the following would be most appropriate action?

A 34-year-old patient complains of intermittent episodes of vertigo, nausea and vomiting that began three days ago. He noticed symptoms worsened significantly when he tried to sit up or get out of bed. The patient has no tinnitus, however has noted some mild hearing loss. His past medical history is unremarkable except for an upper respiratory tract infection which resolved two weeks ago. Which of the following is the most likely diagnosis?

A 21-year-old female has purulent nasal discharge, nasal congestion and facial pain. The pain is made worse by looking downward. She states that her initial symptoms started 14 days ago and have progressively worsened. On physical exam you find tenderness to her maxillary sinuses. Which of the following is the most likely diagnosis?

An 18-year-old male presents the emergency room after sustaining a cut on his right sole while walking on the street barefoot two days ago. The wound is been significantly contaminated with soil. The patient’s last tetanus immunization with six years ago. Which of the following would be the most appropriate to administer?

A five-year-old boy presents the office brought by his mother with concerns of severe pain which occurred on the overnight in his right ear. The patient describes a scratching sound. Examination of the patient’s right ear finds a large insect still alive and moving ear canal. Which of the following is the preferred initial step?

A 9-year-old asymptomatic patient on routine examination of the ears is found to have air fluid levels present and a mild bulging of the left tympanic membrane. The patient has no present complaint and has been a relatively healthy child other than an ear infection three months ago. Which of the following is the most likely diagnosis?

Which of the following is the preferred initial treatment of choice for epistaxis?

A 37-year-old woman has a 2 day history of vertigo and nausea. The diagnosis of benign positional vertigo is made based upon symptoms and a positive Dix-Hallpike maneuver. Which of the following is considered to be the most likely cause of the disorder?

A four-year-old boy is brought in by his mother with concerns about trouble in preschool. She reports that the child does not appear to be paying attention and is also having difficulties with speech. Which of the following must be ruled out first?

A 15-year-old female presents the office complaining of severe fatigue. She has recently had onset of severe sore throat, slight fever and a rash on her chest and upper arms. Your exam is positive for significant cervical lymphadenopathy as well as splenic enlargement. Which of the following is the most likely etiology of her illness?

Which of the following would be the most commonly expected clinical manifestations of acute sinusitis in the pediatric population?

A 13-year-old patient presents with a complaint of three months of pain in his right ear. Examination of the external canal reveals fluffy white debris and exfoliated scales of blackish material. You also note punctate black colonies on the tympanic membrane. Which of the following is the most likely diagnosis?

A nine-year-old male presents with bilateral parotid enlargement. He complains of some pain when eating but has no other complaints. The mother states that the patient’s vaccines are not up-to-date as she does not believe in vaccinating her children. Which of the following is the most likely complication of this patient’s disorder?

Which of the following agents commonly causes gingival hyperplasia?

A 22-year-old presents with a one month history of sneezing, watery rhinorrhea and itchy eyes. Physical exam reveals pale boggy turbinates and mildly injected conjunctiva. The patient has had no fever and has a normal pharyngeal exam. Auscultation of her lungs finds clear fields throughout. The patient is afebrile. Which of the following is the most likely diagnosis?

A concerned mother presents with her six-month-old infant after his recent treatment with antibiotics for acute otitis media. She states the child is feeding poorly and she is concerned the infection is not better. Physical exam finds the infant with white plaques on his buccal mucosa, tongue and palate. Which of the following is the most appropriate initial management?

A five-year-old boy is brought in by his mother for evaluation of recurrent nosebleeds. Physical exam finds a red raw surface with fresh clots in old crusts. Which of the following is the most common cause of this patient’s condition?

A seven-year-old male is brought to the clinic by his mother who is concerned about the patient’s right ear. The child has history recurrent acute otitis media and has been complaining of right ear pain for the last 14 days. The patient reports that the pain has become progressively worse. Physical exam finds otoscopic findings consistent with otitis media. The patient is presently febrile with a temperature of 102°F and you notice a protrusion of his right ear. Which of the following is the most likely diagnosis?

A 70-year-old man notes the slow progression of visual loss in his left eye over a 6 month period. There is no history of trauma or of pain in the eye or periorbital area. Exam reveals a white pupil on visual inspection and the retina is not seen on funduscopic exam. Which of the following is the most likely diagnosis?

A 33-year-old amateur wrestler presents concerned about swelling of his right ear that occurred five days ago during a wrestling match. Exam finds ecchymosis and edema of the external ear which is painful with manipulation. Which of the following is the most appropriate course of action?

A 64-year-old male presents to the office with concern related to hearing loss and otorrhea which have been occurring over the last three months. The patient describes a progressive loss of hearing in his right ear and states she has had transient yellowish discharge which he finds on his pillow. Otoscopic exam finds no erythema and the retraction of the skin in the upper posterior quadrant of the tympanic membrane. Which of the following is the most likely diagnosis?

A 44-year-old male presents complaining of a persistent ringing in his ears. He has no previous medical history, but was recently started on medication after a trip to his general physician. Which of the following medications is most likely responsible for symptoms?

A 38-year-old patient presents to the office with sustained vertigo nausea and vomiting which suddenly onset four days ago. The patient has a past medical history which is positive for both hypertension and diabetes. The patient denies any hearing loss. Cold calorics are performed in the office and the patient has a normal result. Which of the following is the most likely disorder?

A 42-year-old otherwise healthy male presents to the office complaining of difficulty hearing from his right ear with occasional tinnitus and vertigo. Otoscopic exam is completely normal. Hearing tests find the patient to have a 60 dB hearing loss in four frequencies in his right ear but normal readings in his left ear. Tympanometry testing finds results consistent with a healthy tympanic membrane. Which of the following is the most likely diagnosis?

A 23-year-old female presents your office ill appearing, complaining of three days of severe sore throat which has worsened as of this morning. The patient has difficulty speaking, is leaning forward and drooling and has a “hot potato” voice. Physical exam finds in acutely febrile patient with a temperature of 103°F. Exam of the pharynx finds an erythematous pharynx with uvular deviation. Which of the following would be the most appropriate treatment?

A 64-year-old male presents for evaluation of a hoarse voice which he states has become progressively worse over the last three months. He denies any pain and has had no signs of upper respiratory infection. His history is remarkable for a three pack a day history of smoking for the last 24 years. This patient’s presentation and history is most concerning for which of the following?