ENT

ENT

Multiple Choice

A 3-year-old boy, recently removed from his home due to medical neglect, presents with a history of a "draining ear" for an indeterminate period of time. After cleaning the external ear canal, a spherical whitish-gray, cystic like mass is identified behind the left tympanic membrane along the posterior-superior edge. Which of the following is the most likely diagnosis?

• A bony tumor originating from the mastoid air cells

• Granulomatous tissue surrounding a displaced tympanostomy tube

• A foreign body surrounded by keratin debris

• Periosteal new bone formation along the posterior border of the incus in response to chronic purulent otitis media

• Cholesteatoma

Multiple Choice

During a routinely scheduled health maintenance exam, a 3-year-old boy with a history of recurrent otitis media is noted to have a discrete, smooth, grayish-white, rounded, opaque mass in the superior portion of the right tympanic membrane. Which of the following is the most appropriate next step in the treatment of this patient?

• Begin treatment with ofloxacin otic drops

• Begin treatment with oral amoxicillin and ofloxacin otic drops

• Refer for surgical excision

• Observation only, with recheck in 6 months

• Refer for surgical excision only if there is evidence of hearing loss and/or language delay

Multiple Choice

A soft tissue neck film taken during inspiration with the neck extended in a febrile and irritable 32-month-old child demonstrates widening of the retropharyngeal space and reversal of the normal cervical spine curvature. Soft tissue swelling and obliteration of the fat planes are noted on CT. Which clinical manifestations do you expect to find in a patient with the above radiographic findings?

• Unilateral tonsillar swelling associated with soft palate edema and deviation of the uvula

• Facial swelling associated with an abscessed primary molar

• Torticollis

• Anterior compartment swelling of the parotid area

• Shallow, painful ulcerations of the gingiva and posterior pharynx

Multiple Choice

An acutely ill 4-year-old boy with fever, inspiratory stridor, and torticollis is found to have markedly increased depth of the prevertebral space on a lateral soft tissue radiograph of the neck while held in extension. Which of the following is the most appropriate treatment in this patient?

• Ampicillin + gentamicin

• Trimethoprim/sulfamethoxazole

• Cefoxitin

• Cefotetan

• Ampicillin-sulbactam

Multiple Choice

A 9-year-old female presents to your office with a 2-day history of sore throat, fever, and dysphagia. Her best friend was diagnosed with strep throat last week. She's had no vomiting or diarrhea but has had occasional headache and stomachache. She is allergic to amoxicillin but is very healthy otherwise. On exam, she is febrile and uncomfortable with trismus. Her oropharynx is red with pus; uvula swollen, slightly deviated to the right. Left tonsil is larger than the right. Her neck has swollen anterior lymph nodes. Which of the following is the best next course of action?

• Immediate consultation with an otolaryngologist

• Send patient home on antibiotics and steroids to help with the swelling

• Send the patient home on erythromycin

• Send the patient home on amoxicillin

• Obtain a monospot and EBV titers, and send the patient home

Multiple Choice

A 17-year-old boy presents to the ED after a motor vehicle collision. He was a restrained back seat passenger and hit his right ear on the door upon impact. He complains of right ear pain. On exam, there is an auricular hematoma of the right superior helix and triangular fossa. His external auditory canal and tympanic membrane are normal. He has no hearing deficit. What is the next best step in the management of this patient?

• Consult ENT

• Perform drainage of the hematoma

• Discharge the patient with ENT follow-up in 5-7 days

• Admit the patient for observation and IV antibiotics

• Order an ultrasound of the ear

Multiple Choice

A 14-year-old girl presents with difficulty breathing during exercise. She is a cross-country runner and complains of difficulty swallowing, coughing, and hoarseness while running. The symptoms resolve within 15 minutes after running. She tried albuterol 20 minutes before exercise; however, there was no change in her symptoms. Which of the following is most likely to accompany this patient's symptoms?

• Laryngeal adduction with exercise

• Harsh crescendo-decrescendo systolic murmur

• Abnormal methacholine challenge test

• Inspiratory stridor at rest

• Facial flushing with exercise

Multiple Choice

A 15-year-old girl is evaluated for difficulty breathing. The symptoms have occured on and off for the past year. Episodes are accompanied by difficulty swallowing. Her mother reports that she has chronic hoarseness that has not improved with daily omeprazole. Laryngoscopy demonstrates adduction of the vocal cords with inspiration. Which of the following is the most likely risk factor for this patient's condition?

• Human papillomavirus

• BMI <5th percentile

• Aspirin use

• Obsessive-compulsive disorder

• Male gender