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Candice's PANCE disclaimer: Why Start Looking At This Stuff Now? - Correct Answers ✅PA School has one main goal - NOT to teach you medicine, but instead how to think like a clinician and how to take the PANCE. SO START NOW :) Trust me, this will help school, rotations and studying for the PANCE a LOT easier!!!! A 42-year-old male truck driver presents with recurring rhinitis and watery eyes during the spring months. What is the best treatment for this patient? A. desloratadine (Clarinex) B. fluticasone(Flonase) C. montelukast (Singulair) D. diphenhydramine (Benadryl) - Correct Answers ✅Answer is B [Ophthalmology and Otolaryngology]. A. Newer-generation antihistamines have lower rates of drowsiness; desloratine is minimally sedating. However, there is still a risk, especially considering his occupation.
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B. Evidence-based reviews show that intranasal corticosteroid sprays are more effective and less expensive than nonsedating antihistamines. They are also non sedating. However, there may be a delay in relief of symptoms. C. Antileukotriene agents alone or with antihistamines can help with rhinorrhea, sneezing, and congestion but may cause drowsiness. D. First-generation antihistamines have lower cost, but the highest risk of drowsiness. What is the most common bacterial etiology in otitis media? - Correct Answers ✅1. Streptococcus Pneumonia
- Moraxella Catarrhalis
- Haemophilus Influenzae An elderly male presents with unilateral hearing loss for 1 day. He denies URI symptoms, fever, or ear pain or discharge. He further denies any dizziness or headaches. Physical exam reveals normal balance, negative Romberg, but evidence of conductive hearing loss in the affected ear. What is the most likely diagnosis?
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include ear pain, aural pressure, impaired hearing acuity, and fever. Physical exam findings include redness and decreased mobility of the tympanic membrane. What is the treatment of choice for otitis media? - Correct Answers ✅If the patient is > 6months of age and immunocompetent, they can be observed. If no im- provement after 72 hours or if symptoms are worsening, start antibiotics. First line antibiot- ics will be amoxicillin. Give amoxicillin/clavulanic if they have been given a beta lactam in the last 30 days. A patient presents for removal of impacted cerumen in his left ear. He complains of decreased hearing in the affected ear. The Weber test performed on this patient would have which of the following results? A. sound would be heard through air longer than through bone in the left ear B. sound would be heard through bone longer than through air in the left ear C. sound would lateralize to the left ear D. sound would lateralize to the right ear - Correct Answers ✅Answer: C [Ophthalmology and Otolaryngology].
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A. In a sensorineural hearing loss, air conduction exceeds bone conduction in the unaffected ear. This is the Rinne's test. B. See A. C. Cerumen impaction is a cause of unilateral conductive hearing loss. In a properly performed Weber test, sound will lateralize to the affected ear. D. See C. What cranial nerve does an acoustic neuroma affect? - Correct Answers ✅This will affect the 8th cranial nerve (vestibulocochlear) Which of the following patients should be referred for audiologic testing? A. 8-year-old male with otitis media B. 34-year-old male with history of tympanocentesis as a child C. 54-year-old female with chronic cerumen impaction D. 68-year-old healthy female - Correct Answers ✅Answer: D [Ophthalmology and Otolaryngology, Geriatrics].
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A 26 year old female patient came in complaining of dizziness. The patient has episodes of dizziness that lasts 5 minutes and self resolve; it has been ongoing for the past 2 months. The patient also reports tinnitus and hearing loss. What is the treatment of choice? - Correct Answers ✅The diagnosis is Menieres disease. These episodes of vertigo come in clusters for a cou- ple months and then self resolve. Another clue to diagnosis is hearing loss. Vestibular neuritis and BPPV will not have hearing loss. Treat these patients with salt restriction and diuretics. 15 year old patient is complaining of sore throat, fever, and cough. On exam, you notice posterior pharynx exudate. No lymphadenopathy noted. What is the treat- ment of choice for this patient? - Correct Answers ✅The centor criteria gives this patient a score of 2 for the exudate and fever. These patients should have a throat culture done. If positive for group A strep, treat with penicillin. What is the most common etiology of otitis externa? - Correct Answers ✅1. Pseudomonas
- Staph aureus
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- Staph epidermis Who is at risk for developing malignant otitis externa? - Correct Answers ✅Diabetics and those who are immunocompromised are at increased risk. This occurs when infection spreads to the bone. Their pain will be out of proportion to your exam findings. What is the time frame needed for the diagnosis of acute sinusitis? - Correct Answers ✅Acute sinusitis occurs when symptoms have been present < weeks. Chronic sinusitis is diagnosed when symptoms have been present
12 weeks. An 18-year-old water skier presents with left ear pain with pruritus and discharge. Exam reveals pain on auricular manip- ulation as well as redness and swelling of the ear canal with purulent debris. The tympanic membrane is intact. What is the most appropriate management? A. oral fluoroquinolone B. otic antibiotic/anti-inflammatory drops C. surgical intervention
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Where do most nosebleeds originate from? - Correct Answers ✅Most will come from the Keisselbach's plexus. A young child presents with right ear pain and pressure, decreased hearing acuity, and a mild fever for 2 days. Physical exam reveals a reddened tympanic membrane with decreased mobility. What is the most likely diagnosis? A. acute otitis media B. barotrauma C. mastoiditis D. osteoma - Correct Answers ✅Answer: A [Ophthalmology and Otolaryngology, Infectious Disease, Pediatrics]. A. Acute otitis media is most common in infants and chil- dren and presents with the symptoms described. B. Patientswithpooreustachiantubefunctionmaybeunable to equalize barometric stress on the middle ear (i.e., flying, diving, rapid altitude changes), resulting in barotrauma. They present with severe ear pain and hearing loss.
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C. Acute mastoiditis may appear acutely or after several weeks of inadequately treated acute otitis media. Presenting symptoms include postauricular pain and redness with a spiking fever. D. Bony overgrowths in the ear canal can be an incidental finding. Solitary osteomas have no clinical significance unless they cause obstruction or infection. An adult with diabetes mellitus presents with a rapidly developing sore throat with severe pain on swallowing. Examination of the pharynx reveals some mild erythema. Which of the following is true at this time? A. laryngoscopy is contraindicated B. needle biopsy is indicated C. inpatient treatment is necessary D. treatment is mainly supportive - Correct Answers ✅Answer: C [Ophthalmology and Otolaryngology, Endocrinology]. A. With epiglottitis (supraglottitis), laryngoscopy is generally safe in adults and may show a swollen, erythematous
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D. Streptococcus pneumoniae - Correct Answers ✅Answer: C [Ophthalmology and Otolaryngology, Infectious Disease, Pediatrics]. A. The incidence of otitis media due to Haemophilus influen- zae has been significantly decreased with vaccination pro- grams. It rarely causes otitis externa. B. Moraxella catarrhalis is a common pathogen in otitis media. C. The majority of cases of otitis externa are caused by Pseudomonas aeruginosa or Proteus spp. Less common causes include Staphylococcus aureus, Staphylococcus epidermidis, Aspergillus, and Actinomyces. Topical antibiotic coverage should include antipseudomonal activity. D. Acute otitis media typically follows a viral URI. Viruses can cause the infection or predispose the patient to a sec- ondary bacterial infection. Streptococcus pneumoniae is the most common bacterial pathogen. A 45-year-old male presents with acute hoarseness for 2 days. He gives a history of cold symptoms that have been resolving. He denies cigarette smoking. What is the most appropriate patient education point? A. He has an increased risk of leukoplakia of the vocal folds. B. He likely has a bacterial infection and will require
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antibiotics. C. He is at risk for vocal cord paralysis. D. He should avoid singing or shouting until the voice normalizes. - Correct Answers ✅Answer: D [Ophthalmology and Otolaryngology, Infectious Disease]. A. Leukoplakia of the vocal folds is often found in patients who smoke. Voice change is insidious. B. Acute laryngitis is usually viral. C. Vocal cord paralysis is caused by a lesion or damage to the vagus or recurrent laryngeal nerve, which can result from thyroid surgery or cancer, other neck surgery, and lung cancer, among other causes. D. Voice rest is appropriate, as continued strong voice use with laryngitis can lead to traumatic vocal cord nodules, polyps, and cysts but not paralysis. A 36-year-old male presents with purulent nasal discharge, headaches, and maxillary jaw pain for 9 days despite the use of nasal saline lavage. This is the fourth episode of similar symptoms so far this year. What diagnostic modality is most appro- priate at this time? A. computed tomography of sinuses
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D. Endoscopic culture of the affected sinus cavity may provide additional information regarding etiology. Culture and sensitivity of nasal discharge is unlikely to be of any use. A 9-year-old with recurrent acute otitis media presents with ear pain and purulent aural discharge. Which of the following organisms is the most likely agent? A. Mycoplasma pneumoniae B. Haemophilus influenzae C. Pseudomonas aeruginosa D. Streptococcus pneumoniae - Correct Answers ✅Answer: C [Ophthalmology and Otolaryngology, Infectious Disease]. A. Mycoplasma pneumoniae, Haemophilus influenzae, and Streptococcus pneumoniae are more commonly associated with acute otitis media. B. See A. C. Pseudomonas aeruginosa is associated with chronic otitis media. Other organisms that are associated with chronic otitis media are Proteus and Staphylococcus aureus.
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D. See A. A 27-year-old patient with HIV disease presents with loss of appetite and odynophagia. Examination of the buccal mucosa and tongue reveals thick, white plaques somewhat adherent to the underlying mucosa. After scraping the patches with a tongue blade, the surface below appears raw and reddened. What is the most likely diagnosis? A. candidiasis B. carcinoma C. diphtheria D. hairy leukoplakia - Correct Answers ✅Answer: A [Ophthalmology and Otolaryngology, Infec- tious Disease]. A. The thick, white coating from Candida infection can be scraped off revealing a raw, reddened surface underneath. Candida infections are commonly seen in patients who are immunocompromised. B. Cancer of the tongue is more common in men over age 50, especially in patients who abuse tobacco and alcohol. Cancers occur most often on the side of the tongue and any persistent nodule or ulcer must be suspect. Lesions can be red or white.
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children secondary to Hib (Haemophilus influenzae type b) vaccination programs. B. Mononucleosis is suggested by prominent adenopathy and a shaggy, white-gray tonsillar exudate, which may extend into the nasopharynx, especially in young adults. C. Peritonsillar abscess presents with severe sore throat, pain on swallowing, trismus ("lockjaw"), medial deviation of the soft palate, and a muffled ("hot potato") voice. D. These clinical features (fever, tender anterior cervical adenopathy, lack of cough, and pharyngotonsillar exudate) strongly suggest group A- Beta hemolytic streptococcus.
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