PANCE EENT 2 — Questions and Answers
Question 1: A 45-year-old patient presents with sudden painless vision loss in one eye described as a 'curtain coming down.' Fundoscopic exam reveals a pale retina with a cherry-red spot at the macula. What is the most likely diagnosis?
- Central retinal vein occlusion
- Central retinal artery occlusion (Correct answer)
- Retinal detachment
- Vitreous hemorrhage
Correct answer: Central retinal artery occlusion
Central retinal artery occlusion presents with sudden painless monocular vision loss, pale retina with cherry-red macula due to ischemia from loss of blood supply.
Question 2: A 7-year-old is brought in for a school screening failure. Exam reveals the left eye deviates outward when the right eye fixates. The child has no diplopia. What is the most appropriate initial management?
- Strabismus surgery immediately
- Patching of the dominant eye
- Referral to ophthalmology for evaluation (Correct answer)
- Observation only
Correct answer: Referral to ophthalmology for evaluation
Exotropia in a child requires ophthalmology referral to assess for amblyopia and determine the need for patching, glasses, or surgery.
Question 3: A 60-year-old with poorly controlled diabetes presents with right-sided facial pain, purulent nasal discharge, and black necrotic tissue visible in the nasal cavity. CT shows bony erosion of the turbinates. What organism is most likely responsible?
- Aspergillus fumigatus
- Staphylococcus aureus
- Mucor species (Correct answer)
- Pseudomonas aeruginosa
Correct answer: Mucor species
Mucormycosis (rhino-orbital-cerebral) is a life-threatening fungal infection in diabetics and immunocompromised patients, causing black necrotic tissue and bony invasion.
Question 4: A 30-year-old presents with recurrent episodes of severe unilateral eye pain, redness, and halos around lights. Each episode lasts 2-3 hours and resolves spontaneously. IOP during an attack is 45 mmHg. What is the treatment of choice for long-term prevention?
- Topical timolol daily
- Laser peripheral iridotomy (Correct answer)
- Trabeculectomy
- Systemic acetazolamide indefinitely
Correct answer: Laser peripheral iridotomy
Laser peripheral iridotomy creates an opening in the iris to relieve pupillary block and prevent recurrent acute angle-closure glaucoma attacks.
Question 5: A 55-year-old presents with progressive bilateral sensorineural hearing loss, tinnitus, and episodic vertigo lasting 20 minutes to several hours. Audiometry shows low-frequency hearing loss. What is the most likely diagnosis?
- Benign paroxysmal positional vertigo
- Vestibular neuritis
- Acoustic neuroma
- Ménière's disease (Correct answer)
Correct answer: Ménière's disease
Ménière's disease is characterized by the triad of episodic vertigo, fluctuating sensorineural hearing loss (initially low-frequency), and tinnitus due to endolymphatic hydrops.
Question 6: A 3-year-old presents with high fever, drooling, muffled voice, and refusal to open the mouth. Examination shows medial displacement of the tonsil and uvular deviation. What is the most appropriate next step?
- Oral antibiotics and close outpatient follow-up
- CT scan of the neck with contrast
- Immediate needle aspiration or incision and drainage (Correct answer)
- Throat culture and wait for results
Correct answer: Immediate needle aspiration or incision and drainage
A peritonsillar abscess with airway compromise requires immediate aspiration or incision and drainage along with IV antibiotics to relieve the abscess.
Question 7: A 25-year-old presents with sudden severe headache, photophobia, and vision loss in the right eye. Slit-lamp exam shows cells and flare in the anterior chamber. Fundoscopic exam is limited by haze but shows disc hyperemia. What condition should be suspected?
- Bacterial conjunctivitis with iritis
- Uveitis (anterior and posterior) (Correct answer)
- Acute angle-closure glaucoma
- Optic neuritis
Correct answer: Uveitis (anterior and posterior)
Panuveitis (anterior and posterior uveitis) presents with anterior chamber cells/flare, vitreous haze, and disc changes requiring urgent ophthalmologic evaluation.
PANCE EENT 2
A 45-year-old patient presents with sudden painless vision loss in one eye described as a 'curtain coming down.' Fundoscopic exam reveals a pale retina with a cherry-red spot at the macula.
What is the most likely diagnosis?