PANCE EENT 3 — Questions and Answers
Question 1: A 68-year-old presents with gradual bilateral vision loss. Fundoscopic exam reveals drusen deposits and geographic atrophy in the macular region but no hemorrhage or exudate. What type of macular degeneration does this represent?
- Wet (exudative) AMD
- Dry (atrophic) AMD (Correct answer)
- Diabetic macular edema
- Central serous chorioretinopathy
Correct answer: Dry (atrophic) AMD
Dry AMD is characterized by drusen and geographic atrophy without neovascularization or hemorrhage; it accounts for 90% of AMD cases and progresses slowly.
Question 2: A 9-year-old presents with a painless, firm, non-tender nodule on the upper eyelid that has been present for 3 weeks. There is no erythema or purulent discharge. What is the most likely diagnosis?
- Hordeolum (stye)
- Chalazion (Correct answer)
- Dacryocystitis
- Preseptal cellulitis
Correct answer: Chalazion
A chalazion is a chronic, painless granulomatous inflammation of a meibomian gland, presenting as a firm, non-tender eyelid nodule without acute inflammation.
Question 3: A 40-year-old diver presents with right ear pain and conductive hearing loss after a dive to 30 meters. Otoscopy shows a hemotympanum. What is the diagnosis?
- Otitis media
- Barotrauma (ear squeeze) (Correct answer)
- Perilymphatic fistula
- Otitis externa
Correct answer: Barotrauma (ear squeeze)
Middle ear barotrauma occurs when pressure cannot equalize across the tympanic membrane during descent, causing hemorrhage into the middle ear (hemotympanum).
Question 4: A 35-year-old presents with chronic nasal congestion, facial pressure, anosmia, and nasal polyps visible on anterior rhinoscopy. He has a history of aspirin sensitivity and asthma. What triad does this represent?
- Kartagener syndrome
- Samter's triad (AERD) (Correct answer)
- Churg-Strauss syndrome
- Wegener's granulomatosis
Correct answer: Samter's triad (AERD)
Samter's triad (aspirin-exacerbated respiratory disease) consists of nasal polyps, asthma, and aspirin/NSAID sensitivity due to aberrant arachidonic acid metabolism.
Question 5: A 50-year-old presents with progressive hearing loss and a mass behind the ear with pulsatile tinnitus. CT shows a destructive lesion at the jugular foramen. What is the most likely diagnosis?
- Acoustic neuroma
- Cholesteatoma
- Glomus jugulare tumor (Correct answer)
- Meningioma
Correct answer: Glomus jugulare tumor
Glomus jugulare tumors are paragangliomas arising from the jugular bulb, presenting with pulsatile tinnitus and lower cranial nerve deficits with jugular foramen destruction on imaging.
Question 6: A 22-year-old presents with a 3-day history of painful vesicles on the auricle, ear canal pain, and ipsilateral facial droop. She also notes decreased taste on the anterior tongue. What is the diagnosis?
- Bell's palsy
- Herpes zoster oticus (Ramsay Hunt syndrome) (Correct answer)
- Otitis externa with nerve compression
- Malignant otitis externa
Correct answer: Herpes zoster oticus (Ramsay Hunt syndrome)
Ramsay Hunt syndrome is herpes zoster reactivation in the geniculate ganglion causing otalgia, auricular vesicles, facial palsy, and loss of taste in the anterior two-thirds of the tongue.
Question 7: A newborn is noted to have a unilateral nasal obstruction with failure to pass a catheter through the right nostril. The infant becomes cyanotic while feeding but pinks up when crying. What is the diagnosis?
- Deviated nasal septum
- Choanal atresia (Correct answer)
- Nasal encephalocele
- Congenital turbinate hypertrophy
Correct answer: Choanal atresia
Choanal atresia is a congenital blockage of the posterior nasal aperture; neonates are obligate nasal breathers, so they become cyanotic feeding (nose only) but improve when crying (mouth open).
PANCE EENT 3
A 68-year-old presents with gradual bilateral vision loss.
Fundoscopic exam reveals drusen deposits and geographic atrophy in the macular region but no hemorrhage or exudate.
What type of macular degeneration does this represent?