PANCE EENT 4 — Questions and Answers
Question 1: A 70-year-old hypertensive patient presents with sudden unilateral vision loss that lasted 10 minutes and resolved completely. Fundoscopic exam is normal. What is this episode called and what is the first-line imaging study?
- Amaurosis fugax; carotid duplex ultrasound (Correct answer)
- Optic neuritis; MRI of the brain
- Central retinal artery occlusion; CT angiography
- Migraine equivalent; MRI of the brain
Correct answer: Amaurosis fugax; carotid duplex ultrasound
Amaurosis fugax (transient monocular blindness from carotid emboli) requires urgent carotid duplex ultrasound to evaluate for significant ipsilateral carotid stenosis.
Question 2: A 15-year-old presents with bilateral nasal polyps. No history of asthma or aspirin sensitivity. A sweat chloride test is ordered. What underlying condition is being screened for?
- Allergic rhinitis
- Cystic fibrosis (Correct answer)
- Primary ciliary dyskinesia
- Churg-Strauss vasculitis
Correct answer: Cystic fibrosis
Bilateral nasal polyps in a child or adolescent should prompt evaluation for cystic fibrosis, as nasal polyposis occurs in up to 50% of CF patients.
Question 3: A 55-year-old presents with a painless neck mass. Fine-needle aspiration shows squamous cell carcinoma. He has a 40 pack-year smoking history and drinks alcohol daily. Nasopharyngoscopy reveals an asymmetric, ulcerated lesion in the pyriform sinus. What is the most likely primary site?
- Nasopharynx
- Hypopharynx (pyriform sinus) (Correct answer)
- Oropharynx (tonsil)
- Supraglottic larynx
Correct answer: Hypopharynx (pyriform sinus)
Pyriform sinus carcinoma of the hypopharynx commonly presents as a painless neck mass from nodal metastasis, given the rich lymphatic drainage and late local symptoms.
Question 4: A 45-year-old presents with chronic bilateral rhinorrhea, nasal congestion, and excessive sneezing, worst in spring. Nasal smear shows eosinophils. Skin-prick testing is positive for grass and tree pollens. What is first-line pharmacotherapy?
- Oral antihistamines alone
- Intranasal corticosteroids (Correct answer)
- Oral decongestants
- Leukotriene receptor antagonists
Correct answer: Intranasal corticosteroids
Intranasal corticosteroids are the most effective first-line treatment for moderate-to-severe allergic rhinitis, superior to antihistamines for nasal congestion and overall symptom control.
Question 5: A 6-year-old presents with 5 days of fever, purulent nasal discharge, and periorbital edema. CT scan shows opacification of the ethmoid sinuses and a subperiosteal abscess along the medial orbital wall. What is the most appropriate management?
- Oral amoxicillin-clavulanate and close follow-up
- IV antibiotics and urgent surgical drainage (Correct answer)
- Topical nasal decongestants and systemic steroids
- IV antibiotics alone without surgery
Correct answer: IV antibiotics and urgent surgical drainage
Subperiosteal orbital abscess secondary to ethmoid sinusitis requires IV antibiotics plus urgent surgical drainage to prevent optic nerve compression and vision loss.
Question 6: A 30-year-old woman presents with bilateral proptosis, lid retraction, and a stare. Thyroid-stimulating hormone is suppressed and free T4 is elevated. What finding on extraocular muscle testing is most characteristic of her orbital condition?
- Limitation of elevation (inferior rectus restriction) (Correct answer)
- Limitation of abduction (medial rectus palsy)
- Limitation of adduction (lateral rectus restriction)
- Complete ophthalmoplegia
Correct answer: Limitation of elevation (inferior rectus restriction)
Thyroid eye disease (Graves' orbitopathy) most commonly affects the inferior rectus muscle, causing restriction of elevation and hypotropia.
Question 7: A 65-year-old presents with progressive hoarseness of 8 weeks duration and a 15 lb weight loss. Laryngoscopy shows an ulcerated lesion of the true vocal cord with cord fixation. What staging feature does cord fixation indicate?
- T1 disease — limited to true cord
- T2 disease — extension to supraglottis
- T3 disease — fixed cord (Correct answer)
- T4 disease — cartilage invasion
Correct answer: T3 disease — fixed cord
Vocal cord fixation in laryngeal cancer indicates T3 disease regardless of tumor size, reflecting deep invasion of the paraglottic space or cricoarytenoid joint.
PANCE EENT 4
A 70-year-old hypertensive patient presents with sudden unilateral vision loss that lasted 10 minutes and resolved completely.
Fundoscopic exam is normal.
What is this episode called and what is the first-line imaging study?