PANCE EENT 4

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?

Accepted Answer

Amaurosis fugax; carotid duplex ultrasound

Answer

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?

Accepted Answer

Cystic fibrosis

Answer

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?

Accepted Answer

Hypopharynx (pyriform sinus)

Answer

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?

Accepted Answer

Intranasal corticosteroids

Answer

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?

Accepted Answer

IV antibiotics and urgent surgical drainage

Answer

Subperiosteal orbital abscess secondary to ethmoid sinusitis requires IV antibiotics plus urgent surgical drainage to prevent optic nerve compression and vision loss.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE EENT 4