Rosh HEENT Exam | Questions & Answers (100 %Score) Latest Updated 2024/2025
Comprehensive Questions A+ Graded Answers | With Expert Solutions
What presents with patient entering a dark room or movie theater complaining of acute
unilateral painful vision loss, vomiting, and seeing halos around lights, with cloudy
cornea and fixed mid-dilated pupil?
Dx and Tx? - Acute Angle Closure Glaucoma
Dx:
Labs show increased IOP >21 mmHg
Tx:
Topical ßBs: (TIMOLOL)
Carbonic anhydrase inhibitors: (Acetazolamide)
Steroids: (Prednisolone)
Miotics: (PILOCARPINE)
What presents with painful loss of vision with physical exam revealing circumlimbal
injection, steamy cornea, fixed mid-dilated pupil, decreased visual acuity and tearing?
Patient can have colored halos around lights nausea, vomiting, diaphoresis also. -
Angle-closure glaucoma
What most commonly presents with loss of peripheral vision with no other complaints? -
Open-angle glaucoma
What angle is closed in closed angle glaucoma? - Anterior chamber is narrowed
intraocular pressure is acutely elevated >21 mmHG
pressure builds on optic nerve leading to loss of vision
Treatment for closed angle glaucoma? - IMMEDIATE referral to ophthalmologist
1st line: ** Start IV ACETAZOLAMIDE (carbonic anhydrase inhibitor --> to decrease
aqueous humor production
Topical beta blocker (TIMOLOL) and LATANOPROST
USE Miotics--> Pilocarpine, Carbachol
,Definitive treatment: surgical iridotomy
DO NOT use Mydriatics
What nerve is damaged with glaucoma? - Optic Nerve
causes peripheral vision loss
What presents with unilateral ocular pain, nausea/vomiting, headache, intermittent
blurry vision, halos around lights, peripheral vision loss (tunnel vision)? - Acute closed
angle closure glaucoma
What presents with erythema, steamy cornea(corneal epithelial edema or cloudiness),
mid-dilated, nonreactive pupil, and eyes feel hard to palpation? - Acute narrow angle
closure glaucoma
What are diagnostics for acute closed angle glaucoma? - Increased intraocular pressure
>21 by Tonometry
Cupping of optic nerve
What is slow, bilateral, peripheral vision loss? - Open angle glaucoma
What presents with tunnel vision? - Open angle glaucoma
What is management of Open angle glaucoma? - Prostaglandin analogs 1st line:
Latanoprost
What is primary glaucoma? - Open angle
What is most common form of glaucoma? - Open angle glaucoma
What presents with unilateral ocular pain/redness/photophobia with excessive tearing
(no discharge)? - Anterior Uveitis (Iritis)
What is most common cause of Uveitis Iritis? - Idiopathic
Anterior: commonly follows blunt trauma
BOTH anterior and posterior can occur from SYSTEMATIC INFLAMMATORY
DISEASES (HLA-B27 Spondyloathropathies, or infection diseases of CMS,
toxoplasmosis, syphillis, TB)
How do you diagnose and treat Iritis (Uveitis)? - Ophthamalmoscopy and slit lamp
examination will reveal ciliary injection (LIMBIC FLUSH), consensual photophobia,
INFLAMMATORY CELLS AND FLARE within aqueous
, What presents with blurred/decreased vision, floaters and photophobia?
How do you treat? - Posterior Uveitis (Iritis)
Tx: systemic corticosteroids
What is treatment for anterior and posterior Uveitis? - Anterior: Topical steroids for
anterior Iritis
Posterior: Systemic corticosteroids
What presents with purulent nasal discharge, facial pain and pressure, nasal obstruction
and fever? - Acute Sinusitis
What are common organisms causing Acute Sinusitis?
What are risk factors? - Strep Pneumo, H. influenza, and less often Staph A
Risk factors: Cigarette smoking, history of trauma and presence of foreign body
What presents with tenderness to palpation over sinuses, decreased light transmission
(opacification) with transillumination of sinuses?
Treatment? - Sinusitis
Tx: NSAIDS (for pain)
Saline washes, steam and oral and/or nasal decongestants; intranasal corticosteroids
1st line antibiotic: AMOXICILLIN- CLAVULANATE
PCN allergy: Macrolides, TMP-SMX, or doxycycline
What presents with facial pressure/pain worsened with bending down and leaning
forward, headache and purulent sputum or nasal discharge?
Treatment? - Sinusitis
tx: Amoxicillin-Clavulanate, Doxycycline, Trimethoprim-Sulfamethoxazole
along with decongestants, antihistamines, mycolytics and intranasal steroids
What is the scan diagnostic test of choice for Sinusitis? - Ct scan
X ray: Water's view (45 angle to get better view of maxillary sinuses)
