12/31/2023 0 Comments Pance ear practice questions![]() Median age and top offenders for dacrostenosis?ĩ months. Can present w/ osteomyelitis or cavernous sinus thrombosis.Īdmit for broad spectrum IV abx while awaiting cx. MRSA and 2/t chronic sinusitis in adults (given viral sinusitis more common s/p URI). Median age and top offenders for orbital cellulits?ħ-12yo. Occur 2/t systemic DM and HTN > pre/eclampsia, blood dyscrasias and HIV. What is the leading cause of blindness in the US? Painless and 2/t emboli, thrombosis and vasculidities. What is box-carring with a cherry-red spot?ĬRAO. *#1 cause of irreversable central vision loss.* Turn pt to affected side.Ĭlassic causes and presentation of macular degeneration?Īge > chloroquine or phenothiazine -> Drusen deposits in Bruch's membrane causing metamorphopsia w/ neovascularization (give anti-VEGF). Spontaneous or 2/t trauma or severe myopia. VN does not, and labrynthitis does, have hearing loss (with acute vertigo and tinnitus s/p Otitis or viral infection -> meclizine, promethazine or dimenhydrinate).ĪC > BC = SNL (though both AC and BC impaired)Ĭlassic presentation for laryngeal cancer? How to discern vestibular neuritis from labrynthitis? PRESBYCUSIS > Meniere's, Acoustic neuroma, acoustic trauma. Top reasons for sensorineural hearing loss? WAX > OE/OM, TM perf, foreign body (don't remove batteries, refer), otosclerosis, cholesteatoma. Gent/Vanc/Erythro/Neomycins, Quinidine, Chemotx, Loops, ASA, Chloramphenicol. PEARL: Postmenopausal patients who have persistent vulvar lesions must undergo biopsy, which will yield a definitive diagnosis that ranges from lichen sclerosis to squamous cell carcinoma.PANCE ENT PANCE Opthalmology and Otolaryngology Question If the biopsy reveals squamous cell cancer of the vulva, a vulvectomy would be appropriate management. This patient currently has longstanding pruritis of unknown etiology. To perform a vulvectomy (choice E) on this patient would not be indicated at this point. Perhaps more important, to delay a biopsy for a year could result in progression of a possible malignancy. This patient has suffered with pruritis for 2 years and therefore needs to have her problem addressed as soon as possible. To schedule the patient for re-examination in 1 year (choice C) would not be correct. She therefore does not have bacterial vaginosis, and metronidazole gel would not be the most appropriate next step in management. This patient has no significant vaginal discharge and no clue cells on the normal saline wet prep. ![]() To prescribe metronidazole gel (choice B) would be appropriate if the patient had bacterial vaginosis. This patient, however, who has no significant vaginal discharge and no pseudohyphae, does not have evidence of candidiasis (i.e., a yeast infection). To prescribe clotrimazole cream (choice A) would be appropriate if the patient had candidiasis. The proper management of a postmenopausal patient who has persistent pruritis unresponsive to treatment is a biopsy. This patient has no evidence for infection on her speculum examination or wet prep. Patients who have persistent genital pruritus are often treated for candidiasis or are treated with steroids, with no real diagnosis being made. Other risk factors for the development of squamous cell carcinoma include multiple sexual partners, history of abnormal Pap smear, smoking, immunosuppression, and poor hygiene. In a postmenopausal patient this is even more essential, as squamous cell carcinoma of the vulva is more common in this age group. In any woman who has persistent vulvar pruritis that is unresponsive to treatment, biopsy should be considered.
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