Eyes, Ears, Nose, and Throat

Original practice questions written to the published framework for this section. No expert has reviewed them, and they are not taken from any official exam. Try each one before you open the answer.

1. Question 1Foundational

   A 68-year-old develops sudden severe eye pain, headache, nausea, and halos around lights, with a mid-dilated poorly reactive pupil and a hazy cornea. What is the most likely diagnosis?

   1. AAcute angle-closure glaucoma
   2. BAcute anterior uveitis
   3. CBacterial conjunctivitis
   4. DCentral retinal artery occlusion

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   Answer: A. Acute angle-closure glaucoma

   Abrupt blockade of aqueous outflow spikes intraocular pressure, producing severe pain, nausea, corneal edema with halos, and a fixed mid-dilated pupil, and it threatens vision within hours. Acute anterior uveitis is the tempting distractor because it is also painful with a red eye, but it produces a small, poorly reactive pupil and photophobia without corneal haze or systemic nausea.

   Key insight: A painful red eye with a mid-dilated fixed pupil and vomiting is a pressure emergency, not conjunctivitis.

2. Question 2Foundational

   During a Weber test in a person with a conductive hearing loss of the right ear, to which side does the sound lateralize?

   1. ATo the right ear
   2. BTo the left ear
   3. CEqually to both ears
   4. DThe tuning fork is not heard at all

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   Answer: A. To the right ear

   A conductive loss blocks competing ambient sound in the affected ear, so bone-conducted vibration is perceived as louder on that side and the Weber test lateralizes toward the damaged ear. Lateralization to the opposite ear is the tempting distractor because that is what happens with a sensorineural loss, where the affected cochlea simply hears less.

   Key insight: Weber lateralizes to the bad ear in conductive loss and to the good ear in sensorineural loss.

3. Question 3Intermediate

   Which condition should be suspected in an adolescent with several days of worsening sore throat who now has trismus, a muffled hot potato voice, and deviation of the uvula away from a bulging soft palate?

   1. AStreptococcal pharyngitis
   2. BPeritonsillar abscess
   3. CAcute epiglottitis
   4. DInfectious mononucleosis

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   Answer: B. Peritonsillar abscess

   A collection of pus lateral to the tonsillar capsule pushes the tonsil and soft palate medially, deviating the uvula to the opposite side and producing trismus and a muffled voice. Streptococcal pharyngitis is the tempting distractor because it precedes many of these cases, but it causes symmetric tonsillar findings without uvular deviation or trismus.

   Key insight: Asymmetry is the tell: uvular deviation with trismus means drainage, not another course of oral antibiotics alone.

4. Question 4Intermediate

   Which cause of vertigo produces brief episodes lasting under a minute that are triggered by head position change and is confirmed with the Dix-Hallpike maneuver?

   1. AMeniere disease
   2. BVestibular neuritis
   3. CBenign paroxysmal positional vertigo
   4. DVestibular schwannoma

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   Answer: C. Benign paroxysmal positional vertigo

   Displaced otoconia in a semicircular canal cause seconds-long positional vertigo with fatigable nystagmus on Dix-Hallpike testing, and repositioning maneuvers are curative. Meniere disease is the tempting distractor but produces spontaneous attacks lasting twenty minutes to hours together with fluctuating hearing loss, tinnitus, and aural fullness.

   Key insight: Duration sorts vertigo: seconds with position change is positional vertigo, hours with hearing loss is Meniere disease, and days of constant vertigo is vestibular neuritis.

5. Question 5Advanced

   Which funduscopic finding is characteristic of central retinal artery occlusion?

   1. AA cherry-red spot at the macula with diffuse retinal pallor
   2. BDiffuse retinal hemorrhages in all four quadrants with a swollen disc
   3. CCotton-wool spots with microaneurysms and hard exudates
   4. DIncreased cup-to-disc ratio with a pale rim

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   Answer: A. A cherry-red spot at the macula with diffuse retinal pallor

   Loss of retinal arterial perfusion makes the inner retina opaque and pale, while the thin fovea still shows the underlying choroidal circulation as a cherry-red spot. Diffuse hemorrhages with a swollen disc are the tempting distractor because they signal the other sudden painless vascular event of the retina, central retinal vein occlusion.

   Key insight: Sudden painless monocular vision loss with a cherry-red spot is arterial; the blood and thunder fundus is venous.