The NCCPA™ EENT PANCE and PANRE Content Blueprint high-yield question stem review with flashcards
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| Conjunctivitis |
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| Subconjunctival hemorrhage | Patient will present with → a painless, sharply demarcated bright red patch on the sclera noticed on waking or after coughing, sneezing, or straining, with normal vision and no discharge |
| Cataract | Patient will present with → slowly progressive painless blurred vision over months to years, glare, and halos around lights at night; exam shows lens opacity with a diminished red reflex |
| Corneal ulcer | Patient will present as → a contact lens wearer (slept in lenses) with severe pain, photophobia, and redness; fluorescein shows a round ulcer with a white stromal infiltrate (versus the dendritic pattern of herpes keratitis) |
| Keratitis (infectious corneal disease) |
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| Pterygium | Patient will present as → an outdoor worker with an elevated, fleshy, triangular fibrovascular growth extending from the nasal conjunctiva onto the cornea |
| Iritis (anterior uveitis) | Patient will present as → a young adult with ankylosing spondylitis or inflammatory bowel disease and a painful red eye, photophobia (including consensual), ciliary flush, and a small irregular pupil; slit lamp shows cells and flare |
| Scleritis | Patient will present as → a patient with rheumatoid arthritis and severe, deep, boring eye pain that wakes them at night, with violaceous injection that does not blanch with phenylephrine |
| Uveitis | Patient will present as → a patient with HIV and CD4 < 50 with painless floaters and blurred vision; fundus shows hemorrhages and fluffy white infiltrates ("pizza pie") = CMV retinitis; or a patient with sarcoidosis/Behçet with recurrent painful red eyes |
| Dacryoadenitis | Patient will present with → painful swelling of the outer (superotemporal) upper eyelid producing an S-shaped lid, often with a recent viral illness such as mumps or mono |
| Dacryocystitis | Patient will present with → pain, redness, and swelling at the inner (inferomedial) corner of the eye over the lacrimal sac, tearing, and pus expressed from the punctum with pressure |
| Dacryostenosis | Patient will present as → a 2-month-old with chronic tearing and crusting of one eye since birth, a white, non-injected conjunctiva, and reflux of mucoid material with pressure over the lacrimal sac |
| Keratoconjunctivitis sicca | Patient will present as → a middle-aged woman with gritty, burning, "sand in the eye" sensation worse at the end of the day, plus dry mouth (Sjögren); Schirmer test is abnormal |
| Blepharitis | Patient will present with → eyelid crusting, scaling, and red-rimmed lid margins with lash flaking on waking, dry irritated eyes, and associated seborrhea or rosacea |
| Chalazion | Patient will present with → a painless, firm, non-tender nodule in the eyelid that has been there for weeks (meibomian gland granuloma) |
| Ectropion | Patient will present as → an older adult with tearing and dry, irritated eyes; on exam the lower lid turns outward and the exposed palpebral conjunctiva is red |
| Entropion | Patient will present as → an older adult with foreign body sensation, tearing, and a red eye; on exam the lid turns inward and the lashes rub the cornea |
| Hordeolum | Patient will present with → a painful, warm, swollen red lump at the eyelid margin that developed over a day or two (think "H" for Hot = Hordeolum) |
| Nystagmus | Patient will present with → rhythmic, involuntary, repetitive eye movements; horizontal and fatigable with vertigo = peripheral vestibular; vertical or direction-changing = central (brainstem/cerebellum); an alcoholic with confusion and ataxia = Wernicke |
| Optic neuritis | Patient will present as → a young woman with acute monocular vision loss, pain with eye movement, washed-out color vision, and an afferent pupillary defect (think multiple sclerosis) |
| Papilledema | Patient will present as → an obese young woman with headache, transient visual blackouts, and pulsatile tinnitus; fundoscopy shows bilateral optic disc swelling with blurred margins; vision and pain are otherwise preserved |
| Orbital cellulitis | Patient will present as → a child with recent sinusitis and a swollen red eyelid plus pain with eye movement, limited extraocular motility, proptosis, and fever |
| Periorbital (preseptal) cellulitis | Patient will present as → a child with a swollen, red, warm eyelid after an insect bite or skin break, with full painless extraocular movements, no proptosis, and normal vision |
| Macular degeneration | Patient will present as → an older adult with gradual central vision loss ("I can't read or recognize faces") and wavy lines on the Amsler grid; fundus shows drusen (dry) or hemorrhage/neovascularization (wet). Versus glaucoma = peripheral → central loss |
| Retinal detachment | Patient will present as → a myopic or recently post-cataract-surgery patient with sudden flashes of light and a shower of floaters, then a painless "curtain" coming down over one eye |
| Retinopathy (diabetic, hypertensive) | Patient will present as → a diabetic on routine screening with microaneurysms, dot-blot hemorrhages, hard exudates, and cotton wool spots (neovascularization = proliferative); or a hypertensive with A/V nicking, copper wiring, and flame hemorrhages. Vision is often normal until macular edema develops |
| Retinal vascular occlusion |
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| Amaurosis fugax | Patient will present as → an older patient with vascular risk factors describing a "curtain coming down" over one eye that lasted a few minutes and fully resolved; a carotid bruit may be heard (retinal TIA) |
| Amblyopia | Patient will present as → a child with reduced visual acuity in one structurally normal eye that does not correct with lenses, usually with strabismus, unequal refractive error, or a congenital cataract on the same side |
| Glaucoma |
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| Presbyopia | Patient will present as → a 45-year-old holding the menu at arm's length to read it, with otherwise normal distance vision |
| Strabismus | Patient will present as → a child with a "drifting" or crossed eye, an asymmetric corneal light reflex, and movement of the eye on the cover/uncover test — esotropia in-turning, exotropia out-turning |
| Cerumen impaction | Patient will present as → an older adult or hearing-aid user with gradual unilateral hearing loss, fullness, and tinnitus after using cotton swabs; otoscopy shows the canal occluded by wax |
| Otitis externa (acute, malignant) |
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| Acoustic neuroma | Patient will present with → slowly progressive unilateral sensorineural hearing loss and tinnitus, with disequilibrium and sometimes facial numbness; bilateral in neurofibromatosis type 2 |
| Dysfunction of eustachian tube | Patient will present with → ear fullness, popping, an "underwater" feeling, intermittent sharp pain, and fluctuating hearing after a URI or flight; the TM is retracted |
| Labyrinthitis | Patient will present with → sudden, continuous vertigo lasting days, with hearing loss (± tinnitus) after a viral URI and no focal neurologic deficits (vestibular neuritis = the same picture without hearing loss) |
| Vertigo | Patient will present with → a sensation that the room is spinning; BPPV = brief episodes provoked by rolling over in bed with a positive Dix-Hallpike; central = vertical nystagmus, inability to walk, or other neurologic deficits |
| Cholesteatoma | Patient will present with → chronic painless, foul-smelling otorrhea and progressive conductive hearing loss after years of ear infections; otoscopy shows a pearly white mass or retraction pocket in the attic |
| Acute/chronic otitis media | Patient will present as → a toddler with fever, otalgia, and ear tugging a week after a cold; otoscopy shows a bulging, erythematous TM with decreased mobility on pneumatic otoscopy (OME = effusion with a dull, retracted TM and no fever or pain) |
| Otosclerosis | Patient will present as → a woman in her 20s–30s with progressive bilateral conductive hearing loss, a family history of early hearing loss, worsening during pregnancy, and a normal TM |
| Tympanic membrane perforation | Patient will present with → sudden ear pain, otorrhea, and hearing loss — either abrupt relief of pain with drainage during otitis media, or after a slap to the ear, cotton swab, or diving; a defect is visible on otoscopy |
| Hearing impairment (conductive, sensorineural) |
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| Mastoiditis | Patient will present as → a child 1–2 weeks into an otitis media with fever, otalgia, pain, erythema, and swelling behind the ear, and forward, downward displacement of the auricle |
| Meniere disease | Patient will present with → recurrent episodes of vertigo lasting 20 minutes to hours, with fluctuating low-frequency hearing loss, tinnitus, and aural fullness in one ear |
| Tinnitus | Patient will present with → a ringing, hissing, buzzing, or whooshing sound with no external source, often with hearing loss, noise exposure, or a new drug (aspirin, aminoglycoside, loop diuretic); pulsatile or unilateral tinnitus is the red flag |
| Foreign body in ear | Patient will present as → a child with ear pain, decreased hearing, or drainage and a visible object in the canal; or an adult who woke with buzzing and pain from a live insect in the ear |
| Foreign body in eye | Patient will present as → a worker who was grinding or hammering metal without eye protection and now has foreign body sensation, tearing, and a red painful eye; a rust ring may be seen. Seidel sign or a peaked pupil = intraocular FB/globe rupture |
| Foreign body in nose | Patient will present as → a 4-year-old with three days of unilateral purulent, foul-smelling nasal discharge |
| Barotrauma of the ear | Patient will present as → a scuba diver or airline passenger with a URI who developed sudden ear pain and fullness on descent that may have resolved with a "pop"; TM is retracted or shows hemotympanum |
| Blowout fracture | Patient will present as → a patient struck in the eye by a fist or baseball with eyelid swelling, double vision on upward gaze, a sunken eye (enophthalmos), and numbness of the cheek and upper lip (infraorbital nerve) |
| Corneal abrasion | Patient will present with → a history of minor trauma (fingernail, branch, contact lens) followed by sudden eye pain, photophobia, tearing, and foreign body sensation; fluorescein shows a linear or irregular uptake defect |
| Globe rupture | Patient will present as → a patient with penetrating eye trauma or a severe blow and marked vision loss, a teardrop-shaped (peaked) pupil, 360° subconjunctival hemorrhage, a shallow anterior chamber, and a positive Seidel sign |
| Hyphema | Patient will present as → a patient hit in the eye with a ball with blurry vision, pain, and a visible layer of blood in the anterior chamber; pupils may be unequal |
| Epistaxis | Patient will present with → anterior: a child or dry-air nose-picker with bleeding from one nostril that stops with pressure (Kiesselbach plexus); posterior: an older hypertensive or anticoagulated adult with brisk bleeding from both nostrils and blood running down the throat |
| Nasal polyps | Patient will present as → a patient with asthma and aspirin sensitivity (Samter triad) with nasal obstruction and loss of smell; exam shows pale, gray, teardrop-shaped masses in the nose. A child with polyps → cystic fibrosis |
| Rhinitis |
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| Sinusitis | Patient will present with → facial pain/pressure worse with bending forward, purulent nasal discharge, and congestion — either > 10 days without improvement or improving then worsening ("double sickening"); chronic = > 12 weeks |
| Angioedema | Patient will present as → a patient recently started on an ACE inhibitor (or with a family history of similar attacks) with painless, non-pitting swelling of the lips, tongue, or face without urticaria that does not respond to antihistamines |
| Aphthous ulcers | Patient will present as → a 22-year-old with a painful sore for 2 days, no tobacco or alcohol, otherwise well; exam shows a 2-mm round ulcer with a yellow-gray center and red halo on the buccal mucosa (versus HSV: grouped vesicles on the lip after a tingling prodrome) |
| Oral candidiasis | Patient will present as → an infant, an inhaled-steroid user, or an adult with undiagnosed HIV/diabetes with white plaques on the oral mucosa that scrape off, leaving a red base that may bleed |
| Deep neck infection |
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| Dental abscess | Patient will present with → severe, throbbing tooth pain, sensitivity to percussion, and a fluctuant swelling at the gum line, sometimes with unilateral facial swelling and fever |
| Dental caries | Patient will present as → a toddler who goes to bed with a bottle, or an adult with a high-sugar diet, with tooth pain triggered by sweets, cold, or heat and brown-black pits or white chalky spots on the teeth |
| Epiglottitis | Patient will present as → an unvaccinated child (or an adult) with rapid onset of high fever, drooling, dysphagia, and distress — sitting in the tripod position with a muffled "hot potato" voice and inspiratory stridor |
| Gingivitis | Patient will present with → red, swollen gums that bleed with brushing; on phenytoin, a calcium channel blocker, or cyclosporine = gingival hyperplasia; a stressed young adult with painful, "punched-out" bleeding papillae and foul breath = necrotizing gingivitis (Vincent angina) |
| Laryngitis | Patient will present with → hoarseness or loss of voice after a URI; a smoker or drinker with hoarseness lasting more than 2–3 weeks is the cancer stem |
| Peritonsillar abscess | Patient will present as → a teenager or young adult with worsening sore throat, fever, "hot potato" muffled voice, trismus, drooling, referred ear pain, and a unilateral tonsillar bulge with the uvula deviated to the opposite side |
| Pharyngitis |
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| Parotitis | Patient will present as → an unvaccinated child with bilateral parotid swelling and pain with eating (mumps); or a dehydrated elderly or postoperative patient with a unilateral, tender, warm parotid and pus from Stensen's duct (bacterial) |
| Sialadenitis | Patient will present with → postprandial pain and swelling of the submandibular gland, sometimes with a palpable stone in the floor of the mouth and pus from the duct |
| Leukoplakia | Patient will present as → a smoker or smokeless-tobacco user with a painless white plaque on the buccal mucosa or tongue that cannot be scraped off; an HIV patient with a corrugated white lesion on the lateral tongue = oral hairy leukoplakia (EBV) |
| Temporomandibular disorders | Patient will present as → a young woman who grinds her teeth with jaw pain worse with chewing, clicking or popping, limited mouth opening, headaches, and ear pain with a normal ear exam |
| Benign and malignant neoplasms | Patient will present with → a unilateral, painless, persistent lesion or neck mass: a non-healing oral ulcer or red patch in a smoker/drinker, a tonsillar mass in a middle-aged nonsmoker (HPV), a midline neck mass that rises with tongue protrusion (thyroglossal duct cyst), or a lateral neck cyst anterior to the sternocleidomastoid that swells after a URI (branchial cleft cyst) |
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