USMLE Forum Archives - USMLE Step 2 CK - E.N.T. question #2
E.N.T. question #2
revision - 12-25-08 06:40
A 32-year-old man comes to the clinic because of a gradual, complete loss of smell over the past 6 months. He is normally very healthy, does not take any medications, and does not smoke cigarettes, or drink alcohol. He denies any recent history of trauma, change in sleeping or eating habits. He says that he is generally happy and is satisfied with his job and girlfriend. His temperature is 37 C (98.6 F). A complete physical examination is unremarkable. Neurologic examination shows the inability to smell a freshly opened isopropyl alcohol packet held 30 cm from his nose. He is also unable to smell a commercially available odor-producing magic marker-like pen and is unable to detect phenyl ethyl alcohol. A biochemical profile and thyroid function tests are normal.
The most appropriate next step is to:
A. biopsy the olfactory neuroepithelium
B. prescribe a 14-day trial course of antibiotics to treat a possible sinus infection
C. reassure him and reevaluate in 1 month
D. refer him to a psychiatrist for evaluation
E. schedule a CT scan of the head
revision - 12-25-08 06:40
A 32-year-old man comes to the clinic because of a gradual, complete loss of smell over the past 6 months. He is normally very healthy, does not take any medications, and does not smoke cigarettes, or drink alcohol. He denies any recent history of trauma, change in sleeping or eating habits. He says that he is generally happy and is satisfied with his job and girlfriend. His temperature is 37 C (98.6 F). A complete physical examination is unremarkable. Neurologic examination shows the inability to smell a freshly opened isopropyl alcohol packet held 30 cm from his nose. He is also unable to smell a commercially available odor-producing magic marker-like pen and is unable to detect phenyl ethyl alcohol. A biochemical profile and thyroid function tests are normal.
The most appropriate next step is to:
A. biopsy the olfactory neuroepithelium
B. prescribe a 14-day trial course of antibiotics to treat a possible sinus infection
C. reassure him and reevaluate in 1 month
D. refer him to a psychiatrist for evaluation
E. schedule a CT scan of the head
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#1
Re: E.N.T. question #2 bingousmle - 12-25-08 06:59 D is ruled out since the patient is not depressed.
B is unlikely since there is no pertaining history of URTI
tumors of the anterior cranial fossa may be possible but these are best evaluated by MRI , which is not an option
CT is more appropriate for bony abnormalities but there is no history of trauma
A is what i guess the choice....
#6
Re: E.N.T. question #2 babbu5508 - 08-29-10 01:37 E. schedule a CT scan of the head...to rule out any tumors as it a progressive loss of smell or anosmia over months.......
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