2017 EENT Practice Textbook Questions Flashcards
1.
Which of the following would not be typical of a conductive hearing loss?
A.
Marked improvement with amplification
B.
Ability to hear speech in a noisy background
C.
Relatively maintained speech recognition
D.
Loud speech is annoying
E.
Bone greater than air conduction
Answer: D Patients with conductive hearing loss prefer loud speech, which they can understand as well as normal people can. A, B, C, and E are typical for conductive hearing loss.
2.
Which of the following diagnoses would be least likely to be manifested with a unilateral hearing loss?
A.
Acoustic neuroma
B.
Meniere disease
C.
Otosclerosis
D.
Brain stem glioma
E.
Otitis media
Answer: D Brain stem lesions rarely cause unilateral hearing loss unless they involve the root entry zone of the cochlear nerve. Otosclerosis is usually bilateral but often begins unilaterally. The other conditions are typically unilateral.
3.
Which of the following is least likely to be manifested with vertigo?
A.
Acoustic neuroma
B.
Meniere disease
C.
Lateral medullary infarction
D.
Migraine
E.
Vestibular neuritis
Answer: A Acoustic neuroma typically is manifested with unilateral hearing loss or tinnitus. It compresses the vestibular nerve slowly, so central compensation can occur. It rarely is manifested with vertigo. B, C, D, and E commonly are manifested with vertigo.
4.
Which of the following would be an unusual precipitant for benign paroxysmal positional vertigo?
A.
Turning in bed
B.
Yoga class
C.
Driving
D.
Reaching for something on a high shelf
E.
Working under an automobile
Answer: C Benign paroxysmal positional vertigo is typically triggered by movement in the vertical plane (plane of the posterior semicircular canal). It would be unusual to make such a movement while driving. The other maneuvers are common precipitating circumstances.
5.
Which of the following would most likely be associated with a positive head-thrust test result?
A.
Meniere disease
B.
Lateral medullary infarction
C.
Cerebellar infarction
D.
Gentamicin ototoxicity
E.
Otitis media
Answer: D Gentamicin is remarkably selective for the vestibular system, and the head-thrust test is useful for identifying toxicity at the bedside. The head-thrust test result is rarely positive with Meniere disease and would be negative with lateral medullary infarction, cerebellar infarction, and otitis media.
1.
A patient without other systemic disease or immunocompromise presents with otitis externa confined to the external auditory canal. Which of the following interventions would be recommended?
A.
The physician should prescribe an oral quinolone antibiotic.
B.
The physician should order a computed tomographic scan with contrast of the temporal bone.
C.
The physician should prescribe topical antibiotics.
D.
The physician should obtain a neurosurgical consult.
E.
The physician should recommend oral steroid medication.
Answer: C Otitis externa or “swimmer’s ear” usually responds to topical antibiotic treatment. Oral or systemic antibiotics are specifically not recommended unless the patient is immunocompromised or the infection is spreading to the pinna cartilage of the external ear outside of the external auditory canal.
2.
A patient presents to your office with recurrent epistaxis. A crust on the anterior septum is identified on the side of greatest bleeding. There is no active bleeding during the visit. The best course of action is which of the following choices?
A.
The patient should be admitted to the hospital for interventional embolization of the internal maxillary artery.
B.
The patient should be electively scheduled for a computed tomographic angiogram.
C.
The patient should be given a prescription for a β-blocker.
D.
The patient should be queried about aspirin use and be asked to take an “aspirin holiday.”
E.
A bone marrow biopsy should be obtained.
Answer: D Patients with epistaxis are often on antiplatelet drugs for a variety of reasons. On intake history, use of nonsteroidal anti-inflammatory drugs should be specifically sought because curtailing antiplatelet medication will often eliminate troublesome epistaxis.
3.
An adult patient presents with left ear pain but no hearing loss, beginning 4 weeks ago and partially controlled with narcotic pain medication. On physical examination, there is no evidence of otitis externa or otitis media. Which of the following choices is the best next step?
A.
A smoking history should be obtained, a neck examination should be performed, and the patient should be referred for upper airway endoscopic examination.
B.
An empirical trial of oral antibiotics should be prescribed for presumptive otitis media.
C.
An empirical trial of topical antibiotics should be prescribed for presumptive otitis externa.
D.
A magnetic resonance image of the brain and temporal bone, with contrast, should be ordered.
E.
The patient should be sent for a hearing test.
Answer: A Unexplained unilateral otalgia may be a referred pain from an upper aerodigestive tract lesion. Physical examination of the oral cavity, oropharynx, larynx, and hypopharynx should be performed. Tumors of the upper aerodigestive tract often present with an easily palpable, metastatic lymph node in the neck. Smoking, alcohol use, and human papillomavirus infection are risk factors for head and neck cancer.
4.
A patient presents with nasal polyps visible on anterior rhinoscopy and also notes a history of asthma exacerbated by nonsteroidal anti-inflammatory drug use. What is the best treatment recommendation?
A.
The patient should be scheduled for nasal surgery.
B.
The patient should be scheduled for computed tomographic imaging of the sinuses.
C.
The patient should be given a prescription for ciprofloxacin.
D.
The patient should be scheduled for a sweat chloride test.
E.
The patient should be given an oral prednisone taper.
Answer: E This patient likely has aspirin exacerbated respiratory disease, also called Samter’s triad or “aspirin allergy.” Oral corticosteroids can shrink nasal polyps and help control symptoms in patients with this disorder.
5.
A patient presents to your office with a 4-day history of an upper respiratory infection that has prevented attendance at school. The physician should take which of the following steps?
A.
The history suggests chronic infection, and the patient should be given oral antibiotics.
B.
The history suggests acute infection, and the patient should be given oral antibiotics.
C.
The history is consistent with a viral upper respiratory infection, and symptomatic treatment should be recommended.
D.
The patient should be given a prescription for topical antifungal medication.
E.
None of the above
Answer: C Several meta-analyses have shown that oral antibiotics or topical antibiotics provide no meaningful improvement in sinusitis during the first 7 to 10 days of treatment. Supportive care is the best option; it should include decongestants, hydration, fever control with antipyretics, and patience in allowing the symptoms to resolve.
