HEENT/ ID Flashcards
A provider performs an eye examination during a health maintenance visit and notes a
difference of 0.5 mm in size between the patient’s pupils. What does this finding indicate?
a. A relative afferent pupillary defect
b. Indication of a difference in intraocular pressure
c. Likely underlying neurological abnormality
d. Probable benign, physiologic anisocoria
ANS: D
A difference in diameter of less than 1 mm is usually benign. Afferent pupillary defects are
paradoxical dilations of pupils in response to light. This does not indicate differences in
intraocular pressure. A difference of more than 1 mm is more likely to represent an underlying
neurological abnormality.
A patient comes to clinic with diffuse erythema in one eye without pain or history of trauma.
The examination reveals a deep red, confluent hemorrhage in the conjunctiva of that eye.
What is the most likely treatment for this condition?
a. Order lubricating drops or ointments.
b. Prescribe ophthalmic antibiotic drops.
c. Reassure the patient that this will resolve.
d. Refer to an ophthalmologist.
ANS: C
Most subconjunctival hemorrhage, occurring with trauma or Valsalva maneuvers, will
self-resolve and are benign. Lubricating drops are used for chemosis. Antibiotic eye drops are
not indicated. Referral is not indicated.
During an eye examination, the provider notes a red-light reflex in one eye but not the other.
What is the significance of this finding?
a. Normal physiologic variant
b. Ocular disease requiring referral
c. Potential infection in the “red” eye
d. Potential vision loss in one eye
ANS: B
The red reflex should be elicited in normal eyes. Any asymmetry or opacity suggests ocular
disease, potentially retinoblastoma, and should be evaluated immediately
A primary care provider may suspect cataract formation in a patient with which finding?
a. Asymmetric red reflex
b. Corneal opacification
c. Excessive tearing
d. Injection of conjunctiva
ANS: A
An asymmetric red reflex may be a finding in a patient with cataracts. Corneal opacification,
excessive tearing, and corneal injection are not symptoms of cataracts.
Which are risk factors for development of cataracts? (Select all that apply.)
a. Advancing age
b. Cholesterol
c. Conjunctivitis
d. Smoking
e. Ultraviolet light
ANS: A, D, E
Most older adults will develop cataracts. Smoking and UV light exposure hasten the
development of cataracts. Cholesterol and conjunctivitis are not risk factors.
Which is the most common cause of orbital cellulitis in all age groups?
a. Bacteremic spread from remote infections
b. Inoculation from local trauma or bug bites
c. Local spread from the ethmoid sinus
d. Paranasal sinus inoculation
ANS: C
Because the membrane separating the ethmoid sinus from the orbit is literally paper-thin, this
is the most common source of orbital infection in all age groups. Bacteremic spread,
inoculation from localized trauma, and paranasal sinus spread all may occur, but are less
common.
A child’s optic assessment data include unilateral eyelid edema, warmth, and erythema but no
pain with ocular movement is reported. Which characteristic is most likely true about this
child’s infection?
a. Decreased visual acuity may occur.
b. Increased intraocular pressure will be present.
c. Optic nerve compromise is a complication.
d. The eye is typically spared without conjunctivitis.
ANS: D
This child has symptoms of preseptal cellulitis in which the eye is typically spared. The other
findings are consistent with orbital cellulitis.
A patient is experiencing eyelid swelling with erythema and warmth and reports pain with eye movement. Which diagnostic tests will be performed to confirm a diagnosis of orbital cellulitis? (Select all that apply.) a. Blood cultures b. Complete blood count c. CT scan of orbits d. Lumbar puncture e. Visual acuity testing
ANS: B, C
A complete blood count will help distinguish infectious from noninfectious orbital cellulitis.
A CT scan or the orbits is necessary to confirm the diagnosis. Blood cultures do not confirm
the diagnosis of orbital cellulitis but may be used to evaluate whether septicemia is occurring.
Lumbar puncture is indicated if meningitis is suspected. Visual acuity testing may be used to
monitor recovery.
A child sustains an ocular injury in which a shard of glass from a bottle penetrated the eye
wall. The emergency department provider notes that the shard has remained in the eye. Which
term best describes this type of injury?
a. Intraocular foreign body
b. Penetrating eye injury
c. Perforating eye injury
d. Ruptured globe injury
ANS: A
When a portion of the insulting object enters and remains in the eye, the injury is correctly
referred to as an intraocular foreign body. A penetrating injury occurs when something
penetrates through the eye wall without an exit wound. A perforating injury occurs when the
object has both an entry and an exit wound. A ruptured globe injury occurs when blunt force
causes the eye wall to rupture
A patient experiences a penetrating injury to one eye caused by scissors. The provider notes a
single laceration away from the iris that involves the anterior but not the posterior segment.
What is the prognosis for this injury?
a. Because the posterior segment is not involved, the prognosis is good.
b. Blindness is likely with this type of eye injury.
c. Massive hemorrhage and loss of intraocular contents is likely.
d. Retinal detachment is almost certain to occur
ANS: A
Mechanical energy imparted from sharp objects generally results in lacerations, with
disruption that is more localized. The prognosis is better if the posterior segment is not
involved. The other complications are more common with globe ruptures.
Which protective precaution is especially important in a metal fabrication workshop?
a. 2 mm polycarbonate safety glasses
b. Eyewash stations
c. Glasses with UVB protection
d. Polycarbonate goggles
ANS: D
Polycarbonate goggles, which have better side protection, will protect from foreign bodies
that can reach around other lenses and should be used in very high-risk activities, such as
hammering metal on metal or grinding. 2 mm polycarbonate safety glasses are a minimum
safety precaution. Glasses with UVB protection are used in occupations where sunlight
exposure is high. Eyewash stations are necessary where splash injuries or chemical exposures
are possible.
A young child has a pale, whitish discoloration behind the tympanic membrane. The provider notes no scarring on the tympanic membrane (TM) and no retraction of the pars flaccida. The parent states that the child has never had an ear infection. What do these findings most likely represent? a. Chronic cholesteatoma b. Congenital cholesteatoma c. Primary acquired cholesteatoma d. Secondary acquired cholesteatoma
ANS: B
Patients without history of otitis media or perforation of the TM most likely have congenital
cholesteatoma. Primary acquired cholesteatoma will include retraction of the pars flaccida.
Secondary acquired cholesteatoma has findings associated with the underlying etiology
A child is diagnosed as having a congenital cholesteatoma. What is included in management
of this condition? (Select all that apply.)
a. Antibacterial treatment
b. Insertion of pressure equalizing tubes (PETs)
c. Irrigation of the ear canal
d. Removal of debris from the ear canal
e. Surgery to remove the lesion
ANS: A, D, E
Cholesteatoma is treated with antibiotics, removal of debris from the ear canal, and possibly
surgery. PETs and irrigation of the ear canal are not part of treatment for cholesteatoma.
A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with this diagnosis? a. Facial palsy and vertigo b. Fluctuating hearing loss and tinnitus c. Spontaneous horizontal nystagmus d. Vertigo with changes in head position
ANS: C
Many patients with vestibular neuritis will exhibit spontaneous horizontal or rotary
nystagmus, away from the affected ear. Facial palsy with vertigo occurs with Ramsay Hunt
syndrome, caused by herpes zoster. Fluctuating hearing loss with tinnitus is common in
Meniere’s disease. Tinnitus may occur with vestibular neuritis but hearing loss does not occur.
Patients with benign paroxysmal positional vertigo will exhibit vertigo associated with
changes in head position
A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea and vomiting. What is part of the initial diagnostic workup for this patient?
a. Audiogram
b. Auditory brainstem testing
c. Electrocochleography
d. Vestibular testing
ANS: A
An audiogram and magnetic resonance imaging (MRI) are part of basic testing for Meniere’s
disease. The other testing may be performed by an otolaryngologist after referral.
- Which symptoms may occur with vestibular neuritis? (Select all that apply.)
a. Disequilibrium
b. Fever
c. Hearing loss
d. Nausea and vomiting
e. Tinnitus
ANS: A, D, E
Vestibular neuritis can cause severe vertigo, disequilibrium, nausea, vomiting, and tinnitus,
but not fever or hearing loss.
An older adult patient has recently experienced weight loss. The patient’s spouse reports
noticing coughing and choking when eating. What is the likely cause of this presentation?
a. Esophageal dysphagia
b. Oral stage dysphagia
c. Pharyngeal dysphagia
d. Xerostomia causing dysphagia
ANS: C
Pharyngeal dysphagia often results from weakness or poor coordination of the pharyngeal
muscles which can cause delayed swallow and failure of airway protection, leading to
coughing and choking. Esophageal dysphagia is associated with pain after swallowing. Oral
stage disorders are related to poor bolus control and result in drooling or spilling. Xerostomia
is when oral mucous membranes are dry.
Which diagnostic study is best to evaluate a swallowing disorder?
a. Computerized tomography (CT) of the head and neck
b. Electroglottography
c. Electron microscopy
d. Videofluoroscopy (VFES)
ANS: D
Videofluoroscopy is the most appropriate because it visualizes the actual swallow.
Electroglottography and electron microscopy may be appropriate but are more limited. CT
evaluation may aid in diagnosis but does not describe the actual swallow mechanism.
A patient experiences a feeding disorder after a stroke that causes disordered tongue function
and impaired laryngeal closure. What intervention will be helpful to reduce complications in
this patient?
a. Surface electrical stimulation
b. Teaching head rotation
c. Thickened liquids
d. Thinning liquids
ANS: C
Thickening liquids is helpful for patients with disordered tongue function and impaired
laryngeal closure, because there is a reduced tendency for liquids to spill over the tongue base
and cause aspiration. Surface electrical stimulation helps improve strength of muscles but
does not address the problem of aspiration. Teaching head rotation is used for patients with
unilateral laryngeal dysfunction. Thinning liquids is used for patients with weak pharyngeal
contraction.
A patient reports a recurrent sensation of spinning associated with nausea and vomiting.
Which test will the provider order to confirm a diagnosis for this patient?
a. Electroencephalogram (ECG)
b. Holter monitoring and electrocardiogram
c. Neuroimaging with computerized tomography (CT)
d. The Hallpike-Dix positioning maneuver
ANS: D
This patient has symptoms consistent with a vestibular lesion, so the provider will order a
Hallpike-Dix positioning maneuver to evaluate vestibular function. If seizure activity is
suspected, an electroencephalogram will be ordered. Holter monitoring and ECG are used if
patients report syncope or lightheadedness. Neuroimaging with CT is used when patients
possibly have a central lesion which would present with difficulty balancing.
An older adult patient reports sensations of being off balance when walking but does not
experience dizziness. The provider will refer this patient to which specialist for further
evaluation?
a. Audiologist
b. Cardiologist
c. Neurologist
d. Otolaryngologist
ANS: C
This patient has problems of balance without dizziness, suggestive of a central neural lesion
and should be referred to a neurologist. Patients with vertigo are likely to have vestibular
dysfunction and would be referred to an otolaryngologist and possibly an audiologist if
hearing is affected. Patients with syncope or lightheadedness are more likely to have an
underlying cardiac disorder and would be referred to a cardiologist.
A patient is taking a sulfonamide antibiotic and develops a rash that begins peeling. Which type of rash is suspected? a. Erythema multiforme b. Stevens-Johnson c. Urticaria d. Wheal and flare
ANS: B
The Stevens-Johnson syndrome rash typically peels in sheets. Erythema multiforme, urticaria,
and wheal and flare rashes do not peel.
A previously healthy patient has an area of inflammation on one leg which has
well-demarcated borders and the presence of lymphangitic streaking. Based on these
symptoms, what is the initial treatment for this infection?
a. Amoxicillin-clavulanate
b. Clindamycin
c. Doxycycline
d. Sulfamethoxazole-trimethoprim
ANS: A
This patient has symptoms consistent with erysipelas, which is commonly caused by
staphylococcal or streptococcal bacteria. These may be treated empirically with
penicillinase-resistant penicillin if not allergic. Clindamycin, doxycycline, and
sulfamethoxazole-trimethoprim are used for methicillin-resistant staphylococcus aureus
infections
A patient has vesiculopustular lesions around the nose and mouth with areas of honey-colored
crusts. The provider notes a few similar lesions on the patient’s hands and legs. Which
treatment is appropriate for this patient?
a. Mupirocin, 2% ointment
b. Culture and sensitivity of the lesions
c. Sulfamethoxazole-trimethoprim
d. Surgical referral
ANS: A
This patient has symptoms of impetigo which has spread to the hands and legs. Mupirocin,
2% ointment, should be applied three times a day for 10 days. It is not necessary to obtain a
culture since this can be treated empirically in most cases. MRSA is unlikely, so
sulfamethoxazole-trimethoprim is not indicated. Surgical referrals are generally not indicated.
A patient with a purulent skin and soft tissue infection (SSTI). A history reveals a previous
MRSA infection in a family member. The clinician performs an incision and drainage of the
lesion and sends a sample to the lab for culture. What is the next step in treating this patient?
a. Apply moist heat until symptoms resolve.
b. Begin treatment with amoxicillin-clavulanate.
c. Prescribe trimethoprim-sulfamethoxazole.
d. Wait for culture results before ordering an antibiotic.
ANS: C
Because of a history of exposure to MRSA, the patient is likely to be colonized and should be
treated accordingly. Small lesions may be treated with moist heat, but the likelihood of MRSA requires treatment. Amoxicillin-clavulanate is not effective for MRSA. Treatment should be
started empirically.
A patient who has never had an outbreak of oral lesions reports a burning sensation on the oral
mucosa and then develops multiple painful round vesicles at the site. A Tzanck culture
confirms HSV-1 infection. What will the provider tell the patient about this condition?
a. Antiviral medications are curative for oral herpes.
b. The initial episode is usually the most severe.
c. There are no specific triggers for this type of herpesvirus.
d. Transmission to others occurs only when lesions are present.
ANS: B
In herpesvirus outbreaks, the initial episode is generally the most severe. Antiviral
medications may prevent outbreaks, but do not cure the disease. HSV-1 has several specific
triggers. Transmission to others may occur even when lesions are not present.
A patient who has had lesions for several days is diagnosed with primary herpes labialis and
asks about using a topical medication. What will the provider tell this patient?
a. Oral antivirals are necessary to treat this type of herpes.
b. Preparations containing salicylic acid are most helpful.
c. Topical medications can have an impact on pain and discomfort.
d. Topical medications will significantly shorten the healing time.
ANS: C
Topical medications may alleviate discomfort, but do not shorten healing time. Oral antivirals
may help shorten healing, but are not necessary as treatment, since the disease is usually
self-limiting. Salicylic acid should not be used because it can erode the skin.
A patient who has recurrent, frequent genital herpes outbreaks asks about therapy to minimize
the episodes. What will the provider recommend as first-line treatment?
a. Acyclovir
b. Famciclovir
c. Topical medications
d. Valacyclovir
ANS: A
All three oral antiviral medications help reduce the number of occurrences and the frequency
of asymptomatic shedding. Famciclovir and valacyclovir are more costly and no more
effective, so should not be first-line therapy. Topical medications are not useful with
recurrent, frequent genital herpes.
