HENT Flashcards
An adolescent patient comes to the clinic with a painful and swollen left ear. The patient reports being struck in that location the previous day during a martial arts class. On examination, the nurse practitioner observes a fluctuant, tender, discolored swelling of the auricle. The patient has a normal temperature, demonstrates no hearing loss, and reports no symptoms other than those related to the ear. What is the most likely diagnosis?
A.Auricular hematoma
B.Cellulitis
C.Mastoiditis
D.Tympanic membrane perforation
Answer: A. Auricular hematoma
The patient’s symptoms, coupled with the recent trauma to the ear, suggest auricular hematoma. This injury is particularly prevalent among participants in combat sports. Cellulitis and mastoiditis could also cause swelling and tenderness, but they are typically associated with skin warmth and sometimes with fever and other systemic symptoms. Additionally, mastoiditis typically presents behind the ear. Tympanic membrane perforation could potentially occur after trauma but would likely present with some degree of hearing loss.
A 12-year-old patient presents with a 6-month history of chronic foul-smelling discharge from the right ear. The parent reports that the child has experienced multiple ear infections in the past. On examination, a perforation of the tympanic membrane is observed in the right ear, with visible drainage. A Rinne test shows bone conduction greater than air conduction in the right ear, and the Weber test lateralizes to the left ear. What is the most appropriate initial treatment for this patient?
A.Cephalexin (Keflex) orally
B.Ciprofloxacin 0.3% otic solution (Cipro) with or without dexamethasone
C.Topical clotrimazole 1% (Lotrimin)
D.Watchful waiting and non-steroidal anti-inflammatory drugs (NSAIDs) for pain
Answer: B. Ciprofloxacin 0.3% otic solution (Cipro) with or without dexamethasone
The presenting symptoms and assessment findings suggest chronic suppurative otitis media. Otic fluoroquinolones such as ciprofloxacin solution are recommended for treating the disorder. Adding a corticosteroid like dexamethasone can reduce inflammation. Systemic antibiotics may sometimes be prescribed instead of an otic solution, but amoxicillin is typically preferred. Cephalexin may not be effective against the causative bacteria. Clotrimazole is an antifungal agent and would not be appropriate for this condition. NSAIDs for pain and watchful waiting may be suitable for mild, uncomplicated ear infections without chronic symptoms or perforation, but in the case of chronic suppurative otitis media, targeted antibiotic therapy is generally required to clear the infection and prevent complications.
Optic neuritis is associated with
MS
A 42-year-old patient presents to the clinic complaining of facial pain and pressure, especially over the cheeks and forehead, which has been worsening for the past 10 days. They initially had symptoms of a viral upper respiratory infection, including nasal congestion and a runny nose, but those seemed to improve after about 5 days. However, the nasal congestion returned and is now associated with thick, yellowish-green nasal discharge. The patient also reports a decreased sense of smell and a low-grade fever for the past 3 days. Physical examination reveals tenderness upon palpation over the maxillary and frontal sinuses. Given the clinical presentation, what is the most appropriate initial treatment?
A.Prescribe a topical nasal corticosteroid spray
B.Recommend a nasal decongestant spray
C.Prescribe oral amoxicillin-clavulanate (Augmentin)
D.Advise saline nasal irrigation and observation
Answer: C. Prescribe oral amoxicillin-clavulanate (Augmentin)
The patient’s presentation strongly suggests acute bacterial rhinosinusitis, and the appropriate first-line antibiotic treatment for adults with this condition is amoxicillin-clavulanate or amoxicillin alone. A topical nasal corticosteroid spray can be an adjunct treatment due to its anti-inflammatory properties, but it does not address the bacterial cause. A nasal decongestant spray can offer symptomatic relief for nasal congestion, but it does not target the underlying bacterial infection and may result in rebound congestion if used for more than a few days consecutively. Saline nasal irrigation can provide symptomatic relief, but without antibiotic intervention, the bacterial infection may persist or worsen. Given the duration and the nature of the symptoms, antibiotic therapy with amoxicillin-clavulanate is the most appropriate choice.
A 35-year-old patient presents with complaints of sudden vision loss in the left eye over the past week. They describe a central blind spot that has progressively worsened. The vision loss is accompanied by pain upon eye movement. They recall transient episodes of numbness in their legs and fatigue over the past year. Their family history reveals an aunt diagnosed with multiple sclerosis (MS). Which of the following is the most appropriate next step in management?
A.Prescribe oral corticosteroids and monitor for improvement
B.Refer to an ophthalmologist for further assessment
C.Order a complete blood count (CBC) to evaluate for systemic conditions
D.Refer to a neurologist for comprehensive evaluation and potential MRI
Answer: D. Refer to a neurologist for comprehensive evaluation and potential MRI
The patient’s symptoms, which include vision loss, pain with eye movement, and a history of transient numbness, are suggestive of optic neuritis—a condition commonly associated with MS. Given the complexity of the presentation and the potential for MS, a referral to a neurologist is most appropriate. A neurologist can conduct a comprehensive evaluation, which may include an MRI of the brain and optic nerves, lumbar puncture, and other relevant tests. While ophthalmologists are experts in eye conditions, the potential neurological connection necessitates a neurologist’s expertise. Oral corticosteroids might be used in the management of optic neuritis but are premature without a comprehensive evaluation. A CBC may assess for systemic conditions, but it is not specific to the patient’s presentation and would not provide insight into the potential diagnosis of optic neuritis or MS.
A 6-year-old patient is evaluated for potential hearing loss. A tuning fork test is administered. The Weber test lateralizes to the left ear, and the Rinne test indicates air conduction (AC) better than bone conduction (BC) bilaterally. Based on these findings, what is the most likely type and site of the patient’s hearing impairment?
A.Sensorineural hearing loss in the left ear
B.Sensorineural hearing loss in the right ear
C.Conductive hearing loss in the left ear
D.Conductive hearing loss in the right ear
Answer: B. Sensorineural hearing loss in the right ear
If the Rinne test shows that AC is better than BC bilaterally, any hearing loss must be sensorineural. In sensorineural hearing loss, the Weber test shows toward the “good” ear. Since this patient demonstrates AC>BC and lateralization toward the left ear, the patient is experiencing sensorineural hearing loss in the right ear. Sensorineural hearing loss in the left ear would be indicated by AC>BC and lateralization toward the right ear. Conductive hearing loss would be indicated by BC>AC and either lateralization toward the left ear (for conductive loss in the left ear) or lateralization toward the right ear (for conductive loss in the right ear).
A 52-year-old patient comes to the clinic complaining of gradually worsening unilateral hearing loss in the right ear over the past 18 months. Recently, the patient has started to experience episodes of dizziness and has occasionally felt off-balance. They also mention a persistent ringing sound in the affected ear and minor numbness in the face. They deny any history of ear infections, trauma, or loud noise exposure. On examination, the tympanic membrane appears normal, and there is no evidence of middle ear effusion. Weber’s test shows lateralization to the left ear, and Rinne’s test confirms sensorineural hearing loss in the right ear. Which of the following conditions should be highly suspected?
A.Otitis media with effusion
B.Presbycusis
C.Meniere’s disease
D.Acoustic neuroma
Answer: D. Acoustic neuroma
Acoustic neuroma (also known as vestibular schwannoma) is a benign tumor that develops on the vestibulocochlear nerve leading from the inner ear to the brain. Its typical presentation includes unilateral sensorineural hearing loss, tinnitus, and balance issues, all of which the patient is experiencing. Facial numbness or weakness can occur if the tumor affects the facial nerve. Acoustic neuroma necessitates specialist referral for diagnosis and treatment. Otitis media with effusion would typically present with a middle ear effusion, which the patient does not have. Presbycusis is age-related bilateral hearing loss; the patient’s symptoms are unilateral. Meniere’s disease can cause tinnitus, vertigo, and hearing loss but usually presents with episodic severe vertigo and a feeling of fullness or pressure in the ear, which the patient has not mentioned.
A 7-year-old patient, who was recently adopted from an overseas orphanage and has an unclear vaccination history, presents with a 4-day history of malaise, fever, and sore throat. Examination reveals a grayish pseudomembrane covering the tonsils and pharynx, mild stridor, and cervical lymphadenopathy, which together suggest a potential diagnosis of diphtheria. Laboratory tests confirm the presence of Corynebacterium diphtheriae. The patient’s vital signs are stable, and there are no signs of severe respiratory distress. Considering the diagnosis and the current clinical status, which of the following treatment strategies is most appropriate?
A.Administer intramuscular diphtheria antitoxin and prescribe oral antibiotics
B.Refer for hospitalization and intravenous antibiotics administration
C.Initiate corticosteroid therapy to reduce pharyngeal inflammation
D.Administer a diphtheria booster vaccine and provide supportive care
Answer: A. Administer intramuscular diphtheria antitoxin and prescribe oral antibiotics
For a confirmed case of diphtheria, the primary initial intervention is administration of diphtheria antitoxin to neutralize the toxin produced by Corynebacterium diphtheriae. This antitoxin is given intramuscularly. Concurrently, antibiotics, such as penicillin or erythromycin, are prescribed to eliminate the bacteria and prevent transmission. Referring for hospitalization and initiating intravenous antibiotics may be considered in severe cases but may not address the toxin’s effects directly, making the combination of antitoxin and oral antibiotics a more comprehensive approach. Corticosteroid therapy might be used in some infections to reduce inflammation, but it is not a first-line treatment for diphtheria. Administering a diphtheria booster vaccine is an essential preventive measure but does not address the active infection; moreover, supportive care alone is not adequate in treating diphtheria due to its potential complications.
Which method is most appropriate to evaluate the effectiveness of allergen immunotherapy in a patient with allergic rhinitis?
A.Measurement of specific IgE levels
B.Allergy symptom diary
C.Nasal endoscopy
D.Skin prick test
Answer: B. Allergy symptom diary
Evaluating the effectiveness of allergen immunotherapy in a patient with allergic rhinitis can be done using an allergy symptom diary. The patient can record their symptoms over time to assess the improvement or reduction in allergic symptoms, such as nasal congestion, sneezing, and itching. This subjective self-reporting allows for a comprehensive assessment of the treatment’s efficacy. Measurement of specific immunoglobulin E (IgE) levels can aid in the diagnosis of allergies and identify sensitization to specific allergens but may not directly reflect overall treatment success or symptom improvement. Nasal endoscopy is a procedure used to visualize the nasal passages and assess for any anatomical abnormalities or signs of inflammation; it is not specifically used to evaluate treatment success. Skin prick tests are useful for diagnosing immediate hypersensitivity reactions and identifying specific allergens but may not directly indicate treatment effectiveness in allergic rhinitis.
A patient with a history of ankylosing spondylitis presents with eye pain and redness. Slit examination reveals the presence of leukocytes in the anterior chamber. This finding suggest which disease?
A.Optic neuritis
B.Subconjunctival hemorrhage
C.Anterior uveitis
D.Orbital cellulitis
Answer: C. Anterior uveitis
Anterior uveitis is characterized by pain and redness (primarily at the junction between the cornea and the sclera) and the presence of leukocytes in the anterior chamber of the eye on slit lamp examination. Visual loss may vary. Uveitis is often a manifestation of many systemic inflammatory conditions, including spondyloarthritis (such as ankylosing spondylitis and reactive arthritis), sarcoidosis, and other systemic and rheumatic diseases. Optic neuritis presents as painful, monocular visual loss over several hours to a few days. Orbital cellulitis is characterized by eyelid swelling, pain with eye movements, proptosis, and chemosis. Subconjunctival hemorrhage is often caused by a trauma or contact lens use and presents as a focal, flat, red region on the ocular surface due to blood collection between the sclera and the conjunctiva.
Which of the following is a key characteristic of contact lens–related keratitis in a patient with prolonged contact lens wear?
A.Purulent discharge with morning eyelid crusting
B.Corneal haziness with focal white infiltrates
C.Bilateral itching with watery discharge
D.Vesicular eyelid lesions with dendritic corneal ulcers
Which of the following is a key characteristic of contact lens–related keratitis in a patient with prolonged contact lens wear?
A.Purulent discharge with morning eyelid crusting
B.Corneal haziness with focal white infiltrates
C.Bilateral itching with watery discharge
D.Vesicular eyelid lesions with dendritic corneal ulcers
An adult patient presents with complaints of eye redness, sensitivity to light, and blurred vision in one eye over the past week. During the examination, the nurse practitioner notices a constricted pupil and irregularities in the shape of the pupil in the affected eye. The patient also reports a history of joint pain and has been previously diagnosed with an autoimmune disorder. What is the appropriate action?
A.Perform a tear film test
B.Perform a slit-lamp examination
C.Order an MRI of the brain
D.Refer to an ophthalmologist immediately
D.Refer to an ophthalmologist immediately
The patient’s symptoms, including eye redness, sensitivity to light, and blurred vision, are consistent with uveitis, which requires rapid referral to an opthamologist. A constricted and irregularly shaped pupil may also be a sign of this condition. The patient’s history of joint pain and autoimmune disorder adds further support to the diagnosis, as uveitis can be associated with various systemic inflammatory conditions.
A 35-year-old patient presents to the clinic with a 3-week history of “fullness” and “muffled hearing” in the left ear, which is particularly noticeable while they are speaking on the phone. They deny any significant pain, fever, or discharge from the ear. On examination, the tympanic membrane appears dull and retracted without any signs of acute inflammation. Light reflex is difficult to identify, and there is reduced mobility of the tympanic membrane on pneumatic otoscopy. What is the most appropriate next step in management of the patient’s condition?
A.Prescribe oral antibiotics
B.Recommend watchful waiting and follow up in 3 to 4 weeks
C.Administer a nasal steroid spray and provide instructions for its use
D.Initiate oral steroids
Answer: B. Recommend watchful waiting and follow up in 3 to 4 weeks
The patient’s clinical presentation is consistent with otitis media with effusion (OME). The approach to management often depends on the duration and severity of symptoms, along with any associated complications. In many adults with OME, the condition is self-limited and may resolve without specific treatment. Given that the patient lacks signs of acute infection and does not describe significant pain or other complications, watchful waiting and a follow-up in 3 to 4 weeks is a prudent approach. Prescribing oral antibiotics is not recommended unless there is clear evidence of bacterial infection. Nasal steroid sprays can sometimes be considered in OME to decrease nasal inflammation and promote eustachian tube function, but the evidence for their efficacy in adults is limited. Oral steroids are not a primary treatment for OME and are not recommended without specific indications. The watchful waiting approach allows for spontaneous resolution, with a planned reassessment to ensure there is no progression or persistence of the effusion.
A patient presents with difficulty reading signs that are far away. The patient reports that “things look blurry” until they are able to get close enough to read clearly. This presentation suggests the patient is likely experiencing:
A.Hyperopia
B.Amblyopia
C.Presbyopia
D.Myopia
.Myopia
