Module 4 EENT Practice Questions

Question 1

Which of the following would you expect in a patient with acute otitis media?

• Fluid in the middle ear for at least 3 months
• Fluid in the middle ear and a tympanic membrane that is translucent
• Erythema of the ear canal and a grey tympanic membrane
• An erythematous, opaque tympanic membrane

Answer 1

An erythematous, opaque tympanic membrane

Question 2

The first-line antibiotic therapy for an adult with no known drug allergies and suspected group A beta hemolytic streptococcal pharyngitis is

Answer 2

Penicillin

Question 3

What evidence-based tool was developed to assist clinical decision-making when caring for a patient complaining of a sore throat?

Answer 3

Centor score

Question 4

A patient presents for their annual GYN visit. They report waking up yesterday with redness in their left eye. Subjective data also includes - constant watery discharge from the left eye, a feeling of sand in the eye, and they are unable to wear contacts due to discomfort the need to rub their eye. What is the most appropriate plan for this patient?

Answer 4

Review hand hygiene, use of cold compresses and recommend wearing glasses until the symptoms have subsided

Question 5

A patient presents with sudden and severe pain in the right eye after the eyes were dilated for a vision exam. Physical exam findings: the eye is red, with a rainbow-like halo around the pupil and a cloudy cornea. What should the NP do next?

Answer 5

Urgent referral to an ophthalmologist

Question 6

A patient presents with eye irritation. They report their eye was “pasted shut” this morning on arising and is itching and painful. On exam the eye is noted to have conjunctival erythema and purulent discharge. The patient denies any previous occurrence of any similar conditions and denies any allergies. What treatment plan should you initiate based on the subjective and objective data provided?

Answer 6

Topical antibiotics to the affected eye four times a day for 1 week

Question 7

An 18-year-old college freshman is complaining of headache, fatigue, malaise, sore throat, fever, lack of appetite, and “swollen glands.” They also report feeling “ill” with a headache and fatigue before the sore throat started. Vital signs: T-102.1*F, R-20, P-94, BP-124/70. Swollen, tender cervical lymph nodes, swollen red tonsils, and petechiae on the palate. What is the most likely diagnosis?

Answer 7

Infectious Mononucleosis

Question 8

While performing the Rinne test during a physical examination, the patient reports the sound lateralizes to the left ear, with air conduction being greater than bone conduction. This would indicate:

Answer 8

Sensorineural loss in the right ear

Question 9

A patient presents to the clinic. Physical exam findings show mild seborrhea and inflammation of the eyelids that affects only the eyelash hair follicles. There is no ulceration or masses in the eyelids, and the pre-auricular lymph nodes are non-palpable. What is the best treatment for this client?

Answer 9

Dilute baby shampoo for lid cleansing and warm moist soaks

Question 10

An 18-year-old complains of cold symptoms, headache, nasal congestion, sore throat and “throbbing” of the ear at night for 3-4 days, . The patient admits to muffled hearing but denies ringing in the ears. Vital signs: T101.0*F; R:20; P:84; BP: 110/72 What physical assessments should be performed to accurately diagnose the ear problem?

Answer 10

Examine mouth, eyes, and nose for lesions, appearance and hydration status. Palpate frontal and maxillary sinuses. Palpate pre and post auricular lymph nodes and her cervical lymph nodes. Perform an otoscopic examination of both ears and assess tympanic membrane position, translucency, mobility, color, and fluid level.

Question 11

An 18-year-old has had cold symptoms including headache, nasal congestion, and sore throat for 6 days and was seen in clinic 3 days ago for right ear “throbbing.” Physical Exam: right tympanic membrane is red, bulging, and immobile, and purulent fluid is visible behind the membrane. VS: T-102.4*F; R-22; P-88; BP- 130/76. What is the best management plan?

Answer 11

Prescribe Amoxicillin 500 mg bid X 7 days

Question 12

During an annual exam, a patient reports painful sores inside their mouth “every couple of months” and currently has several painful, shallow ulcerations on the oral mucosa. History is negative for the use of tobacco in any form, alcohol, or recreational drugs. Patient is healthy, has no dental appliances, and takes no medications. Physical exam includes: BP 110/68, P-72, R-16, T-98.6*F, and several lesions with a gray-yellow base surrounded by erythema and sizes ranging between 3mm and 8mm. What is your management plan?

Answer 12

Prescribe Dexamethasone elixir 0.5mg/ml strength, to use 5-mL of elixir as swish and spit, four times a day

Question 13

A 25-year-old patient presents to the clinic with complaints of itchy, runny nose, sneezing, and watery, itching eyes. The patient reports the condition worsens in the spring but denies fever or headache. What pharmacological treatment options are the appropriate for this patient?

Answer 13

First generation antihistamines, second generation antihistamines and intranasal steroids

Question 14

A 40-year-old teacher presents to the clinic complaining of a frontal headache x two days. Other symptoms include nasal congestion, sore throat, and yellow nasal drainage. The patient also reports a recent “cold”. Physical exam includes: BP 124/78, P 88, R 20, T 100.1*F, general survey includes speech with a hyponasal quality, no facial asymmetry, and minimal periorbital edema. The headache worsens with bending forward. No polyps or obstructions visible in the nares. Teeth are intact with no visible caries.What is the management plan today?

Answer 14

Watchful waiting

Question 15

What pharmacological management options are available to a patient with blepharitis?

Answer 15

Antibiotic ointment :Erythromycin / bacitracin 0.3 % tobrex ophthalmic soln. 2x/d for 7-10 days

Question 16

What non-pharmacological management options are available to a patient with blepharitis?

Answer 16

Hygiene, warm compresses(diluted baby shampoo) for 5-10m

Question 17

What are the risk factors for bacterial conjunctivitis?

Answer 17

Spread by infectious persons with Haemeophilus influenza or strep.

Also consider STI: chlamydial, gonococcal

Question 18

What are the risk factors for viral conjunctivitis?

Answer 18

Aenovirus, HSV, molluscum contagiosum

Seen in children direct contact with infectious persons, crowded areas

Question 19

What are the risk factors for allergic conjunctivitis?

Answer 19

people that suffer from allergies, environmental, ragweed, household chemicals, pet dander

Question 20

What objective data may we see with otitis externa?

Answer 20

Pain/tenderness of auricle and/or tragus
Erythema and edema of canal
Debris and sloughing tissue in canal 
TM erythematous
Dry canal 
Cerumen that is light brown or golden and flaky 
Narrow canal

Question 21

What subjective data may we see with otitis media?

Answer 21

ear pain on the inside 
fever 
Worse pain when prone (face down)
Tinnitus
nasal congestion 
hearing loss 
recent ear infection or URI 
in severe cases nausea and diarrhea

Question 22

What objective data may we see with otitis media?

Answer 22

fluid behind the tympanic membrane
TM bulging and obscured landmarks
Drainage=possible perforation
tympanic membrane may be grey to red in color

Question 23

What pharmacological management options are available to a patient with otitis media?

Answer 23

OTC NSAIDS

1st line tx: amoxicillin (PCN) if allergic Cefdinir( cephalosporin)

Question 24

What do we know are some complications of untreated or recurrent cases of otitis media?

Answer 24

perforated eardrum (most common complication)
Otitis Media with Effusion (OME)

Question 25

At what point would the APRN transfer care of the patient with otitis media?

Answer 25

tympanic membrane perforation
Unresponsive to antibiotics after 48-72 hrs
facial nerve paralysis
focal neurological signs
pain, swelling behind the ear after developing otitis media
new onset vertigo= mastoid/labyrinthitis, imaging is required

Question 26

What would we tell the patient who asks about returning to work with otitis media? Are they contagious? What about hearing impairment?

Answer 26

They can return to work once symptoms have resolved, and they are not contagious. The hearing loss can last for a while and take weeks to resolve.

Question 27

Can you list some complications for the patient diagnosed with otitis externa?

Answer 27

***Hearing loss
malignant otitis externa
bacterial infection that extends into the cartilage and bone. This is life threatening

Question 28

What is the pathophysiology of epistaxis?

Answer 28

Caused by broken capillaries in the nose. Nose bleeds often occur in the front of the nasal septum.

Many nose bleeds occur from irritants such as: allergies, trauma, blowing forcefully, nose picking, foreign bodies, neoplasm, ETOH or drug use.

Question 29

What differential diagnoses are important when considering rhinitis in a patient?

Answer 29

nasal septal trauma
Drug use
intranasal masses or tumors

Question 30

What patient teaching should be covered for rhinitis?

Answer 30

avoid irritants (wear a mask if possible)
use saline nasal sprays (this is safe in pregnancy)
control environmental conditions if possible
Use nasal inhaler correctly
Decongestants inly for 3 days max
can use antihistamines. 1st generation safe in pregnancy but can be sedating. Do not use decongestants in pregnancy, especially during the first trimester. Second generation antihistamine Zyrtec is safe in pregnancy

Question 31

What group of medications for rhinitis do we not want to use during the first trimester of pregnancy?

Answer 31

Decongestants as there is a risk of birth defects.

Question 32

List the education for a patient regarding the proper way to use nasal steroids.

Answer 32

• shake the bottle and prime before using spray (spray into the air a few times)
• blow nose before spraying
• keep head upright and aim nozzle toward the outer wall of the nostril
• use a finger to close off the nostril that is not getting any medication
• gently sniff NOT SNORT as medication is sprayed by breathing in slowly
• do not blow nose for up to 10 minutes and try not to sneeze
• clean sprayer once a week

Question 33

What is the pharmacological management for a patient with viral pharyngitis?

Answer 33

throat lozenges
NSAIDs
possible dexamethasone to relive pain (controversial)

Question 34

What is the pharmacological management for a patient with bacterial pharyngitis?

Answer 34

pen V (first treatment choice)
amoxicillin (pcn drug class) 
 if allergic to penicillin then give: cephalexin (cephalosporin), azithromycin (macrolide) , or clindamycin (macrolide)

Question 35

How does the clinical presentation differ in viral and bacterial pharyngitis?

Answer 35

Viral: Malaise & myalgias, Cough , Fatigue, May have rhinitis, conjunctivitis, congestion & sputum w/cough, Mily erythema, Little or no exudate, Pharynx may be swollen or pale

Bacterial: Patchy white or yellow exudate, Pharyngeal petechiae, Tender anterior cervical, Adenopathy, + RADT (Rapid GAS test), Nausea/vomiting, May have abdominal pain. Erythema of throat and tonsils

Question 36

What is the clinical presentation you would expect to see in a patient with suspected aphthous ulcers?

Answer 36

oral or round ulcers in the mouth
yellow-white-or grey membranes
Locations: buccal mucosa, lateral or ventral side of the tongue, floor of the mouth, soft palate, and/ or oropharynx, lips

Question 37

What virus is usually the culprit of aphthous ulcers?

Answer 37

HSV

Question 38

What subjective data would you expect from a patient with suspected mononucleosis?

Answer 38

gradual onset, fever, fatigue, body aches, sore throat

Question 39

What objective data would you expect from a patient with suspected mononucleosis?

Answer 39

high fever, pharyngal erythema, tonsillar hypertrophy, white-green-or grey exudate, petechiae on hard palate junction, anterior and posterior cervical adenopathy, rash/jaundice

Question 40

In what age group of patients do we often find mononucleosis?

Answer 40

Teens