Problems of the Eye, Ear, Nose, & Throat Flashcards
Sharon, age 29, is pregnant for the first time. She complains of nasal stuffiness and occasional epistaxis. What do you do?
A. Order lab tests, such as a CBC with differential, hemoglobin and hematocrit
B. Prescribe an antihistamine
C. You do nothing except for client teaching
D. Refer the client to an ear, nose and throat specialist
C. You do nothing except for client teaching
David, age 32, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action?
A. Prescribe nasal steroids and oral decongestants
B. Prescribe antibiotic eardrops
C. Prescribe systemic eardrops
D. Refer David to an ear, nose, and throat specialist
A. Prescribe nasal steroids and oral decongestants
A sexual history of oral-genital contact in a client presenting with pharyngitis is significant when which of the following organisms is suspected? A. Escherichia coli B. Haemophilus influenzae C. Neisseria gonorrhoeae D. Streptococcus pneumoniae
C. Neisseria gonorrhoeae
The most common cause of sensoineural hearing loss is
A. Trauma
B. Tympanic membrane sclerosis and scarring
C. Otosclerosis
D. Presbycusis
D. Presbycusis
How do you describe the cervical lymphadenopathy associated with asymptomatic HIV infection?
A. Movable, discrete, soft, and nontender lymph nodes
B. Enlarged, warm, tender, firm, but freely movable lymph nodes
C. Hard, unilateral, nontender, and fixed lymph nodes
D. Firm but not hard, nontender, and mobile lymph nodes
D. Firm but not hard, nontender, and mobile lymph nodes
You diagnose acute epiglottitis in Sally, age 5, and immediately send her to the local emergeny room. Which of the following symptoms would indicate that an airway obstruction is imminent? A. Reddened face B. Screaming C. Grabbing her throat D. Stridor
D. Stridor
Purulent matter in the anterior chamber of the eye is called A. Hyphema B. Hypopyon C. Anisocoria D. Pterygium
B. Hypopyon
A 42 year old stockbroker comes to your office for evaluation of a pulsating headache over the left temporal region and he rates the pain as an 8 on a scale of 1-10. The pain has been constant for the past several hours and is accompanied by nausea and sensitivity to light. He has had frequent headaches for many years but not as severe and they are usually relieved by over the counter medicines. He is unclear as to a precipitating event but notes that he has had visual disturbances before each headache and has been under a lot of stress in his job. Based on this description, what is the most likely diagnosis of this type of headaache? A. Tension B. Migraine C. Cluster D. Temporal arteritis
B. Migraine
The trachea deviates toward the affected side in all of the following except A. Aortic aneurysm B. Unilateral thyroid lobe enlargement C. Large atelectasis D. Pneumothorax
C. Large atelectasis
Matthew, age 52, has allergic rhinitis and would like some medicine to relieve his symptoms. He is taking cimetidine (Tagamet) for gastroesophageal reflux disease. Which medication would you not order? A. A first-generation antihistamine B. A second-generation antihistamine C. A decongestant D. A topical nasal corticosteroid
B. A second-generation antihistamine
Jessica, an 8 year old third grader is broght to the office by her grandmother, who is the child's babysitter. She has complained of fever and sore throat for the past 2 days. Five other children in her class have been sick with sore throats. She denies difficulty swallowing and has been drinking fluids but has no appetite. ROS reveals that she has clear nasal drainage, hoarseness, and nonproductive cough. She denies vomiting but has had mild diarrhea. On examination she has a temperature of 101.5 F, 3+ erythematous tonsils, and palpable, tender cervical lymph nodes. Based on these findings, what is the most likely diagnosis? A. Mono B. Sinusitis C. Strep pharyngitis D. Viral pharyngitis
D. Viral pharyngitis
Marcia, age 4, is brought into the office by her mother. She has a sore throat, difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and a temperature of 102 F but no pharyngeal erythema or cough. What do you suspect?
A. Epiglottitis
B. Group A beta-hemolytic streptococcal infection pharyngitis
C. Tonsillitis
D. Diphtheria
A. Epiglottitis
You note a completely split uvula in Noi, a 42 year old Asian. What is your next course of action? A. Do nothing B. Refer Noi to a specialist C. Perform a throat culture D. Order a CBC
A. Do nothing
Claude, age 78, is being treated with timolol maleate (Timoptic) drops for his chronic open-angle glaucoma. While performing a new client history and physical, you note that he is taking other medications. Which medication would you be most concerned about?
A. Apsirin therapy as prophylaxis for heart attack
B. Ranitidine (Zantac) for gastroesophageal reflux disease
C. Alprazolam (Xanax), an anxiolytic for anxiety
D. Atenolol (Tenormin), a beta blocker for high blood pressure
D. Atenolol (Tenormin), a beta blocker for high blood pressure
Harry, age 69, has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?
A. A labyrinthectomy
B. Pharmacological therapy
C. A vestibular neurectomy
D. Wearing an earplug in the ear with the most hearing loss
C. A vestibular neurectomy
A 65 year old man presents complaining of left sided deep, throbbing headache along with mild fatigue. On examination the client has a tender, tortuous temporal artery. You suspect temporal arteritis. How do you confirm your diagnosis? A. MRI fo the head B. Erythrocyte sedimentation rate (ESR) C. EEG D. Otoscopy
B. Erythrocyte sedimentation rate (ESR)
Marty has a hordeolum in his right eye. You suspect that the offending organism is A. Herpes simplex virus B. Staphylococcus C. Candida albicans D. Escherichia coli
B. Staphylococcus
The most common offending allergens causing allergic rhinitis are A. Pollens of grasses, trees and weeds B. Fungi C. Animal allergens D. Food sensitivity
A. Pollens of grasses, trees and weeds
Cydney, age 7, is complaining that she feels as though something is stuck in her ear. What action is contraindicated?
A. Inspecting the ear canal with an otoscope
B. Using a small suction device to try to remove the object
C. Flushing the ear with water
D. Instilling several drops of mineral oil in the ear
C. Flushing the ear with water
June, age 50, presents with soft, raised, yellow plaques on her eyelids at the inner canthus. She is concerned that they may be cancerous skin lesions. You tell her they are probably A. Xanthelasmas B. Pingueculae C. The result of arcus senilis D. Actinic keratoses
A. Xanthelasmas
Mavis is 70 years old and wonders if she can donate her corneas when she dies. How do you respond?
A. “As long as you don’t have any chronic illness, you corneas may be harvested.”
B. “They will use corneas only from persons younger than age 65.”
C. “What makes you feel like you are dying?”
D. “Don’t think about such terrible things now.”
B. “They will use corneas only from persons younger than age 65.”
Manny, age 16, was hit in the eye with a baseball. He developed pain in the eye, decreased visual acuity, and injection of the globe. You confirm the diagnosis of hyphema by finding blood in the anterior chamber. What treatment would you recommend while Manny is waiting to see the ophthalmologist?
A. Apply bilateral eye patches
B. Have Manny lie flat
C. Refer him to an ophthalmologist within a week
D. Make sure Manny is able to be awakened every 30 minutes
A. Apply bilateral eye patches
Judy, age 67, complains of a sudden onset of impaired vision, severe eye pain, vomiting, and a headache. You diagnose the following condition and refer for urgent treatment A. Cataracts B. Macular degeneration C. Presbyopia D. Acute glaucoma
D. Acute glaucoma
Which of the following refractive errors in vision is a result of the natural loss of accomodative capacity with age? A. Presbyopia B. Hyperopia C. Myopia D. Astigmatism
A. Presbyopia
The leading cause of blindness in persons age 20-60 in the United States is A. Macular degeneration B. Glaucoma C. Diabetic retinopathy D. Trauma
C. Diabetic retinopathy
A 62 year old obese woman comes in today complaining of difficulty swallowing for the past 3 weeks. She states that “some foods get stuck” and she has been having “heartburn” at night when she lies down, especially if she has had a heavy meal. Occasionally she will awake at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements. She does not drink or smoke. There is no pertinent family history or findings on review of systems (ROS). Physical examination is normal with no abdominal tenderness, and the stool is OB negative. What is the most likely diagnosis?
A. Esophageal varices
B. Esophageal cancer
C. Gastroesophageal reflux disease (GERD)
D. Peptic ulcer disease
C. Gastroesophageal reflux disease (GERD)
Martin, age 24, presents with an erythematous ear canal, pain, and a recent history of swimming. What do you suspect? A. Acute otitis media B. Chronic otitis media C. External otitis D. Temporomandibular joint syndrome
C. External otitis
Barbara, age 72, states that she was told she had atrophic macular degeneration and asks you if there is any treatment. How do you respond?
A. “No, but 5 years from the time of the first symptoms, the process usually stops.”
B. “Yes, there is a surgical procedure that will cure this.”
C. “If we start medications now, they may prevent any further damage.”
D. “Unfortunately, there is no effective treatment, but I can refer you to a rehabilitation agency that can help you adjust to the visual loss.”
D. “Unfortunately, there is no effective treatment, but I can refer you to a rehabilitation agency that can help you adjust to the visual loss.”
Natasha, age 4, has amblyopia. How do you respond when her mother asks about treatment?
A. “We’ll wait until she’s 7 years old before starting treatment.”
B. “Treatment needs to be started now. We’ll cover her ‘bad’ eye.”
C. “Treatment needs to be started now. We’ll cover her ‘good’ eye.”
D. “No treatment is necessary. She’ll outgrow this.”
C. “Treatment needs to be started now. We’ll cover her ‘good’ eye.”
When Judith, age 15, asks you to explain the 20/50 vision in her right eye, you respond
A. “You can see at 20ft with your left eye what the normal person can see at 50ft.”
B. “You can see at 20ft with your right eye what the normal person can see at 50ft.”
C. “You can see at 50ft with your right eye what the normal person can see at 20ft.”
D. “You can see at 50ft with the left eye what the normal person can see at 20ft.”
B. “You can see at 20ft with your right eye what the normal person can see at 50ft.”
Risk factors for oral cancers include
A. A family history, poor dental habits, and use of alcohol
B. Obesity, sedentary lifestyle, and chewing tobacco
C. A history of diabetes, smoking, and a high fat intake
D. Smoking, use of alcohol, and chewing tobacco
D. Smoking, use of alcohol, and chewing tobacco
When you are assessing the internal structure of the eye, absence of a red reflex may indicate
A. A cataract or a hemorrhage into the vitreous humor
B. Acute iritis
C. Nothing, this is a normal finding in older adults
D. Diabetes or long-standing hypertension
A. A cataract or a hemorrhage into the vitreous humor
The immediate goal of myringotomy and tube placement in a child with recurrent episodes of otitis media is to
A. Prevent future infections
B. Have an open access to the middle ear for irrigation and instillation of antibiotics
C. Allow removal of suppurative or mucoid material
D. Relieve pain
C. Allow removal of suppurative or mucoid material
A 22 year old client who plays in a rock band complains that he finds it difficult to understand his fellow musicians at the end of a night of performing, a problem that is compounded by the noisy environment of the "club." These symptoms are most characteristic of which of the following? A. Sensorineural loss B. Conductive loss C. Tinnitus D. Vertigo
A. Sensorineural loss
With a chronic allergy, a client's nasal mucosa appear A. Swollen and red B. Swollen, boggy, pale and gray C. Hard, pale, and inflamed D. Bright pink and inflamed
B. Swollen, boggy, pale and gray
When a practitioner places a vibrating tuning fork in the midline of a client's skull and asks if the tone sounds the same in both ears or is better in one, the examiner is performing A. The Rinne test B. The Weber test C. The caloric test D. A hearing acuity test
B. The Weber test
How should Tommy, age 2 1/2, have his vision screened? A. Using a Snellen letter chart B. Using the Allen test C. Using a Snellen E chart D. Using a Rosebaum chart
B. Using the Allen test
What therapy has proved beneficial for long-term symptom relief of tinnitus? A. Aspirin B. Lidocaine C. Cognitive behavioral therapy D. Corticosporin otic gtts PRN
C. Cognitive behavioral therapy
Jill presents with symptoms of hay fever and you assess the nasal mucosa of her turbinates to be pale. What diagnosis do you suspect? A. Allergic rhinitis B. Viral rhinitis C. Nasal polyps D. Nasal vestibulitis from folliculitis
A. Allergic rhinitis
Which method can be safely used to remove cerumen in a 12 month old child’s ear?
A. A size 2 ear curette
B. Irrigation using hot water from a 3cc syringe
C. A commercial jet tooth cleaner
D. Cerumen should not be removed from a child this young
C. A commercial jet tooth cleaner
Mark, age 18, has a persistent sore throat, fever, and malaise not relieved with penicillin therapy. What do you order next? A. A throat culture B. A monospot test C. A rapid antigen test D. A Thayer-Martin plate test
B. A monospot test
You have made a diagnosis of acute sinusitis based on Martha's history and the fact that she complains of pain behind her eye. Which sinuses are affected? A. Maxillary B. Ethmoid C. Frontal D. Sphenoid
B. Ethmoid
- Maxillary sinus pain is over the cheek and into the upper teeth
- Frontal sinus pain is over the lower forehead
- Sphenoid sinus pain is in the occiput, vertex, or middle of the head
In older adults, the most common cause of decreased visual functioning is A. Cataract formation B. Glaucoma C. Macular degeneration D. Arcus senilis
A. Cataract formation
Greg, age 72, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Greg reports that his vision is "like looking through a veil." He also sees floaters and flashing lights but is not having eye pain. What do you suspect? A. Cataracts B. Glaucoma C. Retinal detachment D. Iritis
C. Retinal detachment
Maggie, a 56 year old woman, comes to the office requesting a test for thyroid disease. She has had some weight gain since menopause and she read on the internet that all women should have a thyroid test. Based on the recommendations from the U.S. Preventive Service Task Force, which one of the following statements should be considered in this woman’s care?
A. All adults should be screened for thyroid disease
B. Evidence is insufficient for or against routine screening for thyroid disease in asymptomatic adults
C. All adults older than 50 should be screened for thyroid disease
D. All perimenopausal women should be screened for thyroid disease
B. Evidence is insufficient for or against routine screening for thyroid disease in asymptomatic adults
A child's head circumference is routinely measured at each well-child visit until age A. 12 months B. 18 months C. 2 years D. 5 years
C. 2 years
