Seidel chapter 13

Question 1

In adults, the length of the external auditory canal is ___ cm.

a. 0.5
b. 1
c. 2.5
d. 4
e. 5

Answer 1

C. 2.5 cm in adults

Question 2

The middle ear contains the

a. cerumen and sebaceous glands.
b. umbo and malleus.
c. vestibule and cochlea.
d. pars tensa and semicircular canals.
e. helix and antihelix

Answer 2

B umbo and malleus
The middle ear contains the ossicles, which are three small bones: the malleus (the umbo is part of the malleus), the incus, and the stapes. The tympanic membrane separates the external ear from the middle ear and is composed of the pars tensa. Cerumen and sebaceous glands lie outside the middle ear; the semicircular canals, vestibule, and cochlea lie in the inner ear. The helix and antihelix are parts of the auricle.

Question 3

The middle ear is normally filled with

a. mucous collection
b. blodd
c. serousfluid
d. cerebrospinal fluid
e. air

Answer 3

E

Question 4

The hair cells of Corti and membrane of Corti

a. maintain equilibrium
b. protect the ear from foreign particles
c. stimulate the eighth cranial nerve
d. transmit vibrations to the ossicles
e. produce a waxy lubricant

Answer 4

C
Vibrations from the tympanic membrane cause the delicate hair cells of the organ of Corti to strike against the membrane of Corti, stimulating impulses in the sensory endings of the auditory division of the eighth cranial nerve

Question 5

The organ of Corti is a coiled structure located inside the

a. cochlea in the inner ear
b. pars flaccida in the tympanic membrane
c. eustachian tube
d. lateral aspect of the pinna
e. targus

Answer 5

A

Question 6

Which ear structure is responsible for equalizing atmospheric pressure when swallowing, sneezing, and yawning?

a. Eustachian tube
b. Inner ear
c. Semicircular canals
d. Triangular fossa
e. Oval window

Answer 6

A

Question 7

The structures that lie along the lateral wall of the nasal cavity near the facial cheek are the _____ sinuses.

a. ethmoid
b. frontal
c. maxillary
d. cribiform
e. sphenoid

Answer 7

C
Ethmoid - lie behind the frontal sinuses
Paranasal - extensions of the nasal cavities within the skull

Question 8

A 5 y/o child presents with nasal congestion and a headache. To assess for sinus tenderness, you should palpate over the

a. sphenoid and frontal
b. maxillary and frontal
c. maxillary only
d. sphenoid only
e. ethmoid and frontal

Answer 8

C

The frontal sinuses don’t develop until 7-8

Question 9

A 30 y/o woman present with rapid swelling beneath her jaw that suddenly appears while she is eating. The swelling is mildly painful but is not hot or red. You suspect Wharton salivary duct stones and proceed to palpate

a. bilarterally along the buccal mucosa
b. under the tongue, along each side of the frenulum
c. dorsum of the tongue
d. besdie the gingivae near each molar
e. along the roof of the mouth

Answer 9

B
The vast majority of stone occur in this duct from the submaxillary gland. Can be palpated along each side of the frenulum under the tongue

Question 10

An infant’s auditory canal, when compared with an adult’s, is

a. short, narrow, and straight
b. short and curved upward
c. long, narrow, and curved forward
d. short and curved downward
e. long, wide. and straight

Answer 10

B

The upward curve in infants is what makes pulling the pinna down causing the straightening of the canal.

Question 11

When examining an infant’s middle ear, the practitioner should use one hand to stabilize the otoscope against the head while using the other hand to

a. pull the auricle down and back
b. hold the speculum in the canal
c. distract the infant
d. stabilize the chest
e. pull the auricle back up

Answer 11

A You should use your other hand to pull the auricle down and back in an effort to straighten the upward curvature of the canal.

Question 12

The eruption of permanent teeth most commonly begins with the

a. upper central incisors
b. upper canines
c. lower central incisors
d. lower canines
e. upper lateral incisors

Answer 12

C The central incisor on the lower jaw usually erupts between 6 and 7 years of age as the first permanent teeth, the lower canines appear at 9 to 10 years of age, the upper central incisors at 7 to 8 years of age, and the upper canines at 11 to 12 years of age. The upper lateral incisors appear at 8 to 10 years of age.

Question 13

The pregnant woman can expect to experience

a. more nasal stuffiness
b. a sensitive sense of smell
c. drooling
d. enhanced hearing
e. decreased vascularity of the gums

Answer 13

A Physiologic changes of pregnancy include nasal stuffiness, a decreased sense of smell, impaired hearing, epistaxis, and a sense of fullness in the ears. Increased vascularity and proliferation of connective tissue of the gums also may occur.

Question 14

During what developmental stage are hoarseness, voice cracking, and a persistent cough a common finding?

a. Adolescence
b. Infancy
c. Menopause
d. Pregnancy
e. Childhood

Answer 14

D Laryngeal changes in pregnancy include hoarseness, deepening or cracking of the voice, vocal changes, and persistent cough.

Question 15

Which of the following is associated with age-related hearing loss?

a. Degeneration of the hair cells of the organ of Corti
b. Excess resorption of bone cells of the ossicle chain
c. Increased pliability of the tympanic membrane
d. More serous cerumen
e. Proliferation of the stria vascularis

Answer 15

A Nearly one third of adults older than 65 years have hearing loss. Age-related hearing loss is associated with degeneration of hair cells in the organ of Corti, loss of cortical and organ of Corti auditory neurons, degeneration of the cochlear conductive membrane, and decreased vascularity in the cochlea.

Question 16

You are performing hearing screening tests. Difficulty in hearing the highest frequencies would be expected in a ___-year-old patient.

a. 7
b. 12
c. 20
d. 40
e. 65

Answer 16

E Nearly one third of adults 65 years of age and older have sensorineural hearing loss.

Question 17

Mr. S presents with the complaint of hearing loss. You specifically inquire about current medications. Which medications, if listed, are likely to contribute to his hearing loss?

a. Chlorothiazide
b. Acetaminophen
c. Salicylates
d. Cephalosporins
e. Penicillins

Answer 17

C Ototoxic medications include aminoglycoside, salicylates, furosemide, streptomycin, quinine, ethacrynic acid, and cisplatin. Chlorothiazide diuretics, acetaminophen, penicillins, and cephalosporins are considered non-ototoxic.

Question 18

Mr. W, age 25 years, has recovered recently from an upper and lower respiratory infection. He describes long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented in which section of his history?

a. Age-specific data
b. Past medical data
c. Family history
d. Social history
e. Personal history

Answer 18

B This information is part of the past medical history.

Question 19

A newborn whose serum bilirubin is greater than 20 mg/100 mL risks later

a. hearing loss.
b. lichen planus.
c. tooth decay.
d. meningitis.
e. sinusitis.

Answer 19

A Risk factors for hearing loss in infants include infection, irradiation, drug abuse, and syphilis in the mother, as well as birth weight less than 1500 g, excessively high bilirubin level, infections (e.g., bacterial meningitis recurrent otitis media), cleft palate, craniofacial abnormalities, ototoxic antibiotic use, head trauma, and hypoxic episodes in infancy.

Question 20

To approximate vocal frequencies, which tuning fork should be used to assess hearing?

a. 100 to 300 Hz
b. 200 to 400 Hz
c. 500 to 1000 Hz
d. 1500 to 2000 Hz
e. Greater than 2000 Hz

Answer 20

C Use of a 500- to 1000-Hz tuning fork approximates vocal frequencies.

Question 21

You are using a pneumonic attachment on the otoscope while assessing tympanic membrane movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to

a. remove all cerumen from the canal.
b. make sure the speculum is sealed form outside air.
c. squeeze the bulb with more force.
d. insert the speculum to depth of 2 cm.
e. use a smaller plastic speculum.

Answer 21

B When using the pneumatic attachment, to see tympanic movement, there should be a seal around the speculum to block outside air. In this manner, the normal tympanic membrane moves as a result of pressure changes from the insufflator bulb.

Question 22

An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or

a. digestive disorder.
b. skeletal anomaly.
c. renal disorder.
d. Ménière disease.
e. heart defect.

Answer 22

C An auricle with a low-set or unusual angle may indicate chromosomal aberrations or renal disorders.

Question 23

When conducting an adult otoscopic examination, you should

a. position the patient’s head leaning toward you.
b. grasp the handle of the otoscope as you would a baseball bat.
c. select the largest speculum that will fit in the canal.
d. ask the patient to keep his or her eyes closed.
e. pull the auricle down and forward.

Answer 23

C Select the largest speculum that will comfortably fit in the patient’s ear. The handle should be held between the thumb and the index finger, supported on the middle finger. The patient’s head should be positioned toward the opposite shoulder. To straighten the external auditory in an adult, pull the auricle up and back. There is no reason for the patient to keep her or his eyes shut.

Question 24

Normal tympanic membrane color is

a. amber.
b. chalky white.
c. greenish.
d. pearly gray.
e. red.

Answer 24

D The expected normal finding for tympanic color is pearly gray.

Question 25

Bulging of an amber tympanic membrane without mobility is most often associated with

a. a middle ear effusion.
b. a healed tympanic membrane perforation.
c. impacted cerumen in the canal.
d. repeated and prolonged crying cycles.
e. a Pseudomonas infection of the auditory canal.

Answer 25

A An amber color, with bulging of the tympanic membrane and without mobility or redness, most often indicates the presence of fluid in the middle ear.

Question 26

In the presence of otitis externa, tympanic membrane perforation, or a myringotomy tube, you should

a. avoid performing otoscopic examinations.
b. clean the inner ear with soap.
c. instill alcohol into the ear.
d. never use a cerumen spoon.
e. avoid instilling fluids.

Answer 26

E Any ear irrigation should be avoided in the presence of otitis externa, perforated tympanic membrane, myringotomy tube, or mastoid cavity. These are not contraindications for otoscopic examinations or clearing the outer canal of cerumen; only the auricle can be cleaned with soap.

Question 27

When hearing is evaluated, which cranial nerve is being tested?

a. III
b. IV
c. VIII
d. IX
e. XII

Answer 27

C The eighth cranial nerve (CN VIII), the vestibulocochlear nerve, is associated with hearing.

Question 28

Speech with a monotonous tone and erratic volume may indicate

a. otitis externa.
b. hearing loss.
c. serous otitis media.
d. sinusitis.
e. dry cerumen.

Answer 28

B Speech with a monotonous tone and erratic volume may indicate hearing loss. Although hearing may be affected in the other choices, they do not result in hearing loss.

Question 29

Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test for

a. air conduction of sound.
b. bone versus air conduction.
c. otitis externa.
d. otitis media.
e. lateralization of sound.

Answer 29

E Placing the fork on the midline vertex of the patient’s head is the Weber test, a test for conductive hearing loss that lateralizes to the affected ear.

Question 30

To perform the Rinne test, place the tuning fork on the

a. top of the head.
b. mastoid bone.
c. forehead.
d. preauricular area.
e. occiput.

Answer 30

B The fork is initially placed against the mastoid bone for the Rinne test, a test for sensorineural loss.

Question 31

You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized to the unaffected ear; for the Rinne test, the air conduction to bone conduction-to-ratio was less than 2:1. You interpret these findings as suggestive of a. 
a defect in the inner ear. 
b. a defect in the middle ear. 
c. otitis externa. 
d. impacted cerumen. 
e. serous otitis.

Answer 31

A These results are consistent with a sensorineural hearing loss, a defect in the inner ear. Otitis externa, impacted cerumen, and serous otitis are conditions that can cause conductive hearing problems.

Question 32

Nasal symptoms that imply an allergic response include

a. purulent nasal drainage.
b. bluish gray turbinates.
c. small, atrophied nasal membranes.
d. a firm consistency of the turbinates.
e. a deviated septum.

Answer 32

B An allergic finding includes bluish gray or pale pink nasal turbinates that are swollen and boggy and a transverse crease at the junction between the cartilage and the bone of the nose.

Question 33

When you ask the patient to identify smells, you are assessing which cranial nerve?

a. I
b. II
c. III
d. IV
e. VIII

Answer 33

A The first cranial nerve (CN I), the olfactory nerve, is tested when you ask a patient to identify different smells.

Question 34

Pallor of the lips and mucous membranes is one sign of

a. anemia.
b. hyperbilirubinemia.
c. liver problems.
d. carbon monoxide poisoning.
e. Peutz-Jeghers syndrome.

Answer 34

A Pallor is an associated sign of anemia.

Question 35

A smooth red tongue with a slick appearance may indicate a. 
a niacin or vitamin B12 deficiency. 
b. oral cancer. 
c. recent use of antibiotics. 
d. a fungal infection. 
e. a geographic tongue.

Answer 35

A A smooth red tongue with a slick appearance may indicate a niacin or vitamin B12 deficiency. Oral cancer involves lesions; recent use of antibiotics can turn the tongue yellow-brown to black and hairy; and fungal infections result in slightly raised white, cream-colored, or yellow spots in the mouth. A geographic tongue has irregular areas of whitish and red areas.

Question 36

White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are

a. Fordyce spots.
b. aphthous ulcers.
c. Stensen ducts.
d. leukoedema.
e. angular cheilitis.

Answer 36

B Aphthous ulcers are white, round, or oval lesions surrounded by a red halo that appear on the buccal mucosa.

Question 37

A hairy tongue with yellowish brown to black elongated papillae on the dorsum

a. is indicative of oral cancer.
b. is sometimes seen after antibiotic therapy.
c. usually indicates a vitamin deficiency.
d. usually indicates anemia.
e. is characteristic of a geographic tongue.

Answer 37

B Recent antibiotic use can turn the tongue yellow-brown to black and hairy.

Question 38

To inspect the lateral borders of the tongue, you should

a. ask the patient to extend the tongue outward.
b. insert the tongue blade obliquely against the tongue.
c. lift the tongue upward with gloved fingers.
d. pull the gauze-wrapped tongue to each side.
e. ask the patient to lift the tongue upward.

Answer 38

D To inspect the lateral borders of the tongue, you should wrap the tongue with a piece of gauze and then pull the tongue to each side for inspection. The other maneuvers do not result in adequate lateral border inspection.

Question 39

A 6-month-old who can hear well can be expected to

a. exhibit the Moro reflex.
b. stop breathing in response to sudden noise.
c. turn his or her head toward the source of sound.
d. imitate simple words.
e. understand simple phrases.

Answer 39

C Six-month-old infants turn their heads toward the source of sound, and they start babbling, but they begin imitating speech sounds closer to 10 months of age. Understanding simple phrases such as “no-no” and “bye-bye” occurs between 10 and 12 months. The Moro reflex and cessation of breathing in response to noise are lost by 3 months of age.

Question 40

Which variation may be an expected finding in the ear examination of a newborn?

a. Diffuse light reflex
b. Purulent material in the ear canal
c. Redness and swelling of the mastoid process
d. Small perforations of the tympanic membrane
e. Increased mobility and clarity of the tympanic membrane

Answer 40

A The newborn’s tympanic membrane does not become conical for several months; therefore, the light reflex appears diffuse.

Question 41

For best results, an otoscopic and oral examination in a child should be

a. conducted at the beginning of the assessment.
b. done after inspection.
c. performed at the end of the examination.
d. performed before palpation.
e. deferred until they can fully cooperate.

Answer 41

C Because young children often resist otoscopic and oral examination, it may be wise to postpone these procedures until the end of the examination after you have gained some trust.

Question 42

Which pediatric patient complaints would you refer immediately to the emergency department?

a. A patient with a temperature of 100.4° F and a toothache
b. A drooling patient with muffled voice and stridor
c. A patient with purulent drainage from the ear and a cough
d. A patient with a seal-like barking cough and anorexia
e. A patient whose epiglottis is visible when the tongue is depressed

Answer 42

B Suspected retropharyngeal abscess, which can cause drooling, a muffled voice, and stridor, is a pediatric emergency because it occludes the airway.

Question 43

Which abnormality is common during pregnancy?

a. Eruption of additional molars
b. Hypertrophy of the gums
c. Epstein pearls
d. Otitis media
e. Koplik spots

Answer 43

B The gums of pregnant women may appear reddened, swollen, and spongy, with the hypertrophy resolving within 2 months of delivery.

Question 44

Expected physical changes associated with older adults include

a. shiny buccal mucosa.
b. teeth appear shorter.
c. wetter nasal mucosa.
d. bristly hairs in the vestibule.
e. smoothing of the tongue.

Answer 44

D With age, the buccal mucosa becomes less shiny, the teeth appear longer because of receding gums, the nasal mucosa are drier, the tongue may appear more fissured, and more bristly hairs appear in the nose, especially in men.

Question 45

Intense pain with movement of the pinna is most closely associated with

a. sinusitis.
b. otitis externa.
c. purulent otitis media.
d. bacterial otitis media.
e. otitis media with effusion.

Answer 45

B Suspect otitis externa (swimmer’s ear) when pulling the pinna reproduces ear pain. The other conditions do not commonly cause the same finding.

Question 46

Severe vertigo, tinnitus, and progressive hearing loss are characteristic of

a. cholesteatoma.
b. Ménière disease.
c. otosclerosis.
d. cocaine abuse.
e. labyrinthitis.

Answer 46

B The classic triad of Ménière disease is vertigo, tinnitus, and progressive hearing loss.

Question 47

Which of the following illicit drugs is commonly associated with nasal septum perforation?

a. Heroin
b. Marijuana
c. PCP
d. Ecstasy
e. Cocaine

Answer 47

E Long-term cocaine snorting causes ischemic necrosis of the septal cartilage and leads to perforation of the nasal septum.

Question 48

Evidence-based practice suggests that the strongest predictor of sinusitis is a.
a maxillary toothache.
b. dull or opaque sinus transilluminations.
c. ineffective decongestants and colored nasal drainage.
d. purulent nasal secretions.
e. any combination of the above.

Answer 48

E Evidence-based practice suggests that the strongest predictor of sinusitis is any combination of these symptoms including maxillary toothache, purulent nasal secretions, dull or opaque sinus transillumination, poor response to decongestants, and colored nasal discharge.

Question 49

You are interviewing a parent whose child has a fever, is batting at her right ear, and is irritable. You ask the parent about the child’s appetite and find that the child has a decreased appetite. This additional finding is most suggestive of

a. acute otitis media.
b. otitis externa.
c. serous otitis media.
d. middle ear effusion.
e. cerumen impaction.

Answer 49

A Anorexia is an initial symptom of acute otitis media and is not found with cerumen impaction or otitis externa or with conditions of fluid in the middle ear.