Section 4. Ear, Nose, and Throat Problems
MULTIPLE CHOICE
1. Which of the following is an example of sensorineural hearing loss?
A.
Perforation of the tympanic membrane
B.
Otosclerosis
C.
Cholesteatoma
D.
Presbycusis
2. The clinician is assessing a patient complaining of hearing loss. The clinician places a tuning
fork over the patient’s mastoid process, and when the sound fades away, the fork is placed
without restriking it over the external auditory meatus. The patient is asked to let the clinician
know when the sound fades away. This is an example of which type of test?
A.
Weber test
B.
Schwabach test
C.
Rinne test
D.
Auditory brainstem response (ABR) test
3. A patient presents to the clinician complaining of ear pain. On examination, the clinician finds
that the patient has tenderness on traction of the pinna as well as when applying pressure over
the tragus. These findings are classic signs of which condition?
A.
Otitis media
B.
Ménière’s disease
C.
Tinnitus
D.
Otitis externa
4. In which of the following scenarios would otitis media (OM) be considered chronic?
A.
Patient has had repeated episodes of acute OM followed by continuous or
intermittent otorrhea lasting for more than 3 months.
B.
Patient has had severe pain and intermittent otorrhea lasting for 2 months.
C.
Patient has had repeated episodes of acute OM followed by continuous or
intermittent otorrhea lasting for more than 1 month.
D.
Patient has had severe pain and continuous otorrhea lasting for 3 months.
5. Which of the following is helpful in evaluating patients with otitis media with effusion?
A.
Lumbar puncture
B.
MRI
C.
Computed tomography (CT) scan
D.
Ultrasound
6. Which of the following treatments is appropriate for a patient who has acute otitis media and
has an allergy to penicillin?
A.
Augmentin 875 mg two times daily for 10 days
B.
Suprax 400 mg daily for 7 days
C.
Amoxicillin 500 mg every 8 hours for 10 days
D.
Zithromax 500 mg on day 1, and then 250 mg daily for 4 days
7. Which immunoglobulin mediates the type 1 hypersensitivity reaction involved in allergic
rhinitis?
A.
IgA
B.
IgE
C.
IgG
D.
IgM
8. Fluctuations and reductions in estrogen may be a contributing factor in which type of rhinitis?
A.
Vasomotor rhinitis
B.
Rhinitis medicamentosa
C.
Atrophic rhinitis
D.
Viral rhinitis
9. Sinusitis is considered chronic when there are episodes of prolonged inflammation with
repeated or inadequately treated acute infection lasting greater than:
A.
4 weeks
B.
8 weeks
C.
12 weeks
D.
16 weeks
10. Which of the following antibiotics provides the best coverage in acute or chronic sinusitis
when gram-negative organisms are suspected?
A.
Penicillin V
B.
Amoxicillin
C.
Levofloxacin
D.
Clindamycin
11. Which of the following can prevent chronic sinusitis?
A.
Patients in the same household with sinusitis should all use the same nasal spray
B.
Treating respiratory infections after a week of symptoms
C.
Using a dehumidifier during sinusitis attacks
D.
Surgery to correct anatomical blockages of the sinus ostia
12. Which type of stomatitis results in necrotic ulceration of the oral mucous membranes?
A.
Vincent’s stomatitis
B.
Allergic stomatitis
C.
Aphthous stomatitis
D.
Herpetic stomatitis
13. Which type of stomatitis is caused by continual exposure to chewing tobacco?
A.
Aphthous stomatitis
B.
Herpetic stomatitis
C.
Nicotinic stomatitis
D.
Allergic stomatitis
14. The presence of hairy leukoplakia in a person with no other symptoms of immune suppression
is strongly suggestive of which type of infection?
A.
Herpes simplex virus type 2
B.
HIV
C.
Pneumonia
D.
Syphilis
15. Which of the following conditions leads to erythematous patches with bluish-white centers on
the lingual and buccal mucosa (Koplik’s spots):
A.
Syphilis
B.
Roseola paramyxovirus infection
C.
Parotitis
D.
HIV
16. Heart valve damage resulting from acute rheumatic fever is a long-term sequelae resulting
from infection with which of the following pathogens?
A.
Coxsackievirus
B.
Cytomegalovirus
C.
Francisella tularensis
D.
Group A streptococcus
17. Which of the following is a disorder of infectious etiology?
A.
Tonsillitis
B.
Kawasaki’s syndrome
C.
Pharyngitis related to allergies
D.
Pemphigus
18. A patient presents with the following signs and symptoms: gradual onset of low-grade fever,
marked fatigue, severe sore throat, and posterior cervical lymphadenopathy. Based on the
signs and symptoms alone, which of the following conditions is most likely the cause?
A.
Gonorrhea
B.
Mononucleosis
C.
Influenza
D.
Herpes zoster
19. A patient presents with nonvesicular lesions that are 2 to 10 mm, symmetrical, and scattered
on the oropharynx and mouth. What is their most likely diagnosis?
A.
Corynebacterium diphtheriae
B.
Primary syphilis
C.
Candida infection
D.
Secondary syphilis
20. A patient presents to the clinician with a sore throat, fever of 100.7F, and tender anterior
cervical lymphadenopathy. The clinician suspects strep throat and performs a rapid strep test
that is negative. What would the next step be?
A.
The patient should be instructed to rest and increase fluid intake, as the infection is
most likely viral and will resolve without antibiotic treatment.
B.
Because the patient does not have strep throat, the clinician should start
broad-spectrum antibiotics in order to cover the offending pathogen.
C.
A throat culture should be performed to confirm the results of the rapid strep test.
D.
The patient should be treated with antibiotics for strep throat, as the rapid strep test
is not very sensitive.
21. Jean has acute otitis externa with fluid that is black and malodorous. Which of the following is
responsible for the infection?
A.
Fungal infection
B.
Staphylococcus infection
C.
Pseudomonas infection
D.
Allergic reaction
22. You have a patient who is a positive for strep on rapid antigen testing (rapid strep test). You
order amoxicillin after checking for drug allergies (patient is negative) but he returns 3 days
later, reporting that his temperature has gone up, not down (101.5F in office). You also note
significant lymphadenopathy, most notably in the posterior and anterior cervical chains, some
hepatosplenomegaly, and a diffuse rash. You decide:
A.
To refer the patient
B.
That he is having an allergic response and needs to be changed to a macrolide
antibiotic
C.
That his antibiotic dosage is not sufficient and should be changed
D.
That he possibly has mononucleosis concurrent with his strep infection
23. Which of the following medications is safe to use when an adult patient has a perforated
tympanic membrane?
A.
Chloroxylenol 1 mg, 4 to 5 drops in the affected ear three times per day for 7 days
B.
Floxin otic 10 drops in affected ear for 7 days
C.
Pramoxine HCL 10 mg, 4 to 5 drops in affected ear three times per day for 7 days
D.
Hydrocortisone 10 mg/mL, 3 drops in affected ear three times per day for 7 days
24. Betty presents with tenderness on traction of the pinna in her right ear and when the provider
places pressure on her right tragus, she expresses she is in pain. The clinician does not suspect
a tympanic membrane rupture, but would like to make Betty more comfortable during the
exam. Which of the following solutions should the clinician administer before attempting an
examination?
A.
Normal saline
B.
Auralgan
C.
Lidocaine
D.
Distilled water
25. Which of the following is the form of external otitis in which bacterial infection extends from
the auditory canal into the skull?
A.
Otitis media
B.
Otitis externa
C.
Necrotizing otitis
D.
Swimmer’s ear
26. Though common as people age, what concerning disease can dysphonia be a cardinal sign
for?
A.
Laryngeal cancer
B.
Viral infection
C.
Bronchitis
D.
Lung cancer
27. A patient has dysphonia 3 days as a result of a viral illness. Which of the following
educational points is correct?
A.
As smoking has no effect on dysphonia, the patient can continue to smoke.
B.
The patient should continue to use their voice to exercise it.
C.
The patient should take cough medication with antihistamines.
D.
Make sure the patient has adequate fluid intake.
28. A patient complains of dull and intermittent left-sided facial pain and left-sided headache that
is worse in the morning. Which of the following diagnoses is most likely?
A.
Pharyngitis
B.
Temporomandibular disorder
C.
Temporomandibular joint disease
D.
Dysphonia
29. A provider is examining a patient with temporomandibular joint disease (TMJ). Which of the
following results would the provider expect from the exam?
A.
The mandibular opening is 40 mm.
B.
There are no sounds elicited from the exam.
C.
The mandible deviates to the left side.
D.
The patient is able to open the mouth without pain or sound.
30. Which of the following medications for temporomandibular disorder has the warning that
patients should NOT drive while taking it?
A.
Flexeril
B.
Naprosyn
C.
Tylenol
D.
Elavil
31. What is the most common site of hemorrhage for epistaxis?
A.
Nasopharynx
B.
Nostril
C.
Posterior nasal cavity
D.
Little’s area
32. What is the initial treatment for uncomplicated anterior epistaxis?
A.
Tilting the head back so the blood does not run out of the nose
B.
Applying firm and continuous pressure superior to the nasal alar cartilages for 10
to 15 minutes
C.
Applying firm and continuous pressure to the nostril for 5 minutes
D.
Letting the nose bleed clot and leaning the head forward
33. A patient just had epistaxis and the provider is counseling them on what to do when they go
home. Which of the following should be included?
A.
Make sure to talk during future nose bleeds to reassure the people around you.
B.
When nose bleeds occur, if you have blood in your mouth, spit it out.
C.
Avoid hot liquids after a nose bleed.
D.
With future nose bleeds, drinking lukewarm beverages helps blood clot.
34. Peter presents with complaints of right hearing loss that has been getting worse and a
congruent headache. What is the most likely diagnosis?
A.
Acoustic neuroma
B.
Presbycusis
C.
Ménière’s disease
D.
Sensorineural hearing loss
35. Which of the following complementary therapies can help a patient with tinnitus?
A.
Increase salt intake
B.
Stop smoking
C.
Not listening to music
D.
Increase caffeine intake