EENT REVIEW ACTIVITY

Linda Moody and Allison Rogers

King University
 A 38 year old woman presents with eye pain. She reports that she
was clearing tall brush from a field when a splintered branch hit her
eye. Which course of action would not be appropriate?

A. Refer her to an ophthalmologist

B. Use fluorescein stain to detect small objects in her eye
C. Immediately remove the foreign object from her eye
D. Educate her on the use of appropriate eye protection to prevent eye
 Answer
C. Immediately remove the foreign object from her eye

Removing foreign objects from the eye can cause globe

rupture (Fitzgerald, 2015).
Hairy leukoplakia of the tongue and thrush are signs of what disease?

A. Secondary fungal infection after antibiotic use

B. Oral candidiasis secondary to failure to properly rinse mouth after
use of ICS for asthma
C. AIDS
D. Precancerous lesions from oral tobacco use
 Answer: C

Hairy leukoplakia of the tongue and thrush are diagnostic signs for
AIDS (Leik, 2014)
 Mr. Boombastic is a 23 year old man that comes in today unable to keep
his right eye open. He states that he has recently begun to wear contact
lenses and symptoms of a scratchy, gritty sensation that worsens with
blinking began immediately after insertion. The most likely diagnosis is:

A. Retinal detachment
B. Corneal abrasion
C. Anterior uveitis
D. Unilateral herpetic conjunctivitis.
 Answer
B. Corneal abrasion

Patients usually complain of a scratchy, gritty

sensation that develops suddenly and worsens
with blinking along with the inability to keep
the eye open (Uphold & Graham, 2013).
Infection of the larynx with HPV has been associated with:

A. Viralpharyngitis
B. Laryngeal neoplasia
C. Laryngeal spasms
D. Chronic cough
 Answer: B

Infection of the larynx with HPV has been associated with laryngeal
neoplasia (Leik, 2014).
This bacterial infection is the leading cause of blindness
worldwide and can be spread through swimming pool water:

A. Group A strep
B. Candidiasis
C. Staph aureus
D. Chlamydia
 Answer
D. Chlamydia

Chlamydia trachomatis is the leading cause of blindness,

affecting 40 million people worldwide (Azari & Barney, 2013).

Treatment with a single dose of oral azithromycin (20 mg/kg) is

effective. Patients may also be treated with topical antibiotic
ointments for 6 weeks (tetracycline or erythromycin)
A 32 year-old female reports a history of a cold with symptoms
resolved two weeks ago except for a dry cough and pain over her left
cheek, which worsens when she bends down. Vital signs are as
follows: temperature 99.2F, heart rate 72, respiratory rate 14. Which
of the following diagnosis is most likely?

A. Allergicrhinitis
B. Acute bronchitis
C. Low grade fever secondary to previous URI
D. Acute sinusitis
 Answer: D

Acute sinusitis is characterized by nasal congestion,

facial or dental pain, postnasal drip, headache, fever,
yellow or green nasal discharge, and pain in teeth or
forehead, worse when bending down. The common
cold is a common precursor to acute sinusitis (Hall,
2017; Leik, 2014)
A 37-year-old woman is newly diagnosed with Menieres disease. What
types of food do you educate her to avoid?

A. Salt, caffeine, and alcohol

B. High fructose corn syrup, fried foods, carbohydrates
C. Meats, dairy, seafood
D. dairy, carbohydrates, alcohol
 Answer
A. Salt, caffeine, and alcohol

Dizziness is due to imbalance of fluid pressure of the inner

ear. Salt retains fluid, caffeine is a stimulant/diuretic and
alcohol can change the composition of the fluid (Fitzgerald,
2015).
A 24 year old woman of 28 weeks gestation comes to the clinic for a checkup. She
complains of nasal stuffiness and is diagnosed with Pregnancy Rhinitis. The NPs
best explanation to her for these symptoms would be:

A.There is an increased incidence of cold symptoms in approximately 20% of

pregnancies.
B.The rise in estrogen in second and third trimesters leads to an increase in
hyaluronic acid in the nasal mucosa, resulting in increased nasal edema and
congestion
C.She has developed an acute case of allergic rhinitis
D.The rise in progesterone in second and third trimesters leads to an increase in
hyaluronic acid in the nasal mucosa, resulting in increased nasal edema and
congestion
 Answer: B

The rise in estrogen in second and third trimesters leads to an

increase in hyaluronic acid in the nasal mucosa, resulting in increased
nasal edema and congestion this is called pregnancy rhinitis.
Manifests as nasal congestion without allergy or infection (Franklin
et al., 2017).
When testing Mr. Smith for hearing loss, he claims bone
conduction through the mastoid process is heard louder than
through the air. You understand this to be an abnormal result of
what test:

A. Webber
B. Tympanometry
C. Rinne
D. Otoacoustic Emissions
 Answer
C. Rinne test
Strike tuning fork and place firmly on the mastoid tip. You ask the
patient to tell you when the sound is no longer present (measure of
bone conduction). Then move the fork so that it resonates beside
the ear and measure (air conduction) (Uphold & Graham, 2013).

Conductive loss: In affected ear the sound is louder when the

tuning fork is on the mastoid than beside the ear
A 45 year-old male patient presents to office with chief complaint of bilateral
nasal stuffiness and blockage that comes and goes, and states that he has
noticed redness and itchy patches scattered on skin. On physical exam clear
discharge is noted from bilateral eyes, nasal mucosa is pale, bilateral nasal
turbinates appear swollen, and a crease is noted across the nasal bridge.
What would most likely be his diagnosis based on these symptoms?

A. Bacterial sinusitis
B. Chronic rhinitis
C. Allergic rhinitis
D. Nasal polyps
 Answer: C

Allergic rhinitis signs and symptoms can include:

Thin, clear nasal discharge

Nasal obstruction, intermittent nasal blockage, or rhinorrhea- typically

bilateral
Facial discomfort

Watery, itchy, puffy eyes

Pale nasal mucosa

Swollen nasal turbinates

Crease along the bridge of nose or allergic salute

(Franklin et al., 2017; Wilder, 2017)

What is the first line treatment based on his diagnosis?

A. Oral decongestants
B. Intranasal steroids
C. Referral to ENT for evaluation of nasal polyps
D. Oral Amoxicillin
 Answer: B

Intranasal steroids should be first-line treatment for

allergic rhinitis because systemic treatments do not
target the nasal mucosa as effectively (Wilder, 2017,
p.386).
 This is an image of what type of ear disorder?

A. Labrythitis
B. Acute otitis media
C. Acute otitis externa
D. Tympanic membrane perforation
 Answer
C. Acute Otitis Externa (AOE)

AOE is diffuse inflammation of the external auditory canal

(American Academy of Family Physicians, 2012).
You are treating a patient for acute otitis media with amoxicillin and
they develop severe nausea and vomiting, what is another
reasonable treatment option?

A. trimethoprim-sulfamethaxazole
B. erythromycin
C. ampicillin
D. cefdinir
 Answer
D. Cefdinir

2nd and 3rd generation cephalosporins like cefdinir,

cefuroxime, cefpodoxime, and ceftriaxone are highly
unlikely to be associated with cross-reactivity with
penicillin allergy on the basis of their distinct
chemical structures (Harmes et al., 2013).
Which of the following methods is used to diagnose gonorrheal
pharyngitis?

A. Serum gonorrheal titer

B. Gen-Probe
C. Culture and sensitivity of the tonsillar area
D. Thayer-Martin culture
 Answer: D

Thayer-Martin culture is recommended for screening to

diagnose gonorrheal pharyngitis (Leik, 2014).
Which is not a risk factor for acute otitis media:

A. Tobacco use

B. Aggressive ear canal hygiene

C. Untreated allergic rhinitis

D. Upper respiratory tract infection

 Answer
B. Aggressive ear canal hygiene

Avoiding conditions that can cause eustachian tube dysfunction,

such as upper respiratory infection, untreated allergic rhinitis,
tobacco use, and exposure to air pollution can lead to a reduction in
AOM occurrences (Fitzgerald, 2015).
A 6 year-old female presents with her mother with a chief complaint of a
severe sore throat for 3 days, along with a generalized rash, fever, and has
vomited once. On physical exam a maculopapular rash is noted with
sandpaper like texture generalized on trunk and bilateral upper and lower
extremities. This best describes:

A. Kawasaki disease
B. Rubella
C. Scarlet fever
D. Allergic reaction from over-the-counter Childrens Chloraseptic
Relief Strips used yesterday
 Answer: C

Signs and Symptoms of Scarlet Fever:

Abrupt illness with sore throat, vomiting, headache, chills, and fatigue

Fever up to 104F

Tonsils are erythematous, swollen, and covered in exudate

Pharynx is inflamed and typically covered in grey-white exudate

Palate and uvula are erythematous, reddened, and petichia are present

Strawberry tongue

Scarlatina rash is red, blanches to pressure, finely papulalr (making the

skin feel course like sandpaper)

(Blosser, OKeffe, & Sanderson, 2017)
Which medication would be appropriate for viral
conjunctivitis?

A. Ciprofloxacin ophthalmic (Ciloxan)

B. Oral acyclovir

C. Polymyxin B ophthalmic drops

D. No antibiotic needed
 Answer

D. No antibiotic needed

No antibacterial therapy is needed as the risk of

superimposed bacterial infection is minimal (Its a
viral infection!) (Fitzgerald, 2015).
A 4 year-old child is brought to the walk-in clinic by his grandmother. The grandmother
states that the child was fine this am when his mother left for work, but as the day progressed
he developed a fever, begin complaining of a severe sore throat, and she was worried
because she is unable to get the child to eat or drink anything. On physical exam you notice
the child is sitting on the grandmothers lap with his neck hyperextended and appears to be
drooling, his respirations are 26 and is noted to be breathing with his mouth open. You are
unable to visualize his pharynx, what should you do next?

A.Use a tongue blade in order to visualize the pharynx and tonsils

B.Tell the grandmother that the child needs to be seen by urgent care
C.Prescribe Amoxicillin and tell the grandmother to have the child gargle with warm salt
water to help ease symptoms of sore throat, and his appetite will return when symptoms
begin to subside
D.Call 911 and have EMS take the child to ER
 Answer: D

Hallmark signs of epiglottitis are hyperextension of neck

and drooling with presenting history of acute onset of
fever, severe, sore throat, and dyspnea.
If epiglottitis is suspected do not examine the throat and
do not place child in supine position. Immediately
transport the child to the hospital by emergency medical
services, the time from onset of symptoms until death may
be only a matter of hours due to sudden airway obstruction
(John, 2017).
Which is a common symptom in a person with primary
open-angle glaucoma?

A. Peripheral vision loss

B. Difficulty with distant vision

C. Blurring of near vision

D. Need for increased lighting

 Answer

A. Peripheral Vision Loss

A gradual onset of peripheral vision loss is most specific for

open angle glaucoma- the second most common cause of
irreversible blindness in North America (Fitzgerald, 2015).
 References
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http://www.aafp.org/afp/2012/1201/p1055.html
Azari, A. & Barney, N. (2013). Conjunctivitis. Journal of the American Medical Association, 310(16), 1721-1729.
Blosser, C. G., OKeefe, C., & Sanderson, S. K. (2017). Infectious diseases and immunizations. In C. E. Burns, A. M. Dunn, M. A. Brady, N. B.
Starr, C. G. Blossser, & D. L. Garzon (Eds.) Pediatric Primary Care, 6th (ed.), (pp. 474-548). St. Louis, MO: Elsevier.
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