HEENT Set 1

Mandy, 44, was given a diagnosis of flu 1 day ago and wants to start on the "new flu medicine" right away. What do you tell her? 1. "The medication is effective only if started within the first 72 hours after symptoms begin." 2. "If you treat a cold, it goes away in 7 days; if you don't treat it, it goes away in 1 week." 3. "The medicine has not proven its effectiveness." 4. "I'll start you on oseltamivir (Tamiflu) today. It may shorten the course of the disease and perhaps lessen the severity of your symptoms."

"I'll start you on oseltamivir (Tamiflu) today. It may shorten the course of the disease and perhaps lessen the severity of your symptoms."

Nystatin (Mycostatin) is ordered for Michael, a 56-year-old banker who has an oral fungal infection. What instructions for taking the medication do you give Michael? 1."Dilute the oral medication with one tablespoon of water for easier digestion." 2."Take the medication with meals so that it's absorbed better." 3."Swish and swallow the medication." 4."Apply the medication only to the lesions."

"Swish and swallow the medication."

Aaron, age 4, is brought in to the clinic by his father. His tympanic membrane is perforated from otitis media. His father asks about repair of the eardrum. How do you respond? 1."The eardrum, in most cases, heals within several weeks." 2."We need to schedule Aaron for a surgical repair." 3."He must absolutely stay out of the water for 3 to 6 months." 4."If the eardrum is not healed in several months, it can be surgically repaired."

"The eardrum, in most cases, heals within several weeks."

Mario, a 17-year-old high school student, came to the office for evaluation. He is complaining of persistent sore throat, fever, and malaise not relieved by the penicillin therapy prescribed recently at the urgent care center. As the nurse practitioner, what would you order next? 1.A throat culture. 2.A Monospot test. 3.A rapid antigen test. 4.A Thayer-Martin plate test.

A Monospot test.

In a young child, unilateral purulent rhinitis is most often caused by: 1.A foreign body. 2.A viral infection. 3.A bacterial infection. 4.An allergic reaction.

A foreign body

Mr. Johnson, age 69, has had Meniere disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? 1.A labyrinthectomy. 2.Pharmacological therapy. 3.A vestibular neurectomy. 4.Wearing an earplug in the ear that has the most hearing loss.

A vestibular neurectomy.

Your client, a 72-year-old smoker of 50 years, is at the office today for a routine physical. During your inspection of the oral mucosa, you discover a white lesion on the lateral surface of the tongue that you suspect to be cancerous. You document your finding as: 1.A superficial, translucent, subepithelial, vesicle-like lesion in the oral mucosa. 2.A white, painless, firm, ulcerated lesion with indurated borders. 3.An abnormal white coating of the dorsal surface of the tongue. 4.A round, smooth, firm lump on the lateral side of the tongue.

A white, painless, firm, ulcerated lesion with indurated borders.

Ellen, a 56-year-old social worker, is seen by the nurse practitioner for complaints of fever; left-sided facial pain; moderate amounts of purulent, malodorous nasal discharge; and pain and headache when bending forward. The symptoms have been occurring for approximately 6 days. On physical assessment, there is marked redness and swelling of the nasal passages and tenderness/pain on palpation over the cheekbones. The nurse practitioner should suspect: 1.Dental abscess. 2.Acute rhinosinusitis. 3.Chronic rhinosinusitis. 4.Nasal tumor.

Acute rhinosinusitis.

Jill, a 34-year-old bank teller, presents with symptoms of hay fever. She complains of nasal congestion, runny nose with clear mucus, and itchy nose and eyes. On physical assessment, you observe that she has pale nasal turbinates. What is your diagnosis? 1.Allergic rhinitis. 2.Viral rhinitis. 3.Nasal polyps. 4.Nasal vestibulitis from folliculitis.

Allergic rhinitis.

A 6-year-old female presents to your pediatric office with her mother complaining of right ear pain for 3 days. This pain resolved with Tylenol. The patient has also had noted fevers of 101.3°F over the last 2 nights. The patient had a nonproductive cough for 7 days prior to the ear pain. On physical exam, the patient has tenderness with tugging on the auricle of the ear. The tympanic membrane is not mobile with pneumatic otoscopy and is erythematous and full. The patient has no drainage from the ear and no mastoid tenderness. What is the next step? 1.Symptom management and reassurance that symptoms will resolve with time. 2.Computed tomography (CT) of the head. 3.Amoxicillin 80 to 90 mg/kg/d. 4.Augmentin 45 mg/kg/d.

Amoxicillin 80 to 90 mg/kg/d.

The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure in children is: 1.Amoxicillin (Amoxil). 2.Amoxicillin and potassium clavulanate (Augmentin). 3.Azithromycin (Zithromax). 4.Prednisone (Deltasone).

Amoxicillin and potassium clavulanate (Augmentin).

Kathleen, age 54, has persistent pruritus of the external auditory canal. External otitis and dermatological conditions, such as seborrheic dermatitis and psoriasis, have been ruled out. What can you advise her to do? 1.Use a cotton-tipped applicator daily to remove all moisture and potential bacteria. 2.Wash daily with soap and water. 3.Apply mineral oil to counteract dryness. 4.Avoid topical corticosteroids.

Apply mineral oil to counteract dryness.

Mia, a 27-year-old school teacher, has a 2-day history of severe left ear pain that began after 1 week of upper respiratory infection (URI) symptoms. On physical examination, you find that she has acute otitis media (AOM). She has a severe allergy to penicillin. The most appropriate antimicrobial option for this patient is: 1.Ciprofloxacin (Cipro). 2.Azithromycin (Zithromax). 3.Amoxicillin (Amoxil). 4.Cephalexin (Keflex).

Azithromycin (Zithromax).

Alexandra, age 34, was treated with oral antibiotics 2 weeks ago for a urinary tract infection. She is seen in the office today for a follow-up visit. On physical examination, the nurse practitioner notices that she has some painless, white, slightly raised patches in her mouth. This is probably caused by: 1.Herpes simplex. 2.Aphthous ulcers. 3.Candidiasis. 4.Oral cancer.

Candidiasis.

Which manifestation is noted with carbon monoxide poisoning? 1.Circumoral pallor of the lips. 2.Cherry-red lips. 3.Cyanosis of the lips. 4.Pale pink lips.

Cherry-red lips.

What is the most common cause of epistaxis? 1.Digital trauma. 2.Warfarin. 3.Vitamin C deficiency. 4.Hemophilia A.

Digital Trauma

Mallory brings her 4-week-old infant to the office because she noticed small, yellow-white, glistening bumps on her infant's gums. She says they look like teeth, but she is worried that they may be cancer. You diagnose these bumps as: 1.Bednar aphthae. 2.Epstein pearls. 3.Buccal tumors. 4.Exostosis.

Epstein pearls.

A 65-year-old man presents complaining of a left-sided, deep, throbbing headache and mild fatigue. On examination, the client has a tender, tortuous temporal artery. You suspect giant cell arteritis (GCA), or temporal arteritis. What is the least invasive procedure to help with diagnosis? 1. Magnetic resonance imaging (MRI) of the head. 2. Erythrocyte sedimentation rate (ESR). 3. Electroencephalogram (EEG). 4. Otoscopy.

Erythrocyte sedimentation rate (ESR)

You are the nurse practitioner caring for Martha, a 47-year-old accountant. 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? 1.Maxillary. 2.Ethmoid. 3.Frontal. 4.Sphenoid.

Ethmoid

Martin, age 24, presents to the office with an erythematous ear canal and pain on manipulation of the auricle. He is on vacation and has been swimming daily at the resort. What is your diagnosis? 1.Acute otitis media. 2.Chronic otitis media. 3.External otitis. 4.Temporomandibular joint (TMJ) syndrome.

External otitis

A 64-year-old obese woman comes in 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 awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements or color of stools. She denies alcohol and tobacco use. 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 occult blood (OB) negative. What is the most likely diagnosis? 1.Esophageal varices. 2.Esophageal cancer. 3.Gastroesophageal reflux disease (GERD). 4.Peptic ulcer disease (PUD).

Gastroesophageal reflux disease (GERD).

You are assessing a first grader and find that the tonsils are touching the uvula. How would you grade this finding? 1.Grade 1. 2.Grade 2. 3.Grade 3. 4.Grade 4.

Grade 3

Which of the following is not a complication of untreated group A streptococcal pharyngitis? 1.Glomerulonephritis. 2.Rheumatic heart disease. 3.Scarlet fever. 4.Hemolytic anemia.

Hemolytic anemia.

Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which sinus to be affected? 1.Maxillary sinus. 2.Ethmoid sinus. 3.Sphenoid sinus. 4.Frontal sinus.

Maxillary sinus.

A 20-year-old male presents to your primary care clinic. This patient is a college student. He complains of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has a temperature of 100.7°F. His ear exam is normal. His nose and throat exam shows mild erythema of the nasal mucosa and edematous, enlarged tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar exudates. He has inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear lung exam. What is his most likely diagnosis? 1.Viral pharyngitis. 2.Mononucleosis. 3.Streptococcal pharyngitis. 4.Upper respiratory infection.

Mononucleosis

Marjorie, age 37, has asthma and has been told she has nasal polyps. What do you tell her about them? 1.Nasal polyps are usually precancerous. 2.Nasal polyps are benign growths. 3.The majority of nasal polyps are neoplastic. 4. They are probably inflamed turbinates, not polyps, because polyps are infrequent in clients with asthma.

Nasal polyps are benign growths.

How would you describe the cervical lymphadenopathy associated with asymptomatic human immunodeficiency virus (HIV) infection? 1.Movable, discrete, soft, and nontender lymph nodes. 2.Enlarged, warm, tender, and firm but freely movable lymph nodes. 3.Hard, unilateral, nontender, and fixed lymph nodes. 4.Nontender, mobile, and firm but not hard lymph nodes.

Nontender, mobile, and firm but not hard lymph nodes.

An 80-year-old woman comes in to the office with complaints of a rash on the left side of her face that is blistered and painful and accompanied by left-sided eye pain. The rash broke out 2 days ago, and she remembers being very tired and feeling feverish for a week before the rash appeared. On examination, the rash follows the trigeminal nerve on the left, and she has some scleral injection and tearing. You suspect herpes zoster ophthalmicus. Based on what you know to be complications of this disease, you explain to her that she needs: 1.Antibiotics. 2.A biopsy of the rash. 3.Immediate hospitalization. 4.Ophthalmological consultation.

Ophthalmological consultation.

Which of the following is not recommended for hoarseness? 1.Vocal rest. 2.Tobacco cessation. 3.Decrease in caffeine use. 4.Oral steroids.

Oral Steroids

Kevin, age 26, has AIDS and presents to the clinic with complaints of a painful tongue covered with what look like creamy white, curdlike patches overlying erythematous mucosa. You are able to scrape off these "curds" with a tongue depressor, which assists you in making which of the following diagnoses? 1. Leukoplakia. 2. Lichen planus. 3. Oral candidiasis. 4. Oral cancer.

Oral candidiasis.

Samantha, age 12, presents with ear pain. When you begin to assess her ear, you tug on her normal-appearing auricle, eliciting severe pain. This leads you to suspect: 1.Otitis media. 2.Otitis media with effusion. 3.Otitis externa. 4.Primary otalgia.

Otitis externa.

Which of the following is not a cause of conductive hearing loss? 1.Presbycusis. 2.Cerumen impaction. 3.Otitis media. 4.Otosclerosis.

Presbycusis.

Max, age 35, 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? 1. Prescribe nasal steroids and oral decongestants. 2. Prescribe antibiotic ear drops. 3. Prescribe systemic antibiotics. 4. Refer Max to an ear, nose, and throat specialist.

Prescribe nasal steroids and oral decongestants.

Erica, age 39, has a sudden onset of shivering, sweating, headache, aching in the orbits, and general malaise and misery. Her temperature is 102°F. The nurse practitioner diagnosed her with influenza (flu). What is your next course of action? 1.Order amoxicillin (Amoxil) 500 mg every 12 hours for 7 days. 2.Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive. 3.Order a complete blood count (CBC). 4.Consult with your collaborating physician.

Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive.

A 75-year-old female presents to your office complaining of dizziness and hearing loss. The patient states she awoke yesterday with dizziness, which she described as feeling the room spinning. She also notes intermittent ringing in her ears. On physical exam, the patient has lateralization of her hearing loss to the unaffected ear. Rinne test shows air conduction lasts longer than bone conduction. What is the next step in helping this patient's symptoms? 1.Order a computed tomography (CT) scan to rule out acoustic neuroma. 2.Start her on high-dose Augmentin. 3.Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks. 4.Immediate referral to an ear, nose, and throat (ENT) specialist.

Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks.

You prescribe Levaquin (levofloxacin) for a severe sinus infection. What is not a possible adverse reaction to this medication? 1.Achilles tendon rupture. 2.Peripheral neuropathy. 3.Nephrotoxicity. 4.Stevens-Johnson syndrome.

Stevens-Johnson syndrome.

What is the most common bacterial pathogen associated with acute otitis media? 1.Streptococcus pneumoniae. 2.Haemophilus influenzae. 3.Streptococcus pyogenes. 4.Moraxella (Branhamella) catarrhalis.

Streptococcus pneumoniae

You diagnose acute epiglottitis in Sally, age 5, and immediately send her to the local emergency room. Which of the following symptoms would indicate that an airway obstruction is imminent? 1. Reddened face. 2. Screaming. 3. Grabbing her throat. 4. Stridor.

Stridor

Cynthia, a 31-year-old woman with a history of depression, is seen in the office today for complaints of headaches. She was recently promoted at her job, and this has caused increased stress. She describes the headache as a tightening (viselike) feeling in the temporal and nuchal areas. The pain is bilateral and tends to wax and wane. It started approximately 2 days ago and is still present. What kind of headache is she describing? 1.Classic migraine. 2.Tension headache. 3.Sinus headache. 4.Cluster headache.

Tension Headache

While doing a face, head, and neck examination on a 16-year-old patient, you note that the palpebral fissures are abnormally narrow. What are you examining? 1.The nasolabial folds. 2.The openings between the margins of the upper and lower eyelids. 3.The thyroid gland in relation to the trachea. 4.The distance between the trigeminal nerve branches.

The openings between the margins of the upper and lower eyelids.

What significant finding(s) in a 3-year-old child with otitis media with effusion would prompt more aggressive treatment and referral? 1.There is a change in the child's hearing threshold to greater than 25 dB. 2.The child has become a fussy eater. 3.The child's speech and language skills seem slightly delayed. 4.Persistent rhinitis is present.

There is a change in the child's hearing threshold to greater than 25 dB.

Which of the following conditions produces sharp, piercing facial pain that lasts for seconds to minutes? 1.Trigeminal neuralgia. 2.Temporomandibular joint (TMJ) syndrome. 3.Goiter. 4.Preauricular adenitis.

Trigeminal neuralgia

Which of the following conditions produces sharp, piercing facial pain that lasts for seconds to minutes? 1. Trigeminal neuralgia. 2. Temporomandibular joint (TMJ) syndrome. 3. Goiter. 4. Preauricular adenitis.

Trigeminal neuralgia.

Susan is a 19-year-old college student and avid swimmer. She frequently gets swimmer's ear and asks if there is anything she can do to help prevent it other than wearing earplugs, which do not really work for her. What do you suggest? 1.Start using a cotton-tipped applicator to dry the ears after swimming. 2.Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming. 3.Use a hair dryer on the highest setting to dry the ears. 4.Stop swimming.

Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming.

A 10-year-old male in 5th grade presents to the pediatric office with his mother complaining of itchy and red eyes for 1 day. The patient complains of watery drainage in both eyes, associated with repetitive itching. On physical exam, he has no fever or constitutional symptoms. His vision is normal, with no decrease in extraocular movements. The patient has a sibling that just started day care recently. He also has bilateral preauricular lymph nodes that are inflamed. What is the patient's diagnosis? 1.Viral conjunctivitis. 2.Bacterial conjunctivitis. 3.Allergic conjunctivitis. 4.Blepharitis.

Viral Conjunctivitis