HEENT

Which of the following conditions is an emergency? a. Acute onset of strabismus in an older adult b. Acute onset of a pinguecula c. Acute onset of subconjunctival hemorrhage in an adult d. Acute onset of conjunctivitis in a child

*a. Acute onset of strabismus in an older adult Acute onset of strabismus in an adult is abnormal and may be a sign of a serious neurological condition. Pinguecula and subconjunctival hemorrhages are benign conditions. Conjunctivitis is usually an easily treated infection.

Which of the following techniques is not used to assess for strabismus? a. Direct ophthalmoscopy b. Cover test c. Corneal light reflex d. Extraocular eye movements

*a. Direct ophthalmoscopy Direct ophthalmoscopy is an advanced assessment technique employed to evaluate the retina, macula, optic nerve, or ocular vasculature.

A patient presents with the chief complaint of headache. Which symptoms elicited during the history would be a red flag for urgent consultation or referral? a. Onset of intense pain was immediate and debilitating b. Throbbing, aching pain has persisted for 24 hours c. Unilateral pain with sensitivity to light and sound d. Waves of nausea during headache, vomited once

*a. Onset of intense pain was immediate and debilitating

What are the three core symptoms of acute sinusitis? a. Purulent nasal drainage, facial pain/pressure, and nasal obstruction b. Sore throat, facial pain/pressure, and dental pain c. Nasal obstruction, dental pain, and fever d. Fever, facial pain, and cough

*a. Purulent nasal drainage, facial pain/pressure, and nasal obstruction

How would you straighten the ear canal in an adult? a. Up and back b. Down and back c. Up and to the front d. Down and to the front

*a. Up and back When examining an adult, always pull up and back on the exam. This helps to straighten the canal for better visualization. When examining a child under the age of 3, the clinician will need to pull back and down on the posterior helix.

The most common cause of conductive hearing loss is a. cerumen b. otitis media with effusion c. presbycusis d. tympanosclerosis

*a. cerumen

In older adults, one of the more common signs of hyperthyroidism is a. new-onset atrial fibrillation b. palpable nontender mass of the anterior neck c. vomiting and abdominal pain d. weight gain and increased appetite

*a. new-onset atrial fibrillation Older adults and individuals with milder hyperthyroidism often have isolated symptoms that warrant evaluation, including unexplained weight loss, decreased appetite, weakness, and new onset of atrial fibrillation.

Which should prompt immediate transport of an athlete with a concussion for emergency evaluation? a. Accurate but slowed mental processing b. Decreasing level of consciousness c. Headache and nausea d. Inability to recall injury

*b. Decreasing level of consciousness

Lymphedema improves with elevation of the limb: a. Yes, always b. Sometimes c. No, never

*b. Sometimes Elevation of the limb may improve swelling in the early stages but not as the condition progresses.

The Centor criteria are used to help determine which diagnosis? a. Otitis media b. Otitis media with effusion c. Strep pharyngitis d. Acute sinusitis

*c. Strep pharyngitis Scores greater than or equal to 3 warrants a rapid strep.

What is the primary function of the iris? a. To regulate the intraocular eye pressure b. To regulate the rods and cones c. To regulate the amount of light that passes through the pupil d. To regulate extraocular eye movements

*c. To regulate the amount of light that passes through the pupil

Patients with medical history of inflammatory or autoimmune disorders are at greater risk for which of the following conditions? a. Cataracts b. Dacryostenosis c. Uveitis d. Orbital cellulitis

*c. Uveitis Uveitis is an inflammatory condition of the uveal tract. Patients with medical history of inflammatory or autoimmune disorders are more likely to develop inflammation of the uveal tract.

A predominant cause of a pterygium is chronic exposure to a. elevated blood glucose *b. ultraviolet sunlight c. cigarette smoke d. cosmetics

*b. ultraviolet sunlight Pterygia are thought to be caused by chronic dry eyes and chronic exposure to wind, dust, and ultraviolet light. Pinguecula and pterygium are both benign growths of the conjunctiva. Pinguecula is a growth that appears as a yellow bump on the inner canthus of the conjunctiva. Pterygium is a growth of fleshy tissue that often arises from the pinguecula.

Which is a systemic cause of epistaxis? a. Intranasal medications b. Digital trauma c. Alcoholism d. Inhaled illicit drugs

*c. Alcoholism Local causes include use of intranasal medications, digital trauma, inhaled illicit drugs, dry environment, deviated septum, and nasal canula oxygen use. Systemic causes include uncontrolled hypertension, alcoholism, coagulopathies, medications that affect coagulation, and vascular malformations.

What is the most common cause of oropharyngeal cancers? a. Smoking b. Poor oral hygiene c. HPV d. Chronic strep infections

*c. HPV It is projected that 70% of oropharyngeal cancers in the United States are caused by HPV, making oropharyngeal cancers the most common HPV-related cancer in the country.

Parents of a newborn are concerned because their baby's head appears misshapen. Which response is most accurate? a. Asymmetry of a newborn's head is likely related to internal bleeding. b. Asymmetry of a newborn's head requires CT scan evaluation. c. Molding of the head after vaginal birth is a common finding. d. Molding of the head after vaginal birth will take months to resolve.

*c. Molding of the head after vaginal birth is a common finding.

Which problem is associated with thyroid hypofunction? a. Exophthalmos b. Graves' disease c. Myxedema d. Thyroid storm

*c. Myxedema

When individuals present with signs and symptoms of head and neck disorders, which of these risk factors for head and neck cancer would need to be assessed as part of their history? a. Alcohol and tobacco use b. Infection with human papillomavirus (HPV) c. Occupational exposures d. Poor oral health e. All of the above

*e. All of the above

When palpating the abdomen of a 20-year-old college student who has been experiencing fatigue, the clinician notes the presence of tenderness in the left upper quadrant with deep palpation. Which anatomic structure is most likely to be the cause of this tenderness? a. Appendix b. Liver c. Spleen d. Thymus

*c. Spleen The spleen is an organ that is below the diaphragm on left side. The reference to the client experiencing fatigue is suggestive of mononucleosis; 50% of individuals experiencing mononucleosis are likely to have splenomegaly, which would allow the spleen to be palpable and tender.

In most cases of lymphadenopathy, the enlarged lymph nodes are found in which region? a. Cervical b. Supraclavicular c. Inguinal d. Axillae

a. Cervical Over half of all localized lymphadenopathy cases involve lymph nodes in the head and neck.

Which are considered part of the lymphatic system? a. Spleen, thyroid, and lymph nodes b. Peyer's patches, thymus, and spleen c. Lymph nodes, tonsils, and liver d. Appendix, gall bladder, and MALT

b. Peyer's patches, thymus, and spleen The thyroid, liver, and gall bladder are not part of the lymphatic system.

Which region of lymphadenopathy would always require further investigation and follow-up? a. Cervical b. Supraclavicular c. Inguinal d. Axillae

b. Supraclavicular Any palpable supraclavicular, infraclavicular, iliac, epitrochlear, or popliteal lymph nodes should be considered abnormal, regardless of size.

Visual acuity in children does not typically reach 20/20 until which age? a. 6 to 12 months b. 2 to 3 years c. 5 to 6 years d. 8 to 9 years

c. 5 to 6 years Normal visual acuity in the newborn ranges from 20/100 to 20/400 and gradually develops to 20/20 by 5 to 6 years of age.

Which is true regarding shotty lymph nodes? a. They are often due to lymphedema. b. They are often large (>10 mm). c. They are often benign. d. They are often due to malignancy.

c. They are often benign. Shotty lymph nodes are a clustering of multiple, small, contiguous lymph nodes that are often benign and associated with a recent viral infection. The description of lymph nodes as "shotty" refers to their similarity to "buckshot or pellets" that are also small, hard, and round.

During the Weber test, the patient reports that the sound is heard louder in the right ear. What does this mean? a. The exam is considered normal. b. There is conductive hearing loss. c. There is sensorineural hearing loss. d. There is both conductive and sensorineural hearing loss.

*b. There is conductive hearing loss. The exam is considered normal if the sound is heard equally in each ear. In unilateral conductive hearing loss, the sound lateralizes to the affected ear (it will be heard louder in the affected ear). In unilateral sensorineural hearing loss, the sound lateralizes away from the affected ear (it will be heard louder in the normal ear). This test can not be performed if the patient is edentulous or has false teeth.

The following instrument is used to measure intraocular eye pressure: a. Lensometer b. Tonometer c. Ophthalmoscope d. Phoropter

*b. Tonometer A tonometer is an instrument that measures IOP by measuring the resistance of the cornea to indentation.

The vision of an individual with type I diabetes has decreased significantly within the last 2 weeks. HbA1c is 12.5%. The most likely ocular finding is a. cataracts b. diabetic retinopathy c. glaucoma d. macular degeneration

*b. diabetic retinopathy Uncontrolled diabetes (HbA1c > 7%) is the primary risk factor for diabetic retinopathy. Cataracts, glaucoma, and macular degeneration do result in decreased vision, but these conditions generally progress slowly and are not a comorbidity of diabetes

As a component of their assessment, clinicians should ask individuals who are immunocompromised about a. daily use of industrial-strength, antibacterial cleansers b. handwashing, food safety, and travel precautions c. their ability to abstain from sexual intimacy and intercourse d. their ability to remain isolated from family and friends

*b. handwashing, food safety, and travel precautions Individuals who are immunocompromised need to take precautions to prevent infections, which include handwashing, safe food handling and storage, limiting exposure to environmental toxins, handling animals safely, practicing safe sex, and taking extra care when traveling.

Physical exam of the thyroid gland in adults normally reveals that the thyroid gland is a. directly above the cricoid and thyroid cartilage b. midline and moves with swallowing c. nodular and tender d. nonpalpable and nonmobile

*b. midline and moves with swallowing The anterior triangle that forms the midline of the neck includes the hyoid bone, thyroid cartilage, cricoid cartilage, trachea, thyroid, and parathyroid glands. When palpating the thyroid gland, ask the individual to swallow while keeping fingers steady in this position, and the thyroid isthmus can be felt rising under the pads of the fingers as the person swallows.

Who most needs an imaging study as part of his or her diagnostic workup? The patient with a. headaches triggered by lack of sleep b. onset of migraines at 60 years of age c. recurrent migraines for 3 to 5 years d. sinus infection concurrent with migraine

*b. onset of migraines at 60 years of age

A 6-month-old infant is brought to the clinic with new onset of vomiting. Which physical exam finding is most reassuring? a. Bulging anterior and posterior fontanels b. Closure of all fontanels with palpable suture lines c. Depressed anterior fontanel and open posterior fontanel d. Flat anterior fontanel and closed posterior fontanel

*d. Flat anterior fontanel and closed posterior fontanel

Which physical finding is indicative of increased intraocular pressure (IOP)? a. Ptosis b. Red pupillary reflex c. Leukocoria d. Papilledema

*d. Papilledema Papilledema describes an edematous optic disk, which is a sign of increased IOP. Leukocoria is a white pupillary reflex (instead of the normal red reflex), which is a sign of retinal disease like retinoblastoma. Ptosis is an asymmetry of the eyelid, which can be benign or a sign of a CN III palsy. A red pupillary reflex is normal.

Which statement is false regarding otitis media with effusion (OME)? a. Will often resolve spontaneously within 3 months b. Can cause speech problems in children c. Is often seen following an acute otitis media d. Will have a normal Weber test

*d. Will have a normal Weber test

A symptom of a retinal tear includes a. clear drainage b. eye pain c. subconjunctival hemorrhage d. floaters

*d. floaters Signs and symptoms of a retinal tear include acute onset of floaters, flashes of light (photopsia), blurred vision, and impaired peripheral vision.

A complete lymphatic exam includes all except a. all lymph nodes b. spleen c. general survey d. pulses

*d. pulses The general survey and palpation of the lymph nodes and spleen are essential parts of the lymphatic exam. Palpating for pulses could add helpful diagnostic information in certain clinical scenarios but is not imperative for the focused lymphatics exam.

All of the following could indicate a foreign body in the nose except a. unilateral nasal obstruction b. unilateral epistaxis c. unilateral chronic sinusitis d. septal deviation

*d. septal deviation In patients with unilateral nasal obstruction, epistaxis, and unilateral chronic sinusitis, a differential diagnosis of intranasal mass or foreign body should be excluded. Found in clinical pearls.

All are characteristics of a lymph node that would warrant further investigation except a. hard b. fixed c. 2 cm in diameter d. tender

*d. tender Hard, matted, fixed, nontender, or irregular lymph node(s) are more suspicious for pathogenicity and require further investigation into the etiology. Tenderness of a lymph node is more indicative of an infectious etiology.

The clinician notes that an individual has an enlarged right epitrochlear lymph node. What further assessment is needed to determine a possible cause? a. Ask additional history questions regarding recent ear infections or sore throats. b. Assess the patient's abdomen, noting any tenderness. c. Carefully examine cervical lymph nodes, checking for any enlargement. d. Examine the patient's arm and hand, assessing for signs of infection.

d. Examine the patient's arm and hand, assessing for signs of infection. Any palpable supraclavicular, infraclavicular, iliac, epitrochlear, or popliteal lymph nodes should be considered abnormal, regardless of size. Palpable nodes often indicate distal infection.

Which is associated with nonallergic rhinitis? a. Nasal itching is a common symptom. b. Allergy testing is positive for IgE. c. It is commonly seen in patients with eczema. d. It can be triggered by medications or pregnancy.

d. It can be triggered by medications or pregnancy. Nonallergic rhinitis can be triggered by medications or pregnancy. Allergy testing is negative for IgE with this condition. All other answers are characteristics of allergic rhinitis.

Standardized assessment of concussion immediately after injury should include testing of a. coordination, balance, and sensation b. exertional maneuvers and strength c. immediate and delayed recall d. orientation to time, person, and place e. all of the above

e. all of the above