EENT & Mouth - Chapter 4 Questions
Following an episode of meningitis, it is most important to assess the child for: a. Hearing loss b. Changes in taste c. Cervical lymphadenopathy d. Tinnitus
a. hearing loss
Following tympanostomy tube insertion, it is important that the tubes remain patent. Which of the following methods may be used to determine patency? a. Visual inspection b. Impedance tympanometry c. Valsalva maneuver d. Instillation of an ototopical suspension
a. visual inspection
Patients with epiglottis prefer to sit in what position? a. Sitting up and leaning forward b. Left lateral position c. Supine with neck hyperextended d. 45-degree upright, resting back
A
A 10-year-old has marked ear pain, not wanting anyone to touch his ear. The canal is edema- tous and exudate is present. TM is normal. How should this be managed? a. Topical fluoroquinolone b. Oral steroids and topical neomycin c. Oral amoxicillin and topical anesthetic d. Oral amoxicillin and topical steroid
A
A 15-month-old failed treatment with amoxi- cillin for an otitis media. At his 2-week recheck, his TM remained red with distorted landmarks and he persisted with nasal congestion, poor nighttime sleeping, and with a 101°F fever for the past 2 days. The next best step would be to treat with: a. A 10-day course of Augmentin b. A 3-week course of a cephalosporin c. A higher dose Amoxicillin and topical antibiotics d. Ceftriaxone and an antihistamine
A
A 3-month-old has a mild asymmetrical corneal light reflex on physical exam. What is the next appropriate step? a. Observe and reevaluate at the next well check b. Refer immediately to ophthalmology c. Begin atropine drops or eye patching d. Protect eyes from sunlight
A
A 3-year-old has an edematous, mildly erythe- matous right upper eyelid for one day with a fever of 103°F. An important eye assessment would be: a. Ocular mobility b. Conjunctival inflammation c. Pupillary reaction d. Optic disc papilledema
A
A 9-month-old is noted to have a bifed uvula. This would increase his risk of developing which disorder? a. Otitis media b. Retropharyngeal abscess c. Sinusitis d. Dentalmal occlusion
A
A conjunctivitis appearing in a 2-day-old newborn is likely due to: a. Chemical irritation from eye drops b. Group B streptococcus c. Chlamydia d. Gonorrhea
A
All but which one of the following conditions requires urgent inpatient admission? a. Cervical adenitis b. Retropharyngeal abscess c. Epiglottis d. Orbital cellulitis
A
Patients with otitis externa should be instructed to do which one of the following? a. Keep ear dry until symptoms improve b. Limit swimming for remainder of summer c. Wear ear plugs at all times with swimming d. Use alcohol drops before swimming each day
A
Patients with sinusitis should be instructed not to participate in what activity? a. Swimming/diving b. Boxing/wrestling c. Weight lifting d. Cross country running
A
Trauma to the eye increases the risk of devel- oping all but which one of the following? a. Strabismus b. Glaucoma c. Cataracts d. Hyphema
A
What complication of sinusitis are adolescent males more prone to? a. Intracranial abscess b. Potts puffy tumor c. Orbital cellulitis d. Dental infection
A
Which one of the following eye findings would be considered an ophthalmic emergency? a. Unilateral vesicular lesions on the upper eyelid in a 3-week-old b. Presence of chemosis in a 5-year-old with bilateral upper eyelid edema c. Cobblestone-like appearance along the inner aspect of the upper eyelid in a 15-year-old d. Bilateral redness along eyelid margins with tiny ulcerated areas in a 16-year-old
A
A 16-year-old was hit in the eye 1 day ago and now has ecchymoses on the upper and lower lids with 5 out of 10 eye pain. All but which of the following would be appropriate to obtain at this time? a. Visual acuity b. Intraocular pressure c. CT scan d. Fluorescein stain
B
Concurrent otitis media and conjunctivitis is likely due to which organism? a. Streptococcus pneumoniae b. Haemophilus influenza c. Moraxella catarrhalis d. Staphylococcus aureus
B
Retropharyngeal abscess is typically seen in what age group and mainstay treatment includes: a. Neonates; hospitalization for IV antibiotics b. 2 to 6 year old; ICU admission and IV antibiotics c. 6 to 12 year old; outpatient oral antibiotics d. Adolescent; ENT drainage of abscess
B
The most appropriate management of a 5-year-old with a firm, nontender nodule in the mid-upper eyelid for 3 weeks would be: a. Cool compresses b. Topical ophthalmic ointment c. Oral antibiotics d. Oral steroids
B
A 10-year-old has a single painful ulcerated lesion on an erythematous base on the inner buccal mucosa. The most likely diagnosis and treatment would be: a. Herpes simplex stomatitis—oral acyclovir b. Herpangina—viscousxylocaine c. Apthous ulcer—triamcinalone in Orabase d. Hand, foot, mouth syndrome—antibiotic mouthwash
C
A 7-year-old has experienced recurrent nose- bleeds in the past 2 months. What finding on the physical exam would suggest an underlying medical cause for the epistaxis? a. Wheezing b. Grade II murmur c. Petechiae d. Tonsil hypertrophy
C
All but which one of the following patients are at an increased risk of developing otitis media? a. 2-year-old with cleft palate repair at 1 year of age b. 15-month-old with Down syndrome c. 9-month-old with lactose intolerance d. 3-year-old with IgA immune deficiency
C
An 8-year-old has chronic intermittent nasal congestion. All but which one of the following would support allergic rhinitis? a. Pale boggy turbinates b. Darkened areas on lower eyelids c. Increased basophils on CBC d. Itchy, watery eyes
C
Corneal abrasions can be managed with topical application of which one of the following? a. Anesthetic for pain control b. Steroids to prevent adhesions c. Antibiotics to prevent infection d. Atropine to prevent ciliary spasm
C
Fluorescein staining of the eye is used to detect a: a. Keratitis b. Foreign body c. Corneal abrasion d. Hyphema
C
In addition to penicillin, all of the following antibiotics can be used to treat strep pharyn- gitis except: a. Clindamycin b. Erythromycin c. Bactrim d. Ceftriaxone
C
Initial exposure to the herpes virus may produce all of the following except: a. Fever and deyhdration b. Submandibular lymph nodes c. Vesicular lesions on tonsils d. Friable and edematous gingivia
C
Prematurity increases the risk of developing which one of the following? a. Nystagmus b. Astigmatism c. Myopia d. Glaucoma
C
The greatest risk in a patient with a hyphema is which one of the following? a. Glaucoma b. Infection c. Rebleed d. Cataracts
C
Which one of the following complications of strep pharyngitis cannot be prevented with antibiotics? a. Peritonsillar abscess b. Cervical adenitis c. Glomerulonephritis d. Acute rheumatic fever
C
A 2-year-old male with a history of chronic serous otitis media is noted to have a pearly white opacity in the upper outer quadrant of his TM. He currently has no symptoms and appears to hear "okay." The most likely diag- nosis and appropriate management would be: a. Tympanosclerosis; no treatment is necessary b. Persistent perforation; prescribe topical antibiotic drops c. Foreign body; perform an ear wash for removal d. Cholesteatoma; refer to otolaryngology
D
Acceptable management options for allergic rhinitis include all of the following except: a. OralCetirizine b. OralMontelukast c. Nasal beclomethasone d. Nasal neosynephrine
D
All but which one of the following assess- ments is used to determine the presence of a strabismus? a. Hirschberg test b. Cover-uncover test c. Extraocular movements d. Pupillary response
D
All but which one of the following is consistent with glaucoma? a. Photophobia b. Epiphora (increase tears) c. Blepharospasm d. Leukocoria (white red reflex)
D
All of the following may predispose a patient to thrush except: a. Age b. Steroid therapy c. Antibiotics d. Poor oral hygiene
D
Appropriate lab tests to obtain in assessment of cervical adenitis include all of the following except: a. Throat culture b. Monotest c. PPD test d. Blood culture
D
Conductive hearing loss can be caused by: a. Brain tumor b. Ototoxic drug exposure c. Loud noises d. Serous otitis
D
Confirming the diagnosis of chlamydia con- junctivitis in a newborn would best be done by obtaining which one of the following? a. Cervical swab of the mother b. Urine PCR from the mother c. Culture of the eye discharge d. Culture of the conjunctivial scrapings
D
Daily eyelid cleansing with diluted baby shampoo and a cotton-tipped applicator would be appropriate in the treatment of which one of the following conditions? a. Dacryostenosis b. Chalzion c. Hordeolum d. Blepharitis
D
Findings consistent of peritonsillar abscess include all of the following except: a. Muffledvoice b. Unilateral enlargement of tonsil c. Trismus d. Exudate on tonsils
D
The incidence of epiglottis has decreased because of which vaccine? a. Hib b. Prevnar c. Varicella d. Meningococcal
D
The organism that causes hand, foot, mouth syndrome is what virus? a. Cytomegalovirus b. Parainfluenza c. Varicella-zoster d. Coxsackie
D
Which foreign body in the nose needs imme- diate removal? a. Bean b. Bead c. Stone d. Battery
D
The mother of 2-year-old Shandahas brought her to the clinic because she thinks the child is having trouble hearing. Your evaluation of the complaint should start with: a. Asking detailed questions related to Shanda's medical history b. Examination of the ear c. Tympanometry and hearing tests d. Assuring the mother that transient hearing loss in childhood is common
a. Asking detailed questions related to Shanda's medical history
Assessment of the red reflex may be used to rule out which of the following? a. Opacities b. Myopia or hyperopia c. Decreased visual acuity d. Blindness
a. Opacities
Marie, at 4 years old, has been brought to the clinic because she "has something wrong with her eye." Marie and her mother report that there has been no injury to the eye and that it has been red since yesterday. Examination reveals conjunctival hyperemia and a copious amount of purulent discharge bilaterally. Vision, pupillary reflexes, and corneal clarity are all normal. Which treatment should be ordered? a. Sodium sulfacetamide ophthalmic solution b. Gentamycin ophthalmic solution c. Tobramycin ophthalmic solution d. Cromolyn sodium ophthalmic solution
a. Sodium sulfacetamide ophthalmic solution
The diagnosis of acute otitis media in a 1-year-old child is based on: a. Abnormal findings when pneu- matic otoscopy and hearing test are performed b. Changes in the tympanic membrane's contour, color, and mobility c. Presence of fever and color of the tympanic membrane d. Presence of fever, ear pain, and tenderness of the pinna
b. Changes in the tympanic membrane's contour, color, and mobility
Connor, 12 months of age, has been treated five times for acute otitis media. When planning Conner's follow-up care, it is most important to evaluate for which of the following? a. Otitis externa b. Hearing loss c. Enlarged tonsils d. shotty lymph nodes
b. Hearing loss
A 1-week-old infant has been diagnosed with nasolacrimal duct obstruction. A typical initial therapy includes: a. Use of prophylactic oral antibiotics b. Nasolacrimal sac massage c. Surgical opening of obstructed ducts d. Referral to an ophthalmologist
b. Nasolacrimal sac massage
The mother of a 5-year-old boy has brought him to the clinic because she thinks he has pinkeye. Which of the following would lead you to consider a diagnosis other than bacterial conjunctivitis? a. Hyperemic conjunctiva b. Scratchy sensation in the eye c. Decreased corneal clarity d. Copious tearing
c. Decreased corneal clarity
The mother of 2-year-old Bridget has brought her to the clinic because "she got bathroom cleanser in her eye." History reveals that about 30 minutes ago, Bridget was sitting on the floor playing with a squeeze bottle of bathroom cleaner, when the bottle accidentally opened and the liquid splashed into her right eye. Physical examination reveals a reddened right eye with an edematous lid. Initial treatment should include: a. Allowing the natural tearing process to cleanse the eye b. Performing a retinal fundoscopic examination to assess for burns c. Irrigating the eye with copious amount of normal saline d. Referring Bridget to an ophthalmologist
c. Irrigating the eye with copious amount of normal saline
Which method might be used to assess the vision of a 1-month-old child? a. Check the vessel pattern of the fundus of the eye b. Watch to see if the infant turns his or her head toward you when you speak c. Observe the pattern of interaction with the mother d. Perform the Titmus test on the infant
c. Observe the pattern of interaction with the mother
During the routine examination of a 12-year-old boy, you detect a group of hard, fixed, nontender lymph nodes, each of which measure about 1 centimeter, in the posterior cervical chain. You are unable to detect any signs of infection. Your management should include: a. Recording the finding and reassessing the nodes in 1 month b. Ordering a 10-day course of a broad spectrum antibiotic and reevaluating the nodes in 2 weeks c. Ordering a CBC, erythrocyte sedimentation rate, and chest radiograph d. Referring the child to an allergist
c. Ordering a CBC, erythrocyte sedimentation rate, and chest radiograph
An 8-year-old boy has been brought to the clinic with a chief complaint of ear pain. When you grasp the pinna of the ear, he says "that hurts real bad." These findings are consistent with a diagnosis of: a. serous otitis media b. mastoiditis c. Otitis externa d. Cholesteatoma
c. otitis externa
In a child with chronic sinusitis, the most accurate method of identifying sinus abnormalities is: a. Dark room transillumination of the sinuses b. Percussion of the paranasal sinuses c. AP, lateral, and occipitomental sinus radiographs d. CT scan of the sinuses
d. CT scan of the sinuses
Julie, at 18 months of age, has been brought to the clinic by her mother who tells you that Julie has had a cold forthe past four days. There is no history of cough and the mother is unsure whether Julie has had fever. Physical examination reveals greenish, blood-tinged mucus with a strong, foul odor, draining from the right nostril. This clinical picture is most consistent with a diagnosis of: a. Allergic rhinitis b. Viral rhinitis c. Acute sinusitis d. Nasal foreign body
d. Nasal foreign body *foul-odor*
The mother of 12-year-old Nathan has brought him to the clinic because he has had a runny nose for 2 weeks. History reveals that Nathan has visited the clinic three other times this year for upper respiratory complaints. Examination reveals slightly edematous and erythematous eyes, pale nasal mucosa with clear mucus, and pharynx with thin secretions posteriorly. There is no tonsillar swelling or exudate. Lips and nail beds are pink. Lymph node examination is significant for multiple shotty nodes. Lungs are clear to auscultation. Which action is appropriate at this time? a. Discuss symptomatic relief of the common cold with Nathan and his mother b. Culture nasal drainage and delay treatment until results are known c. Order an antibiotic d. Order an antihistamine
d. Order an antihistamine
Brian, who is 13 years old, presents to the clinic with a sore throat. History reveals that he had a sore throat a couple of weeks ago and thought he had gotten well. He now has severe pharyngeal pain of 2 days duration and says he has been sweating and thinks he has fever. Physical examination reveals a temperature of 102°F and erythematous and edematous pharynx and soft palate. The right tonsil is swollen and inflamed without exudate and the uvula is displaced to the left. Right cervical nodes are tender. Lungs are clear to auscultation. Brian's signs and symptoms are suggestive of: a. Acute uvulitis b. viral pharyngitis c. Epiglottitis d. Peritonsillar abscess
d. Peritonsillar abscess
Two days after Mike's first visit, his mother brings him back to the clinic because he has a "swollen eye." Observation reveals redness and inflammation of the right eyelid with impaired extraocular movement. Which action is appropriate? a. Reassure the mother that this is a common and usually benign condition b. treat Mike for bacterial conjunctivitis c. Order anti-inflammatory eye drops d. Refer Mike immediately to emergency room
d. Refer Mike immediately to emergency room
Mike, at 10 years of age, has been brought to the clinic with a cold. History reveals that he has had a runny nose and cough for about 10 days. There is no history of frequent respiratory problems. Physical examination reveals a temperature of 100° F and edematous cervical lymph nodes. Eyes are without redness or swelling. Examination of the nose is significant for mucopurulent drainage from the middle meatus bilaterally. The pharynx is ery- thematous without tonsillar enlargement or exudate. Breath is malodorous and lungs are clear to auscultation. Mike's management should include: a. Culture of the nasal drainage b. Radiograph of the sinuses c. Measurement of erythrocyte sedimentation rate d. Use of an antibiotic
d. Use of an antibiotic
Steven, at 10 years of age, has been diagnosed with otitis externa twice this year. Health teaching for Steven and his mother should include: a. Emphasis on consistent use of low-dose prophylactic antibiotics b. Sleeping with the affected ear in the dependent position c. Information on the use of decongestants to open the eustachian tube d. Information on the use of acetic acid after ear canal contact with water
d. information on the use of acetic acid after ear canal contact with water
Which of the following is an expected finding after treatment of acute suppurative otitis media? a.Otitis externa b.Central auditory dysfunction c.Functional hearing loss d.Middle ear effusion
d.Middle ear effusion