Eye, Ear, Nose, And Throat

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Ctichy84

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Quizzes Created: 5 | Total Attempts: 23,027

Questions: 77 | Attempts: 5,497 | Updated: Nov 16, 2023

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The Ear, Eye, Nose, and Throat are essential organs of the body for proper functioning. This quiz contains various ENT practice questions ranging from east, medium, to high level that will gauge your expertise in the topic. If you are someone who is preparing for a medical exam, this quiz will be of immense benefit to you. Share the quiz with your friends and family if you find it informative. All the best!

Questions and Answers

1.

A 74-year-old woman with well-controlled HTN who is taking HCTZ presents with a 3-day history of unilateral throbbing headache with difficulty chewing because of the pain. On physical exam, you find a tender, noncompressible temporal artery. BP is 160/88 mmHg, apical pulse is 98 bpm and respiratory rate is 22/min. The patient is visibly uncomfortable. The most likely diagnosis is:
- A.
  
  Giant cell arteritis
- B.
  
  Impending TIA
- C.
  
  Complicated migraine
- D.
  
  Temporal mandibular joint dysfunction
Correct Answer
A. Giant cell arteritis

Explanation
The patient's presentation of a unilateral throbbing headache, difficulty chewing, and tender, noncompressible temporal artery is highly suggestive of giant cell arteritis. Giant cell arteritis is an inflammatory condition that affects medium and large arteries, particularly the temporal arteries. It commonly presents in older individuals and is associated with symptoms such as headache, jaw claudication, and visual disturbances. The elevated blood pressure and discomfort further support this diagnosis. Impending TIA, complicated migraine, and temporomandibular joint dysfunction do not explain the characteristic findings of tender temporal artery and elevated blood pressure.

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2.

Therapeutic interventions for the patient with Giant Cell Arteritis should include:
- A.
  
  Systemic corticosteroid therapy for many months
- B.
  
  Addition of an ACEI for her antihypertensive regimen.
- C.
  
  Warfarin therapy
- D.
  
  Initiation of topiramate (Topamax) therapy
Correct Answer
A. Systemic corticosteroid therapy for many months

Explanation
The correct answer is systemic corticosteroid therapy for many months. Giant Cell Arteritis is an inflammatory disease that affects the blood vessels, particularly the arteries in the head and neck. Systemic corticosteroids are the mainstay of treatment for this condition, as they help reduce inflammation and prevent complications such as vision loss. The therapy usually lasts for many months to ensure adequate control of the disease. The other options, addition of an ACEI, warfarin therapy, and initiation of topiramate therapy, are not indicated in the treatment of Giant Cell Arteritis.

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3.

Concomitant disease seen with giant cell arteritis includes:
- A.
  
  Polymyalgia rheumatica
- B.
  
  Acute pancreatitis
- C.
  
  Psoriatic arthritis
- D.
  
  Reiter syndrome
Correct Answer
A. Polymyalgia rheumatica

Explanation
Giant cell arteritis is commonly associated with polymyalgia rheumatica, a condition characterized by muscle pain and stiffness, especially in the shoulders and hips. Both conditions often occur together and share similar symptoms such as joint pain and inflammation. This association is believed to be due to the autoimmune nature of both diseases, where the immune system mistakenly attacks healthy tissues. Therefore, polymyalgia rheumatica is a concomitant disease frequently seen in patients with giant cell arteritis.

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4.

One of the most serious complications of giant cell arteritis is:
- A.
  
  Hemiparesis
- B.
  
  Arthritis
- C.
  
  Blindness
- D.
  
  Uveitis
Correct Answer
C. Blindness

Explanation
Blindness is the correct answer because giant cell arteritis is a condition that causes inflammation of the blood vessels, particularly in the head and neck. If the blood vessels supplying the optic nerve become inflamed, it can lead to a condition called anterior ischemic optic neuropathy, which can cause sudden and permanent vision loss. Therefore, blindness is a serious complication of giant cell arteritis.

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5.

An 88-year-old, community-dwelling man who lives alone has limited mobility because of osteoarthritis. Since his last office visit 2 months ago, he has lost 5% of his body weight and has developed angular cheilitis. You expect to find the following on exam:
- A.
  
  Fissuring and cracking at the corners of the mouth
- B.
  
  Marked erythema of the hard and soft palates
- C.
  
  White plaques on the lateral borders of the buccal mucosa
- D.
  
  Raised, painless lesions on the gingiva
Correct Answer
A. Fissuring and cracking at the corners of the mouth

Explanation
The presence of fissuring and cracking at the corners of the mouth, known as angular cheilitis, is indicative of a nutritional deficiency, specifically of vitamin B2 (riboflavin). This is supported by the fact that the patient has also experienced weight loss and has developed angular cheilitis, both of which can be associated with malnutrition. The other findings mentioned, such as marked erythema of the hard and soft palates, white plaques on the buccal mucosa, and raised, painless lesions on the gingiva, are not typically associated with a deficiency in vitamin B2.

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6.

First line therapy for angular cheilitis therapy includes the use of:
- A.
  
  Metronidazole gel
- B.
  
  Hydrocortisone cream
- C.
  
  Topical nystatin
- D.
  
  Oral ketoconazole
Correct Answer
C. Topical nystatin

Explanation
Topical nystatin is the first line therapy for angular cheilitis because it is an antifungal medication that effectively treats fungal infections, which are often the cause of angular cheilitis. It works by inhibiting the growth of fungi and preventing their spread. Other options mentioned, such as metronidazole gel, hydrocortisone cream, and oral ketoconazole, may have different uses or may not be as effective in treating angular cheilitis specifically.

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7.

A 19-year-old man presents with a chief complaint of a red, irritated right eye for the past 48 hours with eyelids that were "stuck together" this morning when he awoke. Exam reveals injected palpebral and bulbar conjunctiva; reactive pupils; vision screen with the Snellen chart of 20/30 in the right eye (OD), left eye (OS) and both eyes (OU); and purulent eye discharge on the right. This presentation is most consistent with:
- A.
  
  Suppurative conjunctivitis
- B.
  
  Viral conjunctivitis
- C.
  
  Allergic conjunctivitis
- D.
  
  Mechanical injury
Correct Answer
A. Suppurative conjunctivitis

Explanation
The patient's symptoms of redness, irritation, and purulent eye discharge, along with the presence of injected palpebral and bulbar conjunctiva, suggest an infection of the conjunctiva. Suppurative conjunctivitis, also known as bacterial conjunctivitis, is characterized by these symptoms and is commonly caused by bacterial pathogens. Viral conjunctivitis and allergic conjunctivitis typically do not present with purulent discharge. Mechanical injury would not explain the presence of purulent discharge and the other symptoms described. Therefore, suppurative conjunctivitis is the most likely explanation for the patient's presentation.

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8.

A 19-year-old woman presents with a complaint of bilaterally itchy, red eyes with tearing that occurs intermittently throughout the year and is often accompanied by a rope-like eye discharge and clear nasal discharge. This is most consistent with conjunctival inflammation caused by a(n):
- A.
  
  Bacterium
- B.
  
  Virus
- C.
  
  Allergen
- D.
  
  Injury
Correct Answer
C. Allergen

Explanation
The symptoms described, including bilateral itchy, red eyes with tearing, rope-like eye discharge, and clear nasal discharge, are characteristic of allergic conjunctivitis. Allergens, such as pollen, dust mites, or pet dander, can trigger an immune response in susceptible individuals, leading to inflammation of the conjunctiva. This type of conjunctivitis is typically chronic and occurs intermittently throughout the year. Bacteria and viruses can cause conjunctivitis as well, but the symptoms described are more indicative of an allergic response. Injury would typically present with different symptoms, such as pain or trauma to the eye.

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9.

Common causative organisms of acute suppurative conjunctivitis include all of the following except:
- A.
  
  Staph aureus
- B.
  
  Haemophilus influenzae
- C.
  
  Strep pneumoniae
- D.
  
  Pseudomonas aeruginosa
Correct Answer
D. Pseudomonas aeruginosa

Explanation
Pseudomonas aeruginosa is not a common causative organism of acute suppurative conjunctivitis. Staph aureus, Haemophilus influenzae, and Strep pneumoniae are known to be causative organisms of this condition. Pseudomonas aeruginosa is more commonly associated with other types of infections, such as urinary tract infections or respiratory infections.

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10.

Treatment options in suppurative conjunctivitis include all of the following ophthalmic preparations except:
- A.
  
  Bacitracin-polymyxin B
- B.
  
  Ciprofloxacin
- C.
  
  Erythromycin
- D.
  
  Penicillin
Correct Answer
D. Penicillin

Explanation
The question is asking for the treatment options in suppurative conjunctivitis, and the correct answer is Penicillin. This means that Penicillin is not a recommended ophthalmic preparation for treating suppurative conjunctivitis. The other options listed, Bacitracin-polymyxin B, Ciprofloxacin, and Erythromycin, are all commonly used ophthalmic preparations for treating this condition.

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11.

Treatment options in acute and recurrent allergic conjunctivitis include all of the following except:
- A.
  
  Cromolyn ophthalmic drops
- B.
  
  Oral antihistamines
- C.
  
  Ophthalmological antihistamines
- D.
  
  Corticosteroid ophthalmic drops
Correct Answer
D. Corticosteroid ophthalmic drops

Explanation
Corticosteroid ophthalmic drops are not a treatment option for acute and recurrent allergic conjunctivitis. Corticosteroids are potent anti-inflammatory medications that can be used to treat various eye conditions, but they are generally reserved for more severe cases or when other treatments have failed. Cromolyn ophthalmic drops, oral antihistamines, and ophthalmological antihistamines are commonly used to relieve the symptoms of allergic conjunctivitis by reducing inflammation and blocking the effects of histamine.

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12.

Anterior epistaxis is usually caused by:
- A.
  
  HTN
- B.
  
  Bleeding disorders
- C.
  
  Localized nasal mucosa trauma
- D.
  
  A foreign body
Correct Answer
C. Localized nasal mucosa trauma

Explanation
Anterior epistaxis refers to nosebleeds that occur in the front part of the nose. The most common cause of anterior epistaxis is localized nasal mucosa trauma, which can result from activities such as nose picking, blowing the nose forcefully, or irritation from dry air. High blood pressure (HTN), bleeding disorders, and foreign bodies can also contribute to nosebleeds, but they are less commonly associated with anterior epistaxis.

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13.

First-line intervention for anterior epistaxis includes:
- A.
  
  Nasal packing
- B.
  
  Application of topical thrombin
- C.
  
  Firm pressure to the area superior to the nasal alar cartilage
- D.
  
  Chemical cauterization
Correct Answer
C. Firm pressure to the area superior to the nasal alar cartilage

Explanation
The first-line intervention for anterior epistaxis is firm pressure to the area superior to the nasal alar cartilage. This technique, known as the "pinch and blow" method, involves pinching the soft part of the nose just below the nasal bone and applying firm pressure for about 10-15 minutes. This helps to compress the blood vessels and stop the bleeding. Nasal packing, application of topical thrombin, and chemical cauterization are alternative interventions that may be used if firm pressure is ineffective or if the bleeding is severe.

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14.

A 58-year-old woman presents with a sudden left-sided headache that is most painful in her left eye. Her vision is blurred and the left pupil is slightly dilated and poorly reactive. The left conjunctiva is markedly injected and the eyeball is firm. Vision screen with the Snellen chart is 20/30 OD and 20/90 OS. The most likely diagnosis is:
- A.
  
  Unilateral herpetic conjunctivitis
- B.
  
  Open-angle glaucoma
- C.
  
  Angle closure glaucoma
- D.
  
  Anterior uveitis
Correct Answer
C. Angle closure glaucoma

Explanation
The patient's sudden left-sided headache, blurred vision, dilated and poorly reactive left pupil, injected conjunctiva, and firm eyeball are all consistent with the symptoms of angle closure glaucoma. Additionally, the significant difference in vision between the right and left eyes (20/30 OD and 20/90 OS) suggests that there is a problem specifically with the left eye. These findings indicate that the most likely diagnosis is angle closure glaucoma, which is characterized by a sudden increase in intraocular pressure due to the closure of the drainage angle in the eye.

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15.

In caring for a patient with angle closure glaucoma, the most appropriate action is:
- A.
  
  Prompt referral to an ophthamologist
- B.
  
  To provide analgesia and repeat the exam when the patient is more comfortable
- C.
  
  To instill a corticosteroid ophthalmic solution
- D.
  
  To patch the eye and arrange follow-up in 24 hours
Correct Answer
A. Prompt referral to an ophthamologist

Explanation
Prompt referral to an ophthalmologist is the most appropriate action in caring for a patient with angle closure glaucoma. Angle closure glaucoma is a medical emergency that requires immediate attention from an ophthalmologist. It is characterized by a sudden increase in intraocular pressure, which can lead to irreversible vision loss if not treated promptly. Prompt referral to an ophthalmologist ensures that the patient receives the necessary specialized care and treatment to relieve the intraocular pressure and prevent further damage to the optic nerve.

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16.

A 48-year-old man presents with a new-onset right eye vision change accompanied by dull pain, tearing and photophobia. The right pupil is small, irregular and poorly reactive. Vision testing obtained by using the Snellen chart is 20/30 OS and 20/80 OD. The most likely diagnosis is:
- A.
  
  Unilateral herpetic conjunctivitis
- B.
  
  Open-angle glaucoma
- C.
  
  Angle-closure glaucoma
- D.
  
  Anterior uveitis
Correct Answer
D. Anterior uveitis

Explanation
The patient's symptoms of new-onset vision change, dull pain, tearing, and photophobia, along with the findings of a small, irregular, and poorly reactive right pupil, are consistent with anterior uveitis. Anterior uveitis is characterized by inflammation of the iris and ciliary body, leading to these symptoms and signs. The vision testing results also support this diagnosis, as there is a significant difference in visual acuity between the two eyes. Unilateral herpetic conjunctivitis typically presents with more severe symptoms and signs, such as vesicular lesions on the eyelids and conjunctiva. Open-angle glaucoma and angle-closure glaucoma typically do not cause acute vision changes or pupil abnormalities.

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17.

Which of the following is a common vision problem in the person with untreated primary open-angle glaucoma (POAG)?
- A.
  
  Peripheral vision loss
- B.
  
  Blurring of near vision
- C.
  
  Difficulty with distant vision
- D.
  
  Need for increased illumination
Correct Answer
A. Peripheral vision loss

Explanation
Untreated primary open-angle glaucoma (POAG) commonly leads to peripheral vision loss. This occurs because the optic nerve, which transmits visual information from the eye to the brain, becomes damaged over time due to increased pressure in the eye. As a result, the person gradually loses their ability to see objects and movement in their side or peripheral vision, while their central vision remains relatively unaffected. This symptom is a hallmark of POAG and can significantly impact a person's daily activities and mobility if left untreated.

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18.

Which of the following is most likely to be found on the funduscopic exam in a patient with untreated POAG?
- A.
  
  Excessive cupping of the optic disk
- B.
  
  Arteriovenous nicking
- C.
  
  Papilledema
- D.
  
  Flame-shaped hemorrhages
Correct Answer
A. Excessive cupping of the optic disk

Explanation
Excessive cupping of the optic disk is most likely to be found on the funduscopic exam in a patient with untreated primary open-angle glaucoma (POAG). This is because POAG is characterized by progressive damage to the optic nerve, which leads to the excavation or cupping of the optic disk. As the disease progresses, the cupping becomes more pronounced, indicating worsening damage to the optic nerve. Arteriovenous nicking, papilledema, and flame-shaped hemorrhages are not typically associated with POAG and may be indicative of other ocular or systemic conditions.

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19.

Risk factors for POAG include all of the following except:
- A.
  
  African ancestry
- B.
  
  DM-II
- C.
  
  Advanced age
- D.
  
  Blue eye color
Correct Answer
D. Blue eye color

Explanation
The correct answer is blue eye color. Blue eye color is not considered a risk factor for primary open-angle glaucoma (POAG). POAG is more common in individuals of African ancestry, those with diabetes mellitus type II (DM-II), and older individuals. However, there is no evidence to suggest that blue eye color increases the risk of developing POAG.

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20.

Treatment options for POAG include all of the following topical agents except:
- A.
  
  Beta-adrenergic antagonists
- B.
  
  Alpha2-agonists
- C.
  
  Prostaglandin analogues
- D.
  
  Mast cell stabilizers
Correct Answer
D. Mast cell stabilizers

Explanation
The correct answer is mast cell stabilizers because they are not used as a treatment option for primary open-angle glaucoma (POAG). Mast cell stabilizers are typically used to treat allergic conditions such as allergic conjunctivitis, not glaucoma. The other options listed (beta-adrenergic antagonists, alpha2-agonists, and prostaglandin analogues) are commonly used topical agents for managing POAG.

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21.

A 22-year-old woman presents with a "pimple" on her right eyelid. Exam reveals a 2-mm pustule on the lateral border of the right eyelid margin. This is most consistent with:
- A.
  
  A chalazion
- B.
  
  A hordeolum
- C.
  
  Blepharitis
- D.
  
  Cellulitis
Correct Answer
B. A hordeolum

Explanation
A hordeolum, also known as a stye, is a common condition characterized by a pustule or abscess on the eyelid margin. It is typically caused by an infection of the oil glands in the eyelid. The presentation of a 2-mm pustule on the lateral border of the eyelid margin aligns with the classic clinical findings of a hordeolum. Chalazion, another eyelid condition, is characterized by a painless, non-infectious, chronic granulomatous inflammation, which is not consistent with the given presentation. Blepharitis is a chronic inflammation of the eyelid margins, but it does not typically present with a pustule. Cellulitis is a more severe infection involving the deeper tissues of the eyelid, and it would present with more significant signs and symptoms than described in the question stem.

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22.

A 22-year-old woman presents with a "bump" on her right eyelid. Exam reveals a 2-mm hard, non-tender swelling on the lateral border of the right eyelid margin. This is most consistent with:
- A.
  
  A chalazion
- B.
  
  A hordeolum
- C.
  
  Blepharitis
- D.
  
  Cellulitis
Correct Answer
A. A chalazion

Explanation
The presentation of a 2-mm hard, non-tender swelling on the lateral border of the right eyelid margin is most consistent with a chalazion. A chalazion is a painless, chronic granulomatous inflammation of the meibomian gland, which can cause a firm, non-tender nodule on the eyelid. A hordeolum, on the other hand, presents as an acute, tender, erythematous swelling, usually involving the eyelash follicle. Blepharitis is inflammation of the eyelid margins, typically causing redness and crusting. Cellulitis is a more severe infection involving the soft tissues around the eye, which would present with erythema, warmth, tenderness, and systemic symptoms.

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23.

Treatment options for uncomplicated hordeolum include all of the following except:
- A.
  
  Erythromycin ophthalmic ointment
- B.
  
  Warm compresses to the affected area
- C.
  
  Incision and drainage
- D.
  
  Oral antimicrobial therapy
Correct Answer
D. Oral antimicrobial therapy

Explanation
The correct answer is oral antimicrobial therapy. Hordeolum, also known as a stye, is a common infection of the eyelid caused by bacteria. The mainstay of treatment for uncomplicated hordeolum includes warm compresses to the affected area to promote drainage and healing, as well as the use of topical antibiotics such as erythromycin ophthalmic ointment to eliminate the bacterial infection. Incision and drainage may be necessary in some cases if the stye does not improve with conservative measures. However, oral antimicrobial therapy is not typically recommended for uncomplicated hordeolum.

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24.

Which of the following is true regarding Meniere disease?
- A.
  
  Neuroimaging helps locate the offending cochlear lesion
- B.
  
  Associated high-frequency hearing loss is common
- C.
  
  It is largely a diagnosis of exclusion
- D.
  
  Tinnitus is rarely reported
Correct Answer
C. It is largely a diagnosis of exclusion

Explanation
Meniere's disease is largely a diagnosis of exclusion, meaning that other possible causes of the symptoms must be ruled out before a diagnosis of Meniere's disease can be made. This is because the symptoms of Meniere's disease, such as vertigo, hearing loss, and tinnitus, can also be caused by other conditions. Neuroimaging is not typically used to locate the offending cochlear lesion in Meniere's disease, and associated high-frequency hearing loss is actually common in this condition. Tinnitus is a common symptom of Meniere's disease, not rarely reported.

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25.

Prevention and prophylaxis in Meniere's disease include all of the following except:
- A.
  
  Avoiding ototoxic drugs
- B.
  
  Protecting the ears from loud noise
- C.
  
  Limiting sodium intake
- D.
  
  Restricting fluid intake
Correct Answer
D. Restricting fluid intake

Explanation
Restricting fluid intake is not a recommended prevention or prophylaxis method for Meniere's disease. Meniere's disease is characterized by an excess buildup of fluid in the inner ear, leading to symptoms such as vertigo, hearing loss, and tinnitus. Restricting fluid intake could potentially worsen the condition by causing dehydration and imbalances in the body. Therefore, it is important to avoid ototoxic drugs, protect the ears from loud noise, and limit sodium intake to manage Meniere's disease, but restricting fluid intake is not necessary.

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26.

You inspect the oral cavity of a 69-year-old man who has a 100-pack-year cigarette smoking history. You find a lesion suspicious for malignancy and describe it as:
- A.
  
  Raised, red and painful
- B.
  
  A denuded patch with a removable white coating
- C.
  
  An ulcerated lesion with indurated margins
- D.
  
  A vesicular-form lesion with macerated margins
Correct Answer
C. An ulcerated lesion with indurated margins

Explanation
The description of an ulcerated lesion with indurated margins suggests a possible malignancy. Ulceration refers to the presence of an open sore or wound, while indurated margins indicate hardened or firm edges around the lesion. These characteristics are concerning for a cancerous growth, as they can be indicative of tissue destruction and infiltration. It is important to further evaluate and potentially biopsy this lesion to confirm the diagnosis and determine appropriate management.

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27.

A firm, painless, relatively fixed submandibular node would most likely be seen in the diagnosis of:
- A.
  
  Herpes simplex
- B.
  
  Acute otitis media
- C.
  
  Bacterial pharyngitis
- D.
  
  Oral cancer
Correct Answer
D. Oral cancer

Explanation
A firm, painless, relatively fixed submandibular node is a characteristic finding in oral cancer. Oral cancer can cause the enlargement of lymph nodes in the submandibular area, which may feel firm to the touch. This is in contrast to conditions like herpes simplex, acute otitis media, and bacterial pharyngitis, which typically do not cause such specific lymph node changes. Therefore, the presence of a firm, painless, relatively fixed submandibular node would be more indicative of oral cancer than the other options.

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28.

A 45-year-old man presents with otitis externa. Likely causative pathogens include all of the following except:
- A.
  
  Fungal agents
- B.
  
  P. aeruginosa
- C.
  
  S. aureus
- D.
  
  M. catarrhalis
Correct Answer
D. M. catarrhalis

Explanation
M. catarrhalis is not a likely causative pathogen for otitis externa. Otitis externa is usually caused by bacterial or fungal agents. P. aeruginosa and S. aureus are commonly associated with otitis externa, while M. catarrhalis is more commonly associated with upper respiratory tract infections such as otitis media or sinusitis. Therefore, M. catarrhalis is the correct answer.

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29.

Appropriate oral antimicrobial therapy for otitis externa with an accompanying facial cellulitis suitable for outpatient therapy includes a course of
- A.
  
  Macrolide
- B.
  
  Cephalosporin
- C.
  
  Fluroquinolone
- D.
  
  Penicillin
Correct Answer
C. Fluroquinolone

Explanation
Fluroquinolones are a suitable oral antimicrobial therapy for otitis externa with an accompanying facial cellulitis that can be treated on an outpatient basis. These antibiotics are effective against a wide range of bacteria, including those commonly associated with these infections. They have good tissue penetration and are well tolerated by most patients. Macrolides, cephalosporins, and penicillins are also commonly used antibiotics, but they may not provide adequate coverage or have the same effectiveness as fluroquinolones in this particular scenario.

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30.

Physical exam findings in otitis externa include:
- A.
  
  Tympanic membrane immobility
- B.
  
  Increased ear pain with tragus palpation
- C.
  
  Tympanic membrane erythema
- D.
  
  Tympanic membrane bullae
Correct Answer
B. Increased ear pain with tragus palpation

Explanation
Increased ear pain with tragus palpation is a common finding in otitis externa. Tragus palpation involves pressing on the small, pointed cartilage in front of the ear canal. In otitis externa, the ear canal is inflamed and infected, leading to pain and tenderness. Pressing on the tragus can worsen the pain, indicating the presence of otitis externa. This finding, along with other symptoms such as tympanic membrane erythema and bullae, helps in diagnosing and confirming otitis externa.

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31.

A risk factor for malignant external otitis includes:
- A.
  
  The presence of an immunocompromised condition
- B.
  
  Age younger than 21 years
- C.
  
  A history of a recent URI
- D.
  
  A complicated course of otitis media with effusion
Correct Answer
A. The presence of an immunocompromised condition

Explanation
The presence of an immunocompromised condition is a risk factor for malignant external otitis. This is because individuals with weakened immune systems are more susceptible to infections, including those affecting the ear. Malignant external otitis is a severe and potentially life-threatening infection of the external ear canal and surrounding tissues. Immunocompromised individuals, such as those with diabetes, HIV/AIDS, or undergoing chemotherapy, have a reduced ability to fight off infections, making them more vulnerable to developing this condition.

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32.

The likely causative organisms in AOM include:
- A.
  
  Certain gram-positive and negative bacteria
- B.
  
  Gram-negative bacteria and pathogenic viruses
- C.
  
  Rhinovirus and S. aureus.
- D.
  
  Predominantly beta-lactamase-producing organisms.
Correct Answer
A. Certain gram-positive and negative bacteria

Explanation
The likely causative organisms in Acute Otitis Media (AOM) include certain gram-positive and negative bacteria. AOM is commonly caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, which are gram-positive and negative bacteria. These organisms are frequently found in the middle ear and can lead to infection and inflammation, resulting in AOM.

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33.

Expected findings in AOM include:
- A.
  
  Prominent bony landmarks
- B.
  
  Tympanic membrane immobility
- C.
  
  Itchiness and crackling in the affected ear
- D.
  
  Submental lymphadenopathy
Correct Answer
B. Tympanic membrane immobility

Explanation
The expected finding in AOM (acute otitis media) is tympanic membrane immobility. This means that the eardrum is not able to move properly in response to sound waves. This is a characteristic sign of AOM and can be detected during a physical examination of the ear. The other options listed (prominent bony landmarks, itchiness and crackling in the affected ear, submental lymphadenopathy) are not typically associated with AOM.

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34.

A 25-year-old woman has a 3-day history of left ear pain that began after 1 week of URI symptoms. On physical exam, you find that she has AOM. She is allergic to PCN (use results in a hive-form reaction). The most appropriate antimicrobial option for her is:
- A.
  
  Ciprofloxacin
- B.
  
  Clarithromycin
- C.
  
  Amoxicillin
- D.
  
  Cephalexin
Correct Answer
B. Clarithromycin

Explanation
Clarithromycin is the most appropriate antimicrobial option for the 25-year-old woman with acute otitis media (AOM) who is allergic to penicillin. Clarithromycin is a macrolide antibiotic that is effective against common pathogens causing AOM, including Streptococcus pneumoniae and Haemophilus influenzae. It is a suitable alternative for patients with penicillin allergy, as it does not cross-react with penicillins. Ciprofloxacin is a fluoroquinolone antibiotic that is not typically used as a first-line treatment for AOM. Amoxicillin and cephalexin are both penicillins, which should be avoided in patients with a known penicillin allergy.

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35.

A reasonable treatment option for AOM that is not improved after 3-day therapy with an appropriate dosage of amoxicillin therapy is:
- A.
  
  Cefuroxime
- B.
  
  Erythromycin
- C.
  
  Cephalexin
- D.
  
  Sulfamethoxazole
Correct Answer
A. Cefuroxime

Explanation
If a patient with acute otitis media (AOM) does not show improvement after a 3-day therapy with an appropriate dosage of amoxicillin, a reasonable treatment option would be cefuroxime. Cefuroxime is a second-generation cephalosporin antibiotic that has a broader spectrum of activity compared to amoxicillin. It is effective against the most common pathogens causing AOM, including Streptococcus pneumoniae and Haemophilus influenzae. Therefore, cefuroxime can be considered as an alternative treatment option for AOM when initial therapy with amoxicillin fails to improve the condition.

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36.

Characteristics of M. catarrhalis include:
- A.
  
  High rate of beta-lactamase production
- B.
  
  Antimicrobial resistance resulting from altered protein-binding sites
- C.
  
  Often being found in middle ear exudate in recurrent otitis media
- D.
  
  Gram-positive organisms
Correct Answer
A. High rate of beta-lactamase production

Explanation
M. catarrhalis is characterized by a high rate of beta-lactamase production. Beta-lactamase is an enzyme that breaks down beta-lactam antibiotics, making them ineffective against bacteria. This characteristic of M. catarrhalis contributes to its antimicrobial resistance. It is important to consider this trait when selecting appropriate antibiotics for treating infections caused by M. catarrhalis. The other characteristics mentioned in the question, such as altered protein-binding sites, being found in middle ear exudate in recurrent otitis media, and being Gram-positive, are not applicable to M. catarrhalis.

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37.

Which of the following is a characteristic of H. influenzae?
- A.
  
  Newer macrolides are ineffective against the organism
- B.
  
  Its antimicrobial resistance results from altered protein-binding sites within the wall of the bacteria
- C.
  
  Some isolates exhibit antimicrobial resistance via production of beta-lactamase
- D.
  
  This is a gram-positive organism
Correct Answer
C. Some isolates exhibit antimicrobial resistance via production of beta-lactamase

Explanation
H. influenzae is a gram-negative organism that can cause various infections, including respiratory tract infections. One of its characteristics is that some isolates exhibit antimicrobial resistance through the production of beta-lactamase. Beta-lactamase is an enzyme that breaks down beta-lactam antibiotics, such as penicillins and cephalosporins, rendering them ineffective against the bacteria. This resistance mechanism is important to consider when selecting appropriate antibiotics for treating H. influenzae infections.

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38.

Which of the following is a characteristic of S. pneumoniae?
- A.
  
  Mechanism of antimicrobial resistance primarily due to the production of beta-lactamase
- B.
  
  Mechanism of antimicrobial resistance usually via altered protein-binding sites held within the microbe's cell
- C.
  
  Organisms most commonly isolated from mucoid middle ear effusion
- D.
  
  Gram-negative organisms
Correct Answer
B. Mechanism of antimicrobial resistance usually via altered protein-binding sites held within the microbe's cell

Explanation
S. pneumoniae is known to primarily develop antimicrobial resistance through the mechanism of altered protein-binding sites within its cell. This means that the microbe modifies the proteins on its surface, which are responsible for binding to antimicrobial drugs and preventing their effectiveness. This alteration allows the microbe to evade the effects of the drugs and continue to survive and reproduce. This mechanism is common among S. pneumoniae strains and contributes to the challenge of treating infections caused by this bacterium.

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39.

Clindamycin is most effective against which of the following organisms?
- A.
  
  S. pneumoniae
- B.
  
  H. influenzae
- C.
  
  M. catarrhalis
- D.
  
  Adenovirus
Correct Answer
A. S. pneumoniae

Explanation
Clindamycin is most effective against S. pneumoniae because it is a bacteriostatic antibiotic that targets and inhibits the growth of bacteria. S. pneumoniae is a common bacterial pathogen that causes respiratory tract infections, such as pneumonia. Clindamycin works by binding to the bacterial ribosome and inhibiting protein synthesis, ultimately leading to the death of the bacteria. It is not effective against viruses like Adenovirus, as it specifically targets bacteria.

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40.

Which of the following is absent in otitis media with effusion?
- A.
  
  Fluid in the middle ear
- B.
  
  Otalgia
- C.
  
  Fever
- D.
  
  Itch
Correct Answer
C. Fever

Explanation
Otitis media with effusion is a condition characterized by the presence of fluid in the middle ear. It is often associated with symptoms such as otalgia (ear pain) and itchiness. However, fever is not typically present in otitis media with effusion. This is because the condition is usually not caused by an infection, unlike acute otitis media which is associated with fever. Therefore, the absence of fever helps differentiate otitis media with effusion from other types of ear infections.

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41.

Treatment of otitis media with effusion usually includes:
- A.
  
  Symptomatic treatment
- B.
  
  Antimicrobial therapy
- C.
  
  An antihistamine
- D.
  
  A mucolytic
Correct Answer
A. Symptomatic treatment

Explanation
Symptomatic treatment is the most appropriate option for the treatment of otitis media with effusion. This approach focuses on managing the symptoms rather than targeting the underlying cause. Otitis media with effusion is characterized by fluid accumulation in the middle ear, causing hearing loss and discomfort. Symptomatic treatment may include pain relievers, such as analgesics or nonsteroidal anti-inflammatory drugs, to alleviate pain and reduce inflammation. It may also involve the use of decongestants or nasal sprays to relieve nasal congestion and improve Eustachian tube function. Additionally, warm compresses or ear drops may be recommended to alleviate symptoms and promote drainage of fluid from the middle ear.

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42.

An 18-year-old woman has a chief complaint of a "sore throat and swollen glands" for the past 3 days. Her physical exam includes a temp of 101F, exudative pharyngitis, and tender anterior cervical lymphadenopathy. Right and left upper quadrant abdominal tenderness is absent. The most likely diagnosis is:
- A.
  
  Streptococcus pyogenes pharyngitis
- B.
  
  Infectious mononucleosis
- C.
  
  Viral pharyngitis
- D.
  
  Vincent angina
Correct Answer
A. Streptococcus pyogenes pharyngitis

Explanation
The most likely diagnosis in this case is Streptococcus pyogenes pharyngitis. This is supported by the presence of symptoms such as sore throat, swollen glands, and exudative pharyngitis, along with a fever of 101F. Additionally, the tender anterior cervical lymphadenopathy is a common finding in streptococcal pharyngitis. The absence of right and left upper quadrant abdominal tenderness suggests that the infection is localized to the throat and lymph nodes, rather than involving the liver or spleen, which would be more characteristic of infectious mononucleosis.

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43.

Treatment options for streptococcal pharyngitis for a patient with PCN allergies include all of the following except:
- A.
  
  Azithromycin
- B.
  
  Trimethoprim-sulfamethoxazole
- C.
  
  Clarithromycin
- D.
  
  Erythromycin
Correct Answer
B. Trimethoprim-sulfamethoxazole

Explanation
Trimethoprim-sulfamethoxazole is not a recommended treatment option for streptococcal pharyngitis in patients with PCN allergies. Azithromycin, clarithromycin, and erythromycin are alternative antibiotics that can be used in such cases. Trimethoprim-sulfamethoxazole is not effective against streptococcal bacteria and is not commonly used to treat this infection.

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44.

You are seeing a 25-year-old man with S. pyogenes pharyngitis. He asks if he can get a "shot of PCN" for therapy. You consider the following when counselling about the use of IM Penicillin:
- A.
  
  There is nearly 100% cure rate in strep pharyngitis when it is used
- B.
  
  Treatment failure rates approach 20%.
- C.
  
  It is the preferred agent in treating group G streptococcal infection
- D.
  
  Injectable PCN has a superior spectrum of antimicrobial coverage compared with the oral version of the drug.
Correct Answer
B. Treatment failure rates approach 20%.

Explanation
The explanation for the given correct answer is that treatment failure rates approach 20%. This means that there is a significant chance that the treatment with IM Penicillin may not be effective in curing the strep pharyngitis. It is important to inform the patient about this possibility in order to set realistic expectations and consider alternative treatment options if necessary.

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45.

With regard to pharyngitis caused by group C streptococci, the NP considers that:
- A.
  
  Potential complications include glomerulonephritis
- B.
  
  Appropriate antimicrobial therapy helps to facilitate more rapid resolution of symptoms
- C.
  
  Infection with these organisms carries a significant risk of subsequent rheumatic fever.
- D.
  
  Acute infectious hepatitis can occur if not treated with an appropriate antimicrobial
Correct Answer
B. Appropriate antimicrobial therapy helps to facilitate more rapid resolution of symptoms

Explanation
Appropriate antimicrobial therapy helps to facilitate more rapid resolution of symptoms in pharyngitis caused by group C streptococci. This means that administering the right antimicrobial medication can help in faster relief from the symptoms of pharyngitis caused by group C streptococci. It suggests that timely treatment with the appropriate antimicrobial can help in managing and resolving the infection more efficiently.

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46.

Clinical presentation of peritonsillar abscesses includes:
- A.
  
  Occipital lymphadenopathy
- B.
  
  Congested cough
- C.
  
  Muffled "hot potato" voice
- D.
  
  Abdominal pain
Correct Answer
C. Muffled "hot potato" voice

Explanation
The correct answer is "Muffled 'hot potato' voice." Peritonsillar abscesses are collections of pus that form in the tissues around the tonsils. The muffled "hot potato" voice is a characteristic symptom of this condition. It occurs because the abscess puts pressure on the surrounding structures, including the vocal cords, leading to a hoarse and muffled voice. The other symptoms listed, such as occipital lymphadenopathy, congested cough, and abdominal pain, are not typically associated with peritonsillar abscesses.

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47.

Patients with strep throat can be cleared to return to work or school after ____ hours of antimicrobial therapy.
- A.
  
  12
- B.
  
  24
- C.
  
  36
- D.
  
  48
Correct Answer
B. 24

Explanation
Patients with strep throat can be cleared to return to work or school after 24 hours of antimicrobial therapy. This is because strep throat is highly contagious and can easily spread to others through respiratory droplets. Antimicrobial therapy helps to kill the bacteria causing strep throat and reduce the risk of transmission. After 24 hours of treatment, the patient's symptoms should improve, and they become less contagious, making it safe for them to return to work or school.

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48.

When advising a patient with scarlet fever, the NP considers that:
- A.
  
  There is increased risk for poststreptococcal glomerulonephritis
- B.
  
  The rash often peels during recovery
- C.
  
  An injectible cephalosporin is the preferred treatment option
- D.
  
  Throat culture is usually negative for group A streptococci
Correct Answer
B. The rash often peels during recovery

Explanation
During the recovery phase of scarlet fever, the rash often peels. This is a characteristic feature of scarlet fever and occurs as the body heals from the infection. The peeling usually starts around the fingers, toes, and groin area, and then spreads to other parts of the body. It is important for the NP to advise the patient and their caregivers about this common occurrence so that they are aware and can provide appropriate care and support during the recovery period.

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49.

The incubation period for S. pyogenes is usually:
- A.
  
  1-3 days
- B.
  
  3-5 days
- C.
  
  6-9 days
- D.
  
  10-13 days
Correct Answer
B. 3-5 days

Explanation
The incubation period for S. pyogenes is usually 3-5 days. This means that after being exposed to the bacteria, it takes about 3-5 days for symptoms to develop. During this time, the bacteria are multiplying and establishing an infection in the body. It is important to note that the incubation period can vary depending on factors such as the individual's immune system and the specific strain of S. pyogenes.

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50.

The incubation period for M. pneumoniae is usually:
- A.
  
  Less than 1 week
- B.
  
  1 week
- C.
  
  2 weeks
- D.
  
  3 weeks
Correct Answer
D. 3 weeks

Explanation
The incubation period for M. pneumoniae is usually 3 weeks. This refers to the time between exposure to the bacteria and the onset of symptoms. During this period, the bacteria multiply and invade the respiratory tract, leading to symptoms such as cough, fever, and sore throat. Understanding the typical incubation period is important for diagnosing and managing M. pneumoniae infections.

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Eye, Ear, Nose, And Throat

Therapeutic interventions for the patient with Giant Cell Arteritis should include:

Concomitant disease seen with giant cell arteritis includes:

One of the most serious complications of giant cell arteritis is:

An 88-year-old, community-dwelling man who lives alone has limited mobility because of osteoarthritis. Since his last office visit 2 months ago, he has lost 5% of his body weight and has developed angular cheilitis. You expect to find the following on exam:

First line therapy for angular cheilitis therapy includes the use of:

A 19-year-old woman presents with a complaint of bilaterally itchy, red eyes with tearing that occurs intermittently throughout the year and is often accompanied by a rope-like eye discharge and clear nasal discharge. This is most consistent with conjunctival inflammation caused by a(n):

Common causative organisms of acute suppurative conjunctivitis include all of the following except:

Treatment options in suppurative conjunctivitis include all of the following ophthalmic preparations except:

Treatment options in acute and recurrent allergic conjunctivitis include all of the following except:

Anterior epistaxis is usually caused by:

First-line intervention for anterior epistaxis includes:

In caring for a patient with angle closure glaucoma, the most appropriate action is:

A 48-year-old man presents with a new-onset right eye vision change accompanied by dull pain, tearing and photophobia. The right pupil is small, irregular and poorly reactive. Vision testing obtained by using the Snellen chart is 20/30 OS and 20/80 OD. The most likely diagnosis is:

Which of the following is a common vision problem in the person with untreated primary open-angle glaucoma (POAG)?

Which of the following is most likely to be found on the funduscopic exam in a patient with untreated POAG?

Risk factors for POAG include all of the following except:

Treatment options for POAG include all of the following topical agents except:

A 22-year-old woman presents with a "pimple" on her right eyelid. Exam reveals a 2-mm pustule on the lateral border of the right eyelid margin. This is most consistent with:

A 22-year-old woman presents with a "bump" on her right eyelid. Exam reveals a 2-mm hard, non-tender swelling on the lateral border of the right eyelid margin. This is most consistent with:

Treatment options for uncomplicated hordeolum include all of the following except:

Which of the following is true regarding Meniere disease?

Prevention and prophylaxis in Meniere's disease include all of the following except:

You inspect the oral cavity of a 69-year-old man who has a 100-pack-year cigarette smoking history. You find a lesion suspicious for malignancy and describe it as:

A firm, painless, relatively fixed submandibular node would most likely be seen in the diagnosis of:

A 45-year-old man presents with otitis externa. Likely causative pathogens include all of the following except:

Appropriate oral antimicrobial therapy for otitis externa with an accompanying facial cellulitis suitable for outpatient therapy includes a course of

Physical exam findings in otitis externa include:

A risk factor for malignant external otitis includes:

The likely causative organisms in AOM include:

Expected findings in AOM include:

A 25-year-old woman has a 3-day history of left ear pain that began after 1 week of URI symptoms. On physical exam, you find that she has AOM. She is allergic to PCN (use results in a hive-form reaction). The most appropriate antimicrobial option for her is:

A reasonable treatment option for AOM that is not improved after 3-day therapy with an appropriate dosage of amoxicillin therapy is:

Characteristics of M. catarrhalis include:

Which of the following is a characteristic of H. influenzae?

Which of the following is a characteristic of S. pneumoniae?

Clindamycin is most effective against which of the following organisms?

Which of the following is absent in otitis media with effusion?

Treatment of otitis media with effusion usually includes:

Treatment options for streptococcal pharyngitis for a patient with PCN allergies include all of the following except:

You are seeing a 25-year-old man with S. pyogenes pharyngitis. He asks if he can get a "shot of PCN" for therapy. You consider the following when counselling about the use of IM Penicillin:

With regard to pharyngitis caused by group C streptococci, the NP considers that:

Clinical presentation of peritonsillar abscesses includes:

Patients with strep throat can be cleared to return to work or school after ____ hours of antimicrobial therapy.

When advising a patient with scarlet fever, the NP considers that:

The incubation period for S. pyogenes is usually:

The incubation period for M. pneumoniae is usually: