Np Test 3: Eye, Ear, Nose, And Throat
(237).jpg "Np Test 3: Eye, Ear, Nose, And Throat")
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- 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
- 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
- 3.Concomitant disease seen with giant cell arteritis includes:
- A.
Polymyalgia rheumatica
- B.
Acute pancreatitis
- C.
Psoriatic arthritis
- D.
Reiter syndrome
- 4.One of the most serious complications of giant cell arteritis is:
- A.
Hemiparesis
- B.
Arthritis
- C.
Blindness
- D.
Uveitis
- 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
- 6.First line therapy for angular cheilitis therapy includes the use of:
- A.
Metronidazole gel
- B.
Hydrocortisone cream
- C.
Topical nystatin
- D.
Oral ketoconazole
- 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
- 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
- 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
- 10.Treatment options in suppurative conjunctivitis include all of the following ophthalmic preparations except:
- A.
Bacitracin-polymyxin B
- B.
Ciprofloxacin
- C.
Erythromycin
- D.
Penicillin
- 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
- 12.Anterior epistaxis is usually caused by:
- A.
HTN
- B.
Bleeding disorders
- C.
Localized nasal mucosa trauma
- D.
A foreign body
- 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
- 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
- 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
- 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
- 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
- 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
- 19.Risk factors for POAG include all of the following except:
- A.
African ancestry
- B.
DM-II
- C.
Advanced age
- D.
Blue eye color
- 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
- 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
- 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
- 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
- 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
- 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
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