Deck 12: Ears, Nose, and Throat

Question 1

Mr. W, age 25 years, has recovered recently from an upper and lower respiratory infection. He describes long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented in which section of his history?

A)Age-specific data
B)Past medical data
C)Family history
D)Social history
E)Personal history

Answer 1

Past medical data

Question 2

An infant's auditory canal, when compared with an adult's, is

A)short, narrow, and straight.
B)short and curved upward.
C)long, narrow, and curved forward.
D)short and curved downward.
E)long, wide, and straight.

Answer 2

short and curved upward.

Question 3

The organ of Corti is a coiled structure located inside the

A)cochlea in the inner ear.
B)pars flaccida in the tympanic membrane.
C)eustachian tube.
D)lateral aspect of the pinna.
E)tragus.

Answer 3

cochlea in the inner ear.

Question 4

You are performing hearing screening tests. Difficulty in hearing the highest frequencies would be expected in a ___-year-old patient.

A)7
B)12
C)20
D)40
E)65

Question 5

A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness, you should palpate over the

A)sphenoid and frontal sinuses.
B)maxillary and frontal sinuses.
C)maxillary sinuses only.
D)sphenoid sinuses only.
E)ethmoid and frontal sinuses.

Question 6

Which of the following is associated with age-related hearing loss?

A)Degeneration of the hair cells of the organ of Corti
B)Excess resorption of bone cells of the ossicle chain
C)Increased pliability of the tympanic membrane
D)More serous cerumen
E)Proliferation of the stria vascularis

Question 7

During what developmental stage are hoarseness, voice cracking, and a persistent cough a common finding?

A)Adolescence
B)Infancy
C)Menopause
D)Pregnancy
E)Childhood

Question 8

The middle ear contains the

A)cerumen and sebaceous glands.
B)umbo and malleus.
C)vestibule and cochlea.
D)pars tensa and semicircular canals.
E)helix and antihelix.

Question 9

Mr. S presents with the complaint of hearing loss. You specifically inquire about current medications. Which medications, if listed, are likely to contribute to his hearing loss?

A)Chlorothiazide
B)Acetaminophen
C)Salicylates
D)Cephalosporins
E)Penicillins

Question 10

The structures that lie along the lateral wall of the nasal cavity near the facial cheek are the _____ sinuses.

A)ethmoid
B)frontal
C)maxillary
D)cribriform
E)sphenoid

Question 11

A 30-year-old woman presents with rapid swelling beneath her jaw that suddenly appears while she is eating. The swelling is mildly painful but is not hot or red. You suspect Wharton salivary duct stones and proceed to palpate

A)bilaterally along the buccal mucosa.
B)under the tongue, along each side of the frenulum.
C)dorsum of the tongue.
D)beside the gingivae near each molar.
E)along the roof of the mouth.

Question 12

The hair cells of Corti and membrane of Corti

A)maintain equilibrium.
B)protect the ear from foreign particles.
C)stimulate the eighth cranial nerve.
D)transmit vibrations to the ossicles.
E)produce a waxy lubricant.

Question 13

The middle ear is normally filled with

A)mucous collections.
B)blood.
C)serous fluid.
D)cerebrospinal fluid.
E)air.

Question 14

The pregnant woman can expect to experience

A)more nasal stuffiness.
B)a sensitive sense of smell.
C)drooling.
D)enhanced hearing.
E)decreased vascularity of the gums.

Question 15

Which ear structure is responsible for equalizing atmospheric pressure when swallowing, sneezing, and yawning?

A)Eustachian tube
B)Inner ear
C)Semicircular canals
D)Triangular fossa
E)Oval window

Question 16

A newborn whose serum bilirubin is greater than 20 mg/100 mL risks later

A)hearing loss.
B)lichen planus.
C)tooth decay.
D)meningitis.
E)sinusitis.

Question 17

To approximate vocal frequencies, which tuning fork should be used to assess hearing?

A)100 to 300 Hz
B)200 to 400 Hz
C)500 to 1000 Hz
D)1500 to 2000 Hz
E)Greater than 2000 Hz

Question 18

In adults, the length of the external auditory canal is _____ cm.

A)0.5
B)1
C)2.5
D)4
E)5

Question 19

The eruption of permanent teeth most commonly begins with the

A)upper central incisors.
B)upper canines.
C)lower central incisors.
D)lower canines.
E)upper lateral incisors.

Question 20

When examining an infant's middle ear, the practitioner should use one hand to stabilize the otoscope against the head while using the other hand to

A)pull the auricle down and back.
B)hold the speculum in the canal.
C)distract the infant.
D)stabilize the chest.
E)pull the auricle up.

Question 21

When conducting an adult otoscopic examination, you should

A)position the patient's head leaning toward you.
B)grasp the handle of the otoscope as you would a baseball bat.
C)select the largest speculum that will fit in the canal.
D)ask the patient to keep his or her eyes closed.
E)pull the auricle down and forward.

Question 22

Pallor of the lips and mucous membranes is one sign of

A)anemia.
B)hyperbilirubinemia.
C)liver problems.
D)carbon monoxide poisoning.
E)Peutz-Jeghers syndrome.

Question 23

Speech with a monotonous tone and erratic volume may indicate

A)otitis externa.
B)hearing loss.
C)serous otitis media.
D)sinusitis.
E)dry cerumen.

Question 24

In the presence of otitis externa, tympanic membrane perforation, or a myringotomy tube, you should

A)avoid performing otoscopic examinations.
B)clean the inner ear with soap.
C)instill alcohol into the ear.
D)never use a cerumen spoon.
E)avoid instilling fluids.

Question 25

Which variation may be an expected finding in the ear examination of a newborn?

A)Diffuse light reflex
B)Purulent material in the ear canal
C)Redness and swelling of the mastoid process
D)Small perforations of the tympanic membrane
E)Increased mobility and clarity of the tympanic membrane

Question 26

Bulging of an amber tympanic membrane without mobility is most often associated with

A)a middle ear effusion.
B)a healed tympanic membrane perforation.
C)impacted cerumen in the canal.
D)repeated and prolonged crying cycles.
E)a Pseudomonas infection of the auditory canal.

Question 27

To perform the Rinne test, place the tuning fork on the

A)top of the head.
B)mastoid bone.
C)forehead.
D)preauricular area.
E)occiput.

Question 28

When hearing is evaluated, which cranial nerve is being tested?

A)III
B)IV
C)VIII
D)IX
E)XII

Question 29

Placing the base of a vibrating tuning fork on the midline vertex of the patient's head is a test for

A)air conduction of sound.
B)bone versus air conduction.
C)otitis externa.
D)otitis media.
E)lateralization of sound.

Question 30

Normal tympanic membrane color is

A)amber.
B)chalky white.
C)greenish.
D)pearly gray.
E)red.

Question 31

You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized to the unaffected ear; for the Rinne test, the air conduction to bone conduction-to-ratio was less than 2:1. You interpret these findings as suggestive of

A)a defect in the inner ear.
B)a defect in the middle ear.
C)otitis externa.
D)impacted cerumen.
E)serous otitis.

Question 32

A 6-month-old who can hear well can be expected to

A)exhibit the Moro reflex.
B)stop breathing in response to sudden noise.
C)turn his or her head toward the source of sound.
D)imitate simple words.
E)understand simple phrases.

Question 33

Nasal symptoms that imply an allergic response include

A)purulent nasal drainage.
B)bluish gray turbinates.
C)small, atrophied nasal membranes.
D)a firm consistency of the turbinates.
E)a deviated septum.

Question 34

White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are

A)Fordyce spots.
B)aphthous ulcers.
C)Stensen ducts.
D)leukoedema.
E)angular cheilitis.

Question 35

A hairy tongue with yellowish brown to black elongated papillae on the dorsum

A)is indicative of oral cancer.
B)is sometimes seen after antibiotic therapy.
C)usually indicates a vitamin deficiency.
D)usually indicates anemia.
E)is characteristic of a geographic tongue.

Question 36

When you ask the patient to identify smells, you are assessing which cranial nerve?

A)I
B)II
C)III
D)IV
E)VIII

Question 37

An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or

A)digestive disorder.
B)skeletal anomaly.
C)renal disorder.
D)Ménière disease.
E)heart defect.

Question 38

You are using a pneumonic attachment on the otoscope while assessing tympanic membrane movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to

A)remove all cerumen from the canal.
B)make sure the speculum is sealed form outside air.
C)squeeze the bulb with more force.
D)insert the speculum to depth of 2 cm.
E)use a smaller plastic speculum.

Question 39

A smooth red tongue with a slick appearance may indicate

A)a niacin or vitamin B₁₂ deficiency.
B)oral cancer.
C)recent use of antibiotics.
D)a fungal infection.
E)a geographic tongue.

Question 40

To inspect the lateral borders of the tongue, you should

A)ask the patient to extend the tongue outward.
B)insert the tongue blade obliquely against the tongue.
C)lift the tongue upward with gloved fingers.
D)pull the gauze-wrapped tongue to each side.
E)ask the patient to lift the tongue upward.

Question 41

Evidence-based practice suggests that the strongest predictor of sinusitis is

A)a maxillary toothache.
B)dull or opaque sinus transilluminations.
C)ineffective decongestants and colored nasal drainage.
D)purulent nasal secretions.
E)any combination of the above.

Question 42

Which abnormality is common during pregnancy?

A)Eruption of additional molars
B)Hypertrophy of the gums
C)Epstein pearls
D)Otitis media
E)Koplik spots

Question 43

For best results, an otoscopic and oral examination in a child should be

A)conducted at the beginning of the assessment.
B)done after inspection.
C)performed at the end of the examination.
D)performed before palpation.
E)deferred until they can fully cooperate.

Question 44

You are interviewing a parent whose child has a fever, is batting at her right ear, and is irritable. You ask the parent about the child's appetite and find that the child has a decreased appetite. This additional finding is most suggestive of

A)acute otitis media.
B)otitis externa.
C)serous otitis media.
D)middle ear effusion.
E)cerumen impaction.

Question 45

Severe vertigo, tinnitus, and progressive hearing loss are characteristic of

A)cholesteatoma.
B)Ménière disease.
C)otosclerosis.
D)cocaine abuse.
E)labyrinthitis.

Question 46

Expected physical changes associated with older adults include

A)shiny buccal mucosa.
B)teeth appear shorter.
C)wetter nasal mucosa.
D)bristly hairs in the vestibule.
E)smoothing of the tongue.

Question 47

Intense pain with movement of the pinna is most closely associated with

A)sinusitis.
B)otitis externa.
C)purulent otitis media.
D)bacterial otitis media.
E)otitis media with effusion.

Question 48

Which of the following illicit drugs is commonly associated with nasal septum perforation?

A)Heroin
B)Marijuana
C)PCP
D)Ecstasy
E)Cocaine

Question 49

Which pediatric patient complaints would you refer immediately to the emergency department?

A)A patient with a temperature of 100.4° F and a toothache
B)A drooling patient with muffled voice and stridor
C)A patient with purulent drainage from the ear and a cough
D)A patient with a seal-like barking cough and anorexia
E)A patient whose epiglottis is visible when the tongue is depressed