EENT Actual Exam EENT Exam

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A patient is diagnosed with otitis externa. He complains of tragal pain, otic discharge, otic itching, and fever. What is the cardinal symptom of otitis externa?

Tragal pain Otic discharge Otic itching Fever -ANSWER-Tragal pain

Explanation:

Otitis externa is "swimmer's ear". This is a superficial infection usually caused by Pseudomonas in the external canal. Fever, a typical systemic symptom is inconsistent with otitis externa since the infection is superficial. The other symptoms listed are typical of patients who are diagnosed with otitis externa. However, the cardinal symptom is tragal pain.

A patient presents to a nurse practitioner clinic with paroxysmal sneezing, clear rhinorrhea, nasal congestion, facial pain. Which symptom below is NOT associated with allergic rhinitis?

Sneezing Rhinorrhea Nasal congestion Facial pain -ANSWER-Facial pain

Explanation:

Facial pain is not associated with allergic rhinitis. In conjunction with nasal congestion, it is most likely a sinus infection. Patients with allergic rhinitis and nasal congestion are more likely to develop acute and chronic bacterial sinusitis because untreated allergic rhinitis results in impaired mucus flow. This increases the risk of infection.Symptoms of bacterial sinusitis include nasal congestion, purulent post-nasal drip or rhinorrhea, facial pain and maxillary tooth pain.There is no symptom that can differentiate bacterial from viral sinusitis.

An NP examines a screaming 2 year-old. A common finding is:

nasal discharge.increased respiratory rate.pink tympanic membranes.coarse breath sounds. -ANSWER-pink tympanic membranes.

Explanation:

The tympanic membrane normally becomes pink and can rarely become red when a child is screaming or crying. This is probably due to flushing and hyperemia of the face that occurs with crying. A distorted or erythematous tympanic membrane with decreased mobility is suggestive of otitis media.

A patient diagnosed with Strept throat received a prescription for azithromycin. She has not improved in 48 hours. What course of action is acceptable?

The patient should wait another 24 hours for improvement.The antibiotic should be changed to a first generation cephalosporin.A different macrolide antibiotic should be prescribed.

A penicillin or cephalosporin with beta lactamase coverage should be considered. -ANSWER-A penicillin or cephalosporin with beta lactamase coverage should be considered

Explanation:

The patient should demonstrate improvement after 48 hours if an antibiotic with the appropriate antimicrobial spectra was prescribed. A macrolide would be a poor choice because there are high rates of Strept resistance to macrolide antibiotics. In light of this, strong consideration should be given to an antibiotic with different antimicrobial spectra. Since Strept was diagnosed and azithromycin was ineffective, the prescriber should consider that the causative agent has macrolide resistance and could be beta lactamase producing. An antibiotic with beta lactamase coverage should be considered. Choice d provides this coverage.

A 93 year-old demented adult has been recently treated for an upper respiratory infection (URI) but drainage from the right nostril persists.What should the NP suspect?

Allergic rhinitis Presence of a foreign body Unresolved URI Dental caries -ANSWER-Presence of a foreign body

Explanation:

Two clinical clues should make the examiner suspect a foreign body.First, the patient has continued drainage despite treatment. Second, the drainage is unilateral. Unilateral drainage from a nostril should prompt the examiner to visualize the turbinates. In this case, a foreign body could probably be visualized.

A 32 year-old patient is a newly diagnosed diabetic. She has developed a sinus infection. Her symptoms have persisted for 10

days. Six weeks ago she was treated with amoxicillin for an upper respiratory infection. It cleared without incident. What should be recommended today?

Prescribe amoxicillin again.Prescribe amoxicillin-clavulanate today.Do not prescribe an antibiotic; a decongestant is indicated only.Prescribe a decongestant and antihistamine. -ANSWER-Prescribe amoxicillin-clavulanate today

Explanation:

Amoxicillin is no longer indicated for initial treatment in adults who have acute bacterial sinusitis. A bacterial cause can be assumed since she's had symptoms for 10 days. A viral infection likely would have run its course by now. After 10 days of persistent symptoms, treatment is reasonable with an antibiotic; especially since this patient is diabetic. She may be having blood sugar elevations that facilitate growth of the causative organism of the sinus infection. A decongestant could be added depending on her blood pressure and personal history of using decongestants.

AV nicking may be identified in a patient with what disease?

Glaucoma Cataracts Diabetes Hypertension -ANSWER-Hypertension

Explanation:

Arteriovenous nicking (AV nicking), or nipping, is commonly seen in patients who have hypertension. It represents retinal microvascular changes. These are typically early changes and usually reflective of current and past blood pressures. More severe damage can be seen when flame hemorrhages or cotton wool spots are identified. These