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NSG 6320 AGNP BOARD EXAM QUESTIONS (latest) Assessment Eye, Ear, Nose and Throat (166 Questions) – South University Savannah | 100% CORRECT ANSWERS

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NSG 6320 AGNP BOARD EXAM QUESTIONS (latest) Assessment Eye, Ear, Nose and Throat (166 Questions) – South University Savannah Question: Ophthalmoscopic examination of the fundus reveals small, ... rounded, slightly irregular red spots embedded in the retina. These findings are consistent with:    superficial retinal hemorrhages.      preretinal hemorrhages.      microaneurysms.      deep retinal hemorrhages.   Explanation: Deep retinal hemorrhages appear as small, rounded, slightly irregular red spots and are sometimes called dot or blot hemorrhages. They occur in a deeper layer of the retina than flame-shaped hemorrhages. Diabetes is a common cause. Superficial retinal hemorrhages appear as small, linear, flame-shaped, red streaks in the fundi and are seen in hypertension, papilledema, and occlusion of the retinal vein. Preretinal hemorrhages lie anteriorly between the retina and the vitreous and are typically larger than retinal hemorrhages. These hemorrhages obscure any underlying retinal vessel. Microaneurysms present as tiny, round, red spots commonly seen in and around the macular area. These are classic in diabetic retinopathy. Question: The whispered voice test allows the examiner to screen for:    low frequency hearing loss.      high frequency hearing loss.      general hearing loss.      conductive hearing loss.   Explanation: The whispered voice test for auditory acuity and allows the examiner to screen for general hearing loss. In the elderly who have presbycusis, high frequency hearing loss is present. Since consonants are higher frequency sounds than vowels, these sounds are often missed. Question: On examination of the tympanic membrane, a red bulging ear drum is detected. This is consistent with:    acute otitis externa.      chronic otitis externa.      acute otitis media.      a serous effusion.   Explanation: A red bulging tympanic membrane may be found in a patient who has acute otitis media. In acute otitis externa, the canal may be swollen, narrow, moist and pale with tenderness on touching. The ear drum is intact. In chronic otitis externa, the skin of the canal may be thickened, red, and pruritic. The ear drum is usually unaffected. With serous effusion the ear drum appears amber and there usually is no bulging of the eardrum. Question: One of the refractive errors of vision that presents with symptoms of blurriness and improved with ive lens, is known as:    hyperopia.      myopia.      strabismus.      astigmatism.   Explanation: Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: Miosis is a term used to describe:    the shape of the pupils.      constriction of the pupils.      dilation of the pupils.      symmetry of the pupils.   Explanation: Miosis refers to constriction of the pupils, mydriasis refers to dilation. Miosis is not associated with the shape or symmetry of the pupils. Question: Otosclerosis is an example of a(n):    conductive hearing loss.      sensorineural hearing loss.      mixed hearing loss.      acquired hearing loss.   Explanation: Otosclerosis is a hereditary disorder of the labyrinthine capsule in which abnormal bone growth occurs around the ossicles resulting in fixation of the stapes. The stapes does not vibrate which reduces sound transmission to the inner ear. This produces a conductive hearing loss. Question: Drooping of the upper eyelid is termed:    an epicanthal fold.      ptosis.      a retracted lid.      ectropion.   Explanation: Ptosis is a drooping of the upper eyelid and can be caused by myasthenia gravis, damage to the oculomotor nerve, or to the sympathetic nerve supply (Horner's syndrome). A weakened muscle, relaxed tissues, and the weight of herniated fat may cause senile ptosis. Ptosis can also be congenital. An epicanthal fold is a vertical fold of skin that lies over the medial canthus. A retracted lid is seen as a wide eyed stare. Ectropion is seen when the lower lid turns outward and exposes the palpebral conjunctiva. Question: When a light beam shines into one pupil causing pupillary constriction in that eye, the term used is:    indirect reaction to light.      consensual reaction to light.      optic radiation.      direct reaction to light.   Explanation: The pupils of both eyes respond identically to a light stimulus regardless of which eye has been stimulated. The direct response describes light entering one eye that produces constriction of the pupil of that eye. A consensual response describes constriction of the unstimulated pupil. These reactions should be compared in both eyes and if there is a difference, further investigation is warranted. Optic radiation is a term used to describe the tract that nerve impulses follow through the retina, optic nerve, and optic tract. Question: Where in the mouth would reddened areas, nodules, or ulcerations that are suspicious of malignancy be present?    Mucous membranes      Tongue      Gums      Palate   Explanation: Reddened areas, nodules, or ulcerations noted on the sides and undersurface of the tongue and the floor of the mouth would be suggestive of cancer. Cancer of the tongue is the second most common cancer of the mouth; the lip is number one. Question: An example of a cause of conductive hearing loss in children would be:    prolonged use of tobramycin.      the presence of a peanut in the ear for three weeks.      congenital rubella syndrome.      maternal history of Herpes infection.   Explanation: Conductive hearing loss is the most common type in children. It occurs when the transmission of sound through the external or middle ear is blocked. It may be temporary or permanent, unilateral or bilateral. It may also be caused by physical abnormalities present from birth, but more commonly, it begins during childhood as the result of middle ear infections, perforation of the eardrum, impacted earwax or objects present in the ear canal. The other choices are examples of sensorineural hearing losses. Question: A man with a history of long-term use of chewing tobacco presents with a mouth lesion that is suspicious for malignancy. Oral assessment findings describe:    a smooth circular pustule lesion on the base of the gum.      a soft, solitary papule lesion located apical to the molar.      a small, shallow, sore lesion at the base of the gums.      an ulcerated lesion with indurated margins on the lateral tongue.   Explanation: Oral malignant lesions present as ulcerated with indurated margins and are not usually circular or smooth. A dental abscess presents as a soft, solitary papule located apical to the molar. Canker sore is a small, shallow sore at the base of the gum. Question: Mydriasis is a term used to describe:    the shape of the pupils.      constriction of the pupils.      dilation of the pupils.      symmetry of the pupils.   Explanation: Miosis refers to constriction of the pupils, mydriasis refers to dilation. Miosis is not associated with the shape or symmetry of the pupils. Question: Ophthalmoscopic examination of the retina reveals AV tapering. This appears as if the:    vein "winds" down on either side of the artery.      vein is twisted on the distal side of the artery.      vein crosses beneath the artery.      vein stops abruptly on either side of the artery.   Explanation: When the arterial walls lose their transparency, changes appear in the arteriovenous crossings. Decreased transparency of the retina probably contributes to AV nicking and AV tapering. In tapering, the vein appears to taper or "wind" down either side of the artery. In AV nicking, the vein appears to stop abruptly on either side of the artery. In the normal eye, the vein appears to cross beneath the artery. With banking, the vein appears to be twisted on the distal side of the artery and forms a dark wide knuckle appearance. Question: Causes of sensorineural hearing loss include all of the following except:    aging.      loud noises over prolonged periods of time.      perforated tympanic membrane.      acoustic neuroma.   Explanation: A perforated tympanic membrane is an example of a cause of a conductive hearing loss. Sensorineural hearing loss involves disorders of the cochlear nerve, cochlea, and an interruption in the neuronal impulse transmission to the brain. Causes include: exposure to loud noises, inner ear infections, acoustic neuroma, aging, and congenital and/or familial disorders. Question: All of the following diseases may be associated with the appearance of a strawberry tongue except:    scarlet fever.      folic acid and B-12 deficiencies.      rubeola.      Kawasaki syndrome.   Explanation: There are five medical reasons for the appearance of strawberry tongue: Kawasaki disease, scarlet fever, folic acid and vitamin B-12 deficiencies, bacterial toxic shock syndrome, and a geographic tongue. Rubeola does not present with a strawberry tongue. Koplik's spots are diagnostic of rubeola and they appear as clustered white lesions on the buccal mucosa. Question: Janeway lesions of the palms and soles appear as:    painful, red, raised lesions.      small, nontender, erythematous nodules.      hemorrhagic vesiculopustular eruptions.      hemorrhagic petechiae.   Explanation: Janeway lesions present as small, nontender, erythematous macular or nodular lesions on the palms or soles. Osler nodules are painful, red, raised lesions on the hands and feet. Both Janeway lesions and Osler nodules are indicative of infective endocarditis. Hemorrhagic vesiculopustular eruptions can be associated with gonococcemia. Hemorrhagic petechiae are suggestive of meningococcemia. Question: Which of the following screening tests for hearing loss can detect both sensorineural and conductive hearing loss?    Weber Test      Rinne Test      Whispered Voice Test      bilateral hearing loss.   Explanation: The Weber hearing screening test can detect unilateral conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss). Question: Examination of the nose and paranasal sinuses reveal local tenderness, pain, fever, and rhinorrhea. These symptoms are suggestive of:    chronic sinusitis of the frontal and maxillary sinuses.      allergic rhinitis.      upper respiratory infection.      acute sinusitis of the frontal and maxillary sinuses.   Explanation: With examination of the nose and paranasal sinuses, the presence of local tenderness, together with symptoms such as pain, fever, and nasal discharge, suggest acute sinusitis involving the frontal or maxillary sinuses. Chronic sinusitis usually lasts longer than 3 months and presents with some of the same symptoms as acute sinusitis. This may include thick yellow or green rhinorrhea, facial pain, headaches, and dizziness. Question: The mouth of a ten-month-old infant has white patches on the mucosa that cannot be removed. These patches are consistent with:    stomatitis.      thrush.      Koplik spots.      measles.   Explanation: Oral thrush is a condition in which the fungus, Candida albicans, accumulates on the lining of the mouth. Oral Candida infections like thrush, are also common side effects of antibiotic therapy due to alterations of the normal bacterial flora. Thrush appears as white patches on the mucosa and does not wipe off. White patches do not appear with stomatitis or measles. Koplik spots are small, white spots with a bluish center on a reddened background that occur on the inside of the cheeks early in the course of measles. Question: In patients who have allergic rhinitis, the nasal mucosa appears:    erythematous.      pale.      green.      yellow.   Explanation: Rhinitis is inflammation of the nasal mucosa. Normally, the nasal mucosa appears somewhat redder than the oral mucosa. With allergic rhinitis, it appears pale, bluish, or a darker red than normal. In viral rhinitis, it tends to appear erythematous and swollen. A yellow or green color may be due to the appearance of exudate in the nasal cavity. Question: Assessment of a 4 year-olds visual acuity resulted in 20/30 in the left eye and 20/40 in the right eye using the Snellen eye chart. This means:    his vision is normal for his age.      his vision is abnormal and further testing is warranted.      the patient may not be able to read so he should be tested with the picture or "E" eye charts.      he has astigmatism.   Explanation: Expected visual acuity in a 4 year old is 20/40. At age 5 years, it is expected to be 20/30. By age 6 years, vision should be 20/20 bilaterally. Question: Round or oval shaped lesions surrounded by erythematous mucosa and noted on an area of the oral mucosa may be:    leukoplakia.      aphthous ulcers.      Koplik's spots.      ulcerative gingivitis.   Explanation: Aphthous ulcers can appear anywhere on the buccal mucosa or tongue. They usually appear as round or oval ulcers, can be white or yellowish gray in color, and are surrounded by a halo of reddened mucosa. They are usually painful. Leukoplakia presents as thickened white patches anywhere on the oral mucosa. Koplik's spots appear in the early stages of measles (rubeola). They appear as small white specks that resemble grains of salt on a red background on the buccal mucosa. They are not usually painful. Ulcerative gingivitis is a painful form of gingivitis that is characterized by the development of ulcers in the interdental papillae. If untreated they can become necrotizing along the gum margins and appear as erythematous ulcers. Question: A deviated trachea could be caused by all of the following except:    pneumothorax.      pneumonectomy.      pneumonia.      atelectasis.   Explanation: Tracheal deviation results from unequal intrathoracic pressure within the chest cavity. When the deviation occurs, the trachea will follow the direction of less pressure. Tracheal deviation can be caused by pneumothorax, atelectasis, pleural effusion, some cancers within the pleural cavity, and pleural fibrosis. Pneumonia is not associated with tracheal deviation. Question: When examining the conjunctiva and sclera, have the patient look upward and then:    cover one eye while visualizing the sclera and conjunctiva of the uncovered eye.      depress both lower lids with your thumbs, exposing the sclera and conjunctiva.      look for excessive tearing or dryness in the conjunctiva sac.      note the position of the lids in relation to the eyeballs and color of the sclera.   Explanation: When examining the conjunctiva and the sclera, the best way to expose these structures is to have the patient look upward and depress both lower lids with your thumbs. Covering one eye while visualizing the other eyes checks for visual acuity. Observing for excessive tearing or dryness assesses the lacrimal apparatus. Checking the position of the lids may identify variations and abnormalities in the eyelids. Question: A sixty-year-old complains of a progressive bilateral hearing loss over the past four months. He has difficulty understanding spoken words and has become sensitive to loud noises. These symptoms are consistent with:    otosclerosis.      mastoiditis.      presbycusis.      Meniere's disease.   Explanation: Presbycusis is the most common hearing problem in people over 50 years of age. Presbycusis is an ongoing loss of hearing linked to changes in the inner ear. Patients have a hard time hearing what others are saying or may become sensitive to loud noises. Hearing loss is usually bilateral. Mastoiditis is an infection of the mastoid process (temporal bone adjacent to the middle ear) and generally results from inadequately treated otitis media. Otosclerosis is a sensorineural hearing loss because of reduced sound transmission to the middle ear. Meniere's disease is a disorder of the middle ear due to impaired absorption of endo endolymph. Question: In order to visualize the opening of Stensen's duct, examine the:    dorsal surface of the tongue.      area beneath the mandible at the angle of the jaw.      buccal mucosa opposite the second molar.      small openings along the sublingual fold under the tongue.   Explanation: The largest salivary gland is the parotid gland and it lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. Its duct, Stensen's duct, runs forward to an opening on the buccal mucosa opposite the second molar. If blood comes out through Stensen's duct when it is palpated, this could suggest parotid cancer. If pus is expelled, it suggests suppurative parotitis. With mumps, the orifice of the Stensen duct appears erythematous and enlarged. The submandibular gland is the size of a walnut. It lies beneath the mandible at the angle of the jaw. Wharton's duct runs up and forward to the floor of the mouth and opens at either side of the frenulum. The smallest, the almond-shaped sublingual gland, lies within the floor of the mouth under the tongue. It has many small openings along the sublingual fold under the tongue. Question: A condition that involves optic nerve damage and visual field changes is termed:    retinoblastoma.      cataracts.      glaucoma.      pterygium.   Explanation: Glaucoma is a leading cause of blindness in the United States. Glaucoma is a condition that produces optic nerve damage and visual field changes. The risk of glaucoma increases with age but can occur in anyone in any age-group. Retinoblastoma is a rapidly developing tumor and is the most common malignant tumor of the eye in children. A cataract is an opacity of the lens and may be seen through the pupil. Pterygium is a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea and may interfere with vision but does not cause blindness. Question: Sudden bilateral and painless visual loss is rare but can be associated with all the following except:    cholinergics.      anticholinergics.      steroids.      chemical exposure.   Explanation: Certain medications are associated with sudden bilateral, painless visual loss. These medication classes include cholinergic, anticholinergics, and steroids. Exposure to chemicals or radiation could result in bilateral painful visual loss. Question: When examining pupillary equality, the left pupil is slightly greater than the right pupil. This condition is termed:    miosis.      anisocoria.      mydriasis.      conjugate.   Explanation: Anisocoria is a condition characterized by an unequal size of the eye's pupils by a difference of 0.4 mm or between the eye's pupils. Miosis refers to constriction of the eye while mydriasis refers to dilation. Conjugate is used to describe symmetrical eye gaze. Question: Redness, bleeding, pain, and swelling of the gums is most likely:    stomatitis.      gingivitis.      leukoplakia.      aphthous ulcers.   Explanation: Swelling, pain, erythema, and bleeding of the gums are symptoms of gingivitis. Stomatitis refers to inflammation of the mouth. Leukoplakia presents as thickened white patches anywhere in the oral mucosa. Aphthous ulcers can appear anywhere on the buccal mucosa or tongue. They usually appear as round or oval ulcers, can be white or yellowish gray in color, and surrounded by a halo of reddened mucosa Question: A condition of the sclera that appears as localized ocular inflammation of the episcleral vessels is most likely:    scleroderma.      episcleritis.      conjunctivitis.      pinguecula.   Explanation: A condition of the sclera when the vessels appear movable over the scleral surface is termed episcleritis. The appearance may be nodular or show only redness and dilated vessels. This condition can be seen in rheumatoid arthritis, Sjo¨gren’s syndrome, and herpes zoster. Scleroderma is a condition characterized by thickened, hardened skin. It may be accompanied by multisystem involvement. Conjunctivitis is an inflammation of the conjunctiva and findings include red, burning, and itchy eyes. Pinguecula refers to a harmless yellowish triangular nodule noted in the bulbar conjunctiva on either side of the iris and may be seen in aging. Question: When a 512 Hz tuning fork is placed over the mastoid bone and then held next to the ear canal with recordings of how long sound was heard in each ear, this is known as the:    absolute bone conduction test.      pure tone audiometry test.      Weber test.      Rinne test.   Explanation: The Rinne test is used to assess the air conduction (AC) and bone conduction (BC) of sound in each ear. Bone conduction uses the skull bone to transmit sound to the cochlea via vibration, bypassing the external and middle ear. To test for this the vibrating tuning fork is held over the mastoid bone until the patient signals the loss of sound. The turning fork is then moved near (but not touching) the ear until the patient indicates they cease to hear sound. This is assessing air conduction which is the transmission of sound to the cochlea via external air and middle ear. Normally, the duration of time a patient hears sound is greater in air conduction than bone conduction and is reported as AC > BC. Question: A patient complains of seeing specks that obscure his line of vision when he looks in a certain direction. This impairment could be caused by:    vitreous floaters.      retinal detachment.      macular degeneration.      scotomas.   Explanation: With fixed defects, or scotomas, lesions appear in the retina or visual pathways of a certain area of the field of vision. Moving specks or strands suggest vitreous floaters causing the specks to be seen throughout the visual fields. Flashing lights or new vitreous floaters suggest detachment of vitreous from retina. With macular degeneration, there is a loss of vision in the central visual fields while peripheral vision remains intact. Question: Current indications for tympanostomy tube placement include all of the following except which one?    Persistent serous otitis media (SOM) that has not responded to a 3 to 6-week course of medical treatment      Recurrent acute otitis media (AOM) that does not respond to, or recurs after, antimicrobial prophylaxis      Complications of acute otitis media (AOM)      Complications of eustachian tube dysfunction   Explanation: Current indications for tympanostomy tube placement are (1) persistent serous otitis media (SOM) that has not responded to a 6 to 12-week course of medical treatment. This includes full and prophylactic doses of antimicrobials (and corticosteroids, as indicated); (2) recurrent acute otitis media (AOM) (at least three episodes in 6 months or four episodes in 12 months) that does not respond to, or recurs after, antimicrobial prophylaxis; (3) complications of AOM such as meningitis, facial nerve paralysis, coalescent mastoiditis, or brain abscess; and (4) complications of eustachian tube dysfunction such as tympanic membrane retraction with hearing loss, ossicular erosion, and/or retraction pocket formation. Question: On examination of the pupils, both are round but the right pupil appears larger than the left and reacts much slower to light. This condition may be indicative of:    a tonic pupil.      oculomotor nerve (CN III) paralysis.      Horner's syndrome.      Argyll Robertson pupils.   Explanation: When the pupil is large, regular, and usually unilateral and the reaction to light is severely reduced and slowed, or even absent, this condition is referred to as a tonic pupil or Adele's pupil. Paralysis of the oculomotor cranial nerve (CN III), the dilated pupil is fixed to light and near accommodation. Ptosis and lateral deviation of the eye are usually present. In Horner's syndrome, the affected pupil reacts briskly to light and near effort but the pupil is small. The pupils in Argyll Robertson condition appear small and irregular shaped and accommodate but do not react to light. Question: Findings following assessment of a person's gaze include the inability of the left eye to look down when turned inward. This condition is most consistent with:    a conjugate gaze.      left cranial nerve III (oculomotor) paralysis      left cranial nerve IV (trochlear) paralysis.      cranial nerve VI (abducens) paralysis.   Explanation: The left eye is unable to look down when turned inward in a left cranial nerve IV paralysis. In conjugate or normal gaze, the normal movement of the two eyes appears simultaneously in the same direction to bring something into view. With a left cranial nerve III paralysis, upward, downward, or inward movements are impaired. With a left cranial nerve VI paralysis, a person's gaze would include eyes conjugate when looking to the right, esotropia (one or both eyes turn inward) appears in the left eye when looking straight ahead, and esotropia is maximum in the left eye when looking to the left. Question: The acronym for pupils that are equal, round, react to light and accommodate is:    PERLA.      PERRLAA.      PERRTLA.      PERRLA.   Explanation: The eyes are assessed for equality in size, shape, reaction to light, and the ability to accommodate. When they appear normal, it is documented as PERRLA. Pupils equal, round, react to light and accommodate. Question: On otoscopic examination, the cone of light can be visualized:    at the 1 o'clock to 2 o'clock position of the left tympanic membrane.      at the 4 o'clock to 5 o'clock position of the left tympanic membrane.      at the 7 o'clock to 8 o'clock position of left tympanic membrane.      at the 12 o'clock position of the left ear tympanic membrane.   Explanation: On otoscopic examination, the cone of light also known as the light reflex, can be visualized at the 7 o'clock to 8 o'clock position of the left tympanic membrane. The cone of light can be visualized at the 4 o'clock to 5 o'clock position of the right tympanic membrane. Question: The function of the auditory ossicles is to:    transmit the light reflex to the light cone.      transform sound vibrations into mechanical waves for the inner ear.      to capture sound waves from the external ear for transmission into the middle ear.      to separate the inner ear from the middle ear.   Explanation: The function of the auditory ossicles is to transform sound vibrations into mechanical waves for the inner ear. Question: On the outer ear, anterior and parallel to the helix, is a curved prominence known as the:    Antihelix      Helix      Auricle      Tragus   Explanation: The antihelix is a curved prominence that is parallel and anterior to the helix and is part of the auricle. The external ear consists of the auricle and ear canal. The auricle is made of cartilage covered by skin and has a firm elastic consistency. The auricle has a prominent curved outer ridge known as the helix. The ear canal opens behind a nodular protuberance that points backward over the entrance to the canal. This is called the tragus. Question: A patient was diagnosed as nearsighted. The term for this condition is:    hyperopia.      myopia.      strabismus.      astigmatism.   Explanation: Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: The sphenoidal sinuses:    are located between the eyes.      surround the nasal cavity.      are located above the eyes.      are located behind the ethmoidal sinuses.   Explanation: The paranasal sinuses include the maxillary, frontal, ethmoidal, and sphenoidal sinuses. The sphenoidal sinuses lie just behind the ethmoidal sinuses. The maxillary sinuses are located around the nasal cavity. The ethmoidal sinuses are between the eyes and the frontal sinuses are located above the eyes. Question: Fordyce spots or granules are considered:    contagious lesions of the lip.      normal sebaceous glands of the buccal mucosa.      a precursor to cancer.      benign lesions of the tongue.   Explanation: Fordyce spots or granules appear as yellow spots in the buccal mucosa or on the lips. They are considered normal sebaceous glands. Question: The gradual loss of vision with a change in color and size of the optic disc is referred to as:    macular degeneration.      glaucoma.      cataracts.      retinoblastoma   Explanation: With glaucoma, there is a change in the color and size of the optic disc resulting in a gradual loss of vision. With macular degeneration, there is a loss of vision in the central visual fields because of damage to the retina. Peripheral vision remains intact. Cataracts usually appear as a cloudiness or opacity in the lens. Retinoblastoma is a rapidly developing cancer of the retina and an absent red reflex is noted on ophthalmoscopic exam. Question: The nasolacrimal duct drains into the:    inferior meatus.      middle meatus.      superior meatus.      vestibule.   Explanation: The nasolacrimal duct drains into the inferior meatus of the nose. Question: Examination of the eye reveals a painful, erythematous, and tender area around the nose and lower eyelid. This condition is most likely:    conjunctivitis.      an obstructed nasolacrimal duct.      dacryocystitis.      pinguecula.   Explanation: Dacryocystitis is an inflammation of the lacrimal sac, the area between the lower eyelid and the nose. Dacryocystitis presents as a painful, red, and tender area around the eye especially near the nose and the lower eyelid. Conjunctivitis is an inflammation of the conjunctiva and findings include red, burning, and itchy eyes. An obstructed nasolacrimal duct would present with a mucopurulent discharge from the puncta of the eye. Pinguecula refers to a harmless yellowish triangular nodule noted in the bulbar conjunctiva on either side of the iris and may be seen in aging. Question: During the newborn’s physical assessment of the mouth, the soft and hard palates are palpated to detect:    a tight frenulum.      an opening in the palates.      thrush.      the presence of a tracheoesophageal fistula.   Explanation: The presence of a cleft palate, or an opening in the hard or soft palates, would need immediate interventions as the child could aspirate with the first feeding. Thrush can be detected by observation and appears as white patches in the mouth. A tight or shortened frenulum would be denoted by observation. A tracheoesophageal fistula is associated with choking, increased salivation, coughing, cyanosis and vomiting when feeding. This is a medical emergency. Question: That portion of the ear that consists of the auricle and ear canal is the:    antihelix.      helix.      tragus.      external ear.   Explanation: The external ear consists of the auricle and ear canal. The auricle is made of cartilage covered by skin and has a firm, elastic consistency. The auricle has a prominent curved outer ridge known as the helix. The antihelix is a curved prominence that is parallel and anterior to the helix. The auditory canal opens behind a nodular protuberance that points backward over the entrance to the canal, known as the tragus. Question: Which of the following findings in a preschooler would indicate the need for further evaluation?    Intelligible speech by 24 months of age      Variation in quality of speech pattern and tone      Responds to facial expressions and gestures rather than to verbal explanations      Looks at people when they speak   Explanation: A child who responds to facial expressions and gestures rather than to verbal explanations is probably expressions rather than verbal clues. These children may have a hearing deficit that needs further evaluation. The other choices are normal behaviors for the preschooler. Question: A 45-year-old patient complains of vertigo, tinnitus and pressure in the right ear. These symptoms are consistent with:    Meniere's disease.      cluster headaches.      benign positional vertigo.      vestibular neuronitis.   Explanation: Meniere's Disease begins with a episodic vertigo and a feeling of fullness or pressure in the affected ear along with fluctuating tinnitus. Dizziness associated with benign positional vertigo typically occurs when the patient rolls over onto the affected side or with tilting the head upward. Nausea and vomiting may be present. Cluster headaches are usually one sided and the patient often has a runny nose with reddening and tearing of the nose without mention of dizziness. In vestibular neuronitis, the dizziness is sudden followed by nausea and vomiting without tinnitus. Question: A patient was diagnosed as being farsighted. The term for this condition is:    hyperopia.      myopia.      strabismus.      astigmatism.   Explanation: Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: A 60-year-old was concerned about a yellowish colored lesion above her right eyelid. Findings revealed a slightly raised yellowish, well circumscribed plaque along the nasal area of her right eyelid. This finding is most consistent with:    a pinguecula.      a chalazion.      episcleritis.      xanthelasma.   Explanation: Slightly raised, yellowish, well-circumscribed plaques appearing along the nasal area of one or both eyelids are consistent with lipid disorders and called xanthelasma. Pinguecula refer to harmless, yellowish, triangular nodules in the bulbar conjunctiva on either side of the iris. A chalazion is a nontender nodule usually on the underside of the eyelid. Episcleritis is an ocular inflammation of the episcleral vessels. Question: The lacrimal puncta are located:    in the lower conjunctival sac.      in the lateral canthus of the upper eyelid.      at the junction of the cornea and sclera.      along the margin of the upper and lower eyelids.   Explanation: The lacrimal puncta are located in each eye along the upper and lower rim of the eyelids. These openings collect tears and send fluid through the nasolacrimal duct and to the inner nose. Question: The patient complains of seeing floating spots. This is consistent with:    macular degeneration.      a detached retina.      glaucoma.      cataracts.   Explanation: A detached retina is the separation of the sensory layer of the retina from the choroid layer. Initially, the patient is aware of the presence of floaters or floating spots, and/or flashing lights. Macular degeneration is the degeneration of the macular area of the retina with a loss of central vision and intact peripheral vision. In patients who have glaucoma, there is damage to the optic nerve and a loss of peripheral vision, the appearance of halos around lights, and difficulty focusing on near objects. Question: A cyclist sustained an avulsion of the upper central incisor. If he is unable to position the tooth in the socket until he is able to be seen by a dentist, he should:    transport the tooth in a cup of lukewarm tap water.      place the tooth between the molars and the inside of the cheek.      rinse the tooth and transport it in a clean dry cloth.      not rinse the tooth but transport it in a clean dry cloth.   Explanation: An avulsion is defined as a tooth that is completely displaced out of its socket. On clinical exam the socket is found empty or filled with a coagulum. The goal is to save the tooth but depends on what is done initially when the tooth becomes displaced. The tooth can be transported in the mouth, keeping it between the molars and the inside of the cheek. If the patient is very young, he/she could swallow the tooth; therefore, it is advisable to get the patient to spit in a container and place the tooth in it. Tap water is avoided because the hypotonic environment causes rapid cell lysis and increased inflammation on reimplantation. Saliva, saline, milk, and culture medias are physiologic medias for storing the tooth until it can be reimplanted. Question: Surgical perforation of the tympanic membrane to allow drainage of middle ear secretions is termed:    otosclerosis.      a myringotomy.      a tympanocentesis.      a tympanoplasty.   Explanation: A myringotomy is the surgical perforation of the tympanic membrane to allow drainage of middle ear secretions and to relieve pain and pressure from a bulging ear drum. Otosclerosis is an abnormal bone growth that occurs around the ossicles. A tympanocentesis is a procedure where a fine needle is inserted into the tympanic membrane to relieve pressure, pain, and to drain secretions, or to obtain a culture of the fluid. A tympanoplasty is a surgical reconstruction of the ossicles and tympanic membrane to help restore hearing. Question: On ophthalmoscopic examination, optic atrophy appears:    pink and hyperemic.      yellowish orange to creamy pink.      pale.      white.   Explanation: In optic atrophy, there is death of the optic nerve fibers. This leads to loss of the tiny disc vessels giving a white appearance. A pink and hyperemic disc is seen in patients with papilledema. The normal disc appears yellowish-orange to creamy pink and the disc vessels are tiny with disc margins that appear sharp. A pale disc with a backward depression is characteristic of glaucomatous cupping. Question: The usual position of the trachea is located:    to the left of the anterior neck and slightly above the jugular notch of the manubrium.      in the middle of the anterior neck behind the jugular notch of the manubrium.      to the right of the anterior neck and slightly above the jugular notch of the manubrium.      in the middle of the anterior neck extending posteriorly to the sternum.   Explanation: The usual position of the trachea is located in the middle of the anterior neck behind the jugular notch of the manubrium. Question: A patient is able to read a magazine without difficulty but cannot distinguish distant objects. This describes:    hyperopia.      myopia.      strabismus.      astigmatism.   Explanation: Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: Eversion of the upper eyelid can be performed by placing the cotton applicator on the upper lid above the level of the internal tarsal plates and then:    gently push up with the stick and the lid will flip.      gently push down with the stick and lift the lashes up and flip the lid inside out.      gently place the thumbs on the lower lids and pull down to fully open the eye.      gently rest the thumb and fingers on the cheek and brow, respectively, and spread the lids.   Explanation: This maneuver is not part of the normal examination, but it is useful when inspecting the conjunctiva of the upper lid when a patient presents with eye pain or suspicion of a foreign body. To perform this, ask the person to keep both eyes open and look down. This relaxes the eyelid, whereas closing it would tense the orbicularis muscle. Slide the upper lid up along the bony orbit to lift up the eyelashes. Grasp the lashes between the thumb and forefinger and gently pull down and outward. With the other hand, place the tip of an applicator stick on the upper lid above the level of the internal tarsal plates and gently push down with the stick while lifting the lashes up. This uses the edge of the tarsal plate as a fulcrum and flips the lid inside out. The other maneuvers are used to visualize the eyes but not the under surface of the upper lid. Question: When inspecting the neck for the thyroid gland, slightly tilt the patient's head back, and using tangential lighting directed downward from the tip of the patient's chin, inspect the:    region above the thyroid cartilage.      region below the cricoid cartilage.      area along the sternomastoid border.      area along the anterior edge of the trapezius.   Explanation: When inspecting the neck for the thyroid gland, slightly tilt the patient's head back and using tangential lighting (light coming in from the side at a right angle) directed downward from the tip of the patient's chin, inspect the region below the cricoid cartilage; located between the thyroid cartilage and the thyroid gland. The area of sternomastoid border allows palpation of the superficial cervical nodes. The posterior cervical lymph nodes are located at the anterior edge of the trapezius. Question: The conductive and sensorineural phases are necessary for hearing to take place. The conductive phase of hearing involves the:    cochlea and the cochlear nerve.      external auditory canal and the middle ear.      ossicles and the inner ear.      transfer of sounds from the external environment into the external auditory canal.   Explanation: Sound traveling from the external ear through the middle ear is considered the first part of the hearing pathway. This is known as the conductive phase. The second part of the pathway is the sensorineural phase and this involves the cochlea and the cochlear nerve. Question: On ophthalmoscopic examination, glaucomatous cupping appears:    pink and hyperemic.      yellowish orange to creamy pink.      pale.      white.   Explanation: A pale disc with a backward depression is characteristic of glaucomatous cupping. A pink and hyperemic disc is seen in patients with papilledema. The normal disc appears yellowish-orange to creamy pink and the disc vessels are tiny with disc margins that appear sharp. In optic atrophy, there is death of the optic nerve fibers and this leads to loss of the tiny disc vessels giving a white appearance. Question: When the corneal reflex is stimulated by shining the light in the right eye, the right eye blinks. The left eye:    does not blink.      blinks.      turns inward.      turns outward.   Explanation: The corneal reflex is the blink reflex and is an involuntary blinking of the eyelids. When the corneal reflex is stimulated, stimulation should elicit both a direct and consensual response of the opposite eye. Question: An inward turning of the lower lid margin is called:    an epicanthal fold.      entropion.      a retracted lid.      ptosis.   Explanation: Entropion is more common in the elderly and occurs when the lower lid margin turns inward. When this irritates the conjunctiva and the lower cornea. Ectropion occurs when the lower lid turns outward and exposes the palpebral conjunctiva. Ptosis is a drooping of the upper eyelid. An epicanthal fold is a vertical fold of skin that lies over the medial canthus of the eye. Question: Which of the paranasal sinuses are accessible to clinical examination?    Ethmoidal sinuses      Sphenoidal sinuses      Frontal sinuses.      Vestibular sinuses   Explanation: There are four paranasal sinuses: frontal, ethmoidal, sphenoidal, and maxillary. Only the maxillary and frontal sinuses are readily accessible to clinical examination. There is not a vestibule sinus cavity. The vestibule is that widened area of the nares where air travels en route to the nasopharynx. Question: If a patient has a history of heat intolerance with a preference to light clothing, this behavior could be consistent with:    hypothyroidism.      hyperthyroidism.      Hashimoto's thyroiditis.      myxedema.   Explanation: Patients with hyperthyroidism experience heat intolerance. Grave's disease and thyrotoxicosis are types of hyperthyroidism. In these cases, there is increased metabolism. Hypothyroidism presents with hypofunction of the thyroid gland and all body functions are slowed. Patients usually gain weight. Those with hypothyroidism have an intolerance to cold. Hashimoto's thyroiditis, and myxedema are conditions seen in patients who have hypothyroidism. Question: When examining the eyes, the right pupil reacts briskly to light, near effort, and is much smaller than the left pupil. This condition is mostly likely:    a tonic (Adele's pupil) pupil.      an oculomotor nerve (CN III) paralysis.      Horner's syndrome.      Argyll Robertson pupils.   Explanation: When the pupil is large, regular, and the reaction to light is severely reduced, absent, or slowed, this condition is referred to as a tonic pupil or Adele's pupil. Paralysis of the oculomotor cranial nerve (CN III), the dilated pupil is fixed to light and near accommodation. Ptosis and lateral deviation of the eye are usually present. In Horner's syndrome, the affected pupil reacts briskly to light and near effort, but the pupil is small. The pupils in Argyll Robertson condition appear small and irregular shaped and accommodate but do not react to light. Question: The most common cause of bacterial pharyngeal infections in children is:    Corynebacterium.      Chlamydia.      mononucleosis.      group A beta-hemolytic Streptococcus.   Explanation: Pharyngitis is caused by swelling between the tonsils and the larynx. Most sore throats are caused by colds, the flu, Coxsackie virus or mononucleosis. Bacteria that cause pharyngitis include group A beta-hemolytic Streptococcus, and less commonly, Corynebacterium, gonorrhea, and Chlamydia can cause sore throat. Question: One of the main differences between a migraine headache and a tension headache is that:    migraine headaches have a rapid onset whereas, tension headaches appear gradually.      nausea is usually absent with migraine headaches and present with tension headaches.      migraine headaches are usually constant and do not throb; tension headaches usually throb.      migraine headaches are generally bilateral and tension headaches are unilateral.   Explanation: Migraine headaches present with a sudden, rapid onset and accompanying symptoms that include nausea and vomiting. 70% of migraine headaches are unilateral and are throbbing or achy and vary in severity. Tension headaches have a gradual onset and usually do not present with nausea. They are usually bilateral and are steady and do not throb. Question: Ophthalmoscopic examination of the fundus reveals blood anterior to the retina and obscuring retinal vessels. These findings are consistent with:    superficial retinal hemorrhages.      preretinal hemorrhages.      microaneurysms.      deep retinal hemorrhages.   Explanation: Deep retinal hemorrhages appear as small, rounded, slightly irregular red spots and are sometimes called dot or blot hemorrhages. They occur in a deeper layer of the retina than flame-shaped hemorrhages. Diabetes is a common cause. Preretinal hemorrhages lie anteriorly between the retina and the vitreous and are typically larger than retinal hemorrhages. These hemorrhages obscure any underlying retinal vessel. Superficial retinal hemorrhages appear as small, linear, flame-shaped, red streaks in the fundus and are seen in hypertension, papilledema, and occlusion of the retinal vein. Microaneurysms present as tiny, round, red spots commonly seen in and around the macular area. These are classic in diabetic retinopathy. Question: The most common disorder of visual acuity in children is:    hyperopia.      myopia.      strabismus.      astigmatism.   Explanation: Myopia, nearsightedness, is the most common disorder of visual acuity in children. Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: A teenage complains of itching and burning of his eye. Examination reveals an erythematous eyelid margin with crusting and a clear mucus discharge. These findings are consistent with:    conjunctivitis.      a chalazion.      a corneal ulcer.      blepharitis.   Explanation: Blepharitis is an inflammation of eyelid margin, glands, and lash follicles. It presents with red-rimmed eyes, irritation, burning, itching of the eyelid margins, and a mucous discharge with crusting and scaling of lid margins. Conjunctivitis is inflammation of the conjunctiva. It presents with erythematous conjunctiva and frequent discharge A chalazion is a granulomatous eyelid cyst or nodule. A corneal ulcer of a local necrosis of the cornea caused by infection, trauma, or misuse of contact lens. Neither of these present with the symptoms described above. Question: What visual acuity constitutes legal blindness?    Visual acuity of 20/80 or worse bilaterally.      Visual acuity of 20/200 or worse in the better eye with ed lens.      Visual acuity of 20/200 in the better eye without ed lens.      Visual acuity of 20/100 with ed lens.   Explanation: A person is usually considered legally blind when visual acuity in the better eye, ed by lens, is 20/200 or worse. One is also considered legally blind if visual acuity is 20 degrees or less in the better eye and the vision is constricted. They are said to have "tunnel" vision in this case. Question: Examples of sudden, painful, unilateral visual loss include all the following except:    retinal detachment.      corneal ulcer.      traumatic hyphema.      acute glaucoma.   Explanation: If a patient reports sudden unilateral visual loss that is painless, vitreous hemorrhage from diabetes or trauma may be considered. It could also be caused by macular degeneration, retinal detachment, retinal vein occlusion, or central retinal artery occlusion. If the loss is painful, causes may be associated with the cornea and anterior chamber; examples include: corneal ulcer, uveitis, traumatic hyphema, and acute glaucoma. Question: The function of the labyrinth in the inner ear is to:    assist with air conduction.      maintain equilibrium.      maintain acoustic transmission.      capture sound waves.   Explanation: The inner ear has 2 main functions: hearing and balance. The cochlear system is dedicated to hearing and the vestibular system is dedicated to balance. The labyrinth is part of the semicircular canals and the vestibular system and is responsible for balance. Question: A 40-year-old male was umpiring a little league baseball game when he was hit in the face with flying debris. He presents with decreased vision and severe pain in the left eye. Findings reveal watery, left ocular discharge. The pupils are normal in appearance and the cornea is slightly cloudy with areas of corneal erythema. These findings are most consistent with:    acute iritis.      corneal injury.      corneal infection.      acute angle closure glaucoma.   Explanation: Corneal injury or infection usually presents with watery or purulent ocular discharge and the severe pain. Acute iritis presents with a moderate aching pain deep within the eye. The pupils are small and irregular and vision is decreased and photophobia is present. The cornea is clear or slightly cloudy with injection confined to the corneal limbus. This is considered an emergency and is usually related to Herpes zoster infection or tuberculosis. With acute angle closure glaucoma, the pain is severe, aching, and deep, but the pupils are dilated and fixed and the cornea appears steamy or cloudy. If an increase in intraocular pressure is present in conjunction with these findings, this would be an emergency situation. Question: Children who pick their noses are at a higher risk for development of:    sinusitis.      epistaxis.      allergic rhinitis.      purulent rhinorrhea.   Explanation: Epistaxis is a nosebleed. This often occurs secondary to damage to small blood vessels located in Kiesselbach's plexus. Other causes could include allergic rhinitis, low humidity, sinusitis, very cold, bleeding disorders, and some medications. Purulent rhinorrhea is seen with an infection in the nose or sinus cavity. Allergic rhinitis and sinusitis may contribute to nose bleeds. Question: A deviated uvula without swelling may be suggestive of a:    vagus nerve lesion.      peritonsillar abscess.      person who smokes cigarettes.      a normal finding in the elderly population.   Explanation: A deviated uvula with no evidence of swelling may be due to a vagus nerve (CN X) lesion. CN X innervates the uvula. The presence of swelling of the uvula with a deviation may be a strong indication of a peritonsillar abscess or parapharyngeal abscess. Peritonsillar abscess and smoking may be associated with a swollen uvula but not associated with deviations of the uvula. A deviated uvula is not a common finding in the elderly; however, if an elderly person experiences a stroke, a deviated uvula may be noted. Question: The maxillary sinuses:    are located between the eyes.      surround the nasal cavity.      are located above the eyes.      are located behind the ethmoidal sinuses.   Explanation: The paranasal sinuses include the maxillary, frontal, ethmoidal, and sphenoidal sinuses. The maxillary sinuses are located around the nasal cavity. The ethmoidal sinuses are between the eyes and the frontal sinuses are located above the eyes. The sphenoidal sinuses lie just behind the ethmoidal sinuses. Question: What part of the ear consists mainly of cartilage covered by skin and has a firm yet somewhat elastic feature?    Antihelix      Helix      Auricle      Tragus   Explanation: The auricle is made of cartilage covered by skin and has a firm, elastic consistency. The external ear consists of the auricle and ear canal. The auricle has a prominent curved outer ridge known as the helix. The antihelix is a curved prominence that is parallel and anterior to the helix. The ear canal opens behind a nodular protuberance that points backward over the entrance to the canal. This is called the tragus. Question: When examining the pupils, the left pupil is noted to be fixed and dilated to light and near accommodation. This condition may be suggestive of:    a tonic pupil.      oculomotor nerve (CN III) paralysis.      Horner's syndrome.      Argyll Robertson pupils.   Explanation: Paralysis of the oculomotor cranial nerve (CN III), the dilated pupil is fixed to light and near accommodation. Ptosis and lateral deviation of the eye are usually present. When the pupil is large, regular, and usually unilateral and the reaction to light is severely reduced and slowed, or even absent, this condition is referred to as a tonic pupil or Adele's pupil. In Horner's syndrome, the affected pupil reacts briskly to light and near effort but the pupil is small. The pupils in Argyll Robertson condition appear small and irregular shaped and accommodate but do not react to light. Question: A term used to describe drainage from the nose is:    rhinitis.      rhinorrhea.      cerumen.      otorrhea.   Explanation: A term used to describe drainage from the nose is rhinorrhea. Rhinitis refers to an inflammation in the nose. Cerumen is the medical term for earwax. Otorrhea refers to ear discharge. Question: The curved outer ridge of the auricle of the ear is known as the:    Antihelix      Helix      Auricle      Tragus   Explanation: The auricle has a prominent curved outer ridge known as the helix. The external ear consists of the auricle and ear canal. The auricle is made of cartilage covered by skin and has a firm elastic consistency. The antihelix is a curved prominence that is parallel and anterior to the helix. The auditory canal opens behind a nodular protuberance that points backward over the entrance to the canal, known as the tragus. Question: Eyelid retraction with exophthalmos presents as:    an inward turning of the lower eyelid.      an outward turning of the lower eyelid.      drooping of the eyelid.      a retracted eyelid with a wide-eyed stare.   Explanation: Lid retraction and exophthalmos is a condition that appears as a wide-eyed stare and suggests retracted eyelids. This condition could be suggestive of hyperthyroidism. An inward turning of the lower eyelid with irritation to the conjunctiva and lower cornea is defined as entropion. This condition is seen commonly in the elderly. Ptosis presents as a drooping of the eyelid caused by damage to the oculomotor nerve, myasthenia gravis, or damage to the sympathetic nervous system. Ectropion exhibits an outward turning of the lower eyelid exposing the palpebral conjunctiva. This condition is more in the elderly. Lid retraction and exophthalmos is a condition that appears as a wide-eyed stare and suggests retracted eyelids. This condition could be suggestive of hyperthyroidism. Question: A patient presents with complaints of earache, blood tinged discharge from the ear, and hearing loss. Findings reveal painful hemorrhagic vesicles on the tympanic membrane and the ear canal. These findings and symptoms are suggestive of:    tympanosclerosis.      serous effusion.      otitis media with purulent effusion.      bullous myringitis.   Explanation: Bullous myringitis is a viral infection characterized by painful hemorrhagic vesicles on the tympanic membrane and/or in the ear canal. Hearing loss, blood tinged discharge from the ear and an earache are classic symptoms. Tympanosclerosis is a deposit of hyaline material within the layers of the tympanic membrane that sometimes follow a severe episode of otitis media. It appears as a chalky white patch with irregular margins. Otitis media with purulent effusion is usually bacterial and the eardrum is red and the landmarks are not visible. Otitis media with serous effusion is usually viral and amber fluid can be seen behind the eardrum. Question: One cause of nasal septum perforation may be:    nasal polyps.      intranasal use of cocaine.      cystic fibrosis.      chronic sinusitis.   Explanation: Perforation of the nasal septum could be caused by trauma, surgery, and intranasal use of cocaine or amphetamines. Nasal polyps obstruct air flow but there is no relationship to nasal septum perforation. Cystic fibrosis or chronic sinusitis are not associated with nasal perforation. Question: Which disorder of the eye can be detected with the cover-uncover and the Hirschberg test?    Amblyopia      Conjunctivitis      Strabismus      Cataracts   Explanation: Strabismus is misalignment of the eyes and can be assessed using the cover-uncover teats and the Hirschberg test (corneal light reflex). With the cover-uncover test, eye muscle weakness is seen as eye deviation when the eye is uncovered. With Hirschberg's test, an asymmetric light reflex indicates a deviation. Cataracts are visualized by a cloudiness or opacity in the lens. Conjunctivitis is diagnosed by observation of a discharge from the eyes and erythema of the conjunctiva. Amblyopia is diagnosed by visual assessment and testing by an optometrist or ophthalmologist. Question: A patient presents with complaints of a bump on the eyelid. Findings reveal nontender, firm nodule with freely movable skin overlying the nodule. This could be consistent with:    blepharitis.      dacryocystitis.      a hordeolum.      a chalazion.   Explanation: Chalazion is a chronic inflammatory lesion that develops when a meibomian gland becomes obstructed. It produces a beady nodule on the lid. Red, scaly, greasy flakes and thickened, crusted lid margins are consistent with blepharitis. Symptoms include burning, itching, tearing, foreign body sensation, and some pain. Hordeolum is often secondary to a localized Staphylococcal infection of the hair follicles at the lid margin. Dacryocystitis is infection and blockage of lacrimal sac and duct. Question: A 50- year-old patient complains of being unable to read the hymnal at church. This describes:    hyperopia.      myopia.      presbyopia.      astigmatism.   Explanation: Presbyopia may begin in the 5th or 6th decade. Symptoms include diminished ability to focus on near objects. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are misaligned. "Crossed-eyed", "wall eye", or "lazy eye" are all associated with strabismus. Question: A swollen deviated uvula may be associated with a:    vagus nerve lesion.      peritonsillar abscess.      person who smokes cigarettes.      a normal finding in the elderly population.   Explanation: The presence of swelling of the uvula with a deviation may be a strong indication of a peritonsillar abscess or parapharyngeal abscess. A deviated uvula with no evidence of swelling may be due to a vagus nerve (CN X) lesion. CN X innervates the uvula. Peritonsillar abscess and smoking may be associated with a swollen uvula but not associated with deviations of the uvula. A deviated uvula is not a common finding in the elderly; however, if an elderly person experiences a stroke, a deviated uvula may be noted. Question: Ophthalmoscopic examination of the retina reveals AV banking. This appears as if the:    vein tapes down on either side of the artery.      vein is twisted on the distal side of the artery.      vein crosses beneath the artery.      vein stops abruptly on either side of the artery.   Explanation: When the arterial walls lose their transparency, changes appear in the arteriovenous crossings. Decreased transparency of the retina probably contributes to AV nicking and AV tapering. In AV nicking, the vein appears to stop abruptly on either side of the artery. In tapering, the vein appears to taper down either side of the artery. In the normal eye, the vein appears to cross beneath the artery. With banking, the vein appears to be twisted on the distal side of the artery and forms a dark wide knuckle appearance. Question: Findings following assessment of a person's eye gaze include both eyes moving in the same direction simultaneously. This condition is most consistent with:    a conjugate gaze.      left cranial nerve III (oculomotor) paralysis      cranial nerve IV (trochlear) paralysis.      cranial nerve VI (abducens) paralysis.   Explanation: In conjugate or normal gaze, the normal movement of the two eyes appears simultaneously in the same direction to bring something into view. With a left cranial nerve VI paralysis, a person's gaze would include eyes conjugate when looking to the right, esotropia (one or both eyes turn inward) in the left eye when looking straight ahead, and esotropia is maximum in the left eye when looking to the left. With a left cranial nerve III paralysis, upward, downward, or inward movements are impaired. The left eye is unable to look down when turned inward in a left cranial nerve IV paralysis. Question: A forty-five-year-old female complains of frequent attacks of dizziness accompanied by a sense of fullness in the right ear, headache, nausea, reduced hearing in the right ear. This patient may need further workup for:    otosclerosis.      Meniere's disease.      Paget's disease.      mastoiditis.   Explanation: Meniere's Disease is a disorder of the middle ear with excessive endolymphatic fluid accumulation in the membranous labyrinth. It may be due to malabsorption or a blocked endolymphatic duct. Symptoms include recurrent attacks of dizziness, a sense of fullness in the ears with roaring or ringing tinnitus. There is gradual but progressive sensorineural hearing loss. It usually occurs in adults around forty years of age. Otosclerosis is a disorder of the labyrinthine capsule where abnormal bone growth occurs around the ossicles leading to a reduction of sound transmission to the inner ear. Paget's disease results in abnormal bone destruction or growth of the bone. It is also a malignant disease of the breast. Mastoiditis is an infection of the mastoid process. Question: When comparing veins and arteries in the eyes of older adults, the arteries appear:    bright red.      widened.      less brilliant.      curvy.   Explanation: In older adults, the fundi lose their youthful shine and light reflections. The arteries look narrowed, pale, straight, and less brilliant than in young or middle adults. Question: An infant with a suspected hearing loss:    communicates through gestures.      sits close to the television with the volume on high.      does not babble.      has unintelligible speech.   Explanation: An infant with a hearing loss does not startle to loud noises, arouses to touch instead of noise, does not turn the head in response to sounds and has little or no babbling or vocalization. A toddler with a hearing loss would communicate with gestures and has little or no intelligible speech and does not respond to surrounding noises. A school aged child with a hearing loss would sit close to the television with the volume on high, may have poor school performance, speech problems and does not respond unless directly in front of the speaker's face. Question: A condition in which the eyes are not properly aligned with each other is termed:    hyperopia.      myopia.      strabismus.      astigmatism.   Explanation: Strabismus, heterotropia, is a condition in which the eyes are misaligned. "Crossed-eyed", "wall eye", or "lazy eye" are all associated with strabismus. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Myopia, nearsightedness, occurs when light rays focus anterior to the retina. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: In the normal ear, all of the following landmarks can be visualized when using the otoscope, except the:    ossicles.      tympanic membrane.      eustachian tube.      cone of light.   Explanation: Otoscopic examination reveals the external canal, tympanic membrane (pars tensa and pars flaccida), cone of light, and the short process and handle of the malleus. The umbo, and the incus can also be visible on otoscopic examination. Question: Leukoplakia was noted during an exam of the mouth. This symptom may be:    a normal finding.      precancerous.      associated with periodontal disease.      consistent with gingivitis.   Explanation: Leukoplakia are thickened white patches located on any area of the mouth. These patches cannot be rubbed off. Most are not serious but some can be considered precancerous. Therefore, they should be evaluated. These lesions are not considered normal findings. Periodontal disease usually includes an infection of the gums and may involve the teeth. Generally, the infection causes redness and swelling but not white patches. Question: A granulomatous eyelid cyst or nodule that is painless and erythematous is termed:    a hordeolum.      a chalazion.      keratitis.      blepharitis.   Explanation: A chalazion is a granulomatous eyelid cyst or nodule that is erythematous and painless. This may be secondary to an untreated hordeolum. Blepharitis is an inflammation of the eyelid margin. Hordeolum is a stye and affects the eyelid. Keratitis is an inflammation of the cornea. Question: A fine rhythmic oscillation of the eyes is termed:    presbyopia.      nystagmus.      strabismus.      proptosis.   Explanation: Nystagmus is a condition characterized by fine rhythmic movements of the eyeball. They occur when the semicircular canals are stimulated but the head is not in motion Question: Symptoms of bacterial conjunctivitis in an infant include:    eyelid edema and purulent discharge from the eyes.      eyelid ecchymosis and watery discharge from the eyes.      vesicular rash or ulceration of eyelids with a watery discharge.      contact dermatitis of the eyelids with a subconjunctival, multilobulated yellow mass.   Explanation: Symptoms of bacterial conjunctivitis in an infant include eyelid edema, bulbar conjunctival injection, purulent or mucopurulent discharge. Viral conjunctivitis presents with eyelid ecchymosis and watery discharge from the eyes. It can have an abrupt onset and present is one or both eyes. A vesicular rash or ulceration of the eyelids with a watery discharge from the eyes is seen in Herpes simplex viral infection of the eyes. Medication induced conjunctivitis presents with a contact dermatitis of the eyelids and a subconjunctival, multilobulated yellow mass. Question: A 30-year-old patient presents with a moderate "aching" in his right eye. Findings reveal a small and irregular shaped right pupil. The cornea appears cloudy with a slight erythematous area around the corneal limbus. There is no ocular discharge noted. These findings are consistent with:    acute iritis.      corneal injury.      corneal infection.      acute angle closure glaucoma.   Explanation: Acute iritis presents with a moderate aching deep within the eye. The pupils are small and irregular and vision is decreased and photophobia is present. The cornea is clear or slightly cloudy with injection confined to the corneal limbus. This is considered an emergency and is usually related to Herpes zoster infection or tuberculosis. Corneal injury or infection usually presents with watery or purulent ocular discharge and severe eye pain. With acute angle closure glaucoma, the pain is severe, aching, and deep, but the pupils are dilated and fixed and the cornea appears steamy or cloudy. If an increase in intraocular pressure is present in conjunction with these findings, this would be an emergency situation. Question: The middle ear consists of:    the helix, antihelix, and the tragus      the malleus, incus, and the stapes      the tympanic membrane, the cone of light, and the pars tensa      the lobule, mastoid process, and the eustachian tube   Explanation: The ossicles are part of the middle ear and consist of the malleus, incus, and the stapes. The helix, antihelix, and tragus are parts of the outer ear. The pars tensa is part of the tympanic membrane. The cone of light is usually visible at the tip of the malleus but not considered part of the ossicles. The lobule is the ear lobe and part of the external ear. The eustachian tube connects the middle ear to the nasopharynx and is not considered a part of the ossicles. Question: A 35-year-old patient complains of vertigo accompanied by nausea and vomiting. Examination reveals bilateral diplopia and an unsteady gait. These symptoms could be suggestive of:    an arrhythmia.      a neurological condition.      an inner ear infection.      orthostatic hypotension.   Explanation: Vertigo symptoms associated with neurologic conditions include: ataxia, diplopia, and dysarthria. Symptoms associated with cardiovascular conditions and vertigo include arrhythmias, orthostatic hypotension, vasovagal stimulation, lightheadedness, weakness, or presyncope. Question: A softening of the skin at the angles of the mouth which may be due to nutritional deficiency is commonly referred to as:    actinic cheilitis.      herpes simplex.      angular cheilitis.      leukoplakia.   Explanation: Angular cheilitis begins with softening of the skin at the angle of the mouth with subsequent development of fissures. This condition may be seen in patients who have nutritional deficiencies or ill fitting dentures. Actinic cheilitis typically results from excessive exposure to sunlight and generally affects the lower lip. The lip becomes slightly everted, scaly, somewhat thickened, and losses its red color. Herpes simplex presents with recurrent and painful vesicles on the lips and surrounding areas. Leukoplakia appears as thickened white patches anywhere in the oral mucosa. Question: All of the following are examples of causes of sensorineural hearing loss in children except:    the presence of cerumen impaction.      prolonged use of tobramycin.      maternal history of Herpes infection.      congenital rubella syndrome.   Explanation: Sensorineural hearing loss involves problems with the transmission of sound from the inner ear to the 8th cranial nerve. It is a permanent condition that usually affects both ears. Sensorineural hearing loss can be present at birth or as a result of conditions acquired later in life. Examples include: prolonged exposure to loud noise, infection, severe head injury, medication exposure and some inherited diseases. Question: Ophthalmoscopic examination of a 30-year-old with a history of an eye injury 3 years ago, reveals a superficial grayish-white opacity in the right cornea. This may be indicative of a:    corneal arcus.      corneal scar.      pterygium.      cataract.   Explanation: A corneal scar presents as a superficial grayish-white opacity in the cornea. A corneal arcus is referred to as a thin grayish-white arc noted on the lower end of the cornea. This is common during normal aging but can be seen in younger people and may be suggestive of dyslipidemia. Pterygium is a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea. A cataract is an opacity of the lens visible through the pupil. Question: With transillumination of the maxillary sinuses, a reddish glow is observed on the hard palate. This red glow would be indicative of:    thickened mucosa or secretions in the maxillary sinuses.      clear maxillary sinuses.      an absent maxillary sinus.      a developmental absence of both maxillary sinuses.   Explanation: A reddish glow noted on the hard palate when transilluminating the maxillary sinuses, would suggest a normal finding. However, if there was an absence of this reddish glow, that could be suggestive of a thickened mucosa or the presence of secretions or lesions in the maxillary  Question: Actinic cheilitis is a condition of the lower lip most commonly seen in:    dark-skinned males who work in coal mines.      people of all races with nutritional deficiencies.      people with a history of intestinal polyps.      fair-skinned men who work outdoors.   Explanation: Actinic cheilitis typically results from excessive exposure to sunlight and generally affects the lower lip. People whose occupation requires them to work for long periods of time in the sun are at high risk for developing this condition. Therefore, it is seen more often in fair-skinned men who work outdoors. The lip becomes slightly everted, scaly, somewhat thickened, and losses its red color. This condition is not seen in Herpes or people with nutritional deficiencies. It can occur in dark-skinned males, but it is unusual. Question: A 4-year-old child presents with bilateral watery discharge from the eyes. Examination reveals subconjunctival hemorrhage, and eyelid ecchymosis. These findings are consistent with:    bacterial conjunctivitis.      Herpes simplex viral conjunctivitis.      allergic conjunctivitis.      adenoviral conjunctivitis.   Explanation: Adenoviral conjunctivitis can have an abrupt onset, be unilateral or bilateral with bulbar conjunctival injection, watery discharge, subconjunctival hemorrhage, and eyelid ecchymosis. Bacterial conjunctivitis can be unilateral or bilateral, may include bulbar conjunctival injection, purulent or mucopurulent discharge and eyelid edema. Symptoms depend on the cause and severity. With Herpes simplex virus conjunctivitis symptoms include bulbar conjunctival injection, watery discharge, mild follicular reaction of conjunctiva, a vesicular rash or ulceration of eyelids, pleomorphic or dendritic epithelial keratitis of cornea or conjunctiva. It is usually unilateral. An allergic conjunctivitis is usually bilateral with conjunctival injection, chemosis, watery discharge, and/or a mild mucus discharge. Question: A patient complains of a sore tongue. Findings reveal a smooth and erythematous tongue. This condition is termed:    gingivitis.      stomatitis.      glossitis.      candidiasis.   Explanation: Glossitis is a term used to describe a sore tongue with an erythematous and smooth surface or a general inflammation of the tongue. Gingivitis refers to an inflammation of the gums. Stomatitis describes inflammation of the mouth including the mucous membranes and the lips. Candidiasis refers to a yeast infection of the mouth and presents with yellowish white patchy lesions in the mouth and tongue. Question: On physical exam, an abnormal Rinne test might indicate:    impaired physical mobility.      impaired visual acuity.      impaired hearing ability.      impaired swallowing ability.   Explanation: The Rinne test uses a tuning fork to compare air conduction to bone conduction and so is used to assess hearing. The other choices are not assessed using the Rinne test. Question: The fleshly projection of the earlobe is known as the:    lobule.      tragus.      auricle.      helix.   Explanation: The fleshy projection of the earlobe is known as the lobule. The auditory canal opens behind a nodular protuberance that points backward over the entrance to the canal. This is known as the tragus. The auricle is made of cartilage covered by skin and has a firm elastic consistency. The auricle has a prominent curved outer ridge known as the helix. Question: Examination of the nasolacrimal duct reveals a mucopurulent discharge from the puncta. This finding is suggestive of:    conjunctivitis.      an obstructed nasolacrimal duct.      dacryocystitis.      pinguecula.   Explanation: An obstructed nasolacrimal duct would present with a mucopurulent discharge from the puncta of the eye. Conjunctivitis is an inflammation of the conjunctiva and findings include red, burning, and itchy eyes. Dacryocystitis is an inflammation of the lacrimal sac, the area between the lower eyelid and the nose. Dacryocystitis presents as a painful, red, and tender area around the eye especially near the nose. A pinguecula refers to a harmless yellowish triangular nodule noted in the bulbar conjunctiva on either side of the iris. This finding may be seen in aging or in patients who are exposed chronically to dust. Question: To palpate for frontal sinus tenderness, press up on the frontal sinuses from under the bony brows, then:    press down on the ethmoid sinus.      press up on the maxillary sinus.      palpate around the orbit.      observe the turbinates.   Explanation: To palpate for sinus tenderness, press up on the frontal sinuses from under the bony brows, then press up on the maxillary sinus. The patient may exhibit signs of pain. Tenderness and purulent discharge could indicate sinusitis of the frontal or maxillary sinuses. Only the frontal and maxillary sinuses are readily accessible for clinical examination. Circling the orbit does not assist in diagnosing sinusitis. Question: A nodular protuberance that points backward over the entrance to the ear canal is called the:    Antihelix      Helix      Auricle      Tragus   Explanation: The auditory canal opens behind a nodular protuberance that points backward over the entrance to the canal, known as the tragus. The external ear consists of the auricle and ear canal. The auricle is made of cartilage covered by skin and has a firm elastic consistency. The auricle has a prominent curved outer ridge known as the helix. The antihelix is a curved prominence that is parallel and anterior to the helix. Question: A 60- year-old patient presents with severe, deep left eye pain. Findings reveal dilated and fixed left pupil and the cornea is cloudy. There is no ocular discharge noted. These findings are most likely consistent with:    acute iritis.      corneal injury.      corneal infection.      acute angle closure glaucoma.   Explanation: With acute angle closure glaucoma, the pain is described as severe, aching, and deep. The pupils are dilated and fixed and the cornea appears steamy or cloudy. If an increase in intraocular pressure is present, this would be an emergency situation. Acute iritis presents with a moderate aching pain deep within the eye. The pupils are small and irregular and vision is decreased and photophobia is usually present. The cornea is clear or slightly cloudy with injection confined to the corneal limbus. This is considered an emergency and is usually related to Herpes zoster infection or tuberculosis. Corneal injury or infection usually presents with watery or purulent ocular discharge and the pain is severe. Question: A patient presents with findings of pain, warmth, redness, and swelling below the inner canthus toward nose. Tearing is present and when pressure is applied to the lacrimal sac, purulent discharge from the puncta is noted. This is suggestive of:    blepharitis.      dacryocystitis.      a hordeolum.      a chalazion.   Explanation: Dacryocystitis is an infection and blockage of lacrimal sac and duct. Symptoms include pain, warmth, redness, and swelling below the inner canthus toward the nose. Tearing is usually present and when pressure is applied to the lacrimal sac, a purulent discharge from the puncta can be noted. Red, scaly, greasy flakes and thickened, crusted lid margins are consistent with blepharitis. Symptoms include burning, itching, tearing, foreign body sensation, and some pain. Hordeolum is an infection usually secondary to localized Staphylococcal infection of the hair follicles at the lid margin. Question: When assessing extraocular movements:    use the Snellen eye chart.      use the ophthalmoscope to view the fundus.      include the cardinal directions of gaze.      shine a penlight into the pupils.   Explanation: When assessing the extraocular movements (EOMs), all six cardinal directions of gaze should be included. Dysconjugate gaze, sustained nystagmus, or lid lag should be evaluated further. The use of the Snellen eye chart assesses visual acuity. The ophthalmoscope is typically used to view the fundus. This visualization does not assess the extraocular movements. Use of a penlight on the pupils will elicit pupillary reaction not extraocular movements. Question: Ptosis is defined as:    an inward turning of the lower eyelid.      an outward turning of the lower eyelid.      drooping of the eyelid.      a retracted eyelid with a wide-eyed stare.   Explanation: Ptosis presents as a drooping of the eyelid caused by damage to the oculomotor nerve, myasthenia gravis, or damage to the sympathetic nervous system. An inward turning of the lower eyelid with irritation to the conjunctiva and lower cornea is defined as entropion. This condition is seen more commonly in the elderly. Ectropion is characterized by an outward turning of the lower eyelid exposing the palpebral conjunctiva. This condition is more common in the elderly. Lid retraction and exophthalmos is a condition that appears as a wide-eyed stare and suggests retracted eyelids. This condition could be suggestive of hyperthyroidism. Question: When a person shifts gaze from a near object to a far object, the pupils:    dilate.      constrict.      remain unchanged.      depends.   Explanation: When a person shifts gaze from a near object to a far object, the pupils dilate to allow more light to enter. If this reaction does not occur, there could be damage to the oculomotor nerve (CN III). Further evaluation may be warranted in this situation. Question: Assessment of a patient's visual acuity resulted in 20/200 using the Snellen eye chart. This means that:    at 200 feet the patient can read printed information that a person with normal vision could read at 20 feet.      at 20 feet the patient can read printed information that a person with normal vision could read at 200 feet.      the patient has normal visual acuity.      the patient may not be able to read so he should be tested with the picture or "E" eye charts.   Explanation: Visual acuity that is ed to 20/200 constitutes legal blindness. The larger the number under 20, the worse the visual acuity. If this is a new finding, the patient needs ophthalmologic evaluation. Question: A 57-year-old man with a history of diabetes complains of difficulty hearing on the telephone and muffled sounds while watching the television at a low volume. He should be further evaluated for:    acoustic neuroma.      granulomatous disease.      cholesteatoma.      presbycusis.   Explanation: Presbycusis is the most common type of sensorineural hearing loss caused by the natural aging of the auditory system. It occurs gradually and initially affects the ability to hear higher-pitched (higher frequency) sounds. It also muffles the sounds of voices. Acoustic neuroma is a rare condition that develops from direct effects on the main nerve or from a tumor pressing on adjacent nerves or brain structures. It causes symptoms of dizziness, loss of balance, and facial numbness. Cholesteatoma and granulomatous disease present with physical symptoms of infectious ear drainage. Question: Ophthalmoscopic examination reveals dark specks noted between the fundus and the lens. These specks are most likely:    superficial retinal hemorrhages.      cataracts.      drusen.      vitreous floaters.   Explanation: Vitreous floaters may be seen as dark specks or strands between the fundus and the lens. They could be a symptom of retinal detachment, retinal tear, or bleeding within the eye. Superficial retinal hemorrhages appear as small, linear, flame-shaped, red streaks in the fundus and are seen in hypertension, papilledema, and occlusion of the retinal vein. Cataracts are opacities in the lens of the eye. Drusen appear as yellowish round spots posteriorly between the optic disc and the macula and are associated with cellular debris. Question: What connects the middle ear to the nasopharynx?    The tympanic membrane      The proximal end of the eustachian tube      The malleus      The ossicles   Explanation: The proximal end of the eustachian tube connects the middle ear to the nasopharynx. Question: Upon examination of the right tympanic membrane, a cone of light was visible at the four o'clock mark. This would be interpreted as:    a perforation of the ear drum.      an acute otitis media.      a normal eardrum.      tympanosclerosis.   Explanation: The normal eardrum or tympanic membrane appears pinkish gray. The handle and short process of the malleus, and the cone of light are all clear and visible. The cone of light fans anteriorly and downward from the umbo putting it in the four o'clock position. A perforation in the eardrum would appear as a hole in the membrane and the cone of light would be absent. In acute otitis media, the eardrum appears red with loss of landmarks and may or may not have a bulge. Tympanosclerosis is a deposit of hyaline material within the layers of the tympanic membrane that sometimes follow a severe episode of otitis media. It appears as a chalky white patch with irregular margins. Question: When examining the eyes, both pupils appear small and have an irregular shape. They are noted to accommodate but do not appear to react to light. This could be indicative of:    a tonic (Adele's pupil) pupil.      oculomotor nerve (CN III) paralysis.      Horner's syndrome.      Argyll Robertson pupils.   Explanation: When the pupil is large, regular, and the reaction to light is severely reduced, absent, or slowed, this condition is referred to as a tonic pupil or Adele's pupil. With paralysis of the oculomotor cranial nerve (CN III), the dilated pupil is fixed to light and near accommodation. Ptosis and lateral deviation of the eye are usually present. In Horner's syndrome, the affected pupil reacts briskly to light and near effort, but the pupil is small. The pupils in Argyll Robertson appear small, are irregular shaped, and accommodate, but do not react to light. Question: Ectropion is defined as:    an inward turning of the lower eyelid.      an outward turning of the lower eyelid.      drooping of the eyelid.      a retracted eyelid with a wide-eyed stare.   Explanation: Ectropion exhibits an outward turning of the lower eyelid exposing the palpebral conjunctiva. This condition is more common in the elderly. An inward turning of the lower eyelid with irritation to the conjunctiva and lower cornea is defined as entropion. This condition is more common in the elderly. Ptosis presents as a drooping of the eyelid caused by damage to the oculomotor nerve, myasthenia gravis, or damage to the sympathetic nervous system. Lid retraction and exophthalmos is a condition that appears as a wide-eyed stare and suggests retracted eyelids. This condition could be suggestive of hyperthyroidism. Question: Gingival hyperplasia could be seen in all the following conditions except:    those patients undergoing phenytoin (Dilantin) therapy.      adolescents with nickel braces.      in patients diagnosed with diabetes.      in adults with leukemia.   Explanation: Gingival hyperplasia describes erythematous, swollen gums that are over grown. This condition can be seen in some patients during pregnancy or puberty, or those with leukemia. It is associated with certain medications: phenytoin, cyclosporine, and calcium antagonists. This condition is not characteristically seen in diabetes. Question: A 30-year-old patient presents with complaints of seeing double in the right eye. Examination reveals diplopia in the right eye when the left eye is closed. This may be suggestive of a:    problem in the cornea.      problem in the optic disc.      palsy of cranial nerve III or IV.      palsy of cranial nerve III or VI.   Explanation: Problems in the cornea or lens present as unilateral diplopia in one eye when the other eye is closed. Diplopia could be suggestive of weakness or paralysis of the extraocular muscles or of a tumor in the cerebellum or brainstem. Vertical diplopia results from damage to cranial nerves (CN) III or IV. If the diplopia is horizontal, it could be suggestive of paralysis of one or more extraocular muscles resulting form damage to cranial nerves (CN) III or VI. Problems in the cornea or lens present as unilateral diplopia. The optic disc is not associated with diplopia. Question: A deposit of uric acid crystals appearing as hard nodules on the helix or antihelix is termed:    a keloid.      a tophi.      a cutaneous cyst.      chondrodermatitis.   Explanation: The antihelix divides the helix from the lobe. Tophi is a deposit of uric acid crystals (that appear commonly in patients with chronically elevated uric acid levels) on the helix or antihelix. They can also appear near the joints, hands, or feet. It is also seen in chronic tophaceous gout. A firm, nodular, hypertrophic mass of scar tissue extending beyond the area of injury is classified as a keloid. A cutaneous cyst has a characteristic dome shaped lump in the dermis forming a benign closed firm sac attached to the epidermis. This lesion was formerly known as a sebaceous cyst. A chronic inflammatory lesion that starts as a painful, tender papule on the helix or antihelix is known as chondrodermatitis. Question: A patient presents with complaints of burning, itching, tearing, and some pain in the eye. Findings reveal red, scaly, greasy flakes and thickened, crusted lid margins. This would be suggestive of:    a chalazion.      blepharitis.      a hordeolum.      dacryocystitis.   Explanation: Red, scaly, greasy flakes and thickened, crusted lid margins are consistent with blepharitis. Symptoms include burning, itching, tearing, foreign body sensation, and some pain. Chalazion is an inflammatory lesion that develops in a meibomian tear gland. Hordeolum is a localized staphylococcal infection of the hair follicles at the lid margin. Dacryocystitis is infection and blockage of lacrimal sac and duct. Question: An eight-year-old complains of itching in the right ear and an increase in pain when the pinna is pulled or the tragus is palpated. Examination reveals slight redness in the ear canal with a clear odorless fluid. This could be suggestive of:    otitis media.      otitis externa.      mastoiditis.      a tympanic membrane rupture.   Explanation: Otitis externa, swimmer's ear, is an infection or inflammation of the external ear or the ear canal. Symptoms include itching and tragal pain. The external canal may have a discharge. Otitis media is a middle ear infection and usually the tympanic membrane is bulging with fluid or pus behind it. Mastoiditis is an infection of the mastoid process (temporal bone adjacent to the middle ear). A ruptured tympanic membrane is usually secondary to infection that causes pus and fluid to build up behind the eardrum and as the pressure increases, the eardrum may rupture. Ear pain decreases when the membrane ruptures and the discharge can be pus, blood, or a clear fluid. Question: If there is an abnormal protrusion, what condition should be suspected if there is an abnormal protrusion of the eyes?    Hypothyroidism      cataracts.      Graves' disease      Glaucoma   Explanation: When assessing the eyes for position and alignment, the abnormal protrusion is suggestive of Graves' disease or ocular tumors. This abnormality is not seen in cataracts', hypothyroidism, or with glaucoma. Question: Sudden visual loss suggests:    retinal detachment.      hyperopia.      macular degeneration.      hyperglycemia.   Explanation: If a patient reports a change in vision and states that the vision loss was sudden, this is suggestive of retinal detachment, vitreous hemorrhage, or occlusion of the central retinal artery. Immediate ophthalmology consultation is needed. With macular degeneration, there is blurring of the entire field of vision and there is a slow central loss of vision. Hyperopia is a refractive error of vision and is associated with gradual blurring but not loss of vision. Hyperglycemia may also cause blurring but not a sudden loss of vision. Question: A six-year-old child presents with sore throat, difficulty swallowing, and a temperature of 102 °F. Findings reveal lymphadenopathy and pharyngeal erythema. This is probably:    sinusitis.      exudative tonsillitis.      pharyngitis.      the flu.   Explanation: Pharyngitis is caused by swelling between the tonsils and the larynx secondary to either viral or bacterial infections. The most common bacterial pharyngeal infections in children are caused by group A beta-hemolytic strep. A patient with sinusitis is more likely to present with nasal congestion, nasal discharge, headache, and an absence of fever. Exudative tonsillitis presents with tonsillar exudate. There is no mention of this in the question stem. Influenza infection typically presents with these symptoms and cough, headache, and body aches. Question: A toddler with a suspected hearing loss would:    exhibit little or no babbling or vocalization sounds.      likely communicate through gestures.      display poor school performance.      need to watch television with the volume on high.   Explanation: A toddler with a hearing loss would communicate with gestures, exhibits little or no intelligible speech, and does not respond to surrounding noises. An infant with a hearing loss does not startle to loud noises, arouses to touch and not noise, does not turn the head in response to sounds and has little or no babbling or vocalization. A school aged child with a hearing loss would sit close to the television with the volume on high, may have poor school performance, speech problems, and inability to ly respond unless directly in front of the speaker's face. Question: A reduction in vision in one or both eyes causing loss of binocular vision is termed:    strabismus.      amblyopia.      cataracts.      macular degeneration.   Explanation: Amblyopia results from anything that causes visual deprivation to the eye, including congenital cataracts, untreated strabismus, and refractive errors. With amblyopia, there is a reduction in vision in one or both eyes causing loss of binocular vision. Cataracts are visualized by a cloudiness or opacity in the lens. Macular degeneration is defined as degeneration of the macular area of the retina. Question: The Rinne hearing test allows the examiner to screen for:    sensorineural hearing loss.      conductive hearing loss.      general hearing loss      bilateral hearing loss.   Explanation: The Rinne hearing test is used primarily for evaluating hearing in one ear as compared to the other ear. It compares the perception of sound transmitted by air conduction to those sounds transmitted by bone conduction through the mastoid. Therefore, it screens for conductive hearing loss. Question: A patient is able to recognize distant objects but has difficulty reading a book's small print. This describes:    hyperopia.      myopia.      strabismus.      astigmatism.   Explanation: Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: On ophthalmoscopic exam of the older adult, there is an increased cup-to-disc ratio: This finding is suggestive of:    cataracts.      macular degeneration.      open angle glaucoma.      blindness.   Explanation: The cup-to-disc ratio compares the diameter of the "cup" portion of the optic disc with the total diameter of the optic disc. In glaucoma, an increase in intraocular pressure will damage the delicate nerve fibers and produces additional cupping of the optic disc. As glaucoma worsens, the cup enlarges until it occupies most of the disc area. Question: The majority of people who present with non-24 hour sleep-wake disorder are:    legally blind.      attention deficit.      color blind.      totally blind.   Explanation: The majority of people who present with non-24 hour sleep-wake disorder are totally blind. This chronic circadian rhythm sleep disorder is defined as a condition of insomnia related to abnormal synchronization between the 24-hour light -dark cycle and the endogenous circadian rhythms of sleep and wake cycles. Question: A person who has been blind since birth presents for a physical exam. Expected findings of the pupillary reaction when light is shown would be:    constriction of both pupils.      dilation of both pupils.      no reaction from either pupil.      it depends.   Explanation: It depends on the type of blindness. Pupillary reaction is controlled by the muscles which are innervated by nerves. As long as there is no damage to the nerve or the muscle, the pupil will still contract or dilate. Question: A localized Staphylococcal infection of the hair follicles at the lid margin is suggestive of:    a hordeolum.      blepharitis.      a chalazion.      dacryocystitis.   Explanation: A localized Staphylococcal infection of the hair follicles at the lid margin is a hordeolum, stye. Symptoms include a painful, red, and swollen pustule at the lid margin. Rubbing the eyes can cause cross-contamination and development of another hordeolum. Red, scaly, greasy flakes and thickened, crusted lid margins are consistent with blepharitis. Chalazion is a chronic inflammatory lesion that develops when a meibomian gland becomes obstructed. It produces a beady nodule on the lid. Dacryocystitis represents an infection of the lacrimal sac and duct. Question: Ophthalmoscopic examination of the fundus reveals tiny, round, red spots in and around the macular area. These findings are consistent with:    superficial retinal hemorrhages.      preretinal hemorrhages.      microaneurysms.      deep retinal hemorrhages.   Explanation: Microaneurysms present as tiny, round, red spots commonly seen in and around the macular area. These are classic in diabetic retinopathy. Superficial retinal hemorrhages appear as small, linear, flame-shaped, red streaks in the fundus and are seen in hypertension, papilledema, and occlusion of the retinal vein. Preretinal hemorrhages lie anteriorly between the retina and the vitreous and are typically larger than retinal hemorrhages. These hemorrhages obscure any underlying retinal vessel. Deep retinal hemorrhages appear as small, rounded, slightly irregular red spots and are sometimes called dot or blot hemorrhages. They occur in a deeper layer of the retina than flame-shaped hemorrhages. Diabetes is a common cause. Question: When administering ear drops to a 6-year-old, the pinna should be pulled:    downward.      downward and back.      upward.      upward and back.   Explanation: To examine the ears of an infant it is usually necessary to pull the auricle backward and downward. In the older child, the external ear is pulled backward and upward. Question: Sudden bilateral and painful visual loss is rare but can be associated with:    cholinergics.      anticholinergics.      steroids.      radiation exposure.   Explanation: Exposure to chemicals or radiation could result in bilateral painful visual loss. Certain medications are associated with sudden bilateral, painless visual loss. These medication classes include cholinergics, anticholinergics, and steroids. Question: Performance of the Weber and Rinne tests to assess for hearing loss is best performed using tuning fork with a frequency of:    256 Hz.      512 Hz.      800 Hz.      1000Hz.   Explanation: Performance of the Weber and Rinne tests to assess for hearing loss is best performed using tuning fork with a frequency of 512 Hz. Tuning forks with lower frequency may be better felt than heard, while tuning forks at higher frequency tend to lose vibratory energy quickly and are difficult to activate for them to be heard with moderate or severe sensorineural impairment. A tuning fork with a frequency of 512Hz is the most effective in assessing for air and bone conduction of hearing. Question: To visualize the ear canal and the tympanic membrane of an adult, use the otoscope with:    the largest ear speculum the canal will accommodate.      the smallest ear speculum.      a pneumatic bulb.      slight pressure with the speculum directed in an upward motion.   Explanation: When examining the ear canal and tympanic membrane it is always best to use the largest speculum that the canal will accommodate. This provides the greatest visualization of the tympanic membrane. Use of a small speculum does not allow for viewing of the entire drum at once. The use of the pneumatic bulb is helpful if one is evaluating for mobility of the drum. When placing the speculum in the ear canal, it is best to use slight pressure when inserting and it should be directed in a slight downward and forward angle. Question: A six-year-old complains that something is in her left eye. There is a red raised area of the left lid. There is redness and tenderness of the eye and tearing. These findings are consistent with:    blepharitis.      conjunctivitis.      a corneal ulcer.      a hordeolum.   Explanation: A hordeolum, or stye, is an infection of the sebaceous gland of the eyelid. Symptoms include a raised area of the lid, pain, redness, tenderness, possible photophobia, tearing, and a sensation of a foreign body in the eye. Conjunctivitis presents with a reddened conjunctiva and presence of a watery or purulent discharge depending on the etiology. A corneal ulcer produces a visible area of ulceration. Blepharitis presents with an erythematous eyelid margin with a mucous discharge, crusting, and scaling of the eyelid margins. Question: ecr   problem in the cornea.      problem in the lens.      palsy of cranial nerve III or IV.      palsy of cranial nerve III or VI.   Explanation: Diplopia could be suggestive of weakness or paralysis of the extraocular muscles or of a tumor in the cerebellum or brainstem. If the diplopia is horizontal, it could be suggestive of paralysis of one or more extraocular muscles resulting from damage to cranial nerves (CN) III or VI. Vertical diplopia results from damage to cranial nerves (CN) III or IV. Problems in the cornea or lens present as unilateral diplopia. It is noted that one kind of horizontal diplopia is physiologic and of no concern. Question: The ethmoidal sinuses:    are located between the eyes.      are located above the eyes.      surround the nasal cavity.      are located behind the sphenoid sinuses.   Explanation: The paranasal sinuses include the maxillary, frontal, ethmoidal, and sphenoidal sinuses. The ethmoidal sinuses are between the eyes and the frontal sinuses are located above the eyes. The maxillary sinuses are located around the nasal cavity. The sphenoidal sinuses lie just behind the ethmoidal sinuses. Question: The ossicles are located in the:    inner ear.      middle ear.      auditory canal.      external ear.   Explanation: The ossicles consist of the incus, malleus, and the stapes and are located in the middle ear. Question: A 50-year-old patient presents with complaints of seeing double bilaterally. Examination reveals a vertical diplopia. This may be suggestive of a:    problem in the cornea.      problem in the lens.      palsy of cranial nerve III or IV.      palsy of cranial nerve III or VI.   Explanation: Diplopia could be suggestive of weakness or paralysis of the extraocular muscles or of a tumor in the cerebellum or brainstem. Vertical diplopia results from damage to cranial nerves (CN) III or IV. If the diplopia is horizontal, it could be suggestive of paralysis of one or more extraocular muscles resulting from damage to cranial nerves (CN) III or VI. Problems in the cornea or lens present as unilateral diplopia. Question: If a patient complains of seeing flashing lights across the field of vision, this could be:    a normal response if around bright lights.      a retinal detachment.      detachment of the vitreous from the retina.      lesion in the visual pathways.   Explanation: Flashing lights or new vitreous floaters suggest detachment of vitreous from the retina. A detached retina would present with sudden loss of vision. With a lesion in the visual pathway, one may visualize fixed defects such as a scotoma. At any rate, this is not a normal finding even if the person was around bright lights. Question: A buildup of excess fluid around the periphery of the eye orbits is known as:    episcleritis.      pinguecula.      ptosis.      periorbital edema.   Explanation: An accumulation of fluid around the periphery of the eye orbits is known as periorbital edema. Question: A child presents with a complaint of a left earache that worsens with head movement. Findings on examination include temperature of 102 °F, cellulitis behind the left ear. These findings are consistent with:    otitis externa.      otitis media.      mastoiditis.      otosclerosis.   Explanation: Mastoiditis is an infection of the mastoid process (temporal bone adjacent to the middle ear) and generally results from inadequately treated otitis media. The mastoid bone fills with infected materials and its honeycomb-like structure may deteriorate. Symptoms include: fever, malaise, possible tinnitus. Otitis externa is an infection of the external canal. Otitis media is a middle ear infection. Otosclerosis is an abnormal bone growth around the ossicles resulting in a conductive hearing loss because the stapes cannot vibrate. Question: On ophthalmoscopic examination of a 70-year-old, a thin grayish white arc is noted on the lower end of the cornea. This appearance is referred to as a:    corneal arcus.      corneal scar.      pterygium.      cataract.   Explanation: Corneal arcus is characterized by the presence of a thin grayish-white arc noted on the lower end of the cornea. This is common during normal aging, but can be seen in younger people and may be suggestive of dyslipidemia. A corneal scar presents as a superficial grayish-white opacity in the cornea. Pterygium is a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea. A cataract is an opacity of the lens visible through the pupil. Question: Ophthalmoscopic examination of the retina reveals a normal arteriovenous crossing. This appears as if the:    vein tapers down on either side of the artery.      vein is twisted on the distal side of the artery.      vein crosses beneath the artery.      vein stops abruptly on either side of the artery.   Explanation: In the normal eye, the vein appears to cross beneath the artery. When the arterial walls lose their transparency, changes appear in the arteriovenous crossings. Decreased transparency of the retina probably contributes to AV nicking and AV tapering. In AV nicking, the vein appears to stop abruptly on either side of the artery. In tapering, the vein appears to taper down either side of the artery. With banking, the vein appears to be twisted on the distal side of the artery and forms a dark wide knuckle appearance. Question: In order to examine the tongue, ask the patient to stick out his tongue and with the examiner's right hand:    stimulate the patient to cough.      pull the tongue downward and push down with the finger on the left hand to elicit the gag reflex.      grasp the tip of the tongue, gently pull it to the left side , and inspect the side of the tongue.      inspect it for symmetry.   Explanation: In order to examine the tongue, ask the patient stick out his the tongue and with the examiner's right hand, grasp the tip of the tongue with a gauze and gently pull it to the patient's left. Inspect the side of the tongue, then palpate it with the left hand, feeling for any induration. Reverse the procedure for the other side. Inspecting for tongue symmetry checks function of cranial nerve XII, hypoglossal. Stimulating the patient to cough and eliciting the gag reflex do not have anything to do with the tongue examination. Question: Most of the paranasal sinuses drain into the:    inferior meatus.      middle meatus.      superior meatus.      vestibule.   Explanation: Most of the paranasal sinuses drain into the middle meatus. Question: Raised or flat, deep purple colored lesions noted in the mouth may be suggestive of:    Koplik's spots.      Kaposi's sarcoma.      torus palatinus.      Fordyce spots.   Explanation: Kaposi's sarcoma (a low-grade vascular tumor associated with human herpes virus 8), is associated with flat or raised deep purple colored lesions of the mouth. Approximately one third of patients with Kaposi’s sarcoma have lesions in the oral cavity. Other sites that could be affected include the gastrointestinal tract and the lungs. Koplik's spots are frequently seen in the early stage of measles (roseola) and appear as small white specks that resemble grains of salt on a red background on the buccal mucosa. Torus palatinus develops as a bony growth in the hard palate and is common in adults. Fordyce spots or granules appear as yellow spots in the buccal mucosa or on the lips. They are considered normal sebaceous glands. Question: Findings following assessment of a person's left eye gaze include impaired movements when attempting to look upward, downward, or inward. This condition is most consistent with:    a conjugate gaze.      left cranial nerve III (oculomotor) paralysis      cranial nerve IV (trochlear) paralysis.      cranial nerve VI (abducens) paralysis.   Explanation: With a left cranial nerve III paralysis, upward, downward, or inward movements are impaired. In conjugate or normal gaze, the normal movement of the two eyes appears simultaneously in the same direction to bring something into view. With a left cranial nerve VI paralysis, a person's gaze would include eyes conjugate when looking to the right, esotropia (one or both eyes turn inward) appears in the left eye when looking straight ahead, and esotropia is maximum in the left eye when looking to the left. The left eye is unable to look down when turned inward in a left cranial nerve IV paralysis. Question: With transillumination of the frontal sinuses, a dim red glow is observed on the forehead. This dim red glow would be indicative of:    thickened mucosa or secretions in the frontal sinuses.      clear frontal sinuses.      an absent frontal sinus.      a developmental absence of both frontal sinuses.   Explanation: A dim red glow noted on the forehead when transilluminating the frontal sinuses, would suggest a normal finding. However, if there was an absence of this red glow, that could be suggestive of a thickened mucosa or the presence of secretions or lesions in the frontal sinuses. Absence of the red glow could also indicate the absence of the frontal sinuses. Question: All of the following symptoms in a 10-month-old would be indicative of acute otitis media (OM)except:    nausea, vomiting, and possibly diarrhea      increased mobility of the tympanic membrane      persistent crying and irritability      reluctance to suck a bottle   Explanation: The hallmark of acute otitis media (AOM) is the recent onset of a middle ear infection manifesting one or more of the following signs or symptoms: otalgia (tugging or rubbing of the ear in children <2yrs), fever, irritability, anorexia, nausea, vomiting , diarrhea, rhinitis or purulent discharge in the ear canal accompanied by decreased mobility of the tympanic membrane (TM). [Show More]

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