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EENT EXAM NEWEST 2025 ACTUAL
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A 30 year old male has been diagnosed with non-allergic rhinitis. What finding is more likely in non-allergic rhinitis than allergic rhinitis? Older age of symptom onset Male gender Post nasal drip Sneezing - CORRECT ANSWER Older age of symptom onset Explanation: Non-allergic rhinitis, often called vasomotor rhinitis, is very common in the US. It is typically diagnosed and differentiated from allergic rhinitis by history. Although both conditions may co-exist in patients, nonallergic rhinitis typically has onset after age 20 years. Allergic rhinitis typically presents prior to age 20 years. The most common symptoms associated with non-allergenic rhinitis are nasal congestion and postnasal drip. It is predominantly reported in females. Common precipitants of non-allergic rhinitis symptoms can occur with exposure to spicy foods, cigarette smoke, strong odors, perfumes, and alcohol consumption. This is frequently treated with topical azelastine.
The throat swab done to identify Streptococcal infection was negative in a 12 year-old female with tonsillar exudate, fever, and sore throat. What statement is true regarding this? A second swab should be done to repeat the test. The patient does not have Strept throat. The patient probably has mononucleosis. A second swab should be collected and sent to microbiology. - CORRECT ANSWER A second swab should be collected and sent to microbiology. Explanation: A second swab is collected, but it is not used to repeat the test. The second swab is sent to microbiology for culture. The sensitivity varies in office Strept tests. Some are as low as 50% and a second swab should be collected. If beta-hemolytic Strept organisms are grown out, then the patient can be diagnosed with Streptococcal infection What is the usual age for vision screening in young children? 2 years 3 years 4 years 5 years - CORRECT ANSWER 3 years Explanation: Initial vision screening should take place at 3 years of age. If the child is not cooperative, screening should be attempted 6 months later. If the
Leukotriene blockers - CORRECT ANSWER Intranasal glucocorticoids Explanation: These agents are particularly effective in the treatment of nasal congestion and would be a good choice for the patient in this scenario. Intranasal glucocorticoids are effective in relieving nasal congestion, discharge, itching, and sneezing. A trial of stopping the oral antihistamine could be tried in this patient. Symptoms would determine whether the antihistamine should be resumed. Conjunctivitis: produces blurred vision in the affected eye. usually begins as a viral infection. produces anterior cervical lymphadenopathy. is common in patients who are nearsighted. - CORRECT ANSWER usually begins as a viral infection. Explanation: Conjunctivitis or "pink eye" usually begins as a viral infection. As the conjunctiva becomes irritated, the eye is rubbed and fingers introduce bacteria. A secondary bacterial infection develops. Conjunctivitis produces a red (or pink) eye, but should never produce blurred vision. A patient with a red eye and blurred vision should be referred to ophthalmology. The pre-auricular nodes may be palpable when a patient has conjunctivitis, not the anterior cervical ones.
At what age would it be unusual to see thrush? At birth 2 months 6 months 8 months - CORRECT ANSWER At birth Explanation: Thrush is an infection in the oral cavity caused by yeast. Yeast grow in a warm, dark, moist environment. It is not unusual to see thrush in young infants who are breast or bottle fed. It would be unusual to see thrush in a newborn. In fact, this should cause concern regarding an immunocompromised state in the infant or hyperglycemia in the mother. A patient presents with severe toothache. She reports sensitivity to heat and cold. There is visible pus around the painful area. What is this termed? Pulpitis Caries Gingivitis Periodontitis - CORRECT ANSWER Pulpitis Explanation:
A patient is diagnosed with otitis externa. He complains of tragal pain, otic discharge, otic itching, and fever. What is the cardinal symptom of otitis externa? Tragal pain Otic discharge Otic itching Fever - CORRECT ANSWER Tragal pain Explanation: Otitis externa is "swimmer's ear". This is a superficial infection usually caused by Pseudomonas in the external canal. Fever, a typical systemic symptom is inconsistent with otitis externa since the infection is superficial. The other symptoms listed are typical of patients who are diagnosed with otitis externa. However, the cardinal symptom is tragal pain. A patient presents to a nurse practitioner clinic with paroxysmal sneezing, clear rhinorrhea, nasal congestion, facial pain. Which symptom below is NOT associated with allergic rhinitis? Sneezing Rhinorrhea Nasal congestion
Facial pain - CORRECT ANSWER Facial pain Explanation: Facial pain is not associated with allergic rhinitis. In conjunction with nasal congestion, it is most likely a sinus infection. Patients with allergic rhinitis and nasal congestion are more likely to develop acute and chronic bacterial sinusitis because untreated allergic rhinitis results in impaired mucus flow. This increases the risk of infection. Symptoms of bacterial sinusitis include nasal congestion, purulent post-nasal drip or rhinorrhea, facial pain and maxillary tooth pain. There is no symptom that can differentiate bacterial from viral sinusitis. An NP examines a screaming 2 year-old. A common finding is: nasal discharge. increased respiratory rate. pink tympanic membranes. coarse breath sounds. - CORRECT ANSWER pink tympanic membranes. Explanation: The tympanic membrane normally becomes pink and can rarely become red when a child is screaming or crying. This is probably due to flushing and hyperemia of the face that occurs with crying. A distorted or erythematous tympanic membrane with decreased mobility is suggestive of otitis media.
Presence of a foreign body Unresolved URI Dental caries - CORRECT ANSWER Presence of a foreign body Explanation: Two clinical clues should make the examiner suspect a foreign body. First, the patient has continued drainage despite treatment. Second, the drainage is unilateral. Unilateral drainage from a nostril should prompt the examiner to visualize the turbinates. In this case, a foreign body could probably be visualized. A 32 year-old patient is a newly diagnosed diabetic. She has developed a sinus infection. Her symptoms have persisted for 10 days. Six weeks ago she was treated with amoxicillin for an upper respiratory infection. It cleared without incident. What should be recommended today? Prescribe amoxicillin again. Prescribe amoxicillin-clavulanate today. Do not prescribe an antibiotic; a decongestant is indicated only. Prescribe a decongestant and antihistamine. - CORRECT ANSWER Prescribe amoxicillin-clavulanate today Explanation: Amoxicillin is no longer indicated for initial treatment in adults who have acute bacterial sinusitis. A bacterial cause can be assumed since she's had symptoms for 10 days. A viral infection likely would have run its course by now. After 10 days of persistent symptoms, treatment is reasonable with an antibiotic; especially since this patient is diabetic. She may be having blood sugar elevations that facilitate growth of the
causative organism of the sinus infection. A decongestant could be added depending on her blood pressure and personal history of using decongestants. AV nicking may be identified in a patient with what disease? Glaucoma Cataracts Diabetes Hypertension - CORRECT ANSWER Hypertension Explanation: Arteriovenous nicking (AV nicking), or nipping, is commonly seen in patients who have hypertension. It represents retinal microvascular changes. These are typically early changes and usually reflective of current and past blood pressures. More severe damage can be seen when flame hemorrhages or cotton wool spots are identified. These often represent current blood pressure elevations since these tend to be more acute evidence of elevated blood pressure. When examining the vessels of the eye: the veins are smaller than the arteries. the arteries are smaller than the veins. the arteries are dark red.
diabetes. An ophthalmology referral is not required at this point for AV nicking. In severe hypertension, the retina can become detached. A patient presents to clinic with a complaint of a red eye. Which assessment below rules out the most worrisome diagnoses? Usual visual acuity Normal penlight exam Normal fundoscopic exam Negative photophobia - CORRECT ANSWER Usual visual acuity Explanation: This is a test that should be done on every patient who presents with an eye complaint; especially if the eye is red. It is not necessary to determine exactly what the visual acuity is; it is necessary to establish that vision is usual. If this is the case, the most worrisome diagnoses can be ruled out: infectious keratitis, iritis, and angle closure glaucoma. Acute otitis media can be diagnosed by identifying which otic characteristic(s)? Decreased mobility of the tympanic membrane ™ Middle ear effusion and erythema of the TM Opacity and erythema of the TM
Marked redness of the TM - CORRECT ANSWER Middle ear effusion and erythema of the TM Explanation: The diagnosis of acute otitis media (AOM) requires the finding of a middle ear effusion (MEE) AND a sign of acute inflammation, such as distinct fullness or bulging of the tympanic membrane (TM), ear pain, or marked redness of the TM. MEE is characterized by the presence of middle ear fluid (bubbles or an air fluid interface) or finding of TM abnormalities (opacity, impaired mobility, or color change). The other finding that constitutes a diagnosis of AOM is the finding of acute, purulent otorrhea that is not due to otitis externa. This characterizes a ruptured TM from otitis media. A teenager with fever and pharyngitis has a negative rapid strept test. After 24 hours, the throat culture reveals "normal flora". Which conclusion can be made? The pharyngitis is not secondary to Strept. The pharyngitis is secondary to a bacterial pathogen but not Strept. The pharyngitis is of undetermined etiology The patient has mononucleosis. - CORRECT ANSWER The pharyngitis is of undetermined etiology Explanation: The patient has a preliminary culture that indicates the presence of normal flora, i.e. no finding of pathogenic organisms like beta hemolytic Strept. A final culture result generally takes longer than 24 hours to complete. It is premature to make a diagnosis at 24 hours with this culture report. The only conclusion that can be made at this time is
Which antihistamine is preferred for treating allergic rhinitis in an older adult? Diphenhydramine Chlorpheniramine Once daily, non-sedating Long-acting, sedating - CORRECT ANSWER Once daily, non-sedating Explanation: The preferred antihistamines are the long acting (once daily dosing) and non-sedating. Long-acting is favorable for older adults because of ease of dosing. Non-sedating is important for safety. The first generation antihistamines are sedating and consequently not as favorable to use in older adults. In a patient who is diagnosed with mastoiditis, which of the following is most likely? Recent history of pharyngitis Fever, cough Displaced pinna Nuchal rigidity - CORRECT ANSWER Displaced pinna Explanation: Mastoiditis is an infection of the mastoid process. The mastoid process is a honeycomb-like structure with air pockets. These become infected with Streptococcus or H. flu most commonly. It is seen in patients
(usually less than age 6 years) with chronic otitis media or less frequently in adults with chronic tooth abscesses. Patients may present with recent history of acute otitis media, history of abscess in the teeth and jaw, fever, and a displaced and erythematous pinna or postauricular area. The tympanic membrane will usually be very red and the patient can become very sick very quickly. Nuchal rigidity is the term used to describe a stiff neck associated with meningitis. A patient who presents with a complaint of sudden decreased visual acuity has a pupil that is about 4 mm, fixed. The affected eye is red. What might be the etiology? Stroke Brain tumor Glaucoma Catarac - CORRECT ANSWER Glaucoma Explanation: This patient needs urgent referral to ophthalmology. While this is a relatively unusual patient in primary care, the primary care clinician must be able to recognize this patient and the need for urgent referral. In a patient with acute angle closure glaucoma, the patient is usually ill appearing, may have nausea and vomiting. This scenario should prompt urgent referra Which of the following is most likely observed in a patient with allergic rhinitis?
The most important question to ask the patient is "what kind of reaction did you have?" Unfortunately, many patients who report penicillin allergy are not actually penicillin allergic. About 2-10% of patients who are penicillin allergic have cephalosporin allergy too. Cephalosporins should never be prescribed for penicillin allergic patients if the patient reports hives or an anaphylaxis after having taken penicillin. A patient has been diagnosed with mononucleosis. Which statement is correct? He is likely an adolescent male. Splenomegaly is more likely than not. He cannot be co-infected with Strept. Cervical lymphadenopathy may be prominent. - CORRECT ANSWER Cervical lymphadenopathy may be prominent. Explanation: Mononucleosis is a common viral infection in adolescents and early twenty year olds. Splenomegaly occurs in about 50% of patients with mononucleosis. While it is not common, it is possible to be co-infected with Streptococcus in the throat. If this is the case, treatment with penicillin should be avoided because of the possibility of an "ampicillin" rash. The most prominent symptoms are fever, fatigue, pharyngitis, and lymphadenopathy. At what age should screening for oral health begin?
At birth 3 months 6 months 1 year - CORRECT ANSWER 6 months Explanation: Examination of the mouth may begin at birth, but oral health screening should begin at 6 months of age. Part of the screening should be for the need for fluoride supplementation. Oral health risk assessment should take place at 6 months, 9 months, and referral to a dental home should take place by one year of age. Oral health risk assessment should continue periodically at health screening visits at 18, 24, and every 6 months until a dental home is established A 70 year-old male has a yellowish, triangular nodule on the side of the iris. This is probably: a stye. a chalazion. a pinguecula. subconjunctival hemorrhage. - CORRECT ANSWER a pinguecula. Explanation: Pinguecula are common as patients age. They usually appear on the nasal side first and then on the temporal side. This is a completely benign finding. A stye is also called a hordeolum. It is a tender, painful
