1|Page
**TEST BANK** FOR **CHAPTER 21: COMMON
EAR, NOSE, AND THROAT COMPLAINTS** IN A
*PRIMARY CARE: THE ART AND SCIENCE OF
ADVANCED PRACTICE NURSING*
# Chapter 21: Common Ear, Nose, and Throat Complaints
## Test Bank
### Section 1: Otology (Ear Disorders) – Questions 1-25
**1. A 6-year-old presents with acute onset of right ear pain after an
upper respiratory infection. Otoscopy reveals a bulging, opaque,
erythematous tympanic membrane with decreased mobility on
pneumatic otoscopy. What is the most appropriate first-line treatment?**
a) Topical antibiotic drops alone
b) Observation for 48-72 hours with analgesics
c) High-dose oral amoxicillin
d) Referral for myringotomy
**Answer: c) High-dose oral amoxicillin**
,2|Page
**Rationale:** This presentation is classic for acute otitis media
(AOM). First-line treatment is high-dose amoxicillin (80-90 mg/kg/day)
for 10 days (or 5-7 days if ≥6 years). Observation is an option only in
select low-risk, older children with non-severe illness.
---
**2. A 45-year-old complains of feeling of "fullness," intermittent
popping, and mild hearing loss for 2 weeks following a flight. Otoscopy
shows a retracted tympanic membrane with visible fluid level. What is
the most likely diagnosis?**
a) Acute otitis media
b) Otitis externa
c) Otitis media with effusion (OME)
d) Cholesteatoma
**Answer: c) Otitis media with effusion (OME)**
**Rationale:** OME presents with middle ear effusion without signs of
acute infection. It often follows Eustachian tube dysfunction (e.g., after
barotrauma or URI). The tympanic membrane is retracted or has fluid
level but is not erythematous or bulging.
---
,3|Page
**3. A 70-year-old diabetic patient with a history of chronic ear itching
presents with severe left ear pain, purulent drainage, and tenderness with
manipulation of the tragus. The tympanic membrane is normal. What is
the most appropriate treatment?**
a) Oral amoxicillin-clavulanate
b) Topical ciprofloxacin/dexamethasone drops
c) Oral fluconazole
d) Dry mopping and oral cephalexin
**Answer: b) Topical ciprofloxacin/dexamethasone drops**
**Rationale:** This is acute otitis externa (swimmer's ear). Topical
antibiotic/corticosteroid drops are first-line. Oral antibiotics are reserved
for severe infection or spreading cellulitis, especially in diabetics
(malignant otitis externa must be ruled out if severe pain persists).
---
**4. Which finding on otoscopy is most suggestive of cholesteatoma?**
a) Retraction pocket with keratin debris in the pars flaccida
b) Bulging, erythematous tympanic membrane
c) Clear, watery otorrhea with transparent TM
d) Cerumen obscuring the entire ear canal
, 4|Page
**Answer: a) Retraction pocket with keratin debris in the pars
flaccida**
**Rationale:** Cholesteatoma is a keratinizing squamous epithelial cyst
typically in the attic (pars flaccida). It appears as a retraction pocket with
pearly white debris and can erode ossicles.
---
**5. A 28-year-old presents with acute hearing loss, tinnitus, and vertigo
that has been episodic over 2 months. Otoscopy is normal. What is the
next best step?**
a) Oral meclizine and follow up in 2 weeks
b) Audiometry and MRI to rule out acoustic neuroma
c) High-dose oral prednisone
d) Referral for tympanostomy tubes
**Answer: b) Audiometry and MRI to rule out acoustic neuroma**
**Rationale:** Unilateral sensorineural hearing loss with tinnitus and
vertigo warrants audiometry and MRI to rule out vestibular schwannoma
(acoustic neuroma). Ménière’s disease is also possible but must exclude
a retrocochlear lesion.
---
**TEST BANK** FOR **CHAPTER 21: COMMON
EAR, NOSE, AND THROAT COMPLAINTS** IN A
*PRIMARY CARE: THE ART AND SCIENCE OF
ADVANCED PRACTICE NURSING*
# Chapter 21: Common Ear, Nose, and Throat Complaints
## Test Bank
### Section 1: Otology (Ear Disorders) – Questions 1-25
**1. A 6-year-old presents with acute onset of right ear pain after an
upper respiratory infection. Otoscopy reveals a bulging, opaque,
erythematous tympanic membrane with decreased mobility on
pneumatic otoscopy. What is the most appropriate first-line treatment?**
a) Topical antibiotic drops alone
b) Observation for 48-72 hours with analgesics
c) High-dose oral amoxicillin
d) Referral for myringotomy
**Answer: c) High-dose oral amoxicillin**
,2|Page
**Rationale:** This presentation is classic for acute otitis media
(AOM). First-line treatment is high-dose amoxicillin (80-90 mg/kg/day)
for 10 days (or 5-7 days if ≥6 years). Observation is an option only in
select low-risk, older children with non-severe illness.
---
**2. A 45-year-old complains of feeling of "fullness," intermittent
popping, and mild hearing loss for 2 weeks following a flight. Otoscopy
shows a retracted tympanic membrane with visible fluid level. What is
the most likely diagnosis?**
a) Acute otitis media
b) Otitis externa
c) Otitis media with effusion (OME)
d) Cholesteatoma
**Answer: c) Otitis media with effusion (OME)**
**Rationale:** OME presents with middle ear effusion without signs of
acute infection. It often follows Eustachian tube dysfunction (e.g., after
barotrauma or URI). The tympanic membrane is retracted or has fluid
level but is not erythematous or bulging.
---
,3|Page
**3. A 70-year-old diabetic patient with a history of chronic ear itching
presents with severe left ear pain, purulent drainage, and tenderness with
manipulation of the tragus. The tympanic membrane is normal. What is
the most appropriate treatment?**
a) Oral amoxicillin-clavulanate
b) Topical ciprofloxacin/dexamethasone drops
c) Oral fluconazole
d) Dry mopping and oral cephalexin
**Answer: b) Topical ciprofloxacin/dexamethasone drops**
**Rationale:** This is acute otitis externa (swimmer's ear). Topical
antibiotic/corticosteroid drops are first-line. Oral antibiotics are reserved
for severe infection or spreading cellulitis, especially in diabetics
(malignant otitis externa must be ruled out if severe pain persists).
---
**4. Which finding on otoscopy is most suggestive of cholesteatoma?**
a) Retraction pocket with keratin debris in the pars flaccida
b) Bulging, erythematous tympanic membrane
c) Clear, watery otorrhea with transparent TM
d) Cerumen obscuring the entire ear canal
, 4|Page
**Answer: a) Retraction pocket with keratin debris in the pars
flaccida**
**Rationale:** Cholesteatoma is a keratinizing squamous epithelial cyst
typically in the attic (pars flaccida). It appears as a retraction pocket with
pearly white debris and can erode ossicles.
---
**5. A 28-year-old presents with acute hearing loss, tinnitus, and vertigo
that has been episodic over 2 months. Otoscopy is normal. What is the
next best step?**
a) Oral meclizine and follow up in 2 weeks
b) Audiometry and MRI to rule out acoustic neuroma
c) High-dose oral prednisone
d) Referral for tympanostomy tubes
**Answer: b) Audiometry and MRI to rule out acoustic neuroma**
**Rationale:** Unilateral sensorineural hearing loss with tinnitus and
vertigo warrants audiometry and MRI to rule out vestibular schwannoma
(acoustic neuroma). Ménière’s disease is also possible but must exclude
a retrocochlear lesion.
---
