NUR677 Final Exam Study Guide
Ears, Eyes, Nose, and Throat (EENT)
Ears
Chapter 66, “Inner Ear Disturbance”
1. A patient is suspected of having vestibular neuritis. Which finding on
physical examination is consistent with this diagnosis?
1. Facial palsy and vertigo
2. Fluctuating hearing loss and tinnitus
3. Spontaneous horizontal nystagmus
4. Vertigo with changes in head position
ANS: C
Many patients with vestibular neuritis will exhibit spontaneous
horizontal or rotary nystagmus, away from the affected ear. Facial
palsy with vertigo occurs with Ramsay Hunt syndrome, caused by
herpes zoster. Fluctuating hearing loss with tinnitus is common in
Meniere’s disease. Tinnitus may occur with vestibular neuritis but
hearing loss does not occur. Patients with benign paroxysmal positional
vertigo will exhibit vertigo associated with changes in head position.
2. A patient reports several episodes of acute vertigo, some lasting up to
an hour, associated with nausea and vomiting. What is part of the
initial diagnostic workup for this patient?
1. Audiogram
2. Auditory brainstem testing
3. Electrocochleography
4. Vestibular testing
ANS: A
An audiogram and magnetic resonance imaging (MRI) are part of basic
testing for Meniere’s disease. The other testing may be performed by an
otolaryngologist after referral.
1. Which symptoms may occur with vestibular neuritis? (Select all that apply.)
1. Disequilibrium
2. Fever
3. Hearing loss
4. Nausea and vomiting
5. Tinnitus
NUR677 Final Exam Study Guide Ears, Eyes, Nose, and Throat (EENT)
,ANS: A, D, E
Vestibular neuritis can cause severe vertigo, disequilibrium, nausea,
vomiting, and tinnitus, but not fever or hearing loss.
Chapter 175, “Dizziness and Vertigo”
1. A patient reports a recurrent sensation of spinning associated with
nausea and vomiting. Which test will the provider order to confirm a
diagnosis for this patient?
1. Electroencephalogram (ECG)
2. Holter monitoring and electrocardiogram
3. Neuroimaging with computerized tomography (CT)
4. The Hallpike-Dix positioning maneuver
ANS: D
This patient has symptoms consistent with a vestibular lesion, so the
provider will order a Hallpike-Dix positioning maneuver to evaluate
vestibular function. If seizure activity is suspected, an
electroencephalogram will be ordered. Holter monitoring and ECG are
used if patients report syncope or lightheadedness. Neuroimaging with
CT is used when patients possibly have a central lesion which would
present with difficulty balancing.
2. An older adult patient reports sensations of being off balance when
walking but does not experience dizziness. The provider will refer this
patient to which specialist for further evaluation?
A. Audiologist
B. Cardiologist
C. Neurologist
D. Otolaryngologist
ANS: C
This patient has problems of balance without dizziness, suggestive of a
central neural lesion and should be referred to a neurologist. Patients with
vertigo are likely to have vestibular dysfunction and would be referred to an
NUR677 Final Exam Study Guide Ears, Eyes, Nose, and Throat (EENT)
,otolaryngologist and possibly an audiologist if hearing is affected. Patients
with syncope or lightheadedness are more likely to have an underlying
cardiac disorder and would be referred to a cardiologist.
Eyes
Chapter 52, “Evaluation of the Eyes”
1. A provider performs an eye examination during a health maintenance
visit and notes a difference of 0.5 mm in size between the patient’s
pupils. What does this finding indicate?
1. A relative afferent pupillary defect
2. Indication of a difference in intraocular pressure
3. Likely underlying neurological abnormality
4. Probable benign, physiologic anisocoria
ANS: D
A difference in diameter of less than 1 mm is usually benign. Afferent
pupillary defects are paradoxical dilations of pupils in response to light.
This does not indicate differences in intraocular pressure. A difference
of more than 1 mm is more likely to represent an underlying
neurological abnormality.
2. A patient comes to clinic with diffuse erythema in one eye without pain
or history of trauma. The examination reveals a deep red, confluent
hemorrhage in the conjunctiva of that eye. What is the most likely
treatment for this condition?
1. Order lubricating drops or ointments.
2. Prescribe ophthalmic antibiotic drops.
3. Reassure the patient that this will resolve.
4. Refer to an ophthalmologist.
ANS: C
Most subconjunctival hemorrhage, occurring with trauma or Valsalva
maneuvers, will self-resolve and are benign. Lubricating drops are used
for chemosis. Antibiotic eye drops are not indicated. Referral is not
indicated.
NUR677 Final Exam Study Guide Ears, Eyes, Nose, and Throat (EENT)
, 1. During an eye examination, the provider notes a red-light reflex in one
eye but not the other. What is the significance of this finding?
1. Normal physiologic variant
2. Ocular disease requiring referral
3. Potential infection in the “red” eye
4. Potential vision loss in one eye
ANS: B
The red reflex should be elicited in normal eyes. Any asymmetry or
opacity suggests ocular disease, potentially retinoblastoma, and
should be evaluated immediately.
Chapter 53, “Cataracts”
1. A primary care provider may suspect cataract formation in a patient with
which finding?
1. Asymmetric red reflex
2. Corneal opacification
3. Excessive tearing
4. Injection of conjunctiva
ANS: A
An asymmetric red reflex may be a finding in a patient with cataracts.
Corneal opacification, excessive tearing, and corneal injection are not
symptoms of cataracts.
1. Which are risk factors for development of cataracts? (Select all that apply.)
1. Advancing age
2. Cholesterol
3. Conjunctivitis
4. Smoking
5. Ultraviolet light
NUR677 Final Exam Study Guide Ears, Eyes, Nose, and Throat (EENT)
Ears, Eyes, Nose, and Throat (EENT)
Ears
Chapter 66, “Inner Ear Disturbance”
1. A patient is suspected of having vestibular neuritis. Which finding on
physical examination is consistent with this diagnosis?
1. Facial palsy and vertigo
2. Fluctuating hearing loss and tinnitus
3. Spontaneous horizontal nystagmus
4. Vertigo with changes in head position
ANS: C
Many patients with vestibular neuritis will exhibit spontaneous
horizontal or rotary nystagmus, away from the affected ear. Facial
palsy with vertigo occurs with Ramsay Hunt syndrome, caused by
herpes zoster. Fluctuating hearing loss with tinnitus is common in
Meniere’s disease. Tinnitus may occur with vestibular neuritis but
hearing loss does not occur. Patients with benign paroxysmal positional
vertigo will exhibit vertigo associated with changes in head position.
2. A patient reports several episodes of acute vertigo, some lasting up to
an hour, associated with nausea and vomiting. What is part of the
initial diagnostic workup for this patient?
1. Audiogram
2. Auditory brainstem testing
3. Electrocochleography
4. Vestibular testing
ANS: A
An audiogram and magnetic resonance imaging (MRI) are part of basic
testing for Meniere’s disease. The other testing may be performed by an
otolaryngologist after referral.
1. Which symptoms may occur with vestibular neuritis? (Select all that apply.)
1. Disequilibrium
2. Fever
3. Hearing loss
4. Nausea and vomiting
5. Tinnitus
NUR677 Final Exam Study Guide Ears, Eyes, Nose, and Throat (EENT)
,ANS: A, D, E
Vestibular neuritis can cause severe vertigo, disequilibrium, nausea,
vomiting, and tinnitus, but not fever or hearing loss.
Chapter 175, “Dizziness and Vertigo”
1. A patient reports a recurrent sensation of spinning associated with
nausea and vomiting. Which test will the provider order to confirm a
diagnosis for this patient?
1. Electroencephalogram (ECG)
2. Holter monitoring and electrocardiogram
3. Neuroimaging with computerized tomography (CT)
4. The Hallpike-Dix positioning maneuver
ANS: D
This patient has symptoms consistent with a vestibular lesion, so the
provider will order a Hallpike-Dix positioning maneuver to evaluate
vestibular function. If seizure activity is suspected, an
electroencephalogram will be ordered. Holter monitoring and ECG are
used if patients report syncope or lightheadedness. Neuroimaging with
CT is used when patients possibly have a central lesion which would
present with difficulty balancing.
2. An older adult patient reports sensations of being off balance when
walking but does not experience dizziness. The provider will refer this
patient to which specialist for further evaluation?
A. Audiologist
B. Cardiologist
C. Neurologist
D. Otolaryngologist
ANS: C
This patient has problems of balance without dizziness, suggestive of a
central neural lesion and should be referred to a neurologist. Patients with
vertigo are likely to have vestibular dysfunction and would be referred to an
NUR677 Final Exam Study Guide Ears, Eyes, Nose, and Throat (EENT)
,otolaryngologist and possibly an audiologist if hearing is affected. Patients
with syncope or lightheadedness are more likely to have an underlying
cardiac disorder and would be referred to a cardiologist.
Eyes
Chapter 52, “Evaluation of the Eyes”
1. A provider performs an eye examination during a health maintenance
visit and notes a difference of 0.5 mm in size between the patient’s
pupils. What does this finding indicate?
1. A relative afferent pupillary defect
2. Indication of a difference in intraocular pressure
3. Likely underlying neurological abnormality
4. Probable benign, physiologic anisocoria
ANS: D
A difference in diameter of less than 1 mm is usually benign. Afferent
pupillary defects are paradoxical dilations of pupils in response to light.
This does not indicate differences in intraocular pressure. A difference
of more than 1 mm is more likely to represent an underlying
neurological abnormality.
2. A patient comes to clinic with diffuse erythema in one eye without pain
or history of trauma. The examination reveals a deep red, confluent
hemorrhage in the conjunctiva of that eye. What is the most likely
treatment for this condition?
1. Order lubricating drops or ointments.
2. Prescribe ophthalmic antibiotic drops.
3. Reassure the patient that this will resolve.
4. Refer to an ophthalmologist.
ANS: C
Most subconjunctival hemorrhage, occurring with trauma or Valsalva
maneuvers, will self-resolve and are benign. Lubricating drops are used
for chemosis. Antibiotic eye drops are not indicated. Referral is not
indicated.
NUR677 Final Exam Study Guide Ears, Eyes, Nose, and Throat (EENT)
, 1. During an eye examination, the provider notes a red-light reflex in one
eye but not the other. What is the significance of this finding?
1. Normal physiologic variant
2. Ocular disease requiring referral
3. Potential infection in the “red” eye
4. Potential vision loss in one eye
ANS: B
The red reflex should be elicited in normal eyes. Any asymmetry or
opacity suggests ocular disease, potentially retinoblastoma, and
should be evaluated immediately.
Chapter 53, “Cataracts”
1. A primary care provider may suspect cataract formation in a patient with
which finding?
1. Asymmetric red reflex
2. Corneal opacification
3. Excessive tearing
4. Injection of conjunctiva
ANS: A
An asymmetric red reflex may be a finding in a patient with cataracts.
Corneal opacification, excessive tearing, and corneal injection are not
symptoms of cataracts.
1. Which are risk factors for development of cataracts? (Select all that apply.)
1. Advancing age
2. Cholesterol
3. Conjunctivitis
4. Smoking
5. Ultraviolet light
NUR677 Final Exam Study Guide Ears, Eyes, Nose, and Throat (EENT)
