NP CERTIFICATION EXAM
Study Guide & Practice Questions
Based on Fitzgerald: NP Certification Examination & Practice Preparation, 4th Ed.
Chapters Covered: ENT • Endocrine • Renal • Infectious Disease
, CHAPTER 4 — EYE, EAR, NOSE & THROAT PROBLEMS
Eye, Ear, Nose & Throat (ENT) Problems
Conjunctivitis
Q1. A 19-year-old man presents with a red, irritated right eye for 48 hours with eyelids "stuck together"
on waking. Exam reveals injected palpebral and bulbar conjunctiva, reactive pupils, and purulent right
eye discharge. This presentation is most consistent with:
A. suppurative conjunctivitis.
B. viral conjunctivitis.
C. allergic conjunctivitis.
D. mechanical injury.
Answer: A. Suppurative conjunctivitis.
Purulent discharge + unilateral involvement + eyelid crusting = bacterial (suppurative) conjunctivitis. Viral
typically presents with watery discharge & URI symptoms.
Q2. A 19-year-old woman has bilaterally itchy, red eyes with tearing occurring intermittently throughout
the year, accompanied by rope-like eye discharge and clear nasal discharge. This is most consistent
with conjunctival inflammation caused by a(n):
A. bacterium.
B. virus.
C. allergen.
D. injury.
Answer: C. Allergen.
Bilateral, itchy, rope-like discharge + seasonal pattern + concurrent clear rhinorrhea = allergic conjunctivitis
(IgE-mediated).
Q3. Common causative organisms of acute suppurative conjunctivitis include all of the following
EXCEPT:
A. Staphylococcus aureus.
B. Haemophilus influenzae.
C. Streptococcus pneumoniae.
D. Pseudomonas aeruginosa.
Answer: D. Pseudomonas aeruginosa.
Pseudomonas causes otitis externa/malignant otitis externa, NOT typical community-acquired conjunctivitis.
Common bacteria: S. aureus, H. influenzae, S. pneumoniae.
Q4. Treatment options in suppurative conjunctivitis include all of the following ophthalmic preparations
EXCEPT:
A. polymyxin B plus trimethoprim.
B. levofloxacin.
C. polymyxin alone.
D. azithromycin.
Answer: C. Polymyxin alone.
Polymyxin alone lacks adequate gram-positive coverage. Effective options: FQ eye drops (gatifloxacin,
levofloxacin, moxifloxacin), polymyxin B + trimethoprim, azithromycin.
Q5. Treatment options in acute and recurrent allergic conjunctivitis include all of the following EXCEPT:
A. cromolyn ophthalmic drops.
, B. oral antihistamines.
C. ophthalmological antihistamines.
D. corticosteroid ophthalmic drops.
Answer: D. Corticosteroid ophthalmic drops.
Corticosteroid eye drops are NOT used for allergic conjunctivitis due to risk of IOP elevation, cataract, and
secondary infections. Use antihistamines/mast cell stabilizers instead.
Q6. The most common virological cause of conjunctivitis is:
A. coronavirus.
B. adenovirus.
C. rhinovirus.
D. human papillomavirus.
Answer: B. Adenovirus.
Adenovirus is the leading cause of viral conjunctivitis (pink eye). Self-limiting over 2–3 weeks. No antibiotic
needed.
Q7. Treatment of viral conjunctivitis can include:
A. moxifloxacin ophthalmic drops.
B. polymyxin B ophthalmic drops.
C. oral acyclovir.
D. no antibiotic therapy needed.
Answer: D. No antibiotic therapy needed.
Viral conjunctivitis is self-limiting. Antibiotics are NOT indicated. Comfort measures: cool artificial tears, avoiding
touching eyes.
Clinical Pearl: Suppurative conjunctivitis: purulent discharge, often unilateral, eyelid crusting. Viral:
watery discharge + URI. Allergic: bilateral, itchy, rope-like mucoid discharge, seasonal.
Ear Disorders — Otitis Externa & Otitis Media
Q8. Anterior epistaxis is usually caused by:
A. hypertension.
B. bleeding disorders.
C. localized nasal mucosa trauma.
D. a foreign body.
Answer: C. Localized nasal mucosa trauma.
Most anterior epistaxis (Kiesselbach plexus area) results from self-induced trauma (nose picking), dry air, or
mucosal irritation.
Q9. First-line intervention for anterior epistaxis is:
A. nasal packing.
B. application of topical thrombin.
C. firm pressure to the area superior to the nasal alar cartilage for at least 10 minutes.
D. chemical cauterization.
Answer: C. Firm pressure to the area superior to the nasal alar cartilage for at least 10
minutes.
Direct, sustained pressure (10–15 min uninterrupted) is the first-line treatment for anterior epistaxis. Lean
forward to avoid swallowing blood.
Q10. The most common clinical finding in patients with epistaxis is:
Study Guide & Practice Questions
Based on Fitzgerald: NP Certification Examination & Practice Preparation, 4th Ed.
Chapters Covered: ENT • Endocrine • Renal • Infectious Disease
, CHAPTER 4 — EYE, EAR, NOSE & THROAT PROBLEMS
Eye, Ear, Nose & Throat (ENT) Problems
Conjunctivitis
Q1. A 19-year-old man presents with a red, irritated right eye for 48 hours with eyelids "stuck together"
on waking. Exam reveals injected palpebral and bulbar conjunctiva, reactive pupils, and purulent right
eye discharge. This presentation is most consistent with:
A. suppurative conjunctivitis.
B. viral conjunctivitis.
C. allergic conjunctivitis.
D. mechanical injury.
Answer: A. Suppurative conjunctivitis.
Purulent discharge + unilateral involvement + eyelid crusting = bacterial (suppurative) conjunctivitis. Viral
typically presents with watery discharge & URI symptoms.
Q2. A 19-year-old woman has bilaterally itchy, red eyes with tearing occurring intermittently throughout
the year, accompanied by rope-like eye discharge and clear nasal discharge. This is most consistent
with conjunctival inflammation caused by a(n):
A. bacterium.
B. virus.
C. allergen.
D. injury.
Answer: C. Allergen.
Bilateral, itchy, rope-like discharge + seasonal pattern + concurrent clear rhinorrhea = allergic conjunctivitis
(IgE-mediated).
Q3. Common causative organisms of acute suppurative conjunctivitis include all of the following
EXCEPT:
A. Staphylococcus aureus.
B. Haemophilus influenzae.
C. Streptococcus pneumoniae.
D. Pseudomonas aeruginosa.
Answer: D. Pseudomonas aeruginosa.
Pseudomonas causes otitis externa/malignant otitis externa, NOT typical community-acquired conjunctivitis.
Common bacteria: S. aureus, H. influenzae, S. pneumoniae.
Q4. Treatment options in suppurative conjunctivitis include all of the following ophthalmic preparations
EXCEPT:
A. polymyxin B plus trimethoprim.
B. levofloxacin.
C. polymyxin alone.
D. azithromycin.
Answer: C. Polymyxin alone.
Polymyxin alone lacks adequate gram-positive coverage. Effective options: FQ eye drops (gatifloxacin,
levofloxacin, moxifloxacin), polymyxin B + trimethoprim, azithromycin.
Q5. Treatment options in acute and recurrent allergic conjunctivitis include all of the following EXCEPT:
A. cromolyn ophthalmic drops.
, B. oral antihistamines.
C. ophthalmological antihistamines.
D. corticosteroid ophthalmic drops.
Answer: D. Corticosteroid ophthalmic drops.
Corticosteroid eye drops are NOT used for allergic conjunctivitis due to risk of IOP elevation, cataract, and
secondary infections. Use antihistamines/mast cell stabilizers instead.
Q6. The most common virological cause of conjunctivitis is:
A. coronavirus.
B. adenovirus.
C. rhinovirus.
D. human papillomavirus.
Answer: B. Adenovirus.
Adenovirus is the leading cause of viral conjunctivitis (pink eye). Self-limiting over 2–3 weeks. No antibiotic
needed.
Q7. Treatment of viral conjunctivitis can include:
A. moxifloxacin ophthalmic drops.
B. polymyxin B ophthalmic drops.
C. oral acyclovir.
D. no antibiotic therapy needed.
Answer: D. No antibiotic therapy needed.
Viral conjunctivitis is self-limiting. Antibiotics are NOT indicated. Comfort measures: cool artificial tears, avoiding
touching eyes.
Clinical Pearl: Suppurative conjunctivitis: purulent discharge, often unilateral, eyelid crusting. Viral:
watery discharge + URI. Allergic: bilateral, itchy, rope-like mucoid discharge, seasonal.
Ear Disorders — Otitis Externa & Otitis Media
Q8. Anterior epistaxis is usually caused by:
A. hypertension.
B. bleeding disorders.
C. localized nasal mucosa trauma.
D. a foreign body.
Answer: C. Localized nasal mucosa trauma.
Most anterior epistaxis (Kiesselbach plexus area) results from self-induced trauma (nose picking), dry air, or
mucosal irritation.
Q9. First-line intervention for anterior epistaxis is:
A. nasal packing.
B. application of topical thrombin.
C. firm pressure to the area superior to the nasal alar cartilage for at least 10 minutes.
D. chemical cauterization.
Answer: C. Firm pressure to the area superior to the nasal alar cartilage for at least 10
minutes.
Direct, sustained pressure (10–15 min uninterrupted) is the first-line treatment for anterior epistaxis. Lean
forward to avoid swallowing blood.
Q10. The most common clinical finding in patients with epistaxis is:
