Maryville University Nurs 621 - HEENT
Exam 1 questions with correct answers
Question 1: What will a physical exam show in a patient with allergic rhinitis?
• Correct ,,,answer,,,: Allergic shiners, hypertrophic turbinates, pale/blue
mucous membranes of the nares, cobblestone appearance to the throat,
swollen eyelids, and erythema to the conjunctiva .
Rationale: Allergic rhinitis produces characteristic physical findings. "Allergic
shiners" (dark circles under the eyes) result from chronic venous congestion. The
"cobblestone" appearance in the posterior pharynx is caused by lymphoid
hyperplasia from chronic post-nasal drip. Pale/bluish nasal mucosa (boggy
mucosa) distinguishes allergic from infectious rhinitis, which typically presents
with erythematous, swollen mucosa.
Question 2: What is the presentation of viral conjunctivitis?
• Correct ,,,answer,,,: Gritty/burning feeling, morning crusting, watery to
serous discharge during the day, unilateral at onset then bilateral within 1-2
days, URI symptoms follow (fever, pharyngitis, adenopathy) .
Rationale: Viral conjunctivitis typically begins in one eye and spreads to the other
within days. The discharge is watery or serous (not purulent), distinguishing it
from bacterial conjunctivitis which produces thick, purulent discharge. The
,presence of URI symptoms is a key differentiator from allergic or bacterial
etiologies.
Question 3: What is the treatment for allergic rhinitis?
• Correct ,,,answer,,,: Oral antihistamines, oral decongestants, nasal steroids,
and saline nasal irrigation .
Rationale: Treatment follows a stepwise approach. Nasal steroids (e.g.,
fluticasone) are first-line for moderate to persistent symptoms. Oral antihistamines
address sneezing, itching, and rhinorrhea. Decongestants provide short-term relief
of nasal congestion. Saline irrigation mechanically removes allergens and
improves mucociliary clearance.
Question 4: What is epistaxis? What are causes of nose bleeds?
• Correct ,,,answer,,,: Nose bleeds. Causes include nasal mucosa dryness,
trauma, and (rarely) HTN or coagulation disorders .
Rationale: Epistaxis is extremely common. Most arise from Kiesselbach's plexus
(anterior septum) where vessels are superficial. Dryness—from low humidity,
heating, or air conditioning—is the most common cause. Hypertension is often
overemphasized as a cause but more commonly contributes to severity rather than
initiation. Coagulation disorders should be suspected with recurrent or prolonged
bleeding.
,Question 5: What is the treatment for nose bleeds?
• Correct ,,,answer,,,: Firm pressure applied superior to the nasal cartilage,
nasal packing, cautery .
Rationale: First-line treatment is pinching the soft cartilaginous portion of the
nose (not the bony bridge) for 10-15 minutes while leaning forward. Nasal packing
(anterior with absorbable or non-absorbable material) is used for persistent
bleeding. Cautery (chemical with silver nitrate or electrical) is reserved for
visualized bleeding points after topical anesthesia.
Question 6: What do we do if a patient is drooling, has stridor, or trouble
breathing in the tripod position?
• Correct ,,,answer,,,: Do not examine these patients. Send straight to the
ER .
Rationale: These findings indicate potential upper airway obstruction—most
concerning for epiglottitis or peritonsillar abscess. The tripod position (sitting up,
leaning forward, chin thrust out) is a compensatory mechanism to maximize
airway diameter. Stridor indicates turbulent airflow through a narrowed airway.
Any manipulation (including tongue depressor use) can precipitate complete
airway obstruction.
Question 7: What are the classic symptoms of a tonsillar abscess?
• Correct ,,,answer,,,: Drooling, stridor, trouble breathing, tripod position .
, Rationale: These are airway emergency signs requiring immediate referral.
Additional findings not listed include "hot potato voice" (muffled voice), unilateral
throat pain, uvular deviation away from the affected side, and trismus (difficulty
opening mouth).
Question 8: What diagnostics would we want for a patient with
signs/symptoms of pharyngitis?
• Correct ,,,answer,,,: Rapid antigen detection testing for strep, throat culture,
CBC with differential, monospot for mono, and special culture if GC or
diphtheria are suspected .
Rationale: The Centor criteria guide testing decisions. Rapid strep testing has high
specificity but variable sensitivity; negative results in high-risk patients should be
confirmed with throat culture. CBC may show lymphocytosis (mono) or
neutrophilia (bacterial). Monospot becomes positive in 90% of mono cases by
week 2. GC and diphtheria cultures are reserved for specific risk factors or clinical
presentations.
Question 9: What are symptoms of acute Group A beta-hemolytic strep?
• Correct ,,,answer,,,: Acute onset with fever, headache, pain, swollen lymph
nodes, petechiae of the palate, erythema and exudates, and a specific throat
odor .
Rationale: GAS pharyngitis presents abruptly (unlike viral pharyngitis which
develops gradually). Palatal petechiae and scarlatiniform rash (sandpaper texture)
Exam 1 questions with correct answers
Question 1: What will a physical exam show in a patient with allergic rhinitis?
• Correct ,,,answer,,,: Allergic shiners, hypertrophic turbinates, pale/blue
mucous membranes of the nares, cobblestone appearance to the throat,
swollen eyelids, and erythema to the conjunctiva .
Rationale: Allergic rhinitis produces characteristic physical findings. "Allergic
shiners" (dark circles under the eyes) result from chronic venous congestion. The
"cobblestone" appearance in the posterior pharynx is caused by lymphoid
hyperplasia from chronic post-nasal drip. Pale/bluish nasal mucosa (boggy
mucosa) distinguishes allergic from infectious rhinitis, which typically presents
with erythematous, swollen mucosa.
Question 2: What is the presentation of viral conjunctivitis?
• Correct ,,,answer,,,: Gritty/burning feeling, morning crusting, watery to
serous discharge during the day, unilateral at onset then bilateral within 1-2
days, URI symptoms follow (fever, pharyngitis, adenopathy) .
Rationale: Viral conjunctivitis typically begins in one eye and spreads to the other
within days. The discharge is watery or serous (not purulent), distinguishing it
from bacterial conjunctivitis which produces thick, purulent discharge. The
,presence of URI symptoms is a key differentiator from allergic or bacterial
etiologies.
Question 3: What is the treatment for allergic rhinitis?
• Correct ,,,answer,,,: Oral antihistamines, oral decongestants, nasal steroids,
and saline nasal irrigation .
Rationale: Treatment follows a stepwise approach. Nasal steroids (e.g.,
fluticasone) are first-line for moderate to persistent symptoms. Oral antihistamines
address sneezing, itching, and rhinorrhea. Decongestants provide short-term relief
of nasal congestion. Saline irrigation mechanically removes allergens and
improves mucociliary clearance.
Question 4: What is epistaxis? What are causes of nose bleeds?
• Correct ,,,answer,,,: Nose bleeds. Causes include nasal mucosa dryness,
trauma, and (rarely) HTN or coagulation disorders .
Rationale: Epistaxis is extremely common. Most arise from Kiesselbach's plexus
(anterior septum) where vessels are superficial. Dryness—from low humidity,
heating, or air conditioning—is the most common cause. Hypertension is often
overemphasized as a cause but more commonly contributes to severity rather than
initiation. Coagulation disorders should be suspected with recurrent or prolonged
bleeding.
,Question 5: What is the treatment for nose bleeds?
• Correct ,,,answer,,,: Firm pressure applied superior to the nasal cartilage,
nasal packing, cautery .
Rationale: First-line treatment is pinching the soft cartilaginous portion of the
nose (not the bony bridge) for 10-15 minutes while leaning forward. Nasal packing
(anterior with absorbable or non-absorbable material) is used for persistent
bleeding. Cautery (chemical with silver nitrate or electrical) is reserved for
visualized bleeding points after topical anesthesia.
Question 6: What do we do if a patient is drooling, has stridor, or trouble
breathing in the tripod position?
• Correct ,,,answer,,,: Do not examine these patients. Send straight to the
ER .
Rationale: These findings indicate potential upper airway obstruction—most
concerning for epiglottitis or peritonsillar abscess. The tripod position (sitting up,
leaning forward, chin thrust out) is a compensatory mechanism to maximize
airway diameter. Stridor indicates turbulent airflow through a narrowed airway.
Any manipulation (including tongue depressor use) can precipitate complete
airway obstruction.
Question 7: What are the classic symptoms of a tonsillar abscess?
• Correct ,,,answer,,,: Drooling, stridor, trouble breathing, tripod position .
, Rationale: These are airway emergency signs requiring immediate referral.
Additional findings not listed include "hot potato voice" (muffled voice), unilateral
throat pain, uvular deviation away from the affected side, and trismus (difficulty
opening mouth).
Question 8: What diagnostics would we want for a patient with
signs/symptoms of pharyngitis?
• Correct ,,,answer,,,: Rapid antigen detection testing for strep, throat culture,
CBC with differential, monospot for mono, and special culture if GC or
diphtheria are suspected .
Rationale: The Centor criteria guide testing decisions. Rapid strep testing has high
specificity but variable sensitivity; negative results in high-risk patients should be
confirmed with throat culture. CBC may show lymphocytosis (mono) or
neutrophilia (bacterial). Monospot becomes positive in 90% of mono cases by
week 2. GC and diphtheria cultures are reserved for specific risk factors or clinical
presentations.
Question 9: What are symptoms of acute Group A beta-hemolytic strep?
• Correct ,,,answer,,,: Acute onset with fever, headache, pain, swollen lymph
nodes, petechiae of the palate, erythema and exudates, and a specific throat
odor .
Rationale: GAS pharyngitis presents abruptly (unlike viral pharyngitis which
develops gradually). Palatal petechiae and scarlatiniform rash (sandpaper texture)
