EENT EXAM QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED GRADED A++
Three most likely causative agents for ABRS
Streptococcus pneumoniae
Hameophilus influenzae
Moraxella catarrhalis (higher incidence in children)
Adults - Amoxicillin-clavulanate (500 mg/125 mg PO tid, or 875 mg/125 mg PO bid)
Which bacterium is the most common pathogen seen in otitis externa infections?
The most common bacteria is Pseudomonas. The second most common bacteria is
Staphylococcus aureus.
What is first line treatment for otitis externa?
Combination topical antibiotic ear drops containing a topical steroid (hydrocortisone) are
the first-line treatment for otitis externa. The topical steroid decreases inflammation and
ear pain. An example is hydrocortisone-neomycin-polymyxin B (Cortisporin). Quinolone
ear drops (e.g., ofloxacin, ciprofloxacin topical drops) are also effective.
An older man is diagnosed with conductive hearing loss in the left ear by the
nurse practitioner. Which of the following is the expected result when performing
a Rinne test on this patient?
,BC>AC
A normal result in the Rinne is air conduction (AC) greater than bone conduction (BC).
When there is a conductive hearing loss (ceruminosis, otitis media), the result will be
BC greater than AC. The reason is that the sound waves are blocked (e.g., cerumen,
fluid in middle ear). Therefore, the patient can hear the sound louder through bone
conduction.
Which structure of the eye is responsible for 20/20 vision (sharpest vision)?
Fovea of the macula - The fovea is located in the center of the macula and is
responsible for the sharpest vision ("20/20 vision") in the eyes. In the fovea, the only
receptors are the cones, which allow us to see in color and in detail. The macula is
responsible for central vision.
During a routine physical examination of a 60-year-old Black woman, the nurse
practitioner notices a triangular thickening of the bulbar conjunctiva on the
temporal side of the patient's face. It is encroaching on the cornea. The patient
denies pain and visual changes. Which of the following is most likely?
Pterygium - A pterygium is a noncancerous growth of clear, thin tissue that lies over the
sclera. One or both eyes may be involved. Risk factors are exposure to sunlight and
wind. The main symptom is a painless area of white tissue with blood vessels on the
inner or outer edge of the cornea. No specific tests are usually needed; physical exam
confirms the diagnosis. No treatment is needed unless it begins to block vision or cause
symptoms.
The cones in the retina of the eye are responsible for:
,Color vision - There are two types of photoreceptors in the human retina: rods and
cones. Cones are active at higher light levels (photopic vision), and are capable of color
vision and night vision, as well as high spatial acuity. The central fovea is populated
exclusively by cones. There are three types of cones referred to as short-wavelength
sensitive cones, middle-wavelength sensitive cones, and long-wavelength sensitive
cones€"S-cones, M-cones, and L-cones for short. Rods are responsible for vision at low
light levels (scotopic vision). They do not mediate color vision, and have a low spatial
acuity.
scotopic vision
Rod-mediated vision, which predominates in dim light.
A cauliflower-like growth with foul-smelling discharge is seen during an
otoscopic examination inside the middle ear of a new patient with a history of
chronic otitis media infection. The tympanic membrane is not visible, and the
patient reports hearing loss in the affected ear. Which of the following conditions
is most likely?
Cholesteatoma - An abnormal skin growth in the middle ear behind the eardrum is
called cholesteatoma. Repeated infections and/or a tear or pulling inward of the
eardrum can allow skin into the middle ear. Cholesteatomas often develop as cysts or
pouches that shed layers of old skin, which build up inside the middle ear. Over time,
the cholesteatoma can increase in size and destroy the surrounding delicate bones of
the middle ear, leading to hearing loss that surgery can often improve. Permanent
hearing loss, dizziness, and facial muscle paralysis are rare, but can result from
continued cholesteatoma growth.
, While performing a funduscopic exam, the nurse practitioner notices
arteriovenous (AV) nicking on the patient's retina. What causes AV nicking?
It is caused by an arteriole crossing a venule, which compresses the venule and causes
it to bulge on each side
AV nicking is one of the most common eye findings found in hypertensive retinopathy.
A 17-year-old high school student is diagnosed by the nurse practitioner with
serous otitis media of the left ear. He states that his nose is always congested
because of a dust mite allergy. His medical history includes allergic rhinitis and
asthma.
What is the expected result of the Rinne test in patients who have serous otitis
media of the left ear?
Bone conduction (BC)>air conduction (AC)
The sound is heard louder by bone conduction versus air conduction (BC > AC) in
serous otitis media and other types of conductive hearing loss. This is because when
the affected ear is filled with fluid, the tympanic membrane cannot move in response to
the sound waves due the fluid trapped inside the middle ear. Because the sound waves
are blocked, the sound is heard better by bone conduction.
A 17-year-old high school student is diagnosed by the nurse practitioner with
serous otitis media of the left ear. He states that his nose is always congested
because of a dust mite allergy. His medical history includes allergic rhinitis and
asthma.
The student reports a history of chronic nasal congestion. He occasionally has
SOLUTIONS VERIFIED GRADED A++
Three most likely causative agents for ABRS
Streptococcus pneumoniae
Hameophilus influenzae
Moraxella catarrhalis (higher incidence in children)
Adults - Amoxicillin-clavulanate (500 mg/125 mg PO tid, or 875 mg/125 mg PO bid)
Which bacterium is the most common pathogen seen in otitis externa infections?
The most common bacteria is Pseudomonas. The second most common bacteria is
Staphylococcus aureus.
What is first line treatment for otitis externa?
Combination topical antibiotic ear drops containing a topical steroid (hydrocortisone) are
the first-line treatment for otitis externa. The topical steroid decreases inflammation and
ear pain. An example is hydrocortisone-neomycin-polymyxin B (Cortisporin). Quinolone
ear drops (e.g., ofloxacin, ciprofloxacin topical drops) are also effective.
An older man is diagnosed with conductive hearing loss in the left ear by the
nurse practitioner. Which of the following is the expected result when performing
a Rinne test on this patient?
,BC>AC
A normal result in the Rinne is air conduction (AC) greater than bone conduction (BC).
When there is a conductive hearing loss (ceruminosis, otitis media), the result will be
BC greater than AC. The reason is that the sound waves are blocked (e.g., cerumen,
fluid in middle ear). Therefore, the patient can hear the sound louder through bone
conduction.
Which structure of the eye is responsible for 20/20 vision (sharpest vision)?
Fovea of the macula - The fovea is located in the center of the macula and is
responsible for the sharpest vision ("20/20 vision") in the eyes. In the fovea, the only
receptors are the cones, which allow us to see in color and in detail. The macula is
responsible for central vision.
During a routine physical examination of a 60-year-old Black woman, the nurse
practitioner notices a triangular thickening of the bulbar conjunctiva on the
temporal side of the patient's face. It is encroaching on the cornea. The patient
denies pain and visual changes. Which of the following is most likely?
Pterygium - A pterygium is a noncancerous growth of clear, thin tissue that lies over the
sclera. One or both eyes may be involved. Risk factors are exposure to sunlight and
wind. The main symptom is a painless area of white tissue with blood vessels on the
inner or outer edge of the cornea. No specific tests are usually needed; physical exam
confirms the diagnosis. No treatment is needed unless it begins to block vision or cause
symptoms.
The cones in the retina of the eye are responsible for:
,Color vision - There are two types of photoreceptors in the human retina: rods and
cones. Cones are active at higher light levels (photopic vision), and are capable of color
vision and night vision, as well as high spatial acuity. The central fovea is populated
exclusively by cones. There are three types of cones referred to as short-wavelength
sensitive cones, middle-wavelength sensitive cones, and long-wavelength sensitive
cones€"S-cones, M-cones, and L-cones for short. Rods are responsible for vision at low
light levels (scotopic vision). They do not mediate color vision, and have a low spatial
acuity.
scotopic vision
Rod-mediated vision, which predominates in dim light.
A cauliflower-like growth with foul-smelling discharge is seen during an
otoscopic examination inside the middle ear of a new patient with a history of
chronic otitis media infection. The tympanic membrane is not visible, and the
patient reports hearing loss in the affected ear. Which of the following conditions
is most likely?
Cholesteatoma - An abnormal skin growth in the middle ear behind the eardrum is
called cholesteatoma. Repeated infections and/or a tear or pulling inward of the
eardrum can allow skin into the middle ear. Cholesteatomas often develop as cysts or
pouches that shed layers of old skin, which build up inside the middle ear. Over time,
the cholesteatoma can increase in size and destroy the surrounding delicate bones of
the middle ear, leading to hearing loss that surgery can often improve. Permanent
hearing loss, dizziness, and facial muscle paralysis are rare, but can result from
continued cholesteatoma growth.
, While performing a funduscopic exam, the nurse practitioner notices
arteriovenous (AV) nicking on the patient's retina. What causes AV nicking?
It is caused by an arteriole crossing a venule, which compresses the venule and causes
it to bulge on each side
AV nicking is one of the most common eye findings found in hypertensive retinopathy.
A 17-year-old high school student is diagnosed by the nurse practitioner with
serous otitis media of the left ear. He states that his nose is always congested
because of a dust mite allergy. His medical history includes allergic rhinitis and
asthma.
What is the expected result of the Rinne test in patients who have serous otitis
media of the left ear?
Bone conduction (BC)>air conduction (AC)
The sound is heard louder by bone conduction versus air conduction (BC > AC) in
serous otitis media and other types of conductive hearing loss. This is because when
the affected ear is filled with fluid, the tympanic membrane cannot move in response to
the sound waves due the fluid trapped inside the middle ear. Because the sound waves
are blocked, the sound is heard better by bone conduction.
A 17-year-old high school student is diagnosed by the nurse practitioner with
serous otitis media of the left ear. He states that his nose is always congested
because of a dust mite allergy. His medical history includes allergic rhinitis and
asthma.
The student reports a history of chronic nasal congestion. He occasionally has
