NURS 5220 – HEENT Case Study: Exam-Style (University-
Level)
3case studies | 60 Questios and Answers
Patient Case:
Name: Marcus D.
Age: 42
Sex: Male
Chief Complaint: “I’ve had this ear pain and stuffiness on the left side for 5 days. It’s getting
worse.”
History of Present Illness:
Marcus reports a dull, aching pain in the left ear that began five days ago and worsened
overnight. He describes associated decreased hearing and a “full feeling” in the ear. No
discharge, but he has had mild nasal congestion. He denies sore throat, fever, or trauma. No
known allergies. He’s taken ibuprofen 400 mg with only slight relief.
Past Medical History: Seasonal allergies, mild asthma (stable), no surgeries.
Medications: Albuterol inhaler PRN, loratadine daily.
Social History: Non-smoker, occasional wine, works in tech, recently returned from a business
trip (long flight).
📸 Physical Exam:
General: Alert, in no acute distress.
Ears:
o Left TM appears erythematous, bulging, immobile with pneumatic otoscopy.
o No discharge noted.
Nose: Mild edema of turbinates, clear discharge.
Throat: No erythema or exudates.
Neck: No lymphadenopathy.
Lungs: Clear bilaterally.
🧠 Question 1: What is the most likely diagnosis?
A) Otitis externa
B) Eustachian tube dysfunction
C) ✓ Acute otitis media
D) Barotrauma-induced rupture
,Rationale: The presence of a bulging, immobile tympanic membrane is classic for acute otitis
media. Barotrauma is possible given air travel, but there's no evidence of rupture or trauma.
🧠 Question 2: Which factor in Marcus’s history most likely contributed to his
condition?
A) History of asthma
B) Use of loratadine
C) ✓ Recent air travel
D) Mild nasal congestion
Rationale: Eustachian tube dysfunction following a flight can cause pressure imbalance, leading
to fluid accumulation and infection (otitis media).
🧠 Question 3: What is the best initial management approach?
A) Start oral steroids
B) Nasal saline irrigation only
C) Refer to ENT immediately
D) ✓ Start amoxicillin 875 mg PO BID for 7–10 days
Rationale: First-line treatment for acute otitis media in adults is high-dose amoxicillin unless
contraindicated.
🧠 Question 4: Which finding on otoscopic exam supports the diagnosis?
A) Clear tympanic membrane with mobility
B) Retracted TM with visible bony landmarks
C) ✓ Bulging, erythematous TM without mobility
D) White plaques on the TM
Rationale: A bulging, red, immobile tympanic membrane is diagnostic of acute otitis media.
🧠 Question 5: Which of the following would warrant ENT referral?
A) Pain persisting for 2 days
B) Temporary hearing loss
, C) ✓ No improvement after 72 hours of antibiotics
D) History of seasonal allergies
Rationale: ENT referral is warranted if there's no improvement after 72 hours of appropriate
therapy.
🧠 Question 6: What advice should be given regarding air travel during
recovery?
A) Use antihistamines before flying
B) ✓ Avoid flying until symptoms resolve
C) Take a decongestant during flight
D) Flying is safe after 24 hours of antibiotics
Rationale: Flying with unresolved middle ear pressure can worsen symptoms or cause rupture.
🧠 Question 7: Which of the following is an expected complication if left
untreated?
A) Epistaxis
B) Sinusitis
C) ✓ Mastoiditis
D) Labyrinthitis
Rationale: A serious complication of untreated otitis media is mastoiditis, an infection of the
mastoid bone
Question 8: Which symptom would indicate that Marcus may be developing a
more severe complication such as mastoiditis?
A) Persistent ear pain only
B) ✓ Postauricular tenderness and swelling
C) Clear nasal discharge
D) Intermittent vertigo
Rationale: Mastoiditis typically presents with pain, redness, and swelling behind the ear. This is
a red flag requiring urgent ENT evaluation.
Level)
3case studies | 60 Questios and Answers
Patient Case:
Name: Marcus D.
Age: 42
Sex: Male
Chief Complaint: “I’ve had this ear pain and stuffiness on the left side for 5 days. It’s getting
worse.”
History of Present Illness:
Marcus reports a dull, aching pain in the left ear that began five days ago and worsened
overnight. He describes associated decreased hearing and a “full feeling” in the ear. No
discharge, but he has had mild nasal congestion. He denies sore throat, fever, or trauma. No
known allergies. He’s taken ibuprofen 400 mg with only slight relief.
Past Medical History: Seasonal allergies, mild asthma (stable), no surgeries.
Medications: Albuterol inhaler PRN, loratadine daily.
Social History: Non-smoker, occasional wine, works in tech, recently returned from a business
trip (long flight).
📸 Physical Exam:
General: Alert, in no acute distress.
Ears:
o Left TM appears erythematous, bulging, immobile with pneumatic otoscopy.
o No discharge noted.
Nose: Mild edema of turbinates, clear discharge.
Throat: No erythema or exudates.
Neck: No lymphadenopathy.
Lungs: Clear bilaterally.
🧠 Question 1: What is the most likely diagnosis?
A) Otitis externa
B) Eustachian tube dysfunction
C) ✓ Acute otitis media
D) Barotrauma-induced rupture
,Rationale: The presence of a bulging, immobile tympanic membrane is classic for acute otitis
media. Barotrauma is possible given air travel, but there's no evidence of rupture or trauma.
🧠 Question 2: Which factor in Marcus’s history most likely contributed to his
condition?
A) History of asthma
B) Use of loratadine
C) ✓ Recent air travel
D) Mild nasal congestion
Rationale: Eustachian tube dysfunction following a flight can cause pressure imbalance, leading
to fluid accumulation and infection (otitis media).
🧠 Question 3: What is the best initial management approach?
A) Start oral steroids
B) Nasal saline irrigation only
C) Refer to ENT immediately
D) ✓ Start amoxicillin 875 mg PO BID for 7–10 days
Rationale: First-line treatment for acute otitis media in adults is high-dose amoxicillin unless
contraindicated.
🧠 Question 4: Which finding on otoscopic exam supports the diagnosis?
A) Clear tympanic membrane with mobility
B) Retracted TM with visible bony landmarks
C) ✓ Bulging, erythematous TM without mobility
D) White plaques on the TM
Rationale: A bulging, red, immobile tympanic membrane is diagnostic of acute otitis media.
🧠 Question 5: Which of the following would warrant ENT referral?
A) Pain persisting for 2 days
B) Temporary hearing loss
, C) ✓ No improvement after 72 hours of antibiotics
D) History of seasonal allergies
Rationale: ENT referral is warranted if there's no improvement after 72 hours of appropriate
therapy.
🧠 Question 6: What advice should be given regarding air travel during
recovery?
A) Use antihistamines before flying
B) ✓ Avoid flying until symptoms resolve
C) Take a decongestant during flight
D) Flying is safe after 24 hours of antibiotics
Rationale: Flying with unresolved middle ear pressure can worsen symptoms or cause rupture.
🧠 Question 7: Which of the following is an expected complication if left
untreated?
A) Epistaxis
B) Sinusitis
C) ✓ Mastoiditis
D) Labyrinthitis
Rationale: A serious complication of untreated otitis media is mastoiditis, an infection of the
mastoid bone
Question 8: Which symptom would indicate that Marcus may be developing a
more severe complication such as mastoiditis?
A) Persistent ear pain only
B) ✓ Postauricular tenderness and swelling
C) Clear nasal discharge
D) Intermittent vertigo
Rationale: Mastoiditis typically presents with pain, redness, and swelling behind the ear. This is
a red flag requiring urgent ENT evaluation.
