NURS 5433 -ENT&UPPER AIRWAY DISORDERS EXAM |
CHAMBERLAIN UNIVERSITY | ALL QUESTIONS AND ANSWERS
2026/2027 | VERIFIED ANSWERS PLUS RATIONALES | GRADED
Q&A COMPREHENSIVE STUDY GUIDE | VERIFIED LATEST 2027
1. A 45-year-side male presents with a three-week history of hoarseness, throat clearing,
and a sensation of a lump in his throat. He denies dysphagia, weight loss, or smoking
history. Which of the following is the most appropriate initial management step?
A. Immediate referral to an otolaryngologist for direct laryngoscopy
B. Initiation of empirical twice-daily proton pump inhibitor therapy and lifestyle
modifications
C. Ordering an immediate soft tissue neck radiograph to rule out foreign bodies
D. Prescribing a 10-day course of broad-spectrum oral antibiotics for acute laryngitis
Empirical treatment with a proton pump inhibitor combined with lifestyle changes is the
standard first-line approach for suspected laryngopharyngeal reflux (LPR) when red flag
symptoms like weight loss or dysphagia are absent.
2. A 62-year-old chronic smoker presents with a two-month history of persistent unilateral
otalgia and a palpable, fixed cervical lymph node. Otoscopic examination of the ear is
completely normal. What is the most critical next diagnostic action?
A. Prescribe ofloxacin otic drops for occult otitis externa
B. Perform a thorough fiberoptic nasopharyngolaryngoscopy to inspect mucosal surfaces
C. Irrigate the external auditory canal to remove impacted cerumen
D. Order a routine pure-tone audiogram to evaluate for sensorineural hearing loss
Referred otalgia via the vagus or glossopharyngeal nerves from a primary upper
aerodigestive tract malignancy is common; a comprehensive endoscopic examination of the
nasopharynx, pharynx, and larynx is mandatory.
3. A 28-year-old female presents with sudden onset of severe sore throat, odynophagia,
muffled "hot potato" voice, and deviation of the uvula to the right. Palpation reveals tender
ipsilateral submandibular lymphadenopathy. What is the most likely diagnosis?
A. Acute bacterial epiglottitis
,B. Peritonsillar abscess
C. Acute infectious mononucleosis
D. Ludwig's angina
A peritonsillar abscess typically presents with severe odynophagia, trismus, a muffled voice,
and contralateral deviation of the uvula due to superior and medial displacement of the
tonsil.
4. A 55-year-old male with a history of poorly controlled type 2 diabetes presents with
rapidly progressive, severe submandibular pain, fever, and a woody swelling of the floor of
the mouth with elevation of the tongue. He exhibits stridor and drooling. Which immediate
action should the clinician take?
A. Discharge home with oral amoxicillin-clavulanate and close follow-up
B. Secure the airway immediately and arrange emergency surgical consultation for Ludwig's
angina
C. Perform an in-office needle aspiration of the submandibular space
D. Order an outpatient magnetic resonance imaging scan of the neck
Ludwig's angina is a rapidly progressive, life-threatening bilateral cellulitis of the
submandibular and sublingual spaces. Airway security is the absolute top priority, followed by
emergent surgical evaluation and broad-spectrum intravenous antibiotics.
5. A 4-year-old child is brought to the emergency department with acute onset of high
fever, drooling, severe respiratory distress, and sitting in a tripod position with the neck
hyperextended. Direct inspection of the pharynx is avoided. What is the definitive imaging
finding expected on a lateral soft tissue neck radiograph?
A. Steeple sign
B. Thumbprint sign
C. Retropharyngeal soft tissue thickening
D. Foreign body radiopacity
The thumbprint sign represents an enlarged, swollen epiglottis characteristic of acute
epiglottitis, a medical emergency where attempting oral inspection can precipitate complete
airway obstruction.
,6. A 35-year-old teacher presents with chronic hoarseness that worsens by the end of the
workweek. Videostroboscopy reveals bilateral, symmetrical, small, fibrous swellings at the
junction of the anterior and middle thirds of the true vocal cords. What is the primary
management strategy?
A. Immediate surgical microlaryngoscopy excision
B. Strict voice rest followed by targeted vocal hygiene and speech therapy
C. High-dose oral systemic corticosteroid burst therapy
D. Empiric antifungal therapy for suspected laryngeal candidiasis
Vocal nodules are benign lesions resulting from chronic mechanical trauma. Primary
treatment centers on eliminating vocal abuse through speech therapy and vocal hygiene,
reserving surgery for refractory cases.
7. A 50-year-old male presents with sudden left-sided hearing loss that developed upon
waking this morning. Weber tuning fork test lateralizes to the right ear, and Rinne test is
positive bilaterally. What is the most urgent intervention?
A. Immediate referral to otolaryngology for evaluation of idiopathic sudden sensorineural
hearing loss
B. Irrigation of the left external auditory canal for cerumen impaction
C. Prescribing mechanical hearing aids for presbycusis
D. Reassurance and observation for two weeks
Idiopathic sudden sensorineural hearing loss is an otologic emergency requiring prompt
evaluation and systemic or intratympanic corticosteroid therapy within the critical
therapeutic window to maximize chances of hearing recovery.
8. A 70-year-old male complains of progressive, bilateral high-frequency sensorineural
hearing loss accompanied by difficulty understanding speech in noisy environments.
Otoscopic examination is normal. What is the most likely diagnosis?
A. Otosclerosis
B. Meniere's disease
C. Presbycusis
D. Acoustic neuroma
, Presbycusis is the age-related, progressive, symmetric loss of high-frequency hearing due to
inner ear cochlear degeneration.
9. A 42-year-old female presents with recurrent episodes of vertigo lasting 2 to 4 hours
each, accompanied by fluctuating low-frequency sensorineural hearing loss, roaring
tinnitus, and a sensation of fullness in the right ear. What is the foundational
pathophysiological mechanism?
A. Bony fixation of the stapes footplate
B. Endolymphatic hydrops within the inner ear
C. Viral inflammation of the vestibular nerve
D. Dislodged otoconia within the semicircular canals
Meniere's disease is characterized by endolymphatic hydrops, an abnormal accumulation of
endolymph fluid in the inner ear labyrinth, leading to episodic vertigo, hearing loss, and
tinnitus.
10. A 65-year-old male presents with a persistent, non-healing ulcer on the lateral border of
his tongue, firm cervical lymphadenopathy, and a 30-pack-year smoking history. What is
the most appropriate initial diagnostic procedure?
A. Punch biopsy of the lesion
B. Incisional or punch biopsy of the tongue lesion and urgent ENT referral
C. Empirical treatment with viscous lidocaine and topical steroids
D. Fine needle aspiration of the lymph node only
Squamous cell carcinoma of the oral cavity requires a definitive tissue diagnosis via biopsy
and immediate oncology/otolaryngology referral for staging and comprehensive
management.
11. A 30-year-old female presents with acute left-sided facial paralysis that developed over
24 hours, including inability to close her left eye, flattening of the forehead creases, and
drooping of the corner of the mouth. Sensation and other cranial nerves are intact. What is
the recommended first-line pharmacological treatment?
A. High-dose oral corticosteroids started within 72 hours of symptom onset
B. Intravenous acyclovir monotherapy
CHAMBERLAIN UNIVERSITY | ALL QUESTIONS AND ANSWERS
2026/2027 | VERIFIED ANSWERS PLUS RATIONALES | GRADED
Q&A COMPREHENSIVE STUDY GUIDE | VERIFIED LATEST 2027
1. A 45-year-side male presents with a three-week history of hoarseness, throat clearing,
and a sensation of a lump in his throat. He denies dysphagia, weight loss, or smoking
history. Which of the following is the most appropriate initial management step?
A. Immediate referral to an otolaryngologist for direct laryngoscopy
B. Initiation of empirical twice-daily proton pump inhibitor therapy and lifestyle
modifications
C. Ordering an immediate soft tissue neck radiograph to rule out foreign bodies
D. Prescribing a 10-day course of broad-spectrum oral antibiotics for acute laryngitis
Empirical treatment with a proton pump inhibitor combined with lifestyle changes is the
standard first-line approach for suspected laryngopharyngeal reflux (LPR) when red flag
symptoms like weight loss or dysphagia are absent.
2. A 62-year-old chronic smoker presents with a two-month history of persistent unilateral
otalgia and a palpable, fixed cervical lymph node. Otoscopic examination of the ear is
completely normal. What is the most critical next diagnostic action?
A. Prescribe ofloxacin otic drops for occult otitis externa
B. Perform a thorough fiberoptic nasopharyngolaryngoscopy to inspect mucosal surfaces
C. Irrigate the external auditory canal to remove impacted cerumen
D. Order a routine pure-tone audiogram to evaluate for sensorineural hearing loss
Referred otalgia via the vagus or glossopharyngeal nerves from a primary upper
aerodigestive tract malignancy is common; a comprehensive endoscopic examination of the
nasopharynx, pharynx, and larynx is mandatory.
3. A 28-year-old female presents with sudden onset of severe sore throat, odynophagia,
muffled "hot potato" voice, and deviation of the uvula to the right. Palpation reveals tender
ipsilateral submandibular lymphadenopathy. What is the most likely diagnosis?
A. Acute bacterial epiglottitis
,B. Peritonsillar abscess
C. Acute infectious mononucleosis
D. Ludwig's angina
A peritonsillar abscess typically presents with severe odynophagia, trismus, a muffled voice,
and contralateral deviation of the uvula due to superior and medial displacement of the
tonsil.
4. A 55-year-old male with a history of poorly controlled type 2 diabetes presents with
rapidly progressive, severe submandibular pain, fever, and a woody swelling of the floor of
the mouth with elevation of the tongue. He exhibits stridor and drooling. Which immediate
action should the clinician take?
A. Discharge home with oral amoxicillin-clavulanate and close follow-up
B. Secure the airway immediately and arrange emergency surgical consultation for Ludwig's
angina
C. Perform an in-office needle aspiration of the submandibular space
D. Order an outpatient magnetic resonance imaging scan of the neck
Ludwig's angina is a rapidly progressive, life-threatening bilateral cellulitis of the
submandibular and sublingual spaces. Airway security is the absolute top priority, followed by
emergent surgical evaluation and broad-spectrum intravenous antibiotics.
5. A 4-year-old child is brought to the emergency department with acute onset of high
fever, drooling, severe respiratory distress, and sitting in a tripod position with the neck
hyperextended. Direct inspection of the pharynx is avoided. What is the definitive imaging
finding expected on a lateral soft tissue neck radiograph?
A. Steeple sign
B. Thumbprint sign
C. Retropharyngeal soft tissue thickening
D. Foreign body radiopacity
The thumbprint sign represents an enlarged, swollen epiglottis characteristic of acute
epiglottitis, a medical emergency where attempting oral inspection can precipitate complete
airway obstruction.
,6. A 35-year-old teacher presents with chronic hoarseness that worsens by the end of the
workweek. Videostroboscopy reveals bilateral, symmetrical, small, fibrous swellings at the
junction of the anterior and middle thirds of the true vocal cords. What is the primary
management strategy?
A. Immediate surgical microlaryngoscopy excision
B. Strict voice rest followed by targeted vocal hygiene and speech therapy
C. High-dose oral systemic corticosteroid burst therapy
D. Empiric antifungal therapy for suspected laryngeal candidiasis
Vocal nodules are benign lesions resulting from chronic mechanical trauma. Primary
treatment centers on eliminating vocal abuse through speech therapy and vocal hygiene,
reserving surgery for refractory cases.
7. A 50-year-old male presents with sudden left-sided hearing loss that developed upon
waking this morning. Weber tuning fork test lateralizes to the right ear, and Rinne test is
positive bilaterally. What is the most urgent intervention?
A. Immediate referral to otolaryngology for evaluation of idiopathic sudden sensorineural
hearing loss
B. Irrigation of the left external auditory canal for cerumen impaction
C. Prescribing mechanical hearing aids for presbycusis
D. Reassurance and observation for two weeks
Idiopathic sudden sensorineural hearing loss is an otologic emergency requiring prompt
evaluation and systemic or intratympanic corticosteroid therapy within the critical
therapeutic window to maximize chances of hearing recovery.
8. A 70-year-old male complains of progressive, bilateral high-frequency sensorineural
hearing loss accompanied by difficulty understanding speech in noisy environments.
Otoscopic examination is normal. What is the most likely diagnosis?
A. Otosclerosis
B. Meniere's disease
C. Presbycusis
D. Acoustic neuroma
, Presbycusis is the age-related, progressive, symmetric loss of high-frequency hearing due to
inner ear cochlear degeneration.
9. A 42-year-old female presents with recurrent episodes of vertigo lasting 2 to 4 hours
each, accompanied by fluctuating low-frequency sensorineural hearing loss, roaring
tinnitus, and a sensation of fullness in the right ear. What is the foundational
pathophysiological mechanism?
A. Bony fixation of the stapes footplate
B. Endolymphatic hydrops within the inner ear
C. Viral inflammation of the vestibular nerve
D. Dislodged otoconia within the semicircular canals
Meniere's disease is characterized by endolymphatic hydrops, an abnormal accumulation of
endolymph fluid in the inner ear labyrinth, leading to episodic vertigo, hearing loss, and
tinnitus.
10. A 65-year-old male presents with a persistent, non-healing ulcer on the lateral border of
his tongue, firm cervical lymphadenopathy, and a 30-pack-year smoking history. What is
the most appropriate initial diagnostic procedure?
A. Punch biopsy of the lesion
B. Incisional or punch biopsy of the tongue lesion and urgent ENT referral
C. Empirical treatment with viscous lidocaine and topical steroids
D. Fine needle aspiration of the lymph node only
Squamous cell carcinoma of the oral cavity requires a definitive tissue diagnosis via biopsy
and immediate oncology/otolaryngology referral for staging and comprehensive
management.
11. A 30-year-old female presents with acute left-sided facial paralysis that developed over
24 hours, including inability to close her left eye, flattening of the forehead creases, and
drooping of the corner of the mouth. Sensation and other cranial nerves are intact. What is
the recommended first-line pharmacological treatment?
A. High-dose oral corticosteroids started within 72 hours of symptom onset
B. Intravenous acyclovir monotherapy
