AGNP BOARD EXAM QUESTIONS Assessment Eye, Ear, Nose and Throat (166 Questions) 2020 - $10.49   Add to cart

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AGNP BOARD EXAM QUESTIONS Assessment Eye, Ear, Nose and Throat (166 Questions) 2020

AGNP BOARD EXAM QUESTIONS Assessment Eye, Ear, Nose and Throat (166 Questions) Question: Ophthalmoscopic examination of the fundus reveals small, rounded, slightly irregular red spots embedded in the retina. These findings are consistent with: superficial retinal hemorrhages. preretinal hemorrhages. microaneurysms. deep retinal hemorrhages. Deep retinal hemorrhages appear as small, rounded, slightly irregular red spots and are sometimes called dot or blot hemorrhages. They occur in a deeper layer of the retina than flame-shaped hemorrhages. Diabetes is a common cause. Superficial retinal hemorrhages appear as small, linear, flame-shaped, red streaks in the fundi and are seen in hypertension, papilledema, and occlusion of the retinal vein. Preretinal hemorrhages lie anteriorly between the retina and the vitreous and are typically larger than retinal hemorrhages. These hemorrhages obscure any underlying retinal vessel. Microaneurysms present as tiny, round, red spots commonly seen in and around the macular area. These are classic in diabetic retinopathy. Question: The whispered voice test allows the examiner to screen for: low frequency hearing loss. high frequency hearing loss. general hearing loss. conductive hearing loss. The whispered voice test for auditory acuity and allows the examiner to screen for general hearing loss. In the elderly who have presbycusis, high frequency hearing loss is present. Since consonants are higher frequency sounds than vowels, these sounds are often missed. Question: On examination of the tympanic membrane, a red bulging ear drum is detected. This is consistent with: acute otitis externa. chronic otitis externa. acute otitis media. a serous effusion. A red bulging tympanic membrane may be found in a patient who has acute otitis media. In acute otitis externa, the canal may be swollen, narrow, moist and pale with tenderness on touching. The ear drum is intact. In chronic otitis externa, the skin of the canal may be thickened, red, and pruritic. The ear drum is usually unaffected. With serous effusion the ear drum appears amber and there usually is no bulging of the eardrum. Question: One of the refractive errors of vision that presents with symptoms of blurriness and improved with ive lens, is known as: hyperopia. myopia. strabismus. astigmatism. Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: Miosis is a term used to describe: the shape of the pupils. constriction of the pupils. dilation of the pupils. symmetry of the pupils. Miosis refers to constriction of the pupils, mydriasis refers to dilation. Miosis is not associated with the shape or symmetry of the pupils. Question: Otosclerosis is an example of a(n): conductive hearing loss. sensorineural hearing loss. mixed hearing loss. acquired hearing loss. Otosclerosis is a hereditary disorder of the labyrinthine capsule in which abnormal bone growth occurs around the ossicles resulting in fixation of the stapes. The stapes does not vibrate which reduces sound transmission to the inner ear. This produces a conductive hearing loss. Question: Drooping of the upper eyelid is termed: an epicanthal fold. ptosis. a retracted lid. ectropion. Ptosis is a drooping of the upper eyelid and can be caused by myasthenia gravis, damage to the oculomotor nerve, or to the sympathetic nerve supply (Horner's syndrome). A weakened muscle, relaxed tissues, and the weight of herniated fat may cause senile ptosis. Ptosis can also be congenital. An epicanthal fold is a vertical fold of skin that lies over the medial canthus. A retracted lid is seen as a wide eyed stare. Ectropion is seen when the lower lid turns outward and exposes the palpebral conjunctiva. Question: When a light beam shines into one pupil causing pupillary constriction in that eye, the term used is: indirect reaction to light. consensual reaction to light. optic radiation. direct reaction to light. The pupils of both eyes respond identically to a light stimulus regardless of which eye has been stimulated. The direct response describes light entering one eye that produces constriction of the pupil of that eye. A consensual response describes constriction of the unstimulated pupil. These reactions should be compared in both eyes and if there is a difference, further investigation is warranted. Optic radiation is a term used to describe the tract that nerve impulses follow through the retina, optic nerve, and optic tract. Question: Where in the mouth would reddened areas, nodules, or ulcerations that are suspicious of malignancy be present? Mucous membranes Tongue Gums Palate Reddened areas, nodules, or ulcerations noted on the sides and undersurface of the tongue and the floor of the mouth would be suggestive of cancer. Cancer of the tongue is the second most common cancer of the mouth; the lip is number one. Question: An example of a cause of conductive hearing loss in children would be: prolonged use of tobramycin. the presence of a peanut in the ear for three weeks. congenital rubella syndrome. maternal history of Herpes infection. Conductive hearing loss is the most common type in children. It occurs when the transmission of sound through the external or middle ear is blocked. It may be temporary or permanent, unilateral or bilateral. It may also be caused by physical abnormalities present from birth, but more commonly, it begins during childhood as the result of middle ear infections, perforation of the eardrum, impacted earwax or objects present in the ear canal. The other choices are examples of sensorineural hearing losses. Question: A man with a history of long-term use of chewing tobacco presents with a mouth lesion that is suspicious for malignancy. Oral assessment findings describe: a smooth circular pustule lesion on the base of the gum. a soft, solitary papule lesion located apical to the molar. a small, shallow, sore lesion at the base of the gums. an ulcerated lesion with indurated margins on the lateral tongue. Oral malignant lesions present as ulcerated with indurated margins and are not usually circular or smooth. A dental abscess presents as a soft, solitary papule located apical to the molar. Canker sore is a small, shallow sore at the base of the gum. Question: Mydriasis is a term used to describe: the shape of the pupils. constriction of the pupils. dilation of the pupils. symmetry of the pupils. Miosis refers to constriction of the pupils, mydriasis refers to dilation. Miosis is not associated with the shape or symmetry of the pupils. Question: Ophthalmoscopic examination of the retina reveals AV tapering. This appears as if the: vein "winds" down on either side of the artery. vein is twisted on the distal side of the artery. vein crosses beneath the artery. vein stops abruptly on either side of the artery. When the arterial walls lose their transparency, changes appear in the arteriovenous crossings. Decreased transparency of the retina probably contributes to AV nicking and AV tapering. In tapering, the vein appears to taper or "wind" down either side of the artery. In AV nicking, the vein appears to stop abruptly on either side of the artery. In the normal eye, the vein appears to cross beneath the artery. With banking, the vein appears to be twisted on the distal side of the artery and forms a dark wide knuckle appearance. Question: Causes of sensorineural hearing loss include all of the following except: aging. loud noises over prolonged periods of time. perforated tympanic membrane. acoustic neuroma. A perforated tympanic membrane is an example of a cause of a conductive hearing loss. Sensorineural hearing loss involves disorders of the cochlear nerve, cochlea, and an interruption in the neuronal impulse transmission to the brain. Causes include: exposure to loud noises, inner ear infections, acoustic neuroma, aging, and congenital and/or familial disorders. Question: All of the following diseases may be associated with the appearance of a strawberry tongue except: scarlet fever. folic acid and B-12 deficiencies. rubeola. Kawasaki syndrome. There are five medical reasons for the appearance of strawberry tongue: Kawasaki disease, scarlet fever, folic acid and vitamin B-12 deficiencies, bacterial toxic shock syndrome, and a geographic tongue. Rubeola does not present with a strawberry tongue. Koplik's spots are diagnostic of rubeola and they appear as clustered white lesions on the buccal mucosa. Question: Janeway lesions of the palms and soles appear as: painful, red, raised lesions. small, nontender, erythematous nodules. hemorrhagic vesiculopustular eruptions. hemorrhagic petechiae. Janeway lesions present as small, nontender, erythematous macular or nodular lesions on the palms or soles. Osler nodules are painful, red, raised lesions on the hands and feet. Both Janeway lesions and Osler nodules are indicative of infective endocarditis. Hemorrhagic vesiculopustular eruptions can be associated with gonococcemia. Hemorrhagic petechiae are suggestive of meningococcemia. Question: Which of the following screening tests for hearing loss can detect both sensorineural and conductive hearing loss? Weber Test Rinne Test Whispered Voice Test bilateral hearing loss. The Weber hearing screening test can detect unilateral conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss). Question: Examination of the nose and paranasal sinuses reveal local tenderness, pain, fever, and rhinorrhea. These symptoms are suggestive of: chronic sinusitis of the frontal and maxillary sinuses. allergic rhinitis. upper respiratory infection. acute sinusitis of the frontal and maxillary sinuses. With examination of the nose and paranasal sinuses, the presence of local tenderness, together with symptoms such as pain, fever, and nasal discharge, suggest acute sinusitis involving the frontal or maxillary sinuses. Chronic sinusitis usually lasts longer than 3 months and presents with some of the same symptoms as acute sinusitis. This may include thick yellow or green rhinorrhea, facial pain, headaches, and dizziness. Question: The mouth of a ten-month-old infant has white patches on the mucosa that cannot be removed. These patches are consistent with: stomatitis. thrush. Koplik spots. measles. Oral thrush is a condition in which the fungus, Candida albicans, accumulates on the lining of the mouth. Oral Candida infections like thrush, are also common side effects of antibiotic therapy due to alterations of the normal bacterial flora. Thrush appears as white patches on the mucosa and does not wipe off. White patches do not appear with stomatitis or measles. Koplik spots are small, white spots with a bluish center on a reddened background that occur on the inside of the cheeks early in the course of measles. Question: In patients who have allergic rhinitis, the nasal mucosa appears: erythematous. pale. green. yellow. Rhinitis is inflammation of the nasal mucosa. Normally, the nasal mucosa appears somewhat redder than the oral mucosa. With allergic rhinitis, it appears pale, bluish, or a darker red than normal. In viral rhinitis, it tends to appear erythematous and swollen. A yellow or green color may be due to the appearance of exudate in the nasal cavity. Question: Assessment of a 4 year-olds visual acuity resulted in 20/30 in the left eye and 20/40 in the right eye using the Snellen eye chart. This means: his vision is normal for his age. his vision is abnormal and further testing is warranted. the patient may not be able to read so he should be tested with the picture or "E" eye charts. he has astigmatism. Expected visual acuity in a 4 year old is 20/40. At age 5 years, it is expected to be 20/30. By age 6 years, vision should be 20/20 bilaterally. Question: Round or oval shaped lesions surrounded by erythematous mucosa and noted on an area of the oral mucosa may be: leukoplakia. aphthous ulcers. Koplik's spots. ulcerative gingivitis. Aphthous ulcers can appear anywhere on the buccal mucosa or tongue. They usually appear as round or oval ulcers, can be white or yellowish gray in color, and are surrounded by a halo of reddened mucosa. They are usually painful. Leukoplakia presents as thickened white patches anywhere on the oral mucosa. Koplik's spots appear in the early stages of measles (rubeola). They appear as small white specks that resemble grains of salt on a red background on the buccal mucosa. They are not usually painful. Ulcerative gingivitis is a painful form of gingivitis that is characterized by the development of ulcers in the interdental papillae. If untreated they can become necrotizing along the gum margins and appear as erythematous ulcers. Question: A deviated trachea could be caused by all of the following except: pneumothorax. pneumonectomy. pneumonia. atelectasis. Tracheal deviation results from unequal intrathoracic pressure within the chest cavity. When the deviation occurs, the trachea will follow the direction of less pressure. Tracheal deviation can be caused by pneumothorax, atelectasis, pleural effusion, some cancers within the pleural cavity, and pleural fibrosis. Pneumonia is not associated with tracheal deviation. Question: When examining the conjunctiva and sclera, have the patient look upward and then: cover one eye while visualizing the sclera and conjunctiva of the uncovered eye. depress both lower lids with your thumbs, exposing the sclera and conjunctiva. look for excessive tearing or dryness in the conjunctiva sac. note the position of the lids in relation to the eyeballs and color of the sclera. When examining the conjunctiva and the sclera, the best way to expose these structures is to have the patient look upward and depress both lower lids with your thumbs. Covering one eye while visualizing the other eyes checks for visual acuity. Observing for excessive tearing or dryness assesses the lacrimal apparatus. Checking the position of the lids may identify variations and abnormalities in the eyelids. Question: A sixty-year-old complains of a progressive bilateral hearing loss over the past four months. He has difficulty understanding spoken words and has become sensitive to loud noises. These symptoms are consistent with: otosclerosis. mastoiditis. presbycusis. Meniere's disease. Presbycusis is the most common hearing problem in people over 50 years of age. Presbycusis is an ongoing loss of hearing linked to changes in the inner ear. Patients have a hard time hearing what others are saying or may become sensitive to loud noises. Hearing loss is usually bilateral. Mastoiditis is an infection of the mastoid process (temporal bone adjacent to the middle ear) and generally results from inadequately treated otitis media. Otosclerosis is a sensorineural hearing loss because of reduced sound transmission to the middle ear. Meniere's disease is a disorder of the middle ear due to impaired absorption of endo endolymph. Question: In order to visualize the opening of Stensen's duct, examine the: dorsal surface of the tongue. area beneath the mandible at the angle of the jaw. buccal mucosa opposite the second molar. small openings along the sublingual fold under the tongue. The largest salivary gland is the parotid gland and it lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. Its duct, Stensen's duct, runs forward to an opening on the buccal mucosa opposite the second molar. If blood comes out through Stensen's duct when it is palpated, this could suggest parotid cancer. If pus is expelled, it suggests suppurative parotitis. With mumps, the orifice of the Stensen duct appears erythematous and enlarged. The submandibular gland is the size of a walnut. It lies beneath the mandible at the angle of the jaw. Wharton's duct runs up and forward to the floor of the mouth and opens at either side of the frenulum. The smallest, the almond-shaped sublingual gland, lies within the floor of the mouth under the tongue. It has many small openings along the sublingual fold under the tongue. Question: A condition that involves optic nerve damage and visual field changes is termed: retinoblastoma. cataracts. glaucoma. pterygium. Glaucoma is a leading cause of blindness in the United States. Glaucoma is a condition that produces optic nerve damage and visual field changes. The risk of glaucoma increases with age but can occur in anyone in any age-group. Retinoblastoma is a rapidly developing tumor and is the most common malignant tumor of the eye in children. A cataract is an opacity of the lens and may be seen through the pupil. Pterygium is a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea and may interfere with vision but does not cause blindness. Question: Sudden bilateral and painless visual loss is rare but can be associated with all the following except: cholinergics. anticholinergics. steroids. chemical exposure. Certain medications are associated with sudden bilateral, painless visual loss. These medication classes include cholinergic, anticholinergics, and steroids. Exposure to chemicals or radiation could result in bilateral painful visual loss. Question: When examining pupillary equality, the left pupil is slightly greater than the right pupil. This condition is termed: miosis. anisocoria. mydriasis. conjugate. Anisocoria is a condition characterized by an unequal size of the eye's pupils by a difference of 0.4 mm or between the eye's pupils. Miosis refers to constriction of the eye while mydriasis refers to dilation. Conjugate is used to describe symmetrical eye gaze. Question: Redness, bleeding, pain, and swelling of the gums is most likely: stomatitis. gingivitis. leukoplakia. aphthous ulcers. Swelling, pain, erythema, and bleeding of the gums are symptoms of gingivitis. Stomatitis refers to inflammation of the mouth. Leukoplakia presents as thickened white patches anywhere in the oral mucosa. Aphthous ulcers can appear anywhere on the buccal mucosa or tongue. They usually appear as round or oval ulcers, can be white or yellowish gray in color, and surrounded by a halo of reddened mucosa Question: A condition of the sclera that appears as localized ocular inflammation of the episcleral vessels is most likely: scleroderma. episcleritis. conjunctivitis. pinguecula. A condition of the sclera when the vessels appear movable over the scleral surface is termed episcleritis. The appearance may be nodular or show only redness and dilated vessels. This condition can be seen in rheumatoid arthritis, Sjo¨gren’s syndrome, and herpes zoster. Scleroderma is a condition characterized by thickened, hardened skin. It may be accompanied by multisystem involvement. Conjunctivitis is an inflammation of the conjunctiva and findings include red, burning, and itchy eyes. Pinguecula refers to a harmless yellowish triangular nodule noted in the bulbar conjunctiva on either side of the iris and may be seen in aging. Question: When a 512 Hz tuning fork is placed over the mastoid bone and then held next to the ear canal with recordings of how long sound was heard in each ear, this is known as the: absolute bone conduction test. pure tone audiometry test. Weber test. Rinne test. The Rinne test is used to assess the air conduction (AC) and bone conduction (BC) of sound in each ear. Bone conduction uses the skull bone to transmit sound to the cochlea via vibration, bypassing the external and middle ear. To test for this the vibrating tuning fork is held over the mastoid bone until the patient signals the loss of sound. The turning fork is then moved near (but not touching) the ear until the patient indicates they cease to hear sound. This is assessing air conduction which is the transmission of sound to the cochlea via external air and middle ear. Normally, the duration of time a patient hears sound is greater in air conduction than bone conduction and is reported as AC > BC. Question: A patient complains of seeing specks that obscure his line of vision when he looks in a certain direction. This impairment could be caused by: vitreous floaters. retinal detachment. macular degeneration. scotomas. With fixed defects, or scotomas, lesions appear in the retina or visual pathways of a certain area of the field of vision. Moving specks or strands suggest vitreous floaters causing the specks to be seen throughout the visual fields. Flashing lights or new vitreous floaters suggest detachment of vitreous from retina. With macular degeneration, there is a loss of vision in the central visual fields while peripheral vision remains intact. Question: Current indications for tympanostomy tube placement include all of the following except which one? Persistent serous otitis media (SOM) that has not responded to a 3 to 6-week course of medical treatment Recurrent acute otitis media (AOM) that does not respond to, or recurs after, antimicrobial prophylaxis Complications of acute otitis media (AOM) Complications of eustachian tube dysfunction Current indications for tympanostomy tube placement are (1) persistent serous otitis media (SOM) that has not responded to a 6 to 12-week course of medical treatment. This includes full and prophylactic doses of antimicrobials (and corticosteroids, as indicated); (2) recurrent acute otitis media (AOM) (at least three episodes in 6 months or four episodes in 12 months) that does not respond to, or recurs after, antimicrobial prophylaxis; (3) complications of AOM such as meningitis, facial nerve paralysis, coalescent mastoiditis, or brain abscess; and (4) complications of eustachian tube dysfunction such as tympanic membrane retraction with hearing loss, ossicular erosion, and/or retraction pocket formation. Question: On examination of the pupils, both are round but the right pupil appears larger than the left and reacts much slower to light. This condition may be indicative of: a tonic pupil. oculomotor nerve (CN III) paralysis. Horner's syndrome. Argyll Robertson pupils. When the pupil is large, regular, and usually unilateral and the reaction to light is severely reduced and slowed, or even absent, this condition is referred to as a tonic pupil or Adele's pupil. Paralysis of the oculomotor cranial nerve (CN III), the dilated pupil is fixed to light and near accommodation. Ptosis and lateral deviation of the eye are usually present. In Horner's syndrome, the affected pupil reacts briskly to light and near effort but the pupil is small. The pupils in Argyll Robertson condition appear small and irregular shaped and accommodate but do not react to light. Question: Findings following assessment of a person's gaze include the inability of the left eye to look down when turned inward. This condition is most consistent with: a conjugate gaze. left cranial nerve III (oculomotor) paralysis left cranial nerve IV (trochlear) paralysis. cranial nerve VI (abducens) paralysis. The left eye is unable to look down when turned inward in a left cranial nerve IV paralysis. In conjugate or normal gaze, the normal movement of the two eyes appears simultaneously in the same direction to bring something into view. With a left cranial nerve III paralysis, upward, downward, or inward movements are impaired. With a left cranial nerve VI paralysis, a person's gaze would include eyes conjugate when looking to the right, esotropia (one or both eyes turn inward) appears in the left eye when looking straight ahead, and esotropia is maximum in the left eye when looking to the left. Question: The acronym for pupils that are equal, round, react to light and accommodate is: PERLA. PERRLAA. PERRTLA. PERRLA. The eyes are assessed for equality in size, shape, reaction to light, and the ability to accommodate. When they appear normal, it is documented as PERRLA. Pupils equal, round, react to light and accommodate. Question: On otoscopic examination, the cone of light can be visualized: at the 1 o'clock to 2 o'clock position of the left tympanic membrane. at the 4 o'clock to 5 o'clock position of the left tympanic membrane. at the 7 o'clock to 8 o'clock position of left tympanic membrane. at the 12 o'clock position of the left ear tympanic membrane. On otoscopic examination, the cone of light also known as the light reflex, can be visualized at the 7 o'clock to 8 o'clock position of the left tympanic membrane. The cone of light can be visualized at the 4 o'clock to 5 o'clock position of the right tympanic membrane. Question: The function of the auditory ossicles is to: transmit the light reflex to the light cone. transform sound vibrations into mechanical waves for the inner ear. to capture sound waves from the external ear for transmission into the middle ear. to separate the inner ear from the middle ear. The function of the auditory ossicles is to transform sound vibrations into mechanical waves for the inner ear. Question: On the outer ear, anterior and parallel to the helix, is a curved prominence known as the: Antihelix Helix Auricle Tragus The antihelix is a curved prominence that is parallel and anterior to the helix and is part of the auricle. The external ear consists of the auricle and ear canal. The auricle is made of cartilage covered by skin and has a firm elastic consistency. The auricle has a prominent curved outer ridge known as the helix. The ear canal opens behind a nodular protuberance that points backward over the entrance to the canal. This is called the tragus. Question: A patient was diagnosed as nearsighted. The term for this condition is: hyperopia. myopia. strabismus. astigmatism. Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: The sphenoidal sinuses: are located between the eyes. surround the nasal cavity. are located above the eyes. are located behind the ethmoidal sinuses. The paranasal sinuses include the maxillary, frontal, ethmoidal, and sphenoidal sinuses. The sphenoidal sinuses lie just behind the ethmoidal sinuses. The maxillary sinuses are located around the nasal cavity. The ethmoidal sinuses are between the eyes and the frontal sinuses are located above the eyes. Question: Fordyce spots or granules are considered: contagious lesions of the lip. normal sebaceous glands of the buccal mucosa. a precursor to cancer. benign lesions of the tongue. Fordyce spots or granules appear as yellow spots in the buccal mucosa or on the lips. They are considered normal sebaceous glands. Question: The gradual loss of vision with a change in color and size of the optic disc is referred to as: macular degeneration. glaucoma. cataracts. retinoblastoma With glaucoma, there is a change in the color and size of the optic disc resulting in a gradual loss of vision. With macular degeneration, there is a loss of vision in the central visual fields because of damage to the retina. Peripheral vision remains intact. Cataracts usually appear as a cloudiness or opacity in the lens. Retinoblastoma is a rapidly developing cancer of the retina and an absent red reflex is noted on ophthalmoscopic exam. Question: The nasolacrimal duct drains into the: inferior meatus. middle meatus. superior meatus. vestibule. The nasolacrimal duct drains into the inferior meatus of the nose. Question: Examination of the eye reveals a painful, erythematous, and tender area around the nose and lower eyelid. This condition is most likely: conjunctivitis. an obstructed nasolacrimal duct. dacryocystitis. pinguecula. Dacryocystitis is an inflammation of the lacrimal sac, the area between the lower eyelid and the nose. Dacryocystitis presents as a painful, red, and tender area around the eye especially near the nose and the lower eyelid. Conjunctivitis is an inflammation of the conjunctiva and findings include red, burning, and itchy eyes. An obstructed nasolacrimal duct would present with a mucopurulent discharge from the puncta of the eye. Pinguecula refers to a harmless yellowish triangular nodule noted in the bulbar conjunctiva on either side of the iris and may be seen in aging. Question: During the newborn’s physical assessment of the mouth, the soft and hard palates are palpated to detect: a tight frenulum. an opening in the palates. thrush. the presence of a tracheoesophageal fistula. The presence of a cleft palate, or an opening in the hard or soft palates, would need immediate interventions as the child could aspirate with the first feeding. Thrush can be detected by observation and appears as white patches in the mouth. A tight or shortened frenulum would be denoted by observation. A tracheoesophageal fistula is associated with choking, increased salivation, coughing, cyanosis and vomiting when feeding. This is a medical emergency. Question: That portion of the ear that consists of the auricle and ear canal is the: antihelix. helix. tragus. external ear. The external ear consists of the auricle and ear canal. The auricle is made of cartilage covered by skin and has a firm, elastic consistency. The auricle has a prominent curved outer ridge known as the helix. The antihelix is a curved prominence that is parallel and anterior to the helix. The auditory canal opens behind a nodular protuberance that points backward over the entrance to the canal, known as the tragus. Question: Which of the following findings in a preschooler would indicate the need for further evaluation? Intelligible speech by 24 months of age Variation in quality of speech pattern and tone Responds to facial expressions and gestures rather than to verbal explanations Looks at people when they speak A child who responds to facial expressions and gestures rather than to verbal explanations is probably expressions rather than verbal clues. These children may have a hearing deficit that needs further evaluation. The other choices are normal behaviors for the preschooler. Question: A 45-year-old patient complains of vertigo, tinnitus and pressure in the right ear. These symptoms are consistent with: Meniere's disease. cluster headaches. benign positional vertigo. vestibular neuronitis. Meniere's Disease begins with a episodic vertigo and a feeling of fullness or pressure in the affected ear along with fluctuating tinnitus. Dizziness associated with benign positional vertigo typically occurs when the patient rolls over onto the affected side or with tilting the head upward. Nausea and vomiting may be present. Cluster headaches are usually one sided and the patient often has a runny nose with reddening and tearing of the nose without mention of dizziness. In vestibular neuronitis, the dizziness is sudden followed by nausea and vomiting without tinnitus. Question: A patient was diagnosed as being farsighted. The term for this condition is: hyperopia. myopia. strabismus. astigmatism. Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: A 60-year-old was concerned about a yellowish colored lesion above her right eyelid. Findings revealed a slightly raised yellowish, well circumscribed plaque along the nasal area of her right eyelid. This finding is most consistent with: a pinguecula. a chalazion. episcleritis. xanthelasma. Slightly raised, yellowish, well-circumscribed plaques appearing along the nasal area of one or both eyelids are consistent with lipid disorders and called xanthelasma. Pinguecula refer to harmless, yellowish, triangular nodules in the bulbar conjunctiva on either side of the iris. A chalazion is a nontender nodule usually on the underside of the eyelid. Episcleritis is an ocular inflammation of the episcleral vessels. Question: The lacrimal puncta are located: in the lower conjunctival sac. in the lateral canthus of the upper eyelid. at the junction of the cornea and sclera. along the margin of the upper and lower eyelids. The lacrimal puncta are located in each eye along the upper and lower rim of the eyelids. These openings collect tears and send fluid through the nasolacrimal duct and to the inner nose. Question: The patient complains of seeing floating spots. This is consistent with: macular degeneration. a detached retina. glaucoma. cataracts. A detached retina is the separation of the sensory layer of the retina from the choroid layer. Initially, the patient is aware of the presence of floaters or floating spots, and/or flashing lights. Macular degeneration is the degeneration of the macular area of the retina with a loss of central vision and intact peripheral vision. In patients who have glaucoma, there is damage to the optic nerve and a loss of peripheral vision, the appearance of halos around lights, and difficulty focusing on near objects. Question: A cyclist sustained an avulsion of the upper central incisor. If he is unable to position the tooth in the socket until he is able to be seen by a dentist, he should: transport the tooth in a cup of lukewarm tap water. place the tooth between the molars and the inside of the cheek. rinse the tooth and transport it in a clean dry cloth. not rinse the tooth but transport it in a clean dry cloth. An avulsion is defined as a tooth that is completely displaced out of its socket. On clinical exam the socket is found empty or filled with a coagulum. The goal is to save the tooth but depends on what is done initially when the tooth becomes displaced. The tooth can be transported in the mouth, keeping it between the molars and the inside of the cheek. If the patient is very young, he/she could swallow the tooth; therefore, it is advisable to get the patient to spit in a container and place the tooth in it. Tap water is avoided because the hypotonic environment causes rapid cell lysis and increased inflammation on reimplantation. Saliva, saline, milk, and culture medias are physiologic medias for storing the tooth until it can be reimplanted. Question: Surgical perforation of the tympanic membrane to allow drainage of middle ear secretions is termed: otosclerosis. a myringotomy. a tympanocentesis. a tympanoplasty. A myringotomy is the surgical perforation of the tympanic membrane to allow drainage of middle ear secretions and to relieve pain and pressure from a bulging ear drum. Otosclerosis is an abnormal bone growth that occurs around the ossicles. A tympanocentesis is a procedure where a fine needle is inserted into the tympanic membrane to relieve pressure, pain, and to drain secretions, or to obtain a culture of the fluid. A tympanoplasty is a surgical reconstruction of the ossicles and tympanic membrane to help restore hearing. Question: On ophthalmoscopic examination, optic atrophy appears: pink and hyperemic. yellowish orange to creamy pink. pale. white. In optic atrophy, there is death of the optic nerve fibers. This leads to loss of the tiny disc vessels giving a white appearance. A pink and hyperemic disc is seen in patients with papilledema. The normal disc appears yellowish-orange to creamy pink and the disc vessels are tiny with disc margins that appear sharp. A pale disc with a backward depression is characteristic of glaucomatous cupping. Question: The usual position of the trachea is located: to the left of the anterior neck and slightly above the jugular notch of the manubrium. in the middle of the anterior neck behind the jugular notch of the manubrium. to the right of the anterior neck and slightly above the jugular notch of the manubrium. in the middle of the anterior neck extending posteriorly to the sternum. The usual position of the trachea is located in the middle of the anterior neck behind the jugular notch of the manubrium. Question: A patient is able to read a magazine without difficulty but cannot distinguish distant objects. This describes: hyperopia. myopia. strabismus. astigmatism. Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: Eversion of the upper eyelid can be performed by placing the cotton applicator on the upper lid above the level of the internal tarsal plates and then: gently push up with the stick and the lid will flip. gently push down with the stick and lift the lashes up and flip the lid inside out. gently place the thumbs on the lower lids and pull down to fully open the eye. gently rest the thumb and fingers on the cheek and brow, respectively, and spread the lids. This maneuver is not part of the normal examination, but it is useful when inspecting the conjunctiva of the upper lid when a patient presents with eye pain or suspicion of a foreign body. To perform this, ask the person to keep both eyes open and look down. This relaxes the eyelid, whereas closing it would tense the orbicularis muscle. Slide the upper lid up along the bony orbit to lift up the eyelashes. Grasp the lashes between the thumb and forefinger and gently pull down and outward. With the other hand, place the tip of an applicator stick on the upper lid above the level of the internal tarsal plates and gently push down with the stick while lifting the lashes up. This uses the edge of the tarsal plate as a fulcrum and flips the lid inside out. The other maneuvers are used to visualize the eyes but not the under surface of the upper lid. Question: When inspecting the neck for the thyroid gland, slightly tilt the patient's head back, and using tangential lighting directed downward from the tip of the patient's chin, inspect the: region above the thyroid cartilage. region below the cricoid cartilage. area along the sternomastoid border. area along the anterior edge of the trapezius. When inspecting the neck for the thyroid gland, slightly tilt the patient's head back and using tangential lighting (light coming in from the side at a right angle) directed downward from the tip of the patient's chin, inspect the region below the cricoid cartilage; located between the thyroid cartilage and the thyroid gland. The area of sternomastoid border allows palpation of the superficial cervical nodes. The posterior cervical lymph nodes are located at the anterior edge of the trapezius. Question: The conductive and sensorineural phases are necessary for hearing to take place. The conductive phase of hearing involves the: cochlea and the cochlear nerve. external auditory canal and the middle ear. ossicles and the inner ear. transfer of sounds from the external environment into the external auditory canal. Sound traveling from the external ear through the middle ear is considered the first part of the hearing pathway. This is known as the conductive phase. The second part of the pathway is the sensorineural phase and this involves the cochlea and the cochlear nerve. Question: On ophthalmoscopic examination, glaucomatous cupping appears: pink and hyperemic. yellowish orange to creamy pink. pale. white. A pale disc with a backward depression is characteristic of glaucomatous cupping. A pink and hyperemic disc is seen in patients with papilledema. The normal disc appears yellowish-orange to creamy pink and the disc vessels are tiny with disc margins that appear sharp. In optic atrophy, there is death of the optic nerve fibers and this leads to loss of the tiny disc vessels giving a white appearance. Question: When the corneal reflex is stimulated by shining the light in the right eye, the right eye blinks. The left eye: does not blink. blinks. turns inward. turns outward. The corneal reflex is the blink reflex and is an involuntary blinking of the eyelids. When the corneal reflex is stimulated, stimulation should elicit both a direct and consensual response of the opposite eye. Question: An inward turning of the lower lid margin is called: an epicanthal fold. entropion. a retracted lid. ptosis. Entropion is more common in the elderly and occurs when the lower lid margin turns inward. When this irritates the conjunctiva and the lower cornea. Ectropion occurs when the lower lid turns outward and exposes the palpebral conjunctiva. Ptosis is a drooping of the upper eyelid. An epicanthal fold is a vertical fold of skin that lies over the medial canthus of the eye. Question: Which of the paranasal sinuses are accessible to clinical examination? Ethmoidal sinuses Sphenoidal sinuses Frontal sinuses. Vestibular sinuses There are four paranasal sinuses: frontal, ethmoidal, sphenoidal, and maxillary. Only the maxillary and frontal sinuses are readily accessible to clinical examination. There is not a vestibule sinus cavity. The vestibule is that widened area of the nares where air travels en route to the nasopharynx. Question: If a patient has a history of heat intolerance with a preference to light clothing, this behavior could be consistent with: hypothyroidism. hyperthyroidism. Hashimoto's thyroiditis. myxedema. Patients with hyperthyroidism experience heat intolerance. Grave's disease and thyrotoxicosis are types of hyperthyroidism. In these cases, there is increased metabolism. Hypothyroidism presents with hypofunction of the thyroid gland and all body functions are slowed. Patients usually gain weight. Those with hypothyroidism have an intolerance to cold. Hashimoto's thyroiditis, and myxedema are conditions seen in patients who have hypothyroidism. Question: When examining the eyes, the right pupil reacts briskly to light, near effort, and is much smaller than the left pupil. This condition is mostly likely: a tonic (Adele's pupil) pupil. an oculomotor nerve (CN III) paralysis. Horner's syndrome. Argyll Robertson pupils. When the pupil is large, regular, and the reaction to light is severely reduced, absent, or slowed, this condition is referred to as a tonic pupil or Adele's pupil. Paralysis of the oculomotor cranial nerve (CN III), the dilated pupil is fixed to light and near accommodation. Ptosis and lateral deviation of the eye are usually present. In Horner's syndrome, the affected pupil reacts briskly to light and near effort, but the pupil is small. The pupils in Argyll Robertson condition appear small and irregular shaped and accommodate but do not react to light. Question: The most common cause of bacterial pharyngeal infections in children is: Corynebacterium. Chlamydia. mononucleosis. group A beta-hemolytic Streptococcus. Pharyngitis is caused by swelling between the tonsils and the larynx. Most sore throats are caused by colds, the flu, Coxsackie virus or mononucleosis. Bacteria that cause pharyngitis include group A beta-hemolytic Streptococcus, and less commonly, Corynebacterium, gonorrhea, and Chlamydia can cause sore throat. Question: One of the main differences between a migraine headache and a tension headache is that: migraine headaches have a rapid onset whereas, tension headaches appear gradually. nausea is usually absent with migraine headaches and present with tension headaches. migraine headaches are usually constant and do not throb; tension headaches usually throb. migraine headaches are generally bilateral and tension headaches are unilateral. Migraine headaches present with a sudden, rapid onset and accompanying symptoms that include nausea and vomiting. 70% of migraine headaches are unilateral and are throbbing or achy and vary in severity. Tension headaches have a gradual onset and usually do not present with nausea. They are usually bilateral and are steady and do not throb. Question: Ophthalmoscopic examination of the fundus reveals blood anterior to the retina and obscuring retinal vessels. These findings are consistent with: superficial retinal hemorrhages. preretinal hemorrhages. microaneurysms. deep retinal hemorrhages. Deep retinal hemorrhages appear as small, rounded, slightly irregular red spots and are sometimes called dot or blot hemorrhages. They occur in a deeper layer of the retina than flame-shaped hemorrhages. Diabetes is a common cause. Preretinal hemorrhages lie anteriorly between the retina and the vitreous and are typically larger than retinal hemorrhages. These hemorrhages obscure any underlying retinal vessel. Superficial retinal hemorrhages appear as small, linear, flame-shaped, red streaks in the fundus and are seen in hypertension, papilledema, and occlusion of the retinal vein. Microaneurysms present as tiny, round, red spots commonly seen in and around the macular area. These are classic in diabetic retinopathy. Question: The most common disorder of visual acuity in children is: hyperopia. myopia. strabismus. astigmatism. Myopia, nearsightedness, is the most common disorder of visual acuity in children. Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: A teenage complains of itching and burning of his eye. Examination reveals an erythematous eyelid margin with crusting and a clear mucus discharge. These findings are consistent with: conjunctivitis. a chalazion. a corneal ulcer. blepharitis. Blepharitis is an inflammation of eyelid margin, glands, and lash follicles. It presents with red-rimmed eyes, irritation, burning, itching of the eyelid margins, and a mucous discharge with crusting and scaling of lid margins. Conjunctivitis is inflammation of the conjunctiva. It presents with erythematous conjunctiva and frequent discharge A chalazion is a granulomatous eyelid cyst or nodule. A corneal ulcer of a local necrosis of the cornea caused by infection, trauma, or misuse of contact lens. Neither of these present with the symptoms described above. Question: What visual acuity constitutes legal blindness? Visual acuity of 20/80 or worse bilaterally. Visual acuity of 20/200 or worse in the better eye with ed lens. Visual acuity of 20/200 in the better eye without ed lens. Visual acuity of 20/100 with ed lens. A person is usually considered legally blind when visual acuity in the better eye, ed by lens, is 20/200 or worse. One is also considered legally blind if visual acuity is 20 degrees or less in the better eye and the vision is constricted. They are said to have "tunnel" vision in this case. Question: Examples of sudden, painful, unilateral visual loss include all the following except: retinal detachment. corneal ulcer. traumatic hyphema. acute glaucoma. If a patient reports sudden unilateral visual loss that is painless, vitreous hemorrhage from diabetes or trauma may be considered. It could also be caused by macular degeneration, retinal detachment, retinal vein occlusion, or central retinal artery occlusion. If the loss is painful, causes may be associated with the cornea and anterior chamber; examples include: corneal ulcer, uveitis, traumatic hyphema, and acute glaucoma. Question: The function of the labyrinth in the inner ear is to: assist with air conduction. maintain equilibrium. maintain acoustic transmission. capture sound waves. The inner ear has 2 main functions: hearing and balance. The cochlear system is dedicated to hearing and the vestibular system is dedicated to balance. The labyrinth is part of the semicircular canals and the vestibular system and is responsible for balance. Question: A 40-year-old male was umpiring a little league baseball game when he was hit in the face with flying debris. He presents with decreased vision and severe pain in the left eye. Findings reveal watery, left ocular discharge. The pupils are normal in appearance and the cornea is slightly cloudy with areas of corneal erythema. These findings are most consistent with: acute iritis. corneal injury. corneal infection. acute angle closure glaucoma. Corneal injury or infection usually presents with watery or purulent ocular discharge and the severe pain. Acute iritis presents with a moderate aching pain deep within the eye. The pupils are small and irregular and vision is decreased and photophobia is present. The cornea is clear or slightly cloudy with injection confined to the corneal limbus. This is considered an emergency and is usually related to Herpes zoster infection or tuberculosis. With acute angle closure glaucoma, the pain is severe, aching, and deep, but the pupils are dilated and fixed and the cornea appears steamy or cloudy. If an increase in intraocular pressure is present in conjunction with these findings, this would be an emergency situation. Question: Children who pick their noses are at a higher risk for development of: sinusitis. epistaxis. allergic rhinitis. purulent rhinorrhea. Epistaxis is a nosebleed. This often occurs secondary to damage to small blood vessels located in Kiesselbach's plexus. Other causes could include allergic rhinitis, low humidity, sinusitis, very cold, bleeding disorders, and some medications. Purulent rhinorrhea is seen with an infection in the nose or sinus cavity. Allergic rhinitis and sinusitis may contribute to nose bleeds. Question: A deviated uvula without swelling may be suggestive of a: vagus nerve lesion. peritonsillar abscess. person who smokes cigarettes. a normal finding in the elderly population. A deviated uvula with no evidence of swelling may be due to a vagus nerve (CN X) lesion. CN X innervates the uvula. The presence of swelling of the uvula with a deviation may be a strong indication of a peritonsillar abscess or parapharyngeal abscess. Peritonsillar abscess and smoking may be associated with a swollen uvula but not associated with deviations of the uvula. A deviated uvula is not a common finding in the elderly; however, if an elderly person experiences a stroke, a deviated uvula may be noted. Question: The maxillary sinuses: are located between the eyes. surround the nasal cavity. are located above the eyes. are located behind the ethmoidal sinuses. The paranasal sinuses include the maxillary, frontal, ethmoidal, and sphenoidal sinuses. The maxillary sinuses are located around the nasal cavity. The ethmoidal sinuses are between the eyes and the frontal sinuses are located above the eyes. The sphenoidal sinuses lie just behind the ethmoidal sinuses. Question: What part of the ear consists mainly of cartilage covered by skin and has a firm yet somewhat elastic feature? Antihelix Helix Auricle Tragus The auricle is made of cartilage covered by skin and has a firm, elastic consistency. The external ear consists of the auricle and ear canal. The auricle has a prominent curved outer ridge known as the helix. The antihelix is a curved prominence that is parallel and anterior to the helix. The ear canal opens behind a nodular protuberance that points backward over the entrance to the canal. This is called the tragus. Question: When examining the pupils, the left pupil is noted to be fixed and dilated to light and near accommodation. This condition may be suggestive of: a tonic pupil. oculomotor nerve (CN III) paralysis. Horner's syndrome. Argyll Robertson pupils. Paralysis of the oculomotor cranial nerve (CN III), the dilated pupil is fixed to light and near accommodation. Ptosis and lateral deviation of the eye are usually present. When the pupil is large, regular, and usually unilateral and the reaction to light is severely reduced and slowed, or even absent, this condition is referred to as a tonic pupil or Adele's pupil. In Horner's syndrome, the affected pupil reacts briskly to light and near effort but the pupil is small. The pupils in Argyll Robertson condition appear small and irregular shaped and accommodate but do not react to light. Question: A term used to describe drainage from the nose is: rhinitis. rhinorrhea. cerumen. otorrhea. A term used to describe drainage from the nose is rhinorrhea. Rhinitis refers to an inflammation in the nose. Cerumen is the medical term for earwax. Otorrhea refers to ear discharge. Question: The curved outer ridge of the auricle of the ear is known as the: Antihelix Helix Auricle Tragus The auricle has a prominent curved outer ridge known as the helix. The external ear consists of the auricle and ear canal. The auricle is made of cartilage covered by skin and has a firm elastic consistency. The antihelix is a curved prominence that is parallel and anterior to the helix. The auditory canal opens behind a nodular protuberance that points backward over the entrance to the canal, known as the tragus. Question: Eyelid retraction with exophthalmos presents as: an inward turning of the lower eyelid. an outward turning of the lower eyelid. drooping of the eyelid. a retracted eyelid with a wide-eyed stare. Lid retraction and exophthalmos is a condition that appears as a wide-eyed stare and suggests retracted eyelids. This condition could be suggestive of hyperthyroidism. An inward turning of the lower eyelid with irritation to the conjunctiva and lower cornea is defined as entropion. This condition is seen commonly in the elderly. Ptosis presents as a drooping of the eyelid caused by damage to the oculomotor nerve, myasthenia gravis, or damage to the sympathetic nervous system. Ectropion exhibits an outward turning of the lower eyelid exposing the palpebral conjunctiva. This condition is more in the elderly. Lid retraction and exophthalmos is a condition that appears as a wide-eyed stare and suggests retracted eyelids. This condition could be suggestive of hyperthyroidism. Question: A patient presents with complaints of earache, blood tinged discharge from the ear, and hearing loss. Findings reveal painful hemorrhagic vesicles on the tympanic membrane and the ear canal. These findings and symptoms are suggestive of: tympanosclerosis. serous effusion. otitis media with purulent effusion. bullous myringitis. Bullous myringitis is a viral infection characterized by painful hemorrhagic vesicles on the tympanic membrane and/or in the ear canal. Hearing loss, blood tinged discharge from the ear and an earache are classic symptoms. Tympanosclerosis is a deposit of hyaline material within the layers of the tympanic membrane that sometimes follow a severe episode of otitis media. It appears as a chalky white patch with irregular margins. Otitis media with purulent effusion is usually bacterial and the eardrum is red and the landmarks are not visible. Otitis media with serous effusion is usually viral and amber fluid can be seen behind the eardrum. Question: One cause of nasal septum perforation may be: nasal polyps. intranasal use of cocaine. cystic fibrosis. chronic sinusitis. Perforation of the nasal septum could be caused by trauma, surgery, and intranasal use of cocaine or amphetamines. Nasal polyps obstruct air flow but there is no relationship to nasal septum perforation. Cystic fibrosis or chronic sinusitis are not associated with nasal perforation. Question: Which disorder of the eye can be detected with the cover-uncover and the Hirschberg test? Amblyopia Conjunctivitis Strabismus Cataracts Strabismus is misalignment of the eyes and can be assessed using the cover-uncover teats and the Hirschberg test (corneal light reflex). With the cover-uncover test, eye muscle weakness is seen as eye deviation when the eye is uncovered. With Hirschberg's test, an asymmetric light reflex indicates a deviation. Cataracts are visualized by a cloudiness or opacity in the lens. Conjunctivitis is diagnosed by observation of a discharge from the eyes and erythema of the conjunctiva. Amblyopia is diagnosed by visual assessment and testing by an optometrist or ophthalmologist. Question: A patient presents with complaints of a bump on the eyelid. Findings reveal nontender, firm nodule with freely movable skin overlying the nodule. This could be consistent with: blepharitis. dacryocystitis. a hordeolum. a chalazion. Chalazion is a chronic inflammatory lesion that develops when a meibomian gland becomes obstructed. It produces a beady nodule on the lid. Red, scaly, greasy flakes and thickened, crusted lid margins are consistent with blepharitis. Symptoms include burning, itching, tearing, foreign body sensation, and some pain. Hordeolum is often secondary to a localized Staphylococcal infection of the hair follicles at the lid margin. Dacryocystitis is infection and blockage of lacrimal sac and duct. Question: A 50- year-old patient complains of being unable to read the hymnal at church. This describes: hyperopia. myopia. presbyopia. astigmatism. Presbyopia may begin in the 5th or 6th decade. Symptoms include diminished ability to focus on near objects. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are misaligned. "Crossed-eyed", "wall eye", or "lazy eye" are all associated with strabismus. Question: A swollen deviated uvula may be associated with a: vagus nerve lesion. peritonsillar abscess. person who smokes cigarettes. a normal finding in the elderly population. The presence of swelling of the uvula with a deviation may be a strong indication of a peritonsillar abscess or parapharyngeal abscess. A deviated uvula with no evidence of swelling may be due to a vagus nerve (CN X) lesion. CN X innervates the uvula. Peritonsillar abscess and smoking may be associated with a swollen uvula but not associated with deviations of the uvula. A deviated uvula is not a common finding in the elderly; however, if an elderly person experiences a stroke, a deviated uvula may be noted. Question: Ophthalmoscopic examination of the retina reveals AV banking. This appears as if the: vein tapes down on either side of the artery. vein is twisted on the distal side of the artery. vein crosses beneath the artery. vein stops abruptly on either side of the artery. When the arterial walls lose their transparency, changes appear in the arteriovenous crossings. Decreased transparency of the retina probably contributes to AV nicking and AV tapering. In AV nicking, the vein appears to stop abruptly on either side of the artery. In tapering, the vein appears to taper down either side of the artery. In the normal eye, the vein appears to cross beneath the artery. With banking, the vein appears to be twisted on the distal side of the artery and forms a dark wide knuckle appearance. Question: Findings following assessment of a person's eye gaze include both eyes moving in the same direction simultaneously. This condition is most consistent with: a conjugate gaze. left cranial nerve III (oculomotor) paralysis cranial nerve IV (trochlear) paralysis. cranial nerve VI (abducens) paralysis. In conjugate or normal gaze, the normal movement of the two eyes appears simultaneously in the same direction to bring something into view. With a left cranial nerve VI paralysis, a person's gaze would include eyes conjugate when looking to the right, esotropia (one or both eyes turn inward) in the left eye when looking straight ahead, and esotropia is maximum in the left eye when looking to the left. With a left cranial nerve III paralysis, upward, downward, or inward movements are impaired. The left eye is unable to look down when turned inward in a left cranial nerve IV paralysis. Question: A forty-five-year-old female complains of frequent attacks of dizziness accompanied by a sense of fullness in the right ear, headache, nausea, reduced hearing in the right ear. This patient may need further workup for: otosclerosis. Meniere's disease. Paget's disease. mastoiditis. Meniere's Disease is a disorder of the middle ear with excessive endolymphatic fluid accumulation in the membranous labyrinth. It may be due to malabsorption or a blocked endolymphatic duct. Symptoms include recurrent attacks of dizziness, a sense of fullness in the ears with roaring or ringing tinnitus. There is gradual but progressive sensorineural hearing loss. It usually occurs in adults around forty years of age. Otosclerosis is a disorder of the labyrinthine capsule where abnormal bone growth occurs around the ossicles leading to a reduction of sound transmission to the inner ear. Paget's disease results in abnormal bone destruction or growth of the bone. It is also a malignant disease of the breast. Mastoiditis is an infection of the mastoid process. Question: When comparing veins and arteries in the eyes of older adults, the arteries appear: bright red. widened. less brilliant. curvy. In older adults, the fundi lose their youthful shine and light reflections. The arteries look narrowed, pale, straight, and less brilliant than in young or middle adults. Question: An infant with a suspected hearing loss: communicates through gestures. sits close to the television with the volume on high. does not babble. has unintelligible speech. An infant with a hearing loss does not startle to loud noises, arouses to touch instead of noise, does not turn the head in response to sounds and has little or no babbling or vocalization. A toddler with a hearing loss would communicate with gestures and has little or no intelligible speech and does not respond to surrounding noises. A school aged child with a hearing loss would sit close to the television with the volume on high, may have poor school performance, speech problems and does not respond unless directly in front of the speaker's face. Question: A condition in which the eyes are not properly aligned with each other is termed: hyperopia. myopia. strabismus. astigmatism. Strabismus, heterotropia, is a condition in which the eyes are misaligned. "Crossed-eyed", "wall eye", or "lazy eye" are all associated with strabismus. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Myopia, nearsightedness, occurs when light rays focus anterior to the retina. In astigmatism, light rays do not focus ly on the retina. This causes blurriness. Question: In the normal ear, all of the following landmarks can be visualized when using the otoscope, except the: ossicles. tympanic membrane. eustachian tube. cone of light. Otoscopic examination reveals the external canal, tympanic membrane (pars tensa and pars flaccida), cone of light, and the short process and handle of the malleus. The umbo, and the incus can also be visible on otoscopic examination. Question: Leukoplakia was noted during an exam of the mouth. This symptom may be: a normal finding. precancerous. associated with periodontal disease. consist

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