CH. 13 Seidel's Guide to Physical Examination

1. The middle ear contains the: ANS: B The middle ear contains the ossi- a. cerumen and sebaceous glands. cles, which are three small bones: b. umbo and malleus. c. vestibule and cochlea. d. pars tensa and semicircular canals. e. helix and antihelix. 2. The hair cells of Corti and mem- brane of Corti: a. maintain equilibrium. b. protect the ear from foreign par- ticles. c. stimulate the eighth cranial nerve. d. transmit vibrations to the ossi- cles e. produce a waxy lubricant. U 3. Which ear structure is responsible for equalizing atmospheric pres- sure when swallowing, sneezing, and yawning? a. Eustachian tube b. Inner ear c. Semicircular canals d. Triangular fossa e. Oval window 4. A 30-year-old woman presents with rapid swelling beneath her the malleus (the umbo is part of the malleus), the incus, and the stapes. The tympanic membrane separates the external ear from the middle ear and is composed of the pars tensa. Ceru- men and sebaceous glands lie outside the middle ear; the semicircular canals, vestibule, and cochlea lie in the inner ear. The helix and antihelix are parts of the auricle ANS: C Vibrations from the tympanic mem- brane cause the delicate hair cells of the organ of Corti to strike against the membrane of Corti, stimulating impuls- es in the sensory endings of the audi- tory division of the eighth cranial nerve. ANS: A The eustachian tube is a cartilaginous and bony passageway between the nasopharynx and the middle ear that opens briefly to equalize the middle ear pressure with that of the atmospheric pressure when swallowing, yawning, or sneezing. ANS: B The vast majority of these stones oc- jaw that suddenly appears while she is eating. The swelling is mild- ly painful but is not hot or red. You suspectWharton salivary duct stones and proceed to palpate: a. bilaterally along the buccal mu- cosa. b. under the tongue, along each side of the frenulum. c. dorsum of the tongue. d. beside the gingivae near each molar. e. along the roof of the mouth. 5. An infant's auditory canal, when compared with an adult's, is: a. short, narrow, and straight. b. short and curved upward. c. long, narrow, and curved for- ward. d. short and curved downward. e. long, wide, and straight. 6. When examining an infant's mid- dle ear, the practitioner should use one hand to stabilize the otoscope against the head while using the other hand to: a. pull the auricle down and back. b. hold the speculum in the canal. c. distract the infant. d. stabilize the chest. e. pull the auricle up. 7. The pregnant patient can expect to experience: cur in the Wharton duct from the sub- maxillary gland, which can be palpated along each side of the frenulum under the tongue ANS: B Compared with an adult's, the infant's auditory canal is shorter and has an upward curve, which is why pulling the pinna down straightens the canal. ANS: A You should use your other hand to pull the auricle down and back in an effort to straighten the upward curvature of the canal. ANS: A Physiologic changes of pregnancy in- a. more nasal stuffiness. b. a sensitive sense of smell. c. drooling. d. enhanced hearing. e. decreased vascularity of the gums 8. During what developmental stage are hoarseness, voice cracking, and a persistent cough a common finding? a. Adolescence b. Infancy c. Menopause d. Pregnancy e. Childhood 9. Which of the following is associat- ed with age-related hearing loss? a. Degeneration of the hair cells of the organ of Corti b. Excess resorption of bone cells of the ossicle chain c. Increased pliability of the tym- panic membrane d. More serous cerumen e. Proliferation of the stria vascu- laris 10. Mr. S presents with the complaint of hearing loss. You specifically in- quire about current medications. Which medications, if listed, are likely to contribute to his hearing loss? clude nasal stuffiness, a decreased sense of smell, impaired hearing, epis- taxis, and a sense of fullness in the ears. Increased vascularity and prolifer- ation of connective tissue of the gums also may occur. ANS: D Laryngeal changes in pregnancy in- clude hoarseness, deepening or crack- ing of the voice, vocal changes, and persistent cough. ANS: A About two-thirds of adults ages 70 years and older have a hearing loss that affects their daily living. Age-relat- ed hearing loss is associated with de- generation of hair cells in the organ of Corti, loss of cortical and organ of Corti auditory neurons, degeneration of the cochlear conductive membrane, and decreased vascularity in the cochlea ANS: C Ototoxic medications include aminogly- coside, salicylates, furosemide, strep- tomycin, quinine, ethacrynic acid, and cisplatin. Chlorothiazide di- uretics, acetaminophen, penicillins, a. Chlorothiazide b. Acetaminophen c. Salicylates d. Cephalosporins e. Penicillins 11. To approximate vocal frequencies, which tuning fork should be used to assess hearing? a. 100 to 300 Hz b. 200 to 400 Hz c. 500 to 1000 Hz d. 1500 to 2000 Hz e. Greater than 2000 Hz 12. You are using a pneumon- ic attachment on the oto- scope while assessing tympan- icmembrane movement.You gently squeeze the bulb but see no move- ment of the membrane. Your next action should be to: a. remove all cerumen from the canal. b. make sure the speculum is sealed form outside air. c. squeeze the bulb with more force. d. insert the speculum to depth of 2 cm. e. use a smaller plastic speculum 13. An ear auricle with a low-set or un- usual angle may indicate chromo- somal aberration or: a. digestive disorder. and cephalosporins are considered non-ototoxic. ANS: C Use of a 500- to 1000-Hz tuning fork approximates vocal frequencies. ANS: B When using the pneumatic attach- ment, to see tympanic movement, there should be a seal around the speculum to block outside air. In this manner, the normal tympanic mem- brane moves as a result of pressure changes from the insufflator bulb. ANS: C A low-set position or unusual angle may indicate a genetic syndrome or be a clue to look for renal anomalies as the b. skeletal anomaly. c. renal disorder. d. Ménière disease. e. heart defect. 14. When conducting an adult oto- scopic examination, you should: a. position the patient's head lean- ing toward you. b. grasp the handle of the otoscope as you would a baseball bat. c. select the largest speculum that will fit in the canal. d. ask the patient to keep his or her eyes closed. e. pull the auricle down and for- ward. 15. . Speech with a monotonous tone and erratic volume may indicate: a. otitis externa. b. hearing loss. c. serous otitis media. d. sinusitis. e. dry cerumen. 16. Placing the base of a vibrating tun- ing fork on the midline vertex of the patient's head is a test for: a. air conduction of sound. b. bone versus air conduction. c. otitis externa. d. otitis media. e. lateralization of sound. 17. To perform the Rinne test, place the tuning fork on the: ears and kidneys grow at the same time during pregnancy. ANS: C Select the largest speculum that will comfortably fit in the patient's ear. The handle should be held between the thumb and the index finger, supported on the middle finger. The patient's head should be positioned toward the oppo- site shoulder. To straighten the external auditory in an adult, pull the auricle up and back. There is no reason for the patient to keep her or his eyes shut ANS: B Speech with a monotonous tone and erratic volume may indicate hearing loss. Although hearing may be affected in the other choices, they do not result in hearing loss. ANS: E Placing the fork on the midline vertex of the patient's head is the Weber test, a test for conductive hearing loss that lateralizes to the affected ear. ANS: B The tuning fork is initially placed a. top of the head. b. mastoid bone. c. forehead. d. preauricular area. e. occiput 18. You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized to the unaffected ear; for the Rinne test, the air conduction to bone conduc- tion-to-ratio was less than 2:1. You interpret these findings as sugges- tive of: a. a defect in the inner ear. b. a defect in the middle ear. c. otitis externa. d. impacted cerumen. e. serous otitis. 19. Nasal symptoms that imply an al- lergic response include: a. purulent nasal drainage. b. bluish gray turbinates. c. small, atrophied nasal mem- branes. d. a firm consistency of the turbinates. e. a deviated septum. 20. A smooth red tongue with a slick appearance may indicate: a. a niacin or vitamin B12 deficien- cy. b. oral cancer. against the mastoid bone for the Rinne test, a test for sensorineural loss. The tuning fork is placed on the midline top of the patient's head for the Weber test, a test that helps assess unilateral hear- ing loss. ANS: A These results are consistent with a sensorineural hearing loss, a defect in the inner ear. Otitis externa, impacted cerumen, and serous otitis are condi- tions that can cause conductive hear- ing problems. ANS: B An allergic finding includes bluish gray or pale pink nasal turbinates that are swollen and boggy and a transverse crease at the junction between the car- tilage and the bone of the nose. ANS: A A smooth red tongue with a slick ap- pearance may indicate a vitamin B12 deficiency. Oral cancer involves le- sions; recent use of antibiotics can turn the tongue yellow-brown to black and c. recent use of antibiotics. d. a fungal infection. e. a geographic tongue. 21. White, rounded, or oval ulcera- tions surrounded by a red halo and found on the oral mucosa are: a. Fordyce spots. b. aphthous ulcers. c. Stensen ducts. d. leukoedema. e. angular cheilitis. 22. A hairy tongue with yellowish brown to black elongated papillae on the dorsum: a. is indicative of oral cancer b. is sometimes seen after antibiot- ic therapy. c. usually indicates a vitamin defi- ciency. d. usually indicates anemia. e. is characteristic of a geographic tongue. 23. To inspect the lateral borders of the tongue, you should: a. ask the patient to extend the tongue outward. b. insert the tongue blade obliquely against the tongue. c. lift the tongue upward with gloved fingers. d. pull the gauze-wrapped tongue hairy; and fungal infections result in slightly raised white, cream-colored, or yellow spots in the mouth. A geographic tongue has irregular areas of whitish and red areas. ANS: B Aphthous ulcers are white, round, or oval lesions surrounded by a red halo that appear on the buccal mucosa. ANS: B Recent antibiotic use can turn the tongue yellow-brown to black and hairy ANS: D To inspect the lateral borders of the tongue, you should wrap the tongue with a piece of gauze and then pull the tongue to each side for inspection. The other maneuvers do not result in adequate lateral border inspection. to each side. e. ask the patient to lift the tongue upward. 24. Which variation may be an expect- ed finding in the ear examination of a newborn? a. Diffuse light reflex b. Purulent material in the ear canal c. Redness and swelling of the mastoid process d. Small perforations of the tym- panic membrane e. Increased mobility and clarity of the tympanic membrane 25. For best results, an otoscopic and oral examination in a child should be: a. conducted at the beginning of the assessment. b. done after inspection. c. performed at the end of the ex- amination. d. performed before palpation. e. deferred until they can fully co- operate. 26. Expected physical changes asso- ciated with older adults include: a. shiny buccal mucosa. b. teeth appear shorter. c. wetter nasal mucosa. d. bristly hairs in the vestibule. e. smoothing of the tongue. ANS: A The newborn's tympanic membrane does not become conical for several months; therefore, the light reflex ap- pears diffuse. ANS: C Because young children often resist otoscopic and oral examination, it may be wise to postpone these procedures until the end of the examination after you have gained some trust. ANS: D With age, the buccal mucosa becomes less shiny, the teeth appear longer be- cause of receding gums, the nasal mu- cosa are drier, the tongue may appear more fissured, and more bristly hairs appear in the nose, especially in men. 27. Intense pain with movement of the pinna is most closely associated with: a. sinusitis. b. otitis externa. c. purulent otitis media. d. bacterial otitis media. e. otitis media with effusion. 28. Severe vertigo, tinnitus, and episodes of hearing loss are the characteristics of: a. cholesteatoma. b. Ménière disease. c. otosclerosis. d. cocaine abuse. e. labyrinthitis. ANS: B Suspect otitis externa (swimmer's ear) when pulling the pinna reproduces ear pain. The other conditions do not com- monly cause the same finding ANS: B Ménière disease is an inner ear disor- der characterized by episodes of hear- ing loss, vertigo, tinnitus, and ear full- ness 29. Evidence-based practice suggests ANS: E that the strongest predictor of si- nusitis is: a. a maxillary toothache. b. dull or opaque sinus transillumi- nations. c. ineffective decongestants and colored nasal drainage. d. purulent nasal secretions. e. any combination of the above. 30. Chronic insufflation of cocaine is associated with which assessment finding? a. Nasal polyp b. Cleft palate Evidence-based practice suggests that the strongest predictor of sinusitis is any combination of these symptoms including maxillary toothache, purulent nasal secretions, dull or opaque si- nus transillumination, poor response to decongestants, and colored nasal dis- charge. ANS: D. Perforated nasal septum c. Deviated nasal septum d. Perforated nasal septum 31. Which finding upon inspection of the external ear is considered nor- mal? a. Tophi b. Otitis externa c. Cauliflower ear d. Darwin tubercle 32. Which is the most exact testing of hearing acuity? a. Weber test b. Rinne test c. Pure tone audiometry d. Whispered voice test 33. Which description is correct re- garding the use of the otoscope on an adult? a. Hold the otoscope with the han- dle down. b. Pull the adult pinna downward to insert the otoscope. c. Perform hearing assessment be- fore the otoscopic examination. d. Use the largest speculum that fits comfortably in the patient's ear. 34. Which finding is considered nor- mal when visualizing the tympanic membrane? a. Pinkish red color b. Presence of red reflex ANS: D. Darwin tubercle ANS: C. Pure tone audiometry ANS: D. Use the largest speculum that fits comfortably in the patient's ear. ANS: C. Visible handle of malleus c. Visible handle of malleus d. Presence of white patches 35. What condition of the oral mu- cous membranes is characterized by thickened white patches that cannot be wiped away? a. Leukoplakia b. Kaposi sarcoma c. Periodontal disease d. Streptococcal pharyngitis 36. Using a nasal speculum, the nurse observes the nasal mucosa to be blue-gray in color. With what is this finding associated? a. Polyp b. Allergy c. Infection d. Furuncle 37. The nurse palpates the areas of the skull behind the ears and is able to identify the mastoid processes, which are nontender. What is the significance? a. This is a normal finding. b. This is associated with hydro- cephaly. c. This occurs with an acoustic neuroma. d. This occurs with chronic ear in- fections. ANS: A. Leukoplakia ANS: B. Allergy ANS: A. This is a normal finding.