NUR677 FINAL EXAM STUDY
GUIDE
Ears, Eyes, Nose, And Throat (EENT)
Ears
Chapter 66, “Inner Ear Disturbance”
1. A Patient Is Suspected Of Having Vestibular Neuritis. Which Finding
On Physical Examination Is Consistent With This Diagnosis?
1. Facial Palsy And Vertigo
2. Fluctuating Hearing Loss And Tinnitus
3. Spontaneous Horizontal Nystagmus
4. Vertigo With Changes In Head Position
ANS: C
Many Patients With Vestibular Neuritis Will Exhibit Spontaneous
Horizontal Or Rotary Nystagmus, Away From The Affected Ear.
Facial Palsy With Vertigo Occurs With Ramsay Hunt Syndrome,
Caused By Herpes Zoster. Fluctuating Hearing Loss With
Tinnitus Is Common In Meniere’s Disease. Tinnitus May Occur
With Vestibular Neuritis But
Hearing Loss Does Not Occur. Patients With Benign Paroxysmal
Positional
Vertigo Will Exhibit Vertigo Associated With Changes In Head
Position.
2. A Patient Reports Several Episodes Of Acute Vertigo, Some Lasting
Up To An Hour, Associated With Nausea And Vomiting. What Is
Part Of The Initial Diagnostic Workup For This Patient?
1. Audiogram
2. Auditory Brainstem Testing
3. Electrocochleography
4. Vestibular Testing
ANS: A
An Audiogram And Magnetic Resonance Imaging (MRI) Are Part Of
Basic Testing For Meniere’s Disease. The Other Testing May Be
Performed By An Otolaryngologist After Referral.
1. Which Symptoms May Occur With Vestibular Neuritis? (Select All
That Apply.)
1. Disequilibrium
,2. Fever
3. Hearing Loss
, 4. Nausea And
Vomiting
5. Tinnitus
ANS: A, D, E
Vestibular Neuritis Can Cause Severe Vertigo, Disequilibrium,
Nausea, Vomiting, And Tinnitus, But Not Fever Or Hearing Loss.
Chapter 175, “Dizziness And Vertigo”
1. A Patient Reports A Recurrent Sensation Of Spinning Associated
With Nausea And Vomiting. Which Test Will The Provider Order
To Confirm A Diagnosis For This Patient?
1. Electroencephalogram (ECG)
2. Holter Monitoring And Electrocardiogram
3. Neuroimaging With Computerized Tomography (CT)
4. The Hallpike-Dix Positioning Maneuver
ANS: D
This Patient Has Symptoms Consistent With A Vestibular Lesion, So
The Provider Will Order A Hallpike-Dix Positioning Maneuver To
Evaluate Vestibular Function. If Seizure Activity Is Suspected, An
Electroencephalogram Will Be Ordered. Holter Monitoring And ECG
Are Used If Patients Report Syncope Or Lightheadedness.
Neuroimaging With CT Is Used When Patients Possibly Have A
Central Lesion Which Would Present With Difficulty Balancing.
2. An Older Adult Patient Reports Sensations Of Being Off Balance
When Walking But Does Not Experience Dizziness. The Provider Will
Refer This Patient To Which Specialist For Further Evaluation?
A. Audiologist
B. Cardiologist
C. Neurologist
D. Otolaryngologist
ANS: C
This Patient Has Problems Of Balance Without Dizziness, Suggestive Of A
Central Neural Lesion And Should Be Referred To A Neurologist. Patients
With Vertigo Are Likely To Have Vestibular Dysfunction And Would Be
Referred To An
, Otolaryngologist And Possibly An Audiologist If Hearing Is Affected.
Patients With Syncope Or Lightheadedness Are More Likely To Have An
Underlying Cardiac Disorder And Would Be Referred To A Cardiologist.
Eyes
Chapter 52, “Evaluation Of The Eyes”
1. A Provider Performs An Eye Examination During A Health
Maintenance Visit And Notes A Difference Of 0.5 Mm In Size
Between The Patient’s Pupils. What Does This Finding Indicate?
1. A Relative Afferent Pupillary Defect
2. Indication Of A Difference In Intraocular Pressure
3. Likely Underlying Neurological Abnormality
4. Probable Benign, Physiologic Anisocoria
ANS: D
A Difference In Diameter Of Less Than 1 Mm Is Usually Benign.
Afferent Pupillary Defects Are Paradoxical Dilations Of Pupils In
Response To Light. This Does Not Indicate Differences In Intraocular
Pressure. A Difference Of More Than 1 Mm Is More Likely To
Represent An Underlying Neurological Abnormality.
2. A Patient Comes To Clinic With Diffuse Erythema In One Eye Without
Pain Or History Of Trauma. The Examination Reveals A Deep Red,
Confluent Hemorrhage In The Conjunctiva Of That Eye. What Is The
Most Likely Treatment For This Condition?
1. Order Lubricating Drops Or Ointments.
2. Prescribe Ophthalmic Antibiotic Drops.
3. Reassure The Patient That This Will Resolve.
4. Refer To An Ophthalmologist.
ANS: C
Most Subconjunctival Hemorrhage, Occurring With Trauma Or
Valsalva Maneuvers, Will Self-Resolve And Are Benign. Lubricating
Drops Are Used For Chemosis. Antibiotic Eye Drops Are Not
Indicated. Referral Is Not Indicated.
GUIDE
Ears, Eyes, Nose, And Throat (EENT)
Ears
Chapter 66, “Inner Ear Disturbance”
1. A Patient Is Suspected Of Having Vestibular Neuritis. Which Finding
On Physical Examination Is Consistent With This Diagnosis?
1. Facial Palsy And Vertigo
2. Fluctuating Hearing Loss And Tinnitus
3. Spontaneous Horizontal Nystagmus
4. Vertigo With Changes In Head Position
ANS: C
Many Patients With Vestibular Neuritis Will Exhibit Spontaneous
Horizontal Or Rotary Nystagmus, Away From The Affected Ear.
Facial Palsy With Vertigo Occurs With Ramsay Hunt Syndrome,
Caused By Herpes Zoster. Fluctuating Hearing Loss With
Tinnitus Is Common In Meniere’s Disease. Tinnitus May Occur
With Vestibular Neuritis But
Hearing Loss Does Not Occur. Patients With Benign Paroxysmal
Positional
Vertigo Will Exhibit Vertigo Associated With Changes In Head
Position.
2. A Patient Reports Several Episodes Of Acute Vertigo, Some Lasting
Up To An Hour, Associated With Nausea And Vomiting. What Is
Part Of The Initial Diagnostic Workup For This Patient?
1. Audiogram
2. Auditory Brainstem Testing
3. Electrocochleography
4. Vestibular Testing
ANS: A
An Audiogram And Magnetic Resonance Imaging (MRI) Are Part Of
Basic Testing For Meniere’s Disease. The Other Testing May Be
Performed By An Otolaryngologist After Referral.
1. Which Symptoms May Occur With Vestibular Neuritis? (Select All
That Apply.)
1. Disequilibrium
,2. Fever
3. Hearing Loss
, 4. Nausea And
Vomiting
5. Tinnitus
ANS: A, D, E
Vestibular Neuritis Can Cause Severe Vertigo, Disequilibrium,
Nausea, Vomiting, And Tinnitus, But Not Fever Or Hearing Loss.
Chapter 175, “Dizziness And Vertigo”
1. A Patient Reports A Recurrent Sensation Of Spinning Associated
With Nausea And Vomiting. Which Test Will The Provider Order
To Confirm A Diagnosis For This Patient?
1. Electroencephalogram (ECG)
2. Holter Monitoring And Electrocardiogram
3. Neuroimaging With Computerized Tomography (CT)
4. The Hallpike-Dix Positioning Maneuver
ANS: D
This Patient Has Symptoms Consistent With A Vestibular Lesion, So
The Provider Will Order A Hallpike-Dix Positioning Maneuver To
Evaluate Vestibular Function. If Seizure Activity Is Suspected, An
Electroencephalogram Will Be Ordered. Holter Monitoring And ECG
Are Used If Patients Report Syncope Or Lightheadedness.
Neuroimaging With CT Is Used When Patients Possibly Have A
Central Lesion Which Would Present With Difficulty Balancing.
2. An Older Adult Patient Reports Sensations Of Being Off Balance
When Walking But Does Not Experience Dizziness. The Provider Will
Refer This Patient To Which Specialist For Further Evaluation?
A. Audiologist
B. Cardiologist
C. Neurologist
D. Otolaryngologist
ANS: C
This Patient Has Problems Of Balance Without Dizziness, Suggestive Of A
Central Neural Lesion And Should Be Referred To A Neurologist. Patients
With Vertigo Are Likely To Have Vestibular Dysfunction And Would Be
Referred To An
, Otolaryngologist And Possibly An Audiologist If Hearing Is Affected.
Patients With Syncope Or Lightheadedness Are More Likely To Have An
Underlying Cardiac Disorder And Would Be Referred To A Cardiologist.
Eyes
Chapter 52, “Evaluation Of The Eyes”
1. A Provider Performs An Eye Examination During A Health
Maintenance Visit And Notes A Difference Of 0.5 Mm In Size
Between The Patient’s Pupils. What Does This Finding Indicate?
1. A Relative Afferent Pupillary Defect
2. Indication Of A Difference In Intraocular Pressure
3. Likely Underlying Neurological Abnormality
4. Probable Benign, Physiologic Anisocoria
ANS: D
A Difference In Diameter Of Less Than 1 Mm Is Usually Benign.
Afferent Pupillary Defects Are Paradoxical Dilations Of Pupils In
Response To Light. This Does Not Indicate Differences In Intraocular
Pressure. A Difference Of More Than 1 Mm Is More Likely To
Represent An Underlying Neurological Abnormality.
2. A Patient Comes To Clinic With Diffuse Erythema In One Eye Without
Pain Or History Of Trauma. The Examination Reveals A Deep Red,
Confluent Hemorrhage In The Conjunctiva Of That Eye. What Is The
Most Likely Treatment For This Condition?
1. Order Lubricating Drops Or Ointments.
2. Prescribe Ophthalmic Antibiotic Drops.
3. Reassure The Patient That This Will Resolve.
4. Refer To An Ophthalmologist.
ANS: C
Most Subconjunctival Hemorrhage, Occurring With Trauma Or
Valsalva Maneuvers, Will Self-Resolve And Are Benign. Lubricating
Drops Are Used For Chemosis. Antibiotic Eye Drops Are Not
Indicated. Referral Is Not Indicated.
