NR 509 FINAL EXAM SUMMER QTR COMPLETE QUESTIONS AND ANSWERS WITH RATIONALES.

NR 509 FINAL EXAM SUMMER QTR COMPLETE QUESTIONS AND ANSWERS WITH RATIONALES. Question 1 The function of the auditory ossicles is to: - Correct Answer: transform sound vibrations into mechanical waves for the inner ear. Rationale: The function of the auditory ossicles is to transform sound vibrations into mechanical waves for the inner ear Question 2 A 35-year-old patient complains of vertigo accompanied by nausea and vomiting. Examination reveals bilateral diplopia and an unsteady gait. These symptoms could be suggestive of: - Correct Answer: a neurological condition. Rationale: Vertigo symptoms associated with neurologic conditions include: ataxia, diplopia, and dysarthria. Symptoms associated with cardiovascular conditions and vertigo include arrhythmias, orthostatic hypotension, vasovagal stimulation, lightheadedness, weakness, or presyncope. Question 3 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: - Correct Answer: xanthelasma. Rationale: 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 4 Assessment of a patient's visual acuity resulted in 20/200 using the Snellen eye chart. This means that: - Correct Answer: at 20 feet the patient can read printed information that a person with normal vision could read at 200 feet. Rationale: Visual acuity that is corrected to 20/200 constitutes legal blindness. The larger the number under 20, the worse the visual acuity. If this is a new finding, the patient needs ophthalmologic evaluation. Question 5 Findings following assessment of a person's left eye gaze include impaired movements when attempting to look upward, downward, or inward. This condition is most consistent with: - Correct Answer: left cranial nerve III (oculomotor) paralysis Rationale: With a left cranial nerve III paralysis, upward, downward, or inward movements are impaired. 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) appears in the left eye when looking straight ahead, and esotropia is maximum in the left eye when looking to the left. The left eye is unable to look down when turned inward in a left cranial nerve IV paralysis. Question 6 Findings following assessment of a person's eye gaze include both eyes moving in the same direction simultaneously. This condition is most consistent with: - Correct Answer: a conjugate gaze. Rationale: 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 7 A patient was diagnosed as being farsighted. The term for this condition is: - Correct Answer: hyperopia. Rationale: 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 correctly on the retina. This causes blurriness. Question 8 A buildup of excess fluid around the periphery of the eye orbits is known as: - Correct Answer: periorbital edema. Rationale: An accumulation of fluid around the periphery of the eye orbits is known as periorbital edema. Question 9 In order to visualize the opening of Stensen's duct, examine the: - Correct Answer: buccal mucosa opposite the second molar. Rationale: 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 10 What connects the middle ear to the nasopharynx? - Correct Answer: The proximal end of the eustachian tube Rationale: The proximal end of the eustachian tube connects the middle ear to the nasopharynx. Question 11 The fleshly projection of the earlobe is known as the: - Correct Answer: lobule. Rationale: The fleshy projection of the earlobe is known as the lobule. The auditory canal opens behind a nodular protuberance that points backward over the entrance to the canal. This is known as the tragus. 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. Question 12 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: - Correct Answer: oculomotor nerve (CN III) paralysis. Rationale: 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 13 A deposit of uric acid crystals appearing as hard nodules on the helix or antihelix is termed: - Correct Answer: a tophi. Rationale: The antihelix divides the helix from the lobe. Tophi is a deposit of uric acid crystals (that appear commonly in patients with chronically elevated uric acid levels) on the helix or antihelix. They can also appear near the joints, hands, or feet. It is also seen in chronic tophaceous gout. A firm, nodular, hypertrophic mass of scar tissue extending beyond the area of injury is classified as a keloid. A cutaneous cyst has a characteristic dome shaped lump in the dermis forming a benign closed firm sac attached to the epidermis. This lesion was formerly known as a sebaceous cyst. A chronic inflammatory lesion that starts as a painful, tender papule on the helix or antihelix is known as chondrodermatitis. Question 14 On the outer ear, anterior and parallel to the helix, is a curved prominence known as the: - Correct Answer: Antihelix Rationale: 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 15 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: